This paper describes cardiovascular disease (CVD) risk factor levels in a population-representative sample of healthy, rural Norwegian children and examines the association between fitness and clustering of CVD risk factors. Final analyses included 111 boys and 116 girls (mean age 9.3+/-0.3). To determine the degree of clustering, six CVD risk factors were selected: homeostasis model assessment score, waist circumference, triglycerides, systolic blood pressure, total cholesterol to high-density lipoprotein ratio and fitness (VO2peak). Clustering was observed in 9.9% of the boys and 13.8% of the girls. In a different analysis, fitness was omitted as a CVD risk factor and analyzed against the five remaining CVD risk factors. Low fitness was a strong predictor for clustering of CVD risk factors, and children in the least-fit quartile had significantly poorer CVD risk factor values than all of those in the other quartiles. Finally, subjects were cross-tabulated into different fat-fit groups. For both sexes, the unfit and overweight/obese group had a significantly higher CVD risk factor score than the fit and normal weight group. Clustering of CVD risk factors was present in this group of rural children. Low fitness, and low fitness and high fatness combined, were highly associated with a clustered CVD risk.