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. 2025 Sep 9:12:1633849.
doi: 10.3389/fcvm.2025.1633849. eCollection 2025.

Associations between obesity and arterial stiffness assessed by cardio-ankle vascular index in healthy children and adolescents

Yuko Horikoshi #  1 , Rie Sakuraba-Hirata  1 , Nina Suzuki  1 , Yuki Inomata  1 , Moe Oikawa  1 , Toa Kotani  1 , Takumu Watanabe  1 , Eri Takahashi  2 , Kanako Okazaki  2 , Masayuki Hoshi  2 , Yasuhiro Endo  2 , Tatsuya Nakanowatari  2 , Hiroaki Abe  2 , Yasuaki Kusumoto  2 , Mieko Yokozuka  2 , Yoshitaka Shiba  2 , Yoshinobu Tanaka  3 , Akihiko Asao  3 , Shigeki Kurasawa  3 , Yasuchika Takeishi  4 , Akiomi Yoshihisa #  1   4
Affiliations

Associations between obesity and arterial stiffness assessed by cardio-ankle vascular index in healthy children and adolescents

Yuko Horikoshi et al. Front Cardiovasc Med. .

Abstract

Aims: Cardio-ankle vascular index (CAVI) is a non-invasive method for evaluating arterial stiffness. In adults, CAVI has been reported to show negative correlation with body mass index (BMI) known as the "obesity paradox"; however, whether this also applies to children remains unclear. In addition, childhood obesity is a problem in developed countries, and the utility of CAVI in children has not yet been clarified. We here aimed to clarify the relationship between obesity parameters and CAVI in healthy children.

Methods: This was a cross-sectional study conducted in 2024. We evaluated CAVI and its associated factors in 590 children aged 6-15 years (mean age: 10.5 years, 51.0% female). Additionally, obesity parameters, including the Rohrer index, percentage of overweight (POW), body fat percentage and body fat mass determined by bioelectrical impedance analysis, and BMI were assessed. The participants were categorized into groups based on the obesity parameters.

Results: CAVI decreased as obesity level increased, showing the lowest CAVI in the highest obesity category. CAVI was positively correlated with age (R = 0.18, p < 0.05), and was negatively correlated with Rohrer index, body fat percentage, body fat mass, POW, BMI, and heart rate, (R = -0.33, R = -0.23, R = -0.14, R = -0.30, R = -0.19, R = -0.14, respectively; p < 0.01 for all). In contrast, CAVI showed no significant correlation with blood pressure or body weight. Furthermore, multiple linear regression analyses after adjusting for possible obesity-related factors including age, sex, blood pressure, and heart rate, showed that all obesity parameters were independent predictors of CAVI.

Conclusion: Obesity parameters are negatively and independently associated with CAVI in healthy children.

Keywords: Rohrer index; body fat percentage; body mass index; cardio-ankle vascular index; obesity paradox; percentage of overweight.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study flow chart. This study included 626 children and adolescents aged 6–15 years. Of the 626 study participants, 36 were excluded because they were unable to maintain a resting state during CAVI measurement or showed irregular waveforms. Furthermore, 29 participants did not undergo BIA measurement. The analysis was ultimately conducted on 561 participants.
Figure 2
Figure 2
Bland-Altman plots of manually measured and CAVI-based vessel lengths for each parameter. The linear regression analysis revealed strong correlations between the vascular lengths measured by the two methods (R = 0.922, p < 0.001), and the Bland-Altman analysis showed mean differences were 3.45 ± 5.36. These results suggest excellent agreement between the two measurements.
Figure 3
Figure 3
Comparison of CAVI by category of percentage of overweight. In both males and females, CAVI was lowest in the group with the highest obesity.
See this image and copyright information in PMC

References

    1. Tavolinejad H, Erten O, Maynard H, Chirinos JA. Prognostic value of cardio-ankle vascular index for cardiovascular and kidney outcomes: systematic review and meta-analysis. JACC Adv. (2024) 3(7):101019. 10.1016/j.jacadv.2024.101019 - DOI - PMC - PubMed
    1. Sato Y, Yoshihisa A, Ichijo Y, Watanabe K, Hotsuki Y, Kimishima Y, et al. Cardio-ankle vascular index predicts post-discharge stroke in patients with heart failure. J Atheroscler Thromb. (2021) 28(7):766–75. 10.5551/jat.58727 - DOI - PMC - PubMed
    1. Watanabe K, Yoshihisa A, Sato Y, Hotsuki Y, Anzai F, Ichijo Y, et al. Cardio-ankle vascular index reflects impaired exercise capacity and predicts adverse prognosis in patients with heart failure. Front Cardiovasc Med. (2021) 8:631807. 10.3389/fcvm.2021.631807 - DOI - PMC - PubMed
    1. Shimizu T, Sakuma Y, Muto Y, Anzai F, Kimishima Y, Sato Y, et al. Impact of cardio-ankle vascular index on future cancer in patients with coronary artery disease. Circ Rep. (2024) 6(9):372–80. 10.1253/circrep.CR-24-0070 - DOI - PMC - PubMed
    1. Okamoto Y, Miyoshi T, Ichikawa K, Takaya Y, Nakamura K, Ito H. Cardio-ankle vascular index as an arterial stiffness marker improves the prediction of cardiovascular events in patients without cardiovascular diseases. J Cardiovasc Dev Dis. (2022) 9(11):368. 10.3390/jcdd9110368 - DOI - PMC - PubMed