Age and gender-specific flow-mediated dilation reference values and predictive factors for Chinese children and adolescents

Abstract

Background

We aim to establish normative reference values of brachial artery flow-mediated dilation (FMD) by age and gender in children and adolescents, and to identify predictors of FMD in this population.

Methods

A representative sample of 1498 healthy children and adolescents aged 8 to 17 years was recruited. Subjects underwent sonographic brachial artery assessment and blood sampling. Smoothed gender-specific FMD percentile curves were constructed using the Lambda-Mu-Sigma (LMS) method. Predictive factors of FMD were identified using linear regression analysis.

Results

Mean FMD among children and adolescents in the community setting was 8.57 ± 0.90%. Smoothed gender-specific FMD in centiles were constructed as a reference benchmark. Regression analysis after adjustment for age, gender, body mass index (BMI) z-score, and baseline artery diameter, when applicable, demonstrated that FMD is positively correlated with age (β = 0.142, p < 0.001, 95% CI [0.081–0.203]) and high density lipoprotein (HDL) (β = 0.103, p = 0.001, 95% CI [0.041–0.165]), while negatively correlated with baseline artery diameter (β = -0.117, p = 0.001, 95% CI [-0.189 – -0.046]), diastolic blood pressure (DBP) (β = -0.053, p = 0.047, 95% CI [-0.105 – -0.001]), glucose (β = -0.091, p = 0.004, 95% CI [-0.153 – -0.030]) and triglyceride (TG) (β = -0.138, p < 0.001, 95% CI [-0.198 – -0.078]). Multivariate regression analysis showed that age, baseline artery diameter, DBP, glucose and TG were independent predictors of FMD.

Conclusions

Normative reference values for FMD were constructed with predictive factors identified for children and adolescents.