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

## TL;DR

This study provides age and gender-specific reference values for blood vessel dilation in Chinese children and identifies factors that influence it.

## Contribution

The study establishes normative FMD reference values and identifies independent predictors for children and adolescents.

## Key findings

- FMD is positively correlated with age and HDL, and negatively with baseline artery diameter, diastolic blood pressure, glucose, and triglycerides.
- Age, baseline artery diameter, DBP, glucose, and TG are independent predictors of FMD in children and adolescents.
- Gender-specific FMD percentile curves were constructed as a reference benchmark.

## Abstract

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.

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.

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.

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

The online version contains supplementary material available at 10.1186/s12887-025-05974-1.