Arterial stiffness in junior high school students: Longitudinal
and Kengo Yoshii
Mathematics and Statistics in Medical Sciences, Graduate School of Medical Science, and
School of Nursing, Kyoto Prefectural University of Medicine, Hirokoji-Kawaramachi, Kamigyo, and
Education, Kyoto University of Education, Fukakusa, Fushimi, Kyoto, Japan
Abstract Background: Early atherosclerotic change is found even in childhood, and there is an urgent need to clarify the
factors causing childhood atherosclerosis and take preventive measures. Early detection of the contributing risk
factors is crucial to facilitate preventive measures. Pulse wave velocity (PWV) is a widely used technique for the
assessment of atherosclerosis in children.
Methods: Lifestyle questionnaire, brachio-ankle PWV (baPWV) and anthropometric data were obtained from junior
high school students in an urban area of Japan between 2006 and 2008, from seventh to ninth grades.
Results: Mean baPWV increased from 867.4 Æ 99.5 m/s to 944.5 Æ 117.5 m/s in boys, and from 864.0 Æ 99.5 m/
s to 923.0 Æ 101.3 m/s in girls. Obese students had higher baPWV than non-obese students in both genders across
each grade. On logistic regression analysis of ninth grade student data, high baPWV was dependent on systolic
blood pressure (SBP), time watching television (TV) and symptoms of depression and anxiety, whereas low baPWV
was dependent on time playing video games, light exercise, sleep and indoor play, as well as good friendship and
Conclusion: Systolic blood pressure, time watching TV, and symptoms of depression and anxiety may contribute
to arterial stiffness and be related to obesity in junior high school students.
Key words atherosclerosis, junior high school, lifestyle, longitudinal study, pulse wave velocity.
Childhood obesity is considered “a crisis in public health”;
the prevalence of obesity and its comorbidities in children is
expected to increase in the future.
disease is likely to occur in individuals with risk factors for
cardiovascular disease in their childhood.
is one such risk factor and the target for preventive measures.
Recently, various non-invasive techniques that determine
carotid intima–media thickness (CIMT), ﬂow-mediated dilata-
tion (FMD), and pulse wave velocity (PWV) have been devel-
oped to estimate atherosclerotic change.
Several studies have
reported on the presence of atherosclerotic change in obese
Although CIMT and FMD are reliable techniques
for the detection of atherosclerosis in children, they require
time and skilled experience. Given that PWV is a relatively
quick procedure that is easy to carry out and reproduce, many
studies have used PWV to assess atherosclerosis in chil-
Aging is an inevitable and integral factor of childhood;
therefore, the results obtained from these studies should be
Few longitudinal studies have reported
on the risk factors of atherosclerotic change in children.
The aim of the present study was hence to conduct a longitu-
dinal study on the effect of lifestyle on PWV in junior high
school students over a period of 3 years, from seventh to ninth
The study consisted of 1,729 junior high school students (930
boys, 799 girls) in Okayama City, Japan. Written informed
consent was obtained from the students and their guardians.
This study was approved by the ethics committee of Kyoto
Prefectural University of Medicine (ERB-C-624-1).
Anthropometric data, data from a lifestyle questionnaire
and measurement of brachio-ankle PWV (baPWV) were
obtained annually over a period of 3 years at the same time in
school hours of “integrated study”.
Brachio-ankle PWV, blood pressure (systolic and diastolic
blood pressure [SBP, DBP]) and heart rate were measured
using an electromyography device (BP-203RPEIII, Omron-
Correspondence: Fumio Inoue, MD, Kyoto University of Educa-
tion, 1 Fujinomori-cho, Fukakusa, Fushimi-ku, Kyoto 612-8522,
Japan. Email: ﬁnoue@kyokyo-u.ac.jp
Received 14 June 2017; revised 15 October 2017; accepted
30 November 2017.
© 2017 The Authors Pediatrics International published by John Wiley & Sons Australia, Ltd on behalf of Japan Pediatric Society
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use,
distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Pediatrics International (2018) 60, 127–135 doi: 10.1111/ped.13475