Our study aimed to explore the correlations between metabolic risk factors and carotid intima-media thickness (cIMT) in children and adolescents with overweight and obesity [1]. As the writer properly noted, cIMT measurements were performed from the far wall of the common carotid artery (CCA) with synchronization to the cardiac rhythm in this study.

Unlike in adults, measuring cIMT in children takes more time due to the significantly thinner arterial walls. Additionally, the near wall of the CCA, the bulb, and the internal carotid artery are less visible on ultrasound compared to the far wall of the CCA, which increases the measurement burden. Therefore, we used semiautomated mode to measure cIMT at the far wall of the CCA following the method used in a 2015 study of 1,017 children and adolescents aged 7–17 years published in Atherosclerosis [2]. Furthermore, in a study of 1,137 healthy children and adolescents, single-sided cIMT measurements were performed to reduce the examination burden, and the semi-automatic software-guided technique was validated [3]. Similarly, both a Brazilian study measuring cIMT in 280 healthy children and adolescents aged 1–15 years [4] and a Spanish study analyzing the correlation between uric acid levels and cIMT in 359 prepubertal children [5] measured at the distal CCA, 1 cm from its bifurcation.

Our study showed correlations between cIMT and age and obesity; however, as pointed out by the authors, caution is required when interpreting the results regarding associations with additional cardiometabolic risk factors due to the limitations of the measurement methods.

Recognizing this limitation, our institution revised the measurement protocol in 2022. Since then, experienced pediatric cardiologists have carefully conducted cIMT measurements across multiple segments, synchronized with the cardiac rhythm. However, at the time of data collection for this study, the number of patients measured using the new method was limited. As a result, we conducted our analysis using data from patients whose cIMT was measured using the previous method focusing on the far wall of the CCA.

We anticipate that, as more patients are tested with the revised cIMT measurement protocol, our future research will contribute further understanding of cardiometabolic risks in children and adolescents.