ObjectivesAlthough the vagus nerve (VN) is easily observed by ultrasonography, few studies have evaluated the cross-sectional area (CSA) of the VN in healthy older individuals from East Asia. In this study, we aimed to report reference values for the CSA of the VN in community-dwelling elderly Japanese individuals and to identify any associated medical history and/or lifestyle factors.MethodsThe present study included 336 participants aged ≥ 70 years from a prospective cohort study conducted in Yahaba, Japan from October 2021 to February 2022. The CSA of the VN was measured bilaterally at the level of the thyroid gland by ultrasonography. Simple linear regression analysis and generalized estimating equation were conducted to identify the associations between clinical and background factors and the CSA of the VN.ResultsIn our cohort, the median CSA of the VN was 1.3 mm2(interquartile range [IQR] 1.1–1.6) on the right side and 1.2 mm2(IQR 1.0–1.4) on the left side. Generalized estimating equation showed that history of head injury (β = 0.19,p< .01), current smoking habit (β = -0.09,p= .03), and BMI (β = 0.02,p< .01) were independently associated with the CSA of the VN.ConclusionWe have reported reference VN CSA values for community-dwelling elderly Japanese individuals. In addition, we showed that the CSA of the VN was positively associated with a history of head injury and BMI and inversely associated with current smoking habit.