An evaluation of early cardiometabolic risk factors in children and adolescents with Turner syndrome

Background and Objectives Turner syndrome (TS) confers increased lifetime risk of type 2 diabetes mellitus and cardiovascular disease. We compared cardiometabolic risk factors and measures of subcutaneous, visceral adipose tissue and intra-myocellular lipid between young TS girls and an age- and BMI-standard deviation scores (SDS)-matched healthy female cohort. Patients and Methods A cross-sectional cohort study was conducted at the Hospital for Sick Children, Toronto. Nineteen TS and 17 control girls (13·7 ± 2·5 vs 12·7 ± 3·4 years of age, respectively, P = 0·30). Multiple-sample oral glucose tolerance test with measurement of fasting insulin, LDL, HDL, triglycerides, adiponectin and highly sensitive C-reactive protein (hsCRP) was performed. Subcutaneous adipose tissue, visceral adipose tissue intramyocellular lipid levels evaluated by magnetic resonance techniques. Insulin secretion (IS), sensitivity (Si) and the insulin secretion-sensitivity index (ISSI-2) were calculated from oral glucose tolerance test data. Results Five TS and no controls had impaired fasting glucose or impaired glucose tolerance; none had type 2 diabetes mellitus. Insulin sensitivity and insulin secretion were similar between groups; ISSI-2 was lower in TS (923·5 ± 307·3 vs 659·1 ± 387·3; P = 0·03). TS girls had higher blood pressure (82·5 ± 13·6 vs 73·5 ± 5·5 mmHg; P = 0·0146), waist circumference (76·0 ±11·8 vs 65·9 ± 9·7; P = 0·0087) and subcutaneous adipose tissue (135·6 ± 88·6 vs 69·3 ± 59·9; P = 0·01) than controls. Visceral adipose tissue, intramyocellular lipid levels and adiponectin were not different between groups. TS girls also had higher triglycerides (1·1 ± 0·6 vs 0·7 ± 0·3; P = 0·003), total cholesterol (4·4 ± 0·7 vs 3·9 ± 0·4; P = 0·02) and hsCRP (2·0 ± 1·9 vs 0·8 ± 0·3; P = 0·01). Conclusions TS girls exhibit more cardiometabolic risk factors and reduced beta cell function compared with age- and BMI-SDS-matched girls. Increased awareness of early risk of type 2 diabetes mellitus and hypertension in TS girls is needed.