title: Associations among slipped capital femoral epiphysis, tibia vara, and type 2 juvenile diabetes.
abstract: BACKGROUND
  Clinical consequences of obesity are numerous and include slipped capital epiphysis of the femur, tibia vara, impaired mobility, insufficient muscle strength, glucose intolerance, type 2 diabetes, hyperlipidemia, nonalcoholic fatty liver disease, cholelithiasis, hypertension, sleep apnea, polycystic ovary disease, increased cardiorespiratory effort, and pseudotumor cerebri, among others. Because slipped capital femoral epiphysis, tibia vara, and type 2 diabetes are observed commonly in obese children, a degree of multiple disease occurrence in a patient would be anticipated; however, the senior author has never observed an obese adolescent who presented at the initial diagnosis with a coexistence of slipped capital femora epiphysis, tibia vara, or type 2 diabetes, so, possibly, these constellations of comorbidities may represent unique obesity phenotypes.
  
  
  METHODS
  We reviewed the population consisting of all consecutive patients with newly diagnosed slipped capital femoral epiphysis or tibia vara from 2000 to 2006 and a selected group of patients with type 2 diabetes treated at the Alfred I. duPont Hospital for Children, Wilmington, DE.
  
  
  RESULTS
  There were 57 cases of slipped capital femoral epiphysis, 41 cases of tibia vara, and 53 cases of type 2 diabetes. The tibia vara group had the highest body mass index (BMI; 40.81 [13.01]); the diabetes group (BMI, 35.76 [7.04]) and the slipped capital femoral epiphysis group (BMI, 29.08 [7.07]) had the lowest BMI. There was no significant difference in age at the disease onset and height between groups. There was no overlap of disease at initial presentation among slipped capital femoral epiphysis, adolescent tibia vara, and type 2 diabetes.
  
  
  CONCLUSIONS
  We observed 3 separate obesity-related phenotypes in adolescents with no overlap of disease at initial presentation among slipped capital femoral epiphysis, adolescent tibia vara, and type 2 diabetes.
authors.affiliation: Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA. jrbowen@nemours.org
authors.forename: James Richard
authors.initials: JR
authors.lastname: Bowen
authors.forename: Morcello
authors.initials: M
authors.lastname: Assis
authors.forename: Kumar
authors.initials: K
authors.lastname: Sinha
authors.forename: Sandra
authors.initials: S
authors.lastname: Hassink
authors.forename: Aaron
authors.initials: A
authors.lastname: Littleton
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D004839:Epiphyses, Slipped / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005269:Femur / Q000002:abnormalities; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D010641:Phenotype; D013977:Tibia / Q000002:abnormalities*