title: An evaluation of early cardiometabolic risk factors in children and adolescents with Turner syndrome.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Divisions of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. clodagh.ogorman@ul.ie
authors.forename: Clodagh S
authors.initials: CS
authors.lastname: O'Gorman
authors.forename: Catriona
authors.initials: C
authors.lastname: Syme
authors.forename: Jun
authors.initials: J
authors.lastname: Lang
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Bradley
authors.forename: Greg D
authors.initials: GD
authors.lastname: Wells
authors.forename: Jill K
authors.initials: JK
authors.lastname: Hamilton
mesh_terms: D000293:Adolescent; D002318:Cardiovascular Diseases / Q000209:etiology*; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology*; D005260:Female; D018149:Glucose Intolerance / Q000150:complications; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat / Q000473:pathology; D024821:Metabolic Syndrome / Q000209:etiology; D009765:Obesity / Q000150:complications; D012307:Risk Factors; D050151:Subcutaneous Fat / Q000473:pathology; D014280:Triglycerides; D014424:Turner Syndrome / Q000150:complications*; D055105:Waist Circumference
chemical_list: D014280:Triglycerides