21/02/2009

Nutritional Issues in Turner Syndrome

A presentation to the TCGI

Annual Conference 2009

Jessica Sheppard

Overview

Features with nutritional impact Short stature Tendency toward overweight High blood pressure High blood lipids Risk of endocrine problems; hypothyroidism,

diabetes Risk of impaired bone health

No special diet, no foods that must be eaten or must be avoided

Short Stature

Turner girls are typically 8-10cm shorter than other girls.

Height and weight should be relatively proportional

Adequate nutrition important for growth and development, especially when on hormone treatment

Short Stature/Weight

Lower energy requirements

Modern obesogenic environment

Most food portions are standard

Weight Management

Any unhealthy trend in growth will be picked up at clinic.

Can be easily addressed with moderate lifestyle changes

No less effective in Turner girls/women

Weight Management

~40 TS girls attending OLCH Endocrine clinic 10 currently linked in with dietetic service

All for weight management Similar degree of overweight as non TS girls at

first assessment Seem to experience same level of success with

weight management as non TS

Weight Management

Approach has changed over last decade Focus on behaviour change, SMART goal

setting Sustainable Measurable Achievable Rewarded Time limited

Weight Management

Individual advice for each client Based on current lifestyle No unrealistic targets set

Weight loss rarely appropriate Progress assessed at each visit based

change in BMI relative to population

Weight Management

Several programmes available Variable results Measurement of success not necessarily

consistent with client expectations Consistent attendance a problem for all

programmes

High blood pressure

Puts stress on circulatory system and kidneys

Regular screening recommended

Weight management, exercise can help

Blood lipids

Cholesterol, Triglycerides

Regular screening recommended

Healthy levels important for everybody

Weight management, exercise can help

Endocrine system

Diabetes Mellitus Increased risk in TS Maintenance of a healthy weight can greatly

reduce risk Regular screening recommended

Hypothyroidism Affects up to 40% of Turner women by age 40 Regular screening recommended

Bone Health

Two main types of bone Cortical

‘Long’ bones e.g. limbs, fingers Thinner in TS

Does not appear to be related to lack of oestrogen

Trabecular Vertebrae, hips

Thinner in any oestrogen-deficient condition

Bone Health

Dietary factors: Vitamin D

Found in and fish, dairy products, vegetable oils Calcium

Found in dairy products, some fruit and veg, some cereal products

Irish RDAs are higher across all age groups Phosphate

Found in dairy products, wholegrains

Bone Health

Other protective factors Oestrogen

Deficiency reduces density of trabecular bone No effect on cortical bone

Weight bearing exercise Strengthens bones, muscles, connective tissue Could reduce risk of falls by improving balance and

dexterity

Role of Phytoestrogens

Plant chemicals found mainly in legumes e.g. soya, clover, chickpeas; also in flaxseed

Structurally similar to human oestrogens

Oestradiol (human)

Genistein (phyto)

Phytoestrogens

Believed to have an oestrogen-like effect

Sometimes marketed as a supplement/alternative to hormone replacement

Claims beneficial effects on bone health, hot flushes, reduced risk of hormone related cancers

Phytoestrogens: Evidence

Animal studies:Genistein and Daidzein (found in soy) have been shown to preserve bone mass

Humans: Lower incidence of hip fracture in South-East Asia, where intake of soy is high. However, incidence of other fractures is not reduced

Phytoestrogens: Evidence

Studies have been of small size and short duration

One study showed that enterodiol (found in flaxseed) can limit hot flushes in menopausal women but high dose of flaxseed caused abdominal side effects

Reduced risk of hormone related cancers is not supported by the scientific evidence

Role of Phytoestrogens

No specific benefits, so no need to actively include unless vegan or milk intolerant. Important to choose calcium enriched products

Perfectly safe to consume, no need to avoid