Transcript Nutritional Issues in Turner Syndrome

Nutritional Issues in
Turner Syndrome
A presentation to the TCGI
Annual Conference 2009
Jessica Sheppard
21/02/2009
Overview
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Features with nutritional impact
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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
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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
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Lower energy requirements
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Modern obesogenic environment
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Most food portions are standard
Weight Management
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Any unhealthy trend in growth will be picked
up at clinic.
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Can be easily addressed with moderate
lifestyle changes
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No less effective in Turner girls/women
Weight Management
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~40 TS girls attending OLCH Endocrine clinic
10 currently linked in with dietetic service
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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
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Approach has changed over last decade
Focus on behaviour change, SMART goal
setting
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Sustainable
Measurable
Achievable
Rewarded
Time limited
Weight Management
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Individual advice for each client
Based on current lifestyle
No unrealistic targets set
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Weight loss rarely appropriate
Progress assessed at each visit based
change in BMI relative to population
Weight Management
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Several programmes available
Variable results
Measurement of success not necessarily
consistent with client expectations
Consistent attendance a problem for all
programmes
High blood pressure
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Puts stress on circulatory system and kidneys
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Regular screening recommended
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Weight management, exercise can help
Blood lipids
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Cholesterol, Triglycerides
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Regular screening recommended
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Healthy levels important for everybody
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Weight management, exercise can help
Endocrine system
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Diabetes Mellitus
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Increased risk in TS
Maintenance of a healthy weight can greatly
reduce risk
Regular screening recommended
Hypothyroidism
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Affects up to 40% of Turner women by age 40
Regular screening recommended
Bone Health
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Two main types of bone
Cortical
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‘Long’ bones e.g. limbs, fingers
Thinner in TS
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Does not appear to be related to lack of oestrogen
Trabecular
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Vertebrae, hips
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Thinner in any oestrogen-deficient condition
Bone Health
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Dietary factors:
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Vitamin D
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Calcium
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Found in and fish, dairy products, vegetable oils
Found in dairy products, some fruit and veg, some
cereal products
Irish RDAs are higher across all age groups
Phosphate
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Found in dairy products, wholegrains
Bone Health
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Other protective factors
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Oestrogen
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Deficiency reduces density of trabecular bone
No effect on cortical bone
Weight bearing exercise
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Strengthens bones, muscles, connective tissue
Could reduce risk of falls by improving balance and
dexterity
Role of Phytoestrogens
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Plant chemicals found mainly in legumes e.g.
soya, clover, chickpeas; also in flaxseed
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Structurally similar to human oestrogens
Oestradiol (human)
Genistein (phyto)
Phytoestrogens
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Believed to have an oestrogen-like effect
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Sometimes marketed as a
supplement/alternative to hormone
replacement
Claims beneficial effects on bone health, hot
flushes, reduced risk of hormone related
cancers
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Phytoestrogens: Evidence
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Animal studies:Genistein and Daidzein (found
in soy) have been shown to preserve bone
mass
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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
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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
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No specific benefits, so no need to actively
include unless vegan or milk intolerant.
Important to choose calcium enriched
products
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Perfectly safe to consume, no need to avoid