Anthropometric variables as cardiovascular risk predictors in a cohort of adult subjects with Turner syndrome

Abstract

Background and purpose

Excessive adiposity is associated with cardiometabolic complications in Turner syndrome (TS) subjects. Reference data for predictive anthropometric indices of overweight/obesity and metabolic syndrome (MetS) are lacking for subjects with TS. The purpose of this study was to identify the best anthropometric predictor of cardiometabolic risk in a Latin-American cohort of TS subjects.

Patients and methods

This was a cross-sectional correlational study conducted in adult TS subjects (n=88) over the past seven years. Anthropometric parameters, body composition and biochemical variables were evaluated in a study and in a reference (n=57) group. Overweight/obesity and MetS were diagnosed using international consensus. The area under the ROC curve (AUC-ROC) was then used to determine the value of each anthropometric variable in predicting MetS or overweight/obesity.

Results

The prevalence of MetS and overweight/obesity in TS subjects was 40% and 48%, respectively. All anthropometric and cardiometabolic variables were significantly increased in TS subjects when compared to the reference group, except for body mass index (BMI) and HDL-c. To detect MetS and overweight/obesity, waist to height ratio (WHtR) was found to have a higher correlation with cardiometabolic variables (TC, LDL-c, HDL-c levels and the LDL-c/HDL-c ratio), and to have a higher AUC-ROC and odds ratio than BMI, waist circumference (WC) and the waist to hip ratio (WHR).

Conclusion

The prevalence of MetS and overweight/obesity is elevated in TS subjects. WHtR was the most useful variable in predicting the presence of MetS and overweight and obesity in this TS cohort. A combination of WHtR with BMI or with WC could have the best clinical utility in identifying adult TS subjects with overweight/obesity and MetS, respectively.

Keywords:

• anthropometric indexes
• body composition
• cardiometabolic risk
• metabolic syndrome
• obesity
• overweight
• Turner syndrome

Acknowledgments

We are extremely grateful to all of the women with Turner syndrome who took part in this study. We acknowledge the contribution of the Ecuadorian Foundation in Support of Turner Syndrome. The authors would like to thank the Consejo de Desarrollo Científico, Humanístico y Tecnológico (CONDES) from University of Zulia, Maracaibo, Venezuela, who provided assistance with the program. This study was supported by the Academie de Recherche et D’Enseignement Superieur of Belgique (grant number 2016-157E); and the Training Research Commission, General Directorate of Research and Postgraduate,Central University of Ecuador (grant number cif3-cv-fcb-2).

Ethics statement

The study protocol was reviewed and approved by the Ethics Committees for Research in Human Subjects of the two participating institutions. The ethical principles of the 1964 Declaration of Helsinki for medical research were adhered to throughout this research. The procedures and possible discomfort/risks were fully explained to all participating subjects before beginning the study. Each then voluntarily decided to take part in the study and approved their participation and signed an informed written consent form in front a witness. Subjects were provided with the option to withdraw their participation in the study at any time without consequence.

Disclosure

The authors declare that they have nothing to disclose and there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.