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

Figures & data

Table 1 Description of the study population

	TS Subjects	Reference Group	P-value
N	88	57
Age (years)	29.33±6.83	29.81±4.7	0.936
Anthropometric Variables
General
Height (cm)	139.4±3.32	148.8±0.23	0.0409
Height SDS	−4.21±0.75	−2.74±0.56	0.05
Weight (kg)	51.45±9.91	52.87±9.08	0.154
Weight SDS	−0.22±1.79	0.4±0.1	0.05
BMI (kg/m^2)	26.35±5.37	24.72±3.89	0.01
BMI SDS	2.75±2.67	1.7±1.3	0.001
Adiposity Central
Waist Circumference (cm)	78.30±2.55	76.20±2.1	0.001
Waist to Hip Ratio	0.88±0.07	0.81±0.01	0.001
Waist to Height Ratio	0.56±0.09	0.49±0.03	0.001
Bioimpedance Variables
Free fat mass (kg)	25.36±8.41	32.77±3.71	0.001
Percentage of Free Fat Mass	35.66±10.36	42.61±5.92	0.001
Fat Mass (kg)	26.35±5.37	18.36±2.13	0.001
Percentage of Fat Mass (%)	36.14±9.71	32.45±3.19	0.001
Free fat mass to Fat Mass Ratio	1.43±0.76	1.8±0.17	0.001
Percentage of Total Body Water (%)	46.11±1.60	51.55±2.27	0.001
Metabolic Variables
Fasting Plasma Glucose (mg/dL)	82.33±11.95	79.72±6.6	0.001
Triglycerides (mg/dL)	163.44±59.55	113.81±40.54	0.001
Total-Cholesterol (mg/dL)	211.42±50.83	189.94±23.70	0.001
LDL-c (mg/dL)	145.64±65.15	111.75±13.68	0.001
HDL-c (mg/dL)	55.75±16.83	55.43±14.16	0.458*
TC to HDL-c Ratio (Castelli Index)	4.59±1.45	3.42±0.92	0.001
Atherogenic Index of Plasma	0.46±0.24	0.36±0.27	0.001
LDL-c to HDL-c Ratio	2.79±1.54	2.14±0.09	0.001
No-HDL-c to HDL-c Ratio	3.09±1.45	1.91±0.82	0.001
Cardiovascular Variables
Systolic blood pressure (mmHg)	139.00±19.0	115.00±15.0	0.001
Diastolic blood pressure (mmHg)	87.0±17.0	71.0±11.0	0.001
Metabolic Syndrome % (n)	40 (35) (29–50^§)	16 (9) (6–25^§)	0.001**
Overweight/Obesity % (n)	49 (43) (36–57^§)	33 (19) (16–34^§)	0.01**

Notes: *Mann-Whitney test. **Two proportion Z-test. § 95% confidence intervals. Metabolic Syndrome is defined by ≥3 of the following: 1) fasting plasma Glucose (≥5.6 mmol/L); 2) Triglycerides (≥1.7 mmol/L); 3) HDL-c (<1.03 mmol/L); 4) Arterial Hypertension; and 5) Waist Circumference >80 cm). Arterial Hypertension is defined by systolic blood pressure (≥130 mmHg) or Diastolic blood pressure (≥85 mmHg); or taking antihypertensive medication. Overweight/Obesity is defined by BMI ≥25 kg/m². The Atherogenic Index of the Plasma is calculated through the formula of log(Triglycerides (mg/mL)/HDL-c (mg/mL)).

Abbreviations: SDS, standard deviation score; BMI, body mass index; HDL-c, high density lipoprotein cholesterol; LDL-c, low density lipoprotein cholesterol; TC, total cholesterol.

Table 2 Comparison between Turner syndrome subjects with and without metabolic syndrome

	MetS TS Subjects	Non-MetS TS Subjects
Prevalence (n)	40 (35)	60 (53)
With Overweight/Obesity %, (n)	77 (27)	30 (16)
Without Overweight/Obesity % (n)	23 (8)	70 (37)
	Mean ± SD		p
Age	32.37±1.19	27.25±0.84	0.0005
Anthropometric Variables
General
Height (cm)	139±0.56	140.4±0.44	0.0595
Weight (kg)	58.14±1.91	47.02±0.76	<0.001
BMI (kg/m^2)	30.18±1.05	23.76±0.36	<0.0001
Adiposity Central
Waist Circumference (cm)	85.69±2.58	73.42±0.97	<0.0001
Waist to Hip Ratio	0.91±0.01	0.86±0.01	0.0017
Waist to Height Ratio	0.62±0.02	0.52±0.07	<0.0001
Bioimpedance Variables
Free fat mass (kg)	24.77±1.15	25.76±1.29	0.3737*
Percentage of Free Fat Mass (%)	53.09±2.33	44.22±2.61	0.0148
Fat Mass (kg)	27.55±1.60	16.2±0.55	<0.0001
Percentage of Fat Mass (%)	45.14±1.60	33.53±0.90	<0.0001
Free fat mass to Fat Mass Ratio	0.74±0.05	1.23±0.10	<0.0001
Total Body Water*	23.84±0.65	24.38±0.66	0.4257*
Percentage of Total Body Water (%)	42.11±1.62	51.82±1.13	<0.0001
Metabolic Variables
Fasting Plasma Glucose (mg/dl)	87.87±2.36	78.78±1.19	0.0003
Triglycerides (mg/dL)	183.6±9.53	149±7.95	0.0068
Total Cholesterol (mg/dL)	222.4±6.70	203.3±7.63	0.0228
LDL-c (mg/dL)	161.7±10.29	134±8.99	0.049
HDL-c (mg/dL)	45.12±1.87	56.97±2.11	0.0002
TC to HDL-c Ratio (Castelli Index)	5.15±0.21	3.70±0.15	<0.0001
Atherogenic Index of Plasma	0.60±0.04	0.40±0.03	<0.0001
LDL-c to HDL-c Ratio	3.72±0.23	2.43±0.17	<0.0001
No-HDL-c to HDL-c Ratio	4.15±0.21	2.70±0.15	<0.0001
Cardiovascular Variables
Systolic blood pressure (mmHg)	140±15	136±12	0.041
Diastolic blood pressure (mmHg)	88±13	85±14	0.0259

Notes: *Mann-Whitney test. Metabolic Syndrome is defined by ≥3 of the following: 1) fasting plasma glucose (≥5.6 mmol/L); 2) Triglycerides (≥1.7 mmol/L); 3) HDLc (<1.03 mmol/L); 4) Arterial Hypertension; and 5) Waist Circumference >80 cm). Arterial Hypertension is defined by systolic blood pressure (≥130 mmHg) or Diastolic blood pressure (≥85 mmHg); or taking antihypertensive medication. Overweight/Obesity is defined by BMI ≥25 kg/m². The Atherogenic Index of the Plasma is calculated through the formula of log(Triglycerides (mg/mL)/HDLc (mg/mL)).

Abbreviations: SDS, standard deviation score; BMI, body mass index; HDL-c, high density lipoprotein cholesterol; LDL-c, low density lipoprotein cholesterol; TC, Total Cholesterol.

Figure 1 Prevalence of the single components of MetS for TS subject and reference groups.

Notes: Prevalence expressed in % (95% CI). *Significant difference between both groups (two proportion Z-test).
Abbreviations: HTA, Arterial Hypertension; Pathological WC, Waist Circumference ≥80 cm.

Table 3 Comparison between Turner syndrome subjects with and without overweight/obesity

	Overweight/Obesity TS Subjects	Non-Overweight/Obesity TS Subjects
N	43	45
With MetS % (n)	63 (27)	18 (8)
Without MetS % (n)	37 (16)	82 (37)
	Mean ± SD		p
Age	31.75±1.04	26.82±0.92	0.0006
Anthropometric Variables
General
Height (cm)	138.6±0.50	141.1±0.44	0.0004
Weight (kg)
BMI (kg/m^2)	29.64±0.85	23.06±0.33	<0.0001
Adiposity Central
Waist Circumference (cm)	84.71±2.09	71.89±0.9786	<0.0001
Waist to Hip Ratio*	0.90±0.012	0.86±0.01	0.001*
Waist to Height Ratio	0.61±0.02	0.51±0.01	<0.0001
Bioimpedance Variables
Free fat mass (kg)*	26.06±1.12	24.67±1.41	0.6167*
Percentage of Free Fat Mass (%)*	47.35±2.45	51.77±2.61	0.1103*
Fat Mass (kg)	25.85±1.42	15.61±0.50	<0.0001
Percentage of Fat Mass (%)	43.33±1.51	32.95±0.90	<0.0001
Free fat mass to Fat Mass Ratio	0.75±0.05	1.12±0.09	0.0004
Total Body Water*	24.20±0.60	24.22±0.75	0.873*
Percentage of Total Body Water (%)	43.55±1.41	52.36±1.29	<0.0001
Metabolic Variables
Fasting Plasma Glucose (mg/dl)*	83.93±1.78	77.56±1.74	0.0246*
Triglycerides (mg/dL)*	181.19±8.20	145.58±9.00	0.0039*
Total Cholesterol (mg/dL)*	221±6.60	201.8±8.43	0.1136*
LDL-c (mg/dL)*	154.6±9.49	136.7±10.07
HDL-c (mg/dL)*	49.17±1.98	53.91±2.04	0.05*
TC to HDL-c Ratio (Castelli Index)	4.73±0.19	3.82±0.19	0.0012
Atherogenic Index of Plasma	0.56±0.03	0.40±0.03	0.001
LDL-c to HDL-c Ratio	3.30±0.21	2.59±0.21	0.0184
No-HDL-c to HDL-c Ratio	3.73±0.19	2.82±0.19	0.0012
Cardiovascular Variables
Systolic blood pressure (mmHg)	139±16	135±18	0.01
Diastolic blood pressure (mmHg)	89±13	82±12	0.0015

Notes: *Mann-Whitney test. Metabolic Syndrome is defined by ≥3 of the following: 1) fasting plasma glucose (≥5.6 mmol/L); 2) Triglycerides (≥1.7 mmol/L); 3) HDLc (<1.03 mmol/L); 4) Arterial Hypertension; and 5) Waist Circumference >80 cm). Arterial Hypertension is defined by systolic blood pressure (≥130 mmHg) or Diastolic blood pressure (≥85 mmHg); or taking antihypertensive medication. Overweight/Obesity is defined by BMI ≥25 kg/m². The Atherogenic Index of the Plasma is calculated through the formula of log(Triglycerides (mg/mL)/HDLc (mg/mL)).

Abbreviations: SDS, standard deviation score; BMI, body mass index; HDL-c, high density lipoprotein cholesterol; LDL-c, low density lipoprotein cholesterol; TC, total cholesterol.

Table 4 Sensitivity, specificity and cut-off points for anthropometric variables predictive of MetS and overweight/obesity in adult TS subjects

A. Optimal Cut-Off Value for BMI, WC, WHR and WHtR Predictive of MetS or Overweight/Obesity
	BMI			WC			WHR			WHtR
	Cut-off(Kg/m^2)	Sensitivity (%)	Specificity (%)	Cut-off (cm)	Sensitivity (%)	Specificity (%)	Cut-off	Sensitivity (%)	Specificity (%)	Cut-off	Sensitivity (%)	Specificity (%)
MetS	≥27.92	61.10	98.10	≥83.10	52.80	94.20	≥0.89	50.00	76.90	≥0.53	62.8	97.62
Overweight/Obesity				≥81.5	59.5	95.7	≥0.89	52.4	82.6	≥0.52	90.5	57.00
B. Sensitivity and Specificity for Anthropometric Variables Predictive of MetS and Overweight/Obesity Based on Established/Recommended Cut-Off Values in Adult TS Subjects
MetS	≥25 Kg/m^2	75.00	69.2	≥80	58.3	84.6	≥0.82	97.22	17.31	≥0.5	91.7	41.33
	≥27.5Kg/m^2	61.10	96.2	≥82	52.8	92.3	≥0.85	88.89	30.77	≥0.52	86.1	48.14
	≥30 Kg/m^2	44.44	98.1	≥85	36.1	96.2	≥0.90	33.33	90.38	≥0.55	61.1	78.81
Overweight/Obesity				≥80	59.5	91.3	≥0.82	97.62	19.57	≥0.5	97.6	41.33
				≥82	54.8	95.7	≥0.85	90.48	34.78	≥0.52	90.5	56.62
				≥85	35.7	100	≥0.90	33.33	93.48	≥0.55	66.7	89.11

Note: Overweight/Obesity is defined by BMI ≥25 kg/m².

Abbreviations: SDS, standard deviation score; BMI, body mass index; WC, waist circumference; WHR, waist to hip ratio; WHtR, waist circumference to height ratio; HDL-c, high density lipoprotein cholesterol; LDL-c, low density lipoprotein cholesterol; TC, Total Cholesterol.

Figure 2 Receiver operating characteristic (ROC) curve for prediction of Metabolic Syndrome (MetS) from waist-to-height ratio (WHtR), waist circumference, waist-to-hip ratio (WHR) and body mass index (BMI) in adult Turner syndrome subjects.

Figure 3 Receiver operating characteristic (ROC) curve for prediction of Overweight/Obesity from waist-to-height ratio (WHtR), waist circumference, waist-to-hip ratio (WHR) and body mass index (BMI) in adult Turner syndrome subjects.