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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 - PowerPoint PPT Presentation
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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