Prevalence of being underweight and overweight and obesity at diagnosis in UK patients with childhood acute lymphoblastic leukaemia 1985-2002.

BACKGROUND: Being underweight or overweight and obesity at diagnosis may all worsen prognosis in childhood acute lymphoblastic leukaemia (ALL), although no studies have estimated the prevalence of an unhealthy weight status at diagnosis in large representative samples using contemporary definitions of weight status based on body mass index (BMI) for age. METHODS: The present study comprised a retrospective study that aimed to estimate prevalence of being underweight and overweight and obesity at diagnosis for patients with childhood ALL on three successive UK treatment trials: UKALL X (1985-1990; n = 1033), UKALL XI (1990-1997; n = 2031), UKALL 97/99 (1997-2002; n = 898).The BMI for age was used to define weight status with both UK 1990 BMI for age reference data and the Cole-International Obesity Task Force (IOTF) definitions. RESULTS: The prevalence of being underweight was 6% in the most recent trial for which data were available. The prevalence of being overweight and obesity was 35% in the most recent trial when expressed using Cole-IOTF definitions and 41% when expressed relative to UK 1990 reference data. CONCLUSIONS: Even with highly conservative estimates, >40% of all UK patients with ALL were underweight, overweight or obese at diagnosis in the most recent trial for which UK data are available (UKALL 97/99, 1997-2002).

Development of bioelectrical impedance-derived indices of fat and fat-free mass for assessment of nutritional status in childhood.

OBJECTIVES: (1) To develop a method of manipulating bioelectrical impedance (BIA) that gives indices of lean and fat adjusted for body size, using a large normative cohort of children. (2) To assess the discriminant validity of the method in a group of children likely to have abnormal body composition. DESIGN: Two prospective cohort studies. SETTING: Normative data: Avon Longitudinal Study of Parents and Children (ALSPAC), population based cohort; proof of concept study: tertiary feeding clinic and special needs schools. SUBJECTS: Normative data: 7576 children measured aged between 7.25 and 8.25 (mean 7.5) (s.d.=0.2) years; proof of concept study: 29 children with either major neurodisability or receiving artificial feeding, or both, mean age 7.6 (s.d.=2) years. MEASURES: Leg-to-leg (Z (T)) and arm-to-leg (Z (B)) BIA, weight and height. Total body water (TBW) was estimated from the resistance index (RI=height(2)/Z), and fat-free mass was linearly related to TBW. Fat mass was obtained by subtracting fat-free mass from total weight. Fat-free mass was log-transformed and the reciprocal transform was taken for fat mass to satisfy parametric model assumptions. Lean and fat mass were then adjusted for height and age using multiple linear regression models. The resulting standardized residuals gave the lean index and fat index, respectively. RESULTS: In the normative cohort, the lean index was higher and fat index lower in boys. The lean index rose steeply to the middle of the normal range of body mass index (BMI) and then slowly for higher BMI values, whereas the fat index rose linearly through and above the normal range. In the proof of concept study, the children as a group had low lean indices (mean (s.d.) -1.5 (1.7)) with average fat indices (+0.21 (2.0)) despite relatively low BMI standard deviation scores (-0.60 (2.3)), but for any given BMI, individual children had extremely wide ranges of fat indices. The lean index proved more stable and repeatable than BMI. CONCLUSIONS: This clinical method of handling BIA reveals important variations in nutritional status that would not be detected using anthropometry alone. BIA used in this way would allow more accurate assessment of energy sufficiency in children with neurodisability and may provide a more valid identification of children at risk of underweight or obesity in field and clinical settings.

Neonatal nephrocalcinosis: long term follow up.

AIMS: To assess the spontaneous resolution of neonatal nephrocalcinosis and its long term effects on renal function. METHODS: Fourteen very low birthweight preterm babies with nephrocalcinosis were followed up at 5-7 years of age; 14 controls were matched for sex, gestation, and birth weight. Height, weight, blood pressure, and renal symptomatology were recorded, and a renal ultrasound scan was performed. Early morning urine osmolality and creatinine ratios of albumin, phosphate, calcium, oxalate and beta microglobulin were determined. Urea and electrolytes in the study group were determined, and glomerular filtration rate (GFR) and TmP/GFR (tubular reabsorption of phosphate per GFR) were calculated. Statistical analysis was performed on a group basis using the Mann-Whitney confidence interval. RESULTS: Mean age was 6.9 years (range 5.81-7.68). An early morning urine osmolality >700 mOsm/kg was achieved in all cases. In two cases and four controls, the calcium/creatinine ratio was >0.7 mmol/mmol. In all cases, the GFR was normal (median 132.6 ml/min/1.73 m(2) (range 104.1-173.1)). Median TmP/GFR was 1.22 mmol/l (0.73-1.61), with two having levels below the normal range. These did not have persisting nephrocalcinosis. Nephrocalcinosis was found in three of the 12 cases scanned and one control. There were no significant differences in urine biochemistry. CONCLUSIONS: Resolution of nephrocalcinosis occurred in 75% of cases. No evidence was found to suggest that nephrocalcinosis is associated with renal dysfunction in the long term. There was evidence of hypercalciuria in the cases and controls, suggesting that prematurity may be a risk factor.

Effect of socioeconomic status on objectively measured physical activity.

BACKGROUND: A socioeconomic gradient in childhood obesity is known to be present by the age of school entry in the UK. The origin of this gradient is unclear at present, but must lie in socioeconomic differences in habitual physical activity, sedentary behaviour, or dietary intake. AIMS: To test the hypothesis that habitual physical activity and/or sedentary behaviour are associated with socioeconomic status (SES) in young Scottish children. METHODS: Observational study of 339 children (mean age 4.2 years, SD 0.3) in which habitual physical activity and sedentary behaviour were measured by accelerometry over six days (study 1). In a second study, 39 pairs of children of distinctly different SES (mean age 5.6 years, SD 0.3) were tested for differences in habitual physical activity and sedentary behaviour by accelerometry over seven days. RESULTS: In study 1, SES was not a significant factor in explaining the amount of time spent in physical activity or sedentary behaviour once gender and month of measurement were taken into account. In study 2, there were no significant differences in time spent in physical activity or sedentary behaviour between affluent and deprived groups. CONCLUSION: Results do not support the hypothesis that low SES in young Scottish children is associated with lower habitual physical activity or higher engagement in sedentary behaviour.

Randomized comparison of photodynamic therapy with topical 5-fluorouracil in Bowen's disease.

BACKGROUND: Bowen's disease (BD; intraepithelial squamous cell carcinoma) is therapeutically challenging because lesions, which may be multiple, are frequently located at sites that heal poorly. There is a small risk of progression to invasive carcinoma. Photodynamic therapy (PDT) is an effective treatment for certain non melanoma skin cancers, but comparison studies with other, better-established therapies are limited. OBJECTIVES: To compare the efficacy and tolerability of PDT and topical 5-fluorouracil (5-FU) in BD. METHODS: Forty patients from two centres were randomized to either topical PDT or 5-FU. The PDT group was treated with 20% 5-aminolaevulinic acid (ALA) applied 4 h before illumination with 100 J cm-2 narrowband red light (630 +/- 15 nm). 5-FU was applied to lesions for 4 weeks. A repeat treatment cycle was performed after 6 weeks if required. Results Twenty-nine of 33 (88%) lesions treated with PDT initially responded completely, compared with 22 of 33 (67%) after 5-FU. After 12 months, two recurrences in the PDT group and six in the 5-FU group reduced complete clinical clearance rates to 82% and 48%, respectively. PDT was significantly more effective (P = 0.006, odds ratio 4.78, 95% confidence interval 1.56-14.62). In the 5-FU group, severe eczematous reactions developed around seven lesions, ulceration in three and erosions in two. No such reactions occurred following PDT. There was no difference in overall pain experienced during each therapy. CONCLUSIONS: Topical ALA-PDT is more effective than topical 5-FU in the treatment of BD, with fewer adverse events. ALA-PDT should be considered one of the first-line therapeutic options for BD.

Protein energy supplements in unwell elderly patients--a randomized controlled trial.

BACKGROUND: To determine whether oral protein energy supplements, prescribed during hospitalization to elderly medical admissions, affect nutritional status and if baseline nutritional state influences this status. We also considered the effects on mortality, length of hospital stay, functional recovery, and institutionalization. METHODS: A prospective randomized controlled trial with no placebo. Consenting patients were stratified in 3 nutritional categories, and patients from each stratum were randomized into treatment or control. Observers were blinded to randomization. The participants were emergency admissions from home to a Medicine for the Elderly Unit in a Scottish hospital. The inclusion criteria were as follows: no known malignancy, the ability to swallow, and nonobesity (BMI < 75th percentile). The intervention was a prescription of 120 mL sip feed, 3 times daily (540 kcal, 22.5 g protein per day) throughout hospitalization, using the medicine prescription chart. The trial was powered to detect change in mean percentage weight. The following outcomes were also considered: anthropometry; mortality, length of hospital stay, functional recovery, and rates of institutionalization. RESULTS: Included in the trial were 381 patients. Nutritional supplementation was associated with significantly better energy intake (p = .001) and weight gain (p = .003) pooled across all nutritional categories. In the most poorly nourished patients, the intervention was associated with reduced mortality (5/34 versus 14/40, p < .05) and more patients improved functionally (17/25 versus 11/28, p < .04). Overall mortality results were 21/186 versus 33/195, odds ratio (OR) 0.62, 95% confidence interval (CI) 0.35, 1.13. CONCLUSIONS: Prescribing sip feed supplements in the medicine prescription chart during hospital stay reduces weight loss. Our data also support other evidence for a reduction in mortality noted in elderly patients on nutritional supplementation. There were suggestions of other clinical benefits.

Nephrocalcinosis in preterm babies.

OBJECTIVES: To determine prospectively the incidence and cause of nephrocalcinosis in preterm infants. STUDY DESIGN: Inborn babies of gestation less than 32 weeks or birth weight less than 1500 g were eligible to be entered into a prospective observational study. Two renal ultrasound scans were performed, the first at 1 month postnatal age and the second at term or discharge. Data were collected on gestation, birth weight, sex, race, family history of renal calculi, oliguria on first day, respiratory support (ventilation, steroid, and oxygen dependency), and use of nephrotoxic drugs (gentamicin, vancomycin, and frusemide). Intake of fluid, calcium, and phosphate and plasma urea, creatinine, calcium, and phosphate were recorded for the first 6 weeks of life. Random urinary calcium/creatinine, oxalate/creatinine, and urate/creatinine ratios and tubular absorption of phosphate were measured once at term. RESULTS: A total of 101 preterm infants were studied. Twenty three (23%) had abnormal ultrasound scans. Sixteen (16%) had nephrocalcinosis. On univariate analysis, gestational age, male sex, duration of ventilation, oxygen dependency, duration and frequency of gentamicin treatment, toxic gentamicin/vancomycin levels, and postnatal dexamethasone were significantly associated with nephrocalcinosis. In addition, babies with nephrocalcinosis had a lower intake of fluid, calcium, and phosphate, longer duration of total parenteral nutrition, and higher urinary oxalate/creatinine and urate/creatinine ratios than infants who did not have the condition. There was also a significant association with plasma urea and creatinine but not with plasma calcium or phosphate or urinary calcium. Multivariate analysis showed that the strongest predictors of nephrocalcinosis were duration of ventilation, toxic gentamicin/vancomycin levels, low fluid intake, and male sex. CONCLUSION: 16% of babies born at less than 32 weeks gestation developed nephrocalcinosis. The multifactorial origin, in particular, the association with extreme prematurity and severity of respiratory disease, is confirmed. In addition, an association with male sex, frequency and duration of gentamicin use, and high urinary oxalate and urate excretion is shown.

Photodynamic therapy for large or multiple patches of Bowen disease and basal cell carcinoma.

BACKGROUND: Photodynamic therapy (PDT) using topical delta-aminolevulinic acid (delta-ALA) is an effective treatment for Bowen disease and certain basal cell carcinomas (BCCs), but its place in clinical practice remains to be established. Patients with large and/or multiple lesions of Bowen disease or BCC can represent a considerable therapeutic challenge. We suggest that delta-ALA PDT may be of particular benefit in such patients. OBSERVATION: In an open study, 35 (88%) of 40 large patches of Bowen disease, all with a maximum diameter greater than 20 mm, cleared following 1 to 3 treatments of delta-ALA PDT, although 4 patches recurred within 12 months. delta-Aminolevulinic acid PDT was also used to treat 40 large BCCs, with an identical 88% initial clearance (after 1-3 treatments), with 4 recurrences within 34 months (range, 12-60 months). In 10 further patients with multiple (> or =3) patches of Bowen disease, 44 (98%) of 45 patches cleared following delta-ALA PDT, although 4 lesions recurred over 12 months. In 3 patients with multiple BCCs, PDT cleared 52 (90%) of 58 lesions, with 2 recurrences during 41 months (range, 12-52 months). Treatments were well tolerated, with only 5 patients with solitary large lesions requiring local anesthesia. CONCLUSIONS: delta-Aminolevulinic acid PDT is an effective tissue-sparing modality achieving good cosmesis. We propose that delta-ALA PDT be considered as a first-line therapy for large and/or multiple areas of Bowen disease and superficial BCCs.

The application of control limits analysis to the myometric assessment of motor performance in neuropathy patients.

Measurement of muscle strength by myometry is used to monitor the natural course and treatment response of motor system diseases, both in individual patients and clinical trials. However, the practical usefulness of myometric data is reliant upon a statistical method for analysing serial strength measurements which distinguishes disease-related changes from random fluctuations in patient performance and operator/device dependent measurement errors. In this study we have applied control limits analysis to this problem. Using hand-held dynamometry, sets of baseline strength measurements were collected on two separate occasions during a period of clinical stability from up to four muscle groups in 22 patients with peripheral neuropathies. From these sets of data, 76 control limits were calculated and then used to describe the inter-measurement variation in muscle strength in individual muscles. The range of control limits was wide, varying from <10% of baseline (in 36% of muscles tested) to >50% (in 4% of muscles tested), with 88% of muscles falling within 30% of baseline. Follow-up data were also collected from all patients, including those undergoing treatment. Control limits analysis is a powerful and simple method for assessing the significance of motor performance changes in individual muscles in patients undergoing serial monitoring and can be easily applied to both single patients and clinical trials.

Describing shape changes in the human mandible using elliptical Fourier functions.

Elliptical Fourier functions (EFF) were generated for the boundary outline of the mandibular form in 24 non-orthodontic growth study subjects at 9, 11, 13, and 15 years of age. The mean residual fit (observed versus predicted points) of the mandibular form was 0.11 mm, with a range from 0.09 to 0.14 mm, suggesting an accurate fit. The mean plot for each of the four age groups was area standardized and superimposed on the centroid. Shape changes in males and females were found to be similar. No significant shape changes were found between 9 and 11 years. Shape changes were observed in the lower incisor area, the mental region, the body of the mandible, and the gonial angle area between 11 and 15 years. These changes coincided with the onset of the pubertal growth spurt.

Orthodontic treatment with fixed appliances in the General Dental Service in Scotland.

The records of 128 subjects treated by orthodontic specialists with fixed appliances in the General Dental Service in Scotland were randomly selected from the Scottish Dental Practice Board for analysis. The results of the study revealed that: (1) Mean post-treatment Peer Assessment Rating was 7.8 +/- 4.6 PAR points. (2) Mean reduction in PAR score was 14.9 +/- 10.6 PAR points. (3) Mean percentage reduction in PAR was 59 per cent. (4) Twenty-eight per cent of the cases were 'greatly improved', 15 per cent of the cases were made 'worse or no different'. (5) Median duration of treatment was 15 months, with a range of 2-41 months. (6) Multiple regression analysis showed that 82 per cent of the variability of PAR change could be predicted by the pretreatment PAR scores and the number of arches treated. Post-treatment PAR scores and duration of treatment could not be predicted with adequate reliability. It was concluded that although about 75 per cent of the cases were treated to at least acceptable alignment and occlusion, the modest average percentage reduction in PAR score could be explained by the low average initial PAR score and the borderline need for treatment in many cases.

Risk assessment of renal cortical scarring with urinary tract infection by clinical features and ultrasonography.

AIMS: To address some of the issues in the ongoing debate over the optimal diagnostic imaging following childhood urinary tract infection (UTI), by determining the risk of missing renal cortical scarring which would be detected on a technetium-99m dimercaptosuccinic acid (DMSA) gold standard if ultrasound alone were used, factoring for clinical features (upper or lower tract), UTI recurrence, and age group (infants, preschool, or school age). METHODS: Details of UTI clinical features and recurrence were recorded for 990 children with a proven UTI, and their DMSA and ultrasound results were compared for each kidney. RESULTS: The risks of missing DMSA scarring varied between 0.4% (school age children with solitary lower tract UTI) and 11.1% (infants with recurrent upper tract UTI). CONCLUSIONS: UTI clinical features are important in assessing the need for DMSA imaging. Current UK imaging guidelines are endorsed, although preschool children with solitary lower tract UTI remain a controversial group and more attention needs to focused on children with recurrent UTI.

Accuracy of clean-catch urine collection in infancy.

OBJECTIVE: To compare the accuracy of cultures of urine obtained by clean-catch urine (CCU) collection and suprapubic aspiration (SPA) in infants. DESIGN: Prospective case series undertaken in a pediatric teaching hospital and associated neonatal unit. Fifty-eight paired urine cultures (CCU collection and SPA) were obtained from 49 infants with suspected urinary tract infection. The primary outcome measure was the presence or absence of significant bacteriuria on both CCU collection and SPA; secondary outcome measures were the success of SPA with ultrasound guidance compared with aspiration without ultrasound guidance. Statistical analysis was done by using a chi(2) test. RESULTS: A false-positive rate of 5% and a false-negative rate of 12% were recorded. Sensitivity was 88.9% (95% CI 65.3-98.6), and specificity was 95.0% (95 CI% 83.1-99. 4). Ultrasound-assisted SPA was successful in 26 of 28 patients (93%) and in 13 of 21 patients (62%) when SPA was performed without ultrasound (chi(2) = 7.08, P =.008). CONCLUSIONS: We conclude that there is a good association in results of culture of urine obtained by CCU collection and SPA and would encourage the use of the CCU technique.

Breakage incidence with direct-bonded lingual retainers.

This study examined the effects of a number of patient and clinical variables on the breakage of bonded retainers, and consisted of a retrospective review of the survival of 200 bonded retainers. Data was collected from two clinical centres between November 1996 and February 1997. The subjects comprised 198 patients of both sexes divided into three age groups. Retainers at both centres were made in 018-inch co-axial wire with Relyabond and Helioprogress adhesives used at each respective centre. The effects on time to first breakage of adhesive, patient sex, and arch (upper/lower) were considered using Kaplan Meier survival graphs and in Log Rank Tests. Finally, a Cox Proportional Hazard Model was used to examine the joint effects of these factors and the patients' ages. Breakage over a 5-year period with Relyabond was 38.8 per cent upper, 22.1 per cent lower, and with Helioprogress 75 per cent upper and 23.2 per cent lower. Breakage appears to be unrelated to the materials used or to the age and sex of the patients. Upper retainers break more often than lowers (P = 0.016) and early breakage is more likely to occur at an adhesive pad than at a wire (9.6 versus 2.5 per cent within 6 months).

Prevalence of protein-energy malnutrition at diagnosis in children with acute lymphoblastic leukemia.

BACKGROUND: The purpose of the present study was to test the hypothesis that protein-energy undernutrition is common in patients with acute lymphoblastic leukemia at diagnosis. Previous studies have failed to establish whether undernutrition is a common feature at diagnosis. METHODS: Body mass index (BMI, weight/height2), expressed as a standard deviation score (SDS) relative to contemporary United Kingdom reference data, was used as the index of nutritional status. The index was calculated in a national cohort of standard-risk patients (n = 1019) treated in the same protocol in the United Kingdom. RESULTS: Prevalence of undernutrition (defined as BMI SDS <-2.0) exceeded expected frequencies in boys (7.6%) and girls (6.7%). These differences were statistically significant (p < 0.001), with a 95% confidence interval for the prevalence of undernutrition of 5.8% to 9.0%. CONCLUSIONS: Undernutrition is relatively common in patients with newly diagnosed acute lymphoblastic leukemia, with a threefold excess of patients below the cutoff used to define undernutrition. Screening for undernutrition at diagnosis of acute lymphoblastic leukemia is indicated, and the BMI SDS is a simple index of nutritional status that could be readily calculated using measurements routinely made at diagnosis. The same simple screening technique could also be used clinically to detect and manage or prevent overnutrition (obesity), which is common in these patients after diagnosis.

Cognitive functioning in people with epilepsy plus severe learning disabilities: a systematic analysis of predictors of daytime arousal and attention.

In spite of the high prevalence of epilepsy and the importance of preserving cognitive function in people with learning disabilities, this population has received relatively little research attention. This study sets out systematically to investigate possible predictive factors of inter-ictal states of arousal and attention. The daytime function of 28 people with epilepsy and severe learning disabilities was assessed by performance on a two-choice reaction time vigilance task, behavioural analysis of time-sampled video recordings taken in naturalistic settings, and carer ratings on visual analogue scales. This methodology yielded eight discrete functional measures, from which two further index measures were derived after principal components analysis. A range of clinical and psychosocial assessments was completed and subjects had 36 hour ambulatory EEG and sleep EEG monitoring. Regression models identified significant predictors of cognitive function from a range of potential explanatory variables i.e. demographic, clinical, pharmacological, background EEG rhythms and sleep parameters. Results indicated that greater severity of learning disability, longer bedtime periods, poor sleep efficiency, frequent seizures and antiepileptic drug polytherapy were significant predictor variables. Explained variance (adjusted R2) was greater than 50% for six of 10 outcome variables (range up to 85%). Furthermore, significant regression equations (P < 0.05) were obtained for all but one variable. Thus, these results appear reasonably robust. Results support an interactional model of daytime arousal and attention in people with epilepsy plus severe learning disabilities. Inter-ictal cognitive function appears to be mediated by a combination of organic, circadian (sleep wake), clinical and pharmacological factors.

No evidence for an effect of nutritional status at diagnosis on prognosis in children with acute lymphoblastic leukemia.

PURPOSE: To test the hypothesis that nutritional status at diagnosis, defined as body mass index standard deviation score (SDS), is related to the prognosis in childhood acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS: The sample consisted of 1,025 patients with standard risk ALL who had been randomized to different intensification therapies. Outcome measures were relapse/no relapse and time to first relapse. The influence of body mass index SDS was tested by survival analysis. RESULTS: There was no evidence that body mass index SDS was related to clinical outcome (proportional hazards model, p = 0.72). CONCLUSIONS: The study results suggest that nutritional status at diagnosis, defined on the basis of the body mass index, at least in developed countries, has no effect on the prognosis in ALL, and it should not be considered as a prognostic factor.

Sleep studies of adults with severe or profound mental retardation and epilepsy.

Sleep patterns of people with mental retardation have received little research attention. This is an important gap in knowledge because understanding the relation between sleep and wakefulness may be critical to care provision. Descriptive sleep information on 28 people with severe or profound mental retardation and epilepsy was presented here. Sleep EEG data, studied both conventionally and by means of a neural network-based sleep analysis system suggest atypical sleep stages with significant depletion of REM sleep and a predominance of "indiscriminate" non-REM sleep. Sleep diaries completed by caregivers reveal lengthy sleep period times, especially among those with profound mental retardation. Possible explanations for these results and their implications were discussed.

Differentiation between cleft lip with or without cleft palate and isolated cleft palate using parental cephalometric parameters.

OBJECTIVE: The purpose of this study was to identify and compare lateral cephalometric measurements in noncleft parents of children with cleft palate (CP) and cleft lip (CL), and cleft lip and palate (CLP). The hypothesis was that discriminant analysis would enable identification of morphometric features that predispose to orofacial clefting and that differ for CP, CL, and CLP and are unevenly distributed within parental pairs. DESIGN: This was a prospective, parametric analysis. SETTING: The study was conducted by the Department of Dental Health, University of Dundee, and the Department of Statistics, University of Glasgow, Scotland. SUBJECTS: From a completely ascertained sample of 286 children with cleft lip and/or palate born in the West of Scotland between January 1, 1980, and December 31, 1984, a sample of 83 parents of children with non-syndromic clefts volunteered for lateral cephalometric examination. METHODS: Thirty-seven cranial and 99 facial landmarks were identified and 37 linear, angular, and area parameters were used to describe the craniofacial skeleton. Analysis of variance was used for a three-way comparison of CL/CLP/CP, and stepwise discriminant analysis was used to determine which variables discriminate best between cleft lip with or without cleft palate [CL(P)] and isolated cleft palate (CP) parents. RESULTS: There were no significant differences whatsoever in the craniofacial morphology between the parents of children with CL and CLP, but differences were found between the CL(P) and CP groups. The most significant of these were in mandibular length, ramus length, mandibular area, and cranial area. Mandibular ramus length alone discriminated between the two groups in 71.4% of CP and in 62.5% of CL(P) cases, while separate analysis of fathers and mothers showed that ramus length and cranial height together reliably distinguish between mothers in 75% of CP and 80% of CL(P) cases. CONCLUSIONS: Previous studies suggests that unaffected parents with non-syndromic children with cleft lip and/or palate have differences in their craniofacial morphology when compared to the general population. This study indicates that these morphologic features differ for CP and CL(P).