Characteristics of Factors Influencing the Occurrence of Cleft Lip and/or Palate: A Case Analysis and Literature Review.

INTRODUCTION: Cleft lip with or without cleft palate (CL/P) stands as the most common congenital facial anomaly, stemming from multifactorial causes. OBJECTIVE: Our study aimed to ascertain the prevalence and characteristics of cleft palates, identify associated risk factors to inform prevention and prenatal detection for early intervention, and assess postoperative rehabilitation protocols for cleft palates. DESIGN: This study employs a retrospective descriptive and clinical approach. PATIENTS: The study includes 103 children with cleft palates treated at the Department of Head and Neck Surgery Clinic for Children and Young Adults, Department of Clinical Pediatrics, University of Warmia and Mazury. METHODS: We conducted a thorough evaluation of records, considering variables such as sex, cleft type, maternal occupation, parental education, and family history of clefts. Data analysis was carried out using R software version GPL-3 and ordinal logistic regression analyses. RESULTS: Notably, children born to mothers who experienced significant stress during pregnancy exhibited a 9.4-fold increase in the odds of having bilateral cleft palates. Conversely, no substantial evidence was found to support the influence of the child's sex, birth order, body mass, maternal exposure to workplace toxins, infections, or drug toxicity on the dependent variable. CONCLUSIONS: Our findings suggest that children with parents who have a history of clefts and those with less educated mothers are more likely to develop bilateral cleft palates. Additionally, children born to mothers experiencing stress during pregnancy face an increased risk of bilateral cleft palates. It is important to note that there is a paucity of literature on rehabilitation following various cleft palate surgical techniques in children.

SMART System in the Assessment of Exercise Tolerance in Adults.

Health-oriented physical activity should meet two key criteria: safety and an optimal level of exercise. The system of monitoring and rationalization of training (SMART) was designed to meet them. SMART integrates a custom-configured inertial measurement unit (IMU) and a sensor with real-time heart rate measurement (HR) using a proprietary computer application. SMART was used to evaluate the safety and exercise load with 115 study participants: 51 women (44.35%) and 64 men (55.65%) aged 19 to 65 years. The exercise test was the 6MWT test. In 35% of the participants, the mean HR exceeded the recognized safe limit of HR 75% max. Ongoing monitoring of HR allows for optimal exercise and its safety. Step count data were collected from the SMART system. The average step length was calculated by dividing the distance by the number of steps. The aim of the present study was to assess the risk of excessive cardiovascular stress during the 6MWT test using the SMART system.

Planning of physiotherapeutic procedure in patients after mandible reconstruction taking into account donor site: a literature review.

BACKGROUND: Mandible tumors are very rare. One of the main methods of the treatments is resection of the tumor and then reconstruction of the mandible. The donor site is often distant tissue-fibula or ilium. Following this, it is necessary to improve the patient in two ways, on one hand restoring the function of the mandible, and on the other hand, improving the donor site area. For that reason, physiotherapy after tumor resection and reconstruction of the mandible is very complicated. The aim of this bibliographic review was to find the methods of the reconstruction of the mandible in the context of patients' functional assessment after surgeries to create effective physiotherapeutic procedures in the feature. METHODS: PEDro, Medline (PubMed), Cochrane Clinical Trials were searched. RESULTS: 767 articles were found. 40 articles were included to this literature review. CONCLUSIONS: Authors showed different kinds of surgeries strategy for patients with tumors of the mandible. They also showed manners of patients' functional assessment in the localization of transplantation and donor site. It could be useful for physiotherapists during planning of comprehensive physiotherapy.

The long-lasting effect of early life family structure on social position, well-being, and biological condition in adulthood.

BACKGROUND: The absence of even one parent has short- and long-term effects on the child's current and future health. The purpose of the study was to determine whether there is a long-term relationship between the type of family in which men were raised and an individual's adult social position, well-being in adulthood and their biological condition regardless of social status in adulthood. MATERIALS AND METHODS: Data for 4528 males, aged 25-80 years, were selected from the archives of the Lower Silesian Medical Centre in Wroclaw, Poland. A total of 329 men declared that they grew up in incomplete families. Height, weight, % fat, cardiovascular and respiratory systems, blood parameters, and health of men who grew up in complete or incomplete families were compared. RESULTS: Growing up in an incomplete family reduced chances for better education, decreased life satisfaction in adulthood, and negatively affected the final height. After taking into account the education achieved, the effect persisted only for diastolic blood pressure, creatinine, and serum phosphorus levels. CONCLUSIONS: Growing up in an incomplete family has a significant impact on male's socioeconomic position (SES), life satisfaction, and final height. A poorer quality of diet is proposed as an early life risk factor for adult health.

Scoliotic posture and biological age measured by pubertal growth spurt in adolescent boys and girls.

Puberty is a critical period in the development of children and adolescents. The muscular dystonia observed during this period and the environmental factors present at home and school promote the adoption of abnormal posture and impaired physical performance. Early detection of postural changes provides opportunities for prevention and treatment. The aim of this study was to compare the body posture and the size of the rotational deformation of the trunk in children aged 10-15 years, before and after pubertal growth spurt. The study included 40 subjects, 19 boys and 21 girls from Wroclaw, Poland, aged 10.3-15.6 years, who reported for the first time to the Postural Defects Outpatient Clinic with suspected rotational deformity of the trunk. Based on the equations, maturity offset (MO) was determined and the age of peak height velocity (APHV) was assessed. The posture was evaluated using a deflection of the plumb line, scapular asymmetry, finger-to-floor test, angle of trunk rotation ATR at 3 spinal levels: proximal thoracic, main thoracic, and lumbar and the Three Rotation Sum (TRS) parameter. These parameters are the earliest clinical signs of scoliosis. In the examined children and adolescents from Wroclaw, irrespective of their calendar age, after the APHV, the characteristics describing lateral curvatures of the spine showed higher values, reaching especially for maximal ATR and for the TRS a highly statistically significant level. Post-pubertal children were also more often characterized by the so-called scoliotic posture - they had a significantly greater trunk deviation measured with the plumb line lowered from C7 (0.3 cm versus 0.9 cm; p = 0.01), a greater difference in the height of lower scapular anles, and a worse score on the finger-to-floor test. In conclusion, scoliometer testing should be permanently incorporated into periodic body measurements at school, especially among 10- to 12-year-old children who are at higher risk for scoliosis progression. Equations for assessing biological age, although associated with an error, appear to be easy to use and useful in screening for risk of developing scoliosis at peri-pubertal age.

Children with Rare Nager Syndrome-Literature Review, Clinical and Physiotherapeutic Management.

Nager syndrome is a rare human developmental disorder characterized by craniofacial defects including the downward slanting of the palpebral fissures, cleft palate, limb deformities, mandibular hypoplasia, hypoplasia or absence of thumbs, microretrognathia, and ankylosis of the temporomandibular joint. The prevalence is very rare and the literature describes only about a hundred cases of Nager syndrome. There is evidence of autosomal dominant and autosomal recessive inheritance for Nager syndrome, suggesting genetic heterogeneity. The majority of the described causes of Nager syndrome include pathogenic variants in the SF3B4 gene, which encodes a component of the spliceosome; therefore, the syndrome belongs to the spliceosomopathy group of diseases. The diagnosis is made on the basis of physical and radiological examination and detection of mutations in the SF3B4 gene. Due to the diversity of defects associated with Nager syndrome, patients require multidisciplinary, complex, and long-lasting treatment. Usually, it starts from birth until the age of twenty years. The surgical procedures vary over a patient's lifetime and are related to the needed function. First, breathing and feeding must be facilitated; then, oral and facial clefts should be addressed, followed by correcting eyelid deformities and cheekbone reconstruction. In later age, a surgery of the nose and external ear is performed. Speech and hearing disorders require specialized logopedic treatment. A defect of the thumb is treated by transplanting a tendon and muscle or transferring the position of the index finger. In addition to surgery, in order to maximize a patient's benefit and to reduce functional insufficiency, complementary treatments such as rehabilitation and physiotherapy are recommended. In our study, we describe eight patients of different ages with various cases of Nager syndrome. The aim of our work was to present the actual genetic knowledge on this disease and its treatment procedures.

How Stress Is Related to Age, Education, Physical Activity, Body Mass Index, and Body Fat Percentage in Adult Polish Men?

Stressful events and chronic tension are considered a burden and a threat to physical, mental, and social health. The aim of the study was to demonstrate the associations of variation in stress exposure with social factors, physical activity, basic components of physical fitness, body mass index (BMI) and percentage of body fat (BFP). An additional objective was to identify the main BFP modifiers among those analyzed. The material consisted of data of ethnically homogeneous group 355 men (32-87 yrs), invited to the study as part of the Wroclaw Male Study research project. The analyzed features included socioeconomic status (age, educational level), elements of lifestyle (physical activity), major and most important stressful life events-Social Readjustment Rating Scale (SRRS) and basic parameters of the somatic structure of the body (BMI, BFP). Statistical analyses included: chi-square test, Mann-Whitney U test and backward stepwise regression (significance level α = 0.05). Stress exposure showed significant socioeconomic variation among the adult Poles studied. Higher levels of education were associated with higher levels of stress. Significant correlations between SRRS and physical activity were found, especially in men older than 60 years and with higher levels of education. A positive relationship was shown between SRRS and BFP, especially in men under 60 years of age. BFP appeared to depend mainly on age and stress. The main determinants of SRRS were age and education level, while BFP turned out to be more sensitive to stress than BMI. The modifying force of physical activity for SRRS appears to be age dependent.

Tilt and mobility of the hip girdle in the sagittal and frontal planes in healthy subjects aged 19-30 years.

BACKGROUND: Disturbances in pelvic girdle tilt can cause compensatory changes affecting postural dysfunctions, and can lead to hip and groin strain changes and back pain. However, we still have no clear information on the normative values of pelvic girdle tilt and mobility. OBJECTIVE: The study aimed to (1) evaluate the position and mobility of the pelvic girdle in the sagittal and frontal planes in asymptomatic adults aged 19-30, (2) evaluate the possible variation of results according to gender and to develop a proposal for normative values, and (3) evaluate whether body mass, height and BMI are related to the magnitude of hip girdle position and mobility. METHODS: The research was conducted in a sample group consisting of 346 men and women using the scaled form of the anthropometric level of the Duometr® The values of position and mobility of the pelvic girdle in the sagittal and frontal planes were analyzed. RESULTS: Differences were noted in the values of the pelvic tilt (p= 0.033) between the men and women. The women showed slightly higher values of posterior range of motion (p= 0.0002) and total range of motion (p= 0.002). The other parameters did not show any significant variation. There was no clear association between body weight, height and BMI and the study variables, except for a small, significant correlation between BMI and posterior pelvic tilt in women (r= 0.175, p= 0.005). In the frontal plane there were no differences in the analyzed variables in terms of gender or side of the body measured. CONCLUSIONS: There was no association between the anthropometric variables and the pelvic girdle tilt and mobility. No size variation by gender was observed in the frontal plane. Slight differences were observed in the sagittal plane. Normative values are proposed.

Age, Education, and Stress Affect Ageing Males' Symptoms More than Lifestyle Does: The Wroclaw Male Study.

An increasing number of subjects are affected by health problems related to the advanced involutional processes. It is extremely important to identify the determinants of the rate of occurrence of physiological, psychological, and social manifestations of aging. The aim was to determine how factors such as lifestyle, level of education, or severity of stressful life events indicate the appearance of aging symptoms in adult men. The material consisted of data of ethnically homogeneous group of 355 men (32−87 years), invited to the study as a part of the Wroclaw Male Study research project. The analyzed features included (1) socioeconomic status: age, educational level, marital status, and having children; (2) elements of lifestyle: alcohol drinking, cigarette smoking, and physical activity; (3) major and most important stressful life events­the Social Readjustment Rating Scale; (4) symptoms related to male aging­the Aging Males' Symptoms. The backward stepwise regression models, the Kruskal−Wallis test, and multiple comparisons of mean ranks were used. Noncentrality parameter δ (delta), two-tailed critical values of the test, and test power with α = 0.05 were calculated. Among the analyzed variables, age was most strongly associated with the intensity of almost all groups of andropausal symptoms in men (p = 0.0001), followed by the level of education (p = 0.0001) and the intensity of stressful life events (p = 0.0108). Selected lifestyle elements turned out to be much less important (p > 0.01). Preventive actions aimed at slowing down the intensification of involutional processes, including teaching strategies for coping with stressful life events, should be implemented in groups of men with specific risk factors from an early age.

Physiotherapeutic methods of treatment of mandibular distal occlusion and the progress of therapy: A case report.

BACKGROUND: Studies have demonstrated a relationship between dental malocclusion and posture defects. The aims of the study were to present (1) the effect of a physiotherapeutic approach to a patient with a distal occlusion defect with the use of a set of exercises to strengthen the muscles responsible for mandibular protrusion, and (2) a non-invasive and easy-to-use method to monitor the effects of therapy. METHODS: Five year old girl with a distal occlusion and with a low basic postural tone was referred to physiotherapy. A therapeutic program i.a. concerning a strengthening of the temporomandibular joint muscles with the use of a flexible tape was proposed. To assess the functional changes of the masticatory apparatus a photoanthropometric method was used. In side-face photos, proportions of 2 linear measurements and values of two angles on the first day of therapy, after 2 and after 4 months of exercises, with the mandible located freely and in the maximum protrusion were compared. RESULTS: A comparison of indices and angles showed a marked improvement in mandibular mobility already after two and four months of the exercises. Using the elastic resistance tape in addition to general developmental exercises allowed for increasing the mobility in the temporomandibular joint. CONCLUSION: Malocclusion should not be considered separately, without taking into account the body posture. The work of the physiotherapist can benefit the orthodontist, correcting postural defects and consequently affecting malocclusion. A comparison of linear measurements and angles can be used to assess the progress of the therapy.

Protocol for Multi-Stage Treatment of Temporomandibular Joint Ankylosis in Children and Adolescents.

Treatment of temporomandibular ankylosis is challenging and frequently leads to re-ankylosis, relapse, dangerous complications and, in turn, the need for multiple operations. In this article, we present a protocol for the treatment of ankylosis of the temporomandibular joints that assumes earlier intervention with the assistance of 3D virtual surgical planning (3DVSP) and custom biomaterials for better and safer surgical outcomes. Thirty-three patients were treated due to either uni- or bilateral temporomandibular ankylosis. Twenty individuals received temporomandibular prosthesis, whereas seventeen required simultaneous 3D virtual surgical/planned orthognathic surgery as the final correction of the malocclusion. All patients exhibited statistically significant improvements in mouth opening (from 1.21 ± 0.74 cm to 3.77 ± 0.46 cm) and increased physiological functioning of the mandible. Gap arthroplasty and aggressive rehabilitation prior to temporomandibular prosthesis (TMJP) placement were preferred over costochondral autografts. The use of 3DVSP and custom biomaterials enables more precise, efficient and safe procedures to be performed in the paediatric and adolescent population requiring treatment for temporomandibular ankylosis.

Vocal Indicators of Size, Shape and Body Composition in Polish Men.

OBJECTIVES: From a human evolution perspective, identifying a link between physique and vocal quality could demonstrate dual signaling in terms of the health and biological condition of an individual. In this regard, this study investigates the relationship between men's body size, shape, and composition, and their vocal characteristics. MATERIALS AND METHODS: Eleven anthropometric measurements, using seven indices, were carried out with 80 adult Polish male participants, while the speech analysis adopted a voice recording procedure that involved phonetically recording vowels /ɑː/, /ɛː/, /iː/, /ɔː/, /uː/ to define the voice acoustic components used in Praat software. RESULTS: The relationship between voice parameters and body size/shape/composition was found. The analysis indicated that the formants and their derivatives were useful parameters for prediction of height, weight, neck, shoulder, waist, and hip circumferences. Fundamental frequency (F0) was negatively correlated with neck circumference at Adam's apple level and body height. Moreover neck circumference and F0 association was observed for the first time in this paper. The association between waist circumference and formant component showed a net effect. In addition, the formant parameters showed significant correlations with body shape, indicating a lower vocal timbre in men with a larger relative waist circumference. DISCUSSION: Men with lower vocal pitch had wider necks, probably a result of larynx size. Furthermore, a greater waist circumference, presumably resulting from abdominal fat distribution in men, correlated with a lower vocal timbre. While these results are inconclusive, they highlight new directions for further research.

Efficacy of immediate physiotherapy after surgical release of zygomatico-coronoid ankylosis in a young child: A case report.

BACKGROUND: Temporomandibular joint ankylosis (TMJ ankylosis) manifests itself as a locked jaw and reduced mouth opening. We hypothesized that the efficacy of TMJ ankylosis surgery in a child may largely depend on physiotherapeutic management. CASE DESCRIPTION: In this case report, we present the treatment of a girl between 1 and 4 years of age, who was unable to open her jaws immediately after birth. Congenital ankylosis was diagnosed. INTERVENTION: Two models of therapeutic management were presented, with a surgical procedure to release bone fusion adopted as a starting point. In the first model, the rehabilitation procedure started 21 days after surgery. OUTCOMES: Despite rehabilitation, no clinical improvement was achieved (i.e. the child was still unable to open her jaws). In the second model, rehabilitation started from the day after surgery and management according to the second model allowed for obtaining therapeutic benefits. After therapy, the girl was able to abduct the mandible to a degree allowing for improved speech and the ability to crush food. CONCLUSIONS: This clinical case shows that the efficacy of surgical procedures may depend on the type of postoperative management. It was demonstrated that physiotherapy started immediately after the procedure to release the ankylosis improved the mandible mobility outcomes for this child.

Differential diagnosis of a calcified cyst found in an 18th century female burial site at St. Nicholas Church cemetery (Libkovice, Czechia).

During archaeological excavations in burial sites, sometimes stoned organic objects are found, in addition to human remains. Those objects might be of a different origin, depending on various factors influencing members of a community (i.e. diseases, trauma), which provides information about their living conditions. The St. Nicholas Church archaeological site (Libkovice, Czechia) in the 18th century horizon of the cemetery, yielded a maturus-senilis female skeleton with a stone object in the left iliac fossa. This object was an oviform cyst-like rough structure, measuring 54 mm in length, 35 mm in maximum diameter and 0.2-0.7 mm shell thickness. Within the object there were small fetal bones (long bones, i.e. femur and two tibias, two scapulas, three ribs, vertebrae and other tiny bone fragments). Methods utilized to analyze the outer and inner surface morphology of the cyst and its inside, included: X-ray, CT imaging, SEM, histological staining and EDS. The EDS analysis revealed the presence of primarily oxygen, calcium and phosphorus in bone samples, and oxygen and silicon, in stone shell. Based on the length of the femur (20.2 mm) and tibia (16 mm) shafts, the fetal age was determined as being in the 15-18 week of pregnancy. The differential diagnosis was conducted, including for the three most probable cases: fetiform teratoma (FT), fetus-in-fetu (FIF) and lithopedion. The possibility of fetiform teratoma was discounted due to the presence of an anatomically correct spine, long bones and the proportions of the find. Although the low calcium content in the shell (2.3% atom mass), the lack of skull bones and the better developed lower limbs indicate fetus-in-fetu rather than lithopedion, the analyses results are unable to conclusively identify the object under one of these two categories since there are insufficient such cases in excavation material with which to draw comparison.

Adolescent age estimation using voice features.

In this paper, a method for evaluating the chronological age of adolescents on the basis of their voice signal is presented. For every examined child, the vowels a, e, i, o and u were recorded in extended phonation. Sixty voice parameters were extracted from each recording. Voice recordings were supplemented with height measurement in order to check if it could improve the accuracy of the proposed solution. Predictor selection was performed using the LASSO (least absolute shrinkage and selection operator) algorithm. For age estimation, the random forest (RF) for regression method was employed and it was tested using a 10-fold cross-validation. The lowest absolute error (0.37 year ± 0.28) was obtained for boys only when all selected features were included into prediction. In all cases, the achieved accuracy was higher for boys than for girls, which results from the fact that the change of voice with age is larger for men than for women. The achieved results suggest that the presented approach can be employed for accurate age estimation during rapid development in children.

Prediction of menarcheal status of girls using voice features.

A method for evaluating the menarcheal status of girls on the basis of their voice features is presented in the paper. The registration procedure consists of voice recording and measuring 20 anthropological features. The input feature vector is a combination of voice and anthropometric parameters, counting 220 features. The optimal set of parameters was selected using five different methods: Method A - stepwise regression (first forward, then backward regression) performed on features with statistically different means/medians; Method B - stepwise regression (forward and backward) on all features, with age; Method C - stepwise regression as in B; including age, Method D - all features with statistically different means/medians, Method E - all features excluding age. For classification purposes three methods were employed: random forest (RF), support vector machine (SVM) and linear discriminant analysis (LDA) classifier. They were tested with 10-fold cross validation. The classification accuracy for RF using only voice features is higher than using only anthropometric data: 86.86% vs. 81.02% respectively. For the other two classifiers, the results do not show as large a difference: 80.60% vs. 82.80% for SVM and 80.66% vs. 82.34% for LDA. The advantage of voice features is more noticeable with sensitivity: 91.92% vs. 83.06% for RF. The obtained results suggest that the presented method can be used for automatic recognition of girls' menarcheal status using voice signal.

The relationship between: occupational status, biological condition and androgen hormone level among Polish adult men: the Wroclaw Male Study.

Population health and its determinants are one of the major challenges to social and economic policy. The aim of this study was to investigate the relationship between occupational activity and biological condition in adult working Polish men. The participants of the study were 300 men (30-65 years), healthy inhabitants of the city of Wroclaw, Poland. Seventeen measures of biological condition were examined. The subjects were divided into three different occupational groups: professionals, soldiers and skilled workers. A comparison of biological age profiles of three occupational groups showed that in the majority of characteristics, professionals had the youngest biological age, whereas skilled workers had the highest biological age. The results for soldiers were not as unambiguous, but biological parameters were generally closer to those for professionals. Inborn biological predispositions and long-term impact of the working environment can influence on the biological condition of various professional groups. Knowledge of the determinants of biological condition might result in efficient use of predisposition to work or may be of help in extending their time of work ability.

Growth, Nutritional Status, and Pulmonary Function in Children with Chronic Recurrent Bronchitis.

Bronchitis is a common health problem in children. Frequent bronchitis in infancy increases the risk of developing chronic respiratory diseases. The aim of the study was to assess the level of growth and the nutritional status in children and youths with special regard to the level of body fatness assessed by measuring skin-fold thickness. Relationships between somatic development, pulmonary function and the course of the disease were also explored. The study was carried out using anthropometric and spirometric measurements and also information on the severity and course of the disease in 141 children with chronic or recurrent bronchitis. All of the subjects were patients of the Pulmonary Medicine and Allergology Center in Karpacz, Poland. The mean body height did not differ significantly between the children examined and their healthy peers. However, the infection-prone children had excessive body fatness and muscle mass deficiency. The increased level of subcutaneous adipose tissue occurred especially in children with short duration of the disease, i.e. a maximum of 1 year. The functional lung parameters were generally normal. The presence of atopic diseases such as allergic rhinitis or atopic dermatitis did not impair the course of the children's somatic development. Also, long-term disease or the presence of additional allergic diseases did not impair lung function in the examined children. Taking appropriate preventive measures is recommended to achieve and maintain normal body weight in children who receive therapy due to bronchitis.

Biological costs of economic transition: Stress levels during the transition from communism to capitalism in Poland.

At the end of the 1980s, Poland began the transformation from an essentially one-party communist system to a politically pluralistic democratic system. These political and economic changes had major social consequences, among others unemployment and a sharp decrease in real personal income. The aim of the study was to investigate the possible relationship between stress in adult men, measured by the Allostatic Load, and the socio-economic deterioration during the first part of the economic transition. The Allostatic Load included eleven markers assessing adverse nutritional intake, cardiovascular activity, inflammatory processes, and lung, hepatic and renal functions. The results indicate a significantly higher risk of metabolic dysregulation in men examined after 1990, compared to men from previous years. After adjustment for socioeconomic variables and lifestyle variables, men examined in 1991 had a 31% greater risk of higher Allostatic Load compared with men examined in 1985 (OR=1.31; p=0.0541), in 1992, this risk was 50% greater (OR=1.50; p<0.01), and in 1993, the risk was 66% greater (OR=1.66; p<0.05). The conclusion is drawn that significantly more stressogenic factors for men were those directly connected with the financial situation of their families, than a sudden but short increase of prices for goods and services.

Evaluation of factors related to bone disease in Polish children and adolescents with cystic fibrosis.

PURPOSE: The aim of the study was to evaluate factors related to bone formation and resorption in Polish children and adolescents with cystic fibrosis and to examine the effect of nutritional status, biochemical parameters and clinical status on bone mineral density. MATERIALS AND METHODS: The study group consisted of 100 children and adolescents with cystic fibrosis with a mean age 13.4 years old. Anthropometric measurements, included body height, body mass and body mass index (BMI); bone mineral densitometry and biochemical testing were performed. Bone mineral density was measured using a dual-energy X-ray absorption densitometer. Biochemical tests included serum calcium, phosphorus, parathyroid hormone and vitamin D concentrations, as well as 24-h urine calcium and phosphorus excretion. Pulmonary function was evaluated using FEV1%, and clinical status was estimated using the Shwachman-Kulczycki score. RESULTS: Standardized body height, body mass and BMI were significantly lower than in the reference population. Mean serum vitamin D concentration was decreased. Pulmonary disease was generally mild, with a mean FEV1% of 81%. Multivariate linear regression revealed that the only factors that had a significant effect on bone marrow density were BMI and FEV1%. There were no significant correlations between bone mineral density and the results of any of the biochemical tests performed. CONCLUSIONS: Nutritional status and bone mineral density were significantly decreased in children and adolescents with cystic fibrosis. In spite of abnormalities in biochemical testing, the factors that were found to have the strongest effect on bone mineral density were standardized BMI and clinical status.