title: Unique facial features distinguish fetal alcohol syndrome patients and controls in diverse ethnic populations.
abstract: BACKGROUND
  Effective management of fetal alcohol spectrum disorders (FASD) is dependent on the timely and reliable diagnosis of affected individuals. There are significant diagnostic difficulties because of the reduced prominence of facial features as children age to adulthood as well as potential population or ethnic differences in the most characteristic alcohol-related facial features.
  
  
  METHODS
  A total of 276 subjects were recruited from 4 sites (Cape Town, South Africa; Helsinki, Finland; Buffalo, New York; and San Diego, California) and completed a detailed dysmorphology evaluation to classify subjects as either fetal alcohol syndrome (FAS; 43%) or control (57%). Computerized anthropometry was employed to identify facial features that could distinguish FAS patients from controls across a wide age range and across ethnically disparate study populations.
  
  
  RESULTS
  Subjects were placed into 1 of 4 populations based on their ancestry (Cape Coloured, Finnish Caucasian, African American, or North American Caucasian). Analyses performed in each of the 4 study populations were able to identify a unique set of variables which provided excellent discrimination between the 2 groups (FAS, control). In each study group, at least one ocular-related measurement, shortened palpebral fissure, reduced outer canthal width, or reduced inner canthal width, was included in the final classification model.
  
  
  CONCLUSIONS
  We found measurements that reflected reduced size of the eye orbit to be a consistent feature discriminating FAS and controls across each study population. However, each population had a unique, though often overlapping, set of variables which discriminated the 2 groups, suggesting important ethnic differences in the presentation of FAS. It is possible that these differences were accentuated by the wide age distribution of the study subjects.
authors.affiliation: St. Vincent Hospital, Indianapolis, Indiana, USA. esmoore@stvincent.org
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Moore
authors.forename: Richard E
authors.initials: RE
authors.lastname: Ward
authors.forename: Leah Flury
authors.initials: LF
authors.lastname: Wetherill
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Rogers
authors.forename: Ilona
authors.initials: I
authors.lastname: Autti-Rämö
authors.forename: Ase
authors.initials: A
authors.lastname: Fagerlund
authors.forename: Sandra W
authors.initials: SW
authors.lastname: Jacobson
authors.forename: Luther K
authors.initials: LK
authors.lastname: Robinson
authors.forename: H Eugene
authors.initials: HE
authors.lastname: Hoyme
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Mattson
authors.forename: Tatiana
authors.initials: T
authors.lastname: Foroud
mesh_terms: D000293:Adolescent; D001741:Black or African American; D000886:Anthropometry / Q000379:methods; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005123:Eye / Q000473:pathology*; D019066:Facies; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis* / Q000208:ethnology* / Q000473:pathology; D005387:Finland; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D011247:Pregnancy; D013019:South Africa; D014481:United States; D044465:White People