Birthe Lykke Thomsen

Whole body bone mineral content in healthy children and adolescents

Data from healthy children are needed to evaluate bone mineralisation during childhood. Whole body bone mineral content (BMC) and bone area were examined by dual energy x ray absorptiometry (Hologic 1000/W) in healthy girls (n=201) and boys (n=142) aged 5–19 years. Centile curves for bone area for age, BMC for age, bone area for height, and BMC for bone area were constructed using the LMS method. Bone mineral density calculated as BMC/bone area is not useful in children as it is significantly influenced by bone size. Instead, it is proposed that bone mineralisation is assessed in three steps: height for age, bone area for height, and BMC for bone area. These three steps correspond to three different causes of reduced bone mass: short bones, narrow bones, and light bones.

The Copenhagen cohort study on infant nutrition and growth: duration of breast feeding and influencing factors

Michaelsen KF, Larsen PS, Thomsen BL, Samuelson G. The Copenhagen cohort study on infant nutrition and growth: duration of breast feeding and influencing factors. Acta Pædiatr 1994;83:565–71. Stockholm. ISSN 0803–5253

Whole body bone mineral accretion in healthy children and adolescents

Data on accretion in bone size and bone mineral content (BMC) are needed to evaluate bone mineralisation during childhood. Whole body bone mineral content (BMC) and bone area (BA) were determined by dual energy x ray absorptiometry (Hologic 1000/W) with a one year interval in healthy girls (n = 192) and boys (n = 140) aged 6–19 years. Annual accretion in BMC (ΔBMC (g/year)) and BA (ΔBA (cm2/year)) according to sex and pubertal stages were calculated. ΔBA and ΔBMC were highly significantly associated with pubertal stages in girls and boys. Centile curves for ΔBA and ΔBMC according to sex and age were constructed using the LMS method. Peak ΔBA and ΔBMC values were reached earlier in girls (12.3 and 12.5 years, respectively) than in boys (13.4 and 14.2 years, respectively). The ΔBA peak was dissociated in time from the ΔBMC peak, indicating that increase in bone size occurs before increase in bone mineral content. Assuming that 32.2% of BMC consist of calcium, the median (90th centile) annual bone calcium accretion in pubertal stage III was 220 mg/day (302) and 317 mg/day (386) for girls and boys, respectively. To obtain an average bone calcium accretion, a high calcium absorption is needed during puberty. This may have implications for dietary calcium requirements at this time.

Psychoeducational intervention for patients with cutaneous malignant melanoma: a replication study.

PURPOSE In 1993, a randomized intervention study among patients with malignant melanoma showed a significant decrease in psychological distress and increased coping capacity 6 months after the intervention and enhanced survival 6 years later. We applied a similar intervention with a few modifications in a randomized controlled trial among Danish patients with malignant melanoma and evaluated results on immediate and long-term effects on psychological distress and coping capacity. PATIENTS AND METHODS A total of 262 patients with primary cutaneous malignant melanoma were randomly assigned to the control or intervention group. Patients in the intervention group were offered six weekly sessions of 2 hours of psychoeducation, consisting of health education, enhancement of problem-solving skills, stress management, and psychological support. The participants were assessed at baseline before random assignment and 6 and 12 months after surgery. The analyses of the main effects of the intervention were based on analyses of covariance. RESULTS The patients in the intervention group showed significantly less fatigue, greater vigor, and lower total mood disturbance compared with the controls, and they used significantly more active-behavioral and active-cognitive coping than the patients in the control group. The improvements were only significant at first follow-up. CONCLUSION The findings of this study support the results of an earlier intervention study among patients with malignant melanoma and indicate that a psychoeducational group intervention for such patients can decrease psychological distress and enhance effective coping. However, this effect is short term and the clinical relevance is not obvious.

Hormone replacement therapy in relation to breast carcinoma incidence rate ratios: A prospective danish cohort study

The goal of the current study was to investigate the relation between hormone replacement therapy (HRT) and breast carcinoma in a prospective study cohort. Particular attention was paid to the type of HRT used and to the association of HRT type with estrogen receptor status and tumor histology.

Influence of breastfeeding and complementary food on growth between 5 and 10 months

The aim of this study was to examine the nature of the association between breastfeeding, complementary feeding and growth in a random sample of infants from Denmark, where the prevalence of breastfeeding is high. A semiquantitative food frequency questionnaire and a questionnaire on breastfeeding duration and on weight and length measurements taken at the infant welfare visit at 5 and 10 months were sent to 590 families with 10‐month‐old infants. A total of 339 infants with complete growth data were included in the analyses. When controlling for mid‐parental height and birth weight infants breastfed for ≥ 7 months gained 198 g less in weight (p < 0:01) and 7 mm less in length (p < 0:01) during the period from 5 to 10 months than infants breastfed for < 7 months. Controlling for these effects, the 10% of the sample with the highest protein intake (i.e. ≥16 energy percentage) gained 262g more than those with a lower protein intake (p= 0:03). Infants breastfed for ≥ 7 months received significantly less cows milk (p < 0:01), and fewer meat‐containing dishes (p < 0:05) and sweets or cakes (p < 0:01), which may partly explain the effect of breastfeeding. The long‐term consequences of this moderate difference in growth velocity are unknown and the findings should not be used to advocate against breastfeeding during late infancy.

Birthweight‐for‐gestational age charts based on early ultrasound estimation of gestational age

Summary. Birthweight‐for‐gestational age charts were based on the analysis of 3888 consecutive births in which the gestational age was estimated by measuring the fetal biparietal diameter before the 20th week of gestation. The data showed, in contrast to previous studies, a linear relation between gestational age and birthweight without inflection after term. The regression parameters showed a strongly significant difference between girls and boys. Thus, boys were 1·5% heavier than girls at 190 days gestation and 3·6% heavier at 300 days gestation. The linearity in the birthweight‐for‐gestational age charts could be due to the more reliable gestational age based on early ultrasound.

Growth retardation in preterm infants

Summary. This paper combines earlier results on the relation between birthweight and gestational age, and the relation between fetal weight and ultrasound measurements of the fetal biparietal diameter (BPD) and mean abdominal diameter (AD) to investigate whether preterm infants (viewed as a group) are smaller than unborn fetuses of the same gestational age. The birthweight distribution for each sex at 223 and 258 days gestation was derived from the birthweight‐for‐gestational age charts based on 3888 newborn infants. The sex‐specific intrauterine weight distribution was estimated from ultrasound measurement of the fetal BPD and AD performed on randomly selected fetuses of gestational age 223 and 258 days. The birthweights were lower than the intrauterine weights, especially early in pregnancy and for female infants. Thus, the 10th birthweight centile for girls at day 223 corresponds to the 4th centile of the‘true’ intrauterine weight, and the‘true’ intrauterine 10th centile corresponds to the 25th centile birthweight at day 223.

Alcohol intake, drinking patterns and risk of postmenopausal breast cancer in Denmark: a prospective cohort study

Objective: The available epidemiological evidence indicates that drinking alcohol per se is associated with breast cancer. However, it has not been investigated how the breast cancer risk for a given total alcohol consumption depends on the drinking frequency. Methods: Within the prospective study on ‘Diet, Cancer and Health’, we examined the relationship between breast cancer, intake of total alcohol and frequency of drinking among 23,778 postmenopausal women, among whom 425 cases of breast cancer accrued during a median follow-up of 4.8 years. Results: The dose–response relationship between total alcohol intake and breast cancer showed an increase in the rate ratio of 1.10 per 10 g/day (95% CI: 1.04–1.16) with no evidence for differences by type of alcohol beverage. No interaction was found between drinking frequency and total alcohol intake in the risk of breast cancer (p = 0.40). Conclusions: The present study supports previous ones in showing a monotonic increase in the risk of breast cancer among postmenopausal women with increasing average daily intake of alcohol, and this relationship with alcohol intake did not depend on drinking frequency.

Urinary Hydroxyestrogens and Breast Cancer Risk among Postmenopausal Women: A Prospective Study

Background: It has been suggested that a low level of the 2-hydroxyestrogen metabolites (2-OHE) and a high level of 16α-hydroxyestrone (16α-OHE1) are associated with an enhanced risk of breast cancer. We examined the association between the metabolite levels and breast cancer in a nested case-control study, which also addressed hormone replacement therapy (HRT) and estrogen receptor status of the tumors. Methods: 24,697 postmenopausal Danish women were enrolled in the “Diet, Cancer and Health” cohort. During follow-up, 426 breast cancer cases were identified and controls were matched by age at diagnosis, baseline age, and HRT use. The concentrations of 2-OHE and 16α-OHE1 in spot urine were measured by an enzyme immunoassay. Incidence rate ratios (IRR) and 95% confidence intervals (95% CI) were estimated for total and estrogen receptor–specific breast cancer and were stratified according to HRT use. Results: A higher incidence of estrogen receptor–positive breast cancer with an enhanced 2-OHE level was observed among current HRT users, IRR per doubling = 1.30 (95% CI, 1.02-1.66), whereas no association was seen among nonusers of HRT, IRR per doubling = 1.00 (95% CI, 0.69-1.45). The association between estrogen receptor–positive breast cancer and the 16α-OHE1 metabolite level was in the opposite direction but slightly weaker and statistically insignificant. For estrogen receptor–negative breast cancer, no significant associations were seen. Conclusions: The risk of breast cancer, in particular the estrogen receptor–positive type, was enhanced among postmenopausal women using estradiol-based HRT and among those who had a high 2-OHE concentration.