Linear growth retardation is the most dominant nutritional problem globally. We aimed to describe linear growth trajectory among infants under 2 years of age using the WHO growth velocity standards.This was a prospective cohort study of infants enrolled at 6 weeks of age and followed up for up to 24 months in Kamwala Urban Health Centre, Lusaka, Zambia. The study was conducted between April 2013 and March 2015. Infants were enrolled if they were 6–12 weeks of age and the mother was willing to participate voluntarily and provided informed consent. Anthropometric data were collected at scheduled clinic visits at 1 month, 2 months, 3 months, then quarterly until the infant was 24 months old. We defined linear growth velocity as the rate of change in height. We estimated linear growth velocity as the first derivative of the penalized cubic spline mixed effects model.A total of 338 children were included in the analysis. Of these, 185 (54.7%) were female, 115 (34.1%) were born to HIV positive mothers and thus classified as HIV Exposed (HE). The mean age of children at enrollment was 1.6 months (SD = 0.15). On average, the growth velocity for 3-month length increments conditional on age were 0–3 months = 2.97 cm/3mo ; 3–6 months = 2.62 cm/3mo ; 6–9 months = 1.57 cm/3mo ; 9–12 months = 1.18 cm/3mo ; 12–15 month = 1.14 cm/3mo ; 15–18 months = 0.87 cm/3mo ; 18–21 months = 0.80 cm/3mo ; and 21–24 months = 0.86 cm/3mo . For both boys and girls, the growth velocity in our cohort were consistently below the 3rd percentile of the WHO linear growth velocity standard. The estimated mean height and the age at which growth begins to falter were 68.6 cm  and 13.6 months  respectively.We found slower rate of growth among otherwise healthy Zambian infants. The data suggests that growth retardation is universal and profound in this cohort and may have already been occurring in utero. Linear growth retardation is the most dominant nutritional problem globally, with approximately 22.2% or 151 million children under five reported to be stunted in 2017 . AttaineFor this reason, we argue in this study that the human growth dynamic is complex and requires robust and clinically relevant indicators to monitor an individual’s growth trajectory. Several authors including Tanner JM 1952; Guo et al. 1991; and Roche & Himes 1980, have suggested that growth velocity can identify growth problems earlier than would have been if using attained growth –6. They Despite this advantage however, very few studies have investigated infant growth using velocity measures. In this study, we aimed to describe the rate of growth among children under two years using the World Health Organization (WHO) growth velocity standards (WHO 2009) . We alsoThe study was undertaken at Kamwala Health Centre, a typical peri-urban clinic in Lusaka. The facility serves a large mixed population with a birth cohort more than 1400 deliveries each year. Within the premises of the clinic is the research facility, through which all under 5 clinic services were offered to the study participants. Recruitment was done while mothers come for the routine clinic visits; those with age eligible infants were invited to information sharing about the study. Motivated mothers were then invited to the research unit where informed consent was administered.This was a prospective cohort study of infants conducted between April 2013 and March 2015. Details of the design were described elsewhere . ChildreSummary statistics (mean and proportions) were used to describe participant’s baseline characteristics. This included infant age at first visit, gender, birthweight, mother’s age at infant birth, maternal HIV status at infant birth, and HAZ. We calculated HAZ for each baseline height measurement available for each child using the WHO child growth standards [WHO 2006] . StuntinK1, K2, … , Kk, and I(x > Kk) is an indicator function that has value 1 if the condition x > Kk is true and 0 otherwise. For fitting μk, we defined a variable that takes a value 1 to represent the whole sample as one super subject. In instances with readings that showed negative linear growth, we recoded as “no growth” by assigning the nominal value of + 0.01 to enable its inclusion in the statistical model.We calculated growth velocity using two approaches. First, for each child, we calculated empirical growth velocity as the difference between two successive length or height measurements divided by the corresponding age gap. Using these values, we calculated the average 3-monthly age-specific growth velocity and 95% confidence interval (CI). The actual ages at which measurements were made were at times delayed (or advanced) compared to the target ages based on scheduled visits. This resulted in some measurement intervals being either longer or shorter than 91 days for a 3-month interval. For this reason, we corrected the actual measurement age to target age using maximum tolerable difference . We adjuWe checked model adequacy using a plot of standardized residual against age. Having estimated the model, we obtained predicted height (based on both the fixed and random effects) for each child at each age. We then estimated the growth velocity as the numerical first derivative of the predicted height with respect to age. To describe the growth trajectory characteristics in terms of the peak height and age at which growth begins to decline, we identified for each child the age with the minimum absolute first derivative where the second derivative was negative. Infants who had less than three height measurements were excluded from the analysis due to the inability to calculate the rate of change of height over the duration of the study. The age and the height at that age were summarized to describe the trajectory characteristics. All analyses were performed using Stata 15 MP .A total of 338 children were included in the analysis. Of these, 185 (54.7%) were female, 115 (34.1%) were born to HIV positive mothers and thus classified as HIV Exposed, and 222 (65.9%) were classified as HIV Unexposed. The mean age of children at enrollment was 1.6 months (SD = 0.15). At enrolment, the prevalence of stunting was 58.6% and severe stunting was 35.8% ; 3–6 months = 2.62 cm/3mo ; 6–9 months = 1.57 cm/3mo ; 9–12 months = 1.18 cm/3mo ; 12–15 month = 1.14 cm/3mo ; 15–18 months = 0.87 cm/3mo ; 18–21 months = 0.80 cm/3mo ; and 21–24 months = 0.86 cm/3mo   in East Africa and a highest of 46.37% (95% CI 37.22 to 55.52) in West Africa .While exclusive breastfeeding seems like a logical low/no cost intervention, its practice in Zambia is rather low. In our earlier study, the prevalence of exclusive breast feeding in children up to 5 months ranged between 39 and 45% ; and theInadequate nutrition not only predispose to acute morbidity (particularly diarrhea and pneumonia), it causes deleterious effects to infant’s growth, eventual cognitive development and future livelihood –19. ThusIn our study, all mothers self-reported exclusive breast feeding, but it is likely that there could have been over reporting, especially given WHO global reports on Zambian that only 40% of infants less than six months of age are exclusively breastfed . We have12, D and folate) are lost together during diarrhea. Moreover, gastroenteritis often induces both vomiting and/or loss of appetite, and thus no replenishment is occurring during that period; therefore, it is logical to suggest that diarrhea deprives the child of both stored nutrition and food intake: material needed for growth [However, the practicality of avoiding exclusive breastfeeding remains challenging even in light of maternal HIV especially among low social economic status populations. Cost, adequacy, hygiene, water safety and ability to appropriately mix formula are well known challenges , 29. Indr growth , 34. OurWhile this study has showed a slower growth in our cohort, it had some limitations. First, it was not primarily designed as an anthropometric study; rather, the parent study was focused on understanding factors that influence rotavirus vaccine taken in healthy infants . Second,We found slower rate of growth among otherwise healthy Zambian infants. The data suggests that growth retardation is universal and profound in this cohort and may have already been occurring in utero. Growth retardation is a complex issue, which requires a robust and dynamic measures to detect early growth retardation among infants for improved and targeted care. Further research is needed to find best approaches to implement nutritional recommendations for the first 1000 days post-conception to prevent early growth faltering in Zambian infants.


Colorectal cancer (CRC) remains one of the most common types of cancer and a leading cause of death worldwide. Previous studies indicated that statins may have a potential protective effect on CRC.We conducted this meta‐analysis to systematically assess the overall and cancer‐specific survival benefit of statin uses on CRC patients. Related references were identified through PubMed, the Cochrane Library, Web of Science, EMBASE, and SCOPUS from inception to August 2017. Adjusted hazard ratios (HRs) were adopted to calculate summary hazard ratios (HRs) with 95% confidence intervals (95% CIs), using a random‐effects model.Total fourteen studies involving 130 994 patients were included in this meta‐analysis. Six studies reported the association between pre‐diagnosis statin uses and CRC mortality, while 11 studies investigated mortality in patients using statins after CRC diagnosis. For pre‐diagnosis statin uses, the pooled HR of all‐cause mortality (ACM) was 0.85  and the pooled HR of cancer‐specific mortality (CSM) was 0.82 . In terms of post‐diagnosis statin uses, the pooled HR of ACM was 0.86 , and the pooled HR of CSM was 0.79 . For post‐diagnosis statin uses, there is no difference in ACM when stratified by KRAS gene (KRAS) mutation status. Results of ACM and CSM did not markedly alter in other subgroup analyses.Our meta‐analysis demonstrates that both pre‐diagnosis and post‐diagnosis statin uses are associated with reduced ACM and CSM for CRC patients. It is estimated to have over 1.8 million new cases and cause 881 000 deaths in 2018.Statins, the inhibitors of 3‐hydroxy‐3‐methylglutaryl coenzyme‐A (HMG‐CoA) reductase, are cholesterol‐lowering agents most commonly prescribed worldwide. Besides their lipid‐lowering effects, various researches have revealed their unexpected preventive effects on tumor development and progression via HMG‐CoA reductase‐independent pathway and HMG‐CoA reductase‐dependent pathway.While many preclinical researches on cells and animals have indicated the positive effects of statins on CRC, such as increasing intracellular oxidative stress, inducing apoptosis and augmenting chemosensitivity,2http://www.crd.york.ac.uk/PROSPERO, CRD42017074280).This systematic review and meta‐analysis were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐analyses.2.1We identified related references through searches of PubMed, the Cochrane Library, Web of Science, EMBASE, and SCOPUS from inception to August 2017, using search strategies Table . All ref2.2The following criteria for eligibility among studies were set before selection of references: (a) the exposure of interest was statin uses before or after diagnosis of CRC, (b) case‐control or cohort studies, (c) outcomes of interest were all‐cause death or cancer‐specific death, (d) articles were published in English, (e) when several articles were published by the same authors or group, the newest or most informative article was selected. Exclusion criteria were the following: (a) no information on all‐cause or cancer‐specific survival, (b) letters to editor or commentary, reviews, (c) clinical studies reporting odds ratios (ORs) or risk ratios, or only univariate analyses. Two investigators extracted following data from the eligible articles independently: the name of first author, year of publication, origin of the study, follow‐up period, patient number, study design, patient characteristics, statin uses, risk estimates and corresponding 95% confidence intervals (95% CIs), and covariates adjusted for in the multivariable analysis. Discrepancies were resolved by consensus, involving a third investigator.2.3X2 and I2 statistics. A P value of <0.1 or I2 >50% were considered as substantial heterogeneity across studies. In addition, we conducted predetermined subgroup analyses based on tumor site, tumor stage, baseline therapy, and KRAS mutation status. A two‐tailed P value <0.05 was considered significantly. All statistical analyses were analyzed by Stata .The methodological quality of included observational studies was independently determined by the Newcastle‐Ottawa scale (NOS),33.1The detailed flow chart of study selection process was summarized in Figure 3.2Six studies reported the association between pre‐diagnosis statin use and mortality in CRC patients. One study3.3I2 = 5.7%, P = 0.346), indicating that pre‐diagnosis statin uses significantly lowered the risk of ACM  and Egger's tests (P = 0.494) (data not shown).For all‐cause mortality (ACM), the pooled HR was 0.85  0.80  with a minor heterogeneity , suggesting that pre‐diagnosis statin uses were associated with a 18% lower CSM  and Egger's tests (P = 0.293) (data not shown).In terms of CSM, the pooled HR was 0.82  with no heterogeneity   in patients with colon cancer. In other subgroups, the heterogeneity did not significantly change. No evidence of publication bias was observed in any analyses using Begg's (P = 0.251) and Egger's tests (P = 0.053) (data not shown).For ACM, the pooled HR was 0.86  with a considerable heterogeneity , suggesting that statin uses reduced the risk of CSM  in patients with colon cancer. In other subgroups, the heterogeneity did not significantly change. No evidence of publication bias was observed in any analyses using Begg's (P = 0.902) and Egger's tests (P = 0.794) (data not shown).In terms of CSM, the pooled HR of eight studies was 0.79  with a significant heterogeneity  after omitting 2015, Hoffmeister. In other subgroups, the heterogeneity did not significantly change (data not shown).Omitting single study in sensitivity analysis did not markedly alter the overall results of ACM and CSM with pre‐ and post‐diagnosis statin uses (data not shown). However, when calculating CSM with post‐diagnosis statin uses, the heterogeneity decreased , statin uses were associated with less polyp number, smaller polyp size, lower incidence rate of advanced APs.To our knowledge, there were four meta‐analysisThere are some limitations in our study. Firstly, heterogeneity does not markedly alter in subgroup analysis. Therefore, other potential sources of heterogeneity, such as using of nonsteroid anti‐inflammatory drugs, statin dose and duration, location of CRC, pathological differentiation, should be further analyzed if data are available. Secondly, owing to the relatively small sample size, some subgroup analysis may contain few studies and conclusions might be less convincing. For instance, in subgroup analysis stratified by KRAS mutation status, only four studies were included. Results may be more stable and reliable with increasing number of studies that could be involved in future. Thirdly, dose‐response analysis was not conducted due to insufficient research data in this study. This might be an important confounding factor when estimating the effects of statins. Furthermore, due to the limited relevant researches, disease‐free survival and recurrence‐free survival were not included in our study. Up until now, available evidence is not sufficient to show any difference in disease‐free survival DFS and recurrence‐free survival RFS in CRC patients taking statin therapy. Whether statins own cancer‐directed benefits or not should be further discussed, and statins prescription should not be a routine for CRC prevention or treatment by now.5In conclusion, our meta‐analysis demonstrates that both pre‐diagnosis and post‐diagnosis statin uses are associated with reduced ACM and CSM for CRC patients. Considering that statins are low cost and wildly used agents worldwide, we believe our updated meta‐analysis can provide new insights into optimizing adjuvant treatment of CRC. Further clinical studies, especially RCTs and basic studies investigating KRAS mutations, are expected to be conducted to confirm the role of statins in CRC treatment.The authors declare that there is no conflict of interest regarding the publication of this paper. Click here for additional data file. Click here for additional data file.


Corrected QT (QTc) interval has been correlated with total and CVD mortality. Although much is known about the relation between prolonged QTc interval and clinical outcome, there is no information on the prevalence and specific risk factors of QTc prolongation in general Chinese population. We evaluated the prevalence of prolonged QTc interval and its risk factors in general Chinese population, aiming to fill in the gaps in the literature and provide evidence for potential CVD risk prediction and disease burden estimate in community.A population-based survey was conducted on 11,209 participants over the age of 35 in rural areas of Liaoning Province from 2012 to 2013. Twelve-lead ECGs and automatic analysis were performed on all participants. Logistic regression adjustments were made by using the Bazett’s formula to correlate specific risk factors with prolonged QTc intervals (> 440 ms) for potential confounders.P < 0.001). Participants with a history of CVD had a higher prevalence of QTc prolongation (40.7% vs. 30.0%). In the fully adjusted logistic regress model, older age, abdominal obesity, hypertension, diabetes, hypokalemia and any medicine used in the past two weeks were associated independently with increased risk for prolonged QTc interval (All P < 0.05). We found no significant differences between general obesity, hypocalcemia and hypomagnesemia with prolongation of QTc interval. Female sex showed opposite results after applying clinical diagnostic criteria, and high physical activity could reduce the risk of prolonged QTc interval.The overall prevalence of prolonged QTc interval was 31.6%. The prevalence increased significantly with age (24.1% among those aged 35–44 years; 28.3%, 45–54 years; 35.2%, 55–64 years; 43.4%, ≥65 years, The prevalence of prolonged QTc interval was relatively high in general Chinese population and listed relevant factors, which would help identify patients at risk in pre-clinical prevention and provide evidence for estimating potential CVD burden and making management strategies in community. The QT interval on the surface electrocardiogram (ECG) indicates the duration from the beginning of ventricular depolarization to the end of ventricular repolarization. Prolonged heart rate-corrected QT (QTc) interval has been correlated with many adverse cardiovascular outcomes including arrhythmia , coronarThe prevalence of prolonged QTc interval has already been reported in patients with different diseases, such as diabetes   and coroProlonged QTc interval is a result of a complex interplay between genetic and environmental factors , 12. As Methods of this study has already been published elsewhere . A repreData collection, measurement methods and the questionnaires of this study have already been published and described previously –16. CardData of demographic characteristics, family income, lifestyle risk factors, history of heart disease and any medicine used in the past two weeks were obtained through standardized questionnaire interviews. Educational level was classified into 3 groups: primary school or below, middle school and high school or above. Family income was divided into 3 groups: ≤5000, 5000–20,000 and > 20,000 CNY/year. Physical activity was divided into occupational physical activity and leisure physical activity. A detailed description of the method has ever been described elsewhere . OccupatAccording to the American Heart Association protocol, after at least 5 min of rest, blood pressure (BP) was measured three times every 2 min using a standardized automatic electronic sphygmomanometer , which had been verified according to the protocol of British Hypertension Society . The parHeight and weight were measured to the nearest 0.1 cm and 0.1 kg, respectively. During this period, the participants wore lightweight clothes and no shoes. Body mass index (BMI) was calculated as body weight in kilograms divided by the square of the body height in meters. Waist circumference (WC) was measured at the level of umbilicus with inelastic tapeline (accurate to 0.1 cm), during which the participants stood at the end of normal expiration.Fasting blood samples were collected in the morning after all participants had fasted for at least 12 h. All blood samples were taken from the antecubital vein by using a BD Vacutainer tube containing EDTA . The serum was then separated from whole blood through the centrifuge, and the serum samples were frozen at − 20 °C for further tests in a certified central laboratory. Total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), serum potassium, serum calcium, serum magnesium, fasting plasma glucose (FPG), and other routine blood biochemical indexes were analyzed by enzymatic method using an automatic analyzer . In addition, all laboratory devices have been calibrated and samples were duplicated by blind method.A MAC 5500  was used by well-trained cardiologists to perform a 12-lead ECGs (rest 10s) for all participants and the results was analyzed automatically through the MUSE Cardiology Information System, version 7.0.0 . And Bazett’s formula was then used to correct QT intervals for heart rate .2 [Hypertension was defined as SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg and/or use of antihypertensive medicines according to the JNC-7 report . Accordi2 . Abdomin2 . Dyslipi2 : TC ≥ 6.2 : FPG ≥ 72 , and we P values less than0.05 were considered as statistically significant.Descriptive statistics of all study variables had been calculated, including categorical variables (expressed as numbers and ratios) and continuous variables . Non-parameter test or an appropriate χ2-test were used to evaluate the differences among these categories. Multivariate logistic regression analysis was adopted to calculate the possible risk factors  for QTc interval prolongation with odds ratios (ORs) and corresponding 95% confidence intervals (CIs). All statistical analyses were conducted using SPSS version 23.0 software, and P < 0.05), while current smokers or drinkers were more common among those participants with normal QTc interval.The present study included 5106 males and 6103 females, with an average age of 54 (SD 11) years. Table P < 0.001, Fig. P < 0.001). The prevalence of QTc interval prolongation was also significantly higher among female participants in all four age groups. While after adjusting specific prolonged QTc interval for sex, this result reverse. Figure P < 0.001). In addition, the prevalence of prolonged QTc interval was higher among the participants with CVD history .Table P < 0.001). Prolonged QTc interval (QTc > 440 ms) was found in 1043 (29.3%) and 2500 (70.6%) of male and female, which is showed in Table P < 0.001). Participants with hypertension and diabetes had increased by 83.8 and 59.3% risks respectively for prolonged QTc interval . Abdominal obesity, high TG and low potassium level were also significantly associated with prolonged QTc interval, which increased by 15.6, 24.1 and 163.6% risks respectively for prolonged QTc interval . Recent use of any medication achieved statistical significance for 13.1% higher risk of prolonged QTc interval . To further eliminate the interference of self-reported medication use, we performed a sensitivity analysis excluding the participants on medication (Table P < 0.001). And female sex, abdominal obesity, hypertension, diabetes and hypokalemia increased by 199.5, 26.4, 93.3, 85.6 and 122.4% respectively . Furthermore, compared to low physical activity, high physical activity reduced to 70.2% risk for prolonged QTc interval . While after setting 450 ms for men and 470 ms for women, which is the clinical diagnosis criteria for long QT syndrome  and 395 (40.1%) of male and female), female sex might be a protective factor among those population, which the risk reduced to 49.7%  in Table P = 0.015).Table al QTc > 40 ms wasIn the present study, we reported a relatively higher prevalence of prolonged QTc interval in general Chinese population compared to Hawaii. We found age, abdominal obesity, hypertension, diabetes, hypokalemia and any medicine used in the past two weeks were associated with increased risk for prolongation of QTc interval.We found the overall prevalence of QTc prolongation was 31.6%, by a 440 ms cut-point for definition using Bazett’s formula, which is the most common method for heart rate adjustment . In a ruWe confirmed the impacts of age, diabetes and hypertension on prolonged QTc interval which were consistent with previous findings , 29, 31.It has been shown that general obesity is correlated with prolonged QTc interval –37. HoweThe strength of the present study was that we for the first time provided a detailed epidemiologic description of prolonged QTc interval in a general population from China with a large sample size and reflects the differences of the prevalence among hypertension, diabetes, dyslipidemia, general obesity and abdominal obesity. Our study had some limitations that need to be considered. First, instead of using sex-specific tertiles for QTc interval, we chose 440 ms as the definition for prolonged QTc interval for both sexes to include all borderline subgroups, and we set 450 ms for men and 470 ms for women to identify specific long QT syndrome. Besides, we used automatically measured QTc values and Bazett’s formula to further analysis. A pooled analysis found that long QTc interval was significantly associated with total and CVD mortality, using 440 ms as the cut-point for the highest category for both sexes in most of the included studies . Our goaWe found the prevalence of QTc interval prolongation is higher in the general Chinese population, especially those with CVD history. Older age, female sex, abdominal obesity, hypertension, diabetes and hypokalemia were associated with increased risks of prolonged QTc interval. This finding would help identify patients at risk in pre-clinical prevention and provide evidence for estimating potential CVD burden and making management strategies for rural Chinese population.


The longitudinal associations between a dietary pattern (DP) and cardiometabolic risk factors and cardiovascular disease (CVD) incidence were investigated in a cohort of adults with severe obesity.2 for men and women, respectively) from the Swedish Obese Subjects study repeatedly followed up for 10 years. Reduced rank regression was used to identify a DP characterized by dietary energy density, saturated fat intake, and fiber density. Mixed models examined relationships between repeated measures of DP z‐scores and cardiometabolic risk factors. Cox proportional hazards models assessed relationships between DP scores and CVD incidence.The analysis included 2,037 individuals with severe obesity (>34 and >38 kg/mz‐score between follow‐ups was associated with an increase in weight [β (SE)] (1.71 ± 0.10 kg), waist circumference (1.49 ± 0.07 cm), BMI (0.60 ± 0.34 kg/m2), serum cholesterol (0.06 ± 0.01 mmol/l), and serum insulin , as well as in serum triglycerides , systolic blood pressure , and diastolic blood pressure . No significant association was observed between repeated measures of the DP z‐scores and CVD incidence .An energy‐dense, high‐saturated‐fat, and low‐fiber DP was derived. A one‐unit increase in the DP An energy‐dense, high‐saturated‐fat, and low‐fiber DP was longitudinally associated with increases in cardiometabolic risk factors in severe obesity but not with CVD incidence. Severe obesity increases the risk of morbidity and mortality Understanding the role of diet and its association with disease outcomes is of great importance as diet is one of the few modifiable lifestyle factors that may be targeted to bring about reductions in disease‐risk profiles. There is considerable evidence for saturated fat and dietary fiber playing a role in the development of CVD. Saturated fatty acids are associated with increases in total blood cholesterol and low‐density lipoproteins concentrations Studying diet as a multidimensional exposure is closer to a real‐world scenario as foods consist of many nutrients, and diet is a combination of foods and nutrients. Dietary pattern (DP) analysis aims to reduce information collected on the reported intake of a large number of food items/groups into a few summary variables representing patterns of food and drink consumption. Reduced rank regression (RRR), a DP method, further allows the input of hypothesized pathways when deriving a DP thus enabling investigation of several closely related diet‐disease pathways together.This study aims to investigate the longitudinal relationships between an energy‐dense, high‐saturated‐fat, low‐fiber DP, cardiometabolic risk factors , and cardiovascular events over a 10‐year period.t) = R]. From this registry population, 2,010 elected to have surgery and 2,037 were contemporaneously matched to the control group using 18 matching variables t = 0) occurred between September 1, 1987 and January 31, 2001.Data were obtained from the Swedish Obese Subjects Study (SOS) study n = 6,897) were used to derive the DP. Subsequent longitudinal analysis used follow‐up data from the SOS control group only .Dietary data provided by the registry population .Written informed consent was obtained for all study participants. The SOS study protocol was approved by the Research Ethics Committee of University of Gothenburg and seven other Swedish regional ethics review boards. The SOS trial has been registered in the ClinicalTrials.gov registry , baseline (t = 0), and then after 0.5, 1, 2, 3, 4, 6, 8, and 10 years. Education status was as follows: five different levels classified into “up to 16 years” and “beyond 16 years” for this study; gender and age were recorded at baseline. At each examination, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were averaged from repeat measures taken using standard methods. Body weight and height were also measured at each examination. Health questionnaires completed at each examination included questions on physical activity ; smoking ; and self‐reported information on previous myocardial infarction (MI) and stroke. Participants also recorded the names of all drugs being taken in the last year, which were coded according to the Anatomical Therapeutic Chemical Classification system t = R, 0, 2, and 10 years and sent to the Central Laboratory of Sahlgrenska University Hospital (accredited according to European Norm 45001) in Gothenburg. Total cholesterol, HDL cholesterol, and insulin were determined from serum samples. Blood glucose was also determined.Participants were examined at registration  or stroke  were obtained from the Hospital Discharge Register, which documents all hospital visits. For the purposes of the current analysis, follow‐up ended on June 16, 2009.t = R, 0, and after 0.5, 1, 2, 3, 4, 6, 8, and 10 years. The SOS dietary questionnaire is a semiquantitative dietary questionnaire that was adapted for the study population, considering the problematic eating characteristics of obese individuals. In addition, asking about the frequency of consumption of food items per day or per week as appropriate, as it places an emphasis on meal portion size, separated for weekdays and weekend. It uses color photographs to aid respondents and help to simplify the reporting of portion size of three basic food groups  in order to identify DPs that best represent the Swedish obese population. The RRR model included the 39 food group intakes (g/day) as predictors, and DED, dietary FD, and percentage energy from saturated fat as response variables. These were chosen as response variables because of consistent evidence for their role in the development of CVD and weight gain. RRR identifies DPs (or patterns in food intake) that attempt to explain the maximum variation in response variables. Each participant is scored for each DP, using a z‐score. The DP z‐scores after t = R were estimated and standardized around the mean z‐score and standard deviation at t = R using a similar approach proposed by Imamura et al. t = 0 to t = 10 therefore represent adherence to the pattern derived at t = R. The RRR models were run using the PLS procedure in SAS v9.1 Identification of the DPs has been previously described z‐scores (exposure), CVD risk factors (outcome), and CVD events (outcome) were examined using mixed models. The mixed models of best fit (based on Akaike information criterion) included a random effect for individual and an unstructured covariance.The relationships between DP z‐scores at t = R, 0, 0.5, 2, 3, 4, 6, 8, and 10 were analyzed in relation with CVD risk factors measured at t = R, t = 0, t = 2, and t = 10 (PROC Mixed in SAS v9.1). The DP z‐score was the continuous exposure variable, and time since registration (years) was the continuous “time” variable. Models were adjusted for gender, education level, and age at registration, and smoking status, physical activity, and, where appropriate, blood pressure, lipid reducing, and diabetes medications at each follow‐up. To visualize longitudinal changes, average risk factor trajectories were generated from the models for tertiles of the DP score at baseline.DP z‐scores at t = R, 0, 0.5, 2, 3, 4, 6, 8, and 10 were analyzed in relation with CVD incidence using Cox proportional hazard analysis . However, serum insulin, cholesterol, DBP, and serum triglyceride levels decreased on average over time (Table P < 0.05). Blood glucose and SBP did not vary significantly with time. This can be observed in Figures Weight, waist circumference, BMI, and serum HDL all increased on average over time (Table 2), and serum insulin . A one‐unit increase in the DP between follow‐ups was associated with, on average, greater serum cholesterol , serum triglycerides , SBP , and DBP , waist circumference (1.49 ± 0.07 cm), BMI  after adjustment for age, sex, smoking, physical activity, and CVD relevant medication use  events. No significant association was observed between repeated measures of the energy‐dense, high‐saturated‐fat, and low‐fiber DP In this group of severely obese individuals, an energy‐dense, high‐saturated‐fat, and low‐fiber DP score was associated with significantly greater weight, waist circumference, BMI, serum insulin, cholesterol, triglycerides, SBP, and DBP during a 10‐year follow‐up. However, it was not associated with CVD incidence. These findings suggest that associations between the DP and CVD risk factors were present at baseline and follow‐up but that other competing factors influenced CVD incidence during the follow‐up of this severely obese adult cohort.P for trend = 0.016). It is, however, difficult to make clear comparisons with the current severely obese population as the EPIC‐Potsdam cohort used had a mean BMI of 27 kg/m2. It may be hypothesized that the greatest impact on CVD risk may already have occurred in these already severely obese individuals. This may be evident in the observation that only major changes in weight, brought about by bariatric surgery, have been shown to impact on CVD incidence after a 10‐year follow‐up in the severely obese The associations observed in this obese group are similar to those in previous studies of DPs and CVD risk There remains interest in the association between individual nutrients and/or foods and the risk of CVD; however, a shift in the thinking of nutritional epidemiologists has led to a number of studies considering the effects of overall DPs. DP analysis has frequently identified, in several cohorts, two DPs, often named the “Western” and “prudent” patterns. A Western DP is often characterized by higher intake of margarines and oil, sausages, coffee, butter, and full‐fat milk. The prudent pattern is often characterized by greater intake of vegetables, fruit, whole grains, fish, and poultry A number of clinical trials have also examined DPs. The DASH trial was based on a DP with high intake of fruits and vegetables and low‐fat dairy products and successfully reduced DBP and SBP and serum homocysteine levels in hypertensive subjects The strength of this study was the use of repeated measures of diet and biological CVD risk factors. Furthermore, the SOS control group is the largest cohort of severely obese individuals in Europe and provides a unique opportunity to investigate diet in a previously understudied population. However, this group of individuals was required to meet a number of inclusion criteria reducing their heterogeneity, and despite choosing not to have surgery, these individuals volunteered to be part of the study and as such are likely more health conscious than the general severely obese population. We attempted to minimize this effect by deriving DP in a broader sample of severely obese individuals. Finally, the prevalence of dietary misreporting is often high in the obese population. The SOS dietary questionnaire was designed with this in mind and has been shown to be a valid measure of diet In this severely obese population, measurements of an energy‐dense, high‐saturated‐fat, and low‐fiber DP were positively associated with fasting serum insulin, total cholesterol, weight, waist circumference, and BMI over a 10‐year period. Despite unfavorable CVD risk, diet was not associated with CVD incidence in this severely obese cohort. The impact of diet on health may have already occurred in these individuals who are severely obese at baseline.


To explore the effects of group singing therapy on depression symptoms and quality of life of patients with stable chronic obstructive pulmonary disease (COPD).n = 30) and control groups (n = 30). The intervention group received group singing therapy once a week for 24 sessions along with routine health education, whereas the control group only received the routine health education. All patients were administered the Hospital Anxiety and Depression Scale depression subscale (HADS-D) and the Clinical COPD Questionnaire (CCQ). Data were collected at baseline and at 1, 3, and 6 months.Patients with COPD were randomly allocated to intervention (Fifty-six participants completed this trial. Significant between-group differences were observed with respect to the main effect of group and time as well as the effect of group × time interaction on HADS-D score. The HADS-D score was significantly improved 1, 3, 6 months after group singing therapy. The CCQ total scores were significantly different between the two groups with respect to the main effect of group and time and the group × time interaction effect. Significantly better CCQ was detected in the intervention group at 3 months and 6 months after intervention.Group singing therapy reduces depressive symptoms and improves the quality of life of patients with stable COPD. Chronic obstructive pulmonary disease (COPD) is characterized by progressive and irreversible airflow obstruction, and is associated with high morbidity and mortality . GloballCOPD is a chronic respiratory disease which is associated with multiple comorbidities including cardiovascular disease, skeletal muscle dysfunction, metabolic syndrome, osteoporosis, depression, and lung cancer . HoweverStudies have shown that identification and treatment of depressive symptoms in patients with COPD may have a favorable effect on mood, exercise tolerance, quality of life, and related symptoms –15. ConsReports have shown that music facilitates expression of emotions among participants , which mThis was a prospective, randomized controlled trial. Participants were recruited from four large communities in Xi’an, Shaanxi Province of China from April to October, 2016. A total of 198 patients were screened; of these, 60 were found to be eligible and consented to participate in the study. The participants were counseled about the purpose of the study, i.e., to exercise the respiratory muscles and prevent recurrent attacks. Patients were randomly allocated to the intervention or control group using a random number table. Single blind method was used in the study. The control group received routine health education, while the intervention group received group singing therapy in addition to routine health education. During the study, two participants in the intervention group withdrew because of deterioration in health status and two participants in the control group were lost to follow-up. A total of 56 patients were eventually included in the analysis. With the consent of the participants, paper questionnaires were distributed and completed by the participants within 20 min at their respective homes. Data were collected and analyzed at baseline and at 1, 3, and 6 months thereafter , 33. Then = 9); (2) severe cognitive (n = 2) or hearing impairment (n = 3), cerebrovascular disease (n = 6), and cardiopulmonary dysfunction (n = 15); (3) patients on antidepressants (n = 4) and other mood-focused therapies (n = 6); (4) patient refusal to participate in the study (n = 36).Inclusion criteria were as follows: (1) patients with COPD, diagnosed according to the criteria of Global initiative for Chronic Obstructive Lung Disease  ; (2) patThis study was approved by the Medical Ethics Committee of the Xi’an Medical University (No. XMU16-046). Written informed consent was obtained from all participants prior to their enrolment. Participants were free to opt out of the study at any time.Patients in the control group were provided with routine health education, which included eight sessions of COPD education (30 min each). Community nurses explained the COPD disease-specific information and preventive information. Smoking cessation is the most important measure to prevent progression of disease and elimination of this risk factor is an important step for prevention and control of COPD. Other education topics included change in unhealthy daily lifestyle choices or habits, significance of respiratory function exercises, and demonstration of how to perform these exercises. Patients were instructed to perform respiratory exercises for 10 min at a time, twice a day, and were asked to participate in physical exercises  as much as possible according to their physical condition. In addition, a health education handbook was offered to all participants. To balance the amount of attention received by both groups, patients in control group were asked to gather once a week for experience sharing after completion of eight sessions of health education.In addition to routine health education, the intervention group received group singing therapy once a week for 24 sessions (each session lasted approximately 60 min). The participants gathered in a large room at a community recreation center and the activity was coordinated by a music therapist and a community nurse. Participants were free to sit, stand, or lean against the wall according to their physical condition. The intervention protocol was implemented as follows:Relaxation exercises The community nurse guided the patients to perform relaxation exercises for the neck and upper abdominal muscles. Neck muscle relaxation required the patient to lower the head and try to position the chin against the chest for l0 s. Upper abdominal muscle relaxation required the patient to gradually lift up the upper limbs and inhale deeply, and then put down slowly the upper limbs and exhale slowly while breathing evenly; the relaxation exercises were repeated several times (5 min).Respiratory exercises The participants were instructed to practice two specific breathing techniques, i.e., pursed-lip breathing and diaphragmatic breathing. Participants were initially encouraged to perform deep inhalation slowly through the nose followed by slow exhalation through pursed lips while paying attention to the upper abdominal muscle movements at the same time (10 min).Vocalization exercises The purpose of this exercise was to train the patients with resonance organ function, and to achieve breath and voice coordination. The patients were asked to vocalize with slowly whispered hum and loud hum, respectively  (15 min).Singing exercises This was the most important part of group singing therapy. The participants sang one song selected from a list of participant-chosen music selection on each occasion . At first the music therapist taught everybody to sing the song several times; subsequently, the participants sang the song accompanied by music therapist on the piano. Finally, the patients copied the song in MP5 format and practiced singing at home for 30 min every day (30 min).Data were collected by means of self-administered questionnaires. The HADS-D subscale was used for assessment of depressive symptoms. This scale was developed by Zigmond et al.  and inclThe Clinical COPD Questionnaire (CCQ) was used to assess the disease-specific quality of life . The quet test. Repeated measures ANOVA and t test were used to compare variables among groups. P values < 0.05 were considered indicative of statistically significant between-group difference.Data were processed using Epidata  software. All statistical analyses were performed using SPSS . Descriptive statistics were generated for demographic variables. Between-group differences with respect to baseline characteristics were assessed using the Chi-squared test and Data pertaining to demographic variables , history of smoking, duration of disease, and COPD stage were obtained from a structured questionnaire and pulmonary function tests. A total of 60 subjects participated in the current study, of whom 56  completed the study and were included in the analysis. Figure F = 38.19, p < 0.001, Partial η2 = 0.414; F = 96.95, p < 0.001, Partial η2 = 0.642; F = 77.67, p < 0.001, Partial η2 = 0.590) . The HADS-D scores in the control group were relatively stable over the duration of the study. In contrast, the intervention group exhibited a significant improvement in HADS-D scores at 1 month , 3 months , and 6 months  after intervention.The depression scores showed significant between-group differences along with the time, which was represented by a group × time interaction effect  = 47.00, p < 0.001, Partial η2 = 0.465; F = 42.02, p < 0.001, Partial η2 = 0.438; F = 42.91, p < 0.001, Partial η2 = 0.440) and symptoms score  = 27.44, p < 0.001, Partial η2 = 0.337; F = 13.37, p < 0.001, Partial η2 = 0.198; F = 11.00, p < 0.001, Partial η2 = 0.169) and mental state score  = 18.99, p < 0.001, Partial η2 = 0.260; F = 14.49, p < 0.001, Partial η2 = 0.212; F = 15.79, p < 0.001, Partial η2 = 0.226) and functional status score  = 37.20, p < 0.001, Partial η2 = 0.408; F = 33.17, p < 0.001, Partial η2 = 0.381; F = 38.66, p < 0.001, Partial η2 = 0.417)]  is a joyful and interesting task and should be easy for patients with COPD to continually engage in the therapy; (2) has no obvious side effects, is of low-cost intervention, and is easy to be carried out for free; (3) helps in exercising the respiratory function, improves vital capacity and cardiac-pulmonary function, and is well accepted by patients with COPD; and (4) inspires confidence and love for life.However, there are several limitations of the study. The main limitation is that patients with very severe COPD were not included. It remains unknown whether patients with severe disease can tolerate group singing therapy and whether singing therapy interventions could offer benefit for these patients. Second, this study lasted for only 6 months and it is not known whether the results noted here could be maintained over time. Third, detailed data pertaining to treatment adherence were not collected as there are no appropriate rating scales.Our findings illustrate that group singing therapy may help reduce symptoms of depression and improve the quality of life of patients with stable COPD. A collaborative clinical team, including multi-disciplinary healthcare professionals and community health service, should pay close attention to and manage symptoms of depression in people with COPD. In clinical practice, there is a need for routine assessment and early detection of symptoms of depression in patients with COPD. Group singing therapy is well accepted by the participants, and nurses may instruct patients with stable COPD to practice it at home or in the community. The enhanced efficacy of the intervention over time can potentially prevent acute exacerbations and improve health-related quality of life among community population. More effort is needed to focus on detailed clinical practice method.It can be concluded that the group singing therapy may help decrease depressive symptoms and improve quality of life. The beneficial effects of group singing therapy increased with increase in the duration of therapy. Furthermore, it is an enjoyable experience and well accepted by the participants, which may facilitate its use as a valuable complementary therapeutic method.


To assess the maternal characteristics and nutritional status according to body mass index (BMI) at 6–14 weeks of gestation and to examine the relationship between maternal nutritional status in early pregnancy and its impact on neonatal birth weight.n = 138) were collected immediately after delivery for blood glucose, insulin, lipid profile, leptin and micronutrients including serum folate, ferritin, homocysteine, vitamin D, and vitamin B12.The investigation was conducted from April 2011 to June 2012 in Dhaka, Bangladesh. A total of 498 primigravida pregnant women participated in the study; women with known diabetes or previous gestational diabetes (GDM) were excluded. Maternal demographic details, pregnancy history and anthropometric measurements were obtained from the mother at the recruitment (6–14 weeks), 2nd visit between 24 and 28 week of gestation and 3rd visit at delivery. Cord venous blood samples of newborns (p <  0.05). The incidence of low birth weight (LBW) and preterm delivery were 11.6 and 5.8% respectively and was not related to maternal BMI at 6–14 weeks of pregnancy. Maternal height was positively (p = 0.02), and homocysteine was negatively associated with neonatal birth weight (p = 0.02). In addition, the newborn’s cord serum folate was positively (p = 0.03) and cord triglyceride was negatively (p = 0.03) associated with neonatal birth weight.The prevalence at 6–14 weeks of pregnancy of anemia , vitamin D deficiency (< 30 nmol/l), vitamin B12 deficiency (< 200 pg/ml), high homocysteine level (> 15 μmol/l), folate deficiency (< 3 ng/ml) and iron deficiency (ferritin < 13 ng/ml) were 19.5, 46.4, 15.1, 1.2, 0.4, and 12.7% respectively. GDM was found in 18.4% women. The prevalence of GDM was higher in overweight women (28.1%) than underweight (16.7%) and normal weight women (16.0%: Multiple maternal micronutrient deficiencies were present in early pregnancy. Maternal BMI in early pregnancy was not related to preterm deliveries or LBW. LBW was associated with lower folate, elevated cord triglyceride concentrations of the neonates and mother’s height and increase in maternal homocysteine levels. The data has important implications for pregnancy care in Bangladesh and other similar communities. Maternal nutrition plays an important role in placental-fetal growth and development. Maternal undernutrition during pregnancy results in intrauterine growth restriction (IUGR) which is associated with increased perinatal morbidity and mortality. These children have an increased risk for development of metabolic syndrome in adult life , 2.Evidence shows that the animal embryo comprises two group of cells in the early embryonic stage. The inner cell mass which develops as the fetus and the outer cell mass become the placenta. These developmental process is influenced by nutrition and hormones , 4. MateLow birth weight (LBW) is considered an indicator of undernutrition in utero. Epidemiological studies have shown that it is associated with a wide range of adverse outcomes in later life, including shorter stature, lower cognitive performance, increased risk factors for later chronic non-communicable disease including, T2DM, HTN, CAD, chronic lung and kidney disease .Even though, the obesity level is rising across the globe, yet more than 20 million infants  are born each year at LBW (< 2.5 kg). LBW remains a problem focused in developing countries, and half of all LBW babies are born in South and central Asia . AlthougData from Bangladesh in this issue is still scarce. As dietary patterns vary from country to country, especially regarding vegetarian and non-vegetarian components in Bangladesh and its neighboring country Indi. Data from India may not be directly applicable to people living in Bangladesh .The purpose of the exploratory study was to examine the relationship between maternal nutritional status as assessed by body mass index (BMI) in early pregnancy and its impact on pregnancy outcomes and neonatal birth weight. In addition, we examined the relationship between neonatal birth weight with neonatal metabolic and micronutrients characteristics.This is one of several sub studies of a prospective multi-center EU FP7 project GIFTS  project conducted from April 2011 and June 2012 in Dhaka, Bangladesh. Other GIFTS studies included analysis of other populations in Pakistan  and BangStudy participants were recruited from five areas  in the Dhaka city, Bangladesh through the monthly household visit by Government Family Welfare Visitors (FWV). These areas are from both urban and semi-urban areas. During these visits, pregnant women were identified by a history of a missed menstrual cycle. Upon confirmation of pregnancy by urine pregnancy test women were invited to visit the Maternal and Child Health Training Institute (MCHTI), a tertiary Government hospital for antenatal care and registration.A given error margin (α) of 5% with 95% confidence from a population of 100,000 and with a prevalence of undernutrition 30% , the reqn = 498). Women who had a history of T2DM, or history of GDM or pregnancy induced HTN were excluded from this study.Pregnant women were recruited in first trimester of their pregnancy (≤14-week gestation). Women who were primigravida, singleton, conceiving without treatment of fertility and were willing to participate in the study were included after written consent , 2nd visit between 24 and 28 week of gestation (n = 327) and 3rd visit at delivery (n = 138). Figure All records from each participant were kept during the study period  criteria in the 2nd trimester (24–28 weeks of gestation). Diagnosis was made by fasting and 2 hours after ingesting 75 g glucose. This was done to avoid high dropout rate because of 3 blood measures in pregnancy. GDM was defined as a fasting plasma glucose (FPG) ≥5.1 mmol/L or plasma glucose ≥8.5 mmol/L 2 hours after ingesting 75 g glucose (2hPG) . Diabete2). Waist circumference was measured by placing a plastic tape at the midpoint between the lower rib margin and the iliac crest. Similarly, hip was measured by taking the extreme end posteriorly and the symphysis pubis anteriorly. Mid arm circumference (MAC) of the left upper arm, measured at the mid-point between the tip of the shoulder and the tip of the elbow. In addition, blood pressure was measured in right hand in sitting position. Prior to the measurement, 10-min rest was assured and using standard cuffs fitted with sphygmomanometer minimized variation in measurement. Maternal food and nutrient intake were assessed at each trimester through Food Frequency Questionnaires (FFQs). The FFQ used in this study had a food list of 135 items. The FFQ consisted of frequency categories . Local household utensils including glasses, spoons, cups and plates were used for estimating the amount of foods and beverages consumed by the respondents. These local utensils acted as visual aids to increase the accuracy of portion size estimations. Food Photo Manual was used, which converts food items of different sizes and composition to gram equivalents. Physical activity levels of participants at work, at home and during leisure time (minutes/day) was recorded following a structured questionnaire used in Bangladesh previously [Data were collected using questionnaire, physical examination and laboratory investigations. Four trained personnel were involved in data collection. A structured pre-formulated questionnaire was used to collect information on age, place of residence, education, type of occupation, socio-economic status , family history of chronic diseases including T2DM, HTN, CAD, and stroke, history of participants’ past illness or any chronic disease, history of addiction, physical activity level, nutritional status, and pregnancy-related history from the mother at the baseline visit. Maternal anthropometry including height, weight, waist, hip and mid upper arm circumference (MUAC) were measured (using standardized measurement protocols) at the time of registration and repeated at the second visit between 24 and 28 weeks’ gestation. BMI was calculated as weight divided by height squared , and vitamin B12 at 1st visits and glucose , insulin and leptin at both visits (1st and 2nd). Serum samples were used for the estimation of serum glucose, lipid profile, insulin, leptin, vitamin D, vitamin B12, folate, ferritin, homocysteine and whole blood used for DNA.Serum glucose was measured by glucose oxidase , serum triglyceride (Tg) by GPO-PAP method , serum cholesterol (Chol) by enzymatic endpoint method  and serum high density lipoprotein cholesterol (HDL-C) by differential precipitation, enzymatic colorimetric test , and low density lipoprotein cholesterol (LDL-C) was estimated by Friedewald’s formula. All serum glucose and lipid profile were measured by using biochemistry auto analyzer (HITACHI 704 Japan), serum insulin, leptin, vitamin D were measured using ELISA kits . Serum folate, ferritin and vitamin B12 were measured using chemiluminescence immunoassay . Serum total homocysteine was measured using Microparticle Enzyme Immunoassay . Serum was not allowed to be thawed until the assay is performed at the Reference Laboratory in Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated using the method of Matthews et al  Intra asn = 138). Trained midwives examined all newborns within 24 h of birth. Newborn outcomes of interest included anthropometric characteristics ). Newborns’ weight was measured with a digital scale  and length was measured using a locally manufactured wooden length board. Head and mid upper arm were measured using a non-stretchable tape.Newborn characteristics including sex and gestational age at birth were recorded at the time of delivery , normal weight (BM 18.5–22.9 kg/m2) and overweight (BMI ≥23 kg/m2) [P <  0.20. In the second phase, the variables with P < 0.20 and the variables with P < 0.05 were then used to fit separate multiple generalized linear regression models. We also checked the correlation between different variables before starting multiple generalized linear regression models. Maternal BMI, LDL-C and HOMA-IR were not included due to their high correlation with maternal weight , total cholesterol  and insulin  respectively. At each stage of the model development, the Akaike Information Criteria (AIC) was used to check if the inclusion of a variable or variables improved the model fit [Descriptive statistics in the form of frequencies (n) and percentages (%) were used to describe the maternal BMI at 6–14 weeks of pregnancy, which we categorized into underweight (BMI < 18.5 kg/m3 kg/m2) . Similar3 kg/m2) . We usedodel fit . The modTable p < 0.05). In addition, insulin, HOMA-IR, cholesterol, LDL-C and leptin levels were significantly lower in underweight women than normal weight and overweight women. No significant difference was observed in vitamin D, vitamin B12, homocysteine, folate and ferritin levels between three groups. The prevalence of anemia , vitamin D deficiency (< 30 nmol/l), vitamin B12 deficiency (< 200 pg/ml), high homocysteine level (> 15 μmol/l), folate deficiency (< 3 ng/ml) and iron deficiency (ferritin < 13 ng/ml) were 19.5, 46.4, 15.1, 1.2, 0.4, and 12.7% respectively. Anemia was significantly higher in underweight women than in women with normal weight . GDM was found in 18.4% women (58 out of 315 at 24–28 weeks). The prevalence of GDM was significantly higher in overweight women (28.1%) than underweight (16.7%) and normal weight women (16.0%: p < 0.05). Only three women (0.95%) were diagnosed with diabetes in pregnancy.Table p < 0.01), reduced height , increased 2 h glucose  and increased vitamin D levels .As seen in Fig. 138 of 498 mothers were followed-up until the birth of their child. Those mothers lost to follow up differed at their first visit (14–18 weeks) in that they had a lower weight , head circumference (cm), MUAC (cm) and ponderal index was 2814 ± 404, 45.9 ± 2.7, 13.4 ± 1.7, 33.1 ± 1.4, 9.8 ± 0.8 and 2.9 ± 0.5, respectively. LBW babies had significantly lower length, weight for height, head circumference, MUAC and ponderal index.Table No significant difference was observed for any of the following parameters  in LBW babies compared to normal weight infants.Table p = 0.02) while homocysteine was negatively associated with neonatal birth weight (p = 0.02). Model 2 showed that a unit increase in homocysteine was associated with a 33.26 g decrease in mean birth weight (p = 0.02).Table p = 0.02). However, a unit increase in folate significantly increase birth weight by 5.26 g (p = 0.03).The associations between neonatal birth weight and neonatal cardiometabolic and micronutrients characteristics were presented in Table Figure 2) and overweight (BMI ≥23 kg/m2) were observed in our study. Our findings are in line with 2007 Bangladesh Demographic and Health Survey (BDHS) [Our data reports the maternal characteristics and nutritional status in early pregnancy (6–14 weeks) and its impact on neonatal birth weight. High prevalence of both underweight (< 18.5 kg/my (BDHS) . As our y (BDHS) –31.In our study, we assessed the level of micronutrient status in early pregnancy , therefore the chances of confounding effect of hemodilution which is common in late pregnancy was unlikely. Our data showed a high prevalence of vitamin D deficiency and insufficiency in pregnant women in early pregnancy. Studies in Pakistan with identical definition for vitamin D deficiency with similar inclusion criteria had shown similar results , 32. SimLimited dietary sources, dark skin pigmentation, and religious or cultural practices that limit skin exposure to sunlight may prevent endogenous production of vitamin D, as illustrated by El-Sonbaty and Abdul-Ghaffar et al.  and GuzeIncreasing evidence suggest that vitamin B12 deficiency is highly prevalent in women of reproductive age, particularly amongst populations with limited intake of animal source foods , 37. EviRegarding iron and folate deficiency, our findings are consistent with other previous urban study in Bangladesh . Lower lThe prevalence of GDM in our study was 18.4%. Two similar studies in India and China with identical definition for GDM reported 18.5 and 19.9% prevalence respectively , 45. BanLike many other developing countries, millions of Bangladeshi children suffer from nutritional deficiencies due to their mothers’ poor nutritional status prior to and during pregnancy. Children are often born with LBW. According to National LBW Survey 2003–2004 reports, 36% babies were born with LBW. The mean birth weight of infants in Bangladesh is 2632 g and the mean birth length is 48.5 cm . In our Our results showed that neonates born to underweight mothers had significantly higher blood glucose, higher cholesterol, but higher HDL-C, and lower vitamin B12 than neonates born to overweight mothers irrespective of their birth weight. Mechanisms underlying these associations are still poorly understood. However, our findings reflect the possible interaction of environmental factors and fetal growth and the in-utero glucose and lipid metabolism. Future long-term longitudinal studies in different ethnicities would help to explore the underlying mechanisms.Finally, we investigated both maternal and neonatal nutritional and cardiometabolic factors on newborn birth weight. In our study, maternal height and weight at inclusion were positively associated with neonatal birth weight in univariate analysis. In the adjusted analysis, maternal height was positively, and homocysteine was negatively associated with neonatal birth weight. A series of studies investigated the relationship between maternal height and birth weight showed that shorter maternal height was associated with reduced fetal growth and low birth weight , 48–51. Among the neonatal variable, cord folate was positively, and triglyceride was negatively associated with birth weight. Literature has shown that folic acid supplement during the last 12 to 16 weeks of pregnancy delivered heavier babies than those born to mothers receiving iron alone. Further, it was found that the effect of the folic acid supplements was more marked on first born children  .As in other studies, we have found that lower birth weight was associated with elevated cord triglyceride concentrations –59. Redun = 16). It should be noted that the exclusion of GDM mothers in their second visit, political violence during the study period were the major causes of participants’ dropout. In addition, the local cultural practice in Bangladesh is that primigravida mothers deliver the child in their parent’s house; this caused a major undertaking to trace all the participants. Because of limited project budget funds and the logistics of cord blood collection and sample processing, we could not collect samples from the majority of home deliveries; analysis of the neonates was therefore mainly restricted to hospital deliveries to ensure data integrity. Reassuringly, with respect to analysis of the neonate data, there is no significant difference in terms of the nutrition status in those mothers who were recruited initially (n = 498) and those who delivered in the hospital (n = 138). At recruitment, 30.9% of the women were categorized as having low BMI (< 18.5), 48.4% normal BMI (18.5–22.9), and 23.9% (overweight and obese). The samples from the newborns were collected from (n = 138) deliveries from the hospitals. Those mothers who delivered were categorized as low BMI were 27.5%, normal 48.6% and over-weight and obese were 23.7%. The difference was not statistically significant (p = 0.43). Therefore, it is less likely that the results were influenced by the high rate of dropouts.Among the strengths of the study were interviewer training for interview technique, questionnaires, recall of the participants, anthropometric measurements, collection of blood, and its subsequent processing (centrifugation and storage). Primigravida mothers were recruited in their 1st trimester to avoid any noise interfering with the analysis. All the maternal and cord blood parameters were determined in the same laboratory, should reduce the chance of error due to different analysis technique. This study also creates an opportunity for long time follow-up of study participants and their offspring which will serve as a relevant data bank for future studies. The limitations of the present study include a higher number of dropouts and thereby limited number of neonatal samples especially those with very low birthweight (Even though areas of residence were selected based on a random sampling procedure but the population were selected from five areas in and around Dhaka city. The people in Bangladesh (98–99%) belong to one ethnic group and have similar body structure. Therefore, results may be interpreted with caution to the Indian Bengali population.However, we could not find any significant differences in the baseline-data for mothers delivered in the hospital or home related to BMI, and therefore, it is less likely to have impacted the results. Home delivery is common in Bangladesh especially in rural and semi-urban population . MicronuMaternal malnutrition including both micro  and undernutrition as measured by BMI was highly prevalent in early pregnancy. LBW was associated with lower folate, elevated cord triglyceride concentrations of the neonates and mother’s height and increase in maternal homocysteine levels. Neonates born to underweight mothers exhibited significantly higher blood glucose, cholesterol, higher HDL-C and lower vitamin B12 irrespective of their birth weight although this conclusion should be tempered by the numbers studied. The results may call for closer monitoring of pregnant women by the antenatal clinics. The data has also important implications for pregnancy care in Bangladesh and other similar communities.


Gestational diabetes mellitus (GDM) has serious effects on both mother and child. Like Type 2 Diabetes Mellitus, it is increasing in prevalence world-wide. In addition to obesity, sleep duration has been named an important risk factor. Using a large cohort study, including data from 48,787 participants of the Japan Environment and Children’s Study (JECS), we examined the association between sleep duration and both random blood glucose levels and GDM rates during pregnancy.Random blood glucose levels were measured during pregnancy. GDM diagnosis was based on the results of 75 g oral glucose tolerance test. Additional anthropometric data was collected from questionnaires for statistical analysis.p = 0.126; ≥10 h sleep: OR 1.13 (1.03–1.25) p = 0.006). Calculating the risk for GDM, women sleeping < 5 h or ≥ 10 h exhibited elevated risks of 1.31-fold and 1.21 respectively. However, this trend was not found to be significant.Compared to mothers averaging 7 to < 10 h sleep (reference group), women receiving < 5 h or ≥ 10 h sleep exhibited significantly elevated random blood glucose levels. This was associated with an elevated risk for positive GDM screening (< 5 h sleep: OR 1.17 (0.96–1.44) Sleep is a critical factor in glucose metabolism, with both abnormally long and short sleep duration increasing random blood glucose levels in pregnant women. Moreover, the risk for positive GDM screening increases significantly with elevated sleep, ≥10 h per night. These findings are promising because they support the idea that sleep duration is a modifiable risk factor, and can be focused upon to improve health and pregnancy outcome. Abnormally long and short sleep duration increases random blood glucose levels, and sleep of ≥10 h per night increases the risk for positive GDM screening in pregnant women.Gestational Diabetes Mellitus (GDM) is a serious health risk for both pregnant women and their offspring. GDM is prevalent worldwide, affecting ~ 13% of pregnancies. Rates of 20–25% are estimated for some countries of North Africa and the Middle East (United Arab Emirates) and the Western Pacific (Singapore and Thailand), whose medians are 12.9 and 11.7%, while rates are significantly lower in North America and many but not all of the European countries with estimated medians of 7.0 and 5.8% respectively . SimilarSleep duration and quality are modifiable factors that have been linked to changes in glucose metabolism and T2DM . Both epAdequate sleep is commonly a challenge to maintain during pregnancy. Changes in sleep, both increases and decreases, are thought to be caused by hormonal changes, physical discomfort, and other pregnancy-related stresses , 8. IndeObesity is a risk factor on the rise in parallel with Diabetes rates in the Americas and European populations. However, while this risk factor is much lower in East Asian populations, it is observed that T2DM rates increase at a lower average body-mass index (BMI) in these populations . It is tJECS is a nationwide, government funded birth cohort study begun in 2011 with the aim to elucidate the effects of environmental factors on the health of mother and child , 14. 103Two questionnaires per person were completed in the first (mean 16 weeks) and second to third trimesters (mean 27 weeks), addressing past pregnancy history, lifestyle, foods, and sleeping habits including sleep start and waking times. Specifically, sleep questions were administered in the second to third trimesters, and had the following phrasing, “What was the average time to get into bed and turn off the light over the last month?” and “What was your average waking time over the last month?”Medical records were obtained, including maternal age, parity, height, pre-pregnancy body weight, body weight before delivery, blood glucose during pregnancy , gestational age at delivery, birth weight, and placental weight. Additional history, including information about Type1 or Type 2 DM or previous GDM diagnosis, and use of steroids during pregnancy were collected. Sleep duration, pre-pregnancy body-mass index (BMI) and gestational weight gain were calculated from raw data.Glucose tolerance screening and testing for GDM was performed according to the protocols of the Obstetrics Society or Diabetes Society of Japan depending on the local institution using a 2-step protocol , non-compliant blood glucose screening results , existing type1 or type 2 diabetes (n = 686), and average sleep duration values less than 3 and over 13 h (n = 2686). Finally, 48,787 subjects were included in the analysis , with values estimated from sleep start and waking time survey responses. The 7 to < 10 h group was set as the reference. Because the random blood glucose level data did not have a normal distribution, the median  per sleeping duration were expressed, and the Mann-Whitney test based upon non-Gaussian distribution was used to compare sleep group blood glucose levels. Covariant factors included age, pre-pregnancy BMI, gestational weight gain , steroidn = 48,787) are provided in Table To begin our analysis, in addition to missing data, mis-reported sleep habits, and pre-existing T1 and T2DM, a large number of participants were excluded due to non-compliant blood glucose screening in order to remove variation associated with differences in screening and testing protocols  levels for each sleep category are presented in Table p = 0.006), compared to the reference group of 7 to < 10 h sleep per night. An elevated risk was also observed in the < 5 h sleep group (OR 1.17 (0.96–1.44)), however the statistical significance of this association fell short (p = 0.126).Comparing the positive-screening rates between the four sleep duration categories Table , signifiFinally, the risk for GDM diagnosis relative to sleep duration was determined using a log-binomial regression model. Women sleeping < 5 h were found to have 1.30-fold risk for GDM. Similarly, women sleeping ≧10 h had a 1.21-fold risk for developing GDM compared to the reference group Table . Howeverp = 0.006), compared to the reference group. An elevated risk in the limited, < 5 h sleep group, although non-significant, was also observed (OR 1.17 (0.96–1.44), p = 0.126). The significant association measured here between excessive or limited sleep and blood glucose metabolism failed to translate into the increased GDM diagnosis rates that are predicted. Indeed, only modest increases could be determined for the < 5 h (OR = 1.31 (0.74–2.30), p = 0.353) and ≥ 10 h (OR = 1.21 (0.90–1.63), p = 0.207) sleep duration groups.This study utilized a large cohort study representing the population of Japan to focus on defining the effects of sleep duration on glucose metabolism and the risk of GDM . Particip = 0.002), were both associated with elevated risk of GDM diagnosis. In the case of minimal sleep, this elevated risk was found to be significant.Based upon similar studies, it was surprising that this large cohort data set did not reveal a significant relationship between sleep and GDM rates. By an alternative analysis, using eight, 1-h sleep duration categories, the same trend was revealed as that using four categories  and GDM is a global medical concern. Importantly, there is evidence for risk factors that are associated with different ethnic groups and races . Two stuWhile the size of this study allowed us to draw significant conclusions about the relationship between sleep quantity and blood glucose metabolism, this study is preliminary in regards to sleep and GDM incidence in Japan. Future questionnaires should include a validated sleep survey to better quantify sleep duration. In addition, data on related, confounding factors not accounted for in this study, such as sleep quality, a primary risk factor of GDM which acts through changing glucose metabolism should be collected , 12.The variability that is inherent in a large, nationwide cohort study was also likely to adversely affect our outcome. Designed to represent the diverse living conditions and areas of Japan, data collection was dependent on a large number of institutions, ranging from university research hospitals to small obstetrics clinics . Even inThis investigation aides the current effort to identify and define modifiable factors associated with the growing global threat of Diabetes. Our findings of a U-shaped association between sleep duration and glucose metabolism, support other current reports. In addition, this report importantly adds unique data from the East Asian population of Japan to help understand racial differences, as well as to address the growing proportion of Diabetes cases associated with this population relative to the entire world.Additional file 1 Fig. S1. Glucose Tolerance and Gestational Diabetes Screening schedule. Table S1. Comparison of the study group and original total population characteristics. Table S2. Risk for GDM associated with sleep duration.Additional file 2. Supplementary Ethics Committee titles of all participating institutions.


Pulmonary veins are involved in pathogenesis and treatment of atrial fibrillation and structures at risk during thoracic surgeries. There is lack of data regarding pulmonary vein morphology and morphometry in normal population.The study was conducted using 135 chest computed tomography studies with intra-venous iodine contrast injection. The study population contained 86 females and 49 males, mean age was 60. 13 had atrial fibrillation.The studies were analyzed using radiological workstation.3. The mean volume of the left atrium in patients with atrial fibrillation was 176 cm3. The sagittal dimension and the volume of the left atrium were correlated with age, r = 0.43 and r = 0.42, respectively. Surface area of the left inferior pulmonary vein ostium was 136 mm2, significantly less than the surface area of other ostia of pulmonary veins. The mean distance between two pulmonary veins was 5.42 mm on the right and 4.02 mm on the left side. 13 types of pulmonary veins outflow patterns were described on the right side and 5 types on the left side. 66.7% of right pulmonary veins and 82% of the left pulmonary veins emptied into the left atrium with two venous trunks on each side .Mean dimensions of the left atrium: transverse 52 mm, coronal 49 mm, and sagittal 35 mm. The mean volume of the left atrium was 93 cmMorphological features of pulmonary veins and morphometry of the left atrium and pulmonary veins are important for clinical purposes and are in accordance with previous papers. Pulmonary veins (PVs) and the left atrium (LA) are central in pathogenesis of atrial fibrillation (AF) , 26. ThiThe modern era of minimally invasive thoracic procedures such as video-assisted thoracic surgery (VATS) for lung cancer resection puts new challenges for surgeons. The atypical venous anatomy during lung resection was acknowledged in 3.12% of 642 analyzed cases by Polaczek et al. . With VAThere is missing data about morphology and morphometry of PVs, LA and the veno-atrial junction in population of patients with population-rate occurrence of AF, a group that would normally undergo surgical treatment for lung cancer.The study was based on retrospective analysis of 135 chest computed tomography examinations with iodine contrast enhancement performed in our institution between 2011 and 2017. Study population was aged 18–84 (average age was 59.97), there were 86 females and 49 males. The clinical indication for MSCT was one of the following: unspecific changes in chest plain radiogram, history of haemoptysis, suspicion of pulmonary embolism and follow-up of peripheral pulmonary nodules of less than 10 nm in diameter; all the radiological reports stated no significant abnormalities, so the study population can be considered representative for the general population of patients. The main inclusion criterion was good contrast enhancement of PVs defined as the density over 80 Hounsfield Units (HU) of the region of interest (ROI) in the right inferior pulmonary vein (RIPV) trunk. The average ROI was 266.11 HU. The exclusion criteria contained all clinical conditions impacting pulmonary circulation and were described in details in the study protocol. The only exception involved patients with AF, who were included in this study, but constituted separate subgroup for analysis. There were 13 cases of AF included.Examinations were performed using Sensation 16  16-row scanner and Revolution GSI  64-row scanner. The reconstructions were made with 1.00 and 1.25 mm thick layers. Iodine intra-venous contrast was injected into the cephalic vein using automatic syringe.After selection of 135 studies from the database the “raw” DICOM files were imported from a server (PACS) to Syngo.via—syngo.via Client 3.0  workstation and processed in syngo.CT Vascular Analysis  work mode. The source material in axial planes was reconstructed into sagittal and coronal planes using multi-planar reformations (MPR). MPR was also used to reconstruct oblique planes. Vascular structures and left atrial appendage (LAA) were identified and presented using curved-planar reformations (CPR). VRT was used to create three-dimensional color-coded images, automatic and manual segmentation techniques were used to brush all structures covering pulmonary vessels.ax), sagittal (LAsag), and coronal (LAco), and the LA volume was calculated using two separate formulas for cuboid LAvol:c = LAax*LAsag*LAco and for ellipsoid LAvol:e = 4/3∏*LAax/2*LAsag/2*LAco/2. Having CPR of LAA and of all identified PVs, the measurements of ostial parameters were made . The ratio of minimal to maximal dimension was considered as the ostial narrowing. The length of each PV trunk was measured from the ostium to the first bifurcation. Shared oblique plane for unilateral PV was established, distance between veins and angle between long axes were measured.All pulmonary veins were identified and the morphology of venous outflow was determined. After identification, the measurement of LA was made: dimensions in axial (LAt test (t) and Pearson’s correlation (r). Parametric data without normal distribution and non-parametric data were analyzed with Mann–Whitney’s U test , Spearman’s correlation (R) and Chi square . P value less than 0.05 was considered as statistically significant. The numbers were presented with two decimal places.All observations were saved as images in TIFF format, all measurements written in the study form. Statistical analysis was performed using Statistica v.13 (StataSoft). Numerical data are presented as mean/average and median (MED) value, standard deviation (SD), minimal (MIN) and maximal (MAX) value, 10th and 90th percentile . Parametric data with normal distribution (in Shapiro–Wilk’s test) were analyzed with Student’s ax = 51.69 mm (SD = 12.09), followed by the coronal dimension-mean LAco = 48.60 mm (SD = 7.18) and sagittal-mean LAsag = 35.00 (SD = 8.83). In subgroup without AF (AF−) LAsag 90p was 41.00 mm , so it was significantly different when compared to AF positive (AF+) subgroup, where LAsag 10p = 39.20 mm , so an arbitrary value of 40 mm for LAsag was a distinction to predict whether it was AF positive or negative case.Left atrium axial dimension was the greatest of all, mean LAvol:c was in average 92.72 cm3  with minimal value as low as 18.55 cm3 and maximal as high as 290.48 cm3. LAvol:e was accordingly lower . LA volume was significantly different when AF was taken into consideration, the median volume was twice higher in AF+ subgroup, compared to AF− subgroup, 166.56 cm3 and 78.95 cm3 for cuboid shape, respectively. Dimensions and volume of LA increased with age; linear correlations with age was proven for LAsag , for LAvol:c  and for LAax . Only LAco did not correlate with age .LA2 (SD = 117.64), with great difference between AF+ and AF− subgroups (403.62 and 210.83 mm2). With age the shape of LAA orifice changes, it gets less flattened and more round shaped: there was correlation between narrowing and age r = 0.27, p = 0.002. In AF+ subgroup, an increase in LAvol:c led strongly to an increase of LAA orifice surface area . The length of LAA should be considered as individual feature, no relation to age or AF was found. The mean LAA length was 27.55 mm .The orifice of LAA is oval and flattened coronally; the narrowing of LAA was 0.62. The mean surface area of LAA orifice was 229.53 mm2 = 12.40, df = 25, p = 0.98, on the left chi2 = 5.76, df = 9, p = 0.76. In AF+ subgroup, the most frequent type observed on the right side was three right pulmonary veins (a separate vein from the middle lobe) observed in 38.46%. No atypical pattern was proven to be more frequent than expected in AF+ group in comparison to AF− group, most likely due to small number of cases in AF+ subgroup. The frequency of all drainage patterns presented in Figs. There was great variability of venous outflow to the LA on the right side, from one to five separate veins were observed, taking into consideration the drainage area and the length of venous trunk, 13 separate drainage patterns were described Fig. . Even if2, and the difference was statistically significant, respectively, right superior pulmonary vein (RSPV) vs. LIPV t = 2.26, p = 0.02, RIPV vs. LIPV t = 2.95, p = 0.003, left superior pulmonary vein vs. LIPV t = 3.86, p < 0.001. There was no difference in the surface area of the ostia of RSPV, RIPV and LSPV. There was also no difference between the surface area of the ostium of common trunk of right PVs (commRPV) and commLPV, t = 1.20, p = 0.24. The narrowing of the ostium decreased (ostium become more round) with the ostium surface increasing, the relation is linear, with mild correlation level, but statistically significant .Detailed morphometry of the most commonly observed pulmonary veins trunks and the openings intto the LA is presented in Table When the median length of the trunks of different veins was compared  it was found that:U = 2655.50, Z = − 8.40, p < 0.001; LSPV vs. RIPV: U = 273.00, Z = 12.84, p < 0.001; LSPV vs. LIPV: U = 2151.50, Z = 8.38, p < 0.001; commLPV vs. LSPV: U = 887.50, Z = − 2.555, p = 0.01);the trunk of LSPV is the longest and it is statistically significant ;the trunk of RIPV is the shortest and the difference is statistically significant  and in the left it was 4.025 mm . Even if numerically the difference of the distance is not spectacular (1.4 mm), the distance between right pulmonary veins and left pulmonary veins ostia is statistically different, sag significantly increases in patients with AF: based upon a sum of 731 literature cases of patients with AF LAsag in AF+ was 39.61 mm, so the proposed arbitrary value of 40.00 mm to predict AF by computed tomography seems reasonable and is also similar with echocardiographic range of normal values of LAsag which is 23–40 mm proposed by Tracz et al. [sag was the parameter which has the strongest correlation with age, so the norm would not apply to adolescent and elderly patients.It is well known that age and morphometry of LA are risk factor of AF , 20, 33.z et al. . This noz et al. . LAsag wDespite LIPV being considered by Elliott as the smallest of all PVs , there iObserved differences of PV trunks length are not only statistically but also clinically important. Short trunk is considered by Stanford and Breen  as diffiThe typical anatomy of right and left PV are two separate ostia on each side, this was true in our series in more than 66% on the right and almost 82% on the left, comparing to literature data where the typical anatomy of right PV was observed in 60–88% and of left PV in 41–91% , 28, 32.Separate vein of the middle lobe was observed in more than 25% of cases and was one of three of right PVs in 20.74%, what made it the most common variation of pulmonary vein outflow in our study. This was also observed in the past by other authors in 7.9–26.7% of cases , 28, 34.Morphological features of pulmonary veins and morphometry of the left atrium and pulmonary veins are important for clinical purposes and our results are accordance with previous papers. With the current data, the range of normal values and typical drainage patterns can help to better identify potentially risky variations and to better prepare for surgery or catheter ablation.


Gammarus duebeni celticus exhibited similar type II (destabilizing) functional responses (FRs) towards native mayfly prey and invasive amphipod prey, when these prey species were presented separately. However, when the two prey species were presented simultaneously, the predator did not exhibit prey switching, instead consuming disproportionately more native prey than expected from the relative abundance of native and invasive species. These consumptive propensities foster reductions of native prey, while simultaneously limiting biotic resistance against the invasive species by the native predator. Since our theoretical considerations and laboratory results match known field invasion patterns, we advocate the increased consideration of FR and prey switching studies to understand and predict the success of invasive species.Invasive species continue to severely impact biodiversity, yet predicting the success or failure of introduced species has remained elusive. In particular, the relationship between community invasibility and native species diversity remains obscure. Here, we apply two traditional ecological concepts that inform prey population stability and hence invasibility. We first show that the native predatory crustacean  Debate Traditionally, ecologists have used the ‘functional response’  to quantify interaction strengths, such as between predator and prey . While tCrangonyx pseudogracilis, invades species-rich freshwater habitats, but faces predation by resident native amphipods [Gammarus duebeni celticus to larvae of the native mayfly Baetis rhodani and the invasive gammarid C. pseudogracilis.In this study, a common field pattern is examined, where an invasive amphipod, mphipods ,10. A pa2.G. d. celticus (1.5–2 cm body length) were collected from Glen Road stream, County Down, UK . Their commonly consumed prey [B. rhodani (0.7–0.8 cm) were collected from Dunore stream, County Antrim , and the invasive amphipod C. pseudogracilis (0.7–0.9 cm) from ponds in Clandeboye Estate, County Down . Each species was transported to the Queen's University Belfast laboratory in source water and maintained separately in continuously aerated source water with stream flora and fauna supplied ad libitum at 12°C (±2°C) and a 12 L : 12 D regime.In November 2014, unparasitized male native river shrimp med prey , native Gammarus duebeni celticus were then selected haphazardly and starved individually for 24 h in cylindrical arenas of 8 cm diameter with 50 ml of filtered source water. In Experiment 1, for the two prey species separately, five prey densities  were introduced into arenas as above containing 150 ml of water and allowed to settle for 30 min prior to the addition of individual predators which were allowed to feed for 24 h; live and eaten prey were then counted. In Experiment 2, the two prey species combined were presented to individual predators for 3 h at seven prey species ratios . Prey were replaced as they were consumed to maintain nominal prey species ratios. Controls for both experiments were one replicate of each experimental group with the predator absent .Ne is the number of prey eaten, N0 is the initial density of prey, a is the attack constant, h is the handling time and T is the total experimental period. The Lambert W function was used for model fitting [n = 2000) to generate 95% confidence intervals. In Experiment 2, Chesson's selectivity index [iα is Chesson's selectivity index for prey type i, in is the number of prey type i available at the start of the experiment, ir is the number of prey type i consumed, m the number of prey types, jr is the number of prey type j consumed and jn the number of prey type j available at the start of the experiment. The value of iα ranges from 0 to 1, with 0 indicating complete avoidance and 1 indicating complete preference. In the two prey systems, values of 0.5 are indicative of no selectivity. Chesson's indices were transformed to reduce extremes :αt is the transformed output and n is the sample size. Beta-regression using the ‘betareg’ package [αt values between ‘prey’ and ‘proportion’, and their interaction.Data analyses were undertaken in ‘R’. The package ‘frair’ was used for FR analyses . In Expe fitting . Data wety index ,16 assum package  in ‘R’ w3.B. rhodani, first-order term = −0.07, p < 0.001; C. pseudogracilis, first-order term = −0.05, p < 0.001). Functional response magnitude (curve asymptote) trended towards being higher upon the native B. rhodani; however, confidence intervals overlapped across all prey densities, and thus, similarities for prey in attack rate and handling time parameters can be deduced . Prey preferences were significantly affected by proportions available , and there was a significant ‘prey × proportion’ interaction  reflecting increases in preference towards B. rhodani at intermediate prey proportions  of both prey species when presented separately. However, where the two prey species were supplied to the predator simultaneously, no prey switching occurred across the prey ratio spectrum, with G. d. celticus consistently showing a significant preference for the native B. rhodani over the invasive C. pseudogracilis. The biotic resistance hypothesis posits that non-native species can be prevented from establishing and spreading, and hence exerting negative ecological impact, due to resident predators and competitors in the recipient area, with higher species richness conducive to higher resistance [C. pseudogracilis populations may be alleviated of resistance by predators which disproportionately consume higher levels of native prey across relative prey availabilities. This, coupled with the type II FR demonstrated, may drive localized reductions/extinctions of native species and hence facilitation of invasive species. Indeed, mayfly populations are known to be seriously depleted in the face of predation by Gammarus species [C. pseudogracilis invades species-rich aquatic systems [The impacts of invasive species on native species populations can be severe and are continuing, and thus, the development of predictive methodologies is crucial to effectively understand and forecast invader success or failure in terms of establishment and spread. Furthermore, we require elucidation of why there are no consistent patterns of invasibility with respect to community diversity. The use of FRs has provided meaningful insights in the context of invader impact , particusistance . However species ,21 and C systems ,10. Our In summary, the application of FRs, prey switching and prey preferences to invasion ecology can foster a new framework to better understand biotic resistance and invader success. While the comparative FR method has been shown repeatedly to be a robust predictor of invader impact , shortco