Phyo Kyaw Myint

Objective: This study aimed to investigate the association between the amount and source of dietary protein and the prevalence of sarcopenic obesity. Design: A prospective study using data from the European Prospective Investigation of Cancer (EPIC)-Norfolk cohort study. Setting: General population-based study conducted in the United Kingdom. Participants: About 14 816 community dwelling men and women aged 39–79 years. Results: The prevalence of sarcopenic obesity was 8·9 % in men and 11·9 % in women. Median dietary intake of total, animal and plant protein intake, based on fat free mass standardised for BMI to assess sarcopenia, was significantly lower in those with sarcopenic obesity compared with those without sarcopenia and obesity (0·80 v . 1·04, 0·51 v . 0·66, and 0·25 v . 0·35 g/kg body weight/d, respectively, all P < 0·001). Higher intakes of protein, either total, animal or plant-based (in g/kg body weight/d), were associated with a significantly lower likelihood of sarcopenic obesity (OR 0·14 (95 % CI: 0·08, 0·20), 0·58 (0·53, 0·62) and 0·46 (0·41, 0·52), respectively, P < 0·001 for all). The prevalence of both sarcopenic obesity and obesity was significantly ( P < 0·001) higher in those with lowest compared with those in the highest intake quartiles of total- animal- and plant protein, but the prevalence of sarcopenia did not appear to depend on protein intake. Conclusions: Our findings indicate that consumption of total, animal- and plant-based protein is important for both the prevention of sarcopenic obesity and obesity during ageing, especially in women, smokers or those living with comorbidities such as diabetes and bronchitis.

Background Pain in the older population is often poorly identified and subsequently poorly managed. Many myths and misconceptions exist amongst both older adults and healthcare professionals, including fear of using other methods of pain management and failure to monitor the impact of current approaches. This leads to underreporting of pain by the older adult population, overprescribing of pain medication, and failure to monitor the impact of prescribed drugs until major health crises such as falls or other serious complications occur, which can result in hospitalisation. Methods The aim of this study was to explore chronic pain prescribing in older adults, both in terms of the population itself and in terms of individual perceptions, experiences and overall needs. As such, two work packages were employed, firstly to explore the wider prescribing patterns using the CPRD database (quantitative work package), and secondly to explore individual experiences using qualitative interviews (qualitative work package). The mixed methods methodology included an epidemiological approach along with qualitative methodology and a discrete choice experiment. Ultimately, the final outcomes of this investigation will lead to adopting a codesigned intervention which will be evaluated in a later research programme. This protocol focuses on both the qualitative work package and the wider project, including a brief outline of the quantitative work package. A more detailed technical protocol for the quantitative work package is available in a linked publication.

Background/Objectives: Multiple sclerosis (MS) is an autoimmune neuroinflammatory disease affecting 2.9 million worldwide. Current immunosuppressive treatments offer limited neuroprotection and often cause adverse effects. Polyphenols with antioxidant and anti-inflammatory properties have been investigated as adjuncts in MS. Methods: On 19 June 2025, Embase, Medline, and ClinicalTrials.gov were systematically searched. Eligible clinical trials assessing polyphenol supplementation in MS were included. Outcomes of interest were Expanded Disability Status Scale (EDSS), annualised relapse rate (ARR), magnetic resonance imaging (MRI) changes, safety, and tolerability. Risk of bias was evaluated using the Cochrane tool, and certainty of evidence was appraised with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The protocol was registered with PROSPERO (CRD420251052042). Results: Of 870 records identified, 13 trials (n = 785) met inclusion. Nanocurcumin consistently improved EDSS in relapsing–remitting MS (3 trials, n = 150; p = 0.039–0.041), while epigallocatechin-3-gallate, silymarin (SM), cranberry extract, and bio-enhanced curcumin extract (BCM-95) curcumin showed no significant impact on disability, relapse rates, or MRI outcomes. Intervention adverse events were generally mild. SM showed potential hepatoprotective effects. Risk of bias was determined as low risk for seven of the trials and of some concern for five of the studies. Most often raising concerns because of selective reporting. Certainty of evidence, assessed using GRADE, was generally moderate, indicating some uncertainty regarding the outcomes. Meta-analysis was not possible due to the heterogeneity of included studies. Conclusions: Nanocurcumin may contribute to improvements in disability outcomes in Relapse Remitting Multiple Sclerosis (RRMS), whereas other polyphenols lack consistent efficacy. However, the evidence base remains limited by small sample sizes and methodological concerns. Larger, multicentre randomised controlled trials are required to establish optimal dosing, long-term safety, and therapeutic potential.

Background: National Medical Products Administration of China has actively encouraged organizations to adopt the Clinical Data Interchange Standards Consortium (CDISC) for clinical data submission since 2020. Objective: This study aimed to explore the knowledge, attitudes, practices, and barriers to using the CDISC among data managers and to propose strategies for promoting CDISC use in China. Methods: A total of 38 participants as leaders or experts of data management departments and teams were recruited from 38 organizations in China from April to August 2022. Data on knowledge, attitude, practice, and barriers to the CDISC, as well as strategies for its dissemination, were collected using a semiqualitative interview guide. For textual data, thematic analysis was conducted using a hybrid approach integrating constructivist and deductive logic, involving iterative coding and theme saturation checks. Results: Of the 38 participants, 36 (94.7%) mentioned that the National Medical Products Administration of China specifying CDISC standards used in submitting data is important for clinical trials, 32 (84.2%) supported this policy, and 29 (76.3%) had experience with CDISC-compliant submissions. The primary barriers to CDISC implementation included high costs, shortage of specialized expertise and training resources, inadequate localization support, inherent complexity of CDISC standards, incomplete standard specifications, lack of detailed regulatory guidelines, low overall proficiency in clinical research, heterogeneity among enterprises and institutions, and challenges related to organizational survival. Corresponding promotional strategies included cost reduction, strengthened publicity and training, adoption of the CDISC from clinical study design, development of supporting tools, integration of traditional Chinese medicine terminology into the CDISC, refinement of CDISC standards, formulation of detailed regulatory guidelines, establishment of a review system, and promotion of collaboration among enterprises and institutions. Conclusions: The CDISC has been recognized, adopted, and supported by most data management experts in China. However, key barriers to its widespread implementation continue to include cost burdens, expertise shortages, and inadequate technological, social, and policy support. Strategies to advance CDISC dissemination should prioritize improving cost-effectiveness, strengthening outreach and training, and refining regulatory frameworks. These findings provide valuable references for international regulators and sponsors in advancing the global adoption of the CDISC.

The heritability of hypertensive disorders of pregnancy (HDP) and HDP’s association with cardiovascular disease in adult offspring were explored through a systematic review and meta-analysis. MEDLINE and EMBASE were searched independently by 2 reviewers (inception to February 18, 2025). Maternal chronic hypertension, antenatal complications, and pediatric cardiovascular disease were excluded. The Critical Appraisal Skills Program checklist was used for critical appraisal. Random-effects meta-analysis was conducted using a generic inverse variance method. Narrative synthesis and pooled results were expressed as odds ratios with 95% CIs. Of 225 studies screened, 11 studies (n=59 185; 48.3% women) assessed cardiovascular disease, and 9 studies (n=58 512) assessed HDP. Offspring age ranged from 19 to 55 years. There were 11 good- and 9 fair-quality studies. Fifteen studies were included in the meta-analysis (n=266 244). Adult offspring exposed to HDP had systolic and diastolic blood pressure that was 3.40 mm Hg (95% CI, 2.44–4.37; I ² =40%) and 2.19 mm Hg higher (95% CI, 1.40–2.98; I ² =51%). Higher odds of hypertension were observed (odds ratio, 1.50 [95% CI, 1.18–1.91]; I ² =66%). Female offspring exhibited 72% increased odds of HDP (OR, 1.72 [95% CI, 1.41–2.09]; I ² =81%) and 90% increased odds of preeclampsia (odds ratio, 1.90 [95% CI, 1.47–2.46]; I ² =36%) following exposure to the same disorders. Increased odds of premature acute coronary syndrome and higher stroke risk were observed following HDP and severe preeclampsia exposure, respectively. In adult offspring, heritability of HDP was high. HDP were associated with hypertension, acute coronary syndrome, and stroke. Lifestyle modifications, cardiovascular disease monitoring, and prevention are paramount.

Older people are at the greatest risk of harm from medicines.1 Rising life expectancy and greater multi-morbidities, has resulted in increased usage of medicines amongst older people.2 Age related ...

Obesity in older persons may increase the risk of falls, but this relationship may vary depending on body composition and cultural behaviors, which may vary across regions and ethnic groups. This study aims to explore the differences in the association between increased BMI and falls among Asian and Caucasian populations, using data from the Malaysian Elders Longitudinal Research (MELoR), the Bavarian Research Association-Sarcopenia and Osteoporosis (FORMOsA) and the 3rd Health Check for European Prospective Investigation of Cancer-Norfolk (EPIC-NORFOLK) studies. We analyzed baseline data from the MELoR, FORMOsA, and EPIC-NORFOLK cohorts, focusing on older women aged ≥65 years (MELoR), ≥70 years (FORMOsA), and ≥55 years (EPIC-NORFOLK). We assessed body mass index (BMI), body composition, fall risk, and physical performance (gait speed, handgrip strength) to explore the relationship between BMI and falls, conducting cross-country and ethnic subgroup analyses. Statistical analysis was performed using multivariable logistic regression to controlling for confounding factors. A total of 10,265 participants aged 55 and over were eligible to be included. The prevalence of people with falls was higher in FORMOsA (54.4%) compared to both MELoR (22.5%) and EPIC-NORFOLK (26.9%) cohorts. It found significant differences in age, gender, BMI, body fat, and fall prevalence across the three cohorts. BMI was significantly associated with fall risk in both the MELoR and FORMOsA studies, but not the EPIC-NORFOLK study. The relationship between BMI and falls remained unchanged after adjustment for age, gender, marital status, education level, smoking status, number of medications and medical comorbidities. Intercontinental and international variations were observed in the relationship between BMI and falls among adults aged 55 and older. While higher BMI was linked to increased fall risk in some populations, these associations varied by body composition and country, suggesting the need for culturally tailored fall prevention strategies among older persons.

Background and Objectives: Anticholinergic burden (ACB) cumulatively leads to adverse outcomes and increased mortality. Taiwan's NHIRD prevalence studies indicate ~60% of elderly patients (≥65) annually receive anticholinergic medications. In those with polypharmacy, 60–80% were exposed to anticholinergic medications, which was linked to higher risks of pneumonia, myocardial infarction, and stroke. This study aims to survey physicians’ knowledge and attitudes on Anticholinergic Burden (ACB) in Taiwan, directly addressing a recognized gap in clinical practice. Materials and Methods: This nationwide, anonymized online 3-month survey (July–September 2025), used the KAP framework. Physicians from 92 hospitals across Taiwan were invited to participate via e-mail. The survey covered demographics, ACB knowledge, attitudes, practices, and feedback, utilizing branching logic. Data was analyzed and presented descriptively. Of 62 respondents, only 23% of physicians were aware of the term 'Anticholinergic Burden' (ACB). Knowledge of specific common medication ACB scores was low (average 1.86/10), and respondents showed significant uncertainty regarding the risks associated with high ACB. Despite 53% of physicians (33/62) rating ACB assessment as "Important/Very Important," this rarely translated into practice: most never calculated scores, and only one did so routinely. Fifty-six participants' overwhelming demand for increased ACB education emphasizes the critical need for training to close both the identified knowledge and knowledge-practice gaps. Conclusions: Physician’s knowledge of medicines with anticholinergic property is relatively low in Taiwan despite the awareness of its importance. There is a clear knowledge and knowledge-practice gap which can be addressed through targeted educational activities.

BACKGROUND: Takotsubo cardiomyopathy is an acute cardiac emergency presenting with severe left ventricular dysfunction. Physical exercise training or cognitive behavioral therapy may enhance myocardial recovery after takotsubo cardiomyopathy. METHODS: In a prospective multicenter clinical trial conducted between February 2020 and August 2023, patients with acute takotsubo cardiomyopathy were randomized 1:1:1 to physical exercise training, cognitive behavioral therapy, or standard care for 12 weeks after index presentation. The primary end point was resting phosphocreatine/gamma-ATP ratio assessed by ³¹ P-magnetic resonance spectroscopy. Secondary end points were the rate of oxygen consumption at peak exercise on cardiopulmonary exercise testing, 6-minute walk distance, left ventricular global longitudinal strain, and the Minnesota Living With Heart Failure Questionnaire. Twelve-week changes in outcome were compared between allocated trial interventions. RESULTS: Seventy-six participants were recruited: the median age was 66 years, and 91% were women. Compared with standard care, the primary end point of myocardial phosphocreatine/gamma-ATP ratio was improved by physical exercise training (0.4 [95% CI, 0.1–0.8]; P =0.016) and cognitive behavioral therapy (0.3 [0.01–0.7]; P =0.043). Both physical exercise training and cognitive behavioral therapy improved rate of oxygen consumption at peak exercise (4.7 [1.4–8.0] and 4.0 [1.5–6.4] mL/min per kg; P =0.001 and 0.004, respectively) and 6-minute walk distance (92.6 [24.7–160.6] and 73.3 [7.9–138.8] m; P =0.004 and 0.029, respectively) compared with standard care. There were no differences in global longitudinal strain or symptom burden. CONCLUSIONS: In patients with acute takotsubo cardiomyopathy, a 12-week intervention with exercise training or cognitive behavioral therapy improved left ventricular myocardial energetics and exercise performance without demonstrable effects on symptoms of heart failure. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04425785.

Background: Intracerebral hemorrhage (ICH) survivors are at increased risk of major adverse cardiovascular and cerebrovascular events (MACE) compared with population controls; however, little is known about the annual rates and risk factors for MACE. Methods: We searched Medline, Embase, and trial registries systematically in April 2024 for studies of adults with ICH, reporting either a MACE composite outcome or both ischemic and hemorrhagic outcomes, with at least one year of follow-up. We excluded studies limited to secondary ICH or isolated non-ICH intracranial hemorrhages. We used the QUIPS tool to assess studies’ risk of bias. The primary outcome was the rate of MACE. We used a random-effects meta-analysis to estimate the annual event rate (per 100 person-years, expressed as %) for each outcome. We conducted subgroup analyses and meta-regression to explore heterogeneity. Results: We included 26 studies, involving 198,289 ICH survivors. Individual studies’ reported annual rate of MACE ranged 4.2–14.6%. The pooled annual rate of recurrent ICH was 2.1% (95% confidence interval (CI) = 1.7–2.6; 26 studies; I ² = 94%) and of ischemic stroke was 2.0% (95% CI = 1.5–2.7; 24 studies; I ² = 95%). Meta-regression analyses identified one statistically significant association between a higher prevalence of atrial fibrillation and an increased risk of ischemic stroke. Discussion: The rates of recurrent ICH and ischemic stroke were comparable among ICH survivors, but evidence about other MACE outcomes remains limited. An individual participant data meta-analysis is needed to investigate the predictors of MACE outcomes, which may help inform risk stratification and prognosis among ICH survivors.