Year 2. May 1. Diversity in Health, Education, and Research.
Minority Health Month concluded in April, however our efforts to address the health inequities experienced by minoritized communities continues year-round. Let me share with you some of the research projects taking place in the department of medicine (DoM) focused on improving our understanding of the development and treatment of illness within communities that are traditionally underrepresented in biomedical research.
UCLA is a national site participating in the NIH funded All of Us Research Program which seeks to build one of the most diverse health databases in the country. This longitudinal cohort study seeks to follow the health journey of diverse patient populations, studying their health profile and medical conditions. The study aims to recruit 1 million participants to contribute data from their electronic health record, biospecimens, and surveys. It considers underrepresented in biomedical research across diversity categories that include ancestry, sexual orientation, income, level of education, access to health care, geography, and disability. The lack of health data from underrepresented communities has posed great challenges in determining the best care and treatment options for many. With this new database, the information collected will provide researchers from across the globe access to biological, environmental, and behavioral data that will increase our ability to answer many pressing research questions.
I am pleased to share that the primary investigator leading this project at UCLA is Zhaoping Li, MD, PhD, executive vice chair in the DoM for the VA Greater Los Angeles Healthcare System. As part of the All of US Research Program, she is leading the first ancillary study under All of Us, titled “Nutrition for Precision Health” which will explore how different diets impact individuals, with a focus on studying participants that are underrepresented in biomedical research. Her study will include two groups: one group will consume an American diet over a 14-day period, the second group will live in a controlled environment and consume a Mediterranean/ DASH diet over the course of three 14-day periods. The goal of the study is to learn how people respond to diets and seeks to identify people who are at risk for developing metabolic disease at early time points. Researchers were recently visited by the NIH in preparation for the launch of their study in May.
“This is the first study of its kind; the intention is to include everyone and not a specific segment of the population that meets a certain criteria. We are truly trying to study everyone so that we can learn what makes individuals likely to develop illness or disease,”states Dr. Li.
This project is a collaborative effort with the American Heart Association and includes DoM faculty members Mopelola Adeyemo, MD, MPH from the division of Clinical Nutrition, and Arleen Brown, MD, PhD, and Alejandra Casillas, MD, MSHS from the division of general internal medicine and health services research.
Next, I would like to highlight the Department of Veterans Affairs’ Million Veteran Program (MVP). The VA Greater Los Angeles Healthcare System serves as one of the larger study sites in the nation with Agnes Wallbom, MD, from the physical medicine and rehabilitation section at the VA Greater Los Angeles Healthcare System, leading this initiative. Similar to the All of Us Research Program, the MVP is a genetic and health research program which examines how genes, lifestyle, and military experience affect health and illness among veteran populations. The study has been collecting data since 2011 and currently has over 930,000 participants with 9% of participants being women, who have been historically underrepresented in VA-based biomedical research.
These two studies not only demonstrate our commitment to improving our understanding of minority health, but also our leadership in precision medicine at the VA and UCLA Health. We will continue to seek new treatments and screenings to target individual health and increase positive health outcomes for all.
In addition to leading important research, our faculty are deeply committed to mentoring trainees to develop the next generation of leaders, through research, grounded in our values and commitment to equity, diversity, and inclusion. For example, at the VA GLA, faculty members Dan Ly, MD, PhD, Utibe Essien, MD, MPH, Donna Washington, MD, MPH served as coauthors with emergency medicine physician Jessica Faiz, MD on the publication “Racial and Ethnic Differences in Barriers Faced by Medical College Admission Test Examinees and Their Association With Medical School Application and Matriculation,” which was recently published in JAMA Health Forum. There is general consensus that it is essential that the medicine workforce resembles the diverse communities that we serve each day. However, in this latest study from Dr. Faiz and the DoM VAGLA faculty, the team noted that financial, social and educational barriers were greater for MCAT examinees who identified as American Indian, Alaska Native, and Hispanic. These barriers correlated with a lower likelihood of applying to or enrolling in med school. Cross sectional studies such as these are critical towards understanding the causes that contribute towards the lack of diversity in medicine and should help us begin to identify solutions to help underrepresented students in medicine achieve their goals of becoming physicians or physician scientists. You may read the publication HERE.
Next, I would like to shine the spotlight on Xiaobei Zhang, PhD, a postdoctoral researcher in the Gupta Lab in the division of digestive diseases, who was recently awarded the American Gastroenterological Association’s Abstract Award for Health Disparities Research. This award is aimed at supporting gastroenterology and hepatology research that improves access to care and treatment of underserved patients. Dr. Zhang shares the following summary about her award-winning abstract:
The study titled “Discrimination Exposure Impacts Unhealthy Processing of Food-Cues: Crosstalk Between the Brain and Gut” explores the connection between experiences of discrimination related to changes in the brain-gut-microbiome system that promote unhealthy responses to different types of foods, potentially leading to unhealthy eating habits and obesity. Discrimination has been linked to a higher obesity risk, almost 3-6 times increased odds of having obesity, but the biological pathways that connect discrimination and obesity are not well understood. The study investigates how chronic experiences of discrimination, as a type of environmental stressor, can modify the bidirectional communication between the brain and gut in response to different types of sweet and savory healthy and unhealthy food images. We found alterations in neural responses to unhealthy food cues (sweet and savory) in the reward processing and motivation regions and in executive control in response to healthy food cues. Discrimination was also associated with altered gut glutamate metabolites involved in oxidative stress and inflammation. Importantly, the study found that discrimination significantly impacts the bidirectional communication between the brain and gut, but only when processing unhealthy sweet foods, highlighting the addictive nature of sweet foods in leading to altered ingestive behaviors and obesity.
Dr. Zhang adds,
“The findings of this study contribute to our understanding of the biological consequences of social inequities, such as discrimination, on unhealthy eating behaviors and obesity. Additionally, this study provides insights into potential avenues for prevention and intervention targeting the normalization of the brain-gut-microbiome system. This research can also inform public health policies and initiatives aimed at increasing access to healthy food and promoting nutritional education in underserved communities.”
Last week, we announced that April Armstrong, MD, MPH will be joining the department as the new chief of the division of dermatology, effective July 17, 2023. For over eight years, Dr. Armstrong has served as the associate dean for clinical research at the University of Southern California (USC). While at USC, she has been instrumental in improving clinical research infrastructure and developing efficient research environments. Additionally, she serves as vice chair in the department of dermatology and director of clinical research support at the Southern California Clinical and Translational Research Institute. Learn more about her as we prepare to welcome Dr. Armstrong this summer.
This weekend I was inducted into the National Academy of Sciences. I am grateful for the kind words of congratulations that I received from many in our community. Part of the ceremony is signing the membership book, that has signatures of all members of the academy since its founding in 1863.
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