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Johnson-Mann CN, Cupka JS, Ro A, Davidson AE, Armfield BA, Miralles F, Markal A, Fierman KE, Hough V, Newsom M, Verma I, Dozic AV, Bihorac A. A Systematic Review on Participant Diversity in Clinical Trials-Have We Made Progress for the Management of Obesity and Its Metabolic Sequelae in Diet, Drug, and Surgical Trials. J Racial Ethn Health Disparities 2023; 10:3140-3149. [PMID: 36536164 PMCID: PMC10645628 DOI: 10.1007/s40615-022-01487-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Individuals from Black and Hispanic backgrounds represent a minority of the overall US population, yet are the populations most affected by the disease of obesity and its comorbid conditions. Black and Hispanic individuals remain underrepresented among participants in obesity clinical trials, despite the mandate by the National Institutes of Health (NIH) Revitalization Act of 1993. This systematic review evaluates the racial, ethnic, and gender diversity of clinical trials focused on obesity at a national level. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of clinicaltrials.gov, PubMed, Cochrane Central, and Web of Science was undertaken to locate phase 3 and phase 4 clinical trials on the topic of obesity that met associated inclusion/exclusion criteria. Ultimately, 18 studies were included for review. RESULTS White non-Hispanic individuals represented the majority of clinical trial participants, as did females. No study classified participants by gender identity. Reporting of race/ethnicity was not uniform, with noted variability among racial/ethnic subgroups. CONCLUSIONS Our findings suggest that disparities remain in the diverse racial, ethnic, and gender representation of participants engaged in clinical trials on obesity relative to the prevalence of obesity in underrepresented populations. Commitment to inclusive and intentional recruiting practices is needed to increase the representation of underrepresented groups, thus increasing the generalizability of future research.
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Affiliation(s)
- Crystal N Johnson-Mann
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA.
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA.
| | - Julie S Cupka
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Alexandra Ro
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Andrea E Davidson
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Brooke A Armfield
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
| | - Frank Miralles
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Asena Markal
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kiara E Fierman
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Victoria Hough
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Mackenzie Newsom
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Isha Verma
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Abdul-Vehab Dozic
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Azra Bihorac
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
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Wang NC, Bagheri M, Olszewski T, Friese KA, Smith HM, Robles ME, Wang C, Brooks A, Bordenstein SR, Ferguson JF, Silver HJ. New-onset vegetarian diet shows differences in fatty acid metabolites in European American and African American women. Nutr Metab Cardiovasc Dis 2021; 31:2436-2448. [PMID: 34176710 PMCID: PMC10317312 DOI: 10.1016/j.numecd.2021.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS The type of fat consumed in animal-based western diets, typically rich in the saturated fat palmitate, has been implicated in cardiometabolic disease risk. In contrast, the most abundant mono- and polyunsaturated fats, more typical in a vegetarian or plant-based diet, potentiate less deleterious effects. This study determined differences in plasma and urine metabolites when switching from omnivorous to vegetarian diet, including metabolites involved in fatty acid utilization. METHODS AND RESULTS A prospective cohort of 38 European (EA) and African American (AA) omnivorous females were matched by age (25.7 ± 5.3y) and BMI (22.4 ± 1.9 kg/m2). Pre-intervention samples were collected while subjects consumed habitual animal-based diet. Changes in metabolites were assessed by ultra-high-performance liquid chromatography-tandem mass spectroscopy (Metabolon, Inc.) upon completing four days of novel vegetarian diet provided by the Vanderbilt Metabolic Kitchen. Changes in several diet-derived metabolites were observed, including increases in compounds derived from soy food metabolism along with decreases in metabolites of xanthine and histidine. Significant changes occurred in metabolites of saturated, monounsaturated and polyunsaturated fatty acids along with significant differences between EA and AA women in changes in plasma concentrations of acylcarnitines, which reflect the completeness of fatty acid oxidation (versus storage). CONCLUSION These data suggest improvements in fatty acid metabolism (oxidation vs storage), a key factor in energy homeostasis, may be promoted rapidly by adoption of a vegetarian (plant-based) diet. Mechanistic differences in response to diet interventions must be understood to effectively provide protection against the widespread development of obesity and cardiometabolic disease in population subgroups, such as AA women.
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Affiliation(s)
- Naomi C Wang
- Vanderbilt University Medical Center, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, USA
| | - Minoo Bagheri
- Vanderbilt University Medical Center, Department of Medicine, Division of Cardiology Medicine, USA
| | - Timothy Olszewski
- Vanderbilt University Medical Center, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, USA
| | | | - Holly M Smith
- Vanderbilt University Medical Center, Department of Medicine, Division of Cardiology Medicine, USA
| | - Michelle E Robles
- Vanderbilt University Medical Center, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, USA
| | - Chuan Wang
- Vanderbilt University Medical Center, Department of Medicine, Division of Cardiology Medicine, USA
| | - Andrew Brooks
- Stanford University, School of Medicine, Department of Genetics, USA
| | - Seth R Bordenstein
- Vanderbilt University, College of Arts and Sciences, Department of Biological Sciences, USA
| | - Jane F Ferguson
- Vanderbilt University Medical Center, Department of Medicine, Division of Cardiology Medicine, USA
| | - Heidi J Silver
- Vanderbilt University Medical Center, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, USA; Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, USA.
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