Malnutrition, a common and underrecognized condition in adults 65 and older. It often remains undiagnosed because the associated symptoms can be difficult to identify. Inadequate nutrition screening commonly leads to the mistreatment of this condition as a normal part of the aging process. The consequences of undiagnosed malnutrition can be detrimental to the health of an older person. The objective of dissertation was to evaluate malnutrition from an epidemiology perspective -- primary prevention: risk factors; secondary prevention: assessment and screening tools; and tertiary prevention: overall survival. Major findings from this dissertation include: Mini Nutrition Assessment was found to be the most valid and reliable predictor for malnutrition when compared with clinical diagnosis, while weight loss and BMI exhibited unfavorable validity and reliability; patients with frailty, functional impairment, abnormal gait speed, cognitive diagnosis, major depression, or poor performance status face a higher risk of developing malnutrition; malnutrition remains an independent risk factor for mortality in older cancer patients, especially those with solid tumors, despite nutritional recommendations regarding an increased dietary intake. Therefore, nutritional support, counseling, and interventions should be initiated as early as possible for this population. My research contributes empirical and theoretical knowledge to the fields of malnutrition and cancer care. Such knowledge is valuable to both academics and clinicians globally. Primary care physicians, nurses, and relatives should all help to enhance these patients’ awareness of their nutrition and health statuses. Recommendations for malnourished, frail, and functionally impaired older cancer patients may include an increased protein intake. One review article has been published by Current Oncology Reports (2019). It comprehensively describes the public health burden, malnutrition prevention, and relationship among cancer cachexia, malnutrition, and sarcopenia. Specifically, the research reveals comprehensive malnutrition prevention is required for improving the nutrition status among older adults with cancer.

The project "Racial disparities in cancer incidence and outcomes", examines hepatocellular carcinoma (HCC) incidence interactions by age, sex, and race/ethnicity in U.S. Specifically, the study employs joinpoint analysis to explore secular trends of HCC incidence and age-period-cohort analysis to disentangle factors that equally influence all age groups at a particular calendar time (period effects) and those that vary by birth generation (cohort effects). The study reveals that HCC increases with variations in rate of change by age and race/ethnicity, with a strong birth cohort effect. Findings are published as, “Sex and Race Disparities in the Incidence of Hepatocellular Carcinoma in the United States Examined through Age–Period–Cohort Analysis,” in Cancer Epidemiology Biomarkers & Prevention (2020). I also explore the predictors of survival among patients with HCC in the United States and found that curative intent treatment, age at diagnosis, sex, race/ethnicity, stage, and presence of comorbid disease were associated with 5-year survival in Medicare patients with HCC. Among these factors, receipt of curative intent treatment was the strongest predictor of 5-year survival. My article, “Predictors of five-year survival among patients with hepatocellular carcinoma in the United States,” explores these results and is published in Cancer Causes & Control (2020). These two projects contribute both to academic and clinical practice and inform future potential targeted interventions on HCC disparity and survival.

My research of microbiome also contributes to cancer prevention. While rich literature exists on oral microbiome and cancer risk, few investigations of the microbiome have been conducted among Mexican Americans, the largest population of Hispanics living within the United States. By analyzing 16sDNA sequencing of oral microbiome profile and diversity, integrated with epidemiology analysis, I found that higher alpha diversity of baseline oral microbiome was associated with higher all-cancer incidence among non-smoking Mexican American women. Therefore, my study provides an empirical basis for more studies using oral microbiome as a cancer biomarker. Results of this project are published in Cancer Prevention Research (2020) and the American Association for Cancer Research recognized me with the 2020 Scholar in Training award. I am also working on a crossover clinical trial to test whether and how an increase in the consumption of pre-cooked, canned dry beans within the context of usual diet and lifestyle can enhance the gut landscape to improve metabolic health and reduce cancer risk. Our early results of the BE GONE trial suggest that an 8-week increase in dry bean intake may be sufficient to balance or enrich the gut microbiome of high-risk colorectal patients. Additionally, my book chapter, “Diet, Microbiome, Inflammation, and Cancer” in Inflammation, Infection, and Microbiome in Cancers (Springer Nature Press May 2021) discusses the microbiome and its relationship with diet, inflammation, and cancer and describes recent human observational and interventional studies evaluating these relationships. Overall, the research suggests that diverse microbial and metabolic responses to different dietary patterns or dietary interventions, as well as high inter-individual variability, may continue to challenge our ability to find clear and consistent results across studies. In sum, my research on microbiome and cancer contributes to a better understanding of important molecular targets/biomarkers for cancer prevention/survival in the United States.

My research focuses on the relationship of diet, microbiome to cancer, as well as cancer disparity and geriatric oncology. By employing epidemiologic methods, including innovative methodologies to integrate omics data and/or biomarkers into epidemiologic study designs, my current research focuses on an examination of the role of biological and modifiable factors in cancer disparities.