- Email: [email protected]
Role of Registered Dietitian Nutritionists in the Research and Promotion of Native and Cultural Foods
RESEARCH Research Editorial
Role of Registered Dietitian Nutritionists in the Research and Promotion of Native and Cultural Foods Hope T. Bilyk, MS, RDN, LDN ARTICLE INFORMATION Article history: Accepted 10 July 2014 Available online 18 September 2014
Keywords: Acculturation Diet Nutritionist Culture 2212-2672/Copyright ª 2015 by the Academy of Nutrition and Dietetics. http://dx.doi.org/10.1016/j.jand.2015.02.026
This article is reprinted from the November 2014 issue of the Journal of the Academy of Nutrition and Dietetics (2014;114(11):1736-1738).
I
N THIS ISSUE OF THE JOURNAL, LOPEZ-ROMERO AND colleagues reported the physiological effects of ingestion of the native Mexican cactus plant (nopal, Opuntia ficus indica) on selected metabolic parameters in both healthy Mexicans and those with type 2 diabetes.1 This research editorial will discuss four topics of interest in the area of native and cultural foods: the central role they play in immigrant diets, the effect of decreased intake with globalization and acculturation, the value of identifying key foods that may contribute to a healthy lifestyle within a culture, and the need for carefully conducted studies of native cultural foods to provide evidence-based findings in the area of alternative and complementary nutrition.
WHAT IS NOPAL? Nopal is a cactus grown throughout Mexico as well as in many regions of North and South America. It has been documented historically as a primary component of the native diet and also is eaten by wildlife. A recent chemical analysis documented changes in nutrient composition based on age of the plant. Young cacti, eaten at 3 to 4 weeks of age as prickly pads or “nopales,” are higher in calcium (up to age 135 days) and soluble fiber. Older cactus are often dehydrated and higher in crude and insoluble fiber.2 Fresh nopales can be purchased in the United States at local bodegas, farmers markets, and some grocery stores. Nopal
Statement of Potential Conflict of Interest: The author has no potential conflict of interest to disclose.
ª 2015 by the Academy of Nutrition and Dietetics.
should be purchased as firm pads/paddles, bright green in color, 6 to 8 inches in length. Before cooking, the cactus spines must be removed using a sharp knife to cut close to the flesh and trim spines from the edges of the leaves. Typically, the flesh is cut into strips approximately the width of green beans. The nopal is boiled until tender, approximately 30 minutes, and drained. The cooked cactus can also be rinsed in cold water, drained, and stored in the refrigerator to use later. As in most native staples, cooking methods and recipes vary widely among each culture depending on region and local traditions.
THE ROLE OF TRADITIONAL FOODS The use of traditional foods has evolved over time within cultures for many reasons. Native plants such as nopales were typically found abundant in the landscape. Others were brought over by foreign settlers and were cultivated but became integrated into native cuisines. Creole or Cajun cuisine is an example. Many evolved as complementary and alternative medicine. A recent survey of 806 adults with diabetes attending community educational conferences in 2004-2006 reported patients of Mexican origin were very likely to use nopal in their treatment of diabetes, whereas whites were more likely to use multivitamins.3
THE EFFECT OF GLOBALIZATION AND ACCULTURATION ON THE CONSUMPTION OF NATIVE FOODS Based on data from several national representative surveys, epidemiological studies have shown important changes in food consumption patterns at the household level in Mexico.4 These studies have shown a decrease in traditional foods and an increase in fats, refined sugars, and soft drinks, and a reduction in vegetable and fruit consumption. In addition, acculturation often decreases the intake of native foods and increases the intake of processed foods. Several studies have shown a correlational relationship between obesity, diabetes, and acculturation.5 Registered dietitian nutritionists (RDNs) need to acquire a working knowledge of cultural foods and eating patterns. Several studies have shown that the compliance to both medication and medical diet therapy is higher when cultural competence and language are matched between the health provider and the patient.6
USE OF NATIVE FOOD COMPONENTS AS WHOLE FOODS VS ADDITIVES An ongoing controversy exists regarding whether there is a greater health benefit from the ingestion of traditional JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
S31
RESEARCH foods in their native form (ie, fresh nopales cactus) vs in food additive or dietary supplementation form (ie, dehydrated nopales cactus). Historically, epidemiological evidence of benefit has been based on the ingestion of native foods in the original basic form. More recently, the food science literature has published many examples of enrichment of cultural staples such as tortillas or the adaptation of a traditional food concept such as mutandabota in southern African culture to a more fortified version.7,8 Nopales in the dehydrated form have been studied by Aquilera-Barreiro and colleagues as a calcium supplement to improve bone mineral density and calciuria in adult Mexican women. Fortification may be applicable when the beneficial ingestion of the fresh natural product exceeds normal portion size.9 Recent research has also studied the potential benefits of native bacteria in food safety. Country ham, beef and salmon jerky, and blue cheese are just a few examples of natural food preservation.10 A recent comparison of raw milk cheeses containing local bacteria strains found beneficial probiotic properties compared with pasteurized cheeses manufactured with commercial bacterial strains.11 Natural foods such as nopal need to be studied to understand the full range of potential health properties.
African Americans.20 Another recent study by Luick and colleagues correlated vitamin D sufficiency with ingestion of local foods in western Alaska.21 Continued research is needed to provide evidence-based data to guide the nutrigenomic recommendations for these foods both within and outside of native cultures. RDNs are in a unique position to integrate cultural research within their practice as well as take the lead in identifying and conducting randomized, placebo-controlled studies that add to the increasing body of evidence of native food value.22
References 1.
Lopez-Romero P, Pichardo-Ontiveros E, Avila-Nava A, et al. The effect of nopal (Opuntia ficus indica) on postprandial blood glucose, incretins, and antioxidant activity in Mexican patients with type 2 diabetes after consumption of two different composition breakfasts [published online ahead of print August 12, 2014]. J Acad Nutr Diet. 2014;114(11): 1811-1818. http://dx.doi.org/10.1016/j.jand.2014.06.352.
2.
Hernández-Urbiola MI, Pérez-Torrero E, Rodriguez-Garcia ME. Chemical analysis of nutritional content of prickly pads (Opuntia ficus indica) at varied ages by organic harvest. Int J Environ Res Public Health. 2011;8(5):1287-1295.
3.
Villa-Caballero L, Morello CM, Chynoweth ME, et al. Ethnic differences in complementary and alternative medicine use among patients with diabetes. Complement Ther Med. 2010;18(6):241-248.
4.
Flores M, Nayeli M, Rivera M, et al. Dietary patterns in Mexican adults are associated with risk of being overweight or obese. J Nutr. 2010;140(11):1869-1873.
5.
Garcia L, Gold EB, Wang L, Yang X, Mao M, Schwartz AV. The relation of acculturation to overweight, obesity, pre-diabetes and diabetes among U.S. Mexican-American women and men. Ethn Dis. 2012;22(1):58-64.
6.
Heiss CJ, Rengers B, Fajardo-Lira C, Henley SM, Bizeau M, Gillette CD. Preparing dietetics practitioners to effectively serve the Hispanic population. J Am Diet Assoc. 2011;111(3):359-364.
7.
Guevara-Arauza JC, Omelas Paz JJ, Mendoza SR, Guerra RE, Paz Maldonado LM, Gonzalez DJ. Biofunctional activity of tortillas and bars enhanced with nopal. Preliminary assessment of functional effect after intake on the oxidative status in healthy volunteers. Chem Cent J. 2011;5(1):10.
8.
Mpofu A, Linnemann AR, Sybesma W, Kort R, Nout MJ, Smid EJ. Development of a locally sustainable functional food based on mutandabota, a traditional food in southern Africa. J Dairy Sci. 2014;97(5):2591-2599.
9.
Aquilera-Barreiro M, Rivera-Márquez JA, Trujillo-Arriaga HM, Tamayo y Orozo JA, Barreira-Mercado E, Rodriguez-Garcia ME. Intake of dehydrated nopal (Opuntia ficus indica) improves bone mineral density and calciuria in adult Mexican women [published online May 21, 2013]. Food Nutr Res. 2013. doi:10.3402.fnr.v57i0.19106.
10.
Lee JH, Hwang J, Mustapha A. Popular ethnic foods in the United States: A historical and safety perspective. Compreh Rev Food Sci Food Safety. 2013;13(1):2-17.
11.
Montel MC, Buchin S, Mallet A, et al. Traditional cheeses: Rich and diverse microbiota with associated benefits. Int J Food Microbiol. 2014;177:136-154.
12.
Leonard WR. The global diversity of eating patterns: Human nutritional health in comparative perspective [published online ahead of print March 5, 2014]. Physiol Behav. 2014;134(Jul):5-14. http://dx.doi. org/10.1016/j.physbeh.2014.02.050.
13.
Sofianou A, Fung TT, Tucker KL. Differences in diet pattern adherence by nativity and duration in the US residence in the Mexican-American population. J Am Diet Assoc. 2011;111(10): 1563-1568.
14.
Evans A, Chow S, Jennings R, et al. Traditional foods and practices of Spanish-speaking Latina mothers influence the home food environment: Implications for future interventions. J Am Diet Assoc. 2011;111(7):1031-1038.
15.
Kim MH, Chung HK. Sensory education program development, application, and its therapeutic effect in children. Nutr Res Pract. 2014;8(1):112-119.
APPLICATION TO CLINICAL PRACTICE The natural global diversity of eating patterns that evolved within cultures has laid the foundation for nutrition counseling.12 Data are emerging that support traditional foods, cooking practices, and home food environments that connect ethnicity to dietary intake patterns to promote healthy lifestyles. The practitioner cannot assume that immigrants will preserve cultural traditions, including food choices. The acculturation and globalization disconnect compared with the native cuisine may be twofold. First, reduced physical activity level compared with native environment and occupations often result in lower energy expenditure, which may promote obesity and risk of diabetes. Second, the erosion of the traditional cultural cuisine tends to promote the introduction of noncultural foods. This is often synonymous with processed and convenience foods of higher calorie density and portion sizes. These lifestyle choices tend to promote obesity and sedentary activity compared with the native culture.5,13,14 RDNs have an opportunity to understand all these issues and apply them to clinical practice. The best audience may be the children of immigrants. A recent study by Kim and Chung in Korea introduced sensory education programs in schools focusing on the cultural appreciation of rice as the foundation of the Korean diet.15 Many other education programs have been described that teach basic ethnic cooking at an early age or strive for traditional foods to be brought to school for lunch from home.16,17 RDNs may also encourage adults to practice reverse acculturation by the reintroduction of traditional foods into the household environment.18,19
THE IMPORTANCE OF CONTINUED RESEARCH There is a growing body of metabolic studies that are beginning to clearly link the role of native foods within cultures. Genetic variations may also contribute to the response of native foods within a culture. Recent research by O’Sullivan and colleagues has reported variations in n-3 fatty acid response to habitual intake of dark green vegetables among S32
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
May 2015 Suppl 1 Volume 115 Number 5
RESEARCH 16.
Watman M. Learning to cook as the Romans do. The Wall Street Journal, Feb 1-2, 2014, C8.
17.
Marshall J. The Lost Art of Feeding Kids. Boston, MA: Beacon Press; 2014.
18.
Kim Y, Park SY. Reverse acculturation: A new cultural phenomenon examined through emerging wedding practice of Korean Americans in the United States. Fam Consum Sci Res J. 2009;37(3): 359-375.
19.
Barón V, Berenice S, Mendoza R, Ruth A, Ríos O, Sarail M. Cultural shock, acculturation and reverse acculturation: The case of Mexican citizens traveling to and back from China and their competitiveness level. Global Conference on Business & Finance Proceedings. 2014;9(1): 658-664.
20.
O’Sullivan A, Armstrong P, Schuster GU, et al. Habitual diets rich in dark-green vegetables are associated with an increased response to u-3 fatty acid supplementation in Americans with African ancestry. J Nutr. 2014;144(4):123-131.
21.
Luick B, Bersamin A, Stern JS. Locally harvested foods support serum 25-hydroxyvitamin D sufficiency in an indigenous population of western Alaska [published online March 20, 2014]. Int J Circumpolar Health. 2014. doi:10.3402/ijch.v73.22732.
22.
Tesoriere L, Butera D, Pintaudi AM, Allegra M, Livrea MA. Supplementation with cactus pear (Opuntia ficus-indica) fruit decreases oxidative stress in healthy humans: A comparative study with vitamin C. Am J Clin Nutr. 2004;80(2):391-395.
AUTHOR INFORMATION H. T. Bilyk is an assistant professor, Department of Nutrition, Rosalind Franklin University of Medicine and Science, North Chicago, IL. Address correspondence to: Hope T. Bilyk, MS, RDN, LDN, Department of Nutrition, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064. E-mail: [email protected]
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the author.
FUNDING/SUPPORT There is no funding to disclose.
May 2015 Suppl 1 Volume 115 Number 5
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
S33
Role of Registered Dietitian Nutritionists in the Research and Promotion of Native and Cultural Foods Hope T. Bilyk, MS, RDN, LDN ARTICLE INFORMATION Article history: Accepted 10 July 2014 Available online 18 September 2014
Keywords: Acculturation Diet Nutritionist Culture 2212-2672/Copyright ª 2015 by the Academy of Nutrition and Dietetics. http://dx.doi.org/10.1016/j.jand.2015.02.026
This article is reprinted from the November 2014 issue of the Journal of the Academy of Nutrition and Dietetics (2014;114(11):1736-1738).
I
N THIS ISSUE OF THE JOURNAL, LOPEZ-ROMERO AND colleagues reported the physiological effects of ingestion of the native Mexican cactus plant (nopal, Opuntia ficus indica) on selected metabolic parameters in both healthy Mexicans and those with type 2 diabetes.1 This research editorial will discuss four topics of interest in the area of native and cultural foods: the central role they play in immigrant diets, the effect of decreased intake with globalization and acculturation, the value of identifying key foods that may contribute to a healthy lifestyle within a culture, and the need for carefully conducted studies of native cultural foods to provide evidence-based findings in the area of alternative and complementary nutrition.
WHAT IS NOPAL? Nopal is a cactus grown throughout Mexico as well as in many regions of North and South America. It has been documented historically as a primary component of the native diet and also is eaten by wildlife. A recent chemical analysis documented changes in nutrient composition based on age of the plant. Young cacti, eaten at 3 to 4 weeks of age as prickly pads or “nopales,” are higher in calcium (up to age 135 days) and soluble fiber. Older cactus are often dehydrated and higher in crude and insoluble fiber.2 Fresh nopales can be purchased in the United States at local bodegas, farmers markets, and some grocery stores. Nopal
Statement of Potential Conflict of Interest: The author has no potential conflict of interest to disclose.
ª 2015 by the Academy of Nutrition and Dietetics.
should be purchased as firm pads/paddles, bright green in color, 6 to 8 inches in length. Before cooking, the cactus spines must be removed using a sharp knife to cut close to the flesh and trim spines from the edges of the leaves. Typically, the flesh is cut into strips approximately the width of green beans. The nopal is boiled until tender, approximately 30 minutes, and drained. The cooked cactus can also be rinsed in cold water, drained, and stored in the refrigerator to use later. As in most native staples, cooking methods and recipes vary widely among each culture depending on region and local traditions.
THE ROLE OF TRADITIONAL FOODS The use of traditional foods has evolved over time within cultures for many reasons. Native plants such as nopales were typically found abundant in the landscape. Others were brought over by foreign settlers and were cultivated but became integrated into native cuisines. Creole or Cajun cuisine is an example. Many evolved as complementary and alternative medicine. A recent survey of 806 adults with diabetes attending community educational conferences in 2004-2006 reported patients of Mexican origin were very likely to use nopal in their treatment of diabetes, whereas whites were more likely to use multivitamins.3
THE EFFECT OF GLOBALIZATION AND ACCULTURATION ON THE CONSUMPTION OF NATIVE FOODS Based on data from several national representative surveys, epidemiological studies have shown important changes in food consumption patterns at the household level in Mexico.4 These studies have shown a decrease in traditional foods and an increase in fats, refined sugars, and soft drinks, and a reduction in vegetable and fruit consumption. In addition, acculturation often decreases the intake of native foods and increases the intake of processed foods. Several studies have shown a correlational relationship between obesity, diabetes, and acculturation.5 Registered dietitian nutritionists (RDNs) need to acquire a working knowledge of cultural foods and eating patterns. Several studies have shown that the compliance to both medication and medical diet therapy is higher when cultural competence and language are matched between the health provider and the patient.6
USE OF NATIVE FOOD COMPONENTS AS WHOLE FOODS VS ADDITIVES An ongoing controversy exists regarding whether there is a greater health benefit from the ingestion of traditional JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
S31
RESEARCH foods in their native form (ie, fresh nopales cactus) vs in food additive or dietary supplementation form (ie, dehydrated nopales cactus). Historically, epidemiological evidence of benefit has been based on the ingestion of native foods in the original basic form. More recently, the food science literature has published many examples of enrichment of cultural staples such as tortillas or the adaptation of a traditional food concept such as mutandabota in southern African culture to a more fortified version.7,8 Nopales in the dehydrated form have been studied by Aquilera-Barreiro and colleagues as a calcium supplement to improve bone mineral density and calciuria in adult Mexican women. Fortification may be applicable when the beneficial ingestion of the fresh natural product exceeds normal portion size.9 Recent research has also studied the potential benefits of native bacteria in food safety. Country ham, beef and salmon jerky, and blue cheese are just a few examples of natural food preservation.10 A recent comparison of raw milk cheeses containing local bacteria strains found beneficial probiotic properties compared with pasteurized cheeses manufactured with commercial bacterial strains.11 Natural foods such as nopal need to be studied to understand the full range of potential health properties.
African Americans.20 Another recent study by Luick and colleagues correlated vitamin D sufficiency with ingestion of local foods in western Alaska.21 Continued research is needed to provide evidence-based data to guide the nutrigenomic recommendations for these foods both within and outside of native cultures. RDNs are in a unique position to integrate cultural research within their practice as well as take the lead in identifying and conducting randomized, placebo-controlled studies that add to the increasing body of evidence of native food value.22
References 1.
Lopez-Romero P, Pichardo-Ontiveros E, Avila-Nava A, et al. The effect of nopal (Opuntia ficus indica) on postprandial blood glucose, incretins, and antioxidant activity in Mexican patients with type 2 diabetes after consumption of two different composition breakfasts [published online ahead of print August 12, 2014]. J Acad Nutr Diet. 2014;114(11): 1811-1818. http://dx.doi.org/10.1016/j.jand.2014.06.352.
2.
Hernández-Urbiola MI, Pérez-Torrero E, Rodriguez-Garcia ME. Chemical analysis of nutritional content of prickly pads (Opuntia ficus indica) at varied ages by organic harvest. Int J Environ Res Public Health. 2011;8(5):1287-1295.
3.
Villa-Caballero L, Morello CM, Chynoweth ME, et al. Ethnic differences in complementary and alternative medicine use among patients with diabetes. Complement Ther Med. 2010;18(6):241-248.
4.
Flores M, Nayeli M, Rivera M, et al. Dietary patterns in Mexican adults are associated with risk of being overweight or obese. J Nutr. 2010;140(11):1869-1873.
5.
Garcia L, Gold EB, Wang L, Yang X, Mao M, Schwartz AV. The relation of acculturation to overweight, obesity, pre-diabetes and diabetes among U.S. Mexican-American women and men. Ethn Dis. 2012;22(1):58-64.
6.
Heiss CJ, Rengers B, Fajardo-Lira C, Henley SM, Bizeau M, Gillette CD. Preparing dietetics practitioners to effectively serve the Hispanic population. J Am Diet Assoc. 2011;111(3):359-364.
7.
Guevara-Arauza JC, Omelas Paz JJ, Mendoza SR, Guerra RE, Paz Maldonado LM, Gonzalez DJ. Biofunctional activity of tortillas and bars enhanced with nopal. Preliminary assessment of functional effect after intake on the oxidative status in healthy volunteers. Chem Cent J. 2011;5(1):10.
8.
Mpofu A, Linnemann AR, Sybesma W, Kort R, Nout MJ, Smid EJ. Development of a locally sustainable functional food based on mutandabota, a traditional food in southern Africa. J Dairy Sci. 2014;97(5):2591-2599.
9.
Aquilera-Barreiro M, Rivera-Márquez JA, Trujillo-Arriaga HM, Tamayo y Orozo JA, Barreira-Mercado E, Rodriguez-Garcia ME. Intake of dehydrated nopal (Opuntia ficus indica) improves bone mineral density and calciuria in adult Mexican women [published online May 21, 2013]. Food Nutr Res. 2013. doi:10.3402.fnr.v57i0.19106.
10.
Lee JH, Hwang J, Mustapha A. Popular ethnic foods in the United States: A historical and safety perspective. Compreh Rev Food Sci Food Safety. 2013;13(1):2-17.
11.
Montel MC, Buchin S, Mallet A, et al. Traditional cheeses: Rich and diverse microbiota with associated benefits. Int J Food Microbiol. 2014;177:136-154.
12.
Leonard WR. The global diversity of eating patterns: Human nutritional health in comparative perspective [published online ahead of print March 5, 2014]. Physiol Behav. 2014;134(Jul):5-14. http://dx.doi. org/10.1016/j.physbeh.2014.02.050.
13.
Sofianou A, Fung TT, Tucker KL. Differences in diet pattern adherence by nativity and duration in the US residence in the Mexican-American population. J Am Diet Assoc. 2011;111(10): 1563-1568.
14.
Evans A, Chow S, Jennings R, et al. Traditional foods and practices of Spanish-speaking Latina mothers influence the home food environment: Implications for future interventions. J Am Diet Assoc. 2011;111(7):1031-1038.
15.
Kim MH, Chung HK. Sensory education program development, application, and its therapeutic effect in children. Nutr Res Pract. 2014;8(1):112-119.
APPLICATION TO CLINICAL PRACTICE The natural global diversity of eating patterns that evolved within cultures has laid the foundation for nutrition counseling.12 Data are emerging that support traditional foods, cooking practices, and home food environments that connect ethnicity to dietary intake patterns to promote healthy lifestyles. The practitioner cannot assume that immigrants will preserve cultural traditions, including food choices. The acculturation and globalization disconnect compared with the native cuisine may be twofold. First, reduced physical activity level compared with native environment and occupations often result in lower energy expenditure, which may promote obesity and risk of diabetes. Second, the erosion of the traditional cultural cuisine tends to promote the introduction of noncultural foods. This is often synonymous with processed and convenience foods of higher calorie density and portion sizes. These lifestyle choices tend to promote obesity and sedentary activity compared with the native culture.5,13,14 RDNs have an opportunity to understand all these issues and apply them to clinical practice. The best audience may be the children of immigrants. A recent study by Kim and Chung in Korea introduced sensory education programs in schools focusing on the cultural appreciation of rice as the foundation of the Korean diet.15 Many other education programs have been described that teach basic ethnic cooking at an early age or strive for traditional foods to be brought to school for lunch from home.16,17 RDNs may also encourage adults to practice reverse acculturation by the reintroduction of traditional foods into the household environment.18,19
THE IMPORTANCE OF CONTINUED RESEARCH There is a growing body of metabolic studies that are beginning to clearly link the role of native foods within cultures. Genetic variations may also contribute to the response of native foods within a culture. Recent research by O’Sullivan and colleagues has reported variations in n-3 fatty acid response to habitual intake of dark green vegetables among S32
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
May 2015 Suppl 1 Volume 115 Number 5
RESEARCH 16.
Watman M. Learning to cook as the Romans do. The Wall Street Journal, Feb 1-2, 2014, C8.
17.
Marshall J. The Lost Art of Feeding Kids. Boston, MA: Beacon Press; 2014.
18.
Kim Y, Park SY. Reverse acculturation: A new cultural phenomenon examined through emerging wedding practice of Korean Americans in the United States. Fam Consum Sci Res J. 2009;37(3): 359-375.
19.
Barón V, Berenice S, Mendoza R, Ruth A, Ríos O, Sarail M. Cultural shock, acculturation and reverse acculturation: The case of Mexican citizens traveling to and back from China and their competitiveness level. Global Conference on Business & Finance Proceedings. 2014;9(1): 658-664.
20.
O’Sullivan A, Armstrong P, Schuster GU, et al. Habitual diets rich in dark-green vegetables are associated with an increased response to u-3 fatty acid supplementation in Americans with African ancestry. J Nutr. 2014;144(4):123-131.
21.
Luick B, Bersamin A, Stern JS. Locally harvested foods support serum 25-hydroxyvitamin D sufficiency in an indigenous population of western Alaska [published online March 20, 2014]. Int J Circumpolar Health. 2014. doi:10.3402/ijch.v73.22732.
22.
Tesoriere L, Butera D, Pintaudi AM, Allegra M, Livrea MA. Supplementation with cactus pear (Opuntia ficus-indica) fruit decreases oxidative stress in healthy humans: A comparative study with vitamin C. Am J Clin Nutr. 2004;80(2):391-395.
AUTHOR INFORMATION H. T. Bilyk is an assistant professor, Department of Nutrition, Rosalind Franklin University of Medicine and Science, North Chicago, IL. Address correspondence to: Hope T. Bilyk, MS, RDN, LDN, Department of Nutrition, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064. E-mail: [email protected]
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the author.
FUNDING/SUPPORT There is no funding to disclose.
May 2015 Suppl 1 Volume 115 Number 5
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
S33