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A Australian Avocados An update on nutrition and health that avocado feeling www.avocado.org.au 2 Introduction This report provides an overview of the nutritional benefits While avocados are technically a fruit they are often used of avocados and summarises scientific evidence spanning as a vegetable and can tick either box when it come to the past 20 years. meeting the recommended two serves of fruit and five serves of vegetables a day. Avocados have also been Avocados are a nutrient-dense fruit that play an important highlighted in the new Australian Dietary Guidelines as a role in healthy diets, contributing almost 20 vitamins, healthy fat alternative to saturated fat spreads, like butter.2 nutrients and phytonutrients. Research shows avocado eaters consume significantly more key nutrients than non On behalf of Avocado Australia’s Avocado Nutrition avocado eaters. Program, I hope you find this a useful resource. In addition, avocados are an excellent source of healthy Lisa Yates monounsaturated fats and have naturally low levels of Advanced Accredited Practising Dietitian 1 sugars and sodium. Avocados are an important dietary source of the B group vitamin folate - an essential nutrient for cell division, blood production, heart health and during pregnancy. Adequate folate is critical for the prevention of foetal neural tube defects. Research also has identified, that as part of a healthy diet, this natural whole food may play a role in helping to manage conditions such as high blood cholesterol,17-24,43 a risk factor for heart disease. Avocado Health Star Rating 4.5 ENERGY SAT FAT SUGARS SODIUM FOLATE 605kJ 3g <1g 3mg 120ug HEALTH STAR RATING LOW PER 100g Health Star Ratings are a quick, at a glance guide found on the front of food packaging to help you choose healthier foods. Star ratings can be from ½ star to 5 stars and the more stars a food or product has the healthier it is. Avocados score 4.5 stars, indicating a healthy food choice. As part of the fruit and vegetable category, avocados lose half a star because, even though they have a low proportion of saturated fat, other fruits and vegetables do not contain saturated fat. If avocados were categorised in the fats and oils category they would get five stars compared to other fats and oils. that avocado feeling A Research Update For Health Professionals 3 Key findings: The research shows that avocados, as part of a healthy diet, may; lower LDL cholesterol and boost HDL cholesterol, contributing to cardiovascular health help the absorption of colourful carotenoids necessary for eye health assist in weight management improve glucose tolerance for people with diabetes. Avocados are also: rich in folate, which is needed during pregnancy for tissue development. How much is a serve? The Australian Dietary Guidelines suggest a serve of fruit weighs 150g and a serve of vegetable weighs 75g, or the equivalent of 100-350kJ energy per serve.1 The edible flesh of an Australian avocado weighs around 160-200g with 100g containing about 600kJ of energy, so a 50g portion providing 300kJ fits the Australian Dietary Guideline recommendations. To keep it simple we recommend 50g of avocado daily, or about a 1/3 of a smaller or a 1/4 of a larger avocado. Many research studies from overseas report the benefits of half an avocado but these are based on smaller avocados with a half weighing 75g. www.avocado.org.au 4 Nutrient Composition Avocados are well known as a rich source of healthy fats but there is much more to this fruit. Vitamins Folate Avocados also provide vitamins C, E and K, minerals such as potassium, plant antioxidants and unusually for a fruit, some protein. They are also naturally low in sugar and sodium.3 Everyone needs the B group vitamin folate as it contributes to normal blood formation and cell division. During pregnancy it is particularly important for tissue development. Avocados are a rich source of folate with a 50g serve In fact, research shows avocado eaters tend to consume significantly more of several key nutrients than nonavocado eaters.1 providing 60ug or 30% of the adult regulatory RDI.3 For more information see page 6. Vitamin C Vitamin C is an antioxidant vitamin that works with Healthy fats vitamin E to help reduce the effects of free radical cell damage. Vitamin C also helps the body’s absorption of plant Monounsaturated fats are needed to maintain heart iron. Avocados are a rich source of vitamin C with a quarter health and aid in the body’s absorption of fat-soluble vitamins and carotenoids. 1,4 of an avocado (50g) providing 11mg of Vitamin C or 25% of Avocados contain healthy RDI for adults.3 fats with a quarter of an avocado (50g) providing 3g of monounsaturated fats. As an avocado ripens the amount of monounsaturated fat it contains increases and saturated fat content decreases.1 Vitamin E Vitamin E is a fat-soluble vitamin commonly found in healthy fat foods including avocado. A quarter of an avocado (50g) provides 1mg of vitamin E or 10% of RDI for adults.3 Vitamin Carbohydrates and sugars E works with vitamin C to reduce cell damage by free radicals and protects cell membranes from oxidation.7 Unlike other fruit, avocados are naturally low in carbohydrate and sugars with a quarter of an avocado (50g) containing just 2.3g carbohydrates of which less than Vitamin K 1g is sugars. Vitamin K is an important nutrient for building bones and 3 also assists the blood to clot. A quarter of an avocado (50g) Fibre contains 11ug of vitamin K or 14% of the RDI for adults.3 Fibre aids a healthy bowel function and increases satiety. Phytochemicals Avocados provide a combination of insoluble and soluble Avocados contain phytochemicals with antioxidant and fibre, in total around 2g per 50g serve.3 anti-inflammatory properties. These include polyphenols and colourful carotenoids such as beta carotene, beta Potassium and sodium cryptoxanthin, lutein and zeaxanthin that help give avocado Research shows that a varied diet high in potassium and its unique colour. 3 These natural antioxidants contribute to low in sodium helps to maintain normal blood pressure cell protection from free radical damage. 5 and protect against heart disease and stroke.6 Avocados positively contribute to a good potassium/sodium balance, with a quarter of an avocado (50g) providing 245mg of potassium and less than 2mg of sodium.3 that avocado feeling A Resource Guide for Health Professionals 5 NUTRITION INFORMATION Servings per package: 4 serves per avocado Serving size: ~ 50g or ¼ avocado Average Quantity per Serving Percentage Daily Intake* Average Quantity per 100g or ½ avocado 303kJ (72Cal) 12% 605kJ (144Cal) Protein, total 0.8g 2% 1.6g Fat, total 6.4g 9% 12.7g – saturated 1.5g 8% 3.0g Energy – trans 0g 0g – polyunsaturated 1.0g 2.0g – monounsaturated 3.2g 6.4g Cholesterol 0mg 0mg Carbohydrate 2.3g – sugars Dietary fibre, total <1% Less than 1g 4.5g Less than 1g 2.1g 7% 4.2g Sodium 1.5mg <1% 3.0mg Potassium 245mg 490mg Folate ** 60ug 30% 120ug Vitamin C 11mg 25% 22mg Vitamin E 1mg 10% 2mg 11ug 14% Vitamin K Polyphenols 22ug 71mg GAE 142mg GAE Beta carotene 127ug 254ug Beta cryptoxanthin 117ug 234ug Lutein & zeaxanthin 271ug 542ug Plant sterols 42mg 84mg * Percentage daily intakes are based on the average adult diet of 8700kJ. Your daily intakes may be higher or lower depending on your energy needs. ** The RDI used to calculate the %DI is the RDI for adults (200μg), whereas for women, at least one month before pregnancy and three months during pregnancy, the recommended intake of folate is 400μg per day which increases to 600ug for the remainder of pregnancy and lactation. Source: NMI Laboratory Analysis results May 2010 average of Hass and Shephard varieties except for: -V itamin C and Beta cryptoxanthin - NUTTAB 2010 http://www.foodstandards.gov.au/science/monitoringnutrients/nutrientables/nuttab/ Pages/default.aspx -V itamin E, lutein zeaxanthin, plant sterols - USDA National Nutrient Database for Standard Reference, Release 26 - Polyphenols - USDA ORAC Release 2, 2010 www.avocado.org.au 6 Avocados and Folate What is folate? Folate is the commonly used name for a water-soluble B-group vitamin found in plant foods, especially avocados and green leafy vegetables. There are also man-made forms of folate, such as folic acid additives and supplements. Folate from plant foods is not as readily absorbed as folic acid,8 but it comes with the added health benefits that plant foods provide, such as nutrients and additional phytochemicals. A serve of avocado (50g) contains 60 micrograms of folate or 30% regulatory RDI for adults, which is 200ug.3 Folate for pregnancy Folate plays an essential role in the healthy development of babies, helping to create DNA, divide cells and in the formation of the neural tube. The baby’s neural tube fuses very early in pregnancy. If it doesn’t close, the result is a neural tube defect (NTD). Spina bifida and anencephaly are the most common forms of NTD affecting about 1 in 500 pregnancies in Australia.9 A varied diet rich in folate may reduce the risk of foetal neural tube defects.10 There are specific folate RDIs for women of childbearing Why is folate important? age due to the importance of this vitamin during pregnancy. FSANZ recommends women of child bearing Folate is important for healthy growth and development age consume a minimum of 400ug of folate for the at all life stages. month before and three months after conception.10 The National Health and Medical Research Council however, Folate for children recommends an adequate intake of folate being 600ug Children and adolescents require folate to produce blood during pregnancy.8 Advice could be that 400ug of folate and help cells divide to meet their growth and development could come from a folic acid supplement, with the needs. remaining 200ug from food sources such as avocado, green leafy vegetables, grains, legumes and fortified Folate for adults foods. A serve of avocado (50g) contributes 60ug of Folate is essential in folate3, which is approximately 15% of the folate RDI bone marrow as it of 400ug per day for women of childbearing age. works with vitamin B12 to produce blood Folate fortification of bread making flour alone may not cells. Too little of either be sufficient to meet the increased folate needs of pregnant of these key vitamins women and therefore eating plant foods naturally rich can cause some forms in folate as well as taking folic acid supplements is also of anaemia resulting recommended.11 in weakness, fatigue, irritability and heart Recommended Daily Intakes (Regulatory RDIs) of Folate* palpitations.8 • 100μg for children aged 1-3 years; • 200μg for children aged 3 years and older; and • 200μg for adults. * Food Standards Australia New Zealand (FSANZ) Food Standards Code 1.1.1 12 that avocado feeling A Research Update For Health Professionals 7 Avocados and Heart Health Clinical studies have consistently demonstrated the positive heart health effect of diets including avocado, particularly on blood lipid profiles. This is primarily because of the Plant sterols Plant sterols help reduce cholesterol re-absorption in the whole food effects of this nutrient-dense fruit.1 intestine, increasing the amount of cholesterol excreted Healthy fats foods can have added plant sterols. Avocados naturally The fats in foods are always a mix of saturated and a quarter of an avocado (50g)3. from the body.15 Certain margarine spreads, milks and other contain small quantities of plant sterols, around 40mg in unsaturated fat, but usually one type predominates. The fats in avocados, like other plant foods, are mostly healthy monounsaturated fats. As well as providing fat-soluble vitamins, the monounsaturated fats in avocados help to control cholesterol production and may reduce the risk of cardiovascular disease.4 Diets high in foods that contain Soluble fibre In a similar way to plant sterols, soluble fibre can lower cholesterol re-absorption from the intestine.16 Avocado provides around 2g total fibre per 50g serve3 with two thirds soluble fibre.16 monounsaturated fats, such as a Mediterranean diet with Antioxidants its olive oil and nuts, have also been shown to shown to Vitamin C, vitamin E, carotenoids, and polyphenols are reduce the risk of cardiovascular disease.13,14 The extensive body of research supporting the cardiovascular benefits of monounsaturated and polyunsaturated fats resulted in the 2013 Australian Dietary Guidelines recommending avocado as a healthy compounds with antioxidant effects that help to protect cells from free radical damage. These compounds also have anti-inflammatory effects that may help prevent atheroschlerosis or the thickening and hardening of arteries associated with heart disease.1 fat alternative to saturated fat spreads.2 Sodium and potassium Australian Dietary Guidelines - Guideline 3 “Replace high fat foods that contain predominately saturated fat such as butter, cream, cooking margarine, coconut and palm oil with foods that contain predominantly polyunsaturated and monounsaturated fats such as oils, spreads, nut butters/ pastes and avocado.”2 A healthy varied diet that contains a high intake of both fruits and vegetables, such as avocado, reduces the risk of heart disease.5 Reducing sodium and maintaining an adequate intake of potassium can help to guard against high blood pressure, heart disease and stroke.6 A 50g serve of avocado contributes less than 2mg of sodium and 245mg of potassium.3 A healthy diet, which is also low in sodium and contains a variety of foods, such as avocado, can reduce high blood pressure.5 www.avocado.org.au 8 Latest Research Participants with high cholesterol and/or type 2 diabetes A recent randomised controlled trial, published in the Cholesterol Journal of the American Heart Association, found that when Eating avocados as part of a healthy diet may lower total ate an avocado (136g) a day for five weeks as part of a and LDL (bad) cholesterol,17-24, 43 major risk factors for heart moderate fat diet, their LDL cholesterol level, LDL particle disease. size number and small dense LDL as well as LDL:HDL ratio 45 overweight/obese people with high LDL cholesterol were all significantly reduced.43 Avocado clinical trials have consistently shown positive effects on blood lipids in studies using a variety of diets and A study published in the Archives of Medical Research on a range of participants including healthy, overweight demonstrated a diet enriched with avocado could or obese, hypercholesterolemic and participants with type significantly lower cholesterol in a week. The 30 participants 2 diabetes. Some of these studies are highlighted below, with normal cholesterol and 37 participants with mild to however, further larger, longer-term studies are required, high cholesterol (15 of whom had type 2 diabetes) were particularly in those with type 2 diabetes. placed on a diet enriched with 300g avocado to replace all Healthy participants Avocado intake in those with normal cholesterol can significantly reduce total and LDL cholesterol, as well as maintain HDL cholesterol. An Australian study, published in the American Journal of Clinical Nutrition, followed 15 women consuming 0.5-1.5 avocados a day as part of a high carbohydrate diet. After three weeks, researchers noted an 8% reduction in total cholesterol and no change to HDL cholesterol. However, the no avocado control diet reduced HDL cholesterol by 14%.18 Another study, published in the Archives of Medical Research, followed 16 healthy volunteers consuming a high carbohydrate, moderate fat diet (50% of energy from carbs and 30% from fat of which 75% of the fat was from avocado) for two weeks. It found, their total and LDL cholesterol was reduced while HDL was maintained, whereas the low saturated fat control diet reduced HDL.19 In short, eating avocado helps maintain other fats each day. At the end of a week, those with normal cholesterol reported a 16% decrease in total cholesterol, while those with mild to high cholesterol reported a 14% reduction in total cholesterol, a 23% reduction in LDL cholesterol and a 14% increase in good HDL cholesterol. Those with type 2 diabetes saw reductions in total and LDL cholesterol of about 20%.22 Since heart disease risk is increased in those with type 2 diabetes including avocado in their diets maybe worthwhile. Also published in the Archives of Medical Research, another small, randomised study examined the effects of avocado as a source of monounsaturated fat on serum lipids. Thirteen people with high cholesterol were randomly assigned one of three vegetarian diets. After four weeks, those consuming the vegetarian diet with 30% of energy from fats (the majority from avocado) had significantly reduced LDL cholesterol.23 HDL levels while lowering LDL cholesterol. Summary The addition of 75-300g of avocado to a variety of healthy diets has been shown to lower total and LDL cholesterol while maintaining HDL cholesterol. These benefits have been noted in participants exhibiting a range of health profiles. that avocado feeling A Research Update For Health Professionals 9 Weight Management Type 2 Diabetes There have been three studies looking at the effect of Two studies have examined the effects of avocado in avocado on an aspect of weight management. 24-26 those with type 2 diabetes (T2D). The Archives of Medical Research study, mentioned previously, also found blood The first study, published in the Nutrition Journal, examined glucose levels were reduced in 13 of the 15 participants the effects of avocados as part of an energy-restricted with T2D, however, authors noted only five of the 15 diet on weight loss, serum lipids and vascular function in had clinical significant reductions.22 A more recent 55 overweight and obese people. The participants were study, published in 2013 in the Nutrition Journal, also randomly divided into two groups – one group consuming investigated the effects of avocado in those with T2D. an energy restricted diet including 200g of avocado a day A small randomised crossover study involving 12 women (30.6g of fat) in place of 30g of other dietary fats, the other with T2D, found that after four weeks each of a high group consuming an energy restricted control diet with no monounsaturated fat diet (with an avocado a day, eating avocado. Following six weeks, body weight, body mass a third at each meal) and a high carbohydrate diet, both index, and percentage of body fat all decreased significantly diets caused a minor cholesterol lowering effect with no in both diet groups. The researchers concluded that 200g a major changes in HDL cholesterol. The avocado diet was day of avocado could be consumed in an energy-restricted associated with a greater decrease in blood triglycerides diet without compromising weight loss when substituted for (20% vs. 7% in the high-carbohydrate diet) and glycemic 30g of other dietary fats. control was similar with both diets. Researchers concluded 24 that including avocado in the diet of those with T2D A randomised crossover study by Loma Linda University could help reduce cholesterol and triglycerides without found that overweight people adding half an avocado (75g) compromising blood glucose control.20 to lunch increased their satiety by 25% and decreased their desire to eat by 30% for 3-5 hours following the meal.25 Clearly more research in the area of T2D is needed but Adding avocado to lunch may help reduce mid meal there have also been interesting T2D preliminary animal snacking. studies that suggest that extracts of avocado leaf and seed may improve blood glucose control.28-33 A recent US analysis of the National Health Survey, published in Nutrition Journal, found that avocado consumers had a lower body weight (an average of 3.4kg less), BMI and waist circumference (4cm smaller waist) compared to those who didn’t eat avocado.26 Further research is required to replicate these findings in larger, long-term trials as well as identify mechanisms for Summary For people with type 2 diabetes, consuming avocado as part of a healthy diet may help manage blood glucose levels as well as lower cholesterol and triglycerides without compromising blood glucose control. the role of avocados in weight management. One potential mechanisms, could be that an extract of avocado fruit inhibits the action of acetyl-CoA carboxylase, a key enzyme in production of fat in the body.27 Summary Initial studies indicate a role for 75-200g of avocado a day in promoting satiety and as an alternative to other dietary fats in energyrestricted diets. People who eat avocado may weigh less, have a lower BMI and waist circumference. www.avocado.org.au 10 Eye Health The macula lutea is a “yellow spot” in the centre of the retina of conversion to vitamin A by 4.6 fold. In the case of responsible for central vision. Macular degeneration is the carrots, absorption was increased six fold and the efficiency result of age related damage and it impacts central vision. of conversion to vitamin A by 12.6 fold.42 This may be particularly important for those who are vitamin A deficient The macula is yellow because it is rich in carotenoids lutein or who avoid eating vitamin A rich foods such as dairy. and zeaxanthin that are thought to combat light-induced damage caused by free radicals.34 Carotenoids help reduce the risk of macular degeneration35,36 and are transported to the macula by HDL cholesterol.37,38 Avocados provide a wealth of benefits as they contain carotenoids39, help boost HDL cholesterol22 and their healthy fats absorb fat soluble carotenoids from other foods. Research shows that adding 75-150g of avocado to a salad or salsa increases the absorption of carotenoids from other Summary Avocados contribute carotenoids that are important for eye health. New research has revealed that adding 75g-150g of monounsaturated fat-rich avocados helps to significantly increase the absorption of carotenoids from other vegetables and aids in their conversion to vitamin A. salad vegetables five-fold.40 The colour of avocados comes from natural carotenoid pigments that are important for eye health. This includes beta carotene and beta cryptoxanthin (oranges), lutein and zeaxanthin (yellows), as well as chlorophyll (green). Pigments in avocado Average in 50g of avocado Conclusion Its wide range of nutrients makes avocado an excellent plant based whole food, and an important addition to a beta carotene^ 127ug healthy diet. Avocado eaters consume significantly more beta cryptoxanthin# 117ug of several key nutrients including dietary fibre, vitamin E lutein and zeaxanthin* 271ug chlorophyll+ 1000ug Sources: ^NMI analysis 2010 average of Shepard and Hass varieties # NUTTAB2010 *USDA National Nutrient Database for Standard Reference, Release 26, + Reference 39 vitamin K, potassium and magnesium. While the scientific evidence suggests avocado consumption has health benefits for weight management, eye health and assisting people with type 2 diabetes, most of the research underpins a potential role for avocado in lowering cholesterol and for heart health. Carotenoids are considered to be proVitamin A as they can be converted to vitamin A in the body. Vitamin A is a necessary fat-soluble vitamin that is needed for normal reproduction, vision and immune function. Preformed vitamin A is found in animal products while carotenoids are largely found in plant foods and eggs.41 Research has recently revealed that eating 150g of avocado with other vegetables rich in carotenoids boosts both the absorption of carotenoids and their conversion to vitamin A. Specifically, avocado enhanced the absorption of beta carotene from tomatoes 2.4 fold and enhanced the efficiency Avocados also are an important dietary source of folate, which is essential during pregnancy for healthy foetal development. Australian Avocado Nutrition is committed to sharing the latest scientific evidence supporting the health benefits of avocados. Our message is simple, eat 50g of avocado daily – that’s about a 1/3 of a smaller or a 1/4 of a larger avocado – either as a tasty addition to meals or as a healthy sandwich spread, as suggested by the Australian Dietary Guidelines. that avocado feeling A Research Update For Health Professionals 11 References 1. DreherML et al. Hass Avocado Composition and Potential Health Effects Critical Reviews in Food Science and Nutrition 2013;53:738–750 2. NHMRC (2013) Australian Dietary Guidelines. Canberra: National Health and Medical Research Council http://www.eatforhealth.gov.au/sites/default/ files/files/the_guidelines/n55_australian_dietary_guidelines.pdf accessed 9 December 2014 3. Australian Avocado website - http://avocado.org.au/nutrition-informationpanel accessed 9 December 2014 4. Schwingshackl L et al. Monounsaturated fatty acids and risk of cardiovascular disease: synopsis of the evidence available from systematic reviews and meta-analyses. Nutrients. 2012 Dec 11;4(12):1989-2007. 5. FSANZ (2014). Food Standards Code Standard 1.2.7 Health and related claims. Available at: http://www.comlaw.gov.au/Series/F2013L00054 accessed 9 December 2014 6. Hunt BD et al. Potassium intake and stroke risk: a review of the evidence and practical considerations for achieving a minimum target. Stroke 2014 May;45(5):1519-22. 7. NHMRC (2006). Nutrient reference values for Australia and New Zealand: Vitamin E. Available at https://www.nrv.gov.au/nutrients/vitamin-e ; accessed 9 December 2014 8. NHMRC (2006). Nutrient reference values for Australia and New Zealand: Folate. Available at http://www.nrv.gov.au/nutrients/folate.htm; accessed 9 December 2014 9. NSW Health Neural Tube DefectsNeural Defects - Spina Bifida & Anencephaly Sheet 59 http://www.genetics.edu.au/Publications-and-Resources/GeneticsFact-Sheets/Fact%20Sheet%2059 accessed 9 December 2014 10. FSANZ (2014). Food Standards Code Standard 1.1A.2 http://www.comlaw. gov.au/Series/F2008B00802 accessed 9 December 2014 11. FSANZ Mandatory folate fortification fact sheet for consumers http:// www.foodstandards.gov.au/consumer/nutrition/folicmandatory/documents/ Mandatory%20Fortification%20Brochure%20for%20Health%20Professionals. pdf accessed 9 December 2014 12. FSANZ 1.1.1 Food Standards Australia New Zealand (2014). Food Standards Code Standard 1.1.1 Preliminary Provisions – Application, Interpretation and General Prohibitions http://www.comlaw.gov.au/Series/F2008B00599 accessed 9 December 2014 13. Mente A et al. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med. 2009;169(7):659-69. 14. Estruch R et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013 Apr 4;368(14):1279-90. 15. Ras RT et al. LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies. Br J Nutr. 2014 Jul;112(2):214-9. 16. Li BW et al. Individual sugars, soluble and insoluble dietary fiber contents of 70 high consumption foods. J food Comp & Anal 2002;15:715-723. 17. Grant, W. C. Influence of avocados on serum cholesterol. Proc. Soc.Exp. Biol. Med. 1960;104:45–47. 18. Colquhoun DM et al. Comparison of the effects on lipoproteins and apolipoproteins of a diet high in monounsaturated fatty acids, enriched with avocado, and a high-carbohydrate diet. Am J Clin Nutr. 1992 Oct;56(4):671-7. 19. Alvizouri-Muñoz M et al. Effects of avocado as a source of monounsaturated fatty acids on plasma lipid levels. Arch Med Res. 1992 Winter;23(4):163-7. 20. Lerman-Garber I et al. Effect of a high-monounsaturated fat diet enriched with avocado in NIDDM patients. Diabetes Care. 1994 Apr;17(4):311-5. 21. Carranza J et al. Effects of avocado on the level of blood lipids in patients with phenotype II and IV dyslipidemias. Arch Inst Cardiol Mex. 1995 JulAug;65(4):342-8. 22. López Ledesma R et al. Monounsaturated fatty acid (avocado) rich diet for mild hypercholesterolemia. Arch Med Res. 1996;27(4):519-23. 23. Carranza-Madrigal J et al. Effects of a vegetarian diet vs. a vegetarian diet enriched with avocado in hypercholesterolemic patients. Arch Med Res. 1997 Winter;28(4):537-41. 24. Pieterse Z et al. Substitution of high monounsaturated fatty acid avocado for mixed dietary fats during an energy-restricted diet: effects on weight loss, serum lipids, fibrinogen, and vascular function. Nutrition. 2005;21(1):67-75. 25. Wien M et al. A randomized 3x3 crossover study to evaluate the effect of Hass avocado intake on post-ingestive satiety, glucose and insulin levels, and subsequent energy intake in overweight adults.Nutr J. 2013 Nov 27;12:155. 26. Fulgoni VL 3rd et al. Avocado consumption is associated with better diet quality and nutrient intake, and lower metabolic syndrome risk in US adults: results from the National Health and Nutrition Examination Survey (NHANES) 2001-2008. Nutr J. 2013 Jan 2;12:1. 27. Hashimura H et al. Acetyl-CoA carboxylase inhibitors from avocado (Persea americana Mill) fruits. Biosci Biotechnol Biochem. 2001 Jul;65(7):1656-8. 28. Ezejiofor AN et al. Hypoglycaemic and tissue-protective effects of the aqueous extract of persea americana seeds on alloxan-induced albino rats. Malays J Med Sci 2013 Oct;20(5):31-9. 29. Lima CR et al. Anti-diabetic activity of extract from Persea americana Mill. leaf via the activation of protein kinase B (PKB/Akt) in streptozotocin-induced diabetic rats J Ethnopharmacol. 2012 May 7;141(1):517-25. 30. Rao US et al. Remnant B-cell-stimulative and anti-oxidative effects of Persea americana fruit extract studied in rats introduced into streptozotocin - induced hyperglycaemic state. Afr J Tradit Complement Altern Med. 2011;8(3):210-7. 31. Edem D et al. Effect of aqueous extracts of alligator pear seed (Persea americana mill) on blood glucose and histopathology of pancreas in alloxaninduced diabetic rats. Pak J Pharm Sci. 2009 Jul;22(3):272-6. 32. Gondwe M et al. Effects of Persea americana Mill (Lauraceae) [“Avocado”] ethanolic leaf extract on blood glucose and kidney function in streptozotocininduced diabetic rats and on kidney cell lines of the proximal (LLCPK1) and distal tubules (MDBK) Methods Find Exp Clin Pharmacol. 2008 JanFeb;30(1):25-35. 33. Brai BI et al. Hypoglycemic and hypocholesterolemic potential of Persea americana leaf extracts. J Med Food. 2007 Jun;10(2):356-60. 34. Widomska J et al. Why has Nature Chosen Lutein and Zeaxanthin to Protect the Retina? J Clin Exp Ophthalmol. 2014 Feb 21;5(1):326. 35. Meyers KJ et al. Genetic evidence for role of carotenoids in age-related macular degeneration in the Carotenoids in Age-Related Eye Disease Study (CAREDS). Invest Ophthalmol Vis Sci. 2014 Jan 29;55(1):587-99. 36. Chew EY et al. Secondary analyses of the effects of lutein/zeaxanthin on age-related macular degeneration progression: AREDS2 report No. 3. JAMA Ophthalmol. 2014 Feb;132(2):142-9. 37. Merle BM et al. Association of HDL-related loci with age-related macular degeneration and plasma lutein and zeaxanthin: the Alienor study. PLoS One. 2013 Nov 6;8(11):e79848. 38. Kijlstra A et al. Lutein: more than just a filter for blue light. Prog Retin Eye Res. 2012 Jul;31(4):303-15. 39. Ashton OB et al. Pigments in avocado tissue and oil. J Agric Food Chem. 2006 Dec 27;54(26):10151-8. 40. Unlu NZ et al. Carotenoid absorption from salad and salsa by humans is enhanced by the addition of avocado or avocado oil. J Nutr. 2005 Mar;135(3):431-6. 41. NHMRC (2006). Nutrient Reference Values for Australia and New Zealand including Vitamin A paper. Available at http://www.nrv.gov.au/nutrients/ vitamin-a accessed 9 December 2014. 42. Kopec RE et al. Avocado Consumption Enhances Human Postprandial Provitamin A Absorption and Conversion from a Novel High-β-Carotene Tomato Sauce and from Carrots. J Nutr. 2014 Aug;144(8):1158-66. 43. Wang L, Bordi PL, Fleming JA, Hill AM, Kris-Etherton PM. Effect of a moderate fat diet with and without avocados on lipoprotein particle number, size and subclasses in overweight and obese adults: a randomized, controlled trial. J Am Heart Assoc. 2015 Jan 7;4(1). pii: e001355. doi: 10.1161/ JAHA.114.001355. www.avocado.org.au 5 AVOCADO FACTS This project has been funded by Horticulture Innovation Australia Limited using the Australian Avocado Industry levy and funds from the Australian Government. 1.There are 850 Australian Avocado growers. 2.Avocados are grown in most states of Australia, across eight main regions. Australia’s diverse climate means we are lucky enough to have year round availability. 3.The industry produces around 60,000 tonnes of fruit per year, 95% of which is consumed in Australia. 4.The two most popular varieties of avocado are Hass (the darker skin variety), which accounts for 80% of all avocados grown, and Shepard (the green skin variety), which accounts for 15%. Atherton/Mareeba 5.Aussies love Avocados, with nearly 3kg of fresh avocados consumed for each person each year. Bundaberg AVOCADO GROWING AREAS Carnarvon Sunshine Coast West Moreton Mt Tambourine Far North Coast Mid North Coast Riverland Perth Sunraysia Pemberton Advanced Accredited Practising Dietitian Lisa Yates prepared this document on behalf of Avocados Australia’s nutrition program – Australian Avocados Nutrition. Avocados Australia is the peak industry body for the Australian avocado industry. The not-for-profit organisation representing avocado growers and associated businesses is committed to improving the health and wellness of all Australians by sharing credible up to date information about the health benefits of avocado. Australian Avocados Connect with us: www www.avocado.org.au @avonutrition and @AusAvos [email protected] www.pinterest.com/AusAvos www.facebook.com/AustralianAvocados www.youtube.com/user/AustralianAvocados This material has been independently reviewed by the Dietitians Association of Australia. To find an Accredited Practising Dietitian freecall 1800 812 942 or www.daa.asn.au ©2015 For more nutrition information as well as recipes and tips on selecting Australian avocados please visit www.avocado.org.au