The role of traditional foods in the Mediterranean diet
Hellenic Health Foundation
WHO Collaborating Centre for Food and Nutrition
University of Athens, School of MedicineDept of Hygiene, Epidemiology and Medical Statistics
Antonia Trichopoulou, MD, PhD
Food and Drinks Innovation Network
The Mediterranean Diet- The Next Big TrendSeminar date : Wednesday June 27th
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The traditional Mediterranean diet
The link between Mediterranean diet and health
The role of traditional foods in health and sustainable diets
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The MD can be thought of as having 9 characteristics:
• high olive oil consumption
• high consumption of legumes
• high consumption of cereals
• high consumption of fruits
• high consumption of vegetables
• moderate consumption of dairy products, mostly as cheese and yogurt
• moderate to high consumption of fish
• low consumption of meat and meat products
• moderate wine consumption, if it is accepted by religion and social norms
OLIVE OIL COMPONENTS
• Major components: Fatty acids– Saturated (8-14%)– Monounsaturated (oleic acid 55-83%)– Polyunsaturated (4-20%)
• Minor components:– Squalene, Sterols, triterpenes– Vitamin E, Beta-carotene– Phenolic compounds (tyrosol, hydroxytyrosol,
oleuropeine, lignanes).
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FDA NewsFOR IMMEDIATE RELEASE
P04-100November 1, 2004
……eating about 2 tablespoons (23 grams) of olive oil daily may reduce the risk of coronary heart
disease………
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For each increase in olive oil of 10 g
7% decreased risk of overall mortality
13% decreased risk of CVD mortality
Buckland et al Am J Clin Nutr. 2012
Olive oil intake and mortality within the Spanish population
Dietary patterns: Greece (Elderly)
0
50
100
150
200
250Potatoes
Vegetables
Legumes
Fruit
Dairy products
Pasta,rice,other grain
Bread
Other Cereals
Meat
Fish
EggsVegetable oil
Butter
Margarine
Sugar
Cakes
Non-alcoholic bev
Wine
Other Alcoholic bev
Sauces
Soups
Soya
Reference EPIC mean (100%)Greece Source: EPIC-Elderly
Many studies have evaluated the association between single foods,
food groups, or nutrients and chronic diseases
Last 10 years: focus on the identification of a dietary pattern
that maximizes longevity
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The traditional Mediterranean diet
The link between Mediterranean diet
and health
The role of traditional foods in health and sustainable diets
Dietary patterns have the ability to:
integrate complex or subtle interactive effects or many dietary exposures
and bypass problems generated by multiple testing
and the high correlations that may exist among these exposures
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Mediterranean diet score
Cut off point: energy adjusted gender-specific median intakeRange: 0-9
Beneficial components Non-beneficial componentsVegetables MeatLegumes Dairies (whole fat)Fruit Unprocessed cerealsFishM/S ratioModerate ethanol intake 1:mean daily consumption (g) Fruits 0: mean daily consumption (g)at/above cut-off, 0: otherwise at/above cut-off, 1: otherwise
Ethanol: 1: for males/females with consumption [10-50]/[5-25] g/day, 0: otherwise
Trichopoulou et al. NEJM 2003 14
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Study RR (95% CI)Weight (%)
Trichopoulou et al. 1995
Kouris-Blazos et al. 1999
Lasheras et al. 2000
Trichopoulou et al. 2003
Knoops et al. 2004
Trichopoulou et al. 2005
Mitrou et al. 2007 (males)
Mitrou et al. 2007 (females)
0.1 0.2 1 2
15.71
12.61
16.46
0.92 (0.91–0.94)
0.93 (0.91–0.95)
Total (95% CI) 100 0.91 (0.89-0.94)
Increased risk
Lagiou et al. 2006 0.93 (0.83–1.04)
8.22 0.93 (0.89–0.97)
11.19 0.88 (0.82–0.94)
16.81 0.75 (0.64–0.87)
2.81 0.48 (0.22–1.02)
6.22 0.79 (0.50–1.25)
9.68 0.69 (0.48–0.99)
Decreased risk
Adherence to MD and overall mortalityAdherence to MD and overall mortality
0.5
-9%
Sofi et al., BMJ 2008
Study RR (95% CI)Weight (%)
Trichopoulou et al. 2003
Knoops et al. 2004
Lagiou et al. 2006
Mitrou et al. 2007 (males)
Mitrou et al. 2007 (females)
0.1 0.2 1 2
34.11
3.78
17.88
0.96 (0.92–1.00)
0.88 (0.81–0.96)
Total (95% CI) 100 0.94 (0.92-0.96)
Increased risk
Fung et al. 2006 0.94 (0.91–0.97)
12.21 0.91 (0.82–1.01)
27.73 0.89 (0.77–1.03)
4.29 0.95 (0.90–1.00)
Decreased risk
Adherence to MD and cancer incidence and/or Adherence to MD and cancer incidence and/or mortalitymortality
0.5
-6%
Sofi et al., BMJ 200816
Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Sofi et al, Am J Clin Nutr 2010;92:1189–96.
Figure 2. Forest plot of the association between a 2-point increase of adherence score to the Mediterranean diet and the risk of mortality from or incidence of cardiovascular diseases. The
center of each square indicates the relative risk of the study, and the horizontal lines indicate 95% CIs. The area of the square is proportional to the amount of information from the study. The
diamond indicates pooled estimates. CHD, coronary heart disease.
a 2-unit increase in Mediterranean diet score
was associated with
27 % reduction in overall mortality
among individuals diagnosed
as having coronary heart disease
Trichopoulou et al. Arch Intern Med 2005
Mediterranean diet and survival of coronary patients: EPIC-Greece cohort
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Rather than single foods or nutrients,
a global health dietary pattern could exert
protective effect
The combination of different types of food with healthy characteristics
might be necessary to express their protective potential
A high degree of adherence to the traditional Mediterranean diet
has been associated with a reduction in:
overall, cardiovascular, and cancer mortality
and
the incidence of other diseases such as the
neurodegeneratives.20
Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek EPIC Study
Trichopoulou et al. Am J Clin Nutr 2005
There is no association
between
Mediterranean diet
and
BMI or W/H ratio
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Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial
Estruch et al. Ann Intern Med, 2006
Compared with a low-fat diet
Mediterranean diets supplemented with nuts have beneficial effects on
cardiovascular risk factors
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The traditional Mediterranean diet is associated with longer survival.
This could be partly attributed to traditional foods, which this diet implies.
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The Mediterranean dietary pattern is expressed by the combination
of a plethora of individual traditional foods and recipes
it incorporates
Olive oil
Traditional foods & recipes
Traditional Mediterranean Diet
The importance of traditional foods
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The traditional Mediterranean diet
The link between Mediterranean diet and health
The role of traditional foods in health and sustainable diets
The term “traditional”
is not
adequately defined or protected at a legislative level
Unintentionally misused
Definition of traditional foods
TRADITIONAL FOODS LEGISLATION AT THE EU LEVEL
Council Regulation (EEC) No 510/06 of 20 March 2006
On the protection of
geographical indications and designations of origin for agricultural products and foodstuffs (PGI & PDO)
Council Regulation (EEC) No 509/06 of 20 March 2006
on agricultural products and
foodstuffs as traditional specialties guaranteed (TSG)
on-line database of PDOs, PGIs and TSGs (DOOR)
http://ec.europa.eu/agriculture/quality/database/index_en.htm
“Traditional Food" definition – EuroFIR
Traditional means conforming to established practice or specifications prior to the Second World War.
Traditional food is a food of a specific feature or features, which distinguish it clearly from other similar products of the same category, in terms of the use of “traditional ingredients” (raw materials or primary products) or “traditional composition” or “traditional type of production and/or processing method”.
Trichopoulou et al. 2006 Trends in Food Science&Technology,
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STUDIES OF TRADITIONAL FOODS IN EUROPE
www.eurreca.org
www.eurofir.net
www.basefood-fp7.eu
www.truefood.eu
Study of Traditional Foods in Greece(1992 – Present)
Health aspects
Cultural aspects
Standardization
Flavonoid content of green pies (mg/100g) and selected beverages (mg/100ml)
0
2
4
6
8
10
12
Quercetin Kaempferol Myricetin Apigenin Luteolin
Green pie Red wine Black tea Apple juice
Trichopoulou et al. Food Chemistry 2000
Trichopoulou et al. Food Chemistry, 2000
The content of sesame bar and other snacks in inorganic constituents (mg/100g)
0
100
200
300
400
500
600
700
800
K Na Ca Mg P
Sesame bar (pasteli) Milk chocolate Mars Bar Waffer Biscuits (filled) Biscuits (plain) Cake Doughnut with marmelade
Trichopoulou et al. 2006 Trends in Food Science & Technology
Identification of Greek traditional foods potentially rich in Vit C for the elderly population group
(% coverage of Dietary Reference Intakes per 100g of food) %
E. Vasilopoulou and A. Trichopoulou. Mediterr J Nutr Metab. 2009 35
Identification of Greek traditional foods potentially rich in Vit E for the infants population group (% coverage of Dietary Reference Intakes per 100g of food)
Vasilopoulou & Trichopoulou Mediterr J Nutr Metab (2009)
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The flavonol, flavone and flavan-3-ol content of a typical traditional serving of fava complemented with "caper in casserole" sauce
0
5
10
15
20
25
30
35
40
1
mg
/ s
erv
ing
Caper in casserole
Fava of Santorini
Source: Study of Traditional Greek foods
Fava
Capers
1
10
100
1000
10000
log
(dai
ly in
take
, mg
)
K Fe Na Ca Mg Zn Cu Mn
Inorganic constituents
Mediterranean menu
EC daily recommendations
Trichopoulou et al. 2005 Diet diversification and health promotion. Forum Nutr.Basel, Karger
TWENTY-SIXTH FAO REGIONAL CONFERENCE FOR EUROPE
Innsbruck, Austria, 26-27 June 2008
PROMOTION OF TRADITIONAL REGIONAL AGRICULTURAL PRODUCTS AND FOOD:
A FURTHER STEP TOWARDS SUSTAINABLE RURAL DEVELOPMENT
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“Countries, communities and cultures that maintain their own traditional food systems
are better able
to conserve local food specialities with a corresponding diversity of crop varieties and animal breeds.
They are also more likely to show a lower prevalence of diet-related chronic diseases.
The Mediterranean diet offers a clear example”.
2010, FAO41
The Mediterranean Diet – from the Greek word diaita, lifestyle – is a social practice based on the set of skills, knowledge, practices and traditions ranging from the landscape to the cuisine, ………………
………………is also manifested through related festivals and celebrations.
These events become the receptacle of gestures of mutual recognition, hospitality, neighborliness, conviviality, intergenerational transmission and intercultural dialogue.
Inscription on the List of the Intangible Cultural Heritage of Humanity
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HECTORHECTOR
Eating Out: Habits, Determinants, and
Recommendations for Consumers and the
European Catering Sector
http://www.nut.uoa.gr/hectorENG.html
platform for collaboration
scientific community catering enterprises
consumer associations
Food types and quantities provided
Characteristics and determinants of out-of-home dietary patterns
Practices of European catering enterprises
The aim of the HECTOR project
• Healthy eating present business
opportunities for the catering sector
since
• healthy eating is a current societal trend
paralleled with an increased demand for
traditional, local and seasonal foods.
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As individuals and as members of social groupswe should do our best to transmit the knowledge and the practice of the traditional diets to the generations to come
in order to •Contribute to better health
•Preserve cultural tradition
•Support agricultural economy
•Protect the environment
Thank you for your attention