the role of traditional foods in the mediterranean diet hellenic health foundation who collaborating...

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 link between Mediterranean diet

and health


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


Knoops et al. 2004


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 (%)


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 link between Mediterranean diet and health


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

Goal 7: Ensure environmental sustainability

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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.

The focus could be on

seasonal foods,

traditional options,

alternative dishes

local products.

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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

Thank you for your attention 48

Thank you

the role of traditional foods in the mediterranean diet hellenic health foundation who collaborating...

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