Transcript CONTENTS

The role of traditional foods in the Mediterranean diet
Antonia Trichopoulou, MD, PhD
University of Athens, School of Medicine
Dept of Hygiene, Epidemiology and Medical Statistics
WHO Collaborating Centre for Food and Nutrition
Hellenic Health Foundation
Food and Drinks Innovation Network
The Mediterranean Diet- The Next Big Trend
Seminar date : Wednesday June 27th
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:
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high olive oil consumption
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high consumption of legumes
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high consumption of cereals
•
high consumption of fruits
•
high consumption of vegetables
•
moderate consumption of dairy products, mostly as cheese and yogurt
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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
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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 News
FOR IMMEDIATE RELEASE
P04-100
November 1, 2004
……eating about 2 tablespoons (23 grams) of olive
oil daily may reduce the risk of coronary heart
disease………
Olive oil intake and mortality
within the Spanish population
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
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Dietary patterns: Greece (Elderly)
Soya
Soups
Potatoes
250
Vegetables
Legumes
200
Sauces
Fruit
150
Other Alcoholic bev
Dairy products
100
50
Wine
Pasta,rice,other grain
0
Non-alcoholic bev
Bread
Cakes
Other Cereals
Sugar
Meat
Margarine
Reference EPIC mean (100%)
Greece
Fish
Butter
Eggs
Vegetable oil
Source: EPIC-Elderly
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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
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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 intake
Range: 0-9
Beneficial components
Vegetables
Legumes
Fruit
Unprocessed cereals
Fish
M/S ratio
Moderate ethanol intake
Non-beneficial components
Meat
Dairies (whole fat)
1:mean daily consumption (g) Fruits
at/above cut-off, 0: otherwise
0: mean daily consumption (g)
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
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Adherence to MD and overall mortality
Study
Weight (%)
RR (95% CI)
Trichopoulou et al. 1995
9.68
0.69 (0.48–0.99)
Kouris-Blazos et al. 1999
6.22
0.79 (0.50–1.25)
Lasheras et al. 2000
2.81
0.48 (0.22–1.02)
Trichopoulou et al. 2003
16.81
0.75 (0.64–0.87)
Knoops et al. 2004
11.19
0.88 (0.82–0.94)
Trichopoulou et al. 2005
8.22
0.93 (0.89–0.97)
Lagiou et al. 2006
12.61
0.93 (0.83–1.04)
Mitrou et al. 2007 (males)
15.71
0.92 (0.91–0.94)
16.46
0.93 (0.91–0.95)
-9%
Mitrou et al. 2007 (females)
Total (95% CI)
100
0.1
0.2
0.5
Decreased risk
1
0.91 (0.89-0.94)
2
Increased risk
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Sofi et al., BMJ 2008
Adherence to MD and cancer incidence and/or
mortality
Study
Weight (%)
RR (95% CI)
Trichopoulou et al. 2003
4.29
0.95 (0.90–1.00)
Knoops et al. 2004
27.73
0.89 (0.77–1.03)
Lagiou et al. 2006
12.21
0.91 (0.82–1.01)
Fung et al. 2006
3.78
0.94 (0.91–0.97)
Mitrou et al. 2007 (males)
34.11
0.96 (0.92–1.00)
17.88
0.88 (0.81–0.96)
-6%
Mitrou et al. 2007 (females)
Total (95% CI)
100
0.1
0.2
0.5
Decreased risk
1
0.94 (0.92-0.96)
2
Increased risk
Sofi et al., BMJ 2008
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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.
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.
Mediterranean diet and survival of coronary patients: EPIC-Greece cohort
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
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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
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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.
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Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek EPIC Study
There is no association
between
Mediterranean diet
and
BMI or W/H ratio
Trichopoulou et al. Am J Clin Nutr 2005
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Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial
Compared with a low-fat diet
Mediterranean diets supplemented with
nuts have beneficial effects on
cardiovascular risk factors
Estruch et al. Ann Intern Med, 2006
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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
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The importance of traditional foods
Olive oil
Traditional foods & recipes
Traditional Mediterranean Diet
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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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Definition of traditional foods
The term “traditional”
is not
adequately defined
or protected at a legislative level
Unintentionally misused
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.eurofir.net
www.eurreca.org
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)
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10
8
6
4
2
0
Quercetin
Kaempferol
Green pie
Trichopoulou et al. Food Chemistry 2000
Trichopoulou et al. Food Chemistry, 2000
Myricetin
Red wine
Black tea
Apigenin
Apple juice
Luteolin
The content of sesame bar and other snacks in inorganic
constituents (mg/100g)
800
700
600
500
400
300
200
100
0
K
Sesame bar (pasteli)
Na
Milk chocolate
Ca
Mars Bar
Waffer
Biscuits (filled)
Trichopoulou et al. 2006 Trends in Food Science & Technology
Mg
Biscuits (plain)
P
Cake
Doughnut with marmelade
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
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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
40
35
30
mg / serving
Capers
25
Caper in casserole
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Fava of Santorini
15
10
5
Fava
0
1
Source: Study of Traditional Greek foods
Inorganic constituents
10000
Mediterranean menu
log(daily intake, mg)
1000
EC daily recommendations
100
10
1
K
Fe Na Ca Mg Zn Cu Mn
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, FAO
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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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HECTOR
Eating Out: Habits, Determinants, and
Recommendations for Consumers and the
European Catering Sector
http://www.nut.uoa.gr/hectorENG.html
The aim of the HECTOR project
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
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Healthy eating present business
opportunities for the catering sector
since
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healthy eating is a current societal trend
paralleled with an increased demand for
traditional, local and seasonal foods.
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The focus could be on
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seasonal foods,
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traditional options,
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alternative dishes
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local products.
Thank you for your attention
As individuals and
as members of social groups
we 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
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Thank you
Thank you for your attention
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