Traditional foods: Why and how to sustain them

Trends in Food Science & Technology 17 (2006) 498–504
Review
Traditional foods:
Why and how to
sustain them
A. Trichopoulou*,
E. Vasilopoulou, K. Georga,
S. Soukara and V. Dilis
&
Department of Hygiene and Epidemiology, School of
Medicine, National and Kapodistrian University of
Athens, Mikras Asias 75, 115 27 Athens, Greece (Tel.:
C30 210 746 2074/210 746 2075; fax: C30 210 746
2079; e-mail: [email protected])
The longevity associated with the Mediterranean Diet could
be partly attributed to Mediterranean traditional foods,
which this diet incorporates. A weekly menu, representative
of the Greek traditional diet, was found compatible with the
nutritional recommendations of the European Commission
and with a high flavonoid content. The analysis of several
traditional Greek foods indicated that they may contribute to
the apparent health benefits of the Greek version of the
Mediterranean diet. The methodology for the study of
traditional foods in Greece is currently being expanded to
12 European countries in the ‘EuroFIR’ project. One of the
aims is to define the term ‘traditional’ ensuring the
classification and exclusive registration of traditional foods.
Introduction
We will firstly consider what a Mediterranean diet is and
how it affects longevity in a clearly Mediterranean country,
Greece. Secondly, we will present evidence indicating that
the traditional Greek Mediterranean diet is compatible with
the European guidelines for a healthy diet. Thirdly, we will
summarize findings about how the Greek traditional diet and
its traditional foods contribute to the beneficial health
effects of the Mediterranean diet. Then we will present the
traditional foods investigation in the context of the
EUROFIR project. Finally, we will address an issue central
* Corresponding author.
0924-2244/$ - see front matter q 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.tifs.2006.03.005
to the EFFoST conference. Is a definition of the term
‘traditional’ necessary?
Traditional foods are an integral part of the Mediterranean diet and there is a need to investigate them in order to
elucidate their role in the beneficial effects of this diet.
Traditional foods are generally considered healthy; therefore, the study of the nutrient and non-nutrient composition
of traditional foods is essential in order for this hypothesis to
be tested.
There is also a need to study traditional foods with a view
to enrich and improve our diet and at the same time
perpetuate important elements of our cultural inheritance.
Unfortunately, throughout Europe traditional foods are
threatened with extinction due to altered lifestyles. The
systematic investigation and registration of traditional foods
contributes to their sustainment, thus enabling the incoming
generations to be acquainted with, and to experience
traditional foods.
Our research team has been working towards this
approach with the objective to formulate a multi-faceted
framework for the systematic investigation of traditional
foods and recipes, aiming primarily at the elucidation of the
role of traditional Greek diet on health.
Traditional foods besides being considered healthy are
also palatable, at least the majority of them. So we have
health and palatability properties, a promising combination for the production and export activities of the
food industry. However, the increased demand for
traditional foods fosters the potential for launching into
the food market poor imitations of traditional foods,
misleading consumers. A prerequisite for minimizing
such a development is the registration and standardization of traditional foods.
Mediterranean diet
Nutritional investigations have provided strong indications that a diet that adheres to the principles of the
traditional Mediterranean one is associated with longevity.
This could be partly attributed to Mediterranean traditional
foods, which this diet incorporates.
The Mediterranean diet was first considered by Keys
(1980) as a low saturated lipid diet that was conveying
protection against coronary heart disease by lowering
plasma cholesterol levels. Over the years, however, the
emphasis has shifted away from the low saturated lipid
A. Trichopoulou et al. / Trends in Food Science & Technology 17 (2006) 498–504
content of this diet towards its high content of olive oil and
its overall composition. Moreover, the study of the
Mediterranean diet expanded beyond its effects on coronary
heart disease, to include possible effects on cancer
occurrence (Trichopoulou, Lagiou, Kuper, & Trichopoulos,
2000), and total mortality (Trichopoulou, Costacou, Bamia,
& Trichopoulos, 2003).
The role of diet in the causation of many chronic diseases
has been studied for over four decades and many foods and
nutrients with beneficial or adverse effects have been
identified (Hu & Willett, 2002; World Cancer Research
Fund, 1997). Relatively few investigations, however, have
focused on the role that whole diets or particular dietary
patterns may play in health and disease. From 1995 onwards,
we and others have operationalized the Mediterranean
dietary pattern by developing a score that captures all the
principal aspects of this diet. The score is very simple and is
based on the nine characteristics of the Mediterranean diet
that can be combined into a uni-dimensional scale. The
characteristics are the following: high olive oil consumption,
high consumption of legumes, high consumption of
unrefined 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 (Trichopoulou et al., 1995,
2003).
Adherence to the Greek traditional Mediterranean diet
was recently assessed by a 10-point Mediterranean-diet
scale that incorporated the above mentioned salient
characteristics of this diet. The results of these studies
indicate that: (a) a higher degree of adherence to the
Mediterranean diet is associated with a reduction in total
mortality. A significant inverse association was evident
for both death due to coronary heart disease and death
due to cancer (Trichopoulou et al., 2003), (b) the
indicated Mediterranean diet score, modified so as to
apply across Europe, was associated with increased
survival among older people in most European populations (Trichopoulou, Orfanos et al., 2005), (c)
adherence to the Mediterranean diet in variable ways,
chosen at will by coronary patients in the general
population, was associated with significant reduction in
long term mortality (fatality) (Trichopoulou, Bamia, &
Trichopoulos, 2005), (d) adherence to the Mediterranean
diet was inversely associated with arterial blood pressure
(Psaltopoulou et al., 2004), and (e) the Mediterranean
diet does not substantially affect body mass index and
the high prevalence of overweight in Mediterranean
countries is accounted for by high prevalence of
inactivity in conjunction with excess energy intake
(Trichopoulou, Naska, Orfanos, & Trichopoulos, 2005).
The outcomes of the above studies indicate that rather
than single foods or nutrients, their synergy could exert a
protective effect (Trichopoulou et al., 2003, Trichopoulou,
Orfanos et al., 2005, Trichopoulou, Bamia et al., 2005),
499
emphasising on the importance of a global healthy dietary
pattern. Moreover, the combination of different types of
food with healthy characteristics might be necessary to
express their protective potential. Therefore, the beneficial
effects of the Mediterranean diet may be partly attributed to
Mediterranean traditional foods, which are richly represented in the traditional diets of the Mediterranean
countries.
Macro- and micronutrients in a traditional Greek
menu
We have analyzed a weekly menu typical of the dietary
pattern of the Greek variant of the Mediterranean diet to
examine whether it meets the nutritional recommendations
developed by the Scientific Committee for Food of the
European Commission concerning macronutrients and
certain micronutrients and to determine the content of the
menu in antioxidant flavonoids.
A typical traditional weekly menu was developed based
on the Greek dietary guidelines, which refer to the
traditional Greek diet (Trichopoulou & Georga, 2004;
Trichopoulou, Vasilopoulou, & Georga, 2005) and are
depicted in the traditional Mediterranean pyramid (Supreme
Scientific Health Council, 1999). The generated weekly
menu refers to adults of both genders and the foods that it
includes are presented in Table 1. The menu is compatible
with the tradition, which has religious roots, of avoiding
foods of animal origin every Wednesday and Friday. Portion
sizes were defined according to Greek market regulations.
The daily energy provided by the Mediterranean menu
under investigation is 2.473 kcal/day or 10.4 MJ/day. The
energy of the Mediterranean menu is attributed to the
following components: proteins (12%), dietary lipids
(40.3%), carbohydrates (41.4%), dietary fibre (2.4%), and
ethanol (4%).
The high intake of total lipids, in particular monounsaturated fatty acids (MUFA), is characteristic of the
Mediterranean diet as is the relatively high intake of
dietary fibre and some minerals such as potassium,
magnesium and iron. The high lipid content of the
Mediterranean diet and the suspicion surrounding lipids as
possible promoters of obesity deserve special consideration. During the last 20 years, however, there has been
an accumulation of scientific evidence about the different
role of different types of ‘fat’ and carbohydrates, on
health and disease. There is no evidence that the adverse
health effects of dietary animal ‘fat’ also apply to olive oil
and perhaps other types of plant oils. In contrast, it
appears that consumption of olive oil in conjunction with
vegetables can convey a substantial degree of protection
against a wide range of chronic diseases. It has been
shown that consumers of large quantities of olive oil have
a low saturated fat intake and a high consumption of
vegetables and legumes (Serra-Majem, Ngo de la Cruz,
Ribas, & Tur, 2003)
A. Trichopoulou et al. / Trends in Food Science & Technology 17 (2006) 498–504
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Table 1. The primary and composite foods of the investigated weekly menu, representative of the traditional Greek diet
Breakfast
Morning
snack
Lunch
Afternoon
snack
Dinner
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Herbal tea
Sugar
Feta
Bread
Grapes
Yogurt
Honey
Apple
Herbal tea
Sugar
Black olives
Bread
Apple
Herbal tea
Sugar
Feta
Bread
Apple
Herbal tea
Sugar
Black olives
Bread
Apple
Herbal tea
Sugar
Feta
Bread
Apple
Herbal tea
Sugar
Feta
Bread
Apple
Green beans
Lentils with
tomato
Green olives
Chicken casserole
Rice (pilaf)
Eggplants casserole
Fish roe salad
Baked
vegetables
Feta
Roast lamb
Feta
Fried wet salted
cod
Chicories
Bread
Red wine
Apple
Bread
Red wine
Pear
Bread
Red wine
Orange
Lettuce salad
Bread
Red wine
Orange
Bread
Red wine
Pear
Raisins
Semolina cake
(halvah)
Greek coffee
Sugar
Spinach pie
Greek coffee
Sugar
Fried potatoes
Greek salad
Feta
Semolina cake
(halvah)
Greek coffee
Sugar
Potatoes casserole
Lettuce salad
Raisins
Greek coffee
Sugar
Cheese pie
Olive oil
cookies
Greek coffee
Sugar
Spinach rice
Bread
Red wine
Pear
Mizithra
(cheese)
Cabbage salad
Pasteli, sesame
bar
Greek coffee
Sugar
Feta
Greek salad
Greek salad
Greek salad
Bread
Bread
Bread
Bread
Bread
Bread
Fried egg
Baked potatoes
Bread
Red wine
Orange
Lettuce salad
Olive oil
cookies
Greek coffee
Sugar
Chilopites
(pasta)
Cabbage
salad
Bread
Mizithra
(cheese)
Source: Trichopoulou, Vasilopoulou et al. (2005). The composite foods are indicated in italics.
The results of our study have been evaluated in
comparison to the relevant recommendations of the
Scientific Committee for Food of the European Commission
(Commission of the European Communities, 1993). The
results indicate that the Mediterranean menu is fully
compatible with the European recommendations (Table 2)
(Trichopoulou, Vasilopoulou et al., 2005).
In addition, we have calculated the flavonoid content of a
traditional Greek plant-based weekly menu. The specific
flavonoids that have been investigated are: flavones:
(luteolin, apigenin), flavonols (myricetin, quercetin, kaempferol, isorhamnetin), flavan-3-ols: (C)-catechin, (K)epicatechin, (K)-epigallocatechin, (K)-epicatechin gallate,
(K)-epigallocatechin gallate, flavanones (eriodictyol,
hesperetin, naringenin), anthocyanidins (cyanidin, delphinidin, malvidin, peonidin, petunidin) and isoflavones
(daidzein, genistein) (Vasilopoulou, Georga, Joergensen,
Naska, & Trichopoulou, 2005). These flavonoids are
common in plant foods and have been investigated in
relation to health (Arts, 2001; Hertog, 1994; Lagiou,
Samoli, Lagiou, Peterson et al., 2004; Lagiou, Samoli,
Lagiou, Tzonou et al., 2004). Summarized results are shown
in Table 3.
The calculated flavone, flavonol and flavan-3-ol values
were additionally supported by the analytical results of
Table 3. The primary and composite foods included in each
Table 2. Daily intake of macro and micronutrients of the
Mediterranean menu
Component
Daily intake
Protein
Total lipids
Dietary fibre
Carbohydrates
Ethanol
Energy value
Fatty acids
SFA
MUFA
PUFA
TFA
Total sterols
Total carotenoids
a-tocopherol
Inorganic constituents
K
Fe
Na
Ca
Mg
Zn
Cu
Mn
74.5 g
110.7 g
29.8 g
255.8 g
14 g
2.473 Kcal
29.8 g
63.8 g
9.9 g
1.4 g
256.8 mg
65.7 mg
4.3 mg
1774 mg
14.9 mg
2632 mg
696 mg
234 mg
10.3 mg
3.80 mg
3.51 mg
Source: Trichopoulou, Vasilopoulou et al. (2005).
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Table 3. The flavonoid content of a Greek traditional Mediterranean menu
Flavonoids
Total flavonols
Total flavones
Total flavan-3-ols
Total flavanones
Total anthocyanidins
Total isoflavones
Grand total
a
Calculated valuea
(mg/week)
Analytical value
(mg/week)
184.89
61.00
228.86
269.12
77.3
260.20
71.15
221.72
–
–
8.75
829.92
–
553.07
Source: Vasilopoulou et al. (2005).
column of Table 1 were combined to form a composite
sample representative of the daily menu. So, in total seven
composite samples were analyzed by Reverse-Phase HPLC.
The analytical values in Table 3 refer to the weekly
flavonoid content derived from the summation of the
content of the seven daily samples.
The data are indications of the flavonoid content of a
typical plant-based Mediterranean menu. The traditional
Mediterranean diet has a high flavonoid content. The
inclusion of herbs and spices in the traditional Greek
cuisine significantly contributes to the flavonoid content of
the diet (Vasilopoulou et al., 2005). Herbs and spices are an
integral part of the traditional Greek diet and although added
in small quantities they are included in almost every
traditional dish. Therefore, their frequent consumption in
conjunction with the fact that they may also provide
flavonoids not included in our study indicates their potential
contribution to the health benefits of the traditional Greek
diet.
The composition of the Mediterranean diet and particularly the traditional Greek diet favours plant foods with
antioxidant potential, which are considered to provide
protection from coronary heart disease and cancer.
Although the list of phytochemicals is extensive (and not
completely defined), the existing data (Vasilopoulou et al.,
2005) suggest that the Mediterranean diet has a high
antioxidant content. Thus, the high phytochemical intake in
conjunction with the sufficient intake of macronutrients and
inorganic constituents may contribute to the health benefits
observed in the Mediterranean basin.
Although the Mediterranean diet and lifestyle were
shaped by climatic conditions, poverty and hardship, rather
than by intellectual insight or wisdom, it seems as if the
overall existing circumstances lead the Mediterranean
populations to a prudent diet by exploiting, to the utmost,
the gifts that nature abundantly favoured them with.
The systematic investigation of traditional Greek
foods
There is a clear need for the registration and standardization of traditional foods, in order for these products to
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have a stable high quality and conform to contemporary
perceptions of proper and safe production. The study of
traditional foods in Greece started in 1992 and over 100
primary and composite traditional Greek foods have been
investigated. The list of traditional recipes studied can be
found on our home webpage (www.nut.uoa.gr) and in the
Composition tables of foods and Greek dishes (Trichopoulou et al., 2004). Their investigation includes several
aspects:
Determination of the nutrient value of primary and
composite traditional foods
Chemical analyses are conducted not only on the
composite foods (recipe) but also on all the individual raw
ingredients used (primary foods). The main analyses
performed are: energy value, water content, proteins, lipid
profile, dietary fibre, inorganic constituents, vitamins and
phytochemicals.
Historical and folkloric review, which documents the
traditional identity of the foods
Documentation of the traditional identity of the foods by
investigating interspersed information in the literature.
Recording of the traditional production methods of the
foods with audio–visual means
This phase involves a written detailed description of the
traditional cooking procedure, as well as audio–visual
recording. In the context of an on-the spot investigation,
the food is prepared by local inhabitants in the region where
it is traditionally consumed. Traditional cooking techniques,
which are slowly vanishing, are recorded.
Technological study of the potential incorporation of
traditional food production into the industrial or semiindustrial context
This study explores the potential standardization of the
food and can be used as a guide for its industrial or semiindustrial production.
Data synthesis
Generation of evidence-based records documenting the
traditional character of foods and recipes under
investigation.
The results of this activity contribute to the
preservation and dissemination of traditional foods,
emphasizing their beneficial potential on health. The
analysis of several traditional Greek foods indicated that
the majority of them are rich in antioxidants and meet
current criteria for a prudent diet. Therefore, the
traditional foods of Greece may contribute to the
apparent health benefits of the Mediterranean diet.
Likewise, the analysis of traditional foods in other
European countries may reveal beneficial health effects
in some or many of them, since tradition rarely, if ever,
honours foods and diets incompatible with good health.
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Fig. 1. Flavonoid content of green pies (mg/100 g) and selected beverages (mg/100 ml).
We highlight below a few indicative examples of typical
Greek traditional foods with potential health benefits:
Green pies of Crete
Two pieces of Cretan green pie (approximately 100 g)
contain 12 times more quercetin than one glass of red wine
(100 ml), and three times more quercetin than a cup of black
tea (200 ml) (Fig. 1) (Trichopoulou, Vasilopoulou et al.,
2000).
Pasteli of Sifnos (Cycladic Island)
The pasteli (sesame bar) is a wholesome sweet with a
high nutritional value, due to its two ingredients—sesame
seeds and honey. The pasteli, compared to other snacks with
a similar energy value, offers exceptional nutrients. It has
higher protein and dietary fibre contents than other snacks
and, although it contains a high proportion of lipids,
cholesterol is absent and the saturated fatty acid content is
low, while mono- and polyunsaturated fatty acids are
predominant. Also the pasteli, compared to other snacks, is
rich in calcium, magnesium and phosphorus and it is
unsalted (Fig. 2) (Trichopoulou, Chamalides et al., 2000).
The European food information resource network
(EuroFIR)
EuroFIR (www.eurofir.net) is a 5-year project funded
under the EU 6th Framework Food Quality and Safety
Programme and started on 1st January 2005. It is a
partnership between 40 universities, research institutes and
small-to-medium sized enterprises from 21 countries and
includes 19 national database compilers. EuroFIR is a
European Network of Excellence on reliable food information and aims to establish a single, authoritative source of
food composition data for Europe.
In achieving its principal objectives EuroFIR operates
along four Horizontal Platforms (Integration, Joint
Research, Spreading of Excellence, Management), each
with a number of activities grouped under workpackages
(WPs). In the Joint Research Activities, the WP on
traditional foods is coordinated by the National and
Kapodistrian University of Athens and generating new
data on traditional foods in Europe. Most current national
databases are lacking data on country specific traditional
foods. This information is necessary for national
databases in order to accurately estimate population
Fig. 2. The content of sesame bar and other snacks in inorganic constituents (mg/100 g).
A. Trichopoulou et al. / Trends in Food Science & Technology 17 (2006) 498–504
dietary intakes. Moreover, the determination of the
macro- and micronutrient composition of traditional
foods is essential in order to elucidate their role in the
traditional dietary pattern of a population. Many
traditional foods are reputed to have health benefits, the
roots of which are poorly understood.
EuroFIR aims to provide data on the nutritional
composition of traditional foods for inclusion in national
food composition tables along with their raw ingredients
and recipes. In particular, we are piloting standardised
procedures and mechanisms for the systematic identification, sample collection and analysis of traditional foods
across 12 European countries (Austria, Belgium, Bulgaria,
Denmark, Germany, Greece, Iceland, Italy, Poland, Portugal, Spain, and Turkey), in order to generate sufficient
quality and representative data on these traditional foods for
future inclusion in national food composition databases.
These data may be attractive for the food industry
(especially SMEs) in order to produce standardised
traditional products.
Traditional foods are considered a legacy long lasting
throughout the centuries and passed on to us by our
ancestors. Due to altered lifestyles this national legacy is
slowly vanishing and the future generations may be totally
deprived of it. Contemporary lifestyle is leading to
increasing consumption of manufactured foods. Thus, the
most efficient way for traditional foods to be reinstated in
the daily diet involves their registration and standardization.
Registration permits the strict definition of the food
according to its traditional cooking procedure and characteristic properties, whilst standardization assures that
manufactured traditional foods maintain the organoleptic,
physicochemical and microbiological properties that
characterize it.
The definition of traditional foods
In a European context, there are two regulations in
force with respect to traditional foods. Council regulation
2081/92 of 14 July 1992 (Council of the European
Communities, 1992a) which applies for the protection of
geographical indications and designations of origin of
agricultural products, and regulation 2082/92 of 14 of
July 1992 (Council of the European Communities,
1992b) on certificates of specific character of agricultural
products and foodstuffs. Regulation 2081/92 has been
successfully implemented in many European foods,
whilst very few foods have been certified according to
the regulation 2082/92 as ‘Traditional Speciality Guaranteed’. One of the reasons for the ‘gap’ in the
enforcement of the regulation is that it does not convey
adequate protection, neither to the producer nor to the
food. Furthermore, it lacks a distinct definition of the
concept of ‘traditional’ resulting in an inability to ensure
the exclusive registration of traditional foods. Only
recently has the EU acknowledged the importance of
503
introducing a definition of the term ‘traditional’ into the
regulation, which according to the proposal is
‘Traditional means proven usage on the Community
market for a period at least equal to that generally
ascribed to a human generation’ (Commission of the
European Communities, 2005).
Acknowledging this weakness in the Commission
regulation as well as the need for the registration of Greek
traditional foods, in the year 2000 AGROCERT (the
standardization, inspection and certification authority in
Greek agriculture) formed a scientific committee, which has
reached the following criteria for the definition of a food as
traditional.
Traditional material
Raw material that has been used in the past in identifiable
geographical origins and is still today being used (taking
into account cases where use was abandoned but was
brought back again) and its characteristics are in accordance
with currently in force specifications of European and
national legislation.
Traditional formulation
The formulation in terms of ingredients, which has been
transmitted from generation to generation (even if the
formulation was abandoned for a time period but was
brought back to use) and is unique or differentiated from the
formulation defined by legislation or templates of the wider
food group in which the product is listed.
Traditional type of production and/or processing
The production and/or processing of a food that has
been transmitted from generation to generation through
oral tradition or other means and is applied until today
(even if it has been occasionally abandoned in the past)
and despite its adjustment to binding rules from national
or European regulations on food hygiene or the
incorporation of technological progress, its production
and/or processing remains in line with methods used in
the past.
Moreover, the EuroFIR working group has preliminarily
defined the term traditional as ‘conforming to established
practice or specifications prior to the Second World War’.
This definition is with respect to traditional foods, which are
considered a cultural issue. The Second World War is a
historical event and virtually stands for ‘prior to the era of
mass food production’. Following the Second World War
technological innovation altered the traditional processing
approaches. Therefore, the Second World War is considered
a time barrier before the food industry revolution, where
populations still applied simple and time-honoured
approaches.
The Mediterranean diet could offer a healthy alternative
approach to low animal fat diet. Its expanded range of
options could promote adherence, particularly over the long
term. The Mediterranean diet is not sharply different from
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A. Trichopoulou et al. / Trends in Food Science & Technology 17 (2006) 498–504
other recommended diets. Two elements distinguish it from
these other prudent diets. It stresses the pattern rather than
individual components and provides no restriction on lipid
intake, so long as lipids are not saturated and are preferably
in the form of olive oil.
Through EuroFIR (European Food Information Resource
Network of Excellence) the methodology of the systematic
investigation of traditional foods, developed and
implemented for over 10 years in Greece, is expanding to
other European countries. In addition, the definitions of the
AGROCERT scientific committee formulated a basis for
further developing and improving the concept of
‘traditional’.
Acknowledgements
This study was supported in part by the EuroFIR
Network of Excellence (FOOD-CT-2005-513944) funded
under the EU 6th Framework Food Quality and Safety
Programme and by the International Foundation for the
Promotion of Nutrition Research and Nutrition Education
(ISFE). We also express out thanks to Ms Alexandra Manoli
for her administrative support.
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