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Modern dietary patterns based on territorial origin - a review

Authors:
  • Latvia University of Life Sciences and Technologies (former Latvia University of Agriculture)
FOODBALT 2019
MODERN DIETARY PATTERNS BASED ON TERRITORIAL ORIGIN
A REVIEW
Evalds Raits1,2*, Asnate Kirse-Ozolina1
1* Department of Food Technology, Faculty of Food Technology, Latvia University of Life Sciences and Technologies,
Rigas iela 22, Jelgava, Latvia, e-mail: evalds.raits@gmail.com
2 Kronis Ltd., “Ozolnieki”, Codes pag., Bauskas novads, LV-3901, Latvia
Abstract
There are different dietary patterns around the globe formed on the account of various anthropogenic factors: cultural, economic and
globalization. Human food consumption patterns can be formulated and defined depending on habitat. For example, since Scandinavian
countries are surrounded by seas, fishery was quite developed historically, and even today seafood constitutes a large part of daily
Scandinavian food plate. On the other hand, world globalization has led to the appearance of such unhealthy food consumption patterns
as unbalanced nutrition or refined product excess in daily diet. There is a strong association between unhealthy eating habits and
diseases, which means that healthy eating habits could lower a wide range of such disease emergence possibility as metabolic syndrome,
type 2 diabetes, and cardiovascular disease. The review discusses types of modern dietary patterns around the globe their origins,
main principles and effects on health, comparison of nutrient ratios among the most popular dietary patterns (Nordic diet, Mediterranean
diet, Okinawa diet) and the “unhealthy” Western diet.
Keywords: Nordic diet, Mediterranean diet, Okinawa diet, Western diet
Introduction
There are different dietary patterns around the globe
formed on account of various anthropogenic factors:
cultural, economic and globalization.
From the biological mechanism point of view,
environment which conditioned human genetic makeup,
i.e., where our ancestors survived, is more favorable for
descendants (Cordain et al., 2005). It is recognized that
industrial revolution and globalization occurred so
recently on the time-scale of evolution, that human
genome cannot be fully adapted to environment
(Carrera-Bastos et al., 2011; Boyd, Eaton, 1985).
The review summarizes types of modern dietary patterns
around the globe their origins, main principles and
effects on health, compares nutrient ratios among the
most popular dietary patterns and the “unhealthy”
Western diet.
1. Nordic diet
Geographical position of Scandinavian (Nordic)
countries (i.e. Denmark, Finland, Norway, Sweden)
provides unique coastal climate and special light
conditions (lack of sunlight in the winter and plenty of
light during the summer period) for plant growth
(Nordic Council of Ministers, 2008).
1.1. Food pyramid
New Nordic Cuisine Manifesto was defined in 2003
with the purpose to popularize Nordic cuisine among the
world (Nordic Council of Ministers, 2008). Principles
and guidelines of the New Nordic Diet were widely
described in the Guidelines for the New Nordic Diet
in 2012. The diet is based on three main cornerstones:
o more calories from plant foods and fewer from
meat;
o more foods from the sea and lakes;
o more foods from the wild countryside”
(Mithril et al., 2011).
Compared to the traditional food pyramid, the base of
ND pyramid is given to high vegetable and fruit
consumption (Figure 1).
Figure 1. Nordic diet food pyramid
(made by author, based on Mithril et al., 2013)
Nordic diet (ND) suggests to establish the daily diet on
(in descending order): fruits and vegetables (including
root vegetables, wild berries and potatoes); whole grains
and legumes; nuts and fresh herbs; dairy products;
seafood; seaweed; free-range meat (including game);
sweets, beverages etc. (Mithril et al., 2013).
1.2. Effect on health
High adherence to ND has been strongly associated
with a positive influence on inflammation (De
Mello et al., 2011; Uusitupa et al., 2013), endothelial
dysfunction (De Mello et al., 2011), blood pressure
reduction in people with metabolic syndrome (MetS)
(Brader et al., 2014; Andersen et al., 2015).
A study in Denmark showed, that there is an evident
connection between adherence to Nordic diet and risk of
type 2 diabetes (T2D), which is explained by the high
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content of dietary fibre, which affect the level of glucose
and insulin sensitivity due to low glycemic index (GI)
(Lacoppidan et al., 2015). However, two independent
studies in Finland (Kanerva et al., 2014), a study in
Germany (Galbete et al., 2018) and a study in Sweden
(Shi et al., 2018) did not find association between
Nordic diet score and T2D biomarkers.
2. Mediterranean diet
Mediterranean diet (MD) origins are found in olive
tree growing areas of the Mediterranean basin, which
are considered natural in all countries of the
Mediterranean coast (Ighbareyeh et al., 2018; Sánchez-
Villegas et al., 2018).
2.1. Food pyramid
Principles and guidelines of MD were widely described
in Bach-Faig et al. (2011), focusing on nutritional
aspects. Later, Dernini et al. (2017) characterized the
benefits of MD in four thematic areas:
1) nutrition and health;
2) environment;
3) economy;
4) society and culture.
According to MD principles, 1/3 to 2/3 of every meal
should consist of vegetables, cereals and fruits,
providing macronutrients, low GI carbohydrates and
antioxidants; whole grains, legumes and dairy products
are considered as the main source of protein (Figure 2).
Figure 2. Mediterranean diet food pyramid
(made by author, based on Bach-Faig et al., 2011;
Davis et al., 2015)
Olive oil is considered as the main source of lipids; wine
and other fermented beverages are recommended as a
polyphenol source (1 glass for women, 2 glasses for
men per day) (Bach-Faig et al., 2011; Davis et al.,
2015).
2.2. Effect on health
Numerous studies show positive effect of adherence to
MD pattern regarding moderate alcohol consumption on
the risk of CVD (e.g. 40% as found by Ndlovu, Van
Jaarsveld, and Caleb (2019). A 12 year follow-up study
even showed that daily alcohol consumption lowers
cardiovascular disease (CVD) risk for 30 to 35%
for men (Mukamal et al., 2003). As reported by
Ndlovu et al. (2019) the type of alcohol is not of
importance, as it is ethanol which affects the density of
cholesterol.
MD has been recognized as a dietary pattern with strong
association with the improvement of MetS risk factors,
body weight reduction in particular (Shai et al., 2008;
Estruch et al., 2016). A randomized controlled trial on
obese postmenopausal women (n=144) with at least one
other MetS criterion, showed a loss of 6.67.6 kg on
average in 16 weeks after energy restricted dietary
intervention (Bajerska et al., 2018).
In the European case-cohort study high adherence to
MD was found to lower possibility of T2D by 12% in
comparison to individuals with low adherence to MD
(Dora Romaguera, 2011). Effects of diet on T2D are
affected by several factors, e.g., low-GI carbohydrates,
low fat dairy, polyunsaturated fatty acids (PUFA) from
vegetable oils, low red meat and processed meat intake
(De Koning et al., 2011).
3. Okinawan diet
As stated by Rosenbaum et al. (2010), residents of
Okinawa prefecture (most southern island chain of
Japan) have a very high life expectancy compared to the
rest of the world. Traditional Okinawan diet (OD) is a
dietary pattern that existed in Okinawa prefecture before
the globalization and westernization after World War II.
It is known for a low-calorie and almost vegetarian
dietary pattern, due to the specific climatic and terrain
conditions (Willcox et al., 2007; Gavrilova, Gavrilov,
2012; Willcox, Willcox, 2014).
3.1. Food pyramid
OD mainly consists of vegetables and legumes, i.e.
sweet potato, cabbages and soy in different variations
(miso, tofu, soy milk etc.), serving as a carbohydrate and
protein source (Figure 3) (Willcox et al., 2014).
Figure 3. Traditional Okinawan diet food pyramid
(made by author, based on Willcox et al., 2014)
3.2. Effect on health
Although seemingly paradoxal, yet historically
established caloric (dietary) restriction is considered to
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be a key factor of longevity (Gavrilova, Gavrilov, 2012).
According to Willcox et al. (2007), Okinawan
population have been consuming 11% less calories than
it would be recommended in relation to body weight.
There is a hypothesis that caloric restriction induces
stress, which triggers the biological pathways that result
in gene encoding which influence longevity, aiding in
metabolism regulation (Willcox, Willcox, 2014).
4. Western diet
There are plenty of scientific papers connecting various
chronic diseases to the so-called Western diet (WD), like
cancer, CVD and diabetes that comprise MetS
(Verboven et al., 2018; WHO, 2014), but what does the
term Western diet actually imply?
According to WHO, overweight individuals composed a
staggering 1.9 billion of all adults. The main cause of
obesity is considered energy intake imbalance with
energy consumption (WHO, 2018).
A study by Serra-Majem et al. (2009) showed
correlation of WD with intake of red and processed
meat, eggs, sauces, fast food, pre-cooked food, whole
dairy products and potatoes. Several other studies
associate WD with high fat and sugar consumption
(Verboven et al., 2018). The breakdown of food groups
in WD is given in Figure 4.
Figure 4. Typical Western diet food pyramid
(made by author, based on Cordain et al., 2005)
According to data presented by Cordain et al. (2005),
based on scientific papers year from year 2001 to 2004,
US diet energy intake constituted of 20.4% refined
grains, 18.6% refined sugars, and 17.6% refined
vegetable oils.
5. Comparison
According to previously mentioned studies, dietary
patterns differ in many ways, e.g. culture of food
consumption, its pattern, physical activity, but
especially in nutrient intake ratios and their “signature”
foods.
5.1. Energy intake
According to EFSA (2017), reference intake (RI) is the
amount of macronutrients needed to maintain
physiological functions, usually expressed as % of daily
energy intake.
The comparison of average nutrient intakes (Table 1)
indicates significant variations between types of diets.
While Mediterranean diet has similar amounts of
carbohydrates, protein and saturated fatty acids to
Western diet, average intake of fat it significantly
higher. In this case, however, the type of fat is of
importance. Okinawa diet shows the greatest differences
compared to the rest of diets.
Table 1
Average nutrient energy intake as a percentage of
total energy among presented dietary patterns
Nutrients
Types of diets
Reference
intake
ND
MD
OD
WD
Carbohydrates,
%
51(a)
43(b)
85(b)
49.9(c)
45-60(d)
Dietary fibre, g
41(a)
n.d.
n.d.
n.d.
25(d)
Protein, %
17(a)
13(b)
9(b)
15.7(c)
10-20(d)
Fat, %
32(a)
42(b)
6(b)
34.4(c)
20-35(d)
Saturated fatty
acids, %
10(a)
9(b)
2(b)
11.6(c)
as low as
possible(d)
ND Nordic diet, MD Mediterranean diet, OD Okinawa
diet, WD Western diet
n.d. not defined
(a) Mithril et al., 2013; (b) Willcox et al., 2014; (c) Paeratakul et
al., 2003; (d) EFSA, 2017
With regards to protein reference intake, the data
presented in Table 1 corresponds to intake 0.80 g per kg
of body weight regardless of gender.
5.2. Signature foods
The term “signature” foods first occurred in (Biltoft-
Jensen et al., 2015) and can be described as foods that
are characteristic to the diet (Andersen et al., 2015;
Biltoft-Jensen et al., 2015).
Signature foods for previously described dietary
patterns are presented in Table 2. WD pattern presents
itself as an unhealthy example of dietary pattern, typical
for most of modern developed countries: fried potatoes,
high amount of salt, refined grain products and simple
sugars (sucrose, glucose) which drastically affect blood
sugar levels. ND, MD and OD dietary patterns have
common food group representatives, all of them
describe whole grains as the main source of dietary fibre
and low-GI carbohydrates. It is recommended to
consider whole grains with legumes as the main source
of protein; sea products as a source for essential amino
acids and PUFAs, fruits and vegetables as the main
source for polyphenols and carbohydrates.
The main differences for MD in comparison to ND and
OD are olives and olive oil as the source of vegetable
lipids, and daily consumption of wine as the source of
polyphenols. ND philosophy implies focus on wild
forest foods, e.g., wild berries, mushrooms and herbs
considered as a source of polyphenols; root vegetables
and cabbage as a source of carbohydrates.
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Table 2
Signature food comparison of different dietary patterns
Types of diet
ND(a)
MD(b)
OD(c)
WD(d)
Root vegetables
Vegetables
Yellow-root
vegetables
Cereals
Cereals
Rice
Whole grain
Whole grain
Whole grain
Refined grain
Potatoes
Sweet potatoes
Potatoes (deep fried)
*
Fruits
Sucrose, fructose, glucose
Cabbage
Kale, collard
Mushrooms
Shiitake mushrooms
Wild plants
Legumes
Legumes
Tofu, soy, legumes
Nuts
Tree nuts
Seeds
Seeds
Sea products
Sea products
Sea products
Game meat
Poultry
Poultry
Eggs
Sea products
Olive oil
Margarine, butter, cooking oils
Herbs
Herbs
Berries
Wine
Alcohol
Salt
ND Nordic diet, MD Mediterranean diet, OD Okinawa diet, WD Western diet
(a) Andersen et al., 2015; (b) Bach-Faig et al., 2011; (c) Willcox, Willcox, 2014; (d) Cordain et al., 2005
* not defined
OD also implies cabbages and cruciferous vegetables,
i.e., kale and collard, and yellow-root vegetables. the
time and serves as the main source of protein today as
well. OD is high in legumes, especially in soy beans and
its by-product soy milk. Soy was common in whole
Asia throughout the time and serves as the main source
of protein today as well.
Conclusions
Nutrition is an important aspect in staying healthy
through one’s life. Therefore, chosen dietary patterns
greatly affect the resistance of the human body to those
chronical diseases where diet is one of the main trigger
factors.
Adherence to dietary patterns with higher complex
carbohydrate, polyunsaturated fatty acid, fruit and
vegetable content have shown the reduction of health
problems in long term. Whereas, consumption of deep
fried and refined foods, high amount of salt and simple
sugars is associated with such chronical diseases as
metabolic syndrome, type 2 diabetes, and cardiovascular
disease. Even though the residents of Mediterranean
terrain and Okinawa prefecture follow dietary patterns
which suggest higher longevity and health benefits, the
globalisation has had a negative effect on their dietary
patterns which now have become closer to those of the
Western diet.
In order to reap maximal health benefits from nutrition,
consumers should try to incorporate signature foods
from Nordic, Mediterranean and Okinawa diet into their
daily lifestyle in the place to traditional Western diet
staple foods.
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... Over the past few decades, nutrition research has evolved from single nutrient studies focussing on specific components, such as vitamins, dietary sugars and fat, to those analysing dietary patterns that capture complex interactions of different food constituents consumed on a routine basis and the level of adherence (Mozaffarian et al., 2018). Different dietary patterns have been identified globally namely Nordic, Mediterranean and the Western diet, each characterised by varied nutrient sources constituting the 'food pyramid' and showing inherent health benefits and adverse effects (Raits and Kirse-Ozolina, 2019). A Dutch study recruited women undergoing ART and estimated their adherence to Dutch dietary recommendations by calculating the Preconception Dietary Risk score (PDR) and found a positive association between high adherence and on-going pregnancy rates (Twigt et al., 2012). ...
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