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Background/Objectives:There are many different cultures within Europe, each with its own distinct dietary habits. Traditional foods are the key elements that differentiate the dietary patterns of each country. Unfortunately, in most countries, there is little information on the nutritional composition of such foods. Therefore, there is a need to study traditional foods to preserve these elements of European culture and, if possible, enrich and improve dietary habits across the continent. The Traditional Foods work package within the European Food Information Resource (EuroFIR) project aimed to provide new nutritional data on traditional foods for use in national food composition tables.Subjects/Methods:A EuroFIR consensus-based method with standardised procedures was applied for the systematic study of traditional foods and recipes in selected European countries. Traditional foods were selected on the basis of the EuroFIR definition of the term ‘traditional food’ and prioritised according to specific criteria. From the prioritised list, the five traditional foods per country to be investigated were selected to represent a full course meal. Protocols with guidelines for the recording of traditional recipes, the collection, preparation and distribution of laboratory samples, as well as quality requirements for laboratory selection, were developed to establish a common approach for use by all countries for the acquisition of reliable data.Results:The traditional character of the selected foods has been documented and traditional recipes have been recorded. Chemical analyses to determine the nutritional composition of 55 traditional foods were performed and the data were evaluated and fully documented according to EuroFIR standards. Information on food description, the recipe, component identification, sampling plan, sample handling, analytical method and performance was collected for each of the 55 investigated traditional foods.Conclusions:This common methodology for the systematic study of traditional foods will enable countries to further investigate their traditional foods and to continue to update their national food composition databases and EuroFIR’s food databank system. © 2010 Macmillan Publishers Limited. All rights reserved.

Background/objectives: Adequate mineral intake is important for the maintenance of bone health, cellular function and general metabolism, and possibly in the aetiology of cancer and other chronic diseases. This study aimed at investigating variation in intakes of selected minerals across 10 European countries participating in the EPIC (European Prospective Investigation into Cancer and Nutrition) study. Methods: Nutrient intakes for 36 034 subjects, aged between 35 and 74 years, in 27 centres were obtained using standardized 24-h dietary recall software (EPIC-SOFT). Mean intakes of calcium, phosphorus, magnesium, iron and potassium were calculated by centre and weighted by season and day of the week and were also stratified by age group. The contribution of food groups to total nutrient intake was calculated. Results: There was clear geographical variability in intakes, with differences ranging from 35% for magnesium to 90% for iron in men and 36% for potassium to 75% for calcium in women, and a twofold difference in sources of haem iron (meat and fish). There was a geographical gradient in iron intake, with higher intakes in Southern than in Northern Europe and also around a twofold north-south gradient in the contribution of fruits and vegetables to potassium intake. Compared with reference intakes, the majority of age groups and centres had intakes above the recommended levels. Dairy foods and products contributed the most to calcium and phosphorus intake in almost all centres. Cereals and cereal products contributed the most to magnesium and iron intakes, except in Greece and Germany. Conclusions: Intakes of minerals vary substantially throughout Europe, with some geographical variability in their food sources. European Journal of Clinical Nutrition (2009) 63, S101-S121; doi: 10.1038/ejcn.2009.77

In the context of the EURRECA project (EURopean micronutrient RECommendations Aligned), we have estimated the micronutrient content of traditional Greek foods in relation to international recommendations. Many of these foods showed a rich micronutrient profile and a file was developed listing a total of 137 traditional Greek foods and dishes. This work indicates that in order to meet micronutrient requirements, a simple solution would be to adhere to traditional dietary patterns, at least for the Mediterranean populations, and reinstate traditional foods into the daily diet. © 2009 Springer-Verlag Italia.

Flavonoids are an important category of plant antioxidants and evidence is accumulating on their favorable effects against the development of heart disease and certain forms of cancer. We analytically determined the flavonol (quercetin, kaempferol, myricetin, isorhamnetin), flavone (luteolin, apigenin) and flavan-3-ol (catechin, epicatechin, epigallocatechin, epigallocatechin gallate, epicatechin gallate) content of a weekly menu representative of the Greek traditional diet. The overall daily average content was found 79.01 mg of which flavonols contribute 47% (37.17 mg/day), flavan-3-ols 40% (31.67 mg/day) and flavones 13% (10.17 mg/day). The levels of agreement between the analytical results and the respective theoretical flavonoid calculations conducted previously on the same weekly menu ranged widely, indicating that caution should be taken when calculated flavonoid values are to be used in epidemiological studies. Compared to northern European and American diets, the traditional Greek diet has a higher flavonoid content, at least with respect to flavones, flavonols and flavan-3-ols. © 2007 Elsevier Ltd. All rights reserved.

Objective: To examine the association between anthropometry and endometrial cancer, particularly by menopausal status and exogenous hormone use subgroups. Methods: Among 223,008 women in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, there were 567 incident endometrial cancer cases during 6.4 years of follow-up. The analysis was performed with Cox proportional hazards modeling. Results: Weight, body mass index (BMI), waist and hip circumferences and waist-hip ratio (WHR) were strongly associated with increased risk of endometrial cancer. The relative risk (RR) for obese (BMI 30- < 40 kg/m2) compared to normal weight (BMI < 25) women was 1.78, 95% CI = 1.41-2.26, and for morbidly obese women (BMI ≥ 40) was 3.02, 95% CI = 1.66-5.52. The RR for women with a waist circumference of ≥88 cm vs.

Traditional foods reflect cultural inheritance and have left their imprints on contemporary dietary patterns. They are key elements for the dietary patterns in different countries and consequently are important to accurately estimate population dietary intakes. However, this information is missing from most current national food composition databases. EuroFIR aims to enrich national food composition tables that lack nutrient data on traditional foods and to provide data on selected bioactive components. In this context, a common definition of traditional foods has been agreed upon for the classification of traditional foods in European food composition tables. A list of traditional foods, for which analytical nutritional and bioactive data will be provided, has been developed. © 2007 Elsevier Ltd. All rights reserved.

Objective: This paper describes the ad hoc methodological concepts and procedures developed to improve the comparability of Nutrient databases ( NDBs) across the 10 European countries participating in the European Prospective Investigation into Cancer and Nutrition ( EPIC). This was required because there is currently no European reference NDB available. Design: A large network involving national compilers, nutritionists and experts on food chemistry and computer science was set up for the ‘EPIC Nutrient DataBase’ ( ENDB) project. A total of 550-1500 foods derived from about 37 000 standardized EPIC 24-h dietary recalls (24-HDRS) were matched as closely as possible to foods available in the 10 national NDBs. The resulting national data sets ( NDS) were then successively documented, standardized and evaluated according to common guidelines and using a DataBase Management System specifically designed for this project. The nutrient values of foods unavailable or not readily available in NDSs were approximated by recipe calculation, weighted averaging or adjustment for weight changes and vitamin/mineral losses, using common algorithms. Results: The final ENDB contains about 550-1500 foods depending on the country and 26 common components. Each component value was documented and standardized for unit, mode of expression, definition and chemical method of analysis, as far as possible. Furthermore, the overall completeness of NDSs was improved (>= 99%), particularly for beta-carotene and vitamin E. Conclusion: The ENDB constitutes a first real attempt to improve the comparability of NDBs across European countries. This methodological work will provide a useful tool for nutritional research as well as end-user recommendations to improve NDBs in the future.

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. © 2006 Elsevier Ltd. All rights reserved.

Background/Aims: The traditional Mediterranean diet is frequently being considered as a prototype for dietary recommendations. We have investigated a weekly menu typical of the Greek variant of the Mediterranean diet to examine the compatibility with the nutritional recommendations of the Scientific Committee for Food of the European Commission, concerning macronutrients and certain micronutrients. Methods: A typical weekly traditional Greek Mediterranean menu was chemically analyzed and certain food constituents, like flavonoids were theoretically estimated. Results: The evaluated typical menu meets all the dietary recommendations for macronutrients. The daily energy intake is derived from dietary lipids (40.3%) and carbohydrates (41.4%). The ratio of α-tocopherol per gram of polyunsaturated fatty acids in the Mediterranean diet under investigation is around 0.4 mg, indicating a well-balanced diet. With respect to microcomponents, with existing recommendations of the Scientific Committee for Food of the European Commission, such as inorganic constituents, the investigated menu meets all the requirements. Conclusion: The diet that the Mediterranean populations developed many years ago, without any scientific input, appears to meet current dietary recommendations. Copyright © 2005 S. Karger AG.

The Mediterranean diet is currently attracting interest because of its health benefits that may be due, in part, to the high content of this diet in antioxidant phytochemicals. The variety and amount of phytochemicals taken with the consumption of primary and composite foods of the Mediterranean diet may provide better antiatherogenic properties than single phytochemicals. Flavonoids are the most important group of plant antioxidants. The Mediterranean diet is characterized by high intake of olive oil, fruit, vegetables, cereals, and legumes, some of which are good sources of flavonoids. Flavonoids consist of six principal classes: flavones, flavonols, flavan-3-ols, flavanones, anthocyanidins and isoflavones. The flavonoid intake from a traditional Greek plant-based weekly menu was calculated and the daily average flavonoid intake was found 118.6 mg/d, of which flavanones contribute 32% (38.5 mg/d), catechins (the most important group of flavan-3-ols) contribute 28% (32.7 mg/d), flavonols 22% (26.4 mg/d), anthocyanidins 9% (11 mg/d), flavones 8% (8.7 mg/d) and isoflavones contribute 1% (1.3 mg/d). Herbs and spices, which are commonly used in the traditional Greek cuisine, although added in small quantities, significantly contribute to the flavonol and flavone intake due to frequent consumption. The Greek version of the Mediterranean diet with its high consumption of fruit and vegetables is characterized by high intake of flavonoids in comparison to diets in northern European countries. © 2005 Bentham Science Publishers Ltd.

The analyses of composite recipes are frequently missing in nutrient databases and their inclusion presupposes expensive and fairly complicated chemical analyses. The nutritional composition of traditional Greek composite foods was determined through chemical analyses and by the computerized program, Unilever Dietary Analysis Program (UNIDAP). The chemical analyses followed standard procedures and were also performed on all the raw ingredients used for preparation for the composite foods. The UNIDAP system was originally based on the British Food Composition Tables, but has been enriched over the years with compositional data representative of Greek food items, derived from chemical analyses conducted in the context of research projects. Some discrepancies were observed between the nutrient values of the raw ingredients that were used for the preparation of the recipes and the UNIDAP database nutrient values for the same ingredients, but despite that, a very good agreement was deduced for the macronutrients and energy content of the composite foods. It is concluded that the UNIDAP generates reliable data on macronutrients and energy content of Greek food recipes. This provides the foundation for developing more up-to-date nutrient database in Greece and supplies health professionals with an important tool for dietary planning, nutrient and food database development, and policy implementation. © 2003 Elsevier Ltd. All rights reserved.

Objectives: There is epidemiologic evidence that the consumption of fried, grilled or barbecued meat and fish that are well-done or browned may be associated with an increased cancer risk. These high-temperature cooking methods are thought to be surrogates for mutagens and carcinogens produced in meat and fish, eg heterocyclic amines or polycyclic hydrocarbons. Since data on food cooking methods are scarce, the aim of this study was to describe the variation in meat and fish cooking methods in different parts of Europe. Design: Using a standardized 24 h recall from a sub-sample of the EPIC cohort (35 644 persons, 35-75 y old), mean daily intake of meat and fish prepared by different cooking methods and the relative contribution of the cooking methods to the overall cooking of meat and fish was calculated. Results: Whereas frying was more often noted in northern Europe, roasting and stir frying were more often used in the south. Concerning high-temperature cooking methods, their frequency of application varies between 15% in the EPIC cohort of North-Italy and 49% in the cohort of The Netherlands. Average consumption of fried, grilled and barbecued meat and fish ranges from a low of 12g/day in the centres in southern Spain to a high of 91 g/day in northern Spain. Conclusion: High variation in both the kind of meat/fish consumed as well as its cooking methods is observed within EPIC. In order to use this variation for the evaluation of the impact of cooking methods on cancer risk, a questionnaire on meat and fish cooking methods is being developed and could be applied in the whole EPIC cohort.

Objectives: To describe and compare the consumption of dairy products in cohorts included in the European Prospective Investigation into Cancer and Nutrition (EPIC). Methods: Data from single 24-hour dietary recall interviews collected through a highly standardised computer-based program (EPIC-SOFT) in 27 redefined centres in 10 European countries between 1995 and 2000. From a total random sample of 36 900, 22 924 women and 13 031 men were selected after exclusion of subjects under 35 and over 74 years of age. Results: A high total consumption of dairy products was reported in most of the centres in Spain and in the UK cohort sampled from the general population, as well as in the Dutch, Swedish and Danish centres. A somewhat low consumption was reported in the Greek centre and in some of the Italian centres (Ragusa and Turin). In all centres and for both sexes, milk constituted the dairy sub-group with the largest proportion (in grams) of total dairy consumption, followed by yoghurt and other fermented milk products, and cheese. Still, there was a wide range in the contributions of the different dairy sub-groups between centres. The Spanish and Nordic centres generally reported a high consumption of milk, the Swedish and Dutch centres reported a high consumption of yoghurt and other fermented milk products, whereas the highest consumption of cheese was reported in the French centres. Conclusion: The results demonstrate both quantitative and qualitative disparities in dairy product consumption among the EPIC centres. This offers a sound starting point for analyses of associations between dairy intake and chronic diseases such as cancer.

Various studies have demonstrated that the nutrient and non-nutrient substances present in vegetables and fruit (V&F) are most likely to be responsible for the beneficial effect of the increased V&F consumption. Urged by scientific evidence, current dietary guidelines strongly recommend the consumption of V&F in substantial amounts. In a recent paper (Brit. J. Nutr. 2000; 84, 549-556) V&F availability in 10 European countries was compared with the WHO recommendations (minimum combined V&F intake of about 400 g/day/person), as well as with guidelines of a minimum daily intake of three portions of vegetables (approx. 250 g/person) and two portions of fruit (approx. 150 g/person). All countries, excluding Greece, had a vegetable intake below the recommended minimum. Moreover, in all countries, the percentages of low vegetable consumers were significantly higher than those of low fruit consumers, suggesting that there is considerable room for improvement in the intake of vegetables, an important source of antioxidants. Wild edible greens are among the vegetables commonly consumed in Greece. These greens have a high flavonoid content, which in several cases substantially exceeds the respective values in foods and beverages, such as onions, black tea and red wine (Food Chemistry 2000; 70, 319-323). The high flavonoid content of edible wild greens requires consideration of their role in contemporary diet, as a possible mean for increasing vegetable consumption.

Mortality statistics from the WHO database covering the period 1960 to 1990 have provided intriguing evidence that something unusual has been affecting in a beneficial way the health of the Mediterranean population. In recent papers, which evaluated the evidence accumulated over the last three decades, it was concluded that the traditional Mediterranean diet meets several important criteria for a healthy diet. Direct evidence in support of the beneficial properties of the Mediterranean diet has also become available. These data were derived from three studies, which have used a diet score, devised a priori on the basis of eight desirable key features of the traditional common diet in the Mediterranean region. The conclusion of these studies is that a diet that adheres to the principles of the traditional Mediterranean one is associated with longer survival. The Greek version of the Mediterranean diet is dominated by the consumption of olive oil and by high consumption of vegetables and fruits. Antioxidants represent a common element in these foods and an antioxidant action provides a plausible explanation for the apparent benefits. Wild edible greens frequently eaten in rural Greece in the form of salads and pies contain very high quantities of flavonoids - considerably higher than those found in red wine or black tea. While there is no direct evidence that these antioxidants are central to the benefits of the Mediterranean Diet, indirect evidence from epidemiological data and the increasing understanding of their mechanisms of action suggest that antioxidants may play a major role.

The traditional Greek diet is dominated by the high consumption of olive oil, fruit and vegetables. Antioxidants represent a common element in these foods and may be important mediators of the beneficial effect of this diet. Wild edible greens are frequently consumed throughout Greece. Seven edible wild greens and traditional Cretan green pies were analyzed for their nutritional composition and flavonoid content, in particular flavonols and flavones. A high nutritional value and a low energy value characterize the wild greens. These wild greens have a very high flavonol content when compared with regular fresh vegetables, fruits and beverages commonly consumed in Europe. Rumex obtusifolius was found to contain twice the amount of quercetin contained in onions. Two pieces of Cretan green pie (100 g) contain approximately 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). Wild greens potentially are a very rich source of antioxidant flavonols and flavones in the Greek diet. Copyright (C) 2000 Elsevier Science Ltd.

Glomerular disease is characterized by morphologic changes in podocyte cells accompanied by inflammation and fibrosis. Thymosin \(\beta_4\) regulates cell morphology, inflammation, and fibrosis in several organs and administration of exogenous thymosin \(\beta_4\) improves animal models of unilateral ureteral obstruction and diabetic nephropathy. However, the role of endogenous thymosin \(\beta_4\) in the kidney is unknown. We demonstrate that thymosin β4 is expressed prominently in podocytes of developing and adult mouse glomeruli. Global loss of thymosin \(\beta_4\) did not affect healthy glomeruli, but accelerated the severity of immune-mediated nephrotoxic nephritis with worse renal function, periglomerular inflammation, and fibrosis. Lack of thymosin \(\beta_4\) in nephrotoxic nephritis led to the redistribution of podocytes from the glomerular tuft toward the Bowman capsule suggesting a role for thymosin \(\beta_4\) in the migration of these cells. Thymosin \(\beta_4\) knockdown in cultured podocytes also increased migration in a wound-healing assay, accompanied by F-actin rearrangement and increased RhoA activity. We propose that endogenous thymosin \(\beta_4\) is a modifier of glomerular injury, likely having a protective role acting as a brake to slow disease progression.

We prospectively evaluated fat intake as predictor of developing breast cancer (BC) subtypes defined by estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 receptor (HER2), in a large (n = 337327) heterogeneous cohort of women, with 10062 BC case patients after 11.5 years, estimating BC hazard ratios (HRs) by Cox proportional hazard modeling. High total and saturated fat were associated with greater risk of ER(+)PR(+) disease (HR = 1.20, 95% confidence interval [CI] = 1.00 to 1.45; HR = 1.28, 95% CI = 1.09 to 1.52; highest vs lowest quintiles) but not ER(-)PR(-) disease. High saturated fat was statistically significantly associated with greater risk of HER2(-) disease. High saturated fat intake particularly increases risk of receptor-positive disease, suggesting saturated fat involvement in the etiology of this BC subtype.

Contributor Portugal: Helena Soares da Costa, Tânia G. Albuquerque, Ana Sanches-Silva, Ana Valente, Tânia Fontes, Carla Mota, Cristina Flores, Mariana Santos, Susana Santiago, Ana Cláudia Nascimento, Carla Martins (INSA, IP). The research leading to these results has received funding from the European Community’s Seventh Framework Programme (FP7/2007-2013) under grant agreement n.º 227118.