Meat in the context of the whole diet: a social and cuisine perspective.

KEY POINTS

* Cuisine is the cultural use of food. It is linked to agriculture and trade as much as nutritional need and culinary artistry.

* Combinations of core foods make up cuisines, but these combinations are constantly changing. Meat is a core food in Australian cuisines, and the use of meat is constantly changing.

* Meat provides important nutrients in dietary patterns based on Australian core foods. Nutrients delivered by meat, such as vitamin B12, iron and zinc, are not easily replaced by alternatives from the same food group in dietary models based on the Australian Guide to Healthy Eating.

* Lean meats have a place in a healthy dietary pattern for managing lifestyle disease risk.

* Improving the overall diet of a population requires an understanding of cuisines used in that population and how core foods contribute to dietary factors linked to health and disease.

INTRODUCTION

Meat is a nutrient-dense food, and this has been the focus for communicating the health benefits of meat consumption. Nutrition communications, however, also relate to overall diet and the prevention of lifestyle-related disease, such as obesity, diabetes and cardiovascular disease. How meat fits into this scenario requires a different form of analysis and communication.

Food is essential to health. We know this from both a cultural and scientific perspective. Culture is reflected in cuisine, and cuisine denotes the use of food. Food choice reflects the whole of social organisation, bringing multiple factors into the picture, such as agriculture and farming, the shape of the economy, and the knowledge of nutrition, to name but a few. Today, nutrition science is a key driver in food choice as it finds ways to expose the details of the food-health relationship and translates this to practice. (1) In the case of meat, science has enabled the description of the multiple nutritional benefits that may be derived from meat consumption. (2) This is relevant to the Australian population as meat is traditionally consumed in Australia, and meat production is a significant part of the country's agricultural economy. (3) Examining meat from a cuisine perspective integrates the cultural and scientific value of meat in a healthy Australian diet. This paper examines meat from a cuisine perceptive in the Australian context and discusses challenges facing nutrition science in translating this knowledge into useful messages for consumers.

FOOD CULTURE AND CUISINE

There are many definitions of cuisine, but most carry the sense of recognisable ways in which foods are combined in meals. They can be identified by names of regions or style of cooking or eating, such as 'Mediterranean', 'Thai', 'Nouvelle' or 'Takeaway'. Cuisine has become an issue in research on global epidemics of lifestyle-related disease. Defined as food culture linked to environmental, climatic, technological and trade issues, (4) cuisine studies are one way of linking food intake with disease patterns. Observations of longevity in populations suggest that certain cuisines, such as that of the Zhejiang province of China, may be protective, (4) but it would be necessary to disentangle this observation from the whole environmental and societal context. The complex interplay of diet and health points to an 'ecological basis of disease', (5) which should not be underestimated in searching for simple answers.

It is recognised that cuisine does not necessarily reflect local food availability, (4) and no single country is entirely self-sufficient in all food items to meet its requirements. (6) This is why food technology (5) and trade are so important in food production and distribution. They also influence the way in which cuisine develops.

Perhaps then, one of the most forgotten features of cuisines is constant change. This should be expected as the social context in which cuisines develop are always in a state of flux. The inclusion of meat in the Australian cuisine reflects the nation's historical context, where reference to meat can be found in a number of settings. (7) Likewise, in a study of trends in successive editions of a prominent national Flemish cookbook, meat was predictably a core ingredient, and changes in Flemish cuisine and food culture were linked to shifts in the status of the Belgian agricultural sector. (8) As in Australia, meat is historically a significant part of the Flemish diet and agricultural economy. The shifts in the position of meat in the cuisine, however, reflected broader social change over time with themes of regional versus exotic cuisines, economy versus extravagance, convenience versus care, and healthy versus sweet diets. With the emergence of dietetics in the 1960s, meat and other protein-rich foods formed part of a five-principles approach to a healthy diet, (8) similar to the Australian five-food-groups model. (9) In Australia, shifts in the position of meat in the diet also reflect changes in the economy, social conditions and health concerns of the time. There are now multiple cuisines and indeed cuisine fusions which include meat in the Australian context, from the traditional barbeque, to stir fries and exotic restaurant meals. The type of meat available has changed with shifts in consumer demand and changes in the supply chain, and with this, the knowledge of the nutritional contribution of meat continues to grow. For example, a recent analysis of nutritional equivalence among foods in the 'meat and equivalents' group found that modelling in alternatives to lean meat in the Australian Guide to Healthy Eating food pattern (9) reduced the ability of the diet to deliver recommended levels of key nutrients such as vitamin B12, zinc and iron. (10) In diet, everything is relative, but changing patterns from core foods can have significant implications.

NUTRITION RESEARCH AND CUISINE

Knowledge of the nutritional value of foods comes from a range of scientific endeavours. These include studies that identify compounds in food and their chemical and biochemical properties, animal model studies of biological mechanisms, human feeding experiments, observational studies of food intake and disease patterns, and dietary intervention trials. With the growth of knowledge in this area, there has been a recognised effort to focus on food as the fundamental unit in nutrition, given the need to provide better food-based advice to populations. (11-13) Cuisine studies fit this framework as they address the issue of food combinations or patterns.

That said, it is difficult to prove whether certain cuisines result in better health outcomes than others. The two main approaches for evaluating dietary patterns--dietary indexes or scores (based on compliance with dietary guidelines or principles) and factor or cluster analysis (based on food intake data)--have significant limitations. With associated problems in accurately measuring food intake, they only produce evidence of modest risk reduction from diet, which is further reduced after controlling for confounding factors. (14) The lack of convincing evidence of effect presents a real challenge which scientists are attempting to address through new methods of research design and analysis. Dietary pattern analysis has to address the complexity of dietary exposure, and arbitrary choices to form food pattern categories for the analysis are a significant limitation. (14) In any case, intervention trials provide stronger evidence than observational studies attempting to draw relationships.

Up until a few years ago, only one trial was found to study dietary patterns related to risk of coronary heart disease and stroke. (15) The Lyon Diet Heart Study demonstrated the superiority of advice targeting a Mediterranean-style cuisine over advice to follow a prudent diet, (16) with recognition that beneficial changes can be made to usual diets and proven to be lasting (in this case, at four-year follow up). (17) A more recent intervention trial, the PREDIMED study also demonstrated the superiority of a Mediterranean cuisine on cardiovascular risk factors, this time providing key foods in olive oil and nuts. (18) This latter development raises the question of the contribution of individual foods in the overall efficacy of a cuisine pattern. Translating the outcomes to practice also requires a clear understanding of the actual food groups that make up the required dietary pattern. (19) Working backwards, a post hoc analysis of food choice patterns in an Australian 'free living' intervention trial found that subjects who achieved healthy dietary fat targets shifted their food choices to leaner meat and low-fat dairy foods in a cuisine that could be identified as Mediterranean or Asian, and ate Takeaway meals less often. (20) This analysis showed that changes in specific food choices were necessary, but overall, these foods related to acceptable cuisine patterns (i.e. identifiable and tasty meals) that had long-term acceptance. Like the study of Flemish cuisine addressed earlier, the naming of cuisines in the Australian study came from recipe books, reflecting the links with actual meal patterns. Thus, meat, for example, was still included, but to address the health targets, there were appropriate shifts to low-fat cuts in identifiable meals. The ability of the Lyon Heart Study to achieve long-lasting effects also could be explained in terms of the intervention relating well to the usual food patterns of the population with modifications where appropriate. Understanding cuisine is likely to be very important in achieving successful long-term healthy dietary patterns.

FUTURE DIRECTIONS

Nutrition science continues to be driven by a growing knowledge of the diet-health/disease relationship. With the prevalence of lifestyle-related disease demanding more effective solutions, much more targeted approaches to intervention are emerging, and these are focusing on foods. There is now more integrated thinking on nutrients, foods and whole diets (cuisines). There is also more integration of knowledge of effects of foods. For example, knowledge of effects on appetite is driving studies of food components, whole foods and meals on subsequent energy (kilojoule) intake as a means to control weight. There has been a substantial amount of work examining the effects of protein in the diet on energy expenditure and satiation, (21) which implicates foods such as meat in a way that is different from just delivery of essential nutrients. This extends to comparisons between protein-rich food sources, driving the emphasis back to whole foods rather than single nutrients. (22)

One interesting new development is the study of the effect of wholemeals on subsequent food intake. New research is emerging that is combining foods that address satiation in a meal with composition addressing known factors such as fat content, alcohol, glycaemic index of carbohydrate foods, protein and fibre levels, energy density, volume, mineral content (notably calcium), and presence of thermogenic or anorectic compounds (e.g. caffeine, capsaicin, antioxidants and catechins). (23) The design of these experiments necessarily requires an understanding not just of food composition but of how foods are combined in meals and whole diets--cuisines--recognised and readily adapted to by the consumer.

Meeting nutritional requirements will always be a key focus in nutrition communications for the population, and nutrient-dense foods, such as lean meat, fish, eggs and seed foods, are major contributors in this regard. As health is viewed more from a life-course perspective (maternal nutrition, lifestyle disease prevention, maintaining wellness or functionality), there is also a greater appreciation of the contribution of single foods in the context of 'whole of diet' models. (24) In either case, the concept of cuisine provides the means of addressing how these issues might be effectively addressed.

CONCLUSIONS

The position of meat in the Australian diet reflects the historical, social and scientific support that this commodity has received as part of the Australian cultural landscape. This is a cuisine phenomenon that can be observed in any culture, and has been reported where food traditions are reinforced by cultural practice, including scholarly work. (25) Challenges remain in positioning all food groups, including meat, in pattern analyses that attempt to link diet and disease risk, and more sensitive food-based dietary trials are required. On the other hand, studies of cuisine and individual meals provide an opportunity to explore the benefits of whole foods such as meat in supporting better control of food intake and greater functionality or wellbeing as life progresses.

ACKNOWLEDGEMENTS

Dr Karen Charlton for assisting with the literature search, Nic Smede and Sally Walker for assistance with style editing.

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Linda TAPSELL

National Centre of Excellence in Functional Foods, University of Wollongong, Wollongong, New South Wales, Australia