Developing a food exchange list for Middle Eastern appetisers and desserts commonly consumed in Jordan Hiba A. BAWADI,1 Naseem M. AL-SHWAIYAT,1 Reema F. TAYYEM,2 Rania MEKARY3 and Georgianna TUURI4 1
Department of Nutrition and Food Technology, Jordan University of Science and Technology, Irbid, and Department of Clinical Nutrition & Dietetic, Hashemite University, Zarqa, Jordan; and 3Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, and 4School of Human Ecology, Louisiana State University and Louisiana State University Agricultural Centre, Baton Rouge, Louisiana, USA 2
Abstract Aim: The present study was conducted to develop a meal-planning exchange list for Middle Eastern foods commonly included in the Jordanian cuisine. Methods: Forty types of appetisers and another 40 types of desserts were selected, with ﬁve different recipes for each item. Recipes were collected from different housewives and Arabic cookbooks. Ingredients’ weight and dish net weight were recorded based on an average recipe, and dishes were prepared accordingly. Dishes were proximately analysed following the Association of Ofﬁcial Analytical Chemists procedures. Proximate analysis was compared with the World Health Organisation Food Composition Tables for the Use in the Middle East, and with food analysis software (ESHA). Results: Signiﬁcant correlations (P < 0.001) were found between macronutrient content obtained from proximate analysis and those obtained from ESHA. The correlation coefﬁcients (r) were 0.92 for carbohydrate, 0.86 for protein and 0.86 for fat. Strong correlations were also detected between proximate analysis World Health Organisation food composition tables for carbohydrate (r = 0.91, P < 0.001) and protein (r = 0.81; P < 0.001) contents. However, this signiﬁcant correlation was not found as strong, yet signiﬁcant for fat (r = 0. 62, P < 0.001). Conclusion: A valid exchange system for traditional desserts and appetisers is now available and ready to be used by dietitians and health-care providers in Jordan and Arab World.
INTRODUCTION Jordan is an Arab country with a population of five million and is considered a part of the Middle East bordered by Syria, Saudi Arabia, Palestine and Iraq. Limited data are available about food pattern in Jordan; however, according to statistics, there is a substantial increase (25%) in daily energy intake from 1962 to 2002. Carbohydrate contribution to daily energy intake decreased from 72% in 1962 to H.A. Bawadi, PhD, CNS, FACN, Assistant professor N.M. Al-Shwaiyat, MSc, Graduate Student R.F. Tayyem, PhD, Assistant professor R. Mekary, PhD, Research Fellow G. Tuuri, PhD, RD, Assistant Professor Correspondence: H.A. Bawadi, Department of Nutrition and Food Technology, Jordan University of Science and Technology, P.O. Box: 3030, Irbid 22110, Jordan. Email: [email protected] Accepted October 2008
have become epidemic not only in the Middle East, but worldwide.9 Diet plays a substantial role in maintaining a good health status, managing chronic conditions and controlling body fat.10–12 It is essential that user-friendly guides be developed to allow individuals to monitor their daily food intake.13 The food exchange systems help individuals monitor food portion sizes, and thus energy intake. Exchange systems simply translate scientific nutrition knowledge into a practical form.14 Foods on the same list can be used interchangeably without changing approximate amounts of carbohydrate, protein, fat and total energy supplied by a meal.15 Ethnic variations and traditions have tremendous influences on food choices. Consequently, a key point for enhancing individuals’ commitment towards healthy eating is to incorporate culturally accepted foods in their meal plans.16 Currently, Jordanian dietitians use the exchange list published by the American Dietetic Association, and so, still facing the limitation of including cultural dishes consumed in Jordan in their meal plans. Despite the existence of regional food composition tables for Middle Eastern countries that include some dishes common in the Jordanian cuisine, ingredients and preparation methods differ substantially across countries. This research, therefore, enables Jordanian practitioners to develop more practical and realistic meal plans that include traditional cuisine to facilitate higher compliance. The growth of cultural diversity in the developed world due to increased political and economic migration from places like Jordan makes it necessary for health-care providers to pay attention to the cultural uniqueness of ethnic food habits. Practitioners outside Jordan working with Jordanian immigrants might also benefit from this research. Middle Eastern main dishes common in the Jordanian cuisine have been previously reported;13 the intention of the current study was to incorporate similar side dishes and desserts into exchange lists.
geographical regions in Jordan) out of the total 20 were asked to provide a detailed recipe for each item. The quantity of each ingredient was averaged (summation of ingredients’ quantities divided by five). Every ingredient in the average recipe was documented in both kitchen (standard cups, spoons) and standard metric measurements (g, mg, L, mL). We expected that every informant would give us a recipe of different sizes according to their family size. In order to standardise the weights used to prepare side dishes, individuals were asked to provide these recipes based on a prior chosen amount of the main ingredient of each recipe. For example, the main item in the cabbage salad is cabbage. Individuals were asked to provide a recipe for preparing cabbage salad from 1 kg of cabbage. One batch of the average recipe was prepared. Preparation conditions were optimised in order to minimise bias; all the cooking was done by same researcher using same kitchen and facilities. The purpose of dishes’ preparation was to get a precise weight of the ingredients and a net weight of the prepared item. Food proximate analysis procedures were conducted, according to the Association of Official Analytical Chemists procedures, to determine the content of protein, fat and carbohydrates.17 Analyses were conducted in the feed analysis laboratory in the Department of Animal Production at Jordan University of Science and Technology. Duplicate homogenised samples (300 g) from each side dish were taken and coded. Samples were desiccated in the oven (NR 200F model, Carbolite, Bamford, England) for three days, and were then ground. Moisture content was determined by calculating the difference between wet and dry sample weights. Ash was measured using a Carbolite furnace (Model CSF 11/7, Bamford, England), and the Kjeldahl method (Kjeletec system used: Model 1026, Tecator, Hoganas, Sweden) was used to determine nitrogen content. Protein was then estimated by multiplying the nitrogen content by 6.25. Total fat (ether extract) was analysed using Soxtec system (Model HT 1043, Tecator, Hoganas, Sweden). Total carbohydrate content was estimated by difference in sample weight moisture, ash, protein and ether extract. Proximate analysis data were obtained per serving size of side dish. Decisions about the serving sizes were based on the amount that yielded the best fit in the exchange system. The following paragraph describes the process of dishes’ fitting to the exchange system. Side dishes were fitted according to their macronutrients’ content based on the American Dietetic Association and the American Diabetes Association exchange system. Every 15 g of carbohydrate was counted as one serving of starch, 7–8 g of protein was considered a serving of meat or milk (depending on the carbohydrate and the fat content of the food) and 5 g of fat was considered a serving of fat. In the present study, we followed Wheeler et al.18 rounding-off method (described below) to fit items with macronutrients’ content of more or less than the above-mentioned values. The rounding was as follows: 1 For carbohydrate exchange: if food portion had 1–5 g of carbohydrates, it was not counted as a serving. If it had 6–10 g of carbohydrates, it was counted as half serving. 21
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And if it had 11–20 g of carbohydrates, it was counted as one serving. 2 For fat exchange: if food portion had 0–2 g of fat, it was not counted as a serving. However, if it had 3 g of fat, it was counted as half serving. And if it had 4–7 g of fat, it was counted as one serving. 3 For protein exchange: if food portion had 0–3 g of protein from the meat and meat substitutes list, it was not counted as a serving. And if it had 4–10 g of protein, it was counted as one serving. Dishes analysis and composition obtained in the present study were compared with other food composition tables in the region, mainly the Food Composition Tables for the Use in the Middle East.19 Other food composition tables used for comparison were Food Composition Tables for Arab Gulf Countries20 and Food Composition Tables for Egypt.21 The Food Composition Tables for the Use in the Middle East prepared by Pellet and Shadervian tackled dishes most common in Lebanon. It is well known that Jordan is closer to Lebanon both geographically and culturally than it is to Gulf States or Egypt. For that reason, we found more common items between our list and Pellet and Shadervian’s list. Thirty-six side dishes out of 80 were found in the Pellet and Shadervian’s work. The composition of these 36 items was compared with that found in the proximate analysis conducted in the present study. The Food Composition Tables for the Use in the Middle East did not comprehensively include all side dishes common in Jordan, so nutrient analysis software program was used (Food Processor for Windows, version 7.71, ESHA Research, Salem, OR, USA) to estimate the combined ingredients of the food items. Amounts entered were edible parts used in cooking. The Food Processor database did not include all items used in the preparation of traditional side dishes, such as knafeh dough, so these items were subjected to proximate analysis and were then added to the database for later use. With regard to comparing studied dishes with the Food Composition Tables for Arab Gulf Countries,20 and with the Food Composition Tables for Egypt;21 common dishes in our study and these composition tables were 26 (8 desserts and 18 appetisers) and 18 (12 desserts and 6 appetisers), respectively.
Statistical analysis Pearson’s correlation coefficients were used to study correlation between macronutrients contents obtained from the proximate analysis and the Food Processor. Linear regression analysis was performed to enable the best prediction of carbohydrate, protein and fat when using the food analysis software. Data were analysed using regression procedure of SAS Institute––SAS for Windows, version 6.0, Cary, NC, USA. Significance was declared at P < 0.05.
RESULTS AND DISCUSSION The macronutrient contents and exchange list of the traditional side dishes are presented in Table 1. Very strong correlations (P < 0.001) were found between macronutrient 22
content obtained from proximate analysis and those obtained from the Food Processor. Correlation coefficients (r) were 0.92 for carbohydrate, 0.86 for protein and 0.86 for fat. Despite the fact that the Food Processor data were obtained from the summation of the analysis of all ingredients in their raw form, unlike proximate analysis that was performed on the cooked items, there were no significant differences in macronutrient content. These differences might be clearly seen in main dishes that require extensive cooking and heat treatment. This finding implies a very useful application of how one can obtain composition data of a combination food without going through an extensive laboratory analysis. To further examine this application, a regression analysis was run to obtain prediction equations for macronutrient content for food items other than the ones included in the present study. Using equations provided in Table 2, macronutrient composition of any food from the Jordanian cuisine can be predicted. Amounts of carbohydrates, protein and fat can be obtained from food analysis software, and after fitting them into the equations, predicted composition can be obtained. Similarly, strong correlations were found between proximate analysis and that published in food composition tables for carbohydrate (r = 0.91, P < 0.001) and protein (r = 0.81; P < 0.001) content. Significant correlation was found for fat (r = 0. 62, P < 0.001); yet, it was not as strong as that found for carbohydrate and protein. When the average recipes from the present study were compared with similar ones published in food composition tables, considerable disparities were found in the types and amounts of oils. Food Composition Tables for Arab Gulf Countries20 included 26 items in common with our analysed items. Controlling for weight, average percentages of error in carbohydrates, protein and fat contents were 7.7%, 2.6% and 5.5%, respectively. Greater differences were found in the macronutrient contents between Jordanian dishes and the Egyptian ones.21 Controlling for weight, averages percentage of error in carbohydrates, protein and fat contents were 14.4%, 3.3% and 5.9% respectively. A major limitation of this research is that it does not provide data about the type of fat (saturated, polyunsaturated and monounsaturated) included in the side dishes. It was not possible to analyse the type of fat in the lab using the high-pressure liquid chromatography technique. Another limitation of the study was the consideration of total carbohydrate rather than available carbohydrate. Fibre content should have been excluded to obtain available carbohydrate as an energy-yielding macronutrient. The findings of the present study are limited because of the fact that our informants were not randomly selected.
CHOESHA = carbohydrate content obtained from Food Processor software; CHOLAB = predicted carbohydrate content (g); FATESHA = fat content obtained from Food Processor software; FATLAB = predicted fat content (g); PROTESHA = protein content obtained from Food Processor software; PROTLAB = predicted protein content (g).
carbohydrates and protein content of side dishes served in Jordan; however, this is not true in the case of fat content. This work is important to consumers, dietitians and researchers. Exchange lists such as these offer user-friendly guides that enables consumers to exchange foods and allows them to make healthier food selections. Dietitians can also use this tool to plan tailored meals for Jordanians’ needs and health status. Dietitians who work with Jordanians living abroad might also find this information beneficial. Main Arab countries that can get maximum benefit from this work include Palestine, Syria and Lebanon. Practitioners in other 24
Arab countries might also benefit from this work, but in less magnitude. Finally, providing nutritional information about traditional dishes in countries where culture has significant impact on eating habits is essential and should be a research priority. Research efforts like this one will set a solid base for nutrition science and practice in the region.
ACKNOWLEDGEMENT The authors would like to thank the Deanship of Research at Jordan University of Science and Technology for financial support (Project Number 2/2006). The assistance of the lab technician Majdi Abu-Shmais is greatly appreciated. Acknowledgment is due to the informants who helped in items’ selection and provided preparation recipes.
REFERENCES 1 Alwan A, Kharabsheh S. Nutrition in Jordan: A Review of the Current Nutritional Trends and Major Strategic Directions of the National Food and Nutrition Policy, 1st edn. Amman: WHO/ MOH/MOA, 2006. 2 Department of Statistics. Household Income and Expenditure Survey. Amman: Department of Statistics, 2002. 3 Department of Statistics. Household Income and Expenditure Survey. Amman: Department of Statistics, 1992. 4 Department of Statistics. Household Income and Expenditure Survey. Amman: Department of Statistics, 1997.
5 Ministry of Health (MoH)/USAID/Quality Assurance Project. Jordan’s Health Status: Finding from Epidemiological Studies and Strategies for Future Surveillance System. Amman: Ministry of Health, 1997. 6 Ministry of Health (MoH), Directors of Disease Control and Prevention. Jordan Morbidity Survey. Amman: Ministry of Health, 1996. 7 Ajlouni K, Jadduo H, Bateiha A. Diabetes and impaired glucose tolerance in Jordan: prevalence and associated risk factors. J Int Med 1998; 244: 317–23. 8 Bateiha A, Jadduo H, Ajlouni K. Hyperlipidemia in Jordan: a community-based survey. Saudi Med J 1997; 18: 279–85. 9 Quam L, Smith R, Yach D. Rising to the global challenge of the chronic disease epidemic. Lancet 2006; 368: 1221–3. 10 Lichtenstein AH, Appel LJ, Brands M et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 2006; 114: 82–96. 11 Plourde G. Preventing and managing pediatric obesity. Recommendations for family physicians. Can Fam Physician 2006; 52: 322–8. 12 American Diabetes Association. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 2007; 30: S48–65.
13 Bawadi HA, Al-Sahawneh SA. Developing meal-planning exchange list for traditional dishes in Jordan. J Am Diet Assoc 2008; 108: 840–46. 14 Wheeler ML, Franz M, Barrier P. Helpful hints: using the 1995 Exchange system for meal planning. Diabetes Spectr 1995; 8: 325–6. 15 Franz MJ, Barr P, Holler H. Exchange lists: revised 1986. J Am Diet Assoc 1987; 87: 28–34. 16 O’Doherty JK, Holm L. Preferences, quantities and concerns: socio-cultural perspectives on the gendered consumption of foods. Eur J Clin Nutr 1999; 53: 351–9. 17 AOAC. Official Methods of Analysis, 15th edn. Arlington, VA: Association of Official Analytical Chemists, 1990. 18 Wheeler ML, Franz M, Barrier P, Holler H, Cornmiller N, Delahanty L. Macronutrient and energy database for 1995 exchange system for meal planning: a Rationale for clinical practice decisions. J Am Diet Assoc 1996; 96: 1167–71. 19 Pellet PL, Shadarevian S. Food Composition Tables for Use in the Middle East, 2nd edn. Beirut: American University of Beirut, 1970. 20 Musiager AO. Food Composition Tables for Arab Gulf Countries. Bahrain: Arab Center for Nutrition, 2006. 21 National Nutrition Institute. Food Composition Tables for Egypt. Cairo: National Nutrition Institute, 2006.
APPENDIX I Description of studied appetisers and desserts common in Jordanian cuisine Local name Dessert Asabe’ zainab Awamah Bain narain Baqlawa Barazeg Bsboseh Gatayef ajwa Gatayef asafery Gatayef jibneh Gatayef jouz Gharaibeh Godrit gader Gras el eid Hareesseh Helbeh Khaliet nahel Knafeh Knafeh maghshosheh Kollaj fozdog halabi Kollaj jibneh Kollaj jouz Kraizh Lafet ilkateeb Layaly libnan Lazageat Lazy cake Mabrosheh Mamoul ajwa Mamoul fostoq Mamoul jouz
Description Deep-fried pieces of flour and Semolina dough dipped in sugar syrup Pieces of semi-liquid dough, deep-fried and dipped in sugar syrup Layers of pastry stuffed in cheese and dipped in sugar syrup Layers of pastry stuffed with nuts and dipped in sugar syrup Round cookie made from wheat flower and topped with sesame semolina cakes with sugar syrup Pancake-like dough stuffed with dates Mini pancakes stuffed with cream-sugar syrup added Pancake-like dough stuffed with cheese and dipped in sugar syrup Pancake-like dough stuffed with walnuts and dipped in sugar syrup Butter cookies made with sugar and wheat flour Layers of flan and cake Wheat bread with sesame Semolina cake with sugar syrup Fenugreek sugar syrup cake Dough with sesame cookies Layers of pastry and cheese filled with sugar syrup Layers of ground toast wheat bread, pudding and cheese filled with sugar syrup Pastry stuffed with pistachios and dipped in sugar syrup Pastry stuffed with cheese and dipped in sugar syrup Pastry stuffed with walnut and dipped in sugar syrup Semolina cake Sesame cookies Cooked semolina and cream with sugar syrup Sticky wheat bread Plain crackers cooked with chocolate Double layers of cake with in apples and jam in between Wheat cookies stuffed with dates Wheat cookies stuffed with pistachios Wheat cookies stuffed with walnuts
Appendix I Continued Local name Mraddad Muhalabiyeh Nammourah Oshil saraya Ruz bi halib Sahlab Smsmieh Zalabia Appetiser Baba gannuj Bagdonseeh Falafel Fareem Fatayer batata Fatayer hummad Fatayer jibneh Fatayer kishk Fatayer lahm Fatayer sabanek Fatayer zatar akhdar Fattoush Foul moudamas Ijee Jibneh bayda Jibneh bayda makli Khubz abyad Khubz shrak Labaneh Magdoos Managish baid Managish zait bi zatar Mshawasheh Qudsieh Salatat banadoura bi basal Salatat banadoura bi laban Salatat banadoura bi tahini Salatat elit Salatat farfahina Salatat il batata Salatat il malfouf Salatat khass Salatat khiyar bi laban Salatat kudar Sambousek jibneh Sambousek lahm Shawarma dajaj (1) Shawarma dajaj (2) Shawarma lahm (1) Shawarma lahm (2) Tabbouli Zatar baladi
Description Jam pie Milk Pudding with different flavours Baked cake dough with almond topping––sugar syrup added Layers of toast wheat bread filled with sugar syrup and covered with pudding Rice pudding Liquid pudding made from milk, sugar and starch and served as a hot drink Sesame bars Fritters in sugar syrup Baked eggplant salad Parsley and sesame seed paste dip A paste of broad beans and/or chickpeas that is deep-fried in oil Wheat bread with ghee Wheat bread dough stuffed with potato Wheat bread dough stuffed with oxalis Wheat bread dough stuffed with cheese Wheat bread dough stuffed with kishk (kishk is a dry mixture of wheat, bulgur and whey) Wheat bread dough stuffed with beef Wheat bread dough stuffed with spinach Wheat bread dough stuffed with fresh thyme Vegetable salad with fried pita Dried fava beans dip Scrambled egg with vegetables Homemade cheese Fried homemade cheese Pita wheat bread Very thin sheets of wheat bread Condensed yoghurt balls Baby eggplants pickled in olive oil Egg pie Dried thyme and sesame pie Arum dip with eggs Chickpeas paste mixed with whole chickpeas and sesame seed paste Tomato and onion salad Tomato and yoghurt salad Tomato and sesame seed paste salad Chicory salad with tahina Purslane salad with olive oil and lemon juice Potato salad with olive oil Cabbage salad with olive oil and lemon juice Lettuce salad with olive oil and lemon juice Cucumber and yoghurt salad Mixed vegetables salad with olive oil and lemon juice dressing Fried cheese-stuffed pastry Fried beef-stuffed pastry Chicken shawerma sandwich made with pita Chicken shawerma sandwich made with very thin sheets of wheat bread Beef shawerma sandwich made with pita Beef shawerma sandwich made with very thin sheets of wheat bread Salad of parsley, tomatoes, onion, lemon juice, olive oil and bulghur Dried thyme mixed with sesame seeds