PRACTICE APPLICATIONS Topics of Professional Interest Global Food Practices, Cultural Competency, and Dietetics: Part 3 Editor’s Note: This is the third article in a three-part series spotlighting food cultures in a variety of countries around the globe. Parts 1 and 2 of this series appeared in the March and April 2015 issues of the Journal. PAKISTAN What Are Some of the Traditional Foods and Dishes of Pakistan? Pakistani cuisine can generally be divided among its regions, but there are certain staples common throughout the country. Wheat and wheat products are ubiquitous, including chapattis—flatbreads, which are found in most meals. Lentils and various vegetable curries are eaten most days, as are the vegetables themselves, ranging from gohbi (cabbage) to channa (chickpeas). Largely for financial reasons, meat—excluding pork, which is never consumed by Muslims for religious reasons—is only consumed a few times a week.1 Some traditional Pakistani dishes include dhal, lentil stew; chicken karahi, a chicken dish including various vegetables and spices; and various chutneys.2 What Are Current Food Practices in Pakistan? In the more affluent areas of Pakistan, consumption of Western-style fast foods and drinks has become more common. This has led to the common concerns about unhealthy diets and obesity. Eating out in general is more common, This article was written by Matthew Fox, a freelance writer in Chicago, IL. http://dx.doi.org/10.1016/j.jand.2015.03.006 especially among males. Some of the foods eaten outside of the home include curry, biryani, fried foods, and lassi, a milk and yogurt drink. Fruit consumption tends to be low due to high costs of produce.1 What Are the Traditional Meal Patterns in Pakistan? There are usually three meals per day in Pakistan. Breakfast consists of paratha (fried flatbread) or chapatti, fried or boiled eggs, and a cup of tea. Lunch has a variety of foods, including meat curries or lentils with bread or rice. Popular lunchtime dishes include aloo gosht (meat and potato curry), vegetables with mutton, or chicken dishes like karahi. Dinner is the largest meal of the day, as it is generally the only meal where the whole family will eat together. It may consist of kebabs of meat and vegetables, qeema, a minced meat dish, and lentils, among other options.3 Between-meal snacks of tea and dessert are not uncommon, though the timing changes depending on whether they are taken by a student or an office worker, for example.1 What Are Some Traditional Health Beliefs in Pakistan, and How Do They Relate to Diet? Pakistanis believe in the power of food to impact health, and this belief lies in the hot or cold nature of a food. Foods that are cold are thought to cause colds, cough, and fever, while hot foods are said to cause digestive problems, rashes, or even miscarriages. Fruit, milk, and rice are considered “cold” foods, and meat, fish, eggs, and some vegetables are considered “hot.” A healthy diet should have a balance of each.1 PANAMA To take the Continuing Professional Education quiz for this article, log in to www.eatrightPRO. org, go to the My Account section of the My Academy Toolbar, click the “Access Quiz” link, click “Journal Article Quiz” on the next page, and then click the “Additional Journal CPE quizzes” button to view a list of available quizzes. ª 2015 by the Academy of Nutrition and Dietetics. What Are Some of the Traditional Foods and Dishes of Panama? Panamanian foods share many similarities with those of other Latin countries, albeit with less spicy flavors. Rice and corn are staple foods in Panama, and seafood is a Panamanian specialty.4 Popular dishes include ceviche, raw fish with shrimp, clams, onions, and hot peppers; patacones, a plantain cut into pieces, fried and refried, and salted; and carimañola, a boiled, ground yucca roll that is filled with chopped meat and fried. There several other food-based traditions in Panama in specific circumstances, such as after the completion of the building of a house or celebration of a baby’s first tooth.5 What Are Current Food Practices in Panama? Panama has been called cresol del razas, a “crucible of races.” Construction of the Panama Canal in the early 20th century allowed for people from many different countries and cultures to pass through or settle in the country, and these myriad cultures have affected modern culinary tastes. Italian, French, Chinese, Spanish, Japanese, and many other types of cuisine have a presence in Panama. People eat out in restaurants for each meal more frequently than in the past, including at American chain restaurants that have been introduced in Panama.5 What Are Meal Patterns in Panama? There are generally three meals a day in Panama. Breakfast is a relatively large meal, and has some form of fried corn dough (almojabanos, pastelito, or torrejitas de maiz), cheeses, meats, and coffee or tea; breakfast may also be a simple dry or hot cereal, along with fresh fruit and juice. Lunch is also usually a large meal, served with rice, beans, chicken or pork, and vegetables such as plantains. Dinner is of similar composition to lunch (rice, beans, meat), though smaller in size.6 What Are Some Traditional Health Beliefs in Panama, and How Do They Relate to Diet? Panamanians are usually strong proponents of the beneficial effects of JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 701 PRACTICE APPLICATIONS herbs and herbal medicines. Chamomile or tilo tea are commonly used as sleeping aids, mastranto tea is said to calm the stomach, and té de boldo, tea from the boldo plant, regulates blood sugar. Green and white tea have also become increasingly popular, used for prostate cancer prevention and its antioxidant properties, respectively.5 PHILIPPINES What Are Some of the Traditional Foods and Dishes of the Philippines? Filipino cuisine has evolved from various cultural influences, including American, Chinese, Hispanic, and Asian cultures. Staple foods in the Philippines include rice, fish, and vegetables. Rice, especially, should be noted for its ubiquity in the Filipino diet, as it is included in every meal. Meats like beef and pork, as well as some seafood, tend to be expensive and are eaten less frequently.7 Ingredients and flavors are diverse in the Philippines. Typical ingredients include garlic, onion, various bananas such as saba, coconut, potato, yam, and many others. Flavors such as tamis, asim, and alat (sweet, sour, and salty, respectively) are common, and flavor combinations like champorodo, sweet porridge, and tuyo, salty, dried fish, are popular.7 Traditional dishes include adobo, a meat dish cooked in vinegar, salt, garlic, and other ingredients. Adobo also describes a cooking style in general. Arroz caldo, a Spanish-inspired thick porridge with chicken, is also popular, among many other dishes.8 What Are Current Food Practices in the Philippines? Western fast food and chains have started replacing traditional Filipino cuisine, especially among the younger generations. The rise in consumption of these foods has led to familiar problems with obesity.9 These and instant, prepackaged foods and meals have begun to change traditional meal patterns among Filipinos, although a trend for healthy eating is currently on the rise.7 What Are Traditional Meal Patterns in the Philippines? There are generally three meals in the Philippines, as well as a late-afternoon 702 snack. Breakfast, called agahan or almusal, is commonly composed of sinangag, leftover rice fried with garlic, as well as other leftovers from the previous night’s meal. The meal can be more elaborate and diverse for affluent eaters, and may include delivered rolls, eggs, or cheeses. Lunch, tanghalian, and dinner, hapunan, tend to be similar and include rice, meat or fish, and vegetables, as well as fresh fruit as a quasidessert. A popular afternoon snack (merienda or minindal) is kakanin, a rice cake served with sugar, sticky rice, or coconut milk.7 What Are Some Traditional Health Beliefs in the Philippines, and How Do They Relate to Diet? Filipinos have a variety of food-based health beliefs. Hot ginger tea is used to soothe sore throats, and boiled rice water called am and chewing guava shoots are used to alleviate baby and adult diarrhea, respectively. Pancit, Filipino noodles, are eaten on one’s birthday to ensure longevity.7 SINGAPORE What Are Some of the Traditional Foods and Dishes of Singapore? Singapore is home to a diverse ethnic population, including people from China, Malaysia, India, and individuals of Eurasian descent. Singaporean food and cooking naturally follows that diversity, giving the country an eclectic mix of cuisine.10 Chinese food in Singapore contains soy sauce, among other ingredients, and would include a dish such as bak kut teh, pork ribs in an herbal soup. Malaysian cuisine regularly uses a variety of spices, and they may be found in asam pedas fish. From India, foods such as tandoori chicken include chili and curry powders. Perankan cuisine, a fusion of Chinese and Malaysian flavors, includes dishes such as otah (fish paste, coconut milk, and chili wrapped in a banana leaf and grilled).11 What Are Current Food Practices in Singapore? Globalization has brought even more variety and diversity to Singaporean foods as international influences meet JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS with tradition. Local foods have seen decreased consumption due to a larger amount of choices, as many restaurants offer foreign cuisine options previously inaccessible. That said, there is experimentation with fusion of traditional and the new, exotic food options available.11 What Are Traditional Meal Patterns in Singapore? There are generally three meals a day in Singapore with an occasional latenight supper. Breakfast often includes toast with kaya, a sweet coconut egg jam, soft boiled eggs, and coffee. Lunch is rice or noodles with stir-fried meat and/or vegetables, and dinner usually consists of similar food choices. Supper is eaten very late, around 12 midnight, and is especially popular on weekends where people will visit late-night eateries that have stir-fried noodles or dessert soups. Common in Singapore are hawker centers, collections of stalls selling simple, local food.11 What Are Some Traditional Health Beliefs in Singapore, and How Do They Relate to Diet? A common health belief in Singapore, especially among the older generations, is that food can be “heaty” or “cooling,” and that eating too much of one type might unbalance the body and affect health. For example, an excess of fried foods, which are considered “heaty,” might cause a sore throat, and drinking a “cooling” tea is meant to counteract that. Foods such as lettuce or pineapple, “cooling” foods, are often disallowed as they are said to cause body aches. “Confinement diets,” diets that avoid excessive hot and cold foods, are common in Singapore, especially following exhausting events such as childbirth.12 SWEDEN What Are Some of the Traditional Foods and Dishes in Sweden? Sweden is a large, cold-to-temperate country with a variety of foods and dishes that change with regions and seasons. Various game animal meats, such as reindeer in the north, or moose, boar, and deer throughout the country, are often eaten. Starches like potatoes May 2015 Volume 115 Number 5 PRACTICE APPLICATIONS commonly go with meat. Swedes have various food preservation techniques that are used on meats, such as gravning, which involves curing meat with salt, vinegar, and sugar. Many other foods come from the widespread Swedish forestlands, such as mushrooms and myriad berries.13 Some traditional Swedish dishes include fil, similar to yogurt, knäckebröd, a flat bread/cracker, and artsoppa, pea soup.14 The term smorgasbord originated in Sweden and refers to a buffetstyle meal which is usually eaten on special occasions and holidays. What Are Current Food Practices in Sweden? Swedes are well attuned to international food trends, and foods from the Mediterranean, Asia, and Africa have influenced the food available and popular in Sweden. Ethnic foods are commonly mixed with native Swedish dishes to develop new flavors.13 Healthy, organic, and locally-grown foods have become more popular in Sweden in recent times.15 Pasta, rice, and other starches have started to replace potatoes as the side dishes for meat. What Are Traditional Meal Patterns in Sweden? Swedes usually eat two or three meals a day. Breakfast can be a large meal and consist of bread, cheese, eggs, strömming (herring), and a beverage. At lunch, common foods include openface meat sandwiches or other meat, starch, and vegetable combinations. Dinner is generally eaten immediately after work or school and its foods are similar to lunch.13 In the past, Fridays were days of fasting for Swedish Catholics, and meat was not allowed to be eaten. Thursdays became a day of eating rich, heavy meals composed of artsoppa and pannkaka (pancakes). Although strict adherence to these Catholic tenets has diminished, these two foods are still popularly served for Thursday meals.13 What Are Some Traditional Health Beliefs in Sweden, and How Do They Relate to Diet? Diet-based health beliefs in Sweden tend to run along the lines of modern May 2015 Volume 115 Number 5 nutritional recommendations—that is, the belief that eating a balanced diet of fruit, vegetables, protein, fiber-rich breads, and dairy leads to better health.13 SYRIA What Are Some of the Traditional Foods and Dishes in Syria? Syria has several staple foods that are available year-round. Rice, cracked wheat, potatoes, vegetables, lamb, beef, and poultry are all common, popular Syrian food. Pork, however, is sometimes not eaten for religious reasons by the Muslim population of the country.16 Some notable Syrian dishes include falafel, balled, ground chick peas with spices which are fried; hummous, puréed chickpeas and sesame paste; baba ganouj, an eggplant purée; and tabouleh, a cracked-wheat and vegetable salad.17 Tea is the most ubiquitous drink of Syria, although soda is fairly popular. Consumption of alcohol is disallowed in Islam, but beer, wine, and arak, an aniseed alcohol, are available. What Are Current Food Practices in Syria? As is becoming more common throughout the world, Syrian eating patterns have begun to change to accommodate the increasing presence of fast foods. The past decade has seen a particular rise in fast-food consumption among teens. This trend has begat familiar concerns over obesity and diabetes. The restaurant business overall has greatly increased in Syria, especially in its capital of Damascus.16 What Are Traditional Meal Patterns in Syria? Syrians generally eat three meals a day. Breakfast is composed of local cheeses and labneh, drained yogurt, along with a variety of olives, fried or boiled eggs, or makdous, a pickled eggplant stuffed with walnuts, minced garlic, and red pepper. Tea is a common breakfast drink.18 Lunch is a larger meal and commonly includes various vegetables cooked with meat, rice, cracked wheat, and potatoes. Dinner is becoming a major meal in Syria, often having multiple courses that include salads, meats, seasonably-available fruits, Syrian sweets such as baklava, and a beverage.16 What Are Some Traditional Health Beliefs in Syria, and How Do They Relate to Diet? Many Syrians believe in the positive health qualities of legumes and beans, such as chick peas and lentils, and that these proteins can replace meat. As such, many choose to lead a vegetarian lifestyle.16 TURKEY What Are Some of the Traditional Foods and Dishes of Turkey? The geopolitical position of Turkey has made it a major cultural crossroads, and its food and dishes have been influenced by these forces. In general, rice, wheat, and vegetables make the foundation of Turkish cuisine, and olives, yogurt, fish, and lamb are found in many dishes as well. Olive consumption is high in Turkey, as in many Mediterranean countries. Yogurt is served with many dishes, such as saksuka, a vegetable dish, and manti, pieces of dough filled with minced meats. Fish is especially important in northern Turkey, particularly the hamsi fish which is included in soups, meal dishes, and even desserts.19 Tarhana, couscous soup, is a key cultural and nutritional dish in the Turkish diet due to its high amounts of carbohydrate and protein. Other traditional Turkish dishes include dolma, vegetables stuffed with rice and meats, and kebap, skewered meat (usually lamb) served with pilav, Turkish rice.20 What Are Current Food Practices in Turkey? Organic farming and food have become much more popular in Turkey recently, and as Turkey is one of the few agriculturally self-sufficient countries in the world, these foods tend to be local.21 Salt consumption has traditionally been very high in Turkey, with Turkish people in the past consuming about 18 g of sodium per day (compared to the European average of 8 to 12 g per day). JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 703 PRACTICE APPLICATIONS The Ministry of Health has instituted a variety of salt-limiting measures, including removing saltcellars from restaurant tables and reducing salt in bread.22 What Are Traditional Meal Patterns in Turkey? Turkish people generally abide by the standard of three main meals a day. Breakfast in Turkey is usually light but can include a variety of foods and flavors, such as roasted bread, eggs, jams and honey, olives, white cheese, tomato, and others. Tea is a staple at breakfast. At lunch, soup and meat, especially köfte, a dish of fried minced meatballs, are served with pilav. Dinner is a larger meal that usually starts with meze, a multi-dish appetizer that can be considered a meal in itself. Meat and potatoes are common follow ups to the meze, while fresh fruit and sweet rice pudding serve as desserts.19 What Are Some Traditional Health Beliefs in Turkey, and How Do They Relate to Diet? Milk with honey is used to alleviate a sore throat, and hot water with mint, lemon, and lime is said to help cure a cold. Crushed sesame seeds and pectin promote a strong body and keep people healthy during cold winters.19 VENEZUELA What Are Some of the Traditional Foods and Dishes of Venezuela? Maiz (corn) and rice can be considered some of the staple foods of Venezuela and are components of many of its dishes. Perhaps the most common, popular food in Venezuela is arepa, a thick disc of precooked cornmeal (or, in some regions, flour). It is essentially a replacement for traditional bread and is served with almost every meal. Arepas can be filled with meat, cheese, beans, and many other foods and flavors.23 Other traditional dishes include pabellón criollo, which consists of rice, fried plantains, black beans, and shredded beef, accompanied by an arepa. The northern Venezuelan diet includes more fish, found in corbullón de pescado, a fish soup. Carne en vara, 704 grilled beef cooked on sticks over a large charcoal fire, is popular in central Venezuela where beef consumption is high.23 What Are Current Food Practices in Venezuela? There has been an increase in the presence of fast-food chains and processed, prepackaged foods in grocery stores. Even important traditional foods like arepas are being transformed, as the fried version of the iconic dish is becoming more popular than the traditional baked version. These changes to the Venezuelan diet have led to an increase in obesity rates and associated health problems; Venezuela is one of the top 10 most obese countries in the world.24 What Are Traditional Meal Patterns in Venezuela? Venezuelans usually eat four meals a day. Breakfast, desayuno, includes arepas filled with ham and cheese, avocado, cafe con leche, and fresh fruit juices. Lunch, almuerzo, is the largest meal of the day and can vary. The meal might include pabellón criollo or pasta with meat, served with vegetables and rice. Between lunch and dinner (cena) is a late-afternoon, small meal/snack called merienda. It usually includes a trip to a café for coffee or espresso. Dinner is the final meal of the day and, like breakfast, it is usually small and based on arepas.25 What Are Some Traditional Health Beliefs in Venezuela, and How Do They Relate to Diet? Hot milk and a small amount of butter is commonly used to clear one’s voice, and chamomile tea is used to treat anxiety and digestive distress. Aloe vera is very popular in Venezuela for use in treating skin maladies, such as cuts or burns.23 References 1. 2. Hakeem R. Cultural food practices: Pakistan. Academy of Nutrition and Dietetics website. http://www.eatrightpro. org/w/media/eatrightpro%20files/news% 20center/knowledge%20center%20faqs/cul tural%20food%20practice%20tip%20sheets/ pakistan_cultural_food_practices.ashx. Accessed March 20, 2015. Food in Every Country: Pakistan. FoodByCountry website. http://www.foodby JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS country.com/Kazakhstan-to-South-Africa/ Pakistan.html. Accessed May 22, 2014. 3. Desi RecipeseEating Habits. Pakistan tum he to ho website. http://www. pakistantumhetoho.com.pk/Eating-habitscuisine. Accessed March 19, 2015. 4. Countries and their cultures: Panama. EveryCulture website. http://www.every culture.com/No-Sa/Panama.html. Accessed May 19, 2014. 5. Gonzalez, RI. Cultural food practices: Panama. Academy of Nutrition and Dietetics website. http://www.eatrightpro. org/w/media/eatrightpro%20files/news% 20center/knowledge%20center%20faqs/ cultural%20food%20practice%20tip%20 sheets/panama_cultural_food_practices. ashx. Accessed March 20, 2015. 6. Food and drink in Panama. AngloInfo website. http://panama.angloinfo.com/lifestyle/ food-and-drink/. Accessed May 19, 2014. 7. Heberlein EP. Cultural food practices: Philippines. Academy of Nutrition and Dietetics website. http://www.eatrightpro. org/w/media/eatrightpro%20files/news% 20center/knowledge%20center%20faqs/ cultural%20food%20practice%20tip%20 sheets/philippines_cultural_food_practices. ashx. Accessed March 20, 2015. 8. Pineda M. 50 Filipino foods that define the Philippines. CNN Travel website. http://travel.cnn.com/explorations/eat/40delicious-filipino-dishes-157035. Accessed May 30, 2014. 9. More obese Filipinos due to social media, fast-food meals. InterAksyon website. http:// www.interaksyon.com/lifestyle/healthyliving-more-obese-filipinos-due-to-socialmedia-fast-food-meals. Accessed May 30, 2014. 10. Countries and their cultures: Singapore. EveryCulture website. http://www.every culture.com/Sa-Th/Singapore.html. Accessed May 20, 2014. 11. Goh N. Cultural food practices: Singapore. Academy of Nutrition and Dietetics website. http://www.eatrightpro.org/w/media/ eatrightpro%20files/news%20center/knowl edge%20center%20faqs/cultural%20food% 20practice%20tip%20sheets/singapore_ cultural_food_practices.ashx. Accessed March 20, 2015. 12. Williams J. Oriental and western views on postnatal confinement. Janet’s Notebook website. http://janetsnotebook.com/2013/ 07/31/oriental-and-western-views-onpostnatal-confinement/. Accessed May 20, 2014. 13. Gustafsson M. Cultural food practices: Sweden. Academy of Nutrition and Dietetics website. http://www.eatrightpro. org/w/media/eatrightpro%20files/news% 20center/knowledge%20center%20faqs/ cultural%20food%20practice%20tip%20 sheets/sweden_cultural_food_practices. ashx. Accessed March 20, 2015. 14. Food in every country: Sweden. FoodByCountry website. http://www.foodbycoun try.com/Spain-to-Zimbabwe-CumulativeIndex/Sweden.html. Accessed June 1, 2014. 15. USDA Foreign Agricultural Service GAIN Report: Sweden. Global Organic Trade guide website. http://www.globalorganic trade.com/files/g_files/Swedish_Organic_ Market_Stockholm_Sweden_4_13_2012. pdf. Accessed June 1, 2014. May 2015 Volume 115 Number 5 PRACTICE APPLICATIONS 16. 17. 18. 19. Labban L. Cultural food practices: Syria. Academy of Nutrition and Dietetics website. http://www.eatrightpro.org/w/ media/eatrightpro%20files/news%20center/ knowledge%20center%20faqs/cultural%20 food%20practice%20tip%20sheets/syria_ cultural_food_practices.ashx. Accessed March 20, 2015. Countries and their cultures: Syria. EveryCulture website. http://www.everyculture. com/Sa-Th/Syria.html. Accessed May 23, 2014. Syrian Drinks: Repast in a teacup. pilot guides website. http://www.pilotguides. com/articles/syrian-drinks-repast-in-a-tea cup/. Accessed May 23, 2014. Atayata F. Cultural food practices: Turkey. Academy of Nutrition and Dietetics website. http://www.eatrightpro.org/w/ media/eatrightpro%20files/news%20center/ knowledge%20center%20faqs/cultural%20 food%20practice%20tip%20sheets/turkey_ cultural_food_practices.ashx. Accessed March 20, 2015. 20. Food in every country: Turkey. FoodByCountry website. http://www.foodby country.com/Spain-to-Zimbabwe-Cumu lative-Index/Turkey.html. Accessed June 1, 2014. 21. Sansal B. Agriculture in Turkey. All About Turkey website. http://www.allabouttur key.com/agriculture.htm. Accessed June 1, 2014. 22. Progress in reducing salt consumption in Turkey. World Health Organization website. http://www.euro.who.int/en/healthtopics/disease-prevention/nutrition/news/ news/2013/04/progress-in-reducing-salt- consumption-in-turkey. Accessed June 1, 2014. 23. Herrera M. Cultural food practices: Venezuela. Academy of Nutrition and Dietetics website. http://www.eatrightpro. org/w/media/eatrightpro%20files/news%20 center/knowledge%20center%20faqs/cul tural%20food%20practice%20tip%20sheets/ venezuela_cultural_food_practices.ashx. Accessed March 20, 2015. 24. Mexico, Venezuela, Guatemala among 10 fattest countries. Latin American Herald Tribune website. http://laht.com/article. asp?ArticleId¼351269&CategoryId¼12394. Accessed June 2, 2014. 25. Typical Venezuelan food. South America Travel Guides website. http://www.south america.cl/Venezuela/Food.htm. Accessed June 2, 2014. DISCLOSURES STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the author. FUNDING/SUPPORT The author has no funding to disclose. May 2015 Volume 115 Number 5 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 705