Developing a Meal-Planning Exchange List for Traditional Pakistani Dishes

Developing a Meal-Planning Exchange List for

Traditional Pakistani Dishes

Thesis submitted in fulfillment of the requirement for the degree of

Doctor of Philosophy in Home Economics

Submitted By

Mahnaz Cosser Ali Khan

Supervisors

Professor Dr. Ayyaz Ali Khan

Professor Dr. Samia Kalsoom

Govt. College of Home Economics Gulberg, Lahore

University of the Punjab

2017 Supervisor's Certificate

It is hereby certified that this thesis "Developing a Meal-Planning

Exchange List for Traditional Pakistani Dishes" is based on the results of research work carried out by Maltnaz Cosser Ali Khan, student of PhD.

Home Economics and that it has not been previously presented for PhD or M.phil degree. ManhnazCosser Ali Khan has done her research work under our supervision. She has fulfilled all the requirements and is qualified to submit accompanying thesis for award of PhD degree. The document has been checked and corrected for typographic and grammatical errors.

Prof. Dr Ayyaz AIi Khan

Superviior

Federal Postgraduate Medical Institute,

Shaikh Zay ed Hospital, Lahore.

Prof. Dr Samia Kalsoom,

Supervisor

Govt. College of Home Economics,

Gulberg, Lahore. Ilechrntion

I, Mahnaz Cosser Ali Khan fr,om the departmsnt of Food md Nutrition h€reby sotmnty declue ftd eis disertatiou is &s r€srilt ofmy indegendelil inrmigdion except uihere I have irdicated other sources. h has not been previousty srbmitted b auy other institution or unirrersity formy dsgrce. **z ltlehnaz Cogtcr AIi trftrn ncsearch€r,

Deprtnent of Food and Nutition,

Govt Collegp ofHme Eaonrcunics,

Gulb€r& Lahore. i

Abstract Pakistani cuisine is culturally diverse as most of the dishes are one-pot combination dishes, the nutritional composition of which are not available in any Food Composition

Tables thus the aim of the study was to develop a Meal Planning Exchange List (MPEL) for Traditional Pakistani Dishes (TPDs). Mixed method sequential exploratory research design was used for this purpose. Data was collected from housewives via focus group discussion and 30 TPDs were selected which made the foundation of the study. The

TPDs were prepared according to the recipes provided by the participants of focus group and net weight of recipes was recorded. Proximate analysis of the dishes was done following the AOAC procedures. Using theoretical triangulation the 30 selected TPDs were grouped into 9 groups and the serving size was adjusted in such a manner that the macro-nutrient and energy content of each TPD in the amount stated was equal to the other TPD within the group ; one way ANOVA established that there was no statistical difference (p value ≥0.05) within the group, and as such mean of macro-nutrients could be representative of each group. The TPDs were categorized under the Bean & Lentil group; Cereal group; Meat group enlisted both lean and medium fat separately; and

Vegetable group presented as Non-starchy and Starchy Vegetables. One-pot combination

TPDs were also grouped together as Meat & Meat Substitute (medium fat ) plus non- starchy vegetables; Meat (medium fat) plus starchy vegetables; and lastly Meat (both lean & medium fat) with cereal group.

Thus, the developed MPEL is comparable to any other FEL worldwide and is ready to be used countrywide for meal planning of Pakistani population both at home and overseas.

Keywords: Meal Planning Exchange List (MPEL), Traditional Pakistani Dishes (TPDs).

ii

The Blessings of Allah (Subhan-o-Tallah) & prayers of my mother has made this possible.

DEDICATED TO FULFILLING

THE DREAMS OF

MY MOTHER

iii

Acknowledgement

Finally the day has come when I am writing my acknowledgement and it seems like a dream come true. This was a long journey which had its bumps, ups and downs but indeed a memorable one; it was an enlightening path through which I passed with the support and strength of my friends and family.

I would first of all like to extend my thanks and gratitude to Professor Dr. Rukhsana

David, Principal and Professor Dr. Nikhat Khan, Vice Principal and Dean Post graduate

Program, Kinnaird College for Women, Lahore for facilitating my research work; my supervisors Professor Dr. Ayyaz Ali Khan and Dr. Samia Kalsoom for guiding me every step of my research and Dr. Sharea Ijaz for her valuable input for shaping my write up.

The most valuable asset of this research pathway is my Kinnaird family, who was by my side every step, either it be their support in the practical work, or just a little shake up to say that you need to get going or just being there for me. My family members are

Memoona, Nasreen, Samiya, Hira, Nida and Aliya. Finally, this research would not have been possible without the unconditional support of my husband, Nasir. Thank you all for being there for me in this long, tedious but fruitful and most important journey of my life.

Mahnaz Cosser Ali Khan iv

TABLE OF CONTENTS

ABSTRACT i ACKNOWLEDGEMENTS iii

TABLE OF CONTENTS iv

LIST OF TABLES vii

LIST OF FIGURES viii

LIST OF ABBREVIATIONS ix

CHAPTER 1 ...... 1 INTRODUCTION ...... 1 1.1 Statement of the Problem ...... 4 1.2 Significance of the Problem ...... 5 1.3 Objectives ...... 6 1.4 Research Questions ...... 6 1.5 Delimitations of the Study...... 7 1.6 Definitions of Key Terms ...... 7 1.7 Operational Definitions ...... 8 CHAPTER 2 ...... 12 REVIEW OF RELATED LITERATURE ...... 12 2.1 Food Exchange List ...... 13 2.2 Historical Background: Revision and Modification ...... 14 2.3 Development of the Food Exchange List ...... 17 2.4 Cultural Importance and Development of Food Exchange List ...... 22 2.5 Validation of Data ...... 26 2.6 Food Exchange List: A Culturally Sensitive Tool for Meal Planning ...... 30 2.7 Food Exchange List and Dietary Management ...... 32 2.8 Food Exchange List: An Effective Tool for Meal Planning ...... 37 CHAPTER 3 ...... 40 METHODOLOGY ...... 40 v

3.1 Research Design...... 40 3.2. Phase I ...... 44 3.3 Sampling Procedure ...... 45 3.4 Focus Group ...... 47 3.5 Procedure ...... 49 3.6 Qualitative Content Analysis of Phase I...... 50 3.7 Phase II ...... 52 3.8 Quantitative Data Analysis of Phase II ...... 59 3.9 Phase III ...... 60 3.10 Summary ...... 63 CHAPTER 4 ...... 65 ANALYSIS AND INTERPRETATION OF DATA...... 65 4.1 PHASE I Descriptive Results...... 66 4.2 Phase II ...... 77 4.3 Phase III ...... 87 4.4. Development of Meal-Planning Exchange List for Traditional Pakistani Dishes ...... 102 CHAPTER 5 ...... 107 DISCUSSIONS AND CONCLUSION ...... 107 5.1. Discussion ...... 107 5.2. Conclusion ...... 126 5.3. Recommendations ...... 127 References

Appendices

1950 Food Values for Calculating Diabetic Diets Appendix A

Comparison of Nutritional Values per Serving of the 1986 and 1976 A.D.A. Exchange Lists Appendix B

Food Exchange List Appendix C

Selected Union Councils as Primary Sampling Unit Appendix D Focused Group Discussion Invitation Appendix E

Consent to Participate in Focus Group Study Appendix F vi

Focus Group Discussion Guide Appendix G Focus Group Checklist Appendix H

Focus Group Question Guide Appendix I Consumer Acceptibility Form Appendix J Recipes Appendix K

Accumulative Table Representing the Results of 18 Focus Groups Appendix L Weight of Dishes Appendix M

Toolkit for Meal-Planning Appendix N

vii

LIST OF TABLES

Sr. Table Titles Page No. No. No.

1 3.1 Summary of Research Methodology 64

2 4.1 Salient Themes of Focus Group Discussion 67

3 4.2 Frequency of Commonly Consumed Traditional 73 Pakistani Dishes

4 4.3 Consumer Acceptability of Traditional Pakistani Dishes 78

5 4.4 Triplicates of Macro-nutrient Content of Prepared 81 Traditional Pakistani Dishes per 100 grams

6 4.5 Macro-nutrient Content of Prepared Pakistani Dishes 83 per 100 grams

7 4.6 Categorizing the Traditional Pakistani Dishes into their 89 Relevant Food

8 4.7a Triplicates of Macro-nutrient Content of Prepared 93 Traditional Pakistani Dishes per serving

9 4.7b Triplicates of Macro-nutrient Content of Prepared 94 Traditional Pakistani Dishes per serving

10 4.8a Macro-nutrient Content of Prepared Traditional 96 Pakistani Dishes per serving

11 4.8b Macro-nutrient Content of Prepared Traditional 97 Pakistani Dishes per serving

12 4.9 Meal-Planning Exchange List for Traditional Pakistani 103 Dishes

viii

LIST OF FIGURES

Sr. Figure Titles Page No. No. No.

1 3.1 Mixed Method Sequential Exploratory Research 41 Design

2 3.2 Flow Diagram Showing Conceptual Framework of the 43 Study

3 3.3 Proximate Analysis using AOAC 2006 56

4 3.4 Conceptual Framework-Layout of the Research 60 Process

ix

LIST OF ABBREVIATIONS

ADA American Diabetic Association

AOAC Association of Official Analytical Chemists

CAA Consumer Acceptability Assessors

CKD Chronic Kidney Disease

FCD Focus Group Discussion

FCT Food Composition Table

FCTs Food Composition Tables

FCTP Food Composition Table of Pakistan

FEL Food Exchange List

FELs Food Exchange Lists

FG Focus Group

MNT Medical Nutrition Therapy

MPEL Meal Planning Exchange List

MSUD Maple Syrup Urine Disease

NCDs Non-Communicable Diseases

NK Natural Killer Cells

PKU Phenylketonuria

TPDs Traditional Pakistani Dishes

TDs Traditional Dishes

UCs Union Councils

USDA United States Department of Agriculture

WHO World Health Organization

1 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

CHAPTER 1

INTRODUCTION

Exchange list have been used for over half a century as a “tool for meal planning” for various populations such as diabetics or for those on weight loss treatment. Development of a meal planning exchange list (MPEL) for traditional dishes (TDs) common to the Pakistani cuisine serves as a database for energy and macronutrient values of foods. However, there is limited research on development of

MPEL for TDs commonly consumed in Pakistani cuisine.

Pakistan is considered a cradle of ancient civilization which can be traced back to 4000 years, today, this rich inheritance is not only seen in its culture but also echoes in its typical traditional cuisine. The art of traditional Pakistani cooking lies in its aromatic blend of spices and herbs; besides combining different food groups as one-pot combination dishes to give it a distinct characteristic flavour, texture and aroma. These traditional Pakistani dishes (TPDs) are a teaser to the taste buds at one end, whereas at the other end it becomes difficult to calculate macro-nutrients and energy content these combination dishes are providing. This is because the nutritional composition of most of the Pakistani dishes is not available in any Food Composition

Tables (FCTs) (Vyas, et al., 2003).

This deficit in information is a limitation in itself for the exact estimation of nutrient intake of individuals and communities, thus recognizing various causes of malnutrition. Therefore, it is theorized that the relationship between nutritional status and dietary intake could be masked by not taking into account difference in methods of cooking for traditional foods in certain communities (Hakeem, 2013). This association of diet and nutritional status cannot be over emphasized as determinants 2 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES of malnutrition and chronic non communicable diseases (World Health Organization

[WHO], 2002). Epidemiologic studies indicate that inappropriate and inadequate dietary intake leads to depleted nutritional reserves, which in turn is associated with low immunity (WHO, 1989) and is manifested as major causes of both chronic and infectious diseases (Calder and Jackson, 2000); leading to high prevalence of morbidity and mortality (Bazzano, Li, Joshipura, & Hu, 2008). Over 52% of all deaths occurring in low- income countries (2015) are associated with nutritional deficiencies besides communicable diseases (WHO, 2017).

The situation in Pakistan is even more grave where on one hand 58.1 % of the households are food insecure and on the other hand wrong food choices has led to an endemic situation of malnutrition with high prevalence of stunting, wasting and micro-nutrient deficiencies (National Nutrition Survey [NNS], 2011). These deficiencies are rooted in dietary inadequacies, inappropriate food combinations and lack of nutritional knowledge. Overcoming these nutritional inadequacies seems like a very easy task, that is, through dietary modification but it is not as easy and simple as it not only involves principles of a healthy diet but also takes into consideration variations in dietary patterns and food choices in relation to demographic variables and health outcomes (Kant, 2004). Food preference is influenced by countless factors, including personal likes and dislikes, lifestyle, tradition and ethnic heritage (Pollard,

Kirk, & Cade, 2002). Prescribing a diet using FCTs is not only time consuming and tedious but adhering to it is even more difficult due to lack of variety and innovation.

Thus, a food exchange list (FEL) was developed over half a century ago that provided a framework within which foods with the same quantity of macro-nutrient were grouped in such a way that it permitted trading off one food with the other 3 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES within the same food group without disturbing the energy content of the diet (Caso,

1950).

This FEL was initially developed in 1950 by the American Dietetic

Association, the American Diabetes Association and since then has been revised periodically (American Diabetes Association [ADA], 2008). The FEL is a simple tool which helps individuals and health professionals to customize the meals with little effort while maintaining consistency in food intake as it allows the use of an array of foods and food combinations while developing meal plans (Wardlaw, 2003). Lack of information regarding the food composition data of culturally variant recipes and portion size (Khokhar, Ashkanani, Garduño-Diaz, & Husain, 2013) has limited its use due to lack of cultural sensitivity. Thus, the cultural sensitivity of this tool cannot be over emphasized as ethnically relevant studies also support the fact that culture plays a very important role in behaviors and personal food choices.

Hence food exchange lists (FELs) has been developed by many countries taking into account their local foods, like the Nigerian FEL, in which local Nigerian foods have been incorporated in the list to provide a certain amount of flexibility by giving food choices for planning a diet both for a healthy individual and those requiring dietary modification (Fadupin, 2009). Similar, FELs were developed by many countries including India (“American Association of Physicians of Indian

Origin” [AAPI], 2011), Jordan (Bawadi & Al-Sahawneh, 2008) and Samoa (Shovic,

1994). This emphasizes the importance of a “meal planning tool” that is culturally sensitive and considers all previously mentioned factors as a must in promoting better nutrition both at an individual and community level (Jiménez-Cruz, Bacardí-Gascón,

Rosales-Garay, Herrera-Espinoza & Willis, 2003). 4 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

In Pakistan some work in this direction was done in 2001 in the shape of Food

Composition Table of Pakistan (FCTP), but it does not take into account the variability in the cooking methods, thus the actual nutrients consumed by the individuals is different from those given in the FCTP, 2001 (Hakeem, 2013).

Therefore, the absence of a MPEL for TPDs has resulted in the use of more complicated methods for assessing food intake during clinical studies, community surveys and in the estimation of standard local food intake.

The TPDs incorporates more than one food group for example “Aloo Gosht”

(Potato and Mutton Curry) that is mutton (Gosht) is cooked along with diced potato

(Aloo) in the traditional way as a one-pot combination dish. This dish would also include tomatoes, onions, garlic and oil as a base curry besides potatoes and mutton.

Thus, this Pakistani potato and mutton curry (Aloo Gosht) would include foods belonging to the starch, meat, vegetable and fat group. The main focus of the study is to develop a MPEL taking into account TPDs that could be grouped together based on their macro-nutrient content. The TPDs will be listed in their serving sizes after cooking so that one dish can be swapped or exchanged with another dish in the quantity stated without changing its macro-nutrient content and total energy intake.

The exchange list thus prepared could be used for meal planning and assessment of food and nutrient intake for people requiring nutritional management in Pakistan.

1.1 Statement of the Problem

The study was to develop a MPEL for dishes common to the Pakistani cuisine.

The entire list will incorporate details of associated energy and macronutrient content along with the appropriate serving size and food groups. The TPDs will be grouped in 5 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES such a manner so that one TPD could be replaced by another dish within the same group in the proportion stated and will yield similar amount of energy and macronutrients.

1.2 Significance of the Problem

The present study aims to develop a MPEL for TDs commonly consumed in

Pakistani cuisine. The developed exchange system in this study would be valid for

TDs consumed in Pakistan and could be used nationwide, by all health care providers.

This will help individual’s check portion sizes of food as well as their energy intake.

Moreover, the TPDs could be consumed interchangeably without any change in estimated amounts of macronutrients (carbohydrate, protein and fats) and total kilo calories supplied by a meal. The current study takes into consideration the cultural relevance of the food as all the dishes will be drawn out from within the Pakistani population. Thus, the developed MPEL for TPDs would be a significant tool to incorporate food options into the daily meals plans.

The Pakistani dietitians frequently use FEL developed by the American Dietetic

Association for estimation of nutrient content of planned meals but face difficulties and constraints as they are unable to include TPDs in their dietary prescription. This research, thus, will enable the practitioners all over Pakistan to take into consideration

TPDs to set realistic and practical meal plans. Additionally, it can be useful for practitioners outside Pakistan working with Pakistani immigrant community. The present study would be of interest and importance both, to the commonality and the health care professionals, in providing healthier food choices within a customized meal plan. Furthermore, practitioners and community workers elsewhere in the world 6 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES may also benefit from this work both during epidemiological studies and while managing the diet of patients with Pakistani ethnic background.

1.3 Objectives

The study was aimed to develop a MPEL for TPDs which could be used as a tool for meal planning by individuals and health professionals.

This study is based on the following objectives:

1. To identify most common TPDs along with their recipes.

2. To evaluate the recipes by quantifying the amount of ingredients in

TPDs.

3. To estimate the amount of macro-nutrient (carbohydrates, proteins and

fats) content of the prepared TPDs through proximate analysis.

4. To categorize TPDs into their representative food groups.

5. To befit serving size of TPDs in the exchange system.

6. To develop a MPEL for TPDs.

1.4 Research Questions

1. What are the most common TPDs and how are they cooked?

2. What is the exact quantity of the ingredients (in terms of grams and

measuring cups/spoons) used for preparation of the specific TPDs?

3. What is the quantity of macro-nutrients in the TPDs per 100 grams?

4. What will be the representation of TPDs in terms of food groups?

5. What will be the exchange unit per serving size of the prepared TPDs?

6. What will be the MPEL for TPDs?

7 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

1.5 Delimitations of the Study

The study was limited to the city of Lahore, which is the capital of Punjab,

Pakistan. Punjab is the representative province of Pakistan as 56% of its population lives in Punjab; Lahore is a metropolitan and second largest city of Pakistan and is considered a melting pot of the country where people from all the provinces and ethnic background have settled in largely because of it being an educational hub.

Lahore boasts the largest accumulation of educational institutions in the country backed by cooperate infra structure and national base. Due to this, Lahore is the focal point for all strata of population, which may be in line with business, occupation, trade, practice, education or any chosen career. This diversity of ethnicities and socio- economic backgrounds makes Lahore a fitting representation of Pakistan.

Secondly, due to limitations of time and recourses, all the traditional Pakistani dishes identified by the focus group were not part of the study and only most commonly consumed dishes were included in the research work which was determined by a prevalence percentage of 60% and above.

1.6 Definitions of Key Terms

1.6.1 Food Exchange List: “a well-known nutrition resource for individuals with diabetes since 1950, has been designed as a diabetes nutrition education tool that places foods into groups that can be exchanged or traded within a group because of their similar nutrient content” (Geil,2008).

1.6.2 Food Group: “A food group format is established by organizing the food sources of nutrients into categories according to similar nutritional properties and their uses in the body” (Nestle, 2013). 8 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

1.7 Operational Definitions

1.7.1 Food Groups: Food groups have evolved from the basic four to eleven food groups over a period of time. However, in the current study, food groups would refer to six food groups identified in ‘My Pyramid’.

1.7.2 Meal Planning Exchange List: Contextual to this research meal planning exchange list would refer to an exchange list which includes cooked foods severed in the form of traditional food dishes.

1.7.3 One pot Dish: A combination dish where two or more food items are cooked together and served as one dish.

1.7.4 Traditional Pakistani Dishes: Relative to this research where ever the term traditional Pakistani dishes is used, it would refer to homemade traditional

Pakistani dishes. Traditional Pakistani dishes included as part of the study are described below:

1.7.4.1 Aloo Bhujia (Potato Gravy): Potatoes (Aloo) cooked in traditional

Pakistani way with blend of spices.

1.7.4.2 Aloo Gobi (Potato Cauliflower Mix) : Dry cuisine mix made from potatoes (Aloo) and cauliflower (Gobi) cooked together in spices.

1.7.4.3 Aloo Gosht (Potato & Mutton Curry): Mutton (Gosht) cooked along with diced potato (Aloo) in aromatic spices and tomato based curry.

1.7.4.4 Aloo Keema (Potato & Mutton Mince) : Minced meat (Keema) and otatoes (Aloo) cooked in a typical Pakistani gravy of tomatoes, onions and spices. 9 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

1.7.4.5 Aloo, Matar, Gajjar (Potato, Peas & Carrot Mix): Dry cuisine mix made from potatoes (Aloo), peas (Matar) and carrots (Gajjar) cooked together in spices.

1.7.4.6 Anday ka Khagina (Scrambled Eggs with Vegetables): Pakistani style scrambled eggs (Anday) dish with tomatoes, onions, green chilies and fresh coriander.

1.7.4.7 Arbi Baigan Ki Bhujia (Taro & Eggplant Gravy): Combination vegetable dish made with taro (Arbi) & eggplant (Baigan) cooked in dry spices.

1.7.4.8 Bhindi Pyaaz (Okra with Onions): Dry preparation of okra (Bhindi) sautéed with caramelized onions (Pyaaz).

1.7.4.9 Bhuna Keema (Stir Fried Mutton Mince): Minced meat (Keema) stir fried in a typical Pakistani way with tomatoes, onions and spices.

1.7.4.10 Channay Ki Daal Aur Kudu (Split Bengal Gram & Bottle Gourd

Gravy): Split Bengal Gram (Chanay Ki Daal) and bottle gourd (Kudu) cooked together as a combination dish.

1.7.4.11 Daal Mash (White Lentil): White lentil (Daal Mash) sautéed in a typical onions and tomatoes gravy and served dry.

1.7.4.12 Daal Moong (Petite Yellow Lentil): Petite yellow lentil (Daal

Moong) sautéed in a typical onions and tomatoes gravy and served dry.

1.7.4.13 Kabuli Chanay ka Salan (Chickpeas Curry): Curry made in the form of stew with Chickpeas (Channay). 10 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

1.7.4. 14 Kadhi Pakora (Gram Flour & Sour Yogurt Gravy with

Fritters): Gravy made from gram flour and sour yogurt with simmered deep fried fritter made from gram flour.

1.7.4.15 Kalay Chanay ka Salan (Brown Bengal Chickpeas Curry): Curry made in the form of stew with Brown Bengal Chickpeas (Kalay Channay).

1.7.4.16 Keema Pyaaz (Mutton Mince with Onions): Minced mutton

(Keema) sautéed in a typical Pakistani gravy of tomatoes, onions and spices with extra addition of onions (Pyaaz).

1.7.4.17 Keema Shimla Mirch (Mutton Mince with Bell Pepper): Minced meat (Keema) sautéed in a typical Pakistani gravy of tomatoes, onions and spices and finished with the addition of bell pepper (Shimla Mirch).

1.7.4.18 Kudu Gosht (Bottle Gourd & Mutton Gravy) : Mutton (Gosht) cooked along with diced bottle gourd (kudu) in a tomato and onions based gravy.

1.7.4.19 Matar Keema (Peas & Mutton Mince): Minced mutton (Keema) and peas (Matar) cooked in a typical Pakistani gravy of tomatoes, onions and spices and herbs.

1.7.4.20 Matar Pulao (Rice with Peas): A rice dish (Pulao) in which rice is cooked with peas (Matar).

1.7.4.21 Murgh Biryani (Boiled Rice layered with Chicken Gravy): A rice dish in which cooked chicken (Murgh) gravy is then added to boiled rice, as alternate layers of rice and chicken. Saffron or yellow food colour is added to give a typical yellow orange colour to the finished dish. 11 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

1.7.4.22 Murgh Handi (Chicken in a Pot): Chicken (Murgh) cooked in a pot

(Handi) with yogurt, onion and traditional spices and herbs.

1.7.4.23 Murgh Karahi (Chicken in Wok): Chicken (Murgh) dish cooked in a wok (Karahi) with addition of oil, tomatoes, garlic, ginger and spices.

1.7.4.24 Murgh Korma (Chicken Curry): A classic dish of chicken (Murgh) stew made in gravy of yogurt and fried onions.

1.7.4.25 Palak Gosht (Spinach & Mutton Gravy): Mutton (Gosht) cooked along with spinach (Palak) as a combination dish.

1.7.4.26 Saboth Masoor Ki Daal (Brown Lentil): Brown lentil prepared in a stew like manner and finished with the addition of garlic cloves tempered in hot oil.

1.7.4.27 Sabzi Pulao (Vegetable Rice): A rice dish (Pulao) in which rice is cooked with two or three vegetables. Usually potatoes, carrots and peas are the choice vegetables but the selection of vegetables may vary.

1.7.4.28 Shaljam Gosht (Turnips & Mutton Gravy): Mutton (Gosht) cooked along with diced turnips (Shaljam) in aromatic spices and tomato based gravy.

1.7.4. 29 Tori Chapni (Cousa Squash Gravy): Cousa Squash (Tori Chapni) sautéed in a typical oil based onions and tomatoes gravy.

1.7.4.30 Yakhni Pulao (Rice in Mutton Broth): An aromatic rice dish

(Pulao) cooked in mutton broth (Yakhni) along with mutton pieces.

12 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

CHAPTER 2

REVIEW OF RELATED LITERATURE

Food is a critical contributor to the physical wellbeing of an individual, not only in terms of providing nutrients to the body, but also in terms of the influence it exerts on many socio-psychological aspects of life (Rozin, Fischler, Imada, Sarubin &

Wrzensiewski, 1999). Food intake patterns have been studied extensively, not only for their social (Ganasegeran, et al., 2012) and psychological determinants (Collins &

Bentz, 2009) but also for their correlation with the nutritional value it provides to maintain the physiological attributes of an individual. The importance of diet in health and its role as the major determinant in healthy lifestyle behavior cannot be over emphasized (WHO, 2002). Developing a dietary pattern relative to nutrient adequacy and health outcome is a task which is not as easy as it seems (Kant, 2004).

An individual chooses food for many reason and foods selected overtime can make a significant difference to the health of that individual (Freeland-Graves & Nitzke,

2002).

Planning a healthy regime not only involves “principles of healthy diet” which include the concepts of “adequacy, balance, energy control, nutrient density, moderation and variety” but also deliberates on various aspects that influence food choices besides the energy and macronutrients it provides. Food choice is affected by many factors including personal preferences, habits, ethnic heritage and tradition

(Pollard, Kirk & Cade, 2002). Developing a diet using the FCT is time consuming and tedious; as giving a selection that is acceptable and one that people can also adhere to requires additional scrutiny. 13 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

A food exchange system is a tool that provides a framework under which the foods with the same amount of carbohydrate, protein, fat and energy content can be grouped together. This allows trading off one food with another within the same food group without disturbing the energy intake or macronutrient content of the diet. This has led to the concept of FEL, which can be used as an effective tool for dietary management for the public at large.

The relation of food intake and certain diseases has long been researched as part of epidemiological studies and specific nutrients have been correlated as determinants of disease (Willet & Stampfer, 1986). However, research alone cannot improve people’s health until the results influence their purchase and consumption of food and drink. The most efficient solution to the problem of insufficient and conflicting public information is for all of the data to be critically evaluated by a well- balanced expert committee convened by an authoritative body to produce dietary guidelines including simple meal planning tools for wide publication (Truswell,

1998).

This chapter will include a comprehensive review of the concept of the FEL, followed by a detail review of its importance and use in the dietary management of chronic non-communicable diseases (CND); its cultural relevance will be highlighted and its use as an effective tool for meal management will be discussed.

2.1 Food Exchange List

Eating variety of foods may help manage and prevent diseases such as diabetes mellitus, certain types of cancer and cardiovascular diseases while 14 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES maintaining a healthy, well-balanced and interesting diet that provides adequate nutrition (Willett, 1994).

Meal planning guidelines have been, developed for the purpose of achieving adequacy to dietary patterns. The meal plan is a guide which shows the number of food choices to be eaten at each meal and snack. Exchange List for Meal Planning was initially developed for diabetic patients in 1950 with the purpose of managing the disease along with giving a variety to the patient’s diet (Caso, 1950). The word exchange refers to the fact that each item on a particular list in the portion itemized may be interchanged with any other food item on the same list based on local culture and individual’s personal preferences. An exchange can be explained as a substitution, choice or serving. Foods have been divided into groups according to the types and amounts of certain nutrients they contribute to the diet. Each food group consists of a list of measured or weighed foods of approximately the same nutritional value; and within each food list, one exchange is approximately equal to the other in terms of energy, carbohydrate, protein, and fat (Wardlaw, 2003). The lists are grouped into three main groups: carbohydrate group; meat and meat substitute group; and fat group (Camelon et al., 1998) based on their macro-nutrient content.

2.2 Historical Background: Revision and Modification

Before 1950, planning a diet of a diabetic patient was chaotic. Problems that led to noncompliance or inconsistency in food recommendations included long methods to calculate the composition of food and size of the recommended portion was stated in impractical measures. Thus by combining food groups of similar composition the first FEL evolved and is represented as Appendix A. (Caso, 1950).

This FEL was then revised periodically with the aim of modification and 15 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES improvement; taking into account concerns that arose with its use. The 1976 revised

FEL concentrated additionally on the energy content and emphasized on reducing cholesterol and fat consumption. The list revision included changes like the milk group being broken into its sub-divisions of “non-fat, low-fat and whole milk” category based on the fat content; starchy vegetables were shifted from the vegetable group and added to the bread exchange; while the vegetable exchange was equal to ½ cup serving size providing 25 kilocalories. The meat group was divided into “medium fat, high fat and protein-rich foods” while the fat conversation was reviewed to display the category of saturation as polyunsaturated or saturated fat (ADA, 1976).

Nutrient evaluation within the modified exchange list was conceded out for several micro and macro nutrients by using FCTs. The average values for all macro-nutrients were similar in the relevant food group with the exception of the milk group (Wyse,

1979).

The FEL was again revised in 1986 with the development of a consumer friendly tool “Healthy Food Choices” for meal planning. This revised FEL not only listed food items into 6 different groups according to their energy content but also positioned itself on the sodium and fiber content. Emphasis was placed to reduce the sodium and increase the fiber intake; and for this very purpose the decision of labeling the foods as high in fiber and low in sodium was taken (Franz, et al., 1987).

The 1986 FEL incorporates the nutrient value allotted to some exchanges which is displayed in Appendix B.

According to American Diabetes Nutrition Recommendations (1994), FEL was modified in 1995 and a fourth version was obtained. The target was to provide flexibility in food choices by improving order and grouping on the list. Important 16 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES updates in food database of this exchange list include; grouping carbohydrate rich foods together, counting fat modified foods in the list, fast food and vegan foods entries to permit more precise computations of conversation from nutrient information on tags and labels of ready-to-use foods and recipes. Order and grouping of foods on the list were the highlights of the revision. Foods belonging to the fruits, starches, milk and other carbohydrates list were included in the carbohydrate group.

Each food item on the list embodied 15 grams of carbohydrate and was interchangeable with the other food item while developing a meal plan (Wheeler et al., 1996). Changes were made in every group except the vegetable group. The meat and its alternative group were separated into high fat, medium fat, lean and very lean meat and meat alternatives. The divisions in the fat group constituted of saturated fats, monounsaturated and polyunsaturated fats; special emphasis was given on the low consumption of total fats particularly saturated fats (Holler, 1996).

The validity of a dietary tool depends on its continued up-gradation with the latest research and development and as such the FEL was revised and updated in

2003. This fifth revision presented the “other carbohydrate list” in detail with the addition of other sweet foods and desserts and renamed the list as “sweets, desserts and other carbohydrates”. Nevertheless, the 1995 and 2003 FEL presented a similar nutrient content for each group on the list (ADA, 2003). In 2008, a six version of the

“Exchange List for Meal Planning” came with a new title of “Choose Your Foods:

Exchange List for Diabetes” (Wheeler, et al., 2008).

The designed tool was helpful in interpreting the nutrition recommendation based on the evidence into healthy eating options (Geil, 2008). Variations were recorded in the classification of food groups in the 2008 edition while the macronutrient and the energy content per serving remained unchanged. Starch list 17 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES was improvised by extracting high fatty starch foods and labeling them for extra fat or prepared with extra fat. The fruit list was modified with the addition of dried fruits with one fruit serving equal to two tablespoons of dried fruits. This revision saw the inclusion of “Dairy –Like Foods” in the Milk Group while beans and soy beans which were previously labeled as “Plant -Based Proteins” were re-grouped and added as a sub category to “Meat and meat substitutes” list. The “Sweets, Desserts and other

Carbohydrate” unit along with the “Non -Starchy Vegetable” group expanded extensively (ADA, 2008).

Furthermore, the free food list was renamed as “Modified–fat Food with

Carbohydrate”; combination foods and fast foods lists were sectioned in different groups for easiness of use; an alcohol list was also included and the selection was itemized against a serving with an energy content of 100 kilocalories (ADA, 2008). A detail food exchange list has been given as Appendix C.

2.3 Development of the Food Exchange List

The core of the FEL is to categorize food items into groups with the same amount of macro-nutrients in the given quantity. Thus, nutritional information regarding the substance make-up of foods becomes the initial step in quantifying food and relating it to human nutrition (Mc Cance & Widdowson, 1940). Various methods for estimation and assessment of the macro-nutrients have been employed for the said analysis. The United States Department of Agriculture (USDA), established in 1862 is also responsible for providing nutrient database of food composition as a standard reference; besides over seeing food safety and issues related to agriculture. The

USDA determines the macro-nutrient content of food through the analytical procedures employed by the Association of Official Analytical Chemists (AOAC). 18 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

2.3.1 Analysis for Determining Nutrient Content

Estimating nutrient content of a particular food or recipe is not always possible from the FCTs available or from the USDA’s National Nutrient Database

(2012). Variations in cooking (Hakeem, 2013) and lack of availability of recipes makes it even more difficult to estimate the nutritional composition of prepared dish and it is therefore of paramount importance that the said dishes or meals be analyzed chemically through various standard methods available.

2.3.1.2 Estimation of Macro-nutrient Content .The proximate composition of foods comprises moisture, ash, fiber, lipid, protein, and carbohydrate contents.

These macro-nutrients are important for many reasons which may include product development, controlling quality for the regulation of various food items and for development of the FEL. Some methods of analysis are rapid while others are time consuming but maybe more accurate. While analyzing food, it is of the upmost importance that the sample is both homogenous and representative (Morawicki, 2010) so as to give a correct energy approximation. The energy content is usually determined by using factors of 4, 9, and 4 for carbohydrate, lipid, and protein respectively and multiplying the values to get the sum expressed as kilocalories

(Imran, Khan, Hassan & Khan, 2008).

The protein content of food is determined by the amount of nitrogen present in the sample which is then converted into protein by using its recommended conversion factor. The factor of 6.25 is generally used to estimate the protein content of most food items but specific recommendations have been made for certain foods like soybeans where a factor of 5.71 is used (Jones, 1941) and a factor of 4.38 is used to 19 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES adjust the protein content of mushrooms (Merrill & Watt, 1973) are just a few to mention. Methods used for assessment of nitrogen content in foods are those of

AOAC and include 968.06 (4.2.04), 992.15 (39.1.16) and for combustion 990.03 while for Kjeldahl the 991.20 method is used (AOAC, 2010). Over half century has passed but the method of determining nitrogen through Kjeldahl is still the most accepted and universally applied method for estimation of nitrogen content of foods

(USDA, 2012).

The total carbohydrate content in food is usually estimated by difference and while using this approach other non-energy contributing components like moisture, ash and fiber are also calculated as the carbohydrate content would be calculated as

[100 − (proteins + fats + moisture + ash in percentage)] (Valdez-Solana et al., 2015).

Since the total carbohydrate content of food includes both monosaccharide and disaccharides, individual sugars may also be determined through liquid chromatography (AOAC 982.14) or gas-liquid chromatography (GLC) or high performance liquid chromatography (HPLC) (USDA, 2014).

Fiber is the indigestible part of food which does not contribute to the overall content of energy or carbohydrate but is an important part of proximate analysis especially where total carbohydrate is determined “by difference”. Methods of fiber determination include enzymatic-gravimetric for soluble and insoluble dietary fiber using methods of AOAC 991.43(32.1.17) and for total dietary fiber AOAC

985.28(45.4.07) (USDA, 2012).

Mostly fat in foods is in the form of triglycerides and may be analyzed through gravimetric methods which may include the use of acid by hydrolysis AOAC 20 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

922.06, 925.12, 989.05, or 954.02 or methods involving extraction by using chloroform and methanol in a mixed solvent system AOAC 983.25. The fat content can thus be expressed as total of individual fatty acids or triglycerides (FAO, 1994).

This procedure has been used for estimation of fat content in vast array of food items.

Ash and moisture determination in food is also important as it contributes to the total sum which is important for determination of “carbohydrate by difference”.

Moisture in food could be determined by forced air (AOAC 950.46) or vacuum oven

AOAC 934.01, 934.06, 964.22. Similarly, ash is analyzed by the use gravimeteric methods AOAC 923.03, 942.05, or 945.46 (AOAC, 2010).

AOAC was set up by the United States Department of Agriculture, so that unified methods of chemical analysis could be established internationally for estimation of nutrient analysis of food, feed raw or processed that could be comparable. Since then, for over a century AOAC methods have been used in various aspects of food and nutrition. AOAC methods have also been used to compare the nutritional differences between three flours samples of wheat, barley, and stinging nettle. Total ash values were calculated through overnight incineration of flour samples at 550°Celsius for 6 hours. The procedure used to determine moisture content required the sample to be oven dried at 100° Celsius until constant weight was reached. Lastly, the carbohydrate content of the flours was found through the difference method. The study was able to conclude that nettle plants are a rich source of protein along with energy besides fiber (Adhikari, Bajracharya & Shrestha, 2016).

The importance of vegetables in the diet mainly Sweet Peppers, Cauliflower, Carrots,

Cabbage, Lettuce, Spinach, Tomatoes, Potatoes, Radishes, and Bottle Gourd was shown through evaluation of their proximate composition including vitamin and 21 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES mineral content. Samples were run in triplicates according to the AOAC 2000 method in which samples were oven dried and powdered in preparation of the analysis. The tests for proximate composition included moisture which was determined by oven dehydration method at the temperature 105˚ Celsius up until the weight remained constant. The Kjeldhal method was used to determine crude protein by estimating the nitrogen content in the food. Acid and alkali digestion was used for estimation of crude fiber besides using Fibertech; while ash content was calculated by burning the sample in a muffle furnace for 6 hours at 550˚Celsius (Hanif, Iqbal, Iqbal, Hanif &

Rasheed, 2006).

2.3.1.3 Analyzes of Cooked Dishes. The use of AOAC methods are not limited to a single ingredient or food item, they are also used for the analysis of recipes. A Nigerian based study on improving recipes from the food plant cocoyam through enrichment by cowpea also utilized the AOAC, 2005 methods to determine crude fiber, protein, fat, ash and moisture contents of samples. Carbohydrate content was estimated through the “difference method” in which the percentage of “protein, fat, crude fiber, ash and moisture” is subtracted from the total sum of 100. The finding revealed that enrichment with cowpea flour of cocoyam based dishes exhibited an improvement in both the macro and micro-nutrient content besides the sensory attributes and acceptability of the cooked dishes (Olayiwola et al., 2013).

Similarly, ash, moisture and protein content of five traditional Cameroonian dishes made with pumpkin was also found using AOAC methods (Ponka et al., 2015).

Likewise, increases in the protein and consequently amino acid content of traditional

Cameroonian dishes prepared with the addition of peanut and cowpea was also assessed by AOAC, 2000 (Ponka, Fokou, Beaucher, Piot & Gaucheron, 2016). The 22 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

AOAC methods were also used for nutrient assessment of composite dishes and consequent development of MPEL for “Traditional Jordanian Dishes” as was exhibited by Bawadi and Al-Sahawneh (2008).

2.4 Cultural Importance and Development of Food Exchange List

Dietary patterns are based on the blueprint any culture places on its traditional foods; which in turn has an effect in developing one’s eating habits. These traditional variations and food choices may affect food and nutrient intake; as cultural diversity of cookery may involve the use of ingredients not ordinarily used in cooking elsewhere. This data about the traditional foods is important as it may help individuals monitor their dietary intake. Thus, consumers should be provided with nutritional information regarding the total energy along with the macronutrient content of the cultural foods (Trichopoulou, Soukara & Vasilopoulou, 2007).

Absence of such information places another challenge on the dietitians for managing the diet of their patients coming from different cultural backgrounds through the use of a “cultural sensitive diet plan”. Such plans may not be accurate or even possible in the absence of a FEL that confers with the said culture.

2.4.1 Methods for understanding cultural norms and practices

Qualitative research plays a significant role in understanding contextual and cultural factors that are important for comprehending social norms so as to enhance the validity of development and intervention tools and programs (Nastasi & Schensul,

2005). Various reasons affecting food choices including food craving and food availability are influenced by a host of factors. Culturally sensitive FEL can only be developed when an insight to the culture is taken into close consideration. Different 23 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES methods have been devised for cultural anthropology studies which include observation, in-depth interviews and focus groups. Amongst them the most popular method for studying cultural variation is through focus group discussion (FGD).

2.4.1.1 Focus group. Focus group provides an informal setting where the individuals interact and are free to give their opinion on subject of discussion. This form of in-depth interview can provide insight in the complexity of cultural effect on food intake and can help uncover type of information not readily available by other methods (Billson, 2006). Focus groups are in fact, guided discussions among the members of the population that provide insight into a specific matter. The discussions are comprised of a set of questions asked to generate data from people of different views. Focus groups are significant for obtaining in-depth qualitative data from a community with different opinions and needs in a considerably short time. Well moderated focus groups become sources of gathering stimulated information from the participants which can only occur through group interaction (Carlsen & Glenton,

2011).

Over years, research studies have utilized different sizes for FGD. The number of participants in a focus group determines both the quality and quantity of information generated. The most generally recommended number of participants if eight to twelve. The size of the focus group depends entirely on the type of study. The sensitive subject matters require a smaller number of participation to ensure the accuracy of the information. However, it is well recognized that smaller focus group for normal topics may result in insufficient information (Fernandes, Silva, Reis &

Leão, 2016). Important significant factors need to be considered before deciding the actual size of focus group for a study. These include the basic layout of the focus 24 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES group session including the total time duration for the activity; number of questions asked and the time given for discussing each question (Tang & Davis, 1995).

Thus, the size of focus group would depend on the research objectives. The main purpose of conducting focus groups is to understand the participants’ perception regarding a specific topic and this requires a focus group to adequately represent all types of participants. The collection of data from different regions of a country with cultural variations will require 20 or 30 focus groups as being sufficient. The larger size of focus group in this case is beneficial as it helps to control multiple variables and groups are selected in order to explore diversity rather than establishing representative of any group (Billson, 2006). Focus groups have been used successfully for collecting qualitative data involving linguistically and culturally varied population, thus making it a useful tool for better understanding of cultural and linguistic perspective of different groups. This provides opportunities to the researcher for shaping up the research work in such a way that would yield more valid results (Halcomb, Gholizadeh, Di Giacomo, Phillips & Davidson, 2007).

The concept of ‘saturation’ is also provided to explain the accurate size and number of focus groups for a qualitative research. However, the concept was not in line with the research and collecting iterative data. The studies that utilized small number or size of focus groups generally mentioned it as a limitation (Carlsen &

Glenton, 2011). The depth in settings with cultural variations is achieved through proper insight into the subject. Most studies have reported to use a focus group with six to twelve participants (Baumgartner, Strong, & Hensley, 2002). However, the aspect to consider is not only gathering of participants at a specific place and time but 25 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES creating an atmosphere where one can relate to the group and is easy in sharing one’s thoughts and experiences (Krueger, 2000).

2.4.1.2 Appraisal of Focus Group Data. The history of focus group can be traced back to over 80 years (Morgan, 1998) and it is surprising to observe that no set framework has been formulated which the focus group researcher can use for analysis of data (Onwuegbuzie, Dickinson, Leech & Zoran, 2009). Different techniques have been employed to interpret qualitative data from focus group which includes key words in “context analysis”, “constant comparison analysis”, “word count”, “domain analysis”, “classical content analysis”, “componential analysis” and “taxonomic analysis”. However, this section will only discuss techniques relevant to the current study which includes constant comparison analysis and classical content analysis.

2.4.1.2.1 Constant Comparison Analysis. The roots of constant comparison analysis can be traced back to Glaser and Strauss (1967), where it was used in grounded theory research as the core for analyzing qualitative data. The affectivity of constant comparison analysis is appreciated in focus group analysis especially where several focus groups prevail within the same study, allowing the researcher to draw out themes and refine them as one focus group is analyzed at a time (Charmaz,

2000).Thus, this technique is also referred to as “coding” (Miles & Huberman, 1994;

Ryan & Bernard, 2000). As the researcher categories small chunks of information while analyzing qualitative data and the underlying themes with a title or code.

Constant comparison can be conducted both deductively where underlying themes or concepts are coded prior to the analysis (Leech & Onwuegbuzie, 2007); and inductively where categories emerge while analyzing data (Boeije, 2002). Constant comparison analysis can be carried out by following three simple steps; firstly the 26 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES data is grouped in small units, attaching a code to each unit; secondly these codes or units are grouped in categories and finally one or more themes are taken out from the identified categories (Strauss & Corbin, 1998).

2.4.1.2.2 Classical Content Analysis. Analyzing qualitative data through

“classical content analysis” is somewhat like “constant comparison analysis” as both places data in small groups or chunks (Onwuegbuzie, Dickinson, Leech, & Zoran,

2009), but instead of creating themes similar codes are group together and counted.

This quantitative procedure (Kelle, 1996) of data analysis is used to determine frequency prevalence and as such qualitative research is presented in a quantitative manner. Morgan (1997) has identified three inimitable means for use of classical content analysis while analyzing data from focus group; firstly, each participant is assessed on to whether the given code is used by him or her; secondly similar assessment is done within the each group and lastly the frequency of each given code is identified. These codes can be identified “deductively, inductively, or abductively” and softwares like NVivo could be used for classical content analysis (Leech &

Onwuegbuzie, 2011).

2.5 Validation of Data

Qualitative data has well been recognized in social science research as a means of collecting information pertaining to individuals and communities but this also warrants development of analytical procedures for enhancement of objectivity

(Miles & Huberman, 1994). Gliner (1994) has depicted triangulation as a way of determining internal validity in qualitative research; at the same time triangulation is used as a means of connecting both qualitative and quantitative research (Blaikie,

1991), in mix- method study design to understand a concept from different angles. 27 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

2.5.1Triangulation

The concept of triangulation was perceived from the discipline of geography that deals with construction and land surveying (Meijer, Verloop & Beijaard, 2002).

Triangulation, is based on the principle that if two points are known, the third unknown point can be found thus, forming a triangle (Thurmond, 2001). Data triangulation finds a central place both in mix-method research and qualitative analysis (Kimchi, Polivka & Stevenson, 1991). This technique emphasizes the significance of using more than one procedure for analysis of data in order to fully understand a concept or phenomenon (Leech & Onwuegbuzie, 2007) and has thus become a practice, widely accepted in social research (Yeasmin & Rahman, 2012).

Social sciences started using triangulation effectively, since 1959 (Campbell and

Fiske,1959) ; with added on developments (Web, 1966) and elaborations (Denzin,

1970) in the next two decades making it possible to use this technique beyond the conventional association with research methods and designs. Essentially,

“triangulation”, is a practice which is generally employed by social science researchers to authenticate and verify their finding by illustrating that independent measures are in conformity with each other or at least do not contradict each other

(Miles & Huberman, 1994). Thus, it may be said that “triangulation” is augmenting both qualitative and quantitative methods of research in such a way so as to provide a powerful solution to a problem which a single method would not be able to address

(Thurmond, 2001).

Different mediums have been used for collection and interpretation of data using “triangulation”. Denzin (1970) acknowledged four kinds of “triangulation” while Miles and Huberman (1994) identified five type of “triangulation” in qualitative research. Broadly speaking, “triangulation” is specified according to the 28 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES component used in research used into four areas namely “investigator triangulation”,

“theoretical triangulation”, “methodological triangulation” and “data triangulation”

(Denzin, 1970). “Triangulation” involving data has been further narrowed down into data type i.e. qualitative and quantitative and data source i.e. collecting data from different individuals, or at different times or from various places (Miles & Huberman

1994). Apart, from this data analysis “triangulation” was introduced as a separate entity in 1991 by Kimchi and his co-workers. The type of “triangulation” used in a study would largely depend on the objectives of the study and the perspective of the researcher, who might opt to use two or more type of “triangulation” techniques resulting in multiple “triangulations” (Polit & Hungler, 1999).

2.5.2 Data Triangulation

“Data Triangulation” validates the consistency of data through different sources which may include time i.e. different points in time; settings (public or private); people from whom the data is collected (Mitchell, 1986); information type retrieved i.e. qualitative or quantitative; employing one or two methods for data analysis, which may be using different statistical test or different families of statistical testing to validate data (Kimchi et al., 1991).This technique allows the researcher to collect large amount of data which on one hand may be beneficial for identifying similar (Banik,1993) or atypical patterns while on the other hand the same large quantity of data may present difficulties in interpretation of data (Thurmond, 2001).

2.5.3 Investigator Triangulation

“Investigator Triangulation” engages more than one individual for performing similar or different task within the same research like investigator, observer, coder or data analyst (Denzin, 1970). The objective of involving multiple researchers within a single research project is aimed at compensating the effect of bias from a single 29 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES researcher; although determining and authenticating bias is difficult (Kimchi et al.,1991) but still this type of “triangulation” reduces the risk of bias at all the various steps of research (Mitchell, 1986) and increases internal validity (Boyd, 2000).

2.5.4 Methodologic Triangulation

“Methodologic Triangulation” can either be used in methods for data collection or research design (Lincoln & Guba, 1985) where qualitative and quantitative methods are used within a single study (Cobb, 2000). Mixing methods permits the researcher to use both viewpoints (Lincoln & Guba, 2000) as sometimes explaining a concept is more relevant than just numbers and mixing both may clarify an answer to the question (Polit & Hungler, 1999). “Multiple triangulation” is more useful in obtaining data and viewpoints regarding family needs by means of collecting data through multiple sources and “methodologic triangulation” which involves using both qualitative and quantitative data (Thurmond, 2001).

2.5.5 Theoretical Triangulation

“Theoretical Triangulation” uses several theories while examining a viewpoint or phenomenon. In “theoretical triangulation” different aspects are studied which may be related or have opposite viewpoints (Denzin, 1970). Using multiple perspectives may decrease alternative explanation to the hypothesis (Mitchell, 1986) and is used for analyzing data from the same statistics set (Boyd, 2000). The use and importance of “theoretical triangulation” cannot be over ruled in explaining and developing constructs in theory by providing an in-depth analysis of the research findings (Banik,

1993).

30 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

2.6 Food Exchange List: A Culturally Sensitive Tool for Meal Planning

Issues related to health are of concern throughout the world and many researches are focused towards this end with the aim of assessing causes and drawing solutions to these health issues. Moreover obesity, a key cause of metabolic conditions including Diabetes Mellitus also lined the approach for the establishment of FEL as a “tool for meal planning” which could be used with ease by individuals of varying ethnic background. The foremost focus was then the incorporation of TDs into a FEL so as to formulate culturally sensitive tool for meal planning. An eighty kilocalorie rice unit was established in Taiwan to develop a FEL, with a comparatively different parameter. This special FEL was developed for Taiwan residents of Chinese origin who experienced difficulty in following the old FEL due to incorrect food classification based on non-nutritional sources. The FEL now consisted of new categories which grouped food on the basis of fat, carbohydrate and protein. Rice the staple of China was the foundation of this study that is why it became most appropriate to the Chinese population (Hung, 1989). Similarly, the

Samoan FEL was developed with conventional foods incorporating usually devoured foods routinely consumed by the Samoan population. The sustenance related issues of this country could not have been attended appropriately due to the absence of socially pertinent FEL (Shovic, 1994).

Likewise, various studies have been conducted throughout the world with the aim of incorporating TDs in a routinely menu, giving space to the advancement of

National Food Based Dietary Guidelines. Keeping in view the same, dietary guidelines were made in Greece which included passable levels of saturated fat, satisfactory levels of fiber and increased consumption of vegetables and fruits 31 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

(Moschandreas & Kafatos, 1999). This concept was updated in 2006 when a weekly menu was developed with the inclusion of Greek TDs. The aim was to list down the traditional foods of Greece in accordance to the macronutrient quantities based on analysis of Greek traditional foods (Trichopoulou, Vasilopoulou, George, Soukara, &

Dills, 2006). Another dietary tool, 'Apple of Health', was shaped for Mexican diabetics which utilizes the same food categories as of USDA “Food Pyramid” as a base of formulating "Apple of Health". Nonetheless, the "Apple of Health" represents beans equally in both the grain group and the meat group. This is so because beans are an important source of protein in the diet for low and middle income Mexicans

(Jiménez-Cruz et al., 2003).

Likewise, in Jordan the national FEL has made it possible to include traditional foods and dishes in the FEL (Bawadi & Al-Sahawneh, 2008) for adherence to a healthy diet; since the country is showing an alarming rise in the incidence of diseases like obesity, diabetes, cardiovascular disease and cancer (Quam, Smith &

Yach, 2006). Several other countries have also expanded FEL with the inclusion of their own traditional foods. Keeping in pace with the rest the Nigerian FEL was developed in 2009, since FEL for local foods of Nigeria was non-existent with the exception of a few studies involving traditional foods (Fadupin, Keshinro & Sule,

2000). Thus making development of FEL mandatory which involved categorizing traditional Nigerian foods (both raw and cooked) into their respective food groups besides standardizing recipes and making them part of the FEL (Fadupin, 2009).

Similarly, the development of Malian FEL in 2009 also included TDs in their FEL for better dietary management of diabetics with an ethnic background of Mali, Africa

(Coulibaly, O’Brien & Galibois, 2009). 32 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

The FEL have been developed and modified for use with varying ethnic relevance, yet non-existent data is available for the Pakistani cuisine. The only related study was conducted by Khan and her co workers (Khan, Kalsoom & Khan, 2015) which concentrated on the nutrient composition of just chapatti as it is presented as part of the fundamental course with each Pakistani meal. This staple food was evaluated for size and comparing weight with the goal that it could be put together as a component of FEL. The research reasoned that a chapatti small in size (15 centimeters crosswise over with a thickness of 4 millimeters) contains 37.5 grams carbohydrates which is equal to 2.5 carbohydrate exchange; whereas a medium sized chapatti with 19 centimeters diameter and a thickness of 4 millimeters contributes 4 carbohydrate exchanges with 56 grams of carbohydrates; and a large chapatti (24 centimeters diameter and a thickness of 4 millimeters) yields 75grams carbohydrates while contributing 5 carbohydrate exchanges (Khan, Kalsoom & Khan, 2015).

Despite being a staple food item the thickness and weight of a chapatti has not been standardized in Pakistan. Differences exist in thickness and weight of a chapatti across the ethnic variations exiting in the country which may lead to varying nutrient content and consequently the number of exchanges. Similarly, a homemade chapatti and a sourdough pitta bread (khamiri roti) may appear interchangeable as breads but may vary in their fat and salt content significantly even for the same portion size and weight. Thus research to establish a culturally relevant FEL is the first step for effective meal planning in a country like Pakistan.

2.7 Food Exchange List and Dietary Management

The relationship of diet with chronic non-communicable diseases (NCDs) cannot be over emphasized especially those that are taking the form of epidemics. 33 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

These include obesity, diabetes, hypertension, cardiovascular diseases and certain types of cancers. (Komesaroff & Thomas, 2007). According to statistical projections, by 2020, percentages of NCDs will double representing 75% of deaths worldwide.

Out of this 75%, ischemic heart disease (IHD) will be responsible for 71% deaths while stroke and diabetes will be a cause of death for 75% and 70% of the population living in developing countries (WHO, 1998). In 2000, the World Health Assembly emphasized on the necessity of promoting healthful dietary intake to lower the risk of

NCDs. This was part of the determination approved in 1992 amid the International

Conference on Nutrition which focused on healthy dietary intake and lifestyles to fight against NCDs (WHO, 1992). Thus, FAO/WHO initiated the development of

“food based dietary guidelines” with scientific backing to combat public health issues related to diet and disease (Vorster, Love & Browne, 2001).

Review of the current literature related to diet and disease has highlighted a link between dietary intake, health and disease focusing on the overall consumption of food intake rather than a single nutrient as free-living individuals consume a variety of food providing them with a whole array of nutrients (Kant, 2004).

Therefore, dietary interventions should be focused on a balance intake of macro and micro-nutrients by promoting healthy food option (Johnson-Down & Egeland, 2010).

Different dietary systems and plans have been utilized for managing NCDs especially diabetes mellitus, these include FEL and the calorie-controlled diets (Keller,

Wackernagel, Messer & Riesen, 1991) which can effectively reduce A1C by 1% in type 1 diabetics and 1–2% in type 2 diabetics depending on the duration of dietary adherence (Pastor, Warshaw, Daly, Franz & Kulkarni, 2002). 34 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

The, FEL devised in 1950 (Caso, 1950) for meal planning of diabetics is still the most effective tool for dietary management of diabetes and since then has been revised five times to keep up with the latest researches and advancements on the relationship of food and nutrition with health (ADA, 2008). This FEL has also been used as an effective tool for dietary management of diabetics especially those with co-morbidities like cardiovascular diseases (CVD) (Geil, 2008).

Dietary fat intake has a direct impact on prevention and progression of NCDs like diabetes, cardiovascular disease, obesity, natural killer (NK) cell activity and many others. FEL focusing on the fat intake was thus developed. This” Fat Portion

Exchange System” enlisted a long list of foods that were grouped in accordance to the type of fat and portion size. One exchange on the list or fat portion was equivalent to

5 grams of fat and an individual fat intake could be calculated according to the daily energy requirements (Boyar & Loughridge, 1985). Literature also supports the relationship of fat intake with NK cells activity in humans and emphasizes that a low or reduced intake of fat in the diet is inversely related to NK cell activity, that is, a reduction in fat intake will positively affect the health of the individual by an increase in the NK cell activity (Barone, Hebert & Reddy, 1989). Similarly fat type is also correlated with the activity of NK cells and animal studies maintain that an increase of 20% to50 % is recorded on low fat and menhaden fish oil containing both

“Docosahexaenoic Acid (DHA) and Eicosapentaenoic Acid (EPA)” (Yaqoob,

Newsholme, & Calder, 1994).

A shift of interest from the overall fat intake was observed with the Lyon Diet

Heart Study which provided significant evidence that Mediterranean dietary pattern provided a protective effect for patients with cardio vascular disease even after 4 35 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES years of first myocardial infarction (De Lorgeril et al., 1999). The two distinguishing features of Mediterranean Diet include a moderate intake of protein and high intake of both vegetables and monounsaturated fats. Thus, the Mediterranean diet is not only tasteful and flavorful but also provides variety making it a Food Model that is easy to follow while maintaining a healthy dietary intake (Altomare et al., 2013).

Compliance to Mediterranean diet pattern is attainable through counseling as a six months clinical trial has indicated an increase of 4 servings of fruits, 8.6 servings of vegetables along with an increase of 48% in dietary intake of monounsaturated fat

(Djuric et al., 2008). Moreover, other interventional trials also ended with the agreement that Mediterranean FEL is a helpful dietary instrument which could be used for improving the quality of diet aimed at accomplishing positive health outcomes (Sidahmed et al., 2014).

Excessive consumption of sodium in a daily dietary routine has been related to high risk of hypertension. Nevertheless, Korean cuisine is known for its high salt content and on an average a Korean adult consumes three folds more salt than the

Dietary Reference Intake (DRIs). The adequacy of the FEL was assessed while planning a weekly menu for hypertensive patients with low sodium intake and it was concluded that the use of FEL was more practical and efficient than using FCT.

Consequently, clinical nutritionist and dietitians use FEL more effectively for dietary management of hypertensive patients on sodium restricted diets (Kwon et al., 2010).

FEL was also designed for special dietary conditions and medically compromised individuals like the Renal FEL was formed for American with ethnic background of Southeast Asia. This FEL listed categorized food based on the potassium, protein and energy content, while phosphorus quantities were listed 36 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES separately. This special FEL did not take into consideration the carbohydrate, dairy and fat groups. Nevertheless this Renal FEL was still useful for diet practitioners in planning dietary interventions for renal patients (Ziegler, Sucher & Downes, 1989).

Another similar individualized FEL for renal patients in South Africa was formulated covering progressive degenerative levels of Chronic Kidney Disease (CKD) which took into consideration common dietary practices of South Africans and other distinctive secular groups residing there. The portion sizes or exchange was based on protein quantity of the particular food (Herselman & Esau, 2005). The FEL showed up gradation through the years and Renal FEL was developed for patients living in

Cape Town, South Africa. This South African Renal exchange list included traditional foods for achieving better compliance of dietary restriction for South

African patients (Ameh, Cilliers & Okpechi, 2016).

Medical Nutrition Therapy is important for treating and managing metabolic syndromes like maple syrup urine disease (MSUD) and Phenylketonuria (PKU) in which protein metabolism is involved and to avoid neurological defects and delays, dietary intervention very early in life are mandatory. Utilization of the typical FEL for the dietary management of MSUD and PKU demonstrated confinement as it had cultural limitations, so FEL was modified by adding local foods to the list so that it could be used by the Central American population (Jiménez, 1993).

Thus FELs are developed to help educate people in adopting healthy eating practices (Kersting, Alexy & Clausen, 2005). The significant feature of these FEL lies in giving individuals choices while maintaining an adequate caloric intake (Stampfer,

Frank, Jo Ann, Eric & Walter, 2000).

37 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

2.8 Food Exchange List: An Effective Tool for Meal Planning

Nutrition education that aims to improve nutrition knowledge, attitudes and dietary behaviors can be facilitated by using appropriate tool like Food Based Dietary

Guidelines on individual and/or community level (Love et al., 2001). Emphasis is thus laid on the conversion of these dietary recommendations into a more precise tool that could measure the macro-nutrient and energy content of the diet. However, to determine the nutrient adequacy of any food based dietary guidelines, exact menus and food amounts are a requirement (Kersting, Alexy & Clausen, 2005). Designing meals in appropriation to the health status of the individual requires understanding of the FEL and its application. A proper understanding of the FEL by clinical nutritionists and healthcare professionals is therefore important for the formulation of a tailor-made diet plan for an individual. Specific steps have thus been outlined for this purpose which may help both in meal planning and nutrition education (Holler,

1991).

FEL has been found very useful in providing food choices for diabetics

(Cabot, 1971) and for this purpose the applicability of FEL formulated by ADA was assessed with patients of diabetes mellitus Type 2. The diabetic patients were served four different menus for breakfast in a clinical trial conducted by Nuttall and his co- fellows and each option of breakfast had the same amounts of macronutrients. The results showed that all the four options were equally effective in controlling blood glucose levels of patients (Nuttall, Mooradian, DeMarais & Parker, 1983). FEL is also be used effectively for counseling and dietary management of patients as part of

MNT (Kuroda & Matsuhisa, 2012). 38 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Dietary Tools are always reassessed and modified as per the need of the hour throughout the world. Keeping at pace with the current developments the Korean FEL was updated in 2001 as it was thought that the prevailing FEL was complicated and impractical to use even by dietitians (Lee & Roh, 2001). Moreover, the effectiveness of the Korean FEL was assessed by comparing it with “Bowl-Based” meal planning tool used for the Korean diabetic patients. The results showed no significant difference between the two tools both in terms of understanding and compliance (Ahn et al., 2009). The FEL can only be effective if it is culturally sensitive and the nutritional composition, especially macro-nutrient content, of foods that are available locally in any society are available. Accessibility of such information may help overcome malnutrition; both under nutrition and over nutrition, especially in communities with limited resources (Bryce, Coitinho, Darnton-Hill, Pelletier, &

Pinstrup-Andersen 2008).

The foundation and keystone in the treatment and management of non- communicable and chronic disease is dietary modification and FEL has shown to be a

“user-friendly” tool both to inculcate healthy food choices and manage disease conditions with nutrient and energy restriction/modification diet plans. Thus, every nation and country should develop their own FEL according to their own traditional and cultural values and norms revising it continuously in order to keep up with recent developments. FEL provides extensive information regarding various food items and their placement in different groups in accordance to the nutrient content and corresponding serving sizes. This information not only helps in planning “customized meals” for individuals but also facilitates masses to make healthful food selection and choices. FEL is also used as an effective tool in MNT by helping in weight management, maintaining lipid profile and plasma glucose levels and combating 39 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES many diet related diseases and their reoccurrences. Ethnically relevant studies sets the basis for new developments and further research needs to be carried out in regions where culture plays a very important role in behaviors and personal choices. The studies which highlight locally relevant issues have the benefit of greater acceptance, better chance of being implemented with success, thus aiding in eliminate existing health issues and this is the aim of the current study to develop a FEL for better health of people.

40 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

CHAPTER 3

METHODOLOGY

This chapter depicts the methods used for data collection in the current study and presents an overview of the research process. A mixed method approach was chosen to address the objectives. The first objective, that is, to identify the most common TPDs along with their recipes was addressed using qualitative method. The second and third objectives were approached by means of quantitative data collection and analysis. This entailed recipe evaluation through preparation of the selected TPDs for the purpose of quantification of ingredients and estimation of the macro-nutrient content through proximate analysis. The last three objectives were specifically achieved through triangulation which focused at categorizing TPDs into their respective food group; befitting the serving size of the TPDs as an exchange unit and development of the MPEL for TPDs.

3.1 Research Design

Mixed method sequential exploratory research design was employed for the current study as mixed method approach uses both qualitative and quantitative data to answer research questions in as single study (Mertens, 2005:292). Conducting a mix method study is complex as it uses both types of information (qualitative & quantitative) in a single research project either to collect or analyze data (Cameron,

2009). Many topologies for the mixed method studies have been developed by theorists for “cross-classifying or combining two or more simple concepts to form a set of interrelated subtypes” (Neuman, 2006: 55). Different approaches for data collection are thus identified but most frequently used includes parallel and sequential 41 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

(Teddlie & Tashakkori, 2003). Parallel approach collects and analyzes both qualitative and quantitative data at the same point in time within a single phase; whereas in the sequential method, qualitative data collected in the first phase forms the base of the quantitative second phase (Creswell & Plano Clark, 2011). The present research employs sequential mix method as the first phase provided the baseline data on which the second phase was build (Creswell, Plano Clark, Gutmann,

Hanson, 2003; Morse, 2003). This type of study design is usually employed when the aim is to develop an instrument with unknown variables and for this reason it is noted as the “instrument development design” (Creswell, Fetters & Ivankova 2004) or the

“quantitative follow-up design” (Morgan, 1998). This use of qualitative and quantitative data in a single study has led the way to “triangulation” as a means of combining both types of data for convergence of results. Thus, the use of

“triangulation” has become an accepted practice in the field of social sciences

(Yeasmin & Rahman, 2012).

Phase II Quantitative

• Focus group • Preparation of • Theoretical discussion dishes • Proximate Phase I analysis Phase III Qualitative Triangulation

Figure: 3.1. Mixed method sequential exploratory research design 42 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

The study employed the mixed method sequential exploratory research design which involved the use of Qualitative and Quantitative Strands of study followed by

“triangulation” for computing of results. The layout of the study is shown in a stepwise manner in Figure: 3.1. First phase consisted of collecting qualitative data which was done through focus groups while the second phase of data collection was quantitative which involved preparation and proximate analysis of macro-nutrients of the prepared TPDs. The third phase incorporated both qualitative and quantitative data through “theoretical triangulation” for development of the MPEL for TPDs.

The conceptual framework of the study was also developed since it attained addressing six objectives. The flow diagram is depicted in Figure 3.2, which illustrates how the objectives were achieved through the use of both “qualitative and quantitative” methods of data collection.

43 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Flow Chart

Objectives

N=440

Sampling Criteria n=412 Population: Pakistan Sample City: Lahore Number of Towns: 9 Union Councils Selected: 18 Focus Groups: 18 FG=18

1. To identify most common TPDs along with their recipes. Dishes Identified: 53 Dish Selection Criteria Frequency distribution: no. of occurrence Relative distribution: f of dishes / Dishes n of FGD 2. To evaluate the recipes through Selected: 30 Percentage Distribution: > 60% quantifying the amount of

ingredients in the TPDs

Dishes 3. To estimate the amount of Preparation macro-nutrient content of the Sensory Evaluation for prepared TPDs through Consumer Acceptability proximate analysis. 9 Point Hedonic Scale Consumer Acceptability Proximate Assessors =30-34 members Analysis/100 g Experiments: 450 4. To categorize TPDs into their representative food groups

5.To befit serving size of TPDs in the exchange system. Triangulation Qualitative + 6. To develop a MPEL for TPDs. Quantitative Data

Figure 3.2. Flow diagram showing conceptual framework of the study 44 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

3.2. Phase I

The first step of this research was exploratory which aimed at identifying the most commonly consumed TPDs at home along with its recipe. Focus group was the choice means for collection of the qualitative data as it has been used extensively for exploring eating behavior (Hargreaves, Schlundt & Buchowski, 2002) and studying personal and contextual factors that affect food choices (Neumark-Sztainer, Story,

Perry & Casey, 1999). Criterion based selection was done using multi-stage random sampling for selection of the focus group participants.

3.2.1 Sampling Frame

3.2.1.1 Study Population. Lahore is a metropolitan and second largest city of

Pakistan besides being the capital of the largest province Punjab in terms of population. Lahore is the cultural heart of Pakistan as it hosts most of the educational institutions along with arts, cuisine, festivals, music, film-making, gardening and intelligentsia of the country.

According to last Population and Housing Census Report, 1998 (Population

Census of Pakistan, 1998), Lahore District had a population of 6319 thousand persons with a population projection of 8922 thousand persons as on 30th June, 2012 by the

Punjab Government (Punjab Development Statistics, 2013). The mean household size is calculated as 6.1 persons per household (Pakistan Social & Living Standards

Measurement Survey: 2011-12, 2013), and thus Lahore comprises of approximately

1462623 households. Administratively, Lahore district is divided into 9 towns and these towns are further divided into 146 Union Councils (UCs) which became the primary sampling unit for the study. 45 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

3.2.1.2 Sampling. The primary sampling unit for the current study was UCs; while randomly (Fish Bowl technique) selected household were the basic sampling unit; whereas the person doing the cooking and befitting the selection criteria was selected for the FGD.

3.2.1.2.1 Sample size calculation. The number or percentage of households cooking their meal completely at home is not known; a prevalence rate of 50% was taken so as to get an appropriate sample size which would yield statistically acceptable results.

Sample size was calculated using the following formula:

n= sample size (when population is more than 10,000) N= total number of households in Lahore = 1462623 P= prevalence = 50% = 0.5 Z= 95% confidence interval = 1.96 Margin of error (e) = 0.05

n=384

Non response was estimated at 15%; therefore, a total of 440 household were included in the study.

3.3 Sampling Procedure

Multi stage random sampling frame was used to select the sample for this component of the study as the technique is comprehensive and more representative of 46 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES the population (Singh, 2006). Random sampling is the best known probability sampling technique where every element in a given population has an equal chance of being selected (Bailey, 1994), thus eliminating the risk of selection bias (Frey, Carl &

Gary 2000). First stage of sampling procedure encompassed the use of simple random sampling using Fish Bowl technique (Teddlie & Yu, 2007) for selecting two UCs from each administrative town as a primary sampling unit. Complete list of towns and

UCs was obtained from the internet as it was important to identify all elements in the population with a certain number or name (Latham, 2007) for using Fish Bowl technique of random sampling. 18 union councils were selected through this technique which became part of the study representing 9 administrative towns of

Lahore. List of selected union councils for the study is attached as Appendix D. One focus group discussion was carried out from each of the selected union council.

Second step of sampling involved household selection as the basic sampling unit for inclusion in the focus group. The number of the household representing each union council was obtained by dividing the total number of the sample with the selected primary sampling unit.

Number of households = Total number of sample size Selected number of UC

= 440 households 18UC

= 24 households per UC

The Counselors from the selected UCs were approached with the request of facilitating data collection for this component of the research. The purpose of the study was explained to the Counselors and all of them extended their support. A list 47 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES of households was obtained from each of the 18 UCs selected and the Counselor was requested to randomly select 24 households from his UC using Fish Bowl technique.

A quick household survey based on the elimination criteria was conducted for these households. The aim of the study was briefed to the female head of the family and one focus person based on the inclusion criteria was selected from each household who agreed to be part of the study. A tentative date for focus group discussion was also shared and telephone numbers were exchanged at this point for follow-up. The date for the focus group discussion was finalized through constant telephonic conversation with all the members of the focus group so that all agree on a mutual date and time. The UC office was selected for conducting focus group discussion and after finalization of the focus group date and time, invitation cards

(Appendix E) were posted to all the members of the focus group. Two days prior to the focus group the researcher visited all the members of the focus group for a reminder and a consent form (Appendix F) was signed at this point.

18 structured focus group discussions were held for 24 housewives (in one focus group) who cooked for their families to ascertain the most commonly used

TPDs in Pakistan.

3.4 Focus Group

The purpose of conducting a focus group discussion for this part of research was to provide participants an environment which would be inductive to expression of opinion (Krueger & Casey, 2000) while discussing various TPDs along with its recipes. Conventionally, focus group research is “a way of collecting qualitative data, which—essentially—involves engaging a small number of people in an informal 48 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES group discussion (or discussions), ‘focused’ around a particular topic or set of issues”

(Wilkinson, 2004, p. 177).

Standard protocol for conducting a focus group was followed (focus group discussion guide and checklist is provided as Appendix G and H).

Questions were carefully designed so as to address the context, process and evaluation (Thomas, 2003).

1. Context: Probing questions were asked to the group members (Lee, 2011) to

identify the most commonly made TPDs at home.

2. Process: Members were prompted (Wearing, 2001) to explain how the various

dishes that were identified prepared so they one generalized recipe could be

drawn upon.

3. Evaluation: Short evaluative questions and probes were used (Huang & Hsu,

2009) as follow-up questions while discussing the different recipes for the

identified TPDs including traditional combination dishes.

Three main questions were formulated in such a way so as to derive the required information from the participants which include identification of the most commonly cooked dishes in the household; amount of dry ingredients required for preparation of the dishes along with a common recipe. The focus group question guide is attached as Appendix I.

Generally a group of 6 to 10 participants are considered apposite for a focus group but Morgan (1997) emphasizes that the number can be smaller or larger depending on the culture, norms and objectives of the study. Comprehensive review of focus group sample size revealed that the number of participants may vary from 3 49 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES to 279 participants with a minimum range of 1 to 13 and the maximum number of 3 to 20 participants in a group (Carlsen & Glenton, 2011); while focus group comprising of 10 to 23 (Braithwaite et al., 2004) and up to 31 participants have also been reported (Gloet, 2002).

A total of 24 housewives were approached for one focus group in the current study as the researcher felt that a smaller group may present too many variations whereas a number of 24 would be appropriate to handle and the opinion can be generalized.

3.4.1 Qualitative Respondent Criteria

The recruitment criterion for inclusion in the focus group was:

1. Female responsible for routine cooking within her household.

2. Female able to cook TPDs independently for her family.

3. Female who’s routine cooking involves cooking for at least 4-6 persons at one

time.

3.5 Procedure

A total of 18 focus groups were conducted within a time span of approximately five months starting from 10th May, 2014 to 4th October, 2014. 24 housewives were invited for each focus group on tea at the union council’s office arranged by the researcher and as mentioned earlier consent form was signed prior to the meeting of the focus group.

The focus group started with a brief introduction of the researcher and the assistant moderator who helped the researcher in pen-recording of the responses.

After a brief informal introduction of all the participants in the focus group, the 50 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES purpose of the focus group was re-emphasized while identifying the objectives of the study.

440 housewives were invited to be part of 18 focus groups in the current study; the number of the invitees was 10% higher than the required sample size of

400 participants, so as to take into account any unavailability of the participant on the day of focus group. 24 housewives were invited for each focus group, but the number of the participants varied from 19 to 24 housewives amongst various focus group. The age of the participants varied from early twenties to late fifties but no difficulty was encountered in developing a rapport within the group and all the participants actively participated in the session. However, care was taken by the researcher to avoid a certain order in asking questions, for example, from left to right or from right to left, rather questions were asked randomly and everyone felt free to participate. The time duration of each focus group varied from 60 minutes to 75 minutes amongst different groups. The discussion ended with serving of tea. The whole session lasted approximately 90 minutes. Based on the researcher’s observation, most participants enjoyed the focus group and were in general conversation during tea realizing that they have common interest to share and left with exchange of phone numbers within the members of the focus group and also the researcher.

3.6 Qualitative Content Analysis of Phase I

3.6.1 Constant Comparison Analysis

Qualitative data was analyzed by constant comparison analysis using basic forms of interpreting as defined by Mayring (2003). Three forms include ‘summary’ meaning reduction of data; ‘explication’ by finding further material and ‘structuring’ 51 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES meaning filtering important aspects from the data (p.58) was identified. The present study incorporated both structuring and filtering the relevant content out of the whole by grouping them into specific categories. Themes and patterns within the data were identified through highlighting similarity and differences across data sets (Braun &

Clarke, 2006). The categories were developed in an inductive manner as it seemed most appropriate for this exploratory part of the research design. Inductive content analysis has been used extensively in social science research which involves studies of the environment and its inter action amongst individuals (Juvani, Isola & Kyngäs,

2005) and support networks that come together for various purposes (Kyngas, 2004).

3.6.1.1 Category or theme construction. Theme construction was based on coding, grouping data in categories and abstraction to draw out the general explanation of the research topic (Elo & Kyngas, 2008). Categories or themes were developed in the current study by identifying the most recurrent or repetitive terms

(Ryan & Bernard, 2000) as initial or open coding while going through the qualitative data; categories were freely generated at this point (Burnard, 1991). After the initial coding the data was grouped together to reduce the number of categories as focused coding. Each category was initialed using the characteristic content word and sub- categories were generated from within to further explicate the content (Dey, 2003).

In the current study the technique used to identify the TPDs was initial coding; while focused coding was employed to depict the commonly used recipe for the said dishes.

52 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

3.6.2 Classical Content Analysis

Qualitative content analysis was carried out using the systematic approach by

Mayring (2007). The basic frequency analysis was used which is the simplest method

of classical content analysis; in this method the count of certain elements in the

context is identified and compared with their frequency of occurrence in relation to

other elements (Mayring 2014). The technique is frequently used both in medical

(Crystal et al., 2000) and social sciences (Tumasjan, Sprenger, Sandner & Welpe,

2010). Similarly, this technique was used to draw out the most commonly used TPDs

using the following formulas.

Frequency distribution: The dishes identified were listed in a tabular format and the

number of occurrence of each dish was entered.

Relative frequency: ____Frequency of the dishes identified____ Total number of participants of focus group

Percentage frequency: Relative frequency x 100%

3.7 Phase II

3.7.1 Selection of Dishes

Percentage frequency of 60 was used as the cut-off line to identify the most commonly cooked dishes. These selected dishes were then used as a base for developing the MPEL for TPDs.

This phase was quantitative and analytic using following steps: 53 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

3.7.1.1 Recipe Verification. Difference which may occur in the ingredients and preparation of the dish amongst the recipe of the participants was minimized by the use of the following protocol. Common recipe derived from each focus group

(total of 18 groups) was used for preparation of the selected dish. Variation between recipes regarding the main component in a dish selected was minimized by asking the housewives to provide the recipe with the given amount of the main component. For example, the housewives were asked to note down the recipe of Murgh Korma

(Chicken Curry) using1kilogram chicken meat.

The quantity of each ingredient in the given recipe was averaged (sum of the total amount of each ingredient divided by the number of recipes provided) (Bawadi

& Al-Sahawneh, 2008). Each ingredient in the recipe was then documented in both kitchen measures i.e. cups and spoons; and standard weights and measurement like grams and milliliters etc.

3.7.1.2 Preparation of the Selected Dishes. All the selected dishes were prepared by the researcher in the Food Laboratory of The Department of Food

Science and Human Nutrition, Kinnaird College for Women, Lahore. The purpose of preparing the selected dishes was to quantify the recipes for accurate weight of the raw/uncooked ingredients and the net weight of the prepared dish. The following sets of rules were followed for preparation of the dishes:

1. All the solid ingredients were weighed using the “Arshia” weighing scale. The

no error was adjusted with the bowl.

2. Liquid ingredients were measured with calibrated measuring cups and spoons.

3. Powder ingredients like spices were measured using measuring spoons. 54 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

4. The net weight of the dish was obtained by subtracting the weight of the

empty cooking utensil (W1) from the weight of the cooked food in the

cooking utensil (W2) (Fadupin, 2009).

Weight of the cooked food = W2 –W1

3.7.1.3 Sensory Evaluation for Consumer Acceptability. Sensory evaluation methods are used to identify the sensory properties of food and to interpret them in terms of human responses and acceptability (Lawless & Heymann, 2010).

Various methods are used to determine the acceptability (liking or disliking) of food and food products but the most commonly used scale to measure acceptance is the 9- point Hedonic scale. This scale was developed by Peryam and Girardot in 1952 at the

Quartermaster Food and Container Institute of the U.S. Armed Forces with the purpose of determining food preferences and acceptability amongst of soldiers and is still the most widely used measure for consumer acceptability by the food industry.

The 9-point Hedonic scale is readily used for determining consumer choice and acceptability of cooked dishes (Resurreccion, 2004) including tenderness and flavor of meat dishes (Platter et al., 2003).

Similarly, a 9-point Hedonic scale was used in the current study to determine the acceptability of prepared Traditional Pakistani Dishes as this scale quantifies the consumer perception of food both in terms of numerical and consumer perception

(Tuorila et al., 2008). The 9 point Hedonic scale denoted 9 as Like Extremely and 1 as Dislike Extremely (Appendix J).

3.7.1.4 Consumer Acceptability Assessors (CAAs). Consumer acceptability test was conducted in the Demonstration room adjacent to the Food Laboratory of 55 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

The Department of Food Science and Human Nutrition, Kinnaird College for

Women, Lahore. The CAAs were from the faculty of Kinnaird College for Women,

Lahore. The faculty members were briefed about the purpose of the research and the acceptance test was explained to them. 37 members agreed to participate in the study; however, the availability of the CAAs varied from 30 to 34 for different dishes.

Similar protocols have been used for consumer acceptability of cooked dishes like

Sabalito pigeon pea stew (Jiménez-Cruz, 2013) and beef steak (Miller, Huffman,

Gilbert, Hamman & Ramsey, 1995).

3.7.2 Proximate Nutrient Analysis

The nutrient analysis was carried out on the prepared dishes after consumer acceptability. Proximate analysis for macro-nutrients comprised of 450 experiments which were carried out on 30 prepared TPDs. Each experiment was repeated 3 times for validity. Methods stated in AOAC, (2006) were used with slight modification according to the sample requirement. Moisture, fiber and ash content were also estimated besides protein and fat as the carbohydrate content in the prepared dishes was determined “by difference” (AOAC, 2006a). The specific method used is schematically represented in figure 3.3. The analyses were conducted by the researcher in the Central Science Laboratory of Kinnaird College for Women,

Lahore.

3.7. 2.1 Preparation of the Sample. Sample was taken from the prepared dish (3Dbulk population). Since direct sampling of 3D population was not possible, therefore the bulk was converted into 2D and homogenized. The homogenization was done using Kenwood, “Multipro Sense Food Processor FPM800” at speed 2 and 3 for one minute or till the time the sample was mixed completely and presented as a paste. 56 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Homogenization was done to reduce the weight and size of the prepared TPDs so as to obtain a representative subsample from the whole. The sample was divided randomly into target segments in time such that any part of the bulk has an equal probability of scrutiny. Three test samples were taken from each prepared dish for proximate analysis. The moisture content of the sample was taken immediately so as to prevent any loss or addition of moisture from the atmosphere. The rest of the samples were coded and refrigerated at -20º Celsius in air-tight containers for further analysis (Curren & King 2002).

Sample

Moisture (AOAC–934-01) Digestion (H2SO4)

Protein: Kjeldahl method Distillation (Conc.NaOH) N x6.25 (AOAC–984-13) Titration (0.1N HCl)

Lipids: Soxhlet method (AOAC–920-39 )

Carbohydrate:% by difference Fiber Ash 100-%moisture+%ash+ (AOAC--978-10 ) AOAC-942-05 %protein+%lipid+%fiber

Figure 3.3. Proximate Analysis using AOAC 2006

3.7.3 Procedure for proximate analysis

Samples were analyzed with slight variations for moisture, ash content, crude protein, crude fat and crude fiber according to their respective methods as described in AOAC (2006) while carbohydrate was determined by difference (AOAC, 2006a).

All the tests were carried out in triplicates. Principle of each method is briefly described as follows: 57 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

3.7.3.1 Moisture Content. The moisture content of samples was estimated by drying the sample in hot air oven (Model: UNB-200 Memmert, Germany) at a temperature of 105± 5 °C for constant weight, that is, the time after which no loss in weight is achieved (Method No. 934.01 AOAC, 2006). The loss in weight is expressed as:

Moisture (%) = Initial Weight – Final Weight x 100 Initial Weight

3.7.3.2 Crude Protein. Crude protein content was determined in term of nitrogen percentage by using Kjeldahl (Model: InKjel 1225 M Behr, Germany) method as described in AOAC (2006) Method No. 984.13. Accordingly, “samples were digested with concentrated H2SO4 by using digestion mixture

(K2SO4:FeSO4:CuSO4 i.e. 100:5:10) until the color was light greenish”. The digested material was “diluted up to 250ml in volumetric flask. 10ml of 40% NaOH as well as

10ml of digested sample was taken in distillation apparatus where liberated ammonia was collected in beaker containing 4% boric acid solution using methyl red as an indicator”. This resulted in formation of ammonium borate that was used for nitrogen determination in sample. Thus “percentage of nitrogen in samples was assessed by titrating distillate against 0.1N H2SO4 solution till color was light golden”. “Crude protein content was estimated by multiplying nitrogen percent (N %) with factor

(6.25)”.

[ N (%) = Vol. of 0.1N H2SO4 x 0.0014x Vol. of dilution (250ml) x 100] [Vol. of distillate taken x Weight of sample]

Crude protein (%) = Nitrogen (%) x 6.25 58 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

3.7.3.3 Crude Fat. The crude fat content in samples was calculated following guidelines of Method No. 920.39 in AOAC (2006). Dried sample (3 grams) was refluxed in soxhlet apparatus (Model: DH, WHM 12395 WITEC, Germany) using diethyl ether as a solvent.

[% Crude fat = Weight of flask with extracted fat - Weight of empty flask x 100] [Weight of Sample]

3.7.3.4 Crude Fiber. The crude fiber was calculated by following the Method

No. 978.10 outlined in AOAC (2006). Fat free sample was digested with 1.25%

H2SO4 followed by 1.25% NaOH solution in Fibertech (Labconco Corporation

Kansas, USA). After filtration and washing with distilled water reaming residues was weighed and ignited in muffle furnace at temperature of 550-650 °C till grey or white ash was obtained. The crude fiber percentage was estimated according to the expression given below.

Crude fiber (%) = Weight loss on ignition (g) x 100 Weight of sample (g)

3.7.3.5 Total Ash. The ash content was estimated by direct incineration of sample according to AOAC (2006) Method No. 942.05. Sample (5 grams) was ignited in muffle furnace (Model: L5/12/B170 Nabertherm, Germany) at 550-600 ºC for 5-6 hours or until grayish white residues were obtained.

Ash (%) = Weight of ash x 100 Weight of Sample

3.7.3.6 Carbohydrate by Difference.Carbohydrate in food is classically determined “by difference” after ascertaining the contentment of other food 59 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES component (AOAC, 2006a). The carbohydrate content of samples was calculated according to the following equation:

Carbohydrate (%) = 100 – (% moisture + % ash + % crude fat + %crude fiber +

% crude protein)

3.8 Quantitative Data Analysis of Phase II

3.8.1 Consumer Acceptability of Traditional Pakistani Dishes

Sensory evaluation of the prepared TPDs was done for the overall acceptability of the recipe on a 9-point hedonic scale where 9 was for like extremely and 1 rated dislike extremely. A cut off point of 5 was used in this study where 5 was considered neutral (neither like or dislike); 1-4 was rated as dislike (unacceptable) and 6-9 was judged as acceptable (like). The results are presented as mean consumer hedonic score and percentage of acceptability through the following formula:

Consumers’ Hedonic Score: Data was presented in tabular form with frequency of the hedonic score sited under the hedonic scale point.

Mean Consumers’ Hedonic Score: Frequency of Consumer Score on HS x HS Score Total number of consumers

Percentage of Consumer Acceptability: Mean Consumer Score on HS____x100 Maximum number of HS Score (9)

HS = Hedonic Scale

3.8.2 Proximate Analysis

All experiments for proximate analysis were carried out in three replicates, mean and standard deviation was calculated using Microsoft office excel and presented in tabular form. 60 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

3.9 Phase III

3.9.1Triangulation

The MPEL for TPDs was formulated using both qualitative and quantitative

data results through the process of triangulation. “Triangulation” uses the “laws of

trigonometry” where two sides of a triangle are known and the third could be

calculated (Yeasmin & Rahman, 2012). Four different approaches have been

articulated for “triangulation” by Denzin (1978) and Patton (1999) which involves

using data, method, theoretical and analyst or investigators approach for interpretation

of qualitative or mix method studies. “Theoretical triangulation” was applied in the

current study as a fitting method since facts in theory were used for the final

interpretation of results (Rennie, Venville & Wallace, 2010) for formulation of the

MPEL for TPDs. The layout of the study is presented in figure 3.4.

Qualitative Data Proposal Development

Focus Group

Data Analysis Qualitative Study Quantitative Data Experimentation Results

Triangulation

Quantitative Quantitative Data

Study Results Analysis

Figure 3.4 Conceptual Framework- Layout of the Research Process

61 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

3.9.2 Triangulation Procedure

The most commonly used TPDs were identified through analyzing the qualitative data of focus group discussion along with its recipes. The recipes of the

TPDs were then verified and prepared in the Food Science Laboratory of Kinnaird

College for Women, Lahore and the ingredients were quantified during preparation of these dishes. Based on the recipe and ingredients, TPDs were grouped in their relevant food groups (step one).

Next, quantitative data retrieved from proximate analysis of macro-nutrient content of prepared TPDs per 100 grams was used to adjust serving size of each dish per exchange unit of the relevant food group (step two). Finally, the MPEL for TPDs was formulated (step three), by combining the finding of the first two steps, thus completing “triangulation” procedure. The “triangulation” procedure is described below in a stepwise sequence.

3.9.2.1 Step1: Categorization of the Traditional Pakistani Dishes into

Food Groups. The identified TPDs were categorized into their relevant food groups based on the ingredients of the recipe extracted from the qualitative data of the focus group. “Food group framework” is a configuration of food sources that are grouped together according to analogous nutritional and functional properties (Nestle, 2013).

The TPDs were disseminated into basic food groups of beans and lentils, cereal, dairy, meat (lean & medium fat) and vegetables (starchy & non-starchy).

3.9.2.2 Step 2: Befitting the Serving Size of Traditional Pakistani Dishes in the Food Exchange System. Proximate analysis of prepared TPDs revealed the macro-nutrient content of the dishes per 100 grams of the sample. Varying serving sizes were calculated accordingly so as to put together the TPDs in such a way that 62 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES one dish could be exchanged or swapped with another dish in the amount stated within the same food group.

The food group schema used for the current study is as below:

1. Beans and Lentils

2. Cereals

3. Meat (Lean)

4. Meat (Medium Fat)

5. Vegetables (Non-Starchy)

6. Vegetables (Starchy)

Combinations

7. Meat & Meat Substitute (medium fat ) plus Non-Starchy Vegetables

8. Meat (Medium Fat) plus Starchy Vegetables

9. Meat (Lean & Medium Fat) plus Cereal

3.9.2.3 Step 3: Development of the Meal-Planning Exchange List for Traditional

Pakistani Dishes. The final step grouped the TPDs into their relevant food group according to the macro-nutrient content they contributed per serving. One-way analysis of variance (ANOVA) was used to determine whether there was any significant statistical difference amongst the group for any of the macro-nutrient. p value of ≥ 0.05 would be indicative that there was no significant statistical difference within the group and the mean values of carbohydrate, protein, fat and energy may thus be used as a representative of the group. However, a range was used for the fat content of the last group, namely “Meat (Lean & Medium Fat) plus Cereal” as it combined both lean and medium fat meat choice in one group.

The mean values were rounded off to the nearest tenth. 63 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

3.10 Summary

The study was conducted in three phases and three different techniques of data collection and analysis was employed to answer the research questions. A summary of the research methodology is presented in tabular form as Table 3.1.

64 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Table 3.1 Summary of Research methodology

Objective Research Question Sample/ Participants Data Collection Tools Data Analysis Technique To identify most common TPDs What are the most common Sample Size : 412 participants in Qualitative Data Constant Comparison Analysis along with their recipes. TPDs and how are they cooked? 18 focus groups Focus Group Discussion presented as main themes and Participants: 19-24 housewives sub theme for recipe extraction. in each focus group Classical Content analysis presented as frequency distribution, relative frequency and percentage frequency for identifying common TPDs.

What is the exact quantity of the Sample Size: 30 TPDs were Quantitative Data Sensory Evaluation for To evaluate the recipes through ingredients (in terms of grams identified using a cutoff Recipe verification through consumer acceptability of the quantifying the amount of and measuring cups/spoons) point of 60% preparation of the TPDs and prepared TPDs. The consumers ingredients in TPDs. used for preparation of the prevalence. consumer acceptability by hedonic score are presented as, specific TPDs? sensory evaluation using a 9 mean consumers hedonic score point Hedonic Scale and percentage of consumer acceptability To estimate the amount of What is the quantity of macro- Sample Size: 450 experiments Quantitative Data (Proximate Mean and standard deviation of macro-nutrient (carbohydrates, nutrients in TDs per 100 grams? 15 experiments were Analysis) three replicates was calculated proteins and fats) content of the conducted on each Ash using Microsoft office Excel and prepared TPDs through sample. Crude Fiber presented in tabular form. proximate analysis. Experiments were conducted in 3 Moisture replicates. Protein Fat Carbohydrate (by difference) To categorize TPDs into their What will be the representation Sample Size: 30 TPDs. Results of qualitative data TPDs were disseminated into its representative food groups. of TPDs in terms of food (recipe extraction) was used as basic food groups. groups? part of Triangulation

To befit serving size of TPDs in What will be the exchange unit Sample Size: 30 TPDs. Results of quantitative data Serving size of TPDs was fitted the exchange system. per serving size of the prepared (proximate analysis) was used in the exchange system. TPDs? as part of Triangulation

To develop a MPEL for TPDs. What will be the MPEL for Sample Size: 30 TPDs. Results of qualitative and ANOVA was used to determine TPDs? quantitative data was used no significant statistical through Theoretical difference within the group for Triangulation each macro-nutrient so that mean values could be representative of the group.

65 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

CHAPTER 4

ANALYSIS AND INTERPRETATION OF DATA

The present research was carried out with the main objective of developing a

MPEL for TPDs. The study design was mix method exploratory sequential.

The first phase was conducted for identification of TPDs along with its recipes. Results of the qualitative data retrieved in this phase are presented as themes and sub themes; and are organized as frequency distribution, relative frequency and percentage frequency to answer the first research question of the study. The second phase of the study was quantitative which involved preparation and consumer acceptability of the selected sample of prepared TPDs followed by proximate analysis, consequently answering the second and third research questions. The final stage of the study integrated qualitative and quantitative data by applying “Theoretical

Triangulation” to answer the fourth, fifth and sixth research question of the study that is, categorizing the TPDs into its relevant food group; befitting the serving size of

TPDs in the exchange system and developing a MPEL for TPDs.

The presentation of the results is reported in the following sequence:

Phase I-----Qualitative

Phase II--- Quantitative

Phase III--- Theoretical Triangulation

66 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

4.1 PHASE I Descriptive Results

4.1.1 Identification of Salient Themes from Focus Group Discussion

Focus group was chosen to collect qualitative data for the first part of the study as it allows interaction amongst the participants in a congenial environment, thus enabling them to express their views freely and helping the researcher understand the importance of culture in the type and preparation of food usually served at home.

18 focus groups were conducted over a period of five months starting from10th May,

2014 to 4th October, 2014. A total of 440 housewives were invited out of which 412 participated in 18 focus groups which were conducted to identify the most common

TPDs along with their recipes.

Data from the focus group was analyzed using thematic analysis which involved reading and rereading the transcripts and coding the distinct themes through initial and focused coding. The analysis of the focus group resulted in three main distinctive themes which provided the baseline data on the following areas:

1. Most common TPDs.

2. Cooking method and recipes of the TPDs.

3. Grounds for combining different food groups as one-pot combination dishes.

Results of the focus group are presented in a tabular form as Table 4.1 which highlights the major themes and sub-themes along with the focus group interpretation.

67 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Table 4.1 Salient Themes of Focus Group Discussion

Focus Group Question Major Themes Sub-themes Focus Group Interpretation

Think of TPDs, what comes to your A list of TPDs was generated. mind? All the participants in the focus group stated that they have three meals a day and would generally prepare fresh everyday; everyone also agreed that they enjoyed eating Traditional Pakistani Food and would like their children to develop the same habit. The type of dishes one was familiar with seemed to be the most commonly cooked dishes in the households. New recipes for different dishes were tried out by Frequently most housewives especially due to the availability of different Which TPDs did you cook at home consumed cooking shows and channels, but those dishes were prepared during the last week? TPDs only occasionally and routine cooking still comprised of dishes and recipes the housewives were familiar with. Generally speaking the most frequently cooked TPDs were those that were usually prepared in their in-laws or their own homes before marriage as the participants were familiar with the taste, appearance, aroma and how prepared and served. Familiarity

The likes and dislikes of the family members were given importance while preparing meals. The participating housewives were responsible for deciding the daily menu of Likes & their families and in doing so she would mostly take into Dislikes consideration likes of the head of the family, her children and other members of family. The most frequently cooked dishes in the household would be those she was familiar with and that were liked by all members of the family.

68 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Focus Group Question Major Themes Sub-themes Focus Group Interpretation

The participants of the focus groups commonly used Which TPDs did you cook at home meat including chicken, mutton and beef. When asked during the last week? about the preference majority of the participants preferred chicken while cooking a meat dish alone like Murgh Karahi (Chicken in a Wok), Murgh Handi (Chicken in a Pot) and Murgh Korma (Chicken Curry). Whereas, mutton was preferred for one-pot combination dishes with vegetables (Non-Starchy and Starchy) like Kudu Gosht (Bottle Gourd & Mutton Gravy), Shaljam Gosht (Turnip & Mutton Gravy), Palak Gosht (Spinach & Mutton Gravy) and Familiarity Aloo Gosht (Potato & Mutton Curry). Discussing minced meat, it was seen that most of the participants in the focus Preference for groups preferred mutton over beef and chicken. Mutton Mince type of meat was consumed alone as Bhuna Keema (Stir Fried Mutton Mince) or in combination with Starchy Vegetables like potatoes and peas in the form of Aloo Keema (Potatoes & Mutton Mince) and Matar Keema (Peas & Mutton Mince) respectively. Non-Starchy Vegetables were also used with mutton mince like onions in the form of Keema Pyaaz (Mutton Mince with Onions). Preference for type of meat was also seen with specific combination TDs like chicken was preferred for a TPD Murgh Biryani where boiled rice is layered with chicken gravy in a one-pot dish and mutton was preferred for Yakhni Pulao where rice is cooked in mutton broth along with mutton pieces. Fish was only consumed occasionally and that too was specific to the winter season.

A thick bottom pan is usually used for daily household cooking. First step is always to heat oil followed by the addition of How do you cook food at home? Traditional Base onions which are cooked until translucent. Ginger, garlic paste Method gravy paste and tomatoes are added next and cooked till they become soft and pulpy. All powder spices are added one by one along with a 69 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

small amount of water to transform it into a gravy paste “masala”. Focus Group Question Major Themes Sub-themes Focus Group Interpretation

Major findings were that the most common dishes were those that were easy to prepare and there was always a standard How do you cook food at home? Traditional Convenience method to make the recipe. Moreover, most of the ingredients Method used in those dishes were easily available throughout the year.

A general consensus was seen in the preparation of the TDs. Beans were added to the basic gravy paste made with onions and tomatoes and sautéed for afew, then water was added and Beans beans were cooked till tender. The dishes were served in the form of stew and included Kabuli Chanay ka Salan (Chickpeas Curry) and Kalay Chanay ka Salan (Brown Bengal Chickpeas Curry).

Please share your basic recipe for Daal Mash (White Lentil) and Daal Moong (Petite Yellow vegetables, lentils, beans chicken Lentil) were also seen cooked in a similar manner as that of and combination one-pot dishes beans whereas Saboth Masoor ki Daal (Brown Lentil) was Lentils simply boiled in water with the addition of onions, garlic and Basic recipe spices and finished with the addition of garlic cloves tempered in hot oil.

Vegetables were also cooked in a similar pattern, that is, Vegetables addition of vegetables to the base gravy and cooked in its own juices.

Chicken was usually cooked alone but each traditional dish had a specific recipe with was agreed upon by all of the participants Chicken like Murgh Karahi (Chicken in a Wok ) was made with the addition of tomatoes, Murgh Handi (Chicken in a Pot) included yogurt in its recipe while Murgh Korma (Chicken Curry) was made in a gravy of both onions, tomatoes and yogurt.

70 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Focus Group Question Major Themes Sub-themes Focus Group Interpretation

A common consensus was also seen in the cooking method of Please share your basic recipe for one-pot combination dishes. These dishes usually comprise of vegetables, lentils, beans chicken Basic recipe mutton and vegetables cooked in a traditionally set pattern. and combination one-pot dishes. One-pot Mutton is sautéed in oil with onions and ginger garlic paste, combination tomatoes and spices are added next and further cooked for five dishes minutes, water is added to meat and cooked till tender; remaining water is dried and vegetables are added and cooked till done and finished accordingly as gravy like Shaljam Gosht (Turnips &Mutton Gravy) or as a stew like Aloo Gosht (Potato & Mutton Curry). Recipes are presented as Appendix K.

Various one-pot combination dishes were seen coming up in the focus group discussion and different food groups were mixed or combined together for taste and flavor like mutton mince with bell pepper as Keema Shimla Mirch and Palak Gosht where spinach is cooked with mutton . Potatoes and cauliflower are Taste also cooked together in the form of Aloo Gobi and rice is Grounds for cooked with carrots, peas and potatoes as Sabzi Pulao. Another Combination popular dish was combining sour yogurt with gram flour and Dishes cooking it in gravy, the dish was finished with the addition of fritters made with gram flour as Kadhi Pakora. This combination dish was appreciated for its taste.

Combinations of different food groups were also seen for enhancement of sensory attributes like Channay Ki Daal aur Kudu (Split Bengal Gram & Bottle Gourd Gravy) were cooked together as a combination dish for purpose of flavor and Sensory texture. Similarly, onions are added to okra for improvement of attributes appearance and texture in a typical TPD of Bhindi Pyaaz. 71 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Focus Group Questions Major Themes Sub-themes Focus Group Interpretation

All participants agreed in having three meals a day with Please share your basic recipe for breakfast being the least important and dinner the most vegetables, lentils, beans chicken important as it was usually a family meal. Different types of and combination one-pot dishes. TPDs were cooked to give variety to their daily menu and in doing so vegetables were either cooked alone like Tori Chapni Grounds for (Cousa Squash Gravy) or two and three vegetables were Combination grouped together. Popular combinations included Arbi Baigan Dishes Variety Ki Bhujia (Taro & Eggplant Gravy) and Aloo, Matar, Gajjar (Potatoes, Peas & Carrots) were also cooked together as one- pot combination dish. Lentils and beans were also seen in the weekly menu of almost all participants of focus group like Daal Maash (White Lentil) and Daal Moong (Petite Yellow Lentil). Variety was also seen in mixing different food groups like rice cooked with peas as a popular dish of Matar Pulao.

72 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

4.2 Identification of Common Traditional Pakistani Dishes

Focus group was used to identify the most commonly consumed TPDs and for this purpose 18 focus groups were conducted with 412 participants, ranging from 19 to 24 housewives per focus group.

Classical content analysis with basic frequency was used to identify the TPDs consumed. Frequency distribution, relative frequency and percentage frequency was used to identify commonly consumed TPDs.

An accumulative table of all 18 focus groups is presented as Table 4.2 and the dishes are listed in alphabetical order; * identifies the dishes with a percentage frequency of

60% and more. Results of individual focus groups are presented as Appendix L.

73 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Table 4.2 Frequency of Commonly Consumed Traditional Pakistani Dishes

Sr #. Traditional Pakistani Dish Frequency Relative Percentage (n=412) Frequency Frequency 1. Aloo Anday 209 0.51 51 2. Aloo Bhujia 322 0.78 78* 3. Aloo Gobi 284 0.69 69* 4. Aloo Baigan 116 0.28 28 5. Aloo Gosht 335 0.81 81* 6. Aloo Palak 221 0.54 54 7. Aloo, Matar, Gajjar 300 0.73 73* 8. Aloo Keema 269 0.65 65* 9. Aloo Walay Chawal 209 0.51 51 10. Anday Ka Khagina 276 0.67 67* 11. Arbi Baigan Aur Tori Ki Bhujia 130 0.32 32 12. Arbi Baigan Ki Bhujia 252 0.61 61* 13. Bhuna Keema 298 0.72 72* 14. Bhindi Pyaaz 276 0.67 67* 15. Channay Ki Daal Aur Kudu 303 0.74 74* 16. Channay Ki Daal Gosht 216 0.52 52 17. Chapli Kabab 136 0.33 33 18. Daal Mash 277 0.67 67* 19. Daal Moong 263 0.64 64* 20. Daal Moong Masoor 175 0.42 42 21. Kabuli Chanay Ka Salan 259 0.63 63* 22. Kabab Ka Salan 160 0.39 39 23. Kachnar 107 0.26 26 24. Kadhi Pakora 269 0.65 65* 25. Kalay Chanay Ka Salan 264 0.64 64* 26. Kali Tori Ki Bhujia 152 0.37 37 27. Karalay Pyaaz 213 0.52 52 28. Keema Pyaaz 255 0.62 62* 29. Keema Shimla Mirch 282 0.68 68* 30. Kofta Salaan 149 0.36 36 31. Kudu Gosht 287 0.70 70* 32. Mash,Moong Aur Channay Ki Daal 167 0.41 41 33. Matar Pulao 274 0.67 67* 34. Matar Keema 275 0.67 67* 35. Mungaray Aloo 190 0.46 46 36. Murgh Biryani 297 0.72 72* 37. Murgh Handi 256 0.62 62* 38. Murgh Karahi 306 0.74 74* 39. Murgh Korma 265 0.64 64* 40. Murgh Pulao 228 0.55 55 41. Nargisi Koftae 150 0.36 36 42. Palak Gosht 260 0.63 63* 43. Pataa Gobi Aur Aloo 145 0.35 35 44. Saag 238 0.58 58 45. Saboth Maash Ki Daal 160 0.39 39 46. Saboth Masoor Ki Daal 262 0.64 64* 47. Sabzi Pulao 256 0.62 62* 48. Shaljam Gosht 271 0.66 66* 49. Tali Machli 178 0.43 43 50. Tori Chapni 290 0.70 70* 51. Tori Ghost 125 0.30 30 52. Tori Aur Anday Ki Bhujia 119 0.29 29 53. Yakhni Pulao 345 0.84 84* * represents 60% and above 74 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Table 4.2 depicts the TPDs consumed by the respondents of the focus groups.

A total of 53 dishes were identified which included a vast variety of dishes ranging from rice dishes to non starchy vegetables, starchy vegetables, beans, lentil dishes, meat dishes and one-pot combination dishes. TPDs scoring a percentage frequency of

≥ 60 % were the selected sample for the study.

Potatoes (Aloo) seem to be the most popular vegetable as eleven TPDs were identified. Potatoes are cooked alone as Aloo Bhujia or in combination with other vegetables like cauliflower (Aloo Gobi), eggplant (Aloo Baigan), spinach (Aloo

Palak), radish pods (Mungaray Aloo), cabbage (Pataa Gobi Aur Aloo), pea and carrots (Aloo, Matar, Gajjar). Potatoes are also cooked with eggs (Aloo Anday), mutton (Aloo Gosht), mutton mince (Aloo Keema) and rice (Aloo Walay Chawal).

Besides potatoes, other vegetables are also seen as part of the Pakistani cuisine as twenty two dishes were identified other than potatoes which included single vegetable as a key component or two, three vegetables combined during preparation as mixed vegetables dishes. Vegetables were also seen cooked in combination with mince, mutton and rice. Single vegetable dishes included mountain ehony Bauhinia variegate (Kachnar), cousa squash (Tori Chapni), sponge gourds (Kali Tori Ki Bhujia) and mustard greens (Saag). Whereas, combination of vegetables that were identified during the FGD included okara and onions (Bhindi Pyaaz), bitter gourd (Karalay

Pyaaz), taro and eggplant (Arbi Baigan Ki Bhujia), taro, eggplant and sponge gourds

(Arbi Baigan Aur Tori Ki Bhujia). Combination of vegetables and mutton including mutton mince dishes range includes bell pepper (Keema Shimla Mirch), peas (Matar

Keema) and onions (Keema Pyaaz), bottle gourd (Kudu Gosht) spinach (Palak Gosht) and sponge gourds (Tori Gosht). 75 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

The Traditional Pakistani cuisine also combines vegetables with rice and legumes and a prevalence percentage of 67 and 62 were seen for peas cooked with rice (Matar Pulao); and carrots, peas and potatoes in combination with rice as Sabzi

Pulao. Vegetable like bottle gourd cooked with split Bengal gram (Channay Ki Daal

Aur Kudu) was also on the list with 74 % prevalence.

Apart from vegetables; beans and lentil dishes also made a popular addition to the list of TPDs and eleven dishes belonging to the said category were identified in the FGD. Lentil dishes included white lentil (Daal Mash), petite yellow lentil (Daal

Moong), brown lentil (Saboth Masoor Ki Daal), white, petite yellow and split Bengal gram (Mash,Moong Aur Channay Ki Daal), petite yellow and red lentil (Daal Moong

Masoor), black gram (Saboth Maash Ki Daal). Split Bengal gram is also cooked in combination with bottle gourd (Channay Ki Daal Aur Kudu) and mutton (Channay Ki

Daal Ghost). In addition chickpeas/ garbanzo beans (Kabuli Chanay Ka Salan) and brown Bengal chickpeas (Kalay Chanay Ka Salan) are also part of the TPDs.

Furthermore, an interesting combination of gram flour with sour yogurt is seen as a popular TPD of Kadhi Pakora; this dish comprises of deep fried gram flour (besan) and onion fritters, simmered in spiced, sour yogurt and gram flour gravy.

TPDs signify the use of different types of meat like chicken, mutton, beef and fish. Amongst the types identified, chicken (Murgh) seems the most frequently consumed as” Murgh Karahi” (Wok in Chicken), “Murgh Handi” (Chicken in a Pot) and “Murgh Korma” (Chicken Curry). Chicken is also prepared with rice in TPDs like “Murgh Biryani” and “Murgh Pulao”. Mutton is usually seen in one-pot combination dishes like “Matar Keema” (Peas & Mutton Mince); however, mutton mince is seen cooked alone (Bhuna Keema) and as meat balls curry (Kofta Salaan). 76 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Eggs are also part of the Pakistani cuisine as afew traditional dishes incorporates eggs like “Anday Ka Khagina” which is Pakistani style scrambled eggs (Anday) dish with tomatoes, onions, green chilies and fresh coriander. Eggs are also cooked in combination with vegetables like sponge gourds (Tori Aur Anday Ki Bhujia) and potatoes (Aloo Anday); while eggs incorporates with mince as “Nargisi Koftae” where meat balls are stuffed with boiled eggs and served in a typical gravy of tomatoes and onions. TPDs of beef and fish are not very common and only one dish each is identified as “Chapli Kabab” for beef mince and fried fish (Tali Machli).

A total of 53 TPDs were identified with Yakhni Pulao as the most popular

TPD scoring a frequency of 345 and percentage frequency of 84%. Yakhni Pulao is a rice dish, which is known for its aroma as rice is cooked in mutton broth along with mutton pieces. Yakhni Pulao was followed by Aloo Gosht with a percentage frequency of 81%, which is a one-pot combination dish in which mutton (Gosht) is cooked along with diced potato (Aloo) in aromatic spices and tomato based curry.

While the lowest percentage frequency of TPDs was ehony Bauhinia variegate

(Kachnar) with a score of 26%.

30 TPDs scored a percentage frequency of ≥ 60% and these dishes formed the base of the study.

77 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

4.2 Phase II

The study was conducted using sequential exploratory study design where the results of Phase I (Qualitative) become the base of Phase II (Quantitative). During

Phase I focus groups were conducted and TPDs were identified along with their recipes. Overall 53 TPDs were enlisted but only 30 dishes were included in the study using a cut off value of 60% frequency prevalence. These dishes were prepared in the

Food Science Laboratory of Food Science and Human Nutrition Department,

Kinnaird College for Women, Lahore, Pakistan from 8th December, 2014 to 30th

April, 2015.

The recipes of the dishes were drawn out through constant comparison analysis and were verified by quantifying the ingredients in standard measures and weight during preparation. Sensory evaluation of the prepared TPDs was carried out for consumer acceptability. Recipes of the 30 prepared dishes are presented as

Appendix K.

4.2.1 Consumer Acceptability

The consumer acceptability of the prepared TPDs was done on a Hedonic scale of 1-9 where 9 was for like extremely and 1 rated dislike extremely. A cut off point of 5 was used as this was ranked neutral, neither like or dislike, making values of 6 to 9 as acceptable for the current study.

Faculty members from Kinnaird College for Women, Lahore, Pakistan agreed to be part of the study by rendering their services as Consumer Acceptability

Assessors (CAAs) for sensory evaluation of the prepared TPDs. Overall, 37 faculty members agreed to be part of the CAAs panel, however the availability of the CAAs ranged from 30 members to 34 members for different TPDs. 78 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Table 4.3 Consumer Acceptability of Traditional Pakistani Dishes Traditional Pakistani Frequency of Consumer Score on Hedonic Scale Mean Consumer Score on Hedonic Scale Total Mean Percentage Dishes Score Acceptability Hedonic Scale 9 8 7 6 5 4 3 2 1 9 8 7 6 5 Consumer Acceptability Assessors N Aloo Bhujia 34 6 12 11 05 0 - - - - 1.59 2.82 2.26 0.88 0.00 7.55 84 Aloo Gobi 32 4 11 12 03 2 - - - - 1.13 2.75 2.63 0.56 0.31 7.35 82 Aloo Gosht 30 6 11 10 03 0 - - - - 1.80 2.93 2.33 0.60 0.00 7.67 85 Aloo, Matar, Gajjar 30 7 10 09 03 1 - - - - 2.10 2.67 2.10 0.60 0.17 7.63 85 Aloo Keema 33 7 11 10 03 2 - - - - 1.91 2.67 2.12 0.55 0.30 7.55 84 Anday ka Khagina 31 6 08 09 05 3 - - - - 1.74 2.06 2.03 0.97 0.48 7.28 81 Arbi baigan ki bhujia 32 5 05 10 12 0 - - - - 1.41 1.25 2.19 2.25 0.00 7.09 79 Bhuna Keema 30 7 10 10 03 0 - - - - 2.10 2.67 2.33 0.60 0.00 7.70 86 Bhindi pyaaz 32 3 08 07 10 4 - - - - 0.84 2.00 1.53 1.88 0.63 6.88 76 Channay Ki Daal Aur Kudu 30 8 07 07 03 5 - - - - 2.40 1.87 1.63 0.60 0.83 7.33 81 Daal Mash 34 5 08 11 06 4 - - - - 1.32 1.88 2.26 1.06 0.59 7.11 79 Daal Moong 30 6 07 06 04 7 - - - - 1.80 1.87 1.40 0.80 1.17 7.04 78 Kabuli Chanay Ka Salan 31 5 06 08 05 7 - - - - 1.41 1.55 1.81 0.97 1.13 6.87 76 Kadhi Pakora 32 9 08 06 06 3 - - - - 2.53 2.00 1.31 1.13 0.47 7.44 83 Kalay Chanay Ka Salan 31 7 07 05 06 6 - - - - 2.03 1.81 1.13 1.16 0.97 7.10 79 Keema Pyaaz 30 7 07 06 10 0 - - - - 2.10 1.87 1.40 2.00 0.00 7.37 82 Keema Shimla Mirch 30 6 06 08 10 0 - - - - 1.80 1.60 1.87 2.00 0.00 7.27 81 Kudo Gosht 31 6 08 10 03 4 - - - - 1.74 2.06 2.26 0.58 0.65 7.29 81 Matar Keema 32 3 06 04 15 4 - - - - 0.84 1.50 0.88 2.81 0.63 6.66 74 Matar Pulao 33 5 09 11 05 3 - - - - 1.36 2.18 2.33 0.91 0.45 7.23 80 Murgh Biryani 32 2 05 14 09 2 - - - - 0.56 1.25 3.06 1.69 0.31 6.87 76 Murgh Handi 34 6 11 09 07 1 - - - - 1.59 2.59 1.85 1.24 0.15 7.42 82 Murgh Karahi 31 9 04 08 07 3 - - - - 2.61 1.03 1.81 1.35 0.83 7.63 85 Murgh Korma 32 7 14 03 04 4 - - - - 1.97 3.50 0.66 0.75 0.63 7.51 83 Palak Gosht 33 6 07 13 06 1 - - - - 1.64 1.70 2.76 1.09 0.15 7.34 82 Saboth Masoor Ki Daal 31 9 07 04 08 3 - - - - 2.61 1.81 0.90 1.55 0.48 7.35 82 Sabzi Pulao 31 4 05 08 14 0 - - - - 1.16 1.29 1.81 2.71 0.00 6.97 77 Shaljam Gosht 31 5 07 05 14 0 - - - - 1.45 1.81 1.13 2.71 0.00 7.10 79 Tori Chapni 32 2 07 12 10 1 - - - - 0.56 1.75 2.63 1.88 0.16 6.97 77 Yakhni Pulao 32 7 12 07 06 0 - - - - 1.99 3.00 1.53 1.13 0.00 7.65 85 79 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Consumer acceptability of prepared TPDs was assessed on a Hedonic Scale of

1-9. Table 4.3 clearly illustrates that none of the prepared dishes had a score ≤ 4 indicating that all the prepared TPDs were acceptable to the consumers.

Bhuna Keema (Stir Fired Mutton Mince) rated highest with a mean consumer acceptability score of 7.70 and percentage of 86 for consumer acceptability. This was closely followed by Aloo Gosht (Potato & Mutton Curry), Aloo, Matar, Gajjar

(Potato, Peas & Carrot Mix), Murgh Karahi (Chicken in Wok), Yakhni Pulao (Rice in

Mutton Broth), all had a consumer acceptability of 85%. Aloo Bhujia (Potato Gravy) and Aloo Keema (Potato & Mutton Mince) both had a mean score of 7.55 on the

Hedonic Scale of 1-9 and percentage consumer acceptability of 84.

Kadhi Pakora (Gram Flour & Sour Yogurt Gravy with Fritters) and Murgh

Korma (Chicken Curry) scored consumer acceptability of 83%; while Aloo Gobi

(Potato Cauliflower Mix), Murgh Handi (Chicken in a Pot), Saboth Masoor ki Daal

(Brown Lentil), Palak Gosht (Spinach and Mutton Gravy) and Keema Pyaaz (Mutton

Mince with Onions) had consumer acceptability of 82%. This was followed by Anday ka Khagina (Scrambled Eggs with Vegetables), Channay Ki Daal Aur Kudu (Split

Bengal Gram & Bottle Gourd Gravy), Keema Shimla Mirch (Mutton Mince with Bell

Pepper) and Kudu Gosht (Bottle Gourd & Mutton Gravy), all scoring 81% for consumer acceptability. Matar Pulao (Rice with Peas) scored a mean consumer acceptability score of 7.23 and 80% for consumer acceptability. The lowest score on the hedonic scale was for Matar Keema (Peas & Mutton Mince) with a mean consumer acceptability score of 6.66 on a scale of 9 and a percentage of 74 for consumer acceptability. The other prepared TPDs were accepted with a consumer acceptability ranging between 76% and 79%. 80 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

4.2.2 Estimation of Macro-nutrient Content of Prepared Traditional Pakistani Dishes

Proximate analysis was carried out for the estimation of macro-nutrient content of prepared TPDs. These analyses were conducted by the researcher in the

Main Laboratory of Kinnaird College for Women, Lahore, Pakistan following the standard procedure of AOAC, 2006. 450 tests were conducted over a period of six months, 3 tests were run for each nutrient namely protein, fat, fiber, ash and moisture from 8th December, 2014 to 2nd June, 2015.

MPEL is based on macro-nutrient content namely carbohydrate, protein and fat along with the energy it contributes in kilocalories. However, moisture, ash and fiber of the prepared TPDs were also estimated as carbohydrate was calculated by difference. Results of each nutrient are presented as triplicates in Table 4.4 while

Table 4.5 depicts the mean readings ± SD per 100 grams of sample of prepared TPDs.

81 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Table 4.4

Triplicates of Macro-nutrient Content of Prepared Traditional Pakistani Dishes per 100 grams

CHO CHO CHO Protein Protein Protein Fat Fat Fat Moisture Moisture Moisture Fiber Fiber Fiber Ash Ash Ash Energy Energy Energy

R1 R2 R3 R1 R2 R3 R1 R2 R3 R1 R2 R3 R1 R2 R3 R1 R2 R3 R1 R2 R3

Aloo Bhujia 14.30 14.10 14.50 5.00 4.70 5.30 12.20 12.50 11.90 66.50 66.66 66.34 0.80 0.82 0.78 1.20 1.22 1.18 187.00 187.70 186.30 Aloo Gobi 9.21 9.16 9.25 2.60 2.50 2.70 08.58 08.45 08.57 77.00 77.21 76.94 1.20 1.25 1.15 1.41 1.43 1.39 124.46 122.69 124.93 Aloo Gosht 5.89 5.92 5.87 6.8 6.75 6.85 09.50 09.60 9.40 77.21 77.04 77.37 0.40 0.45 0.35 0.20 0.24 0.16 136.26 137.08 135.48 Aloo, Matar, Gajjar 12.95 12.90 13.00 4.25 4.32 4.18 10.80 10.50 10.90 68.8 68.63 69.17 1.20 1.50 0.90 2.00 2.15 1.85 166.00 163.38 166.82 Aloo Keema 7.81 7.90 7.87 9.19 9.22 9.16 16.50 16.70 16.50 64.52 64.35 64.34 0.40 0.20 0.60 1.58 1.63 1.53 216.50 218.78 216.62 Anday ka Khagina 6.30 6.28 6.31 10.80 10.83 10.77 16.90 16.69 16.75 62.70 62.94 62.83 0.70 0.73 0.67 2.60 2.53 2.67 220.50 218.65 219.07 Arbi baigan ki 11.06 11.03 11.08 3.50 3.30 3.70 8.87 8.90 8.99 74.88 74.93 74.69 1.02 1.03 1.01 0.67 0.81 0.53 138.07 137.42 140.03 bhujia Bhuna Keema 5.48 5.50 5.45 14.4 14.30 14.50 28.53 28.51 28.55 48.09 48.10 48.09 0.90 0.93 0.87 2.60 2.66 2.54 336.29 335.79 336.75 Bhindi pyaaz 5.45 5.52 5.39 2.40 2.45 2.35 11.85 11.87 11.90 78.02 77.85 78.11 1.20 1.28 1.12 1.08 1.03 1.13 138.05 138.71 138.06 Channay Ki Daal 9.99 9.86 10.13 6.90 6.70 7.10 11.20 11.40 10.96 70.00 70.07 69.96 0.91 0.99 0.83 1.00 0.98 1.02 168.36 168.84 167.56 Aur Kudu Daal Mash 14.73 14.75 14.71 10.18 10.14 10.22 12.96 12.88 13.04 58.73 58.82 58.64 1.70 1.77 1.63 1.70 1.64 1.76 216.28 215.48 217.08 Daal Moong 15.52 15.61 15.44 9.20 9.00 8.97 12.76 12.65 12.69 60.32 60.37 60.87 1.50 1.62 1.38 0.70 0.75 0.65 213.72 212.29 211.85 Kabuli Chanay Ka 9.38 9.35 9.42 5.81 5.86 5.76 10.17 10.19 10.18 72.16 72.10 72.18 1.63 1.59 1.67 0.85 0.91 0.79 152.29 152.55 152.34 Salan Kadhi Pakora 9.69 9.72 9.67 6.78 6.76 6.80 9.47 9.41 9.53 70.76 70.65 70.86 2.80 2.76 2.84 0.50 0.70 0.30 151.11 150.61 151.65 Kalay Chanay Ka 9.48 9.50 9.47 6.32 6.34 6.30 10.50 10.48 10.60 72.00 71.92 71.99 1.10 1.12 1.08 0.60 0.64 0.56 157.70 157.68 158.48 Salan Keema Pyaaz 3.75 3.70 3.79 13.60 13.70 13.50 23.64 23.61 23.67 56.24 56.26 56.23 0.87 0.85 0.89 1.90 1.88 1.92 282.16 282.09 282.19 Keema Shimla 3.75 3.74 3.77 9.95 9.98 9.92 18.09 18.21 17.97 64.79 64.54 65.03 0.87 0.91 0.83 2.55 2.62 2.48 217.61 218.77 216.49 Mirch Kudo Gosht 3.50 3.39 3.47 6.45 6.41 6.49 9.80 9.90 10.00 78.20 78.11 78.13 0.85 0.94 0.76 1.20 1.25 1.15 128.00 128.30 129.84 Matar Keema 10.57 10.59 10.54 14.70 14.60 14.80 20.80 20.67 20.54 50.98 51.16 51.20 1.20 1.28 1.12 1.75 1.70 1.80 288.28 286.79 286.22 Matar Pulao 18.6 18.70 18.50 3.19 3.21 3.17 14.50 14.30 14.70 62.46 62.51 62.41 0.80 0.90 0.70 0.45 0.38 0.52 217.66 216.34 218.98 Murgh Biryani 11.62 11.53 11.70 6.80 6.78 6.82 6.80 6.83 6.77 72.40 72.42 72.39 1.80 1.82 1.78 0.58 0.62 0.54 134.88 134.71 135.01 Murgh Handi 4.68 4.72 4.65 10.90 10.60 11.20 20.57 20.48 20.66 61.84 62.25 61.42 0.78 0.76 0.80 1.23 1.19 1.27 247.45 245.60 249.34 Murgh Karahi 7.00 7.20 6.80 13.50 13.70 13.30 20.68 20.61 20.75 54.62 54.37 54.87 2.40 2.42 2.38 1.80 1.70 1.90 268.12 269.09 267.15 Murgh Korma 6.04 6.01 6.06 10.45 10.49 10.41 17.95 17.86 18.04 62.20 62.20 62.21 0.75 0.78 0.72 2.61 2.66 2.56 227.51 226.74 228.24 Palak Gosht 6.42 6.50 6.47 11.40 11.20 11.60 18.85 18.82 18.88 59.68 59.70 59.53 1.83 1.90 1.76 1.82 1.88 1.76 240.93 240.18 242.20 Saboth Masoor Ki 8.62 8.67 8.57 5.40 5.20 4.96 9.00 8.90 9.10 75.28 75.33 75.87 0.50 0.78 0.22 1.20 1.12 1.28 137.08 135.58 136.02 Daal Sabzi Pulao 20.01 20.03 19.98 3.45 3.48 3.42 15.50 15.40 15.30 58.09 58.17 58.32 1.15 1.06 1.24 1.80 1.86 1.74 233.34 232.64 231.30 Shaljam Gosht 5.36 5.34 5.39 8.80 8.60 9.00 13.80 13.70 13.90 69.36 69.53 69.18 1.08 1.13 1.03 1.60 1.70 1.50 180.84 179.06 182.66 Tori Chapni 5.58 5.59 5.56 2.68 2.65 2.71 11.30 11.20 11.20 75.97 76.06 76.09 2.68 2.66 2.70 1.79 1.84 1.74 134.74 133.76 133.88 Yakhni Pulao 12.62 12.65 12.58 7.50 7.90 7.10 11.50 11.20 11.80 66.85 66.70 67.01 0.85 0.89 0.81 0.68 0.66 0.70 183.98 183.00 184.92 82 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

The proximate composition of the TPDs was analyzed as prescribed by AOAC

(2006). Each analysis was carried out in triplicates to enhance the precision of measurement. Table 4.4 depicts the raw data of the proximate analysis of the TPDs per

100 grams.

83 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Table 4.5

Macro-nutrient Content of Prepared Traditional Pakistani Dishes per 100 grams

Traditional Pakistani Nutrients Dishes CHO Protein Fat Moisture Fiber Ash Energy (grams) (grams) (grams) (%) (grams) (grams) (kcal) Mean± SD Mean± SD Mean± SD Mean± SD Mean± SD Mean± SD Mean± SD Aloo Bhujia 14.30±0.20 05.00±0.30 12.20±0.30 66.50±0.16 0.80±0.02 1.20±0.02 187.00±0.70 Aloo Gobi 09.21±0.05 02.60±0.10 08.53±0.08 77.05±0.16 1.20±0.05 1.41±0.02 124.03±1.34 Aloo Gosht 05.89±0.03 06.80±0.05 09.50±0.10 77.21±0.17 0.40±0.05 0.20±0.04 136.27±0.80 Aloo, Matar, Gajjar 12.95±0.05 04.25±0.07 10.73±0.23 68.87±0.30 1.20±0.30 2.00±0.15 165.40±2.02 Aloo Keema 07.86±0.05 09.19±0.03 16.57±0.13 64.40±0.12 0.40±0.20 1.58±0.05 217.30±1.48 Anday ka Khagina 06.30±0.02 10.80±0.03 16.78±0.12 62.82±0.12 0.70±0.03 2.60±0.07 219.41±1.09 Arbi baigan ki bhujia 11.06±0.03 03.50±0.20 08.92±0.07 74.83±0.14 1.02±0.01 0.67±0.14 138.51±1.52 Bhuna Keema 05.48±0.03 14.40±0.10 28.53±0.02 48.09±0.01 0.90±0.03 2.60±0.06 336.28±0.49 Bhindi pyaaz 05.45±0.07 02.40±0.05 11.87±0.03 77.99±0.14 1.20±0.08 1.08±0.05 138.27±0.44 Channay Ki Daal Aur 09.99±0.14 06.90±0.20 11.19±0.23 70.01±0.06 0.91±0.08 1.00±0.02 168.25±0.69 Kudu Daal Mash 14.73±0.02 10.18±0.04 12.96±0.08 58.73±0.09 1.70±0.07 1.70±0.06 216.28±0.80 Daal Moong 15.52±0.09 09.06±0.14 12.70±0.06 60.52±0.35 1.50±0.12 0.70±0.05 212.62±1.10 Kabuli Chanay Ka Salan 09.38±0.04 05.81±0.05 10.18±0.01 72.15±0.05 1.63±0.04 0.85±0.06 152.39±0.16 Kadhi Pakora 09.69±0.03 06.78±0.02 09.47±0.06 70.76±0.11 2.80±0.04 0.50±0.20 151.12±0.53 Kalay Chanay Ka Salan 09.48±0.02 06.32±0.02 10.53±0.07 71.97±0.05 1.10±0.02 0.60±0.04 157.95±0.53 Keema Pyaaz 03.75±0.05 13.60±0.10 23.64±0.03 56.24±0.02 0.87±0.02 1.90±0.02 282.15±0.06 Keema Shimla Mirch 03.75±0.02 09.95±0.03 18.09±0.12 64.79±0.25 0.87±0.04 2.55±0.07 217.62±1.15 Kudo Gosht 03.45±0.06 06.45±0.04 09.90±0.10 78.15±0.05 0.85±0.09 1.20±0.05 128.71±1.13 Matar Keema 10.57±0.03 14.70±0.10 20.67±0.13 51.11±0.13 1.20±0.08 1.75±0.05 287.10±1.18 Matar Pulao 18.60±0.10 03.19±0.02 14.50±0.20 62.46±0.05 0.80±0.10 0.45±0.07 217.66±1.32 Murgh Biryani 11.62±0.09 06.80±0.02 06.80±0.03 72.40±0.02 1.80±0.02 0.58±0.04 134.87±0.16 Murgh Handi 04.68±0.04 10.90±0.30 20.57±0.09 61.84±0.42 0.78±0.02 1.23±0.04 247.46±1.88 Murgh Karahi 07.00±0.20 13.50±0.20 20.68±0.07 54.62±0.25 2.40±0.02 1.80±0.10 268.12±0.97 Murgh Korma 06.04±0.03 10.45±0.04 17.95±0.09 62.20±0.01 0.75±0.03 2.61±0.05 227.50±0.76 Palak Gosht 06.46±0.04 11. 40±0.20 18.85±0.03 59.64±0.11 1.83±0.07 1.82±0.06 241.10±1.10 Saboth Masoor Ki Daal 08.62±0.05 05.19±0.23 09.00±0.10 75.49±0.38 0.50±0.28 1.20±0.08 136.23±0.85 Sabzi Pulao 20.01±0.03 03.45±0.03 15.40±0.10 58.19±0.13 1.15±0.09 1.80±0.06 232.43±1.13 Shaljam Gosht 05.36±0.03 08.80±0.20 13.80±0.10 69.36±0.18 1.08±0.05 1.60±0.10 180.85±1.81 Tori Chapni 05.58±0.02 02.68±0.03 11.23±0.07 76.04±0.07 2.68±0.02 1.79±0.05 134.13±0.61 Yakhni Pulao 12.62±0.04 07.50±0.40 11.50±0.30 66.85±0.16 0.85±0.04 0.68±0.02 183.97±0.97 84 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Table 4.5 depicts the results of proximate analysis of prepared dishes which clearly indicates variation in the macronutrient content amongst different TPDs per

100 grams of the sample. Sabzi Pulao (Vegetable Rice) is the highest contributor to the carbohydrate group with 20.01±0.03 grams, followed by Matar Pulao (Rice with

Peas) with 18.60±0.10 grams per 100 grams of sample. The carbohydrate content of

Daal Moong (Petite Yellow Lentil) and Daal Mash (White Lentil) was 15.52±0.09 grams and 14.73±0.02 grams per 100 grams of sample respectively. Meat dishes lend the lowest scores to the carbohydrate group with Keema Pyaaz (Mutton Mince with

Onions) contributing 3.75±0.05grams and Keema Shimla Mirch (Mutton Mince with

Bell Pepper) 3.75±0.02grams per 100 grams of the sample respectively. Kudu Gosht

(Bottle Gourd & Mutton Gravy) and Murgh Handi (Chicken in a Pot) also lend

3.45±0.06 grams 4.68±0.04 grams of carbohydrates per 100 grams of the sample.

The protein content of TPDs was topped by Matar Keema (Peas and Mutton

Mince) and Bhuna Keema (Stir Fried Mutton Mince) each contributing 14.70±0.10 grams and 14.40±0.10 grams per 100 grams respectively. On the other hand

Traditional Vegetable Pakistani Dishes attained the lowest score and includes Aloo

Gobi (Potato Cauliflower Mix) 2.60±0.10grams, Bhindi Pyaaz (Okra with Onions)

2.40±0.05grams, Tori Chapni (Cousa Squash Gravy) 2.68±0.03grams per 100 grams of sample.

Fat content of all TPDs also showed wide variation and registered ranges from

08.53±0.08 grams for Aloo Gobi (Potato Cauliflower Mix) to 28.53±0.02 grams per

100 grams of sample for Bhuna Keema (Stir Fried Mutton Mince). Most frequently occurring figures for fat content ranged between 9grams to 13 grams per 100 grams of sample. TPDs include dry mix cuisine to stews and gravies and as such the moisture content of the TPDs also varied like 48.09±0.01 % for Bhuna Keema (Stir Fried 85 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Mutton Mince) to 78.15±0.05 % for Kudu Gosht (Bottle Gourd & Mutton Gravy).

The moisture content of Aloo Gobi (Potato Cauliflower Mix), Aloo Gosht (Potato and

Mutton Curry) Bhindi Pyaaz (Okra with Onions) and Tori Chapni (Cousa Squash

Gravy) ranged from 76 to 78 percent. The lowest ranges of moisture content of TPDs were scored by Matar Keema (Peas & Mutton Mince), Murgh Karahi (Chicken in

Wok) and Keema Pyaaz (Mutton Mince with Onions) showing a range of 51 to

56.24%. The rest of the scores ranged from 58% to 76%.

The TPDs also contributed fiber to the overall percentage of nutrient estimation and the highest contributor to the fiber content was Kadhi Pakora (Gram

Flour & Sour Yogurt Gravy with Fritters) with 2.80±0.04 grams per 100 grams of sample followed by Tori Chapni (Cousa Squash Gravy), Murgh Karahi (Chicken in

Wok), Palak Gosht (Spinach & Mutton Gravy) and Murgh Biryani (Rice cooked with

Chicken Gravy) giving 2.68±0.02 grams, 2.40±0.02 grams, 1.83±0.07 grams and

1.80±0.02 respectively for 100 grams of sample. Other dishes that had relatively high fiber content were beans and lentil dishes that included Daal Mash (White Lentil),

Daal Moong (Petite Yellow Lentil) and Kabuli Chanay ka Salan (Chickpeas Curry) giving a range between 1.50 grams to 1.70 grams per 100 grams of sample. The lowest score for fiber was reported by Aloo Gosht (Potato & Mutton Curry) and Aloo

Keema (Potato & Mutton Mince) 0.40±0.05grams and 0.40±0.20 grams respectively.

The highest contributor to the ash content of TPDs was Anday ka Khagina

(Scrambled Eggs with Vegetables), Bhuna Keema (Stir Fried Mutton Mince) and

Murgh Korma (Chicken Curry) showing figures of 2.60±0.07 grams, 2.60±0.06 grams and 2.61±0.05 grams respectively. The lowest value for ash was seen in Aloo Gosht

(Potato & Mutton Curry) reporting 0.20±0.04 grams per 100 grams of the sample. 86 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

The last and the most important parameter was the amount of energy that 100 grams of TPDs contributed and the list was topped by Bhuna Keema (Stir Fried

Mutton Mince) with 336.28±0.49 kilocalories while the bottom low was scored by

Aloo Gobi (Potato Cauliflower Mix) with124.03±1.34 kilocalories. Eleven TPDs were seen with an energy value range of 134 kilocalories and 170 kilocalories and enlisted dishes ranged from the vegetable group like Aloo, Matar, Gajjar (Potato, Peas

& Carrot Mix), Kabuli Chanay Ka Salan (Chickpeas Curry) from the bean group, to the combination dish of Murgh Biryani (Boiled Rice layered with Chicken Gravy) with134.87±0.16 kilocalories.

87 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

4.3 Phase III

Phase III uses the integrated data analysis approach which combines the qualitative and quantitative data of Phase I and Phase II respectively wherein using

‘Theoretical Triangulation” with the objective of developing a MPEL for TPDs.

The MPEL for TPDs is developed in a step wise procedure. The qualitative data from phase I provided information regarding the most commonly consumed

TPDs along with their recipes; second step identified the macro-nutrient of the TPDs per 100 grams of the sample; while step three involves disseminating the recipes of the TPDs into their relevant food groups. Finally MPEL for TPDs is developed using qualitative and quantitative data by combining them in light of the existing literature using “Theoretical Triangulation”. The MPEL groups TPDs according to the food groups they represent and the serving size of each TPD is fitted in the food exchange system. MPEL for TPDs is presented in full as Table 4.7, while the steps are traced through Table 4.6 to Table 4.7a and Table 4.7b.

88 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

4.3.1 Categorizing the Traditional Pakistani Dishes into their Relevant Food Group

The current study employed “Theoretical Triangulation” for development of

MPEL for TPDs which was conducted in three steps. Step one entails categorizing the

TPDs into its relevant food group while step two groups the cooked TPDs, into the exchange system based on the macro-nutrient content. The serving size is adjusted according to the exchange group the dish is representing.

The current study was a sequential exploratory study in which the results of one phase are dependent on the results of the preceding phase. Likewise based on the qualitative data obtained by the respondents, the identified TPDs were prepared and ingredients quantified. Based on the information the recipes were disseminated and the TPDs were categorized according to the different food groups which are represented in Table 4.6.

89 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Table 4.6

Categorizing the Traditional Pakistani Dishes into their Relevant Food Group

Traditional Pakistani Dishes Food Groups Aloo Bhujia (Potato Gravy) Vegetable ( Starchy) Aloo Gobi (Potato Cauliflower Mix) Vegetable (Starchy & Non Starchy) Aloo Gosht (Potato & Mutton Curry) Meat (Medium Fat) and Vegetable (Starchy) Aloo, Matar, Gajjar (Potato, Peas & Carrot Mix) Vegetable(Starchy & Non Starchy)

Aloo Keema (Potato & Mutton Mince) Meat (Medium Fat) and Vegetable (Starchy) Anday ka Khagina (Scrambled Eggs with Meat (Medium Fat) and Vegetable (Non-Starchy) Vegetables) Arbi baigan ki bhujia (Taro & Eggplant Gravy) Vegetable (Starchy & Non Starchy)

Bhuna Keema (Stir Fried Mutton Mince) Meat (Medium Fat) Bhindi pyaaz (Okra with Onions) Vegetable(Non Starchy) Channay Ki Daal Aur Kudu Bean and lentil and Vegetable (Non starchy) (Split Bengal Gram & Bottle Gourd Gravy) Daal Mash (White Lentil) Bean and lentil Daal Moong (Petite Yellow Lentil) Bean and lentil Kabuli Chanay Ka Salan (Chickpeas Curry) Bean and lentil

Kadhi Pakora (Gram Flour & Sour Yogurt Bean and lentil and dairy Gravy with Fritters Kalay Chanay Ka Salan (Brown Bengal Bean and lentil Chickpeas Curry) Keema Pyaaz (Mutton Mince with Onions) Meat (Medium Fat) and Vegetable (Non-Starchy)

Keema Shimla Mirch (Mutton Mince with Bell Meat (Medium Fat) and Vegetable (Non-Starchy) Pepper) Kudo Gosht (Bottle Gourd & Mutton Gravy) Meat (Medium Fat) and Vegetable (Non-Starchy)

Matar Keema (Peas & Mutton Mince) Meat (Medium Fat) and Vegetable (Starchy)

Matar Pulao (Rice with Peas) Cereal and Vegetable (Starchy) Murgh Biryani (Boiled rice, layered with Meat (lean) and Cereal chicken Gravy) Murgh Handi (Chicken in a Pot) Meat (lean) Murgh Karahi (Chicken in Wok) Meat (lean) Murgh Korma (Chicken Curry) Meat (lean) Palak Gosht (Spinach & Mutton Gravy) Meat (Medium Fat) and Vegetable (Non-Starchy)

Saboth Masoor Ki Daal (Brown Lentil) Bean and lentil Sabzi Pulao (Vegetable Rice) Cereal and Vegetable (Starchy & Non-Starchy)

Shaljam Gosht (Turnips & Mutton Gravy) Meat (Medium Fat) and Vegetable (Non-Starchy)

Tori Chapni (Cousa Squash Gravy) Vegetable (Non Starchy)

Yakhni Pulao (Rice in Mutton Broth) Meat (Medium Fat) and Cereal

90 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Grouping of the TPDs into their relevant food groups as per the ingredients of the recipe revealed that potatoes is the only starchy vegetable that was cooked alone as Aloo Bhujia (Potato Gravy), besides this dish starchy vegetables are cooked in combination with other non-starchy vegetables like cauliflower is cooked in combination with potatoes as Aloo Gobi (Potato Cauliflower Mix) and similarly potatoes is part of a combination of both another starchy vegetable Matar (peas) and non-starchy vegetable Gajjar (carrots) cooked as Aloo, Matar, Gajjar (Potato, Peas and Carrot Mix). Taro (starchy vegetable) is also cooked with eggplant (non-starchy vegetable) as Arbi Baigan Ki Bhujia (Taro and Eggplant Gravy). Only two TPDs comprises of non-starchy vegetables, which are namely, Bhindi pyaaz (Okra with

Onions) and Tori Chapni (Cousa Squash Gravy).

TPDs which are cooked with one main ingredient included Beans and Lentils

Group; and Meat Group both lean and medium fat choices. In the beans group TPDs includes Kabuli Chanay Ka Salan (Chickpeas Curry) and Kalay Chanay Ka Salan

(Brown Bengal Chickpeas Curry) while the lentils group list down Daal Mash (White

Lentil), Daal Moong (Petite Yellow Lentil) and Saboth Masoor Ki Daal (Brown

Lentil). Bean and Lentil group also enlists two TPDs which combines non- starchy vegetable and dairy group with the said group as Channay Ki Daal Aur Kudu (Split

Bengal Gram & Bottle Gourd Gravy) and Kadhi Pakora(Gram Flour & Sour Yogurt

Gravy with Fritters) respectively. In the meat group (medium fat) only one TPD namely Bhuna Keema (Stir Fried Mutton Mince) is present while mutton is seen as part of combination dishes which includes starchy vegetables, non-starchy vegetables and rice (cereal group). 91 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

TPDs also combine meat (medium fat) and non starchy vegetables includes

Anday ka Khagina (Scrambled Eggs with Vegetables), Keema Pyaaz (Mutton Mince with Onions), Keema Shimla Mirch (Mutton Mince with Bell Pepper), Kudu Gosht

(Bottle Gourd & Mutton Gravy), Palak Gosht (Spinach & Mutton Gravy) and Shaljam

Gosht (Turnips & Mutton Gravy). Similarly, the list of meat (medium fat) and non starchy vegetables includes Aloo Gosht (Potato & Mutton Curry), Aloo Keema

(Potato & Mutton Mince) and Matar Keema (Peas & Mutton Mince).

Amongst the cereal group rice is seen cooked with vegetables both starchy and non-starchy, besides combining rice with meat and chicken as Yakhni Pulao (Rice in

Mutton Broth) and Murgh Biryani (Boiled rice, layered with chicken Gravy) respectively. Combination of rice with starchy and non starchy vegetables includes

Matar Pulao (Rice with Peas) and Sabzi Pulao (Vegetable Rice) respectively.

Furthermore, the TPDs which are cooked as a meat alone dish are usually chicken based; these dishes are cooked using different cooking styles so that each dish has its distinct flavor and taste. These dishes include Murgh Handi (Chicken in a Pot),

Murgh Karahi (Chicken in Wok) and Murgh Korma (Chicken Curry).

92 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

4.3.1 Befitting the Traditional Pakistani Dishes in Food Exchange List

Befitting the TPDs into the Food Exchange System starts by grouping the

TPDs into the food group they represent. The weight of the prepared TPDs is calculated by subtracting the weight of the cooking utensil from the end result which comprises of cooking utensil plus cooked food; alongside 1 cup, 1/2 cup, 1/4 cup were also measured and weighed so as to calculate the serving size that befits in the exchange system of the identified group (Appendix M). After grouping the TPDs into its relevant food group, serving size of each TPD is calculated in such a way that the macro-nutrient content of each dish, in the amount stated, is the same; making it possible for one TPD to be swapped with another, within the group.

Dissemination of TPDs into an exchange that is representative of the relevant food group is shown in Table 4.8a and b. The Table shows the mean reading of each prepared TPD with ± standard deviation (SD) whereas 3 readings calculation for each nutrient is given in Table 4.7a and b. One way ANOVA is used to detect any difference within the group. A value of ≥0.05 is indicative that there is no statistical difference within the group.

93 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Table 4.7a

Triplicates of Macro-nutrient Content of Prepared Traditional Pakistani Dishes per Serving

Group Serving Amount CHO CHO CHO Protein Protein Protein Fat Fat Fat Energy Energy Energy size Cup grams R1 R2 R3 R1 R2 R3 R1 R2 R3 R1 R2 R3

Bean and Lentil Channay Ki Daal Aur Kudu ½ 100 9.99 9.86 10.13 6.90 6.70 7.10 11.20 11.40 10.96 168.36 168.84 167.56 Daal Mash 1/3 78 11.49 11.51 11.47 7.94 7.91 7.97 10.11 10.05 10.17 168.71 168.13 169.29 Daal Moong 1/3 78 12.11 12.18 12.04 7.18 7.02 7.00 9.95 9.87 9.90 166.71 165.63 165.26 Kabuli Chanay Ka Salan ½ 110 10.32 10.2`9 10.36 6.39 6.45 6.34 11.19 11.21 11.20 167.55 167.85 167.60 Kadhi Pakora ½ 110 10.66 10.69 10.64 7.46 7.44 7.48 10.42 10.35 10.48 166.26 165.67 166.80 Kalay Chanay Ka Salan ½ 106 10.05 10.07 10.04 6.70 6.72 6.68 11.13 11.11 11.24 167.17 167.15 168.04 Saboth Masoor Ki Daal ½ 123 10.60 10.66 10.54 6.64 6.40 6.10 11.07 10.95 11.19 168.59 166.79 167.27

Cereal Matar Pulao ½ 88 16.37 16.46 16.28 2.81 2.82 2.79 12.76 12.58 12.94 191.56 190.34 192.74 Sabzi Pulao ½ 82.5 16.51 16.52 16.48 2.85 2.87 2.82 12.79 12.71 12.62 192.55 191.95 190.78

Meat (Lean) Murgh Handi ¼ 56 2.62 2.64 2.60 6.10 5.94 6.27 11.52 11.47 11.57 138.56 137.55 139.61 Murgh Karahi ¼ 52 3.64 3.74 3.54 7.02 7.12 6.92 10.75 10.72 10.79 139.39 139.92 138.95 Murgh Korma ¼ 62 3.74 3.73 3.76 6.48 6.50 6.45 11.13 11.07 11.18 141.05 140.55 141.46

Meat (Medium Fat) Bhuna Keema ¼ 51.5 2.82 2.83 2.81 7.42 7.36 7.47 14.69 14.68 14.70 173.17 172.88 173.42 Keema Pyaaz ¼ 60 2.25 2.22 2.27 8.16 8.22 8.10 14.18 14.17 14.20 169.26 169.29 169.28 Keema Shimla Mirch 1/3 79 2.96 2.95 2.98 7.86 7.88 7.84 14.29 14.39 14.20 171.89 172.83 171.08

94 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Table 4.7b

Triplicates of Macro-nutrient Content of Prepared Traditional Pakistani Dishes per Serving

Group Serving Amount CHO CHO CHO Protein Protein Protein Fat Fat Fat Energy Energy Energy size Cup grams R1 R2 R3 R1 R2 R3 R1 R2 R3 R1 R2 R3

Vegetable (Non-Starchy) Bhindi pyaaz 1/3 76 4.14 4.20 4.10 1.82 1.86 1.79 9.00 9.02 9.04 104.84 105.42 104.92 Tori Chapni 1/3 78 4.35 4.36 4.34 2.09 2.07 2.11 8.81 8.74 8.74 105.05 104.38 104.46 Vegetable (Starchy) Aloo Bhujia 1/3 79 11.30 11.14 11.46 3.95 3.71 4.19 9.64 9.88 9.40 147.76 148.32 147.20 Aloo Gobi ½ 119 10.96 10.90 11.00 3.09 2.98 3.21 10.21 10.06 10.20 148.09 146.06 148.64 Aloo, Matar, Gajjar ½ 89 11.53 11.48 11.57 3.78 3.84 3.72 9.61 9.35 9.70 147.73 145.43 148.46 Arbi baigan ki bhujia ½ 106 11.72 11.69 11.74 3.71 3.50 3.92 9.40 9.43 9.53 146.32 145.63 148.41

Meat & Meat Substitute (medium fat ) + Non-Starchy Vegetables Anday ka Khagina 1/3 67 4.22 4.21 4.23 7.24 7.26 7.22 11.32 11.18 11.22 147.72 146.50 146.78 Kudo Gosht ½ 115 4.03 3.90 3.99 7.42 7.37 7.46 11.27 11.39 11.50 147.23 147.59 149.30 Palak Gosht ¼ 61.5 3.95 4.00 3.98 7.01 6.89 7.13 11.59 11.57 11.61 148.15 147.69 148.93 Shaljam Gosht ¼ 81 4.34 4.33 4.37 7.13 6.97 7.29 11.18 11.10 11.26 146.50 145.10 147.98 Meat & Meat Substitute (medium fat )+ Starchy Vegetables Aloo Gosht ½ 115 6.77 6.81 6.75 7.82 7.76 7.88 10.93 11.04 10.81 156.73 157.64 155.81 Aloo Keema 1/3 72 5.62 5.69 5.67 6.62 6.64 6.60 11.88 12.02 11.88 155.88 157.50 156.00 Matar Keema ¼ 54 5.71 5.72 5.69 7.94 7.88 7.99 11.23 11.16 11.09 155.67 154.84 154.53 Meat + Cereal Murgh Biryani ¾ 138 16.04 15.91 16.15 9.38 9.36 9.41 9.38 9.43 9.34 186.10 185.95 186.30 Yakhni Pulao 2/3 126.5 15.96 16.00 15.91 9.49 9.99 8.98 14.55 14.17 14.93 232.75 231.49 233.93

95 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Table 4.7a and 4.7b exhibits the raw data depicting replicates (n=3) of macro-nutrient content of prepared TPDs per serving.

96 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Table 4.8a

Macro-nutrient Content of Prepared Traditional Pakistani Dishes per serving

Traditional Serving Amount CHO Proteins Fat Energy Pakistani Dishes size Cup grams grams Grams grams Kcal Mean± SD Mean± SD Mean± SD Mean± SD

Beans and Lentils Channay Ki Daal 1/2 100.00 9.99±0.14 6.90±0.20 11.19±0.23 168.25±0.69 Aur Kudu Daal Mash 1/3 78.00 11.49±0.02 7.94±0.03 10.11±0.06 168.71±0.58 Daal Moong 1/3 78.00 12.11±0.07 7.07±0.11 9.91±0.04 165.87±0.84 Kabuli Chanay Ka 1/2 110.00 10.32±0.04 6.39±0.06 11.20±0.01 167.67±0.18 Salan Kadhi Pakora 1/2 110.00 10.66±0.03 7.46±0.02 10.42±0.07 166.24±0.57 Kalay Chanay Ka 1/2 106.00 10.05±0.02 6.70±0.02 11.16±0.08 167.45±0.59 Salan Saboth Masoor 1/2 123.00 10.60±0.06 6.38±0.28 11.07±0.12 167.55±1.04 Ki Daal MEAN 10.75±1.36 6.98±0.96 10.72±0.81 167.39±1.52 p value .995 .957 .998 .747 Cereals

Matar Pulao 1/2 88.00 16.37±0.09 2.81±0.02 12.76±0.18 191.55±1.21 Sabzi Pulao 1/2 82.50 16.50±0.02 2.85±0.03 12.71±0.09 191.76±0.98 MEAN 16.43±0.07 2.83±0.02 12.73±0.03 191.66±0.11 p value .614 .470 .610 .731 Meat (Lean)

Murgh Handi 1/4 56.00 2.62±0.02 6.11±0.17 11.52±0.05 138.57±1.04 Murgh Karahi 1/4 52.00 3.64±0.10 7.02±0.10 10.75±0.04 139.42±0.05 Murgh Korma 1/4 62.00 3.74±0.02 6.48±0.03 11.13±0.06 141.02±0.47 MEAN 3.33±0.71 6.54±0.48 11.13±0.39 139.67±1.35 p value .991 .998 .957 .846 Meat (Medium Fat)

Bhuna Keema 1/4 51.50 2.82±0.01 7.42±0.06 14.69±0.01 173.16±0.28 Keema Pyaaz 1/4 60.00 2.25±0.03 8.16±0.06 14.18±0.02 169.28±0.02 Keema Shimla 1/3 79.00 2.96±0.02 7.86±0.02 14.29±0.10 171.93±0.85 Mirch MEAN 2.68±0.43 7.81±0.39 14.39±0.30 171.46±2.18 p value .998 .999 .978 .971 Vegetables (Non-Starchy)

Bhindi pyaaz 1/3 76.00 4.15±0.05 1.82±0.04 9.02±0.02 105.06±0.36 Tori Chapni 1/3 78.00 4.35±0.01 2.09±0.02 8.76±0.05 104.63±0.42 MEAN 4.25±0.01 1.96±0.14 8.89±0.13 104.85±0.22 p value .920 .997 .991 .854

Results are the means ±SD of samples with three replicates. There is no statistical difference within the group (p value of ≥ 0.05) .

97 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Table 4.8 b Macro-nutrient Content of Prepared Traditional Pakistani Dishes per serving

Traditional Serving Amount CHO Proteins Fat Energy Pakistani Dishes size Cup Grams Grams Grams Grams Kcal Mean± SD Mean± SD Mean± SD Mean± SD Vegetables (Starchy)

Aloo Bhujia 1/3 79.00 11.30±0.16 3.95±0.24 9.64±0.24 147.76±0.56 Aloo Gobi 1/2 119.00 10.95±0.05 3.09±0.11 10.16±0.10 147.60±1.54 Aloo, Matar, Gajjar 1/2 89.00 11.53±0.05 3.78±0.06 9.55±0.20 147.21±1.78 Arbi baigan ki 1/2 106.00 11.72±0.03 3.71±0.21 9.45±0.08 146.79±1.62 bhujia MEAN 11.38±0.43 3.63±0.54 9.70±0.46 147.34±0.55 p value .840 .669 .989 .073 Meat & Meat Substitute (Medium Fat ) + Non-Starchy Vegetables

Anday ka Khagina 1/3 67.00 4.22±0.01 7.24±0.02 11.24±0.08 147.00±0.72 Kudo Gosht ½ 115.00 3.97±0.07 7.42±0.05 11.39±0.12 148.04±1.26 Palak Gosht ¼ 61.50 3.98±0.03 7.01±0.12 11.59±0.02 148.26±0.67 Shaljam Gosht ¼ 81.00 4.35±0.02 7.13±0.16 11.18±0.08 146.53±1.45 MEAN 4.13±0.22 7.20±0.22 11.35±0.24 147.46±0.93 p value .968 .530 .812 .169 Meat & Meat Substitute (Medium Fat ) + Starchy Vegetables

Aloo Gosht ½ 115.00 6.78±0.03 7.82±0.06 10.93±0.12 156.73±0.92 Aloo Keema 1/3 72.00 5.66±0.04 6.62±0.02 11.93±0.09 156.46±1.04 Matar Keema ¼ 54.00 5.71±0.02 7.94±0.06 11.16±0.07 155.01±0.66 MEAN 6.05±0.73 7.46±0.84 11.34±0.59 156.07±1.06 p value .996 .994 .946 .434 Meat + Cereal

Murgh Biryani ¾ 138.00 16.03±0.12 9.38±0.03 9.38±0.05 186.12±0.18 Yakhni Pulao 2/3 126.50 15.96±0.05 9.49±0.51 14.55±0.38 232.72±1.23 MEAN 15.98±0.05 9.44±0.06 11.97±2.59 209.42±23.3 p value .802 .423 .996 .999 Results are the means ±SD of samples with three replicates. There is no statistical difference within the group (p value of ≥ 0.05) .

98 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

TPDs are grouped into their representative food groups based on the ingredients.

Five main groups are formulated, namely Bean and Lentil Group, Cereal Group, Meat

Group, Vegetable Group and Combinations. The last three groups are further subdivided into categories which give a total of nine groups. The Vegetable Group is divided into

Starchy and Non-Starchy Vegetables; Meat Group is disseminated into Lean and Medium

Fat choices while the Combination category is further sub-grouped as Meat and Meat

Substitute plus Non-Starchy Vegetables, Meat (Medium Fat) plus Starchy Vegetables and

Meat plus Cereal Group.

Accordingly, seven TPDs are listed in the Bean and Lentil Group with a mean contribution of 10.75±1.36 grams of carbohydrate, 6.98±0.96 grams of protein and

10.72±0.81 grams of fat; while each Traditional Pakistani Dish presents a different serving size and weight. Channay Ki Daal Aur Kudu (Split Bengal Gram & Bottle Gourd Gravy) contributes 1/2 cup and 100 grams to the food exchange system while Daal Mash (White

Lentil) and Daal Moong (Petite Yellow Lentil) both enlists a serving size of 1/3 cup (78 grams). The serving size of Kabuli Chanay Ka Salan (Chickpeas Curry) and Kadhi

Pakora(Gram Flour & Sour Yogurt Gravy with Fritters) is 1/2 cup with110 grams of weight. Kalay Chanay Ka Salan (Brown Bengal Chickpeas Curry) and Saboth Masoor Ki

Daal (Brown Lentil) also shows a serving size of 1/2 cup but with varying weight of 106 grams and 123 grams respectively. The p value for all the macro-nutrient is more than 0.05 indicating that there is no statistical difference between the values of macro-nutrients within the group.

The Cereal Group lists two TPDs which includes Matar Pulao (Rice with Peas) and

Sabzi Pulao (Vegetable Rice), each contributing 1/2 cup of serving to the exchange and a mean value of 16.43±0.07grams of carbohydrates, 2.83±0.02grams of proteins, 12.73±0.03 99 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES grams of fat and 191.66±0.11 kilocalories. Next on the list is Traditional Pakistani Meat

Dishes which are categorized into lean and medium fat. Murgh Handi (Chicken in a Pot),

Murgh Karahi (Chicken in Wok) and Murgh Korma (Chicken Curry) all were listed in the

Lean Meat Group with 1/4 cup of each contributing 2.62, 3.64 and 3.74 grams of carbohydrate; 6.11, 7.02 and 6.48 grams of protein; and 11.52, 10.75 and 11.13 grams of fat respectively. However, none of the macro-nutrient showed any statistical difference within the group as the p value is more than 0.05 for all of the macro-nutrients. Bhuna

Keema (Stir Fried Mutton Mince), Keema Pyaaz (Mutton Mince with Onions) and Keema

Shimla Mirch (Mutton Mince with Bell Pepper) are all grouped under the Meat dishes

(Medium Fat) and the group presented a mean value of 2.68±0.43 grams for carbohydrates,

7.81±0.39 grams for proteins, 14.39±0.30 grams fat and 171.46±2.18 kilocalories. The p value for all the macro-nutrient is ≥ 0.05 indicating that there is no statistical difference within the group of each macro-nutrient.

Bhindi Pyaaz (Okra with Onions) and Tori Chapni (Cousa Squash Gravy) are two

TPDs that are listed under the Vegetable (Non-Starchy) group. These dishes contributes 1/3 cup serving size to the exchange system with a mean value of 104.85±0.22 kilocalories, and p value range of .854 to .997, indicating that there is no statistical difference within the group as all the values are more than 0.05. The TPDs that are grouped under the umbrella of Starchy Vegetables includes Aloo Bhujia (Potato Gravy), Aloo Gobi (Potato Cauliflower

Mix), Aloo, Matar, Gajjar (Potato, Peas & Carrot Mix) and Arbi baigan ki bhujia (Taro &

Eggplant Gravy). The carbohydrate content of the Starchy Vegetable Group varies from

10.95grams per serving of Aloo Gobi (Potato Cauliflower Mix) to 11.72 grams per serving of Arbi Baigan Ki Bhujia (Taro & Eggplant Gravy); however the variation within the group showed no statistical difference as the p value is .840. Similar results are also seen for 100 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES protein, fat and energy with a mean value of 3.63±0.54 grams protein, 9.70±0.46 grams fat and 147.34±0.55 kilocalories per serving with a p value of .669, .989 and .073 respectively.

The traditional Pakistani cuisine also combines two food groups in different TPDs and as such Anday ka Khagina (Scrambled Eggs with Vegetables), Kudu Gosht (Bottle

Gourd & Mutton Gravy), Palak Gosht (Spinach & Mutton Gravy) and Shaljam Gosht

(Turnips & Mutton Gravy) are clustered under the Meat and Meat Substitute (Medium Fat) plus Non-Starchy vegetables. The mean contribution of the carbohydrate content is

4.13±0.22 grams per serving with Kudu Gosht (Bottle Gourd & Mutton Gravy) representing the lowest value of 3.97±0.07 grams per serving and Shaljam Gosht (Turnips

& Mutton Gravy) the highest value of 4.35±0.02 grams per serving. Nevertheless, a significance factor of p ≥ 0.05 reveales no statistical difference within group for any of the macro-nutrient.

The Pakistani cookery also combines starchy vegetables mainly potatoes and peas in various TPDs in the form of combination dishes that include Aloo Gosht (Potato &

Mutton Curry), Aloo Keema (Potato & Mutton Mince) and Matar Keema (Peas & Mutton

Mince). The mean energy contribution of the group is 156.07±1.06 kilocalories per serving; the mean contribution for fat is 11.34±0.59 grams per serving with Aloo Gosht (Potato &

Mutton Curry) touching the lower bound with 10.93±0.12 grams per serving and Aloo

Keema (Potato & Mutton Mince) the upper bound with 11.93±0.09 grams per serving.

However, the protein and carbohydrate content of Aloo Keema (Potato & Mutton Mince) is lowest amongst the group, that is, 6.62±0.02 grams for protein and 5.66±0.04 grams per serving respectively. Like other groups this group also exhibits no statistical difference amongst the macro-nutrient content as the p value is more than 0.05. 101 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Finally, amongst the one-pot combination dishes of meat, both lean and medium fat are seen with cereal (rice) as Murgh Biryani (Boiled Rice, layered with Chicken Gravy) and Yakhni Pulao (Rice in Mutton Broth). These TPDs show little variation in the carbohydrate and protein content which is reported as a mean value of 15.98±0.05 grams per serving and 9.44±0.0 6 grams per serving respectively, with a standard deviation of

≤0.10. However, the fat content shows a SD of 2.59 grams per serving, but the p value remains more than ≥0.05.

102 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

4.4. Development of Meal-Planning Exchange List for Traditional Pakistani Dishes

The final step of the current study is to present the data in a meaningful manner and in a format that is user friendly so that it could be used as a tool for calculation of Traditional

Pakistani Meals with easy. Table 4.9 presents the MPEL for TPDs. This is also presented as a Toolkit for Meal Planning (Appendix N) for ease and convenience of use.

103 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Table 4.9

Meal-Planning Exchange List for Traditional Pakistani Dishes

Beans and Lentils Each Serving = 11 grams carbohydrate, 7 grams protein, 11 grams fat, 170 kilocalories

Traditional Pakistani Dishes Measure (Cups) Weight (Grams)

Channay Ki Daal Aur Kudu 1/2 100.00 Daal Mash 1/3 78.00 Daal Moong 1/3 78.00 Kabuli Chanay Ka Salan 1/2 110.00 Kadhi Pakora 1/2 110.00 Kalay Chanay Ka Salan 1/2 106.00 Saboth Masoor Ki Daal 1/2 123.00

Cereals Each Serving = 16 grams carbohydrate, 3 grams protein, 13 grams fat, 190 kilocalories

Matar Pulao 1/2 88.00 Sabzi Pulao 1/2 82.50

Meat (Lean) Each Serving = 3 grams carbohydrate, 7 grams protein, 11 grams fat, 140 kilocalories

Murgh Handi 1/4 56.00 Murgh Karahi 1/4 52.00 Murgh Korma 1/4 62.00

Meat (Medium Fat) Each Serving = 3 grams carbohydrate, 8 grams protein, 14 grams fat, 170 kilocalories

Bhuna Keema 1/4 51.50 Keema Pyaaz 1/4 60.00 Keema Shimla Mirch 1/3 79.00

Vegetable (Non-Starchy) Each Serving = 4 grams carbohydrate, 2 grams protein, 9 grams fat, 105 kilocalories

Bhindi pyaaz 1/3 76.00 Tori Chapni 1/3 78.00

Vegetable (Starchy) Each Serving = 11grams carbohydrate, 4 grams protein, 10 grams fat, 150 kilocalories

Aloo Bhujia 1/3 79.00 Aloo Gobi 1/2 119.00 Aloo, Matar, Gajjar 1/2 89.00 Arbi baigan ki bhujia 1/2 106.00

Combinations Meat & Meat Substitute (Medium Fat ) + Non-starchy vegetables Each Serving = 4 grams carbohydrate, 7 grams protein, 11 grams fat, 145 kilocalories

Anday ka Khagina 1/3 67.00 Kudo Gosht 1/2 115.00 Palak Gosht 1/4 61.50 Shaljam Gosht 1/4 81.00

Meat (Medium Fat) +Starchy Vegetables Each Serving = 6 grams carbohydrate, 7 grams protein, 11 grams fat, 155 kilocalories

Aloo Gosht 1/2 115.00 Aloo Keema 1/3 72.00 Matar Keema 1/4 54.00

Meat + Cereal Each Serving = 16 grams carbohydrate, 9 grams protein, 9--12 grams fat, 195 kilocalories

Murgh Biryani ¾ 138.00 Yakhni Pulao 2/3 126.50 104 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

The developed MPEL for TPDs clearly groups the most commonly consumed dishes in nine categories. A common denominator of macro-nutrient and energy delineates each group but the serving size and weight of each dish is contributing is different. Seven TPDs are grouped under Bean and Lentils contributing 11 grams of carbohydrate, 7 grams of protein, 11 grams of fat and 170 kilocalories per serving.

However, the serving size and weight are different for each of the Bean and Lentil

Dish. Channay Ki Daal Aur Kudu (Split Bengal Gram & Bottle Gourd Gravy) contributes1/2 cup and 100 grams while Daal Mash (White Lentil) and Daal Moong

(Petite Yellow Lentil) both have a serving size of 1/3 cup and weight of 78 grams. The serving size of Kabuli Chanay Ka Salan (Chickpeas Curry) and Kadhi Pakora (Gram

Flour and Sour Yogurt Gravy with Fritters) is 1/2 cup and 110 grams while Kalay

Chanay Ka Salan (Brown Bengal Chickpeas Curry) and Saboth Masoor Ki Daal

(Brown Lentil) also show a serving size of 1/2 cup but with varying weight of 106 grams and 123 grams respectively.

Two TPDs namely Matar Pulao (Rice with Peas) and Sabzi Pulao (Vegetable Rice), are positioned in the Cereals, each contributing 16 grams carbohydrate, 3 grams protein, 13 grams fat and 190 kilocalories with a serving size of 1/2 cup and weight of 88 grams and 82.50 grams respectively. Three TPDs namely Murgh Handi (Chicken in a Pot),

Murgh Karahi (Chicken in Wok) and Murgh Korma (Chicken Curry) are all seen in the

Lean Meat category with 1/4 cup of each contributing 3 grams carbohydrate, 7grams protein and 11grams fat and 140 kilocalories to the energy content . Bhuna Keema (Stir

Fried Mutton Mince), Keema Pyaaz (Mutton Mince with Onions) and Keema Shimla 105 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Mirch (Mutton Mince with Bell Pepper) are all grouped under the Meat (Medium Fat)

category and each serving in the amount stated contributes 3 grams carbohydrate, 8

grams protein, 14 grams fat with 170 kilocalories. The serving size and weight of each

dish is however, different as Bhuna Keema (Stir Fried Mutton Mince), Keema Pyaaz

(Mutton Mince with Onions) present 1/4 cup serving with 51.50 grams and 60 grams of

weight respectively while Keema Shimla Mirch (Mutton Mince with Bell Pepper)

exhibits a serving size of 1/3 cup (78 grams).

The Traditional Vegetable Pakistani Dishes are divided into Non- Starchy and

Starchy Vegetables. Amongst the Non-Starchy Vegetables Bhindi pyaaz (Okra with

Onions) and Tori Chapni (Cousa Squash Gravy) are grouped together while contributing

4 grams carbohydrate, 2 grams protein, 9 grams fat and 105 kilocalories; both contributing 1/3 cup serving size to the exchange system. The category of the Starchy

Vegetables embraces four TPDs which includes Aloo Bhujia (Potato Gravy), Aloo Gobi

(Potato Cauliflower Mix), Aloo, Matar, Gajjar (Potato, Peas & Carrot Mix) and Arbi

Baigan Ki Bhujia (Taro and Eggplant Gravy). Each dish contributes a varying size and weight but all are represented with 11 grams carbohydrate, 4 grams protein, 10 grams fat and 150 kilocalories.

Thirty TPDs identified in the first phase of the study as the most popular dishes are grouped into nine categories as per the contribution to the food group and macro- nutrient content. Out of these six categories represents a single food group whereas three comprises of one-pot combination dishes. The combination group of Meat and Meat

Substitute (Medium Fat) and Non-Starchy vegetables lists four TPDs which includes

Anday ka Khagina (Scrambled Eggs with Vegetables), Kudu Gosht (Bottle Gourd & 106 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Mutton Gravy), Palak Gosht (Spinach & Mutton Gravy) and Shaljam Gosht (Turnips &

Mutton Gravy) each providing 4 grams carbohydrate, 7 grams protein, 11 grams fat and

145 kilocalories in the respective stated serving size. The Meat (Medium Fat) and Starchy

Vegetables groups three TPDs, namely Aloo Gosht (Potato & Mutton Curry), Aloo

Keema (Potato & Mutton Mince) and Matar Keema (Peas & Mutton Mince). The energy contribution of 155 kilocalories encompasses 6 grams carbohydrate, 7 grams protein and

11 grams fat per serving. The last category groups Meat (both Lean & Medium Fat) and

Cereal (rice) together which includes Murgh Biryani (Boiled Rice layered with Chicken

Gravy) and Yakhni Pulao (Rice in Mutton Broth). This group provides a range of 9—

12grams for fat as it envelops the variation of fat content for different meat choices since lean and medium fat are both presented in the same group.

107 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

CHAPTER 5

DISCUSSIONS AND CONCLUSION

5.1. Discussion

The current study aimed at developing an instrument which could be used as a tool for estimation of dietary intake of people with Pakistani origin. The developed tool incorporates Traditional Pakistani Dishes (TPDs) in a Meal-Planning Exchange List

(MPEL) so as to provide a framework which could be used by individuals and health care professionals in planning daily meals with reference to the food and dishes routinely consumed.

There are no gold standards in MPEL as dietary preferences and cooking regimen varies from country to country and even within countries. In line with the guidelines provided by American Dietetic Association and American Diabetic Association (1995) for development of MPEL, many similar studies were able to develop culturally sensitive tool which took into account the foods native to the population for which the

MPEL was formulated (Fadupin, 2009).

This study is first of its kind in Pakistan as it takes into consideration distinctive cooking methods which are used in preparation of the TPDs. Convincing data is not available regarding the nutrient composition of cooked Pakistani dishes which in turn is imperative for correct estimation of nutrient intake (Hakeem, 2013). The Food

Composition Tables of Pakistan (FCTP) 2001, developed by the Department of

Agriculture Chemistry, NWFP Agriculture University, Peshawar, UNICEF and Ministry of Planning and Development, Government of Pakistan, Islamabad enlists a few varieties of raw and cooked Pakistani foods. 108 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

However, it has been noticed that the nutritive value of cooked TPDs was actually higher than the ones reported in the FCTP (Hakeem, 2013) because it does not take into account the distinct cooking methods. Besides the above, insufficient data also exists regarding the most commonly consumed TPDs and their recipes (Vyas et al., 2003), which further exemplifies the uniqueness of this study as it depicts both the highlighted aspects.

This study was conducted in Lahore, the capital city of Punjab, which is the largest province of Pakistan in terms of population, as it houses approximately 56% of the Pakistani population (Population Census, 1998). Unfortunately, till date no updated population census has taken place, however the Bureau of Statistic Pakistan estimates a yearly population projection and data reveal that till December, 2013, 55.57 % population of Pakistan is still living in the Punjab Province. Lahore is a Mega Metropolitan City of

Pakistan (Punjab Local Government Act 2013), apart from ranking forty second in the world (Demographia World Urban Areas, 2013) in terms of urbanization. Lahore known as the city of schools, colleges and gardens; is an educational hub and hosts numerous institutions some with a history of over a hundred years. The past two decades has seen it evolve as a commercial center with a lot of industries making this city their headquarters.

This makes Lahore the center point of economic, social, cultural and educational activities and homes individuals from all walks of life across Pakistan, making it an appropriate representative of the country.

Qualitative data; which comprised of identifying the most common TPDs and their recipes, was collected from the housewives across Lahore. Attention was given to 109 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES include all the areas of Lahore by inclusion of all towns of the city through multistage random sampling technique; where randomly selected UCs were the primary sampling unit while randomly selected households formed the basic sampling unit and the housewives who were responsible for cooking food for their families became the actual participants of the study. The researcher was unable to take the specific cultural background of the participants into consideration which remained as one of the limitation of the study. Extensive coverage of the nine administrative towns of Lahore during the sampling procedure, however, provided the cultural insight in the dietary pattern of Pakistan which was important to the study as it provided baseline data for the research.

Focus group discussion (FGD) was used appropriately for data collection for this part of the study as this methodology is culturally responsive and is easy to work with a varied range of population (Rodriguz, Schwartz, Lahman & Geist, 2011). FGD has been used for over 80 years (Morgan, 1998) as a reliable medium for collecting qualitative data (Madriz,2000) however, its use in the field of nutritional research was very novel in

Pakistan as the method provided the housewives a congenial environment where they could freely express their viewpoints (Krueger & Casey, 2000). The participants of the

FGD actively took part in the discussion while sharing their cooking methods and coming up with approximate recipes as the setting provided by focus group created an atmosphere which was socially oriented (Krueger, 2000) in such a way that it gave them a sense of belongingness (Peters, 1993). It was interesting to observe the enthusiasm of the housewives as they involved themselves while answering simple questions like

“Which TPDs did you cook at home during the last week?” The participants shared that 110 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES they have never been involved in any research study of this type previously and wanted that the findings be shared with them. Themes and sub-themes emerged from constant comparison analysis, (Leech and Onwuegbuzie, 2008) used to tabulate the narrative data retrieved from the FGD which highlighted various aspects of Pakistani cookery.

Constant comparison analysis showed that all TPDs share a common base recipe comprising of onions and tomatoes sautéed in oil, which in turn contributes significantly to the overall energy content of the TPDs. This variability in the nutrient content is easily observable while comparing data from the current study with the FCTP (2001) in which100 grams of cooked Daal Mash (White Lentil) yields 158 kcal with 22.5 grams carbohydrate, 10.6 grams protein and 1 gram of fat; whereas the same amount of Daal

Mash (White Lentil) when cooked in the traditional Pakistani style contributes 14.73 grams of carbohydrate, 10.18 grams protein, 12.96 grams fat and 216.28 kilocalories.

This re-emphasizes the importance of cooking methods for assessment of the nutritive composition of TPDs.

Other aspects which were highlighted during the FGD along with the cooking methods and techniques, was the preference for certain meat type and it was observed that out of the four kinds of meat available in Pakistan namely beef, mutton, chicken and fish; only mutton and chicken are more commonly used in the Pakistani cuisine. Similar fondness for a particular type of meat is also seen in the Cajun cooking which basically focuses on seafood and pork; besides this aged chicken is also part of the cuisine but mutton is rarely seen on the table of Cajuns’ (Brasseaux, 2000). Furthermore, specific meat preference was also seen for specific TPDs like chicken is preferred for “Murgh

Biryani” (Boiled Rice layered with Chicken Gravy) and mutton for “Yakhni Pulao” (Rice 111 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES in Mutton Broth). Meat preference for specific TDs of various cultures is also observed as beef is the choice meat for the traditional Jordanian Malfouf mihshy (cabbage leaves stuffed with rice and minced beef) dish (Bawadi & Al Sahawneh, 2008); fish for Malian

Zamai, riz gras (fried rice with blue fish and vegetables) and turkey for mole poblano'

(turkey in deep- brown sauce) a typical Mexican dish (Cusack, 2000). In Pakistan, choice meat for TPDs prepared from a single main ingredient was chicken like Murgh Karahi

(Chicken in a Wok), Murgh Handi (Chicken in a Pot) and Murgh Korma (Chicken

Curry); whereas, Jordanian cookery combines chicken with potatoes and onions in typical

Jordanian dishes like Djaj ma’ batata (broiled chicken & potatoes) and Djaj mhamar

(roasted chicken with onions) respectively (Bawadi & Al Sahawneh, 2008). Mutton is used in combination with non-starchy and starchy vegetables as one-pot combination dishes in Traditional Pakistani Cookery like Kudu Gosht (Bottle Gourd & Mutton

Gravy), Shaljam Gosht (Turnip & Mutton Gravy), Palak Gosht (Spinach & Mutton

Gravy) and Aloo Gosht (Potato & Mutton Curry); while meat (beef) is either cooked alone as “Kafta b’ tehineh (broiled kabab with sesame paste) or in combination with starchy vegetables like “Kibbeh b’batata (baked layers of mashed potatoes and minced beef) and non-starchy vegetable dish of “Tabakh roho”(eggplant cooked with beef & tomatoes) in a typical Jordanian Cuisine (Bawadi & Al Sahawneh, 2008). Similarly, the

Traditional Nigerian cuisine “Egusi and Efo” (Sanusi & Olurin,2012) combines assorted meats including (Crayfish, Prawns, Beef, Ponmo, Goat meat, Cow leg, Shaki and other offals) with Efo Elegusi (pumpkin leaves) spinach and Bitterleaf in a one-pot combination dish. 112 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Additionally, the qualitative data retrieved from FGD is also presented in tabular form using classical content analysis. Relevant frequency and percentage frequency was used to identify the most commonly consumed TPDs. FGD put across the actuality that the TPDs are quiet varied and ranged from dishes of the meat group like “Chapli Kabab”

(mince beef patty) and Tali Machli (fried fish) to simple Aloo ki Bhujia. Furthermore, different indigenous foods are used like the flower of ehony Bauhinia variegate

(Kachnar) which is cooked as a novel vegetable; though the prevalence of consumption was only 26% mainly because of its tenure of availability as ehony Bauhinia variegate has to be picked and cooked in its budding form; and radish pods (Mungaray) which are also cooked as a vegetable especially in combination with potatoes (Mungaray Aloo).

Similarly, pumpkin flower (Kohnda Phool) and sunhemp flower (Sanai Phool) are part of the native foods consumed in Jharkhand, India (Ghosh-Jerath, Singh, Kamboj,

Goldberg, & Magsumbol, 2015).

Food or dishes selected to be part of any FEL is generally based on the most commonly consumed food (Coulibaly et al., 2009; Sanusi & Olurin, 2012) or most frequently prepared food in the household (Bawadi, Al-Shwaiyat, Tayyem, Mekary, &

Tuuri, 2009). The current study took into account both aspects which remains the strength of the study while including 30 dishes as part of the study remains one of the limitation as previously conducted two similar studies in Jordan formulated the MPEL with 80 commonly consumed dishes (Bawadi & Al-Sahawneh, 2008; Bawadi et al.,

2009). 113 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

A total of 53 TPDs were identified from the FGD; initially the study aimed at including only 20 TPDs but in the light of the current results a cut off line of 60% was used so as to assure the inclusion of commonly consumed dishes and as such 30 dishes were identified which made the foundation of the study. The second step in this sequential study was aimed at preparation of the selected TPDs so that the ingredients could be quantified using the recipes retrieved from the FGD. This provided an insight into the constituents of the TPDs as preparation of these dishes involves the use of more than one basic ingredient which in turn is important for the overall assessment of energy consumption (Liaqat, Khan, & Mohammad, 2009).

Estimation of nutrient content of the prepared TPDs was done through proximate analysis (AOAC, 2006) instead of reverting to Food Composition Tables or the Nutrient

Data for Standard Reference (USDA, 2012); so as to take into account the variability of the cooking methods (Hakeem, 2013). Standard procedures provided by the AOAC,

(2006) are routinely used for the estimation of nutrient content of raw (Sharif et al.,

2015), cooked (Gokoglu, Yerlikaya, & Cengiz, 2004) and processed food (Sade, 2009).

Qualitative and quantitative data retrieved from the first three steps was interpreted through the use of “triangulation” for the development of MPEL for TPDs.

“Triangulation” is widely used in qualitative and mix method research for the purpose of gaining profound insight in the phenomenon being studied; as it is based on the principle that two known points can be used to locate the third unknown point in a form of a triangle (Thurmond, 2001). Various types of “triangulation techniques” are implied for interpretation of mix method as the strength of this technique lies in the fact that it uses both qualitative and quantitative data in a single study (Cobb, 2000) providing a 114 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES multifaceted view regarding the research problem being studied (Foss & Ellefsen, 2002).

“Theoretical triangulation” was the most fitting type of “triangulation” for the interpretation of data for the current study as it enables the researcher to go about in a cyclical manner between data collected and data analysis till a conclusion is reached.

In the current study, the three sides of triangulation include categorization of the

TPDs in the relevant food groups based on the ingredients of the recipes; while grouping the TPDs under a representative food group became the second side; and finally adjusting the serving size of each TPD within the group in such a way that each TPD in the amount stated could be used interchangeably giving way to the MPEL for TPDs. This is presented using the mean reading of each nutrient for each group, thus becoming the founded third side.

MPEL for TPDs is developed systematically in a step wise procedure using both qualitative and quantitative data. Initially the 30 selected TPDs were disseminated into their relevant food group as per the ingredients of the recipes, hence formulating one side of the “triangle”. Grouping of food into various categories is usually done by taking in view biological classification and nutritional properties, mainly the macro-nutrient content. The micro-nutrient content is not taken into consideration while grouping foods into its relevant category due to the vast diversification within the group and the fact that majority of the micro-nutrient are either water soluble or heat viable and are easily lost during process of cooking and as such a standard cannot be maintained due to difference of preparation and cooking methods.

Initially, United States Department of Agriculture took the initiative of grouping food according to its nutrient content in 1916 (USDA, 1917-1918) and between then and 115 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES now the number of food groups has varied from four to twelve with the aim of providing a balanced diet based on the macro-nutrient content (ADA, 2008).

However, diversifications has been observed in grouping of different foods amongst various cultures especially for the beans and lentil group since it branches out globally in different ways as it is considered a representative of both carbohydrate and protein. Therefore, food listed under this category varies among different cultural FEL depending upon how food item is perceived within the culture regarding its nutritional contribution to the diet. “The Apple of Health” a culturally sensitive FEL for Mexican population has placed beans in two different groups, that is, grains and meat group. Beans is the staple for the Mexicans and therefore generally it is placed in the grain category but since it is also the source of protein for majority of the middle and low income classes in

Mexico it also finds a place in the meat and meat substitute group (Jiménez-Cruz, et al.,

2003).Similarly, Korean FEL enlists pulses and products in the Meat-Medium fat category (Korean Diabetes Association, 2010).

On the other hand Indian FEL “Exchange List for Indians with Diabetes” has placed cooked legumes in the Meat and meat substitute (very lean) group while beans, peas, garbanzo and lentils are placed in the starch group (Patel, 2011). The current study categorizes Kabuli Chanay ka Salan (Chickpeas Curry), Kalay Chanay ka Salan (Brown

Bengal Chickpeas Curry), Daal Moong (Petite Yellow Lentil), Daal Mash (White Lentil) and Saboth Masoor ki Daal (Brown Lentil) cooked in the traditional way under the bean and lentil group. These TPDs are true representative of the group, but besides this two one-pot dishes namely Channay Ki Daal Aur Kudu (Split Bengal Gram & Bottle Gourd 116 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Gravy) and Kadhi Pakora (Gram Flour & Sour Yogurt Gravy with Fritters) are also listed in the above group. The inclusion of TPD Channay Ki Daal Aur Kudu (Split Bengal

Gram and Bottle Gourd Gravy) made from “Kudu” (bottle gourd) and “Channay Ki

Daal” (split chickpeas) is based on the nutrient content as the dish is more representative of the bean and lentil group compared to the vegetable group in terms of its macro- nutrient contribution. Similarly, Kadhi Pakora (Gram Flour and Sour Yogurt Gravy with

Fritters) which is a TPD made by cooking gram flour and sour yogurt together and adding “Pakora” (fritters) made from a batter of gram flour, onion, coriander leaves and spices. This dish is categorized under the bean and lentil group as the main ingredient is gram flour which is made from chickpeas and besides the “Pakora” (fritters) are also made from gram flour.

Grouping different foods under the same roof in a particular food group largely depends on the importance of the food group in the meal pattern, and how the ethnicity of a society perceives it. The cereal or the grain group generally represents the main course or base of dietary pattern in various cuisines and as such foods are grouped accordingly

(USDA, 1995). Potatoes found their place in the grain group and so did starch jelly and chestnuts in the Korean FEL (KDA, 2010) as these foods form either the main course or side dish in Korean cuisine. In the developed MPEL for TPDs “Matar Palao” (Rice with peas) and “Sabzi Palao”(Vegetables rice) which includes potatoes, carrots and peas cooked together with rice are grouped in the cereal group which is similar to the grouping of the Indian FEL where potatoes, peas and rice both are placed in the same group except that the title of the group is “Starch Exchange” in place of cereal (Patel, 2011). The North

American FEL also places rice, potatoes and peas in the “Starch Exchange” (ADA, 2008) 117 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES but has further sub categories which place rice under cereal whereas potatoes and peas are placed under starchy vegetables.

Meat and meat substitutes are also grouped in a multifarious manner in different

FELs depending upon its cultural relevance as Malian FEL simply includes protein rich foods such as beef, mutton, chicken, fish and eggs in the list (Coulibaly, O’Brien &

Galibois 2009); while variations like beef, mutton, chicken, fish, evaporated milk, powdered milk, cowpea cooked, cowpea pudding and peanut are seen in the Nigerian

FEL (Fadupin, 2009). On the other hand the North American FEL (ADA, 2008) has sub- categorized Meat and Meat Substitutes into three categories namely lean selection, medium fat selection and high fat selection depending on the percentage of fat each type of meat contributes to the exchange; enlisting egg whites, fish and chicken in the lean selection, whole eggs, veal, beef and lamb in medium selection and bacon along with processed meats in the high fat selection (ADA, 2008). Similarly the FEL for “Indians with diabetes” have grouped the meat and meat substitutes according to the ADA list but further adds another group to it as very lean which includes cooked legumes and farmer cheese /curd cheese (Patel, 2011). Comparable to the pattern of ADA (2008), MPEL for

TPDs places meat dishes into categories namely lean and medium fat selection; dishes made from mutton mince like Bhuna Keema (Stir Fried Mutton Mince) Keema Pyaaz

(Mutton Mince with Onions) and Keema Shimla Mirch (Mutton Mince with Bell Pepper) are cited in the medium fat section while dishes made from chicken, that is, Murgh Handi

(Chicken in a Pot), Murgh Karahi (Chicken in Wok) and Murgh Korma (Chicken Curry) are listed in the lean selection. 118 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Similarities are observed in the FEL of different countries yet categorization of vegetables is seen with variation and different approaches are used for grouping of vegetables (Slavin & Lloyd, 2012). The cataloging is generally based on the botanic family, nutritional composition or part of plant consumed (Pennington & Fisher, 2008).

The Southwestern Nigerian FEL has grouped vegetables according to edible part of the plant and has placed cassava and yam under the Roots and Tubers Group (Sanusi &

Olurin, 2012) while North American FEL has enlisted these vegetables under “Starches” with a sub-group of “Starchy Vegetables” (ADA, 2008). The Indian FEL applies the same parameter for classification of vegetables and groups starchy vegetables with the starch group and non-starchy vegetables are listed under the vegetable exchange (Patel,

2011). Similarly, the North American FEL lists non-starchy vegetables as a separate group (ADA, 2008). Using the same references the presented MPEL for TPDs has also categorizes the vegetable group on similar lines by placing Bhindi Pyaaz (Okra with

Onions) and Tori Chapni (Cousa Squash Gravy) in the non-starchy vegetables and Aloo

Bhujia (Potato Gravy) in the starchy vegetable category. However, an atypical trend is observed in the traditional Pakistani vegetable dishes as a general inclination is seen in combining various vegetables as one-pot dish like “ Aloo Ghobi” (Potatoes &

Cauliflower), “Aloo, Matar, Gajjar (Potatoes, peas, carrots) and “Arvi baygan ki bhujia”

(Taro & Eggplant). These dishes combine starchy with non-starchy vegetables like potatoes which is a starchy vegetable is cooked with non-starchy vegetables like cauliflower, eggplant and carrots. Nevertheless, these TPDs are placed in the starchy vegetable group as its nutrient contribution, is more representative of this group compared to the non-starchy vegetable group. 119 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Similarly, one-pot combination dishes is also seen as part of Pakistani cookery in which meat (medium fat) is cooked in combination with starchy and non-starchy vegetables and as such separate groups have been identified in the developed MPEL for

TPDs.

Meat & Meat Substitute (medium fat) and Non-starchy vegetable group includes

“Anday ka Khageena” (Scrambled Eggs with Vegetables) which is combination of eggs, tomatoes and onions, “Kudu Gosht” (Bottle Gourd & Mutton Gravy), Palak Gosht

(Spinach & Mutton Gravy), and Shaljam Gosht (Turnips & Mutton Gravy) are all combinations of non-starchy vegetables with mutton (meat group, medium fat).

Similarly, meat group, (medium fat) also combines with starchy vegetables in the preparation of “Aloo Gosht (Potato & Mutton Curry), Aloo Keema (Potato & Mutton

Mince) and “Matar Keema (Peas & Mutton Mince). Combination of meat both lean and medium fat with rice (Cereal Group) is also seen in dishes like “Murgh Biryani” (Boiled rice layered with Chicken gravy) and “Yakni Palao”( Rice in Mutton Broth) as one-pot combination dishes.

Typically such dishes are simply grouped together under combination foods like chicken nugget is equal to 1 carbohydrate, 2 medium fat meat and 1fat exchange; chow mein (without rice and noodles) is equal to 1carbohydrate and 2 lean meat exchange

(ADA, 2003); “Barazek” a traditional Jordanian dessert correspond to 1 starch, 2 fat exchanges (Bawadi et al., 2009). Similar pattern is observed in all the FELs while addressing cooked combination food as it is broken down into different food groups that contributed towards making of a combination dish. 120 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

Initially this research was also targeted towards this end but using the

“Theoretical Framework of Triangulation” this research went a step further by grouping the combination dishes into sub-groups, thus making the second side of the triangle.

Formulation of the third side of the “triangle” included adjusting the serving sizes of different TPDs in such a way that the mean was a representation of the whole, thus formulating the third side of the triangle. One way ANOVA was applied to assess the difference within the group and p value > 0.05 was indicative that there is no statistical difference (Sow, 2014) within the group for each macro-nutrient and as such in the amount stated the TPDs could be interchanged with each other (Cho et al., 2011).

Finally, MPEL for TPDs lists the cooked dishes under nine groups which includes Bean and Lentil, cereal, meat (lean), meat (medium fat), vegetables (non-starchy), vegetables

(starchy) and combinations which includes meat plus meat substitutes and non-starchy vegetables; meat(Medium Fat) plus starchy vegetables; meat plus cereal group. The Bean and Lentil group includes TPDs which contributes 11 grams carbohydrate, 7 grams protein, 11 grams fat and 170 kilocalories per serving. Similar values for protein and carbohydrate are seen in the Malian food exchange system in the Legume group with the exception of fat as it does not enlists fat and as such finds only 90 kilocalories to its credit

(Coulibaly, O’Brien & Galibois 2009). The difference in the fat content is probably due to the fact that the developed MPEL for TPDs takes into account the cooked dish and as discussed earlier the traditional Pakistani cooking method is based on sautéing onions and tomatoes in oil before the addition of the main ingredients, hence contributing a significant amount of fat to the cooked dishes. The North American Food Exchange list

(ADA, 2008) has grouped Beans, Peas and Lentils (cooked) together and therefore shows 121 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES slight variation in the macro-nutrient content, that is, 15 grams carbohydrates, 7 grams protein, 0-3 grams fat and 125 kilocalories per serving (ADA, 2008) the difference is seen in the carbohydrate and fat content which is possibly due to the difference in the cooking method. The Traditional Pakistani Bean and Lentil Dishes are cooked and presented in a gravy form, meaning that there is certain amount of moisture present in the final prepared dish, thus accounting for lower percentage of carbohydrate; nevertheless both the amounts of carbohydrates are representative of one carbohydrate exchange

(Wheeler et al., 1996).

Importance of a culturally sensitive MPEL cannot be over emphasized (Cho et al.,

2011) and per se the cereal group is seen under varying heading and macro-nutrient content like Malian Food Exchange System enlist its cereals and grains under the starch list caption contributing 28 grams carbohydrates, 3 grams protein, trace of fat with 125 kilocalories per serving (Coulibaly, O’Brien, Galibois 2009), while the Grains group in

Korean Food Exchange List contributes 23 grams carbohydrates, 2 grams protein and 100 kilocalories per serving (KDA,2010). The Nigerian Food Exchange List focuses only on the carbohydrate content and has listed its cereals under two serving sizes contributing 10 and 15 grams of carbohydrate per serving (Fadupin, 2009). The North American FEL has a main group of Starches which is sub-grouped as Breads and Flours; Cereal, Grains and

Pasta; Starchy Vegetables and Snacks all contributing 15 grams carbohydrates, 3 grams protein, 0-1 grams fat and 80 kilocalories per serving (ADA,2008); similar macro- nutrient values per serving is also seen in the “Food exchange List for Indians”

(AAPI,2011). Whereas, the developed MPEL for TPDs takes into account dishes cooked in the Pakistani style (addition of fat) and enlists “Matar Palao” (Rice with peas) and 122 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

“Sabzi Palao”(Vegetables rice) in the Cereal group which provides 13 grams fat besides

16 grams carbohydrates, 3 grams protein, and 190 kilocalories per serving; the protein content is similar to the Cereal and Grain group of the Food Exchange List of North

America, India and Mali likewise the carbohydrate content of the MPEL for TPDs presents a difference of only 1 gram per serving which equates to 1 exchange of carbohydrate (Wheeler et al., 1996) and is considered similar to the North American and

Indian FELs.

Meat dishes in the developed MPEL for TPDs are sub-grouped as lean and medium fat. The macro-nutrient content each contributes per serving is 3 grams carbohydrate, 7 grams protein, 11 grams fat, 140 kilocalories for the lean category and 3 grams carbohydrate, 8 grams protein, 14 grams fat, 170 kilocalories for medium fat respectively. Interestingly, it is observed that the meat dishes in this list are contributing a small amount of carbohydrate 3 grams per serving whereas no carbohydrate is listed in any of the FELs for the meat group as meat does not contain carbohydrate. This contribution of carbohydrate to the Traditional Pakistani Meat Dishes is mainly attributed to the Pakistani cookery style where a base is prepared in the form of “masala” (paste made from onions, tomatoes and oil) before the addition of meat. Similarly, variation in the fat content of the developed MPEL for TPDs may be ascribed to the cooking style as lean selection of the Traditional Pakistani Meat Dishes give 11 grams of fat in comparison with 0-3 grams fat in lean or low fat meat selection for Indian (AAPI, 2011),

Korean (KDA, 2010) and North American (ADA, 2008) FEL. Correspondingly, medium fat selection of Traditional Pakistani Meat Dishes contributes 14 grams fat per serving compared to 5 grams of fat in meat group (medium fat selection) for Indian (AAPI, 2011) 123 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES and Korean FEL (KDA, 2010) while the North American FEL offers a range of 4-7 grams fat per serving (ADA, 2008). Comparatively, Nigerian and Malian FEL just provides a single group of protein or meat and meat substitutes that provides 7 grams protein, 6 grams fat and 90 kilocalories without any sub-groups.

The vegetable group in the Food Exchange System by and large contributes 5 grams carbohydrate, 2 grams protein and 25 kilocalories per serving for the non starchy vegetables (AAPI, 2011; Coulibaly, O’Brien, Galibois 2009) while Korean FEL (KDA,

2010) contributes 3 grams carbohydrate, 2 grams protein and 20 kilocalories per serving.

The current study places the Traditional Pakistani Vegetable Dishes into two sub-groups non-starchy vegetables and starchy vegetables; similar categorization is seen in the North

American FEL but the amount of macronutrients each contributes varies largely because the developed MPEL for TPDs takes into account the traditional cooking method also.

Accordingly the listed Traditional Pakistani Non–Starchy Vegetable Dishes lend 4 grams carbohydrate, 2 grams protein, 9 grams fat and 105 kilocalories per serving; again the major variation and difference is seen in the amount of fat the group contributes against its counterparts. Likewise, the second sub-group, that is, Traditional Pakistani Starchy

Vegetable Dishes indicates having 11grams carbohydrate, 4 grams protein, 10 grams fat and 150 kilocalories per serving as against the starchy vegetable group of North America

(ADA,2008) and Indian FEL (AAPI, 2011) which contributes15 grams carbohydrate, 3 grams protein, 0-1 gram fat and 80 kilocalories per serving.

The combination dishes in the FELs are generally broken down into their relevant food groups like “Bean flour steamed” contributes 3 legume and 2.5 fat exchange in Malian FEL (Coulibaly, O’Brien, Galibois 2009) and “Kulfi” (traditional 124 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

South Asian Ice cream) contributes 1 carbohydrate and 1 fat exchange in Indian FEL

(AAPI,2011); whereas the North American FEL has listed macro-nutrients individually against each prepared food like “Muffins” (1oz.) as 15 grams carbohydrate and 3 gram fat and 1/2 cup of Regular Ice Cream as 15 grams carbohydrate and 10 grams fat (ADA,

2008).

The last segment of the developed MPEL for TPDs comprises of combination dishes; though all of the TPDs are combination dishes with the exception of a few; these one-pot dishes combines main food groups like meat group with non-starchy vegetables, starchy vegetables and cereals (rice) and as such are sub-divided into categories accordingly. The meat & meat substitute (medium fat) plus non-starchy vegetables contributes 4 grams carbohydrate, 7 grams protein, 11 grams fat and 145 kilocalories per serving size while one serving of meat (medium fat) plus starchy vegetables has 6 grams carbohydrate, 7 grams protein, 11 grams fat and 155 kilocalories. The nutrient content of both groups are similar in terms of protein and fat; and the only variation is seen in the carbohydrate content which is understandable as they represents non-starchy and starchy vegetables. Both groups appropriately represent the protein exchange with 7 grams of protein which is a standard representation of the meat group in terms of protein content

(Wheeler, et al., 1996 . Lastly meat & cereal group representing 16 grams carbohydrate, 9 grams protein, 9-12 grams fat and 195 kilocalories per serving. Thus, this provides an easy to the use framework to consumer for one-pot combination dishes so that they are able to interchange one TPD for another instead of calculating different food groups. 125 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

The developed MPEL for TPDs stands comparable to FEL developed by other countries like North America (ADA, 2008), Korea (KDA, 2010), India (APPI, 2011),

Mali (Coulibaly, O’Brien, Galibois 2009) and Nigeria (Fadupin, 2009).

This tool is ready to be used by individuals and health professionals as a tool for planning of diet plans with greater diversity and variety which in turn will ensure compliance on part of the individual as he or she will be able to swap one TPD for another.

126 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

5.2. Conclusion

Development of MPEL for TPDs is intricate involving the use of both qualitative and quantitative data in a sequential mix method exploratory approach. This implies addressing six objectives starting from identifying the most commonly used TPDs along with the ingredients used and technique of preparation; quantifying the said recipes during preparation; analyzing the prepared TPDs for its macro-nutrient content through proximate analysis; disseminating the TPDs into their relevant food groups; befitting the serving size of TPDs in the food exchange system by computing the macro-nutrient content of the drawn out serving size per dish and finally augmenting a MPEL for TPDs through integrating the results of both qualitative and quantitative data while employing

“triangulation”.

Conclusively, MPEL for 30 TPDs is prepared and is ready to be used. The MPEL has assembled the TPDs dishes into five main food groups. These food groups include:

Beans and Lentils, Cereal, Meat (Lean & Medium Fat), Vegetables (Starchy & Non-

Starchy) and Combination Group. Furthermore, the Combination Group also has specific

Combinations Categories of Meat (Lean & Medium Fat) plus Cereal Group; Meat

(Medium Fat) plus Starchy Vegetables; and Meat and Meat Substitute (Medium Fat) plus

Non-Starchy Vegetables.

Thus, it may be concluded that developing of MPEL for TPDs is achievable as a practical user-friendly tool which may be used to tailor-fit diet in dietary regimes for

Pakistanis using their traditional foods both in Pakistan and elsewhere.

This research study is the ground breaking research for TPDs and it is hoped that it will set roots for further similar study which will incorporate the whole Pakistani cuisine. 127 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

5.3. Recommendations

The research study was a challenging one as it was an exploratory study it gave an insight both to the cultural relevance of traditional dishes and its macro-nutrient content.

The researcher is convinced about the research design used and would like to recommend further studies based on the sequential design selected covering a complete range of traditional raw foods, other cooked traditional dishes and desserts. The recommendations could be listed as:

1. Trial for acceptability of the MPEL by patients and their families should be run in

outpatient wards of hospitals and health centers.

2. Use of the current developed MPEL for TPDs by health professional should be

encouraged by making this dietary tool readily accessible through policy and

governmental sector, so as to replace it with the food exchange list of ADA

currently used.

3. Software should be developed to make the MPEL for TPDs more user friendly.

4. Incorporate it as part of the nutrition education curriculum.

5.3.1 Recommendations for Further Research

1. Traditional raw foods should also be incorporated in the FEL like tuk

malanga (Basal seed drink), sardai (Drink made with almonds, poppy

seeds, pumpkin seeds, cantaloupe seeds and water melon seeds) are just

afew to mention.

2. FEL should also be developed for home made Traditional Pakistani

Desserts Dishes.

128 DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES

128

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1950 Food Values for Calculating Diabetic Diets

Group Amount Weight Carbohydrates Protein Fat Energy (grams) (grams) (grams) (grams) (calories)

Milk, ½ pt 240 12 8 10 170 whole

Vegetable, As ------Group A desired Vegetable, ½ cup 100 7 2 ------36 Group B

Fruit varies ------10 ------40 Bread varies ------15 2 ------68 exchanges Meat 1 oz 30 ------7 5 73 exchanges

Fat 1 tsp 5 ------5 45 exchanges

Source: Caso, E.K. (1950). Calculation of diabetic diets; Report of the Committee of Education, American Dietetic Association and diabetes Branch, United State Public Health Service. Journal of American Dietetic Association: 26: 575–82.

APPENDIX B

Comparison of Nutritional Values per Serving of the 1986 and 1976 A.D.A. Exchange Lists

1986 1976

Food Group CHO Protein Fat Energy CHO Protein Fat Energy

grams grams grams kcal grams grams grams kcal

Starch/Bread 15 3 -- 80 15 2 -- 70

Meat/meat Substitute

Lean -- 7 3 55 -- 7 3 55

Med.fat --- 7 5 75 --- 7 5.5 77.5

High Fat --- 7 8 100 --- 7 8.0 100

Vegetables 5 2 -- 25 5 2 -- 25

Fruits 15 -- -- 60 10 -- -- 40

Milk

Skim 12 8 ---- 90 12 8 ---- 80

Low fat 12 8 5 120 12 8 5 120

Whole 12 8 8 150 12 8 8 150

Fat ------5 45 ------5 45

Source: Easton, P.S., Harker, C.S., Higgins, C. E.& Mengel, .C.(1991).Nutrition Care of People with Diabetes Mellitus: A nutritional Reference for Health Professionals. Food products press(subsidiary of The Haworth Press Inc.), Binghamton, NY, pp. 24- 26.

APPENDIX D

Selected Union Councils as Primary Sampling Unit

Sr. Towns Selected Union Union No. of # Councils Council Households Code

1. Ravi Town Andaroon Bhaati Gate UC-29 11068 Shahdra UC-7 10751

2. Shalamar Town Begum pura UC-18 9820 Shad Bagh UC-23 9986

3. Wagha Town Salamat Pura UC-40 11175 Daroghawala UC-42 10879

4. Aziz Bhatti Mughal Pura UC-48 8558 Town Mian Meer UC-54 8664

5. Nishtar Town Boston Colony UC-134 9641 Farid Colony UC-137 8974

6. Data Gunj Kareem Park UC-69 9207 Bukhsh Town Mozang UC-79 11881

7. Gulberg Town Paak Daaman UC-75 10517 Makkah Colony UC-98 10017

8. Samanabad Rehman Pura UC-107 10167 Town Gulgasht Colony UC-88 8811

9 Allama Iqbal Niaz Baig UC-118 11480 Town Chungi UC-121 9018

APPENDIX E

INVITATION

FOCUS GROUP

DISCUSSION

SESSION: 1 HOUR (followed by refreshments)

YOU ARE REQUIESTED TO PARTICIPATE IN THE FOCUS GROUP DISCUSSION ON “DEVELOPING A MEAL-PLANNING EXCHANGE LIST FOR TRADITIONAL PAKISTANI DISHES”.

Time: 11 am

Dated: 10th May, 2014

Venue: Union Council Office, Lahore. APPENDIX F

Consent to Participate in Focus Group Study

The purpose of the group discussion and the nature of the questions have been explained to me. I consent to take part in a focus group to discuss Traditional Pakistani Dishes I make at home for my family.

My participation is voluntary. I understand that I am free to leave the group at any time. If I decide not to participate at any time during the discussion, my decision will in no way affect the services that I receive from the Union Council of my area of residence.

None of my experiences or thoughts will be shared with anyone outside the group unless all identifying information is removed first. The information that I provide during the focus group will be grouped with answers from other people so that I cannot be identified.

Please Print Your Name Date

______

Please Sign Your Name

______

APPENDIX G

Focus Group Discussion Guide

1. WARM UP AND EXPLANATION

A. Introduction 1. Asalam-o-Alikum and Good Morning. 2. I would like to welcome you and extend my gratitude for attending this discussion. 3. This discussion is part of a project that is being conducted to find out the common Traditional Pakistani Dishes 4. During this discussion, I will ask you a series of questions related to Traditional Pakistani Dishes. Please feel free to express your thoughts about Pakistani Dishes and how they are cooked. Your opinions and ideas are very important to us.

B. Ground Rules 1. Please remember that there is no right or wrong answers to any of these questions. Also, feel free to state your own viewpoints, feelings and personal experiences. 2. We want and need to hear from everyone here today. The more information we get from you, the more it will help us to develop a meal-planning exchange list that represents typical Pakistani dishes. 3. All comments are welcomed-both positive and negative. If you don’t have an answer or do not understand the question, it is okay to tell me so. It helps us even when you don’t have an answer to a question. Please feel free to express yourself especially if you disagree with someone else’s cooking method. 4. It is important to be honest, but please realize that you don’t have to say anything about yourself that makes you feel uncomfortable. 5. We are here to learn what you know about Traditional Pakistani Dishes and how you cook them. We want to learn from you. Your opinions are very valuable to us. If you should have any other query during the discussion please wait until the end of the discussion and we will be happy to answer any of your questions.

APPENDIX G

C. Procedure 1. Please remember that you will not be identified in any way so feel free to express yourself. 2. This discussion is strictly confidential. What you hear and what you say should not be shared with anyone outside this room. This information should stay here. 3. This is a group discussion, so you don’t have to wait for me to call on you. Please speak one at a time because that way everyone will hear what you say and it will make it easier for me to understand. Also, please be considerate of your fellow participants and give each other an opportunity to speak. If you have a soft voice, please speak a bit louder so that your comments will be clear. 4. We have a lot of information to go over, so I may have to change the subject at times or move ahead in the middle of our discussion. Please stop me if you want to add additional information that you feel is important to our discussion. 5. Our session will last about 1 hour. We will not take a break, but please feel free to get up and use the restroom.

D. Self-Introduction 1. Let’s start by introducing ourselves. As I said before, my name is Mahnaz Nasir Khan and I am a PhD schloar. 2. Now, please introduce yourselves. Give your name with a brief introduction about your family.

APPENDIX H

Focus Group Checklist

Remember to bring the following:

 Two writing pencils (in case the lead in a pencil breaks/or a pen runs out of ink  A notepad with sufficient paper for taking notes during the entire focus group  A flip chart  Dry eraser and or regular markers of different colors  Name tags or badges  Tape for affixing flip chart pages to the wall, as needed.  Extra tapes  Extra pens for participants if required  Focus group guide  Note taking form

APPENDIX I

Focus Group Question Guide

Question Type Question Opening What is your name and on which street do you live? Introduction How would you describe a Traditional Pakistani Dish?

1. Key or Main Think of Traditional Pakistani Dishes, what comes to your mind? Context or Probing Think back a month and share with us which were the most frequently cooked dishes at your home?

Process or Prompting What did you have for dinner last night? Do you have special meals at weekends?

Evaluation or Follow-up Name dishes you would typically consume at lunch and dinner? Does your family have any typical eating habits; I mean any special preferences. 2. Key or Main Which traditional dishes did you cook at home during the last week?

Context or Probing Has the type of dishes you cook or consume has changed since you got married? Process or Prompting Do you consider the likes and dislikes of your family members while deciding what to cook? Do you or your family members have a certain preference for the type of meat consumed? I mean in terms of beef, mutton, fish or chicken. Evaluation or Follow-up Is there any specific preference for the type of meat used in a particular Traditional Pakistani Dish? Could you name afew? 3. Key or Main How do you cook food at home? Please share your basic recipe for vegetables, lentils, beans and combination one- pot dishes. Context or Probing Is there a basic recipe you follow for cooking? Do you always cook each food item separately or in combination? Process or Prompting Which vegetables would you commonly add to meat? Do you cook each vegetable separately or combine two or more vegetables together. Evaluation or Follow-up Why do you combine different food items, I mean meat and vegetables? APPENDIX J

Consumer Acceptibility Form

Serial No. and name of Taditional Pakistani Dish

Please taste the given sample and rate it according to your acceptability

APPENDIX K

Recipe Name: Aloo Bhujia (Potato Gravy) Recipe Category: Starchy Vegetables Serving: 1/3 cup = 79 grams Yield: 1 ½ cup = 355.5 grams

Ingredients Weights Measures Directions

Aloo 500 grams (peeled 3 large Cut Aloo (potatoes) in square shape (3inches) (Potatoes) 422 grams)

83 grams (peeled Heat oil in a pan, add sliced onions and sauté Onions 1 medium 76 grams) until light brown.

Tomatoes 98 grams 2 small Add chopped tomatoes mix well and stir fry.

Add all the spices, add ¼ cup water to avoid Oil 3 tablespoon spices from burning

1 ½ Salt Cook for one minute till gravy thickens. teaspoon 1 ½ Red Chili Add Aloo (potatoes) along with 1 cup of water. teaspoon Cover the pan with lid, lower the flame and cook Turmeric ½ teaspoon until potatoes get tender. Dry When Aloo (potatoes) are done, cook till water coriander ½ teaspoon dries and the gravy thicken. powder Fresh For Serve hot and use fresh coriander leaves for coriander garnishing garnishing. leaves Recipe Name: Aloo Gobi (Potato Cauliflower Mix) Recipe Category: Starchy Vegetables Serving: = ½ cup=119 grams Yield: 4 ½ cups = 1071 grams

Ingredients Weights Measures Directions

1 kg (unpeeled) Gobi Cut Gobi (cauliflower) and Aloo (potatoes)

(Cauliflower) in cubes 519 grams (peeled and cut)

500 grams Aloo (unpeeled) Add oil in the pan and add ginger garlic 5 small (Potatoes) paste and stir fry for 1 minute. 420 grams (peeled and cut)

100 grams (cut Then add onions and fry them until they get Onions 1 medium and peeled 90 light brown color. grams) Add tomatoes (cut in small cubes) to make Tomatoes 112 grams 2 small gravy paste.

Add all the spices along with some water to Oil 7 Tablespoons prevent spices from burning.

Cook for one minute then add Gobi Ginger/garlic 1 Tablespoon (cauliflower) and Aloo (potatoes) along with paste 2 to 3 tablespoon of water.

Cover the pan with lid and let the vegetables Red chili 1 ½ teaspoon cook on low flame for 5 to 10 minutes.

When Gobi (cauliflower) and Aloo Salt 1 ½ teaspoon (potatoes) get tender and soft cook till water dries up.

Switch off the flame and serve Aloo Gobi Turmeric 1 teaspoon (Potato & Cauliflower Mix) hot.

Fresh coriander 1 bunch Use fresh coriander leaves for garnishing leaves Recipe Name: Aloo Gosht (Potato & Mutton Curry) Recipe Category: Combination Dish Meat (Medium Fat) + Starchy Vegetables Serving: 1/2 cup=115 grams Yield: 7 cups = 1610 grams

Ingredients Weights Measures Directions

Gosht Cut Aloo (potatoes) in square shape (3 350 grams (Mutton) inches). Keep aside.

500 grams Aloo Take oil in the pan, add onions and fry till (peeled and cut + (Potatoes) golden brown. 439 grams)

350 grams 2 large/3 Add tomatoes and all the spices along with Onions (peeled 336 medium some water to prevent them from burning. grams)

Cook for one minute or till the gravy is 250 grams (cut Tomatoes 4 small formed, and then add Gosht (mutton), yogurt 233 grams) and 1/2 cup of water.

Let it cook on low flame till Gosht (mutton) Oil 2/3 cup gets tender or use pressure cooker to save time.

Ginger garlic When Gosht (mutton) is done, remove the lid 2 tablespoon paste and cook till the oil separates. Keep stirring

Now add Aloo (potatoes), mix well, add 1/2 Salt 2 teaspoon cup water and cook till tender.

Red chili Add water and cook for five more minutes on 2 teaspoon powder medium flame to get the desired consistency.

Serve hot, and garnish with fresh coriander Turmeric 1 teaspoon leaves.

Yogurt ¼ cup

Fresh Coriander For garnishing Leaves

Recipe Name: Aloo Keema (Potato & Mutton Mince) Recipe Category: Combination Dish Meat (Medium Fat) + Starchy Vegetables Serving: 1/3 cup =72 grams Yield: 2 ¼ cup = 486 grams

Ingredients Weights Measures Directions

Keema Cut onions and Aloo (potatoes) into 250 grams ( Mutton Mince) cubes.

64 grams (peeled Take oil in the pan, add onions and fry till Onions 1 medium 50 grams) golden brown.

82 grams (peeled Add tomatoes Keema (Mutton Mince) and Tomatoes 1 medium 78 grams ) all the spices, along with 1/2 cup of water.

Cook till Keema (Mutton Mince) gets Aloo 168 grams (peeled 2 small tender or use pressure cooker for 5 to 10 (Potatoes) cut 125 grams) minutes to save time.

Once tender, cook Keema (Mutton Mince) Oil 1/3cup till water dries and oil separates out.

Add Aloo (potatoes) with ¼ cup water and Ginger garlic 2 teaspoon cook until Aloo (potatoes) are tender. paste Cook until water dries up.

Sprinkle fresh coriander leaves for Salt 1 teaspoon garnishing.

Red chili powder 2 teaspoon

Turmeric ½ teaspoon

Fresh Coriander For Garnishing Leaves

Recipe Name: Aloo, Matar, Gajjar (Potato, Peas & Carrot Mix) Recipe Category: Starchy Vegetables Serving: ½ cup= 89 Yield: 2 ¾ cups = 489.5 grams

Ingredients Weights Measures Directions

64 grams Onion 1 Cut all vegetables into small cubes. (peeled 45 grams)

Tomatoes 66 grams 1 Take oil in the pan and add onions to it. Gajjar 236 grams 2 ( 1cup cut cubes) Fry the onions until golden brown. (Carrots) (peeled)

Aloo 280 grams 3 ( 1.5 cups cut Add tomatoes and all spices along with (Potatoes) ( 235 peeled) cubes) some water to prevent them from burning.

Cook for one minute till a gravy is formed, Matar 115 grams (shelled) ¾ cups then add all the vegetables and 1/2 cup of (Peas) water.

Cover the pan with lid, lower the flame and Oil ¼ cup cook until vegetables get tender and soft.

When vegetables are done, cook till water Salt 1 teaspoon dries up to form gravy.

Red chili 1 ½ teaspoon Switch off the flame and serve the dish hot.

Turmeric ¼ teaspoon Recipe Name: Anday Ka Khagina (Scrambled Eggs with Vegetables) Recipe Category: Combination Dish Meat & Meat Substitute (Medium Fat) + Non-Starchy Vegetables Serving: 1/3= 67 grams Yield: 1 cup = 201 grams

Ingredients Weights Measures Directions

Anday Cut onions, tomatoes and green chillies into 6 (Eggs) small cubes.

48 grams (35 Onions 1 small Beat the Anday(eggs) in a bowl. grams)

Add oil in a pan, once oil gets hot add onions in Tomatoes 25 grams 1 small it.

When onions get golden brown add tomatoes Oil 2tablespoon and green chilies, cook for 1 to 2 minutes.

Add all the spices with some amount of water Green Chilies 4 to prevent spices from burning.

When all the ingredients get mixed and water Salt ½ teaspoon dries up add Anday (eggs) in it.

Red chili ½ teaspoon Cook until Anday (eggs) are done. powder

Turmeric ½ teaspoon Garnish with fresh coriander leaves.

Fresh coriander For Garnishing leaves

Recipe Name: Arbi Baigan Ki Bhujia (Taro & Eggplant Gravy) Recipe Category: Starchy Vegetables Serving: ½ cup=106 Yield: 5 cups =1060 grams

Ingredients Weights Measures Directions

500 grams Arbi Cut Arbi (Taro) and Baigan (Eggplant) into (peeled cut 370 (Taro) cubes grams)

500 grams Take a small amount of oil in pan and add Baigan (peeled cut 480 Arbi (Taro). Fry for 1 to 2 minutes and take it (Eggplant) grams) out in a bowl.

Add the remaining oil in the pan and add 221 grams (cut Tomatoes 4 small onions. Fry until onion become golden 211 grams) brown. 177 grams Add all the spices along with some water and Onions (peeled 125 2 medium tomatoes and stir fry. grams)

Now add fried Arbi (Taro) and Baigan Oil ½ cup (Eggplant) cubes to the gravy along with 3-4 tablespoon of water.

Cover the pan with lid and cook for 10-15 Salt 2 teaspoon minutes on low flame.

Red chili When vegetables are done, cook until oil 2 teaspoon powder separates from the curry.

Turmeric 1teaspoon

Recipe Name: Bhindi Pyaaz (Okra with Onions) Recipe Category: Non-Starchy Vegetables Serving: 1/3 = 76grams Yield: 2 ½ cups = 570 grams

Ingredients Weights Measures Directions

Bhindi 500 grams raw Wash and pat dry Bhindi (Okra), cut its head and

(Okra) (cut 305 grams) stem ends. Cut into 1 inch pieces.

Pyaaz 263 grams (peeled 3 medium Cut the Pyaaz (Onions) into small cube pieces. (Onions) 203 grams)

173 grams (cut Take a pan, add 2 tablespoons of oil and stir fry Tomatoes 2 medium 159 grams) Bhindi (Okra); take out Bhindi (Okra) in a bowl.

Add rest of the oil in the pan, add onions and fry Oil 1/3 cup them. When onions get golden brown, add tomatoes and Salt 1 teaspoon cook for 1 to 2 minutes.

1 ½ Add all the spices with some amount of water to Red chili teaspoon prevent spices from burning.

¼ Add fried Bhindi (Okra) to the gravy and cover the Turmeric teaspoon pan with lid.

Cook it on very low flame for 5 minutes. Recipe Name: Bhuna Keema (Stir Fried mutton Mince) Recipe Category: Meat (Medium Fat) Serving: ¼ cup = 51.5 grams Yield: 1 cup = 206 grams

Ingredients Weights Measures Directions

Keema (Mutton 125 grams Cut the onions into small cubes. Mince) 63 grams (peeled 49 Heat ¼ cup oil in a wok, add in onion and fry till Onions 1 medium grams) golden brown.

82 grams Now add ginger garlic paste and Keema (Mutton Tomatoes 1 medium (cut 78 grams) Mince), cook till water dries.

Add tomatoes, green chilies, all spices and cook Oil ¼ cup well.

Ginger garlic 2 teaspoon Garnish with fresh coriander paste

Salt 1teaspoon

Red chili 2 teaspoon powder

Turmeric ½ teaspoon

Cumin seeds ½ teaspoon

Fresh coriander 1 bunch leaves Recipe Name: Kabuli Chanay Ka Salan (Chickpeas Curry) Recipe Category: Bean and lentil group Serving: 1/2 cup = 110 grams Yield: 7 cups = 1540 grams

Ingredients Weights Measures Directions

Chanay Soak Chanay (chickpeas) over night. Wash under 500 grams 3 cups (chickpeas) running water, drain and keep aside.

In a pan heat oil and add onions, fry till golden brown. Add tomatoes, ginger garlic paste, all spices Onions 400 grams 4 medium and yogurt in the pan and cook for one minute. Keep stirring till a pulpy paste is made and oil separates from gravy.

Add Chanay( chickpeas) along with 2-3 cups of Tomatoes 194 grams 2 medium water.

Cook it for 25 to 30 minutes (use pressure cooker to Oil ¾ cup save time), or till Chanay (chickpeas) are tender.

Cover and cook on low flame till the desired Ginger paste 1 teaspoon consistency of the curry.

Yogurt ½ cup

Dry coriander ½ teaspoon powder Black pepper ½ teaspoon powder

Red chili powder 1 ½ teaspoon

Salt 2 teaspoon

Turmeric ½ teaspoon

Cumin seeds 2 teaspoon

Garlic cloves 6 grams 2

Recipe Name: Murgh Biryani (Boiled Rice layered with Chicken Gravy) Recipe Category: Combination Dishes Meat + Cereal Serving: 3/4 cup = 138 grams Yield: 6 1/4 cups =1150grams

Ingredients Weights Measures Directions

250 Heat oil in the pan. Add the whole spices and sliced Murgh grams onion, fry till they are light brown. Add in ginger paste (Chicken) (1/4 kg) and garlic paste, fry again till it releases aroma.

250 Add Murgh (chicken), cook till the oil starts to separate. Rice grams Now mix in well beaten yogurt and tomatoes, cook for (1/4 kg) some time till the tomatoes are a bit pulpy.

175 Mix in salt, red chili powder, turmeric and add one cup of Onions grams water. Simmer on low flame till the oil starts to separate.

125 Add fresh coriander, mint leaves and green chilies and Tomatoes grams fry again for few minutes. Take it off the flame.

Fill a large pot with four liter water, salt, one stick of Yogurt 68 grams 1/3 cinnamon, two green cardamom and three cloves. Bring it to rolling boil.

Add rice to boiling water and cook till 3/4 done. Oil 3/4 cup Meanwhile strain the clarified oil from the chicken gravy and keep aside.

Green chili 2-4 Strain the rice in a strainer.

1/3 Layering: Spread a little clarified oil from the Murgh Cumin seeds teaspoon (Chicken) gravy in a large pot.

Spread a layer of rice over it. Spread Murgh (Chicken) 1/3 with little gravy over the rice. Top it with another layer of Turmeric teaspoon rice. Then another layer of Murgh (Chicken) with gravy. Finish with last layer of rice.

Now sprinkle the clarified oil on top, all over the rice. Dry coriander 1 teaspoon Mix Zarda (yellow) food colour in a small amount of powder water and sprinkle over the top layer. Red chili 1 Spread a thick cloth over the mouth of the pan and cover

powder tablespoon it with a tight lid. Garam masala whole Heat a griddle pan and place the pot over it. 1 (mixture of Steam the Murgh Biryani (Boiled Rice layered with tablespoon whole hot Chicken Gravy) over very low flame for 15 minutes. spices)

Fresh coriander 1 bunch & mint leaves

Zarda color ¼ teaspoon (Yellow food or pinch colour)

Recipe Name: Daal Mash (White Lentil) Recipe Category: Beans and Lentils Serving: 1/3 cup =78 grams Yield: 2 1/3 cups = 546 grams

Ingredients Weights Measures Directions

Daal mash Wash Daal Mash (White Lentil) and soak it for at 177 grams 1 cup (White lentil) least 30 minutes.

67 grams Onions (peeled 63 1 medium Take oil in the pan and add onions to it. grams)

Tomatoes 220 grams 2 medium Fry the onions until golden brown.

Add tomatoes and all the spices along with some Oil 1/3 cup water to prevent them from burning.

Salt 1 ½ teaspoon Cook till gravy is formed.

Add Daal Mash (White Lentil) and ½ cup of Red chili 2 teaspoons water. Cover the pan with lid, lower the flame and powder cook until tender.

Garnish with all spices powder, julien ginger, Turmeric ½ teaspoon green chillies, coriander leaves. Zeera (Cumin 1 teaspoon seeds) ½ teaspoon Pepper

1 inch square Ginger (julienne)

Recipe Name: Daal Moong (Petite Yellow Lentil)

Recipe Category: Beans and Lentils Serving: 1/3 cup=78 grams Yield: 2 1/2 cups = 585 grams

Ingredients Weights Measures Directions

Soak Daal Moong (Petite Yellow Lentil) Daal Moong In cold water for 20 minutes. Wash under (Petite Yellow 204 grams 1 cup running water, drain and keep aside. Lentil)

In a pan heat oil and add onions, fry till golden 90 grams (88 brown. Add tomatoes, ginger garlic paste, all Tomatoes grames 1 medium spices and yogurt in the pan and cook for one peeled) minute. Keep stirring till a pulpy paste is made and oil separates from gravy.

93 grams Add Daal Moong (Petite Yellow Lentil) Onions (peeled 83 1 medium Along with 1 cup of water. grams )

18 grams (16 Ginger 1 ½ inch piece Cook it for 10 to 15 minutes or till is tender. grams peeled)

Cover and cook on low flame till the desired Garlic 2 cloves consistency.

Oil 1/3 cup

Salt ½ teaspoon

Red chili ½ teaspoon

Turmeric ¼ teaspoon

Recipe Name: Channay Ki Daal Aur Kudu (Split Bengal Gram & Bottle Gourd Gravy) Recipe Category: Beans and Lentils Serving: = 1/2 cup =100 grams Yield: = 4 cups = 800 grams

Ingredients Weights Measures Directions

Kudu 375 grams (peeled Peel and cut Kudu (Bottle Gourd) into 3 cups cut cubes (Bottle Gourd) 310 grams) inch squares. Wash and keep aside. Channay Ki Daal ¼ cup (boil for Boil Channay Ki Daal (Split Bengal (Split Bengal 53 grams 45 mins) Gram) in water till tender. Gram) 196 grams (peeled Onion 2 medium Drain and keep it aside. 174 grams)

In a pan heat oil and add onions, fry till golden brown. Add tomatoes, ginger garlic paste, all spices and yogurt in the Tomatoes 204 grams 3 medium pan and cook for one minute. Keep stirring till a pulpy paste is made and oil separates from gravy.

Add kudu (Bottle Gourd) pieces. Cook Oil 6 Tablespoons for 10 to 15 minutes or till is tender.

Add boiled Channay Ki Daal (Split Green chilies 2 Bengal Gram) to kudu (Bottle Gourd)

14 grams unpeeled Cover and cook on low flame till the Ginger (peeled 12 grams) desired consistency.

Garlic 3-4 cloves

Cumin seeds ½ teaspoon

Turmeric ¼ teaspoon

Fresh Coriander For Garnishing Leaves Recipe Name Kalay Chanay ka Salan (Brown Bengal Chickpeas Curry) Recipe Category: Beans and Lentils Serving: 1/2 cup =106 grams Yield = 6 1/2 cups = 1378 grams

Ingredients Weights Measures Directions

Kalay chanay Soak Kalay Chanay (Brown Bengal Chickpeas) (Brown 500 grams 2 ¾ cups over night. Wash under running water, drain and Bengal keep aside. Chickpeas)

In a pan heat oil and add onions, fry till golden 216 grams brown. Add tomatoes, ginger garlic paste, all Onions unpeeled(peeled 2 medium spices and yogurt in the pan and cook for one =192 grams) minute. Keep stirring till a pulpy paste is made and oil separates from gravy.

Add Kalay Chanay (Brown Bengal Chickpeas) Tomatoes 220 grams 2 medium along with 2-3 cups of water.

Cook it for 25 to 30 minutes (use pressure cooker Oil 3/4cup to save time), or till Kalay Chanay (Brown Bengal Chickpeas) are tender.

Cover and cook on low flame till the desired Ginger garlic 2 tablespoon consistency of the curry.

Turmeric 1 teaspoon

Red chili teaspoon

Recipe Name: Saboth Masoor ki Daal (Brown Lentil)

Recipe Category: Beans and Lentils Serving: 1/2 cup = 123 grams Yield: 3 1/2 cups = 861 grams

Ingredients Weights Measures Directions

Saboth Masoor ki Daal Wash and soak Saboth Masoor ki Daal 193 grams 1 cup (Brown Lentil) (Brown Lentil) for 30 minutes.

50 grams Put all the ingredients together and cook in Onion (peeled 30 1 small a pressure cooker for 15 minutes. grams)

Heat ½ cup oil in a frying pan, cut and add Garlic 4 grams 2 cloves garlic and fry till light brown .

Add on top of cooked Saboth Masoor ki Water 1 liter 4 cups Daal (Brown Lentil) as tempering and serve hot.

Salt 1 teaspoon

Chillies 1 ½ teaspoon

Turmeric ½ teaspoon

Oil 1/3 cup Recipe Name: Kadhi Pakora (Gram Flour and Sour Yogurt Gravy with Fritters) Recipe Category: Beans and Lentil Serving: 1/2 cup = 110 grams Yield: 7 ½ cups--- 1650 grams

Ingredients Weights Measures Directions

Kadhi

In a bowl mix together yogurt, turmeric powder, Gram flour 114 grams 1cup chili powder and salt.

Yogurt 464 grams 2 cups Add a little water and mix well. 100 grams Onion (peeled 93 1 small Add in gram flour with a little more water. grams) Heat little oil in a pan, add in chopped onion and Salt 2 teaspoon sauté for a few seconds.

Add in yogurt mixture. Add 2000 ml water and Red chili let it cook on medium flame for 30-45 minutes 1 table spoon powder or till the Kadhi (Gram Flour and Sour Yogurt Gravy) thickens.

Turmeric ½ teaspoon

Oil ½ cup

Water 2000 ml

Pokora

(Fritters)

In a bowl put together onion, coriander leaves Gram flour 114 grams 1 cup and green chilies.

Unpeeled 123 Add in crushed red pepper, cumin seeds, Onion grams without 1 medium coriander seeds, and salt and gram flour. Add a peel =120 grams little water to make a thick paste. Keep aside.

Heat oil in a wok and spoon out the mixture to Green chilies 18 grams 4 fry fritter

Add all the fritters in Kadhi (Gram Flour and Red chili 1 ½ teaspoon Sour Yogurt Gravy). Remove from fire and keep aside. Lastly heat a little oil, add in cumin seed and temper the prepared dish of Kadhi Pokora Salt 1 teaspoon (Gram Flour and Sour Yogurt Gravy with Fritters)

Cumin seeds 1 teaspoon

Dry ½ teaspoon coriander

Fresh green 1/2 bunch

Oil for frying

Recipe Name: Kudu Gosht (Bottle Gourd & Mutton Gravy) Recipe Category: Meat & Meat Substitute (Medium Fat) + Non-Starchy Vegetables Serving: 1/2 cup = 115 grams Yield: 2 1/2cups = 575 grams

Ingredients Weights Measures Directions

Kudu Cut Kudu (Bottle Gourd) in square shape(3 inches). (Bottle 250 grams Wash and keep aside. Gourd) Gosht Take oil in the pan, add onions and fry till golden 125grams (Mutton) brown. 153 grams Add tomatoes and all the spices along with some water Onions AP, EP: 124 1 medium to prevent them from burning. grams

Cook for one minute or till the gravy is formed, and Tomatoes 130 grams 1 large then add Gosht (mutton), and 1/2 cup of water.

Let it cook on low flame till Gosht (mutton) gets tender Oil ¼ cup or use pressure cooker to save time.

1/2 When Gosht (mutton) is done, remove the lid and cook Salt teaspoon till the oil separates. Keep stirring

Red Chilli Now add Kudu (Bottle Gourd) mix well and cover with ½ tsp. powder lid. Let it cook on low flame till tender.

Turmeric Remove lid and cook on medium flame to get the ¼ tsp. Powder desired consistency. Garlic ½ whole Serve hot, and garnish with fresh coriander leaves. Peeled knob Ginger 1/2 tsp. Crushed Fresh For coriander Garnishing leaves

Recipe Name: Matar Pulao (Rice with Peas) Recipe Category: Cereals Serving: ½ cup = 88grams Yield: 4 1/8 cups = 726 grams

Ingredients Weights Measures Directions

125 gram (with Matar pods unshelled) 1/2 cup Shell Matar (peas), wash and keep aside. (Peas) 56 grams (Shelled) (Shelled)

Rice 209 grams 1 cup Wash rice and soak in water for 20 minutes

Take oil in the pan, add onions and fry till Onion 90 grams 1 medium golden brown.

Add all whole hot spices and salt along with Oil 1/2 cup ginger garlic paste. Stir fry for 30 seconds till aroma releases. Add Matar (peas), stir fry for 30 seconds and Ginger garlic 1 teaspoon add ½ cup water. Cover and let it cook for 10 paste minutes or till tender.

Add 2 cups of water and bring to boil. Drain Cumin seeds 1 teaspoon rice and add to boiling water with Matar (peas).

Whole Black Cover with lid and cook on medium flame for 7-8 Pepper 10 -15 minutes or till the rice is done.

Cinnamon 2 small

Stick pieces

Salt 1 teaspoon

Recipe Name: Matar Keema (Peas & Mutton Mince) Recipe Category: Combination Dish Meat (Medium Fat) + Starchy Vegetables Serving: 1/4 cup =54 grams Yield: 2 cups = 432 grams

Ingredients Weights Measures Directions

Keema ( Mutton 250 grams Shell Matar (Peas), wash and keep aside. Mince) 64 grams ( peeled Take oil in the pan, add onions and fry till Onions 50 grams) 1 medium golden brown.

83 grams (cut Add tomatoes Keema (Mutton Mince) and all Tomatoes 1 medium cubes 79 grams) the spices, along with 1/2 cup of water.

Cook till Keema (Mutton Mince) gets tender or Oil 1/3 cup use pressure cooker for 5 to 10 minutes to save time. 250 grams Matar (unshelled) Once tender, cook Keema (Mutton Mince) till 1 cup (Peas) 125 grams water dries and oil separates out. ( shelled) Add Matar (Peas), with ¼ cup water. Cover Ginger garlic 2 teaspoon with lid and cook till Matar (Peas), are tender. paste Cook until water dries up.

Salt 1 teaspoon

Red chili 2 teaspoon powder

Turmeric ½ teaspoon Recipe Name: Murgh Handi (Chicken in a Pot) Recipe Category: Meat (Lean) Serving: 1/4 =56 grams Yield: 1 1/3 cup = 299 grams

Ingredients Weights Measures Directions

250 grams Murgh boneless cut Peel and chop onions and crush tomatoes. (Chicken) cubes 61 grams Heat oil in a pan, add onions, garlic and stir fry for Onion (peeled 46 1 small 30 seconds. grams) Add crushed tomatoes, whipped yogurt and Oil 1/4 cup Handi Masala(Mixture of Spices) and fry for 30 minutes.

Add Murgh (Chicken) and cook till tender and oil Yogurt ½ cup seperates. 43 grams (37 Tomatoes 1 small grams) Handi Masala (Mixture of 1 tablespoon spices) Cumin seeds ½ teaspoon Recipe Name: Murgh Karahi (Chicken in Wok) Recipe Category: Meat (Lean) Serving: 1/4cup = 52 grams Yield: 3 cups = 624 grams

Ingredients Weights Measures Directions

Murgh Heat oil in a wok and add onions cut, garlic 500grams (Chicken) and ginger paste, stir fry for 30 seconds.

Then add crushed coriander and cumin, stir Tomatoes 337 grams well. 112 grams Onion (peeled 100 1 medium Add Murgh (chicken), cook for 1-2 minutes. grams) Add green chilies (with one slit down) and Oil ½ cup fresh coriander and mix it well.

Add roughly grind tomatoes, yogurt, salt, Yogurt ½ cup crushed red chili and turmeric.

Cook covered with lid till Murgh (chicken) Salt 1 teaspoon is done, and water has dried.

Garnish with sliced ginger, green chilies and Red chili powder 2 teaspoon fresh coriander.

Crushed red chili 1 teaspoon

Turmeric ½ teaspoon powder Crushed cumin 1 teaspoon seeds Ginger garlic 2 teaspoon paste Ginger (finely 2 table spoon sliced) Recipe Name: Murgh Korma (Chicken Curry) Recipe Category: Meat (Lean) Serving: 1/4cup = 62 grams Yield: 4 ¾ cups = 1178 grams

Ingredients Weights Measures Directions

Murgh 500 grams Peel and cut onions. (Chicken)

570 grams In a big pot heat oil and add whole spices, onion Onions (466 grams 4 medium and fry till golden. peeled)

Add ginger garlic paste, fresh coriander, mint Yogurt 1 ½ cup leaves, green chilies and fry again.

Now add the spices powder and roast for a while Oil 7/8 cup and then add the Murgh (chicken).

Ginger garlic 3 Cook Murgh (chicken) till the oil separates. Now

paste tablespoon add yogurt, tomatoes, and 1/2 cup of water.

Cover the pot and cook, till Murgh (chicken) is Turmeric powder 1 teaspoon tender. Uncover pot and cook till oil separates.

Add water and let korma (curry) simmer for few Red chili powder 2 teaspoon minutes, till the desired consistency.

Coriander 1 Garnish with fresh coriander leaves. powder tablespoon 1 ½ Salt teaspoon Cardamom black 3 large

Cardamom green 2

Jafel ½ teaspoon

Jawateri ½ teaspoon

1 small Fresh mint leaves bunch Fresh coriander 1 small

leaves bunch Recipe Name: Palak Gosht (Spinach & Mutton Gravy) Recipe Category: Meat & Meat Substitute (Medium Fat) + Non-Starchy Vegetables Serving: 1/4 cup = 61.5 grams Yield: 3 ½ cup = 861 grams

Ingredients Weights Measures Directions

1 kg raw Cut 615 grams Palak Cut the stems from Palak (spinach leaves) and chop (Boiled 550 (Spinach) the leaves. grams)

Gosht Wash the Palak (spinach leaves) thoroughly under 275 grams (Mutton) running water.

Add Palak (spinach leaves) to boiling water and boil Onion 130 grams 1 medium for 5 minutes

Tomatoes 155 grams 2 medium Drain Palak (spinach leaves) and let it cool.

Ginger garlic Blend the boiled Palak (spinach leaves) in a 33 grams 1 tsp paste blender for 30 seconds. Keep aside.

Take oil in the pan, add onions and fry till golden Oil 2/3 cup brown.

Add tomatoes and all the spices along with some Salt ¾ tsp water to prevent them from burning.

Red chilli Cook for one minute or till the gravy is formed, and ¾ tsp powder then add Gosht (mutton) and 1/2 cup of water.

Let it cook on low flame till Gosht (mutton) gets Yogurt 102 grams ½ cup tender or use pressure cooker to save time. When Gosht (mutton) is done, remove the lid and

cook till the oil separates. Keep stirring Now add Palak (spinach leaves), mix well, add

yogurt and let it cook till desired consistency. Recipe Name: Keema Pyaaz (Mutton Mince with Onions) Recipe Category: Meat (Medium Fat) Serving: 1/4 cup =60 grams Yield: 1 1/2 cups = 360 grams

Ingredients Weights Measures Directions

Keema ( Mutton 250 grams Cut the onions in small cubes. Mince) 63 grams unpeeled Take oil in the pan, add onions and fry till Onions 1 medium (peeled 50 grams) golden brown.

82grams (cut cubes Add tomatoes Keema (Mutton Mince) and Tomatoes 1 medium 78 grams ) all the spices, along with 1/2 cup of water.

Additional Cook till Keema (Mutton Mince) gets 125grams (peeled Pyaaz 1 large tender or use pressure cooker for 5 to 10 101 grams ) (Onions) minutes to save time. Once tender, cook Keema (Mutton Mince) Oil 1/3 cup till water dries and oil separates out. Add additional Pyaaz (onions), cover with Ginger garlic garlic 7 cloves =63 2 teaspoon lid and cook on low flame until water dries paste grams up and Pyaaz (onions) softens.

Take oil in the pan, add onions and fry till Salt 1 teaspoon golden brown. Red chili 2 teaspoon powder

Turmeric ½ teaspoon Recipe Name: Keema Shimla Mirch (Mutton Mince with Bell Pepper) Recipe Category: Meat (Medium Fat) Serving: 1/3 cup =79 grams Yield: 2 cups = 474 grams

Ingredients Weights Measures Directions

125 unpeeled Shimla Mirch Wash and cut Shimla Mirch (Bell Pepper) and (deseeded cut 2 small (Bell Pepper) onions in small cubes. 108 grams)

Keema Take oil in the pan, add onions and fry till 250 grams ( Mutton Mince) golden brown. 73 grams unpeeled Add tomatoes Keema (Mutton Mince) and all Onions 1 medium (peeled 47 the spices, along with 1/2 cup of water. grams) 55 grams (cut Cook till Keema (Mutton Mince) gets tender or Tomatoes cubes 49 1 medium use pressure cooker for 5 to 10 minutes to save grams) time.

Once tender, cook Keema (Mutton Mince) till Oil 1/3 cup water dries and oil separates out.

Add Shimla Mirch (Bell Pepper), cover with lid Ginger garlic 2 teaspoon and cook on low flame until water dries up and paste Shimla Mirch (Bell Pepper) softens.

Salt 1 teaspoon

Red chili powder 2 teaspoon

Turmeric ½ teaspoon Recipe Name: Sabzi Pulao (Vegetable Rice)

Recipe Category: Cereals Serving: 1/2 cup = 82.5 grams Yield: 4 cups =660 grams

Ingredients Weights Measures Directions

Rice 209 grams 1 cup Wash rice and soak in water for 20 minutes

Gajjar 94 grams (unpeeled) Remove heads of Gajjar (Carrots), peel and cut 1 (Carrot) 60 grams (peeled) in small squares. Wash and keep aside.

Aloo 88 grams (unpeeled) Peel and cut Aloo (Potatoes) in small squares. 1 (Potatoes) 72 grams(peeled) Wash and keep aside.

150 gram (with pods Matar unshelled) Shell Matar (peas), wash and keep aside. (Peas) 73 grams (Shelled) Take oil in the pan, add onions and fry till 145 grams unpeeled Onion 2 medium golden brown. (peeled 108 grams)

Add all whole hot spices and salt along with Oil ½ cup ginger garlic paste. Stir fry for 30 seconds till aroma releases. Add Matar (peas), stir fry for 30 seconds and add ½ cup water. Cover and let it cook for 5 Ginger garlic 1 minutes; now add Gajjar (Carrots) and Aloo paste teaspoon (Potatoes). Cook for another 5 minutes or till all Sabzi (Vegetables) is tender.

Add 2 cups of water and bring to boil. Drain rice 1 Cumin seeds and add to boiling water with Sabzi teaspoon (Vegetables).

Whole Black Cover with lid and cook on medium flame for 7-8 Pepper 10 -15 minutes or till the rice is done.

Cinnamon 2 small

Stick pieces 1 Salt teaspoon Recipe Name: Shaljam Gosht (Turnips & Mutton Gravy) Recipe Category: Meat & Meat Substitute (Medium Fat) + Non-Starchy Vegetables Serving: 1/4 cup = 81 grams Yield: 3 2/3 cups = 1188 grams

Ingredients Weights Measures Directions

Shaljam 500 grams unpeeled Peel and cut turnips in square shape(3

(Turnips) (peeled 408 grams) inches). Wash and keep aside.

Gosht Take oil in the pan, add onions and fry 250 grams (Mutton) till golden brown.

Add tomatoes and all the spices along unpeeled 350 grams 2 large or 3 Onions with some water to prevent them from (peeled 336 grams ) medium burning. Cook for one minute or till the gravy is 250 grams (cut –233 Tomatoes 4 small formed, and then add Gosht (mutton), grams) yogurt and 1/2 cup of water. Let it cook on low flame till Gosht Oil 2/3cup (mutton) gets tender or use pressure cooker to save time. When Gosht (mutton) is done, remove Ginger garlic 2 tablespoon the lid and cook till the oil separates. paste Keep stirring Now add Shaljam (turnips), mix well. Salt 2 teaspoon Cover with lid and cook on low flame till tender.

Red chili Remove lid and on medium flame to get 2 teaspoon powder the desired consistency.

Serve hot, and garnish with fresh Turmeric 1 teaspoon coriander leaves.

Yogurt 1/4 cup Fresh Coriander For garnishing Leaves Recipe Name: Tori Chapni (Cousa Squash Gravy)

Recipe Category: Non-Starchy Vegetables Serving: 1/3 cup=78grams Yield: 2 cups = 468 grams

Ingredients Weights Measures Directions

Tori Chapni 520 grams Peel and cut Tori Chapni (Cousa Squash) (Cousa (355 grams peeled into small 1 inch cubes. Wash and keep Squash) cut) aside.

Onions unpeeled 229 2 medium Cut onions in small pieces

Take oil in a pan , add onions and fry till Tomatoes 130 grams 2 medium onions get golden brown color

Add allspices, tomatoes some water and Oil ¼ cup cook for 2 to 3 minutes

Add Tori Chapni (Cousa Squash) and mix Salt 1 teaspoon well

Cover the pan with lid and cook it for 10-15 Chillies 1 ½ teaspoon minutes on very low flame or till Tori Chapni (Cousa Squash) is softens. Uncover lid and cook on medium flame Tumeric ½ teaspoon while stirring with a wooden spoon till oil separates. Recipe Name: Yakhni Pulao (Rice in Mutton Broth)

Recipe Category: Meat + Cereal Serving: 2/3 cup =126.50 grams Yield: 5cups = 950 grams

Ingredients Weights Measures Directions

Rice 250 grams 1 ¼ cups Wash rice and soak in water for 20 minutes

Boil mutton in a large pan, with 8 cups of water, Mutton 250 grams salt, onions, fennel seeds, ginger and garlic.

Cook till mutton is done and water remains 4 cups. Salt 2 teaspoon Take off from stove and keep aside.

Once cool, take out pieces of mutton in a bowl and Garlic 56 grams strain rest of the broth in another bowl. Keep aside. unpeeled 18 Ginger grams (peeled 1 ½ inch Peel and cut onions. 16 grams) 108 grams Take oil in the pan, add onions and fry till golden Onion for rice (peeled 95 1 small brown. grams)

142 grams Add all whole hot spices and salt along with ginger Onions for (peeled 123 1 medium garlic paste. Stir fry for 30 seconds till aroma broth grams) releases.

Add cooked mutton pieces along with whipped Yogurt 4 tablespoon yogurt and stir fry until light brown. Now add Yakhni (Broth) and bring to boil. 7 Drain rice and add to the boiling broth along with Oil Tablespoons mutton pieces. Cinnamon 2 –(1 inch Cover with lid and cook on medium flame for 10

sticks piece) -15 minutes or till the rice is done.

Fennel seeds ½ teaspoon

Cumin seeds ½ teaspoon

Whole black 4 pepper Cardamom 5 black large Cardamom 6 green

Water 1500 ml Appendix L

Accumulative Table Representing the Results of 18 Focus Groups

Sr. Focus Group Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Total Freq Relative Percent No. n(no.of participants/FG 23 19 24 24 20 24 21 24 24 22 24 23 23 24 22 23 24 24 412 Freq Freq 1. Aloo Anday 11 08 13 14 15 15 10 13 12 08 09 11 12 10 16 09 11 12 209 0.51 51 2. Aloo Bhujia 17 12 18 19 18 19 16 19 17 16 18 17 20 19 19 20 18 20 322 0.78 78 3. Aloo Gobi 19 17 20 17 18 18 15 14 17 16 13 12 15 14 13 17 16 12 284 0.69 69 4. Aloo Baigan 12 04 10 03 05 02 05 07 09 06 06 11 03 09 12 07 03 02 116 0.28 28 5. Aloo Gosht 18 16 20 19 21 18 18 20 19 20 21 17 20 18 19 15 17 19 335 0.81 81 6. Aloo Palak 11 14 12 15 11 06 13 15 09 12 19 09 10 11 13 08 11 12 221 0.54 54 7. Aloo, Matar, Gajjar 19 17 21 16 17 21 19 13 15 16 17 19 16 15 12 18 17 12 300 0.73 73 8. Aloo keema 10 17 19 15 18 15 12 13 12 12 18 16 17 16 14 13 15 17 269 0.65 65 9. Aloo walay Chawal 14 13 11 11 12 10 08 09 14 12 10 12 14 12 09 13 14 11 209 0.51 51 10. Anday ka Khagina 19 18 14 19 13 13 15 14 17 13 19 12 18 18 11 15 14 14 276 0.67 67 11. Arbi Bagan aur tori ki Bhujia 07 06 06 09 07 06 09 07 09 04 08 10 05 11 10 07 03 06 130 0.32 32 12. Arbi baigan ki Bhujia 11 14 17 14 16 17 14 15 18 15 16 14 12 11 12 11 9 16 252 0.61 61 13. Bhuna Keema 18 17 22 17 22 19 21 18 16 11 12 15 14 13 17 16 12 18 298 0.72 72 14. Bhindi pyaaz 17 20 22 18 23 15 13 13 15 12 11 10 15 16 13 12 19 12 276 0.67 67 15. Channay Ki Daal Aur Kudu 15 21 19 16 14 11 20 21 16 16 18 18 16 13 17 19 18 15 303 0.74 74 16. Chanay ki Daal Ghost 16 12 14 11 13 09 09 11 12 10 13 12 10 10 13 12 14 15 216 0.52 52 17. Chapli Kabab 10 07 10 09 06 06 05 08 09 07 11 10 09 06 09 05 04 05 136 0.33 33 18. Chinese Rice 16 12 14 11 15 12 10 10 13 12 14 15 12 10 16 09 11 12 224 0.54 54 19. Daal Mash 18 15 18 17 17 13 15 15 11 11 17 15 18 19 18 12 17 11 277 0.67 67 20. Daal Moong 11 16 17 10 11 14 12 12 10 15 18 21 20 18 12 16 19 11 263 0.64 64 21. Daal Moog Masoor 10 09 12 08 13 14 11 07 09 07 08 11 09 07 06 11 13 10 175 0.42 42 22. Kabuli Chanay ka Salan 18 16 20 20 16 12 17 12 11 10 12 11 15 12 10 19 11 17 259 0.63 63 23. Kabab ka Salan 09 05 12 10 07 10 11 09 04 07 10 07 08 09 09 10 06 07 160 0.39 39 24. Kachnar 06 09 05 04 05 05 04 05 08 06 06 09 05 04 05 05 07 09 107 0.26 26 25. Kadhi Pakora 16 18 19 17 17 15 13 13 15 15 15 18 10 13 18 12 13 12 269 0.65 65 26. Kalay Chanay ka Salan 17 16 21 17 13 12 12 12 15 13 17 11 17 10 11 21 17 12 264 0.64 64 27. Kali tori ki bhujia 10 09 07 08 09 07 06 06 10 09 06 09 08 11 09 08 10 10 152 0.37 37 28. Karalay Piyaz 09 10 11 09 11 16 12 14 11 13 11 10 12 13 14 12 14 11 213 0.52 52 29. Keema Pyaaz 11 15 18 14 14 18 14 14 16 14 12 13 17 16 12 11 14 12 255 0.62 62 30. Keema Shimla Mirch 14 15 19 16 16 16 17 16 15 17 17 15 12 17 15 10 18 17 282 0.68 68 Appendix L

Sr. Focus Group Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Total Freq Relative Percent No. n(no.of participants/FG 23 19 24 24 20 24 21 24 24 22 24 23 23 24 22 23 24 24 412 Freq Freq

31. Kofata Salaan 06 06 09 10 08 05 09 07 09 07 12 06 09 07 10 09 09 11 149 0.36 36 32. Kudu Gosht 15 16 21 18 16 16 21 20 14 14 12 11 15 14 17 17 11 19 287 0.70 70 33. Mash,moong aur chanay ki daal 11 09 09 07 10 09 07 11 10 12 13 08 06 06 09 11 10 09 167 0.41 41 34. Matar Pulao 14 13 20 15 17 14 15 15 18 18 17 12 14 12 11 16 18 15 274 0.67 67 35. Matar Keema 18 16 20 13 12 17 17 17 17 17 12 15 13 15 16 15 13 12 275 0.67 67 36. Mungaray aloo 09 07 11 10 12 13 08 10 08 13 10 10 09 11 12 07 08 10 190 0.46 46 37. Murgh Biryani 18 16 18 14 18 19 12 12 15 15 17 16 19 18 17 19 15 17 297 0.72 72 38. Murgh Handi 18 14 19 12 12 13 12 12 12 11 16 17 17 9 19 13 17 13 256 0.62 62 39. Murgh Karahi 18 17 19 16 16 15 17 17 19 17 20 14 16 12 17 18 19 19 306 0.74 74 40. Murgh Korma 16 15 14 12 16 19 15 12 12 11 16 17 13 15 19 13 17 13 265 0.64 64 41. Murgh Pulao 15 10 11 13 13 12 15 14 17 11 12 15 07 15 11 13 12 12 228 0.55 55 42. Nargasi Kofatay 09 07 11 10 09 06 10 08 12 11 07 06 10 07 03 06 11 07 150 0.36 36 43. Palak Gosht 17 11 16 15 12 13 13 13 16 17 14 14 10 17 16 15 13 18 260 0.63 63 44. Pataa Gobi aur Aloo 09 04 08 10 05 11 06 09 07 10 10 07 06 06 09 11 10 07 145 0.35 35 45. Saag 15 11 10 12 13 14 12 14 17 16 11 14 11 13 12 15 13 15 238 0.58 58 46. Saboth Maash ki daal 13 11 08 10 09 11 06 09 07 10 10 07 06 06 09 11 10 07 160 0.39 39 47. Saboth Masoor ki Daal 16 15 18 19 12 18 22 15 12 11 13 12 11 11 12 14 14 17 262 0.64 64 48. Sabzi Pulao 11 14 18 17 17 13 15 15 12 13 20 16 12 13 12 11 12 15 256 0.62 62 49. Shaljam Gosht 16 12 16 16 16 16 17 14 15 12 13 15 16 15 17 16 15 14 271 0.66 66 50. Tali mashali 10 08 10 12 14 09 10 10 08 07 11 10 06 09 12 11 09 12 178 0.43 43 51. Tori Chapni 17 15 15 19 19 18 20 16 17 15 15 21 17 12 14 12 15 13 290 0.70 70 52. Tori Ghost 06 06 05 08 09 07 06 06 10 09 06 09 05 04 05 08 06 10 125 0.30 30 53. Tori aur anday ki bhujia 07 06 06 09 07 06 09 07 09 04 08 07 05 07 06 07 03 06 119 0.29 29 54. Yakhni Pulao 21 17 20 20 17 19 19 18 19 20 21 20 20 19 19 20 19 17 345 0.84 84

Appendix M

Weight and Measure of Prepared Traditional Pakistani Dishes

Traditional Pakistani W2 W1 Total Total Serving Serving Dishes (Wt. of (Wt. of yield yield size size Cooking Empty Weight Measure Weight Measure Utensil + Cooking Cooked Utensil) Food) Grams Grams Grams Cups Grams Cups

Aloo Bhujia 1015.50 660.00 355.50 1 1/2 79.00 1/3 Aloo Gobi 2022.00 951.00 1071.00 4 1/2 119.00 1/2 Aloo Gosht 2840.00 1230.00 1610.00 7 115.00 1/2 Aloo, Matar, Gajjar 1149.50 660.00 489.50 2 3/4 89 1/2 Aloo Keema 1125.00 639.00 486.00 2 1/4 72 1/3 Anday ka Khagina 990.00 789.00 201.00 1 67 1/3 Arbi baigan ki bhujia 1704.00 644.00 1060.00 5 106 ½ Bhuna Keema 866.00 660.00 206.00 1 51.5 ¼ Bhindi pyaaz 1531.00 961.00 570.00 2 1/2 76 1/3 Channay Ki Daal Aur 1751.00 951.00 800.00 4 100 1/2 Kudu Daal Mash 1206.00 660.00 546.00 2 1/3 78 1/3 Daal Moong 1245.00 660.00 585.00 2 1/2 78 1/3 Kabuli Chanay Ka 2850.00 1310.00 1540.00 7 110 1/2 Salan Kadhi Pakora 2310.00 660.00 1650.00 7 1/2 110 1/2 Kalay Chanay Ka Salan 2688.00 1310.00 1378.00 6 1/2 106 1/2 Keema Pyaaz 1149.00 789.00 360.00 1 1/2 60 1/4 Keema Shimla Mirch 1263.00 789.00 474.00 2 79 1/3 Kudo Gosht 1885.00 1310.00 575.00 2 1/2 115 1/2 Matar Keema 1071.00 639.00 432.00 2 54 1/4 Matar Pulao 1386.00 660.00 726.00 4 1/8 88 1/2 Murgh Biryani 2101.00 951.00 1150.00 6 1/4 138 3/4 Murgh Handi 1250.00 951.00 299.00 1 1/3 56 1/4 Murgh Karahi 1585.00 961.00 624.00 3 52 1/4 Murgh Korma 2488.00 1310.00 1178.00 4 1/4 62 1/4 Palak Gosht 2171.00 1310.00 861.00 3 1/2 61.5 1/4 Saboth Masoor Ki 2091.00 1230.00 861.00 3 1/2 123 1/2 Daal Sabzi Pulao 1320.00 660.00 660.00 4 82.5 1/2 Shaljam Gosht 2418.00 1230.00 1188.00 3 2/3 81 1/4 Tori Chapni 1107.00 639.00 468.00 2 78 1/3 Yakhni Pulao 1901.00 951.00 950.00 5 126.5 2/3

Appendix N