Introduction

Pasta is an ancient food widely consumed in the world and represents one of the staple foods of the Mediterranean diet. There are many theories concerning its origin. Some researchers place its origin in the thirteenth century by Marco Polo, who introduced pasta in Italy upon returning from one of his trips to China in 1271. However, pasta dates much further back, maybe to the ancient Etruscans, who made pasta by grinding several cereals and grains and then mixing them with water, a blend that was later on cooked producing a tasty and nutritious food. The term ‘macaroni,’ which is currently referred to as a long type of pasta, is found in the documents of Roman writers since the first centuries ‘after Christ.’ However, both the Etruscans and the Romans baked their noodles in an oven, so boiled pasta had yet to be born in Italy. As the centuries went by, pasta continued to appear on the tables of Italy with different names. For example, in 1400, pasta was called ‘lasagna’ and pasta manufacturers were referred to as ‘lasagnare,’ while in 1800, their name turned into ‘vermicellai.’ Between 1400 and 1800, a new kind of pasta, that is, ‘fidelli,’ started being manufactured besides ‘lasagne’ and ‘vermicelli.’ ‘Fidelli’ were pasta threads with a cylindrical shape, and pasta manufacturers became known as ‘fidellai.’

According to the American historian Charles Perry, who has written several articles on the origins of pasta, the first clear western reference to boiled noodles is in the Jerusalem Talmud of the fifth century AD written in Aramaic for which the term ‘itriyah’ was used. By the tenth century, ‘itriyah’ in many Arabic sources referred to dried noodles bought from a vendor, as opposed to fresh ones made at home.

Pasta Ingredients and Production

Pasta is mainly produced with wheat flour and water: eggs and/or other optional ingredients can also be added. Pasta manufacturers typically use milled durum wheat (semolina) although soft wheat flour and other cereal flours are also used. pasta traditionally consumed in Italy is made exclusively with durum wheat flour, while in other countries, pasta made from soft wheat and/or other cereal flours are also frequently consumed. Durum wheat pasta is made from durum wheat semolina (Triticum turgidum L. var. durum) to which water is added, the reactant, that allows modification of gluten via the input of mechanical and thermal energy to produce pasta. Wheat proteins help with strengthening pasta structure by means of entangled aggregation. Starch, the major component of semolina and pasta, occurs in the form of granules dispersed within the protein network.

Pasta processing consists of three main operations: (1) hydrating and mixing–kneading of semolina to make a dough (formation of gluten network), (2) shaping the dough through extrusion, and (3) stabilizing the shaped pasta pieces, usually by drying. This sequence of operations is developed in an industrial automated scale. The process of hydrating and mixing–kneading of semolina produces a homogeneous hydrated dough that is essential for producing high-quality pasta. To obtain the most homogeneous hydrated mass, semolina and water first undergo high-speed premixing (using a single or double shaft, vertical or horizontal) to ensure intimate contact between semolina particles and water droplets. Further mixing then takes place in the main mixing unit, generally under vacuum, that removes air bubbles before the mass passes in the extrusion section.

After the dough is mixed, it is transferred to the extruder in order to obtain a specific form (spaghetti, macaroni, etc.) with the development of a continuous network of gluten proteinthat surrounds the starch granules. This process facilitates maintenance of pasta structure during cooking. The extrusion auger forces the dough through the die under high pressure, followed by cutting. The die holes are designed to give pasta the desired shape and size. Compression and extrusion are obtained with different machines. Until recently, most dies were made of bronze, which was relatively soft and required repair or periodic replacement. Recently, dies have been improved by fitting the extruding surface of the die with Teflon® inserts to extend the life of the dies and improve pasta quality.

Drying is the most difficult and critical step to control in the pasta production process. Drying consists of passing a flow of hot or warm air over the fresh pasta product, so that the thermohygrometric properties of the air progressively decrease the pasta moisture content at a level acceptable for dried pasta. Nowadays, the majority of pasta-drying processes adopt air temperatures in the range of about 70–100 °C while keeping product temperatures between 60 and 90 °C. The objective of drying is to lower the moisture content of pasta from ∼31% to 12–13%, so that the finished product is hard, retains its shape, and can be stored without spoiling. Dried pasta stored at room temperature is stable for years at room temperature.

The best pasta is produced from durum wheat semolina, due to the dough excellent rheological properties, pasta superior color, cooking quality, and consumer acceptance. Whole grain wheat and other grains such as rice, buckwheat, barley, spelt, millet, oats, quinoa, and corn are also sometimes used to make pasta, which can be made also from more than one type of grain, and, in such a case, it is called ‘multigrain.’

Pasta can be enriched, supplemented, or fortified or remain conventional. In recent years, several ingredients have been developed and are being used to improve the nutritional quality of pasta, for example, fibers, proteins, and vitamins.

On the basis of scientific evidence showing beneficial effects on health of whole grain product consumption, production of whole wheat pasta is increasing in recent years and many efforts have been made to improve its rheological and organoleptic properties and to implement its consumption even if this product is not yet widely consumed. Whole wheat pasta is significantly higher in fiber and nutrients than its refined counterpart: during the refining process, wheat loses roughly 60% of its grain, a portion that includes its most nutritious components, the bran and the germ. Consequently, refined wheat provides less than half the amount of B vitamins, minerals, and fibers than whole grains. At present, there are no food labeling regulations setting the minimum whole grain content required for a given food to be considered whole grain. The Whole Grains Council recommends manufacturers to label as ‘whole grain’ only products containing a higher percentage of whole grain than refined grain (i.e., at least 51% whole grain). The HEALTHGRAIN Forum proposes two labeling categories, one for bread and pasta indicating 100% whole grain if the content of whole grain flour is almost over 90% of dry material and the other category for foods defined as ‘rich in whole grain’ where the amount of whole grain must be specified.

Production and Consumption

The last report of the International Pasta Organization (IPO) () states that in 2012, about 13.5 million tons of dry pasta has been produced in the world. Among the pasta-producing countries, Italy ranks first with an annual production of about 3.33 million tons, followed by the United States (2.00 million tons), Brazil (1.19 million tons), Russia (1.08 million tons), and Turkey (1.00 million tons). The European Union produces 36.4% of pasta, followed by Central and South America with 21.9% and by North America with 16.9%; Asia and Australia are the countries with the lowest pasta production, that is, 1.8% and 0.4%, respectively. Italy is the first pasta-exporting country with about 1.8 million tons, followed by Turkey (436 thousand tons), Belgium (137 thousand tons), the United States (133 thousand tons), and China (109 thousand tons). Italy is the largest per capita/year pasta consumer in the world (26 kg), followed by Venezuela (13.2 kg), Tunisia (11.1 kg), and Greece (10.6 kg); Switzerland (9.2 kg) and Sweden (9.0 kg) consume more pasta per capita than the United States (8.8 kg).

Composition and Nutritional Qualities

Pasta is an important source of carbohydrates, especially starch. A portion of 100 g of uncooked pasta contains about 68.1 g starch, 4.2 g soluble sugars, 2.7 g fiber, 10.9 g protein, and 1.4 g fat, providing about 353 kcal (1478 kJ). pasta also contains vitamins B1 and B2, as well as some minerals. In the United States, however, pasta is vitamin- and mineralenriched. During cooking, some of the nutrients get lost either in the water or by heat, especially some starch, proteins, phosphorus, and vitamin B1.

The biological value of proteins in durum wheat pasta is not particularly elevated given its low content of essential amino acids: in particular, wheat proteins are deficient in lysine. Based on high or low temperature used in drying, 100 g of pasta contains from ∼22% to 26% lysine recommended dietary intake. However, pasta is usually consumed with other foods with different protein contents that improve the nutritional value of the pasta dish. The addition of eggs to the basic ingredients increases its protein content (about 20% higher compared to wheat pasta) and its biological value since eggs contain about 139% of the recommended dietary intake for lysine. However, the addition of eggs increases also the fat content of pasta.

Whole grain pasta contains fewer calories for 100 g of dry product (about 324 kcal per 1356 kJ) and supplies more fiber (∼6 g) and 25% more proteins than the traditional refined pasta. Whole grain pasta is an excellent source of B vitamins and iron and provides significantly higher levels of the essential trace mineral selenium, a micronutrient with antioxidant properties. Whole wheat pasta also contains appreciable levels of alpha-linolenic acid. The most common whole grain pastas are made from whole wheat, bsectionn rice, or buckwheat, but quinoa, spelt, and kamut are also used to make whole grain pasta. Not all whole grain pasta is made from 100% whole grain flour, however. Some are made from a mixture of whole grain flour and ground legumes and flax, ingredients that improve the product texture while boosting its protein and unsaturated fatty acid content.

Compared to wheat, buckwheat contains proteins with a high biological value due to a well-balanced amino acid composition (rich in lysine and arginine) and antioxidant molecules, such as rutin (a flavonol glycoside), which is recommended for people with capillary fragility. Corn pasta has about half as much proteins as traditional wheat pasta, but it is otherwise nutritionally comparable. pasta from rice flour does not contain any gluten. Bsectionn rice flour compared to white rice flour is made from rice that has only the inedible hull removed; therefore, it is high in fiber and produces pasta dough similar to whole wheat pasta, with the exception that dough made from bsectionn rice flour is stickier. This kind of pasta is consumed in Asian countries and available in Asian markets or health food stores. Compared to common wheat, the composition of the kamut grain is richer in several minerals, including magnesium and zinc and selenium, a powerful antioxidant. Compared to wheat flour, kamut flour is also characterized by a percentage of vitamin E higher than 30%, as well as a higher content of proteins, lipids, and fatty acids. Oat and barley flours are mixed with wheat flour because they are rich in beta-glucan, a type of viscous fiber that improves pasta texture. Soy flour can be used to supplement proteins in macaroni and to produce a quick-cooking pasta product. Spaghetti with high protein and high lysine content can be obtained by adding up to 35% soy flour without adverse effects on flavor and texture and could result in greater acceptability of a soy-based diet.

Among the different types of pasta, the inulin-enriched pasta is to be counted for its content of nondigestible fructooligosaccharide with prebiotic effects.

Starch is the most abundant nutrient in pasta and the source of rapidly released glucose during digestion, regardless of the type of cereal used. The starch of pasta contains two major glucose polymers, amylose and amylopectin, which differ in the degree of polymerization (DP) of glucose chains and in the frequency of branches. In particular, wheat endosperm contains ∼75–80% of starch as amylopectin and 20–25% as amylose. Amylose is a predominantly linear molecule with glucose chains linked through alpha-1,4 linkages in the range of 1000–2000 DP, while amylopectin is a complex and highly branched molecule in the range of 50000–500 000 DP. In amylopectin, glucose units are linked in a linear way with alpha-1,4 linkages. Branching takes place with alpha-1,6 bonds occurring every 24–30 glucose units, resulting in a soluble molecule that can be quickly degraded since it has many end points for enzymes to attach onto. In contrast, amylose contains very few alpha-1,6 bonds or even none at all. This causes it to be hydrolyzed more slowly but to have a higher density and to be insoluble. In raw products, native starch occurs naturally as insoluble semicrystalline granules assembled in some way to form an ordered granular architecture and is not digested by human bowel enzymes. When it is heated in excess water, the starch granules undergo an irreversible phase transition, referred to as gelatinization, in which the highly ordered structure is disrupted.

The extent of starch gelatinization is the key factor in determining the digestibility and nutritional properties of starchy foods. The starch, before being absorbed in the small intestine, must be hydrolyzed to its monosaccharide components. The digestion of starch begins with salivary amylase, but this activity is much less important than that of pancreatic amylase in the small intestine. Amylase hydrolyzes starch, with the primary end products being maltose, maltotriose, and alphadextrins; some glucose is also produced. The products of alpha-amylase digestion are hydrolyzed into their monosaccharide components by enzymes expressed on the brash border of the small intestinal cells, the most important of which are maltase, sucrase, isomaltase, and lactase. However, starch digestibility is influenced also by the physical structure of food. In the case of pasta, molecular rearrangements of proteins may lead to the formation of large proteinaggregates, which reduce pasta starch accessibility to the action of alpha-amylase during digestion that results in a lower but prolonged increase of blood glucose concentrations in the postprandial period. Addition of viscous fiber or inulin in pasta further reduces the rate of starch digestion.

Health Effects

Pasta is a key component of the traditional Mediterranean diet, a dietary pattern that confers health benefits compared to current Western dietary patterns.

Several decades of observational and intervention studies have clarified the characteristics of lifestyles able to prevent chronic diseases and extend longevity. It is well known that both an excess of calorie intake and an inappropriate composition of the habitual diet are relevant for the development of obesity and other chronic diseases. There is a general consensus among nutrition scientists and related experts concerning the optimal distribution of macronutrients: carbohydrates at 45–60% of calories, fats at 25–30% of calories, and proteins at 15–20% of calories. However, appropriate food choices may be more important than the overall amount of each of these macronutrients. This implies that avoiding extreme and/or unbalanced diets and favoring macronutrient-balanced eating patterns are as important as emphasizing the preferential use of unsaturated fats, whole grain and low-glycemic index (GI) foods, fiber-rich fruit and vegetables, and a combination of plant and animal proteinsources.

The GI is a measure of the blood glucose-raising ability of the available carbohydrates in foods. A large body of evidence shows that a diet with a low GI may be able to prevent weight gain and reduce the risk of type 2 diabetes and coronary heart disease. GI is calculated by dividing the incremental area under the curve (AUC) of blood glucose concentrations, measured after the ingestion of a portion of the test food by the AUC of blood glucose concentrations achieved with a portion of the reference food (glucose or white bread). The test and the reference food must contain the same amount (50 g) of carbohydrate and are evaluated in the same group. This index was proposed for the first time in 1981 by Jenkins as an alternative system for classifying carbohydrate-containing foods.

Among carbohydrate-rich foods, spaghetti has a lower GI than bread, pizza, and other cereal foods. The average GI of durum wheat spaghetti from different manufacturers, cooked 10–15 min in water, is 46%. Other types of durum wheat pasta (i.e., macaroni, penne, and fusilli) or fresh pasta, made from soft wheat flour and eggs, also have a low GI that ranges from 32% to 47%. These values are also superimposable to those of whole grain boiled spaghetti (42%) and soy spaghetti (47%). As mentioned earlier, the low GI of these products is consistent with a low rate of starch accessibility to digestion, due to the formation of large proteinaggregates surrounding the starch. This is relevant since it is able to reduce insulin secretion and consequently the risk of reactive hypoglycemia during the postabsorption period; moreover, it contributes to increase glucagon-like peptide-1 (GLP-1) that regulates postprandial satiety and glucose metabolism.

The majority of the intervention studies, mainly performed in high-risk subjects – obese subjects or people with insulin resistance/metabolic syndrome – and in diabetic patients, have shown that a low-GI diet induces favorable changes on body weight regulation, blood glucose, and insulin metabolism and lipid control.

A meta-analysis of randomized controlled trials has demonstrated that a diet with low GI, at least in the medium term (< 6 months), promotes a greater weight gain and total fatmass loss compared to diet with high GI. This result has also been confirmed by a systematic review in which the authors evaluated the independent role in body weight reduction of GI and other variables of diet in healthy subjects, in glucose-intolerant subjects, and in type 1 and type 2 diabetic patients.

Epidemiological evidence also suggests that a diet with a low GI and rich in fiber contributes to diabetes prevention and to an improvement of the plasma lipid profile. The benefits of low-GI foods on blood glucose control and other metabolic parameters are particularly evident in intervention studies performed in diabetic patients and in other high-risk individuals compared to healthy subjects. In relation to blood glucose control, data clearly show that in diabetic patients, low-GI/ high-fiber diets improve blood glucose concentrations, especially in the postprandial state, reduce the number of hypoglycemic events, and also lower the level of glycated hemoglobin. The beneficial metabolic effects of low-GI foods are independent of the fiber content. However, a combination in the diet of both low-GI and fiber -rich foods may enhance the beneficial effects of each component. These findings have led some food industries to develop new types of pasta rich in fiber, like those made from whole grain wheat flour or barley and oat flour. In particular, pasta made from whole grain wheat flour, beyond its content of dietary fiber, is also rich in oligosaccharides, minerals, vitamins, and antioxidant components that may have an additional beneficial influence on several biological functions. As a matter of fact, the habitual consumption of whole grain foods is consistently associated with reduced risk of developing obesity, type 2 diabetes, and cardiovascular diseases in several epidemiological studies. These benefits have been related to multiple mechanisms; worth considering are (1) the lower energy content of whole grain products, as well as the higher satiating effect, favoring a lower energy intake per eating occasion and, in the long term, playing an important role in body weight regulation, and (2) the higher fiber, resistant starch, and oligosaccharide content fermented by gut microbiota with production of short-chain fatty acids (SCFA), as acetic, propionic, and butyric acids, which improve the control of glucose and lipid metabolism, decrease gastric emptying rate, and increase satiety. In particular, an intervention study, performed in subjects with the metabolic syndrome, showed that whole grain wheat pasta consumed in the context of a mixed meal significantly reduces postprandial insulin and triglyceride plasma levels, compared to refined cereal products. For these reasons, the consumption of whole grain foods in the diet has been included in the nutritional recommendations of the United States and other countries as a dietary strategy targeting the whole population.

Beneficial effects on glucose and lipid metabolism have been also reported in subjects consuming pasta made from barley or oat flour, two cereals particularly rich in beta-glucan, or pasta added with guar. These types of pasta, compared to traditional refined wheat pasta, induced an even lower increase of plasma glucose, insulin, and triglyceride levels in the postprandial period and decreased even more both fasting and postprandial plasma cholesterol concentrations. The benefits on glucose metabolism of barley and oat pasta are related to the high viscosity of beta-glucans, which delays gastric emptying and limits starch accessibility to digestive enzymes, thus prolonging nutrient digestion and absorption in the small intestine.

Finally, consumption of pasta enriched in fructooligosaccharides and inulin has been proposed as a useful tool to prevent inflammatory gastrointestinal diseases and colon cancer, thanks to its prebiotic effects. The prebiotic activity might have a beneficial impact also on fat storage, insulin resistance, and subclinical inflammation.

However, despite the potential health benefits of new pasta formulations, it needs to be underlined that the types of pasta commonly available in food shops represent a healthy choice among carbohydrate-rich foods for their low GI and high satiating ability. Moreover, according to the Mediterranean tradition, pasta is the main ingredient of a complex dish in which other ingredients are also present, among these being olive oil, vegetables such as tomatoes, and products of animal origin. When animal products like fish, cheese, and meat are present in the dish, their amount is usually small and it can be considered optimal from the nutritional standpoint, being a good source of low-GI carbohydrates, rich in fiber, and with a balanced content of high-quality proteins and unsaturated fats, not to mention micronutrients and polyphenols.

In conclusion, scientific evidence supports the health benefits of regular pasta intake, in particular if it is consumed in the context of a diet balanced for energy density and macronutrient distribution, according to the Mediterranean dietary pattern. In fact, pasta, due to its low GI, represents an ideal source of carbohydrates in the diet of healthy individuals, obese subjects, and diabetic patients. In this context, the alarm about the possible dangers of a high consumption of dietary carbohydrates certainly does not apply, on the basis of the available scientific evidence, to healthy carbohydrate-rich foods like pasta. In contrast, it is strongly advised to favor pasta consumption, in those countries where its consumption is low, in substitution of other carbohydrate foods with higher GI. Furthermore, in order to enhance whole grain intake in the daily diet, whole grain pasta consumption should be considered in addition or in substitution of refined grain pasta.

See also:

Further Reading

• Atkinson FS, Foster-Powell K, and Brand-Miller JC (2008) International tables of glycemic index and glycemic load values: 2008. Diabetes Care 31: 2281–2283.
• Casiraghi MC, Pagani MA, Erba D, Marti A, Cecchini C, and D’Egidio MG (2013)
Quality and nutritional properties of pasta products enriched with immature wheat grain. International Journal of Food Sciences and Nutrition 64: 544–550.
• Castro-Quezada I, Roma´n-Vin˜as B, and Serra-Majem L (2014) The Mediterranean diet and nutritional adequacy: a review. Nutrients 6: 231–248.
• Fardet A (2010) New hypotheses for the health-protective mechanisms of whole-grain cereals: what is beyond fibre? Nutrition Research Reviews 23: 65–134.
• Giacco R, Della Pepa G, Luongo D, and Riccardi G (2011) Whole grain intake in relation to body weight: from epidemiological evidence to clinical trials. Nutrition, Metabolism, and Cardiovascular Diseases 21: 901–908.
• Giacco R, Costabile G, Della Pepa G, et al. (2014) A whole-grain cereal-based diet lowers postprandial plasma insulin and triglyceride levels in individuals with metabolic syndrome. Nutrition, Metabolism, and Cardiovascular Diseases 24: 837–844.
• Harris KA and Kris-Etherton PM (2010) Effects of whole grains on coronary heart disease risk. Current Atherosclerosis Reports 12: 368–376.
• Ley SH, Hamdy O, Mohan V, and Hu FB (2014) Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet 383: 1999–2007.
• Livesey G, Taylor R, Hulshof T, and Howlett J (2008) Glycemic response and health—a systematic review and meta-analysis: relations between dietary glycemic properties and health outcomes. The American Journal of Clinical Nutrition 87: 258–268.
• Mancini M, Ordovas JM, Riccardi G, Rubba P, and Strazzullo P (eds.) (2011) Nutritional and metabolic bases of cardiovascular disease. UK: Wiley-Blackwell.
• Pollini CM, Panto` F, Nespoli A, Sissons M, and Abecassis J (2012) Manufacture of pasta products. In: Sissons M, Abecassis J, Marchylo B, and Carcea M (eds.) Durum wheat chemistry and technology, 2nd ed., pp. 161–175. St. Paul, MN: AACC International.
• Riccardi G, Rivellese AA, and Giacco R (2008) Role of glycemic index and glycemic load in the healthy state, in prediabetes, and in diabetes. The American Journal of Clinical Nutrition 87: 269–274.
• Sissons M, Abecassis J, Marchylo B, and Carcea M (eds.) (2012) Durum wheat chemistry and technology, 2nd ed. St. Paul, MN: AACC International.
• Slavin J (2013) Fiber and prebiotics: mechanisms and health benefits. Nutrients 22: 1417–1435.
• Wolever TM (2013) Glycemic index claims on food labels: review of Health Canada’s evaluation. European Journal of Clinical Nutrition 67: 1229–1233.

Relevant Websites

– HHS and USDA guidelines – Health and Human Services.
www.internationalpasta.org/index.aspx – International Pasta Organization.

Over the years, pasta has gained an unearned reputation as a contributor to health issues, such as weight gain, diabetes, and cardiovascular disease (CVD). The sustained popularity of low-carbohydrate diets has further propagated the belief that eating pasta is bad for health, but the evidence is insufficient to support these perceptions. Pasta has a long culinary history as one of the major components of the Mediterranean diet, which has been proven through years of research to be a healthy dietary pattern.

‘‘Pasta,’’ Italian for ‘‘dough,’’ is typically thought of as an Italian staple, and for good reason. According to the National Pasta Association, Italian per-capita consumption of pasta tops the list of 47 pasta-consuming countries, with a total of 57 lb consumed per person per year. The latest statistics clearly show that pasta is popular in the United States as well. Americans consume almost 20 lb of pasta per person per year, putting them seventh of the 47 countries. Although far less than the amount of pasta Italians put on their plates, pasta still makes a significant and affordable contribution to American diets.¹ As of a March 2017 report from the US Department of Labor Statistics, spaghetti and macaroni cost an average of $1.27 per pound (8 servings) in the United States, making it affordable for almost everyone.²

PASTA HISTORY

Despite pasta being thought of as an Italian dish, there is some evidence that the Chinese ate pasta as long ago as 5000 BC, although some believe that pasta dates back even farther to ancient Etruscan civilizations.³ The earliest written record of pasta was in 1279, where pasta was included among the items in a will, referred to as a ‘‘bariscella plena da macaroni’’ (basket full of macaroni).³ Macaroni was considered a fashionable food in late 18th-century Paris, and Thomas Jefferson is credited with introducing it to the United States almost half a century later. Jefferson even drew plans for a pasta-making machine⁴ and later purchased a machine for making it.⁵ Around 1800, the first mechanical devices to produce pasta appeared in Italy,¹ and the first American pasta factory was opened in Brooklyn, New York, in 1848, by a French man named Antoine Zerega. Almost 200 years passed before tomatoes, brought to Europe by the Spanish explorer Cortez, were paired with pasta to create the traditional Italian dish, spaghetti with tomato sauce.

HOW PASTA IS MADE

Originally, pasta was made by grinding several cereals and grains together and mixing them with water before cooking.⁶ Today, durum wheat (Triticum turgidum L.) is the preferred raw material worldwide and is grown specifically for the manufacturing of pasta. Compared with common wheat (Triticum aestivum L) , which is used to make bread and oriental-style noodles, durum wheat is harder, and milling produces a coarse particle called semolina, a golden yellow flour, which is then used to make pasta. Couscous is semolina cooked with water. The compact structure of semolina, produced from high-protein durum wheat, allows pasta to maintain its cooking consistency, flavor, and texture.

The production of good-quality pasta begins with the milling of high-quality durum wheat. Before milling, the durum wheat kernels are cleaned of any foreign substances coming from the field and are then brushed to clean the external layer of the bran. As the wheat is fed into a mill, rollers remove the bran and germ, while the endosperm is cracked into coarse pieces. Through sifting, the endosperm particles are separated from the bran and ground, creating semolina flour of the correct particle size and quality.⁷ The semolina is then mixed with water to form a dough, which is kneaded to bring it to the proper consistency. Highprotein durum wheat is desirable because it generally yields a semolina of uniform size with a minimum number of starchy particles and thus will hydrate evenly during mixing.⁷ The kneaded dough is then extruded through a ‘‘laminator’’ for flat shapes, such as lasagna and tagliatelle, or through various molds or dies to give the desired shape for other pasta varieties (round dies for short pastas, rectangular for long pastas). The extrusion process creates a tight protein shield around the starch molecules to provide pasta’s strong, elastic structure.

The extruded dough is sent through dryers that circulate hot air for several hours to keep the dough from sticking and forming lumps and to strengthen the protein shield. Drying pasta, which ensures it is strong and will have a long storage life, is the most delicate step of the entire production process.⁷ The drying of short pasta occurs in steps as it is moved along dryer belts. Long pasta requires a longer drying time because of its thickness. It is hung on sticks and then cut to length at the end of the drying process. If pasta is not dried properly, cracking may develop.⁷ The pasta is moved through a number of drying zones that are maintained at a precise temperature and relative humidity to reduce the moisture to about 12%. Drying time can vary greatly (4–48 hours) depending on the shape and length of pasta. From there, the pasta is sent to automatic packing machines to be weighed and packed in boxes or bags. There are more than 600 pasta shapes produced worldwide, but the most popular in the United States are spaghetti, thin spaghetti, elbow, rotelle, penne, and lasagna.⁸ Dry pasta typically lasts 1 to 3 years if stored in an airtight container

For specialty pastas, such as lasagna, egg noodles, or vegetable pasta, additional ingredients, such as eggs (federal guidelines stipulate that egg noodles contain a minimum of 5.5% egg solids⁹ ), tomatoes, or spinach, are added. Other types of pasta are made using ingredients such as rice, barley, corn, legumes, and beans.⁹ Several countries, including Italy, France, and Greece, have decreed that dried pasta be produced exclusively from durum wheat, and using other cereals not specifically mentioned is considered a fraudulent claim.¹⁰ Other countries, including the United States, Canada, Australia, and Spain, traditionally consume pasta made from only durum wheat semolina, but there is no regulation mandating its use in pasta, and several other types of pasta are available.¹

A more recent pasta option is precooked pasta in a pouch, which is packaged fully cooked and can be microwaved and ready to eat in 60 seconds. Preparation uses less water, and because it is ready to eat in less time than traditional pasta, it uses less energy. Barilla Ready-Pasta, for example, uses 78% less energy and 45% less water than cooking of traditional pasta. Like traditional pasta, it contains no preservatives.¹¹ Nutritionally, precooked and traditional pasta are similar in calories per serving and provide the same amount of protein, carbohydrates, and fiber, and both are free of saturated fat, trans-fat, and cholesterol. However, precooked pasta contains a small amount of oil and salt, similar to what many people add when preparing pasta at home. As a result, precooked pastas have slightly more fat (about 2 g per serving for precooked elbow vs 1 g for regular elbow) and more sodium (about 200 mg per serving for precooked elbow vs 0 mg for regular elbow) than traditional pastas.

NUTRITIONAL VALUE OF PASTA

Most dry pasta in the United States is enriched with iron, riboflavin, thiamine, and folic acid. A 2-oz serving of semolina pasta (about 1 cup, cooked) supplies the equivalent of 25% or more of the Daily Value (100 Kg) of folic acid, making it an excellent source of the B vitamin, and it is a good source of iron, providing about 10% of the Daily Value. Pasta is naturally very low in sodium and is cholesterol free. Whole-grain pasta can provide up to 25% of recommended daily fiber intake in every 2-oz dry portion,⁸ and it provides oligosaccharides, phenolics, lignans, and phytic acid, but it is not fortified with folic acid.¹²,¹³. Pasta made with vegetable purees, such as spinach, carrots, lentils, or zucchini, may provide as much as ½ serving of vegetables.

‘‘Whole-grain pasta can provide up
to 25% of recommended daily fiber
intake in every 2-oz dry portion.’’

While pasta can be served alone, in the Mediterraneanstyle diet, widely followed in Italy and surrounding areas, it is typically served with a tomato sauce, herbs and spices, olive oil, vegetables, lean meats, beans, or lentils, making it a very efficient way to incorporate other nutrient-dense foods into the diet.

Because pasta is a source of gluten, it cannot be included in the diets of individuals with celiac disease or gluten intolerance. Although not studied as much as semolina pasta, gluten-free varieties of pasta made with corn, rice, soy, quinoa, millet, lentil, or amaranth are available.

SUSTAINABILIY

Pasta is a simple plant-based food that has a low environmental impact, with a carbon footprint that is much less than beef, cheese, fish, pork, eggs, or poultry. Life cycle analyses of pasta products, from production to retail, have shown that the most significant impact on the environment occurs during the phase of wheat cultivation -80% of the ecological footprint, approximately 60% of the carbon footprint, and the entirety of the water footprint.¹⁴ In 2010, a project for the development and spread of more sustainable cultivation of durum wheat was begun. Italy was the first cultivation area considered, because it is the country where Barilla, the largest global producer of pasta products, purchases approximately 70% of the durum wheat needed for its entire pasta production.¹⁵ It was determined through life cycle analyses of products from production to retail that the most significant impact on the environment occurs during the phase of cultivation. The project developed and tested diversified crop systems and encouraged rotations with durum wheat as only one of the crops in the rotation, multicropping and intercropping, to increase productivity and crop quality in conventional and organic agricultural systems.

Only quality certified seeds were used, and sustainability was extended to whole farms, not only to single crops. It demonstrated that greenhouse gas emissions and production costs could be reduced by up to 30%, according to the specific climatic conditions year to year. Production yields increased by up to 20%, according to year-to-year specific conditions, with improved revenue for farmers. Since 2012, this system has succeeded in reducing the environmental impacts, increasing profits and system resilience.¹⁴ Farmers in Italy have access to a support system for technical decisions (granoduro.net, in Italian), which is linked to a meteorological network that provides advice on how to optimize cultivation practices.¹⁴

PASTA IS A CULTURAL FOOD AND PART OF A HEALTHY DIETARY PATTERN

Semolina pasta is a key component of many of the world’s traditional healthy dietary patterns, including the Mediterranean diet, which has been associated with a lower mortality rate,¹⁶ a reduced incidence of cardiovascular disease (CVD),¹⁷ a lowered risk of metabolic syndrome,¹⁸ and some types of cancer¹⁹ and has been associated with improved biomarkers of aging.²⁰ The Mediterranean diet has its origins in the Mediterranean basin, which historians have called ‘‘the cradle of society,’’ because it is where the history of the ancient world took place. It is the result of a blending of cultures in the region and has a rich and complicated history.²¹ The diet is not a specific plan or program, but a collection of eating habits traditionally followed by the people in the Mediterranean region. The hypothesis that consumption of a Mediterranean diet, which typically includes pasta, is associated with a lower incidence of CVD was first proposed in the 1950s, and research since then has continued to support that theory.²² Recently, published findings from the Italian Nurses Health Study and the MOLI-sanistudy found a higher consumption of semolina pasta was associated with a greater adherence to a traditional Mediterranean diet.²³

Although pasta is an integral part of the traditional Mediterranean diet, how pasta is served and paired with other foods varies from region to region, even within Italy, where semolina pasta is the bed rock of the traditional diet. Processed, whole-grain pasta is a relatively modern food, and while it is high in fiber and carries health benefit of its own, it is not a component of the traditional Mediterranean diet.

DIETARY PATTERNS, PASTA, AND HEALTH

Many consumers tend to think of foods as being either good or bad, foods to eat more of or foods to avoid completely. Carbohydrates, including pasta, have been on the ‘‘avoid’’ list for some time, identified as major contributors to diseases and chronic conditions, particularly obesity, diabetes, and heart disease. Popular diet books promise that avoiding carbohydrate-rich foods, including pasta, will lead to better health. However, a recent prospective cohort study and meta-analysis of 15 428 adults aged 45 to 64 years in the United States found increased mortality with both high and low percentage of carbohydrate diets in a median of 25 years of follow-up.²⁴ Minimal risk was observed at an intake of 50% to 55% of calories as carbohydrate (see Table 1).

Certain dietary patterns have been identified as major risk factors for cardiovascular morbidity and mortality.²⁵ Studies strongly suggest that carbohydrate-rich pasta contributes to a healthy dietary pattern, and the traditional Mediterranean dietary pattern, which includes pasta, represents a substantial improvement in the way people currently eat in industrialized countries, where overconsumption is a problem.¹³ Portion control is as important for pasta as it is for any every other food in a healthy diet, and as with other calorie containing foods, overconsumption can lead to weight gain. The recommended serving size for pasta is 2 oz uncooked or approximately 1 cup cooked.

‘‘Studies strongly suggest that
carbohydrate-rich pasta contributes
to a healthy dietary pattern.’’

CARDIOVASCULAR DISEASE

As part of a prospective cohort study, the diets of 1838 men, aged 47 to 67 years, were analyzed to identify dietary patterns and association with CVD. Of the 3 dietary patterns established, the pattern that included pasta was not associated with CVD incidence or risk factors at follow-up.²⁶

The effect of dietary patterns on CVD in 3226 men, aged 60 to 79 years, who participated in the British Regional Heart Study, was examined. Three dietary patterns were identified as ‘‘high-fat/low-fiber’’ (characterized by a high consumption of red meat, meat products, fried potato, white bread, eggs, and beer and a low intake of wholemeal bread); ‘‘prudent’’ (characterized by a high consumption of poultry, fish, vegetables, legumes, fruits, pasta and rice, whole meal bread, eggs, sauces, soups, and olive oil); and ‘‘high-sugar’’ (characterized by a high consumption of breakfast cereals, full-fat cheese, biscuits, puddings, chocolates, sweets, and sweet spreads and a low consumption of beer).²⁵

The ‘‘high-fat/low-fiber’’ dietary pattern was associated with an increased risk of all-cause mortality after adjusting for confounders. In 11 years of follow-up, the ‘‘high-sugar’’ dietary pattern was associated with a borderline significant trend for an increased risk of CVD events and coronary heart disease specifically. The ‘‘prudent’’ dietary pattern, which was high in pasta, among other foods, was not significantly associated with cardiovascular outcomes or mortality.²⁶ A systematic review of prospective cohort studies and randomized controlled dietary interventions examined pasta and pasta-related fiber and grain intake in relation to cardiometabolic risk factors. While the authors concluded that pasta meals resulted in significantly lower post prandial glucose response than bread or potato meals, evidence of how pasta intake influences cardiometabolic disease risk was lacking.²⁷

It has been suggested that low-carbohydrate diets, which, by definition, would limit or exclude pasta, may result in the opposite of the desired effect, increasing the risk of CVD. A study of 43 396 Swedish women followed for an average of 15.7 years showed that each 20-g decrease in daily carbohydrate intake and 5-g increase in daily protein intake corresponded with a statistically significant increase in the overall risk of CVD.²⁸ The authors concluded that a low-carbohydrate, proinflammatory, and prothrombolitic dietary pattern increases the risk of coronary artery atherosclerosis progression, independent of traditional cardiovascular risk factors. The findings are relevant when a low-carbohydrate diet is followed on a regular basis, without consideration of the type of carbohydrate (complex vs refined) or the source of protein (plant vs animal). Animal studies suggest that low-carbohydrate, high-protein diets have adverse vascular effects that are not reflected in serum lipid levels or other markers of cardiovascular risk, including inflammatory markers and histological indicators of inflammation.²⁹

WEIGHT

While carbohydrate-rich foods, such as pasta, have been vilified by consumers as a cause for weight gain, and sometimes avoided completely, a significant inverse relationship has been demonstrated between carbohydrate consumption, and pasta in particular, and BMI, waist circumference, and waist-to-hip ratio.²³

A 2-year study of 322 moderately obese subjects with a mean age of 52 years compared a Mediterranean diet, which typically includes pasta, to a low-fat diet and a low carbohydrate diet and found the Mediterranean diet to be just as effective for weight loss as the low-carbohydrate diet and more effective than the low-fat diet.³⁰ Among the 272 participants who completed the trial, the mean weight losses were 3.3 kg for the low-fat group, 4.6 kg for the Mediterranean-diet group, and 5.5 kg for the low-carbohydrate group.

In a study referenced earlier, the diets of more than 23 000 adult subjects at least 18 years of age were assessed using either a food frequency questionnaire or a single 24- hour dietary recall. Pasta consumption was found to be associated with better adherence to a Mediterranean diet. A significant inverse association of body weight and BMI with pasta consumption was established in both men and women.²³

In a Norwegian study of more than 41 000 people 20 years or older, who completed a dietary questionnaire, those with central obesity reported a lower frequency of pasta and rice consumption, as well as a less frequent intake of fruits, berries, and vegetable, than those without centralobesity.³¹ However, after adjustment for lifestyle variables, there was no association between pasta and central adiposity.

A systematic review and meta-analysis of 29 randomized controlled studies in adults found that pasta, consumed in the context of a low-GI dietary pattern, does not adversely affect adiposity, but was found to reduce body weight and BMI compared with higher-GI diets.³² Most subjects (66%) were overweight or obese; 31% had diabetes, and 3% had coronary heart disease. However, there were inconsistencies among the estimates for waist circumference and body fat in the studies, and none of the included studies assessed the effect of pasta alone. Despite the limitations, the researchers concluded that pasta, in the context of a low-GI dietary pattern, significantly reduced body weight (mean difference, 0.63 kg) and BMI (mean difference, 0.26 kg/m2) compared with higher-GI dietary patterns.

Another study compared the effectiveness of 4 diets with 4 levels of carbohydrates (65%, 55%, 45%, or 35%) among 811 overweight adults.³³ After following the groups for 2 years, the researchers determined that weight loss (an average of 4 kg) was similar, whether the subjects consumed a diet with 65% carbohydrates or 35% carbohydrates, suggesting that a high-carbohydrate diet, which includes pasta, can be just as effective for weight loss as a low-carbohydrate diet.

A Swedish cross-sectional study of 250 000 men and women aged 25 to 64 years, given dietary questionnaires 4 times over a 13-year period, found that an increased consumption of pasta was associated with a reduction in waist circumference over time.³⁴

The DIETFITS randomized clinical trial compared weight loss resulting from a healthy, low-fat diet or a healthy, low carbohydrate diet in 481 adults aged 18 to 50 years for 12 months and found no significant difference in weight change (j5.3 kg for the low-fat diet vs j6.0 kg for the low-carbohydrate diet) even when insulin resistance was present.³⁵

A small crossover study (4 male and 4 female subjects) that compared fullness, hunger, and postprandial thermogenesis following a meal of refined-grain pasta, whole-grain pasta, and refined-grain pasta with legumes, found that consumption of whole-grain pasta may promote fullness and reduce hunger more than refined grain pasta or refined-grain pasta with legumes.³⁶ However, a randomized, placebocontrolled, double-blind cross over tail of 36 healthy men and women found that high-protein or high-fiber pastas did not produce greater satiety response than traditional pasta.³⁷

A small study of 24 males, aged 20 to 30 years, BMI 20 to 24.9 kg/m2, was carried out to determine the effect of a meal of pulses (chickpeas, lentils, navy beans, or yellow peas) and pasta on food intake, satiation (as measured by subsequent food intake), and blood glucose, compared with a meal of pasta and tomato sauce.³⁸ The pasta meals with lentils or beans resulted in lower food intake than pasta and sauce alone, suggesting that the effect of pasta on appetite varies depending on other components of the meal.

Pasta may also aid weight loss by acting as a source of resistant starch. When pasta is cooked, then refrigerated, resistant starch is formed. Resistant starch like that in cooked and cooled pasta is not digested or absorbed in the upper digestive tract and passes to the large bowel and has a beneficial effect on the gut microbiota. Several studies have investigated the effect of resistant starch on energy balance and body weight. When pasta is refrigerated, double helices of amylose molecules and long-branch chains of amylopectin in the pasta form and cannot be hydrolyzed by the amylase enzyme in the digestive tract.³⁹ It is a good substrate for fermentation, which increases short-chain fatty acid concentrations and lowers bowel pH.⁴⁰ Because of its ability to increase fat oxidation and reduce fat storage in adipocytes, resistant starch has been suggested to be an aid in weight loss.⁴⁰

BLOOD SUGAR

While pasta is classified as a refined carbohydrate and is sometimes grouped together with other refined carbohydrate foods, such as pies, cakes, and cookies, not all refined grains have the same effect on blood sugar. Pasta, of any shape or size, made from high-protein durum wheat, has a fairly low GI, ranging from 33 to 61,⁴¹ because of the physical entrapment of gelatinized starch granules in a sponge-like network of protein (gluten) molecules in the pasta dough.⁴⁶ Glycemic index is the relative ranking of the carbohydrate in foods according to the impact they have on blood glucose levels. Carbohydrate-containing foods with a low GI value (≤55) are more slowly digested, absorbed, and metabolized and cause a lower and slower rise in blood glucose and therefore insulin levels⁴⁶ (Table 1). pasta’s dense starch and protein structure, achieved by its unique extrusion process, allows the starch to be digested more slowly, diminishing its effects on blood glucose levels, yielding a low to medium GI. While the importance of GI and glycemic load in health is controversial, a 2015 International Scientific Consensus Summit of the International Carbohydrate Quality Consortium, established by the Nutrition Foundation of Italy and Oldways Preservation and Exchange Trust, as well as the 12th European Nutrition Conference,⁴²,⁴⁷ concluded that postprandial glycemia was important in overall health and that GI was relevant to the prevention and management of diabetes and coronary heart disease, and probably obesity. Moderate to weak associations were observed for selected cancers. However, GI may not always be the best approach to guiding food choices, as there is substantial variability in individual responses to GI value determinations. Even in healthy individuals, glycemic status significantly contributes to the variability in GI values estimates.⁴³ Both conferences concluded that the relationship between postprandial glucose and health has been established in people with diabetes and strongly suggested among healthy individuals.

‘‘Pasta, of any shape or size, made
from high-protein durum wheat, has
a fairly low Glycemic Index (GI)
ranging from 33 to 61.’’

Different brands of the same pasta; the size of the pasta, differences in the type of flour used, the time, temperature, humidity, drying, and extrusion technique used, as well as the cooking time, can result in differences in the degree of starch gelatinization and thus GI values.⁴¹ The addition of toppings to pasta further lowers the GI.⁴⁴ One study looked at the addition of cheddar cheese, chili con carne, baked beans, or tuna to cooked pasta. All toppings lowered the GI. For example, the addition of cheddar cheese to pasta further lowered the GI of a test meal to 27, considered to be a low GI. In a study previously cited, which compared the effect of the addition of pulses to pasta and tomato sauce, all pulses led to lower blood glucose peaks relative to pasta and tomato sauce.³⁸

The American Diabetes Association has stated that the belief that people with diabetes can eat only small amounts of starchy foods, such as bread, potatoes, and pasta, is a myth.⁴⁸ The reality is that grain-based foods with a low GI such as pasta have been shown to be beneficial for people with diabetes.⁴⁵ However, portion size is key. The amount of carbohydrate-rich foods allowed in a diet for diabetes is based on several factors and should be calculated on an individual basis.

Pasta should be cooked al dente, which means ‘‘to the tooth’’ in Italian. Al dente pasta will be slightly firm, not soft. While al dente pasta has a fairly low GI, consuming a large amount at a meal can have a marked effect on blood glucose and, like any food, can lead to overconsumption of calories.

SUMMARY

Despite pasta being cast in a negative light, semolina pasta has a long culinary history as part of the traditional Mediterranean diet, is the bedrock of Italian cuisine and has become increasingly popular in many other countries, including the United States. The Mediterranean dietary pattern, which is associated with a reduced risk of several chronic conditions, including cardiovascular disease (CVD), several types of cancer, overweight and obesity, and metabolic syndrome, is 1 of 3 healthy dietary patterns recommended by the 2015 US Dietary Guidelines Scientific Report.⁴⁹

Economical and readily available, enriched and fortified pasta made with high-protein semolina provides a source of iron, thiamine, riboflavin, and folic acid, and research suggests that pasta is a healthful additionto any diet, because of its relatively low GI. The processing of semolina pasta results in a tight protein shield around starch molecules. This compact protein-starch matrix causes the carbohydrate in pasta to be digested, absorbed, and metabolized more slowly than other refined carbohydrates, resulting in a slower rise in blood glucose and insulin levels.

Semolina pasta has also been determined to have a low environmental impact, with a small carbon footprint, compared with most animal foods. The largest producer of pasta worldwide has embarked on a project to develop and spread sustainable practices in the cultivation of durum wheat to be used in the production of semolina pasta. Consumers want affordable, convenient, and wellliked foods. Most pasta can be cooked for 6 to 7 minutes, making it a convenient as well as an affordable food that can help Americans meet the current and future dietary guidelines. Its unique profile as a low-cost, convenient, versatile, and nutritious food with a long shelf life establishes an important role for pasta in meeting the nutrient needs of not only the United States, but globally as well.

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My Memories

My love for food started from a pasta dish. I watched while my mother, an excellent cook from whom I inherited the passion for cooking, prepared delicious meals. They were always different, and she paid great attention and the care to cook even the most seemingly simple dishes, such as pasta, and I learned by observing and memorizing her gestures. I especially liked to wait for the water to boil, and then, while the pasta was cooking, I stared at the pot, contemplating the delicious dish to come. Tasting pasta during cooking was another rite to make sure it was al dente. The fact that my mother gave value to my judgment, when I was only a child, meant a lot. Growing up, I realized she wanted, slowly, to involve me in the kitchen because the “independence” of each of us also begins in being able to prepare a meal to feed ourselves. Tasting the pasta was a sort of initiation and has been one of the most important lessons. “You mustn’t be distracted. You have to follow the cooking because even a minute longer can be enough to overcook pasta”- said my mother- “if pasta is overcooked it will taste like glue and even the best seasoning will not give flavor to the dish.”

Pasta: the importance of being al dente

Al dente is the term for the perfect pasta cooking and is also the word that my mother often said to make sure I did not forget this first basic rule. But even before the cooking is the choice of pasta to make a difference. In Italy, there are many shapes, sizes and brands. There are national brands and those products within each Italian region. The quality is top-notch but there is always one brand better than another. The quality of grain (in Italy, pasta is only made with durum wheat) and water are the two most important ingredients by which one has to judge the excellence of pasta. Sometimes, it is difficult even for Italians to choose between the shelves of supermarkets offering dozens and dozens of types of pasta. My mother has always had very clear ideas on her favorites and I was educated to choose with critical eyes. Even as a child I was used to eating organic durum wheat pasta, whole wheat pasta, and pasta made with ancient grains. As an adult, I also discovered corn, rice and buckwheat pasta, naturally gluten-free, which I appreciate for its high digestibility. I often propose gluten free pasta, especially in my summer recipes for a light, easily dish.

Pasta: Italian culinary excellence

Pasta is the best known symbol of Italian cuisine. Abroad, it is customary to believe that freshpasta is more popular than dry pasta. In truth, it is not so. Strictly prepared with durum wheat, dried pasta, cooked al dente, and combined with not too elaborate sauces is one of the signature dishes of the Mediterranean Diet (UNESCO Intangible Heritage), a dish that Italians consume daily. The common belief of foreigners is that pasta (like pizza) makes you fat. However, many Italians eat a plate of pasta once a day and are among the longest-lived people in the world (along with the Japanese) and are some of the less obese in the world. The pasta’s condiments of the Mediterranean Diet are also fresh and seasonal, proving to be a healthy and simple option for a meal.

Pasta: a shape for each sauce

The most common types of dried pasta in the world are “rigatoni”, “penne”, “fusilli” and “spaghetti” but in Italy there are endless amounts of forms of dry pasta Below is a list of the most common shapes with which you can create as many tasty recipes.

Pasta: dried pasta is made with durum wheat

In Italy, dried pasta is only made with durum wheat, while other Countries allow the use of wheat. The Italian durum wheat holds, in fact, optimal cooking. Italy is a precious puzzle of gourmet foods where each type of pasta and sauces represents different traditions of each city.

From my book, The Vegetarian Italian Kitchen.