Pasta’s History and Role in Healthful Diets : Nutrition Today (2024)

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 Frenchman 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. High-protein 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 μg) 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 Mediterranean-style 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 semolina 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.

SUSTAINABILITY

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-sani study 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 bedrock 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.

SUMMARY OF SELECTED STUDIES ON PASTA AND HEALTH OUTCOMES

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, wholemeal 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 postprandial 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 central obesity.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 (−5.3 kg for the low-fat diet vs −6.0 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, placebo-controlled, double-blind crossover 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 addition to 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 well-liked 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.

REFERENCES