Exploring how fermented foods could revolutionize health and sustainability in a rapidly changing world. A European initiative seeks to understand how these age-old staples could shape that future.
Review: Health benefits and risks of fermented foods—the PIMENTO initiative. Image Credit: Tatjana Baibakova / Shutterstock
A recent review article by a large international team of researchers, published in the journal Frontiers in Nutrition, outlined the aims for evaluating the health risks and benefits of fermented foods (FFs). The paper emphasizes the critical role of FFs in not only human health but also in addressing broader societal issues, such as planetary health and sustainable food systems.
The impact of food systems on planetary health is a societal issue necessitating a shift towards more sustainable and health-promoting diets. At a time when diets are changing towards processed foods, it is critical to sustain and enhance food as a source of diverse nutrients and beneficial microbes.
FFs are presented as a pivotal component of this transition due to their ability to contribute both nutritionally and environmentally. The potential of FFs to improve human health has increasingly become relevant. FFs hold a strategic place in European diets due to their many benefits.
FFs have unique properties, including extended shelf life, live microbes and their metabolites, bioactive compounds, and vitamins. Nevertheless, consolidating evidence on FFs from studies on foodomics, food ecosystems, nutrigenomics, and systemic approaches to food microbiology is needed to fully understand the potential of FFs.
The paper highlights the need for a coordinated approach to synthesize this emerging evidence, enabling FFs to be integrated effectively into public health policies. Promoting innovation of FFs (PIMENTO) is a European initiative to address the specified needs through research.
PIMENTO’s working group 3 (WG3) aims to evaluate the health risks and benefits of FFs by compiling a set of 16 interconnected reviews based on the European Food Safety Authority (EFSA) guidelines for health claims. This systematic and structured approach is designed to ensure that the health benefits of FFs are supported by robust scientific evidence, incorporating human studies, food characterization, and mechanistic data.
Seven reviews will focus on biological and clinical endpoints related to health indicators across organ systems, and nine will address broader biological questions. These reviews are not standalone but rather part of an integrated effort to provide a holistic understanding of how FFs impact human health. The present paper summarizes the aims of these reviews.
Research questions of PIMENTO WG3 reviews
Research questions of PIMENTO WG3 reviews are grounded in a detailed methodology that combines systematic and non-systematic reviews, ensuring a comprehensive analysis of the evidence. Several probiotic microbes closely related to those found in FFs have been beneficial in managing gastrointestinal (GI) symptoms in various populations.
The PIMENTO systematic review will evaluate whether the consumption of FFs is beneficial for normal defecation and GI discomfort in a healthy adult population.
Food allergy (FA) is an abnormal immune reaction following exposure to specific foods. FAs affect up to 3% of adults and 10% of children, and their prevalence is increasing worldwide. The PIMENTO systematic review will assess the effects of FFs on the development of FA symptoms in an FA population and a population at a higher risk of FAs.
In the context of pathogenic diseases, immunity refers to safeguarding health by preventing dysbiosis. The paper emphasizes the need for maintaining a balanced microbiota, particularly in the female genital system, where vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV) are the most prevalent pathogenic conditions in females, which also elevate the risk of obstetric complications or susceptibility to other infections. The PIMENTO review will focus on whether FFs can prevent BV or VVC.
The global prevalence of type 2 diabetes is increasing. One PIMENTO review will address whether FF intake maintains insulin sensitivity or fasting blood glucose levels or reduces postprandial glucose response in prediabetic and healthy adults. The review aims to clarify the role of FFs in metabolic health by focusing on specific biomarkers associated with diabetes risk. Cardiovascular disease has been the leading cause of morbidity and mortality globally. The PIMENTO WG3 will address whether consuming fermented dairy products influences blood lipids in a healthy adult population.
The proper function of bones relies on essential nutrients, particularly calcium. However, efficient calcium absorption is critical to bone health, and age, pregnancy, and health status may influence its absorption. Fermentation processes may enhance calcium bioavailability, making FFs particularly beneficial for populations at risk of osteoporosis. The PIMENTO review will investigate the effects of FFs on bone health in healthy adults and those with osteopenia and osteoporosis.
FFs affect the functions of the central nervous system, albeit how FFs impact cognitive performance is unclear. However, the ability of microbes to modify the chemical composition of foods as well as gut microbiota composition may account for the FFs’ effects on cognitive performance. As such, a systematic review will assess whether FFs with Bifidobacterium or Lactobacillus species benefit cognitive performance in healthy adults and those with mild cognitive impairment.
Bioactive compounds exhibit diverse properties, including anti-microbial, antioxidant, anti-hypertensive, and anti-inflammatory effects. Fermentation can increase bioactive compounds in foods. The systematic review will address whether fermentation-derived compounds are related to effects on clinical endpoints in human studies. This focus on bioactive compounds highlights the potential of FFs to contribute to a range of health benefits beyond their traditional nutritional roles.
The human body cannot produce most vitamins and requires provision through diet. Although vitamins are present in many foods, deficiencies occur, leading to vitamin-specific health problems. In this regard, the systematic review will evaluate whether vitamin-fortified FFs can address the vitamin needs of deficient and healthy populations.
Anemia, or iron deficiency, affects a substantial proportion of the population, especially pregnant individuals and children. Evidence suggests that fermentation enhances iron bioavailability in foods. The systematic review will focus on whether regular bread and sourdough fermentation elevate iron status, bioavailability, and absorption in humans.
Ethnic FFs are foods that originate from the culture and heritage of ethnic people. Evidence suggests that ethnic FFs like kimchi, doenjang, and koumiss positively affect health. The paper discusses the importance of preserving these traditional foods, which are at risk of disappearing due to urbanization and changing dietary habits.
The systematic review will examine the health effects of ethnic FFs. Diet composition is an important determinant of mortality risk. As such, the review will address the impact of FFs on mortality risk.
One systematic review will evaluate whether the effects of FFs on distinct health outcomes depend on population characteristics and whether FFs could be used for tailored nutritional strategies. This approach aligns with the growing field of personalized nutrition, where FFs could be leveraged to optimize health outcomes based on individual differences.
Food safety is essential, given that sufficient amounts of safe and sustainable food must be secured for the global population. While fermentation is among the oldest processes for safe food production, the renewed interest in FFs warrants safety assessment.
As such, one systematic review will evaluate the major chemical and microbiological hazards due to FFs and their related risks. The review highlights that despite their long history, FFs must be continuously evaluated for safety, particularly as new fermentation processes and products are developed.
Further, novel FFs with improved functional properties can be produced using new species (for starter culture), raw materials, or both. Therefore, one systematic review will examine the effects of novel FFs. Finally, the last systematic review will focus on the health effects of fermented whey.
Conclusions
Conclusions drawn from this extensive analysis will help shape future research and policy, particularly in aligning FF innovations with public health goals and sustainable development objectives. In sum, the systematic approach adopted by the PIMENTO WG3 to assess 16 research questions will provide comprehensive and harmonized results, which could be used to define a strategic roadmap for research on FFs’ health benefits and risks.
Further, the roadmap will define additional research in the thematic areas identified at the Belgrade workshop conducted in 2022. Besides, the methodology adopted by the WG3 should be applied beyond this food category.
