Lactose digestion from yogurt: mechanism and relevance

Fermented foods and gastrointestinal health: underlying mechanisms

Although fermentation probably originally developed as a means of preserving food substrates, many fermented foods (FFs), and components therein, are thought to have a beneficial effect on various aspects of human health, and gastrointestinal health in particular. It is important that any such perceived benefits are underpinned by rigorous scientific research to understand the associated mechanisms of action. Here, we review in vitro, ex vivo and in vivo studies that have provided insights into the ways in which the specific food components, including FF microorganisms and a variety of bioactives, can contribute to health-promoting activities. More specifically, we draw on representative examples of FFs to discuss the mechanisms through which functional components are produced or enriched during fermentation (such as bioactive peptides and exopolysaccharides), potentially toxic or harmful compounds (such as phytic acid, mycotoxins and lactose) are removed from the food substrate, and how the introduction of fermentation-associated live or dead microorganisms, or components thereof, to the gut can convey health benefits. These studies, combined with a deeper understanding of the microbial composition of a wider variety of modern and traditional FFs, can facilitate the future optimization of FFs, and associated microorganisms, to retain and maximize beneficial effects in the gut.

Executive summary: The role of dairy food intake for improving health among Black Americans across the life continuum

Given the complex relationships that many Black individuals have with dairy foods, due to issues with lactose intolerance or other cultural factors, the National Medical Association has made considerable efforts to examine the role that dairy foods play in the health and well-being of Black Americans. Over the last two decades, the National Medical Association and its partners have produced multiple reports on the value of including adequate milk and dairy foods in the diets of Black Americans. These publications have highlighted the impact that inadequate consumption of dairy foods and nutrients have on chronic disease risks. Past publications have also provided evidence-based recommendations for the proper diagnosis and management of lactose intolerance. This new series of evidence reviews focuses on dairy's role in improving nutrition and health among Black Americans across the life course and covers an extensive amount of new research that highlights additional health disparities and provides further evidence-based strategies for the management of lactose intolerance. Much like the 2020-2025 Dietary Guidelines for Americans, this work utilizes a life course approach to better address dairy intake on health outcomes for different ages and life stages: 1) pregnancy, fetal development, and lactation, 2) infants, toddlers, and young children, 3) older children and adolescents, 4) adults, and 5) geriatric populations. Overall, the findings and conclusions from this series of evidence reviews continue to indicate that higher dairy intake is associated with reduced risk for many of the most commonly occurring deficiencies and diseases impacting each life stage, and that Black Americans would receive significantly greater health benefits by increasing their daily dairy intake levels to meet the national dietary recommendations than they would from continuing to fall short of these recommendations. However, these recommendations must be considered with appropriate context and nuance as the intake of different dairy products can have different impacts on health outcomes. For instance, vitamin D fortified dairy products and fermented dairy products like yogurt - which are low in lactose and rich in live and active cultures - tend to show the greatest impacts for reducing disease risk across the life continuum, while whole-fat dairy foods may be most beneficial in early life for optimal brain development, and more protein-rich options may be most beneficial in later life to help maintain muscle mass and function.

The detection, characterization, and quantification of dominant degradation products of nisin A and Z in selected dairy products by liquid chromatography-high-resolution mass spectrometry technique

Nisin, a bacteriocin produced through fermentation using bacterium Lactococcus lactis, has several commercial variants such as nisin A and nisin Z. Nisin serves as a natural preservative with antimicrobial properties in various food products, including dairy and beverages, for extending product shelf life. The efficacy and safety of nisin A as a bacteriocin has been well characterized. However, there is limited evidence regarding the efficacy, stability, and safety of nisin Z as a food preservative, as it has not undergone comprehensive regulatory reviews. In this work, we studied the stability of nisin A and Z in a selection of yogurt drinks and found nisin to be unstable, particularly in fruit-flavored yogurt drinks. Both nisin A and Z could experience significant degradation leading to the nisin parent ion peaks dropping below detectable level before the product's expiry date. Compared with nisin A, the formation of oxidized metabolite nisin Z+O appeared to be the predominant reaction for nisin Z. These findings highlight the need for further scientific research to understand the behavior of nisin Z under different application conditions, which is crucial for assessing the efficacy and safety of nisin Z under these conditions. One potential application of this knowledge is to optimize the formulation of yogurt-based drinks to stabilize nisin Z and sustain its biopreservative function throughout the product's shelf life. Additionally, the current study shows that for the testing of the presence of nisin A or nisin Z, it is imperative to cover both the parent and the main degradant(s) of nisin. This is especially true for nisin Z, for which the regulatory approval status may vary in different markets. As such, the confirmative identification of nisin Z and its key metabolites in commercial products would be essential.

An overview of fermentation in the food industry - looking back from a new perspective

Fermentation is thought to be born in the Fertile Crescent, and since then, almost every culture has integrated fermented foods into their dietary habits. Originally used to preserve foods, fermentation is now applied to improve their physicochemical, sensory, nutritional, and safety attributes. Fermented dairy, alcoholic beverages like wine and beer, fermented vegetables, fruits, and meats are all highly valuable due to their increased storage stability, reduced risk of food poisoning, and enhanced flavor. Over the years, scientific research has associated the consumption of fermented products with improved health status. The fermentation process helps to break down compounds into more easily digestible forms. It also helps to reduce the amount of toxins and pathogens in food. Additionally, fermented foods contain probiotics, which are beneficial bacteria that help the body to digest food and absorb nutrients. In today's world, non-communicable diseases such as cardiovascular disease, type 2 diabetes, cancer, and allergies have increased. In this regard, scientific investigations have demonstrated that shifting to a diet that contains fermented foods can reduce the risk of non-communicable diseases. Moreover, in the last decade, there has been a growing interest in fermentation technology to valorize food waste into valuable by-products. Fermentation of various food wastes has resulted in the successful production of valuable by-products, including enzymes, pigments, and biofuels.

Investigation of Trehalose Supplementation Impacting Campylobacter jejuni and Clostridium perfringens from Broiler Farming

In 2006, the European Commission banned the use of antibiotic promoters in animal feed. However, there is a new situation in poultry disease where it is necessary to study feed additives, which can overcome the diseases that were previously controlled through the addition of antibiotics and antimicrobial growth promoters in the feed. Therefore, trehalose was investigated to determine whether it impacts the growth performance and pathogenic bacteria (C. jejuni and C. perfringens) inoculation in broilers. In the first experiment, the tolerance of broilers to the addition of trehalose to their feed was investigated. There was no significant difference (p > 0.05) in body weight changes, daily weight gain, feed intake or feed conversion ratio during the feeding period. Within a 35-day feeding period, it was concluded that a trehalose dosage up to 10% does not exert a negative effect on broiler farming. Moreover, there was no significant difference (p > 0.05) in the broilers' growth performance, as well as C. jejuni and C. perfringens counts in the intestines and feces of broilers observed over a 5-week feeding period. However, Lactobacillus counts significantly increased in these groups with 3% and 5% trehalose supplementation. The findings indicate that trehalose supplementation in the feed cannot directly decrease C. jejuni and C. perfringens counts but may enhance gut health by raising Lactobacillus counts in chicken gut, particularly when enteropathogenic bacteria are present.

Physicochemical Characteristics, Antioxidant Properties and Consumer Acceptance of Greek Yogurt Fortified with Apple Pomace Syrup

Despite having high polyphenolic phytochemicals and functional components, apple pomace (AP) is often discarded in landfills, leading to pollution. The study aimed to find a sustainable application for AP in Greek yogurt fortified with AP syrup (APS). Physicochemical characteristics and antioxidant properties were analyzed for APS (APS0.00, APS1.25, APS2.50, APS3.75, APS5.00). As the AP content in the syrup increased, moisture content, titratable acidity, and viscosity significantly increased (p < 0.05). The total polyphenols and flavonoid content of APS increased with increasing AP content. In Greek yogurt fortified with APS (APY), reducing sugar content (0.55 mg/mL to 0.71 mg/mL) significantly increased with fermentation time and AP content, whereas pH level (6.85 to 4.28) decreased. The antioxidant activities by DPPH radical scavenging activity, ABTS radical scavenging activity, ferric reducing antioxidant power, and reducing power were also significantly increased with the AP content and fermentation time. In the consumer acceptance test of APY, APY1.25 had significantly high scores in overall acceptance, taste acceptance, and aftertaste acceptance with purchase intent (p < 0.05). The Greek yogurt fortified with APS as functional food had improved antioxidant properties and consumer acceptance, suggesting the possibility of developing sustainable AP products.

Design and Volatile Compound Profiling of Starter Cultures for Yogurt Preparation

Stable symbiotic starter cultures were created using selected strains of Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus salivarius subsp. thermophilus with antimicrobial activity against pathogens and necessary antibiotic sensitivity, growth kinetic parameters, and metabolic profiles. The volatile compound profiles of the obtained starter cultures were determined and their specificity was proven depending on the ratio of monocultures in each combination. The influence of the freeze-drying process on the starter cultures in relation to the production of aromatic components was investigated and it was demonstrated that this process had a significant effect on the content of the aroma-forming substances in the fermented milk. However, the influence of the pre-cooling process and crude fat content from 1.5 to 3.0% did not notably affect the levels of volatile compounds synthesized by the selected starter cultures. Comprehensive data for all volatile aromatic metabolites in the fermented milk were also obtained. These designed symbiotic starter cultures can be used to produce traditional Bulgarian yogurt with increased functional and probiotic properties.

Enhanced Stability and Function of Probiotic Streptococcus thermophilus with Self-Encapsulation by Increasing the Biosynthesis of Hyaluronan

The harsh conditions of the gastrointestinal tract limit the potential health benefits of oral probiotics. It is promising that oral bioavailability is improved by strengthening the self-protection of probiotics. Here, we report the encapsulation of a probiotic strain by endogenous production of hyaluronan to enhance the effects of oral administration of the strain. The traditional probiotic Streptococcus thermophilus was engineered to produce hyaluronan shells by using traceless genetic modifications and clustered regularly interspaced short palindromic repeat interference. After oral delivery to mice in the form of fermented milk, hyaluronan-coated S. thermophilus (204.45 mg/L hyaluronan in the milk) exhibited greater survival and longer colonization time in the gut than the wild-type strain. In particular, the engineered probiotic strain could also produce hyaluronan after intestinal colonization. Importantly, S. thermophilus self-encapsulated with hyaluronan increased the number of goblet cells, mucus production, and abundance of the microorganisms related to the biosynthesis of short-chain fatty acids, resulting in the enhancement of the intestinal barrier. The coating formed by endogenous hyaluronan provides an ideal reference for the effective oral administration of probiotics.

Can Lactose Intolerance Be a Cause of Constipation? A Narrative Review

Lactose intolerance and constipation are common in children and impact everyday life, not only for patients but also their families. Both conditions can be comorbid with other diseases or form a part of their clinical presentation, but constipation is not usually associated with lactose intolerance. The typical symptoms of lactose intolerance include abdominal pain, bloating, flatus, diarrhoea, borborygmi, and less frequently nausea and vomiting. In approximately 30% of cases, constipation can be a symptom of lactose intolerance. Constipation is characterized by infrequent bowel movements, hard and/or large stools, painful defecation, and faecal incontinence, and is often accompanied by abdominal pain. This paper provides a narrative review on lactose intolerance, its epidemiology, pathogenesis, the correlation between lactose intolerance and constipation in children, and potential mechanisms of such association.

Impact of Infectious Disease after Lactococcus lactis Strain Plasma Intake in Vietnamese Schoolchildren: A Randomized, Placebo-Controlled, Double-Blind Study

Lactococcus lactis strain Plasma (LC-Plasma) is reported to have anti-viral effects via direct activation of plasmacytoid dendritic cells, which upregulate the production of type I and III interferons. A randomized, placebo-controlled, double-blind, parallel group study was designed for elementary schoolchildren, grades 1 to 3, in Vietnam. LC-Plasma or a control were administered to schoolchildren as a beverage (1.0 × 10¹¹ count LC-Plasma/day/person). The primary endpoint was to determine the efficacy of LC-Plasma in reducing the cumulative days absent from school due to upper respiratory disease (URID) and gastrointestinal disease (GID), and the secondary endpoint was to evaluate the potency of LC-Plasma on URID/GID symptoms and general well-being scores. LC-Plasma intake significantly reduced the cumulative days absent from school due to URID/GID (Odds ratio (OR) = 0.57, p = 0.004) and URID alone (OR = 0.56, p = 0.005); LC-Plasma also significantly reduced the number of cumulative fever positive days during the first 4 weeks of intervention (OR = 0.58, p = 0.001) and cumulative days with diarrhea during the last 4 weeks of the intervention period (OR = 0.78, p = 0.01). The number of positive general wellbeing days was significantly improved in the LC-Plasma group compared with the control throughout the intervention period (OR = 0.93, 0.93, p = 0.03, 0.04 in the first and last 4 weeks of the intervention, respectively). These data suggest that LC-Plasma seems to improve the health condition of elementary schoolchildren and reduces school absenteeism due to infectious disease, especially URID.

Biotechnological Applications of Probiotics: A Multifarious Weapon to Disease and Metabolic Abnormality

Consumption of live microorganisms "Probiotics" for health benefits and well-being is increasing worldwide. Their use as a therapeutic approach to confer health benefits has fascinated humans for centuries; however, its conceptuality gradually evolved with methodological advancement, thereby improving our understanding of probiotics-host interaction. However, the emerging concern regarding safety aspects of live microbial is enhancing the interest in non-viable or microbial cell extracts, as they could reduce the risks of microbial translocation and infection. Due to technical limitations in the production and formulation of traditionally used probiotics, the scientific community has been focusing on discovering new microbes to be used as probiotics. In many scientific studies, probiotics have been shown as potential tools to treat metabolic disorders such as obesity, type-2 diabetes, non-alcoholic fatty liver disease, digestive disorders (e.g., acute and antibiotic-associated diarrhea), and allergic disorders (e.g., eczema) in infants. However, the mechanistic insight of strain-specific probiotic action is still unknown. In the present review, we analyzed the scientific state-of-the-art regarding the mechanisms of probiotic action, its physiological and immuno-modulation on the host, and new direction regarding the development of next-generation probiotics. We discuss the use of recently discovered genetic tools and their applications for engineering the probiotic bacteria for various applications including food, biomedical applications, and other health benefits. Finally, the review addresses the future development of biological techniques in combination with clinical and preclinical studies to explain the molecular mechanism of action, and discover an ideal multifunctional probiotic bacterium.

Lactococcus lactis Strain Plasma Intake Suppresses the Incidence of Dengue Fever-like Symptoms in Healthy Malaysians: A Randomized, Double-Blind, Placebo-Controlled Trial

Dengue fever (DF) is a mosquito-borne disease still with no effective treatment or vaccine available. A randomized, placebo-controlled, double-blinded, parallel-group trial was undertaken to evaluate the efficacy of oral intake of Lactococcus lactis strain plasma (LC-Plasma) on the presentation and severity of DF-like symptoms among healthy volunteers. Study participants (320) were assigned into two groups, and consumed either placebo or LC-Plasma tablets (approximately 100 billion cells/day) for 8 weeks. The clinical symptoms of DF were self-recorded through questionnaires, and exposure to DENV was determined by serum antibody and/or DENV antigen tests. No significant differences between groups were observed for exposure to DENV, or the symptomatic ratio. Results obtained showed that participants from the LC-Plasma group reported a significant reduction in the cumulative incidence days of DF-like symptoms, which include fever (p < 0.001), muscle pain (p < 0.005), joint pain (p < 0.001), and pain behind the eyes (p < 0.001), compared to that of the placebo group. Subgroup analysis revealed a significantly (p < 0.05) reduced severity score in the LC-Plasma group when study sites were separately analyzed. Overall, our findings suggest that LC-Plasma supplementation reduces the cumulative days with DF-like symptoms, and the severity of the symptoms. Daily oral intake of LC-Plasma, hence, is shown to mitigate the DF-like symptoms.

Purified lactases versus whole-cell lactases-the winner takes it all

Lactose-free dairy products are in great demand worldwide due to the high prevalence of lactose intolerance. To make lactose-free dairy products, commercially available β-galactosidase enzymes, also termed lactases, are used to break down lactose to its constituent monosaccharides, glucose and galactose. In this mini-review, the characteristics of lactase enzymes, their origin, and ways of use are discussed in light of their potential for hydrolyzing lactose. We also discuss whole-cell lactase catalysts, which appear to have great potential in terms of cost reduction and convenience, and which are more natural alternatives to purified enzymes. Lactic acid bacteria (LAB) already used in food fermentations seem to be optimal candidates for whole-cell lactases. However, they have not been industrially exploited yet due to technical hurdles. For whole-cell lactases to be efficient, the lactase enzymes inside the cells must be made available for lactose hydrolysis, and thus, cells need to be permeabilized or disrupted prior to use. Here we review state-of-the-art approaches for disrupting or permeabilizing microorganisms. Lastly, based on recent scientific achievements, we propose a novel, resource-efficient, and low-cost scenario for achieving lactose hydrolysis at a dairy plant using a LAB whole-cell lactase.Key points• Lactases (β-galactosidase) are essential for producing lactose-free dairy products• Novel permeabilization techniques facilitate the use of LAB lactases• Whole-cell lactase catalysts have great potential for reducing costs and resources Graphical abstract.

GABA enhancement by simple carbohydrates in yoghurt fermented using novel, self-cloned Lactobacillus plantarum Taj-Apis362 and metabolomics profiling

This study aimed to enhance natural gamma aminobutyric acid (GABA) production in yoghurt by the addition of simple sugars and commercial prebiotics without the need for pyridoxal 5′-phosphate (PLP) cofactor. The simple sugars induced more GABA production (42.83–58.56 mg/100 g) compared to the prebiotics (34.19–40.51 mg/100 g), with glucose promoting the most GABA production in yoghurt (58.56 mg/100 g) surpassing the control sample with added PLP (48.01 mg/100 g). The yoghurt prepared with glucose also had the highest probiotic count (9.31 log CFU/g). Simulated gastrointestinal digestion of this GABA-rich yoghurt showed a non-significant reduction in GABA content and probiotic viability, demonstrating the resistance towards a highly acidic environment (pH 1.2). Refrigerated storage up to 28 days improved GABA production (83.65 mg/100 g) compared to fresh GABA-rich yoghurt prepared on day 1. In conclusion, the addition of glucose successfully mitigates the over-use of glutamate and omits the use of PLP for increased production of GABA in yoghurt, offering an economical approach to produce a probiotic-rich dairy food with potential anti-hypertensive effects.

Development of Personalized Nutrition: Applications in Lactose Intolerance Diagnosis and Management

Recent discoveries in the “omics” field and the growing focus on preventive health have opened new avenues for personalized nutrition (PN), which is becoming an important theme in the strategic plans of organizations that are active in healthcare, food, and nutrition research. PN holds great potential for individual health optimization, disease management, public health interventions, and product innovation. However, there are still multiple challenges to overcome before PN can be truly embraced by the public and healthcare stakeholders. The diagnosis and management of lactose intolerance (LI), a common condition with a strong inter-individual component, is explored as an interesting example for the potential role of these technologies and the challenges of PN. From the development of genetic and metabolomic LI diagnostic tests that can be carried out in the home, to advances in the understanding of LI pathology and individualized treatment optimization, PN in LI care has shown substantial progress. However, there are still many research gaps to address, including the understanding of epigenetic regulation of lactase expression and how lactose is metabolized by the gut microbiota, in order to achieve better LI detection and effective therapeutic interventions to reverse the potential health consequences of LI.

Effect of Sea Buckthorn (Hippophae rhamnoides L.) Mousse on Properties of Probiotic Yoghurt

The stability of the physico-chemical and sensory characteristics of yoghurts during refrigerated storage is important for industry and the consumer. The aim of the study was to evaluate the nutritional value, microbiological quality, sensory properties, and structure of natural probiotic yoghurts made with the addition of sea buckthorn fruit mousse during refrigerated storage. In this study, we produced natural, probiotic organic yoghurts with the addition of superfoods, i.e., sea buckthorn (Hippophae rhamnoides L.) fruit mousse, using ABT-1 probiotic yoghurt starter culture based on Lactobacillus acidophilus LA-5, Bifidobacterium lactis BB-12, and Streptococcus thermophilus. Physico-chemical (acidity, nutritional value, and structure) as well as microbiological and sensory changes occurring during 21-day refrigerated storage were determined. The yoghurts were characterized by high sanitary and hygienic quality during the whole refrigerated storage. Fourier-Transform Infrared (FTIR) spectra were also used in the analyses of the obtained yoghurt samples. The applied yoghurt additive was visible at the spectral level as an increase in the intensity of the characteristic bands for vibrations related to protein, fat, and polysaccharide structures. Sea buckthorn can be used as a modern and unconventional addition to yoghurts with health-promoting properties. Micrographic studies have shown that the addition of sea buckthorn mousse significantly changes the microstructure of the yoghurt. The structure of sea buckthorn to yoghurt seems to be more susceptible to the influence of damaging factors, which is also confirmed by the FTIR test conducted during the storage.

Occurrence of Inborn Errors of Metabolism in Newborns, Diagnosis and Prophylaxis

Inborn errors of metabolism (IEM) are a heterogeneous group of rare genetic disorders that are generally transmitted as autosomal or X-linked recessive disorders. These defects arise due to mutations associated with specific gene(s), especially the ones associated with key metabolic enzymes. These enzymes or their product(s) are involved in various metabolic pathways, leading to the accumulation of intermediary metabolite(s), reflecting their toxic effects upon mutations. The diagnosis of these metabolic disorders is based on the biochemical analysis of the clinical manifestations produced and their molecular mechanism. Therefore, it is imperative to devise diagnostic tests with high sensitivity and specificity for early detection of IEM. Recent advances in biochemical and polymerase chain reaction-based genetic analysis along with pedigree and prenatal diagnosis can be life-saving in nature. The latest development in exome sequencing for rapid diagnosis and enzyme replacement therapy would facilitate the successful treatment of these metabolic disorders in the future. However, the longterm clinical implications of these genetic manipulations is still a matter of debate among intellectuals and requires further research.

Energy and Nutrient Intake of Americans according to Meeting Current Dairy Recommendations

Most Americans do not meet dairy food recommendations from the 2015 Dietary Guidelines for Americans (DGA). This study assesses differences in nutrient intake between Americans who meet recommendations for dairy intake and those who do not, using data from the National Health and Nutrition Examination Survey from 2013–2014 and 2015–2016 (n = 5670 children ages 2–18 years and n = 10,112 adults ages 19+). Among children and adults, those meeting dairy food recommendations were significantly more likely to have adequate intake (% above Estimated Average Requirement (EAR)) of calcium, magnesium, phosphorus, riboflavin, vitamin A, vitamin B12, and zinc and consume above the Adequate Intake (AI) for potassium and choline than Americans not meeting dairy recommendations, regardless of age, sex, or race/ethnicity. Americans meeting dairy recommendations were also more likely to exceed recommendations for sodium and saturated fat but consume less added sugars. Nearly 60% of Americans 2 years and older not meeting dairy recommendations consumed calcium and magnesium below the EAR. Only about 20% of Americans who did not meet dairy recommendations consumed above the AI for potassium. Dairy foods make important and unique contributions to dietary patterns, and it can be difficult to meet nutrient needs without consuming recommended amounts of dairy foods.

Biochemical and Antioxidant Activity of Yogurt Supplemented with Paprika Juice of Different Colors

Paprika is known to contain polyphenolic compounds that have good antioxidant properties. This study was conducted to investigate the benefits of adding paprika juice of different colors to yogurt and to determine how paprika affects the quality characteristics of yogurt. Stirred yogurt samples supplemented with different levels of red, orange, or yellow paprika juice were inoculated with mixes of Streptococcus thermophilus and Lactobacillus delbrueckii ssp. bulgaricus. Paprika addition decreased the pH but increased titratable acidity, lactic acid bacteria (LAB) counts, total polyphenol content (TPC), levels of vitamin A and C, and antioxidant activity. Proteolysis and viscosity of paprika-containing yogurts were significantly higher than those of the control yogurt without paprika juice (p<0.05). In particular, the viscosity of red paprika yogurt was significantly higher than that of yogurts containing 5% orange and yellow paprika juices (each p<0.05). The antioxidant activity of the methanol extract of the yogurt containing 2.5% orange paprika juice was the highest. Storage at 4°C for 15 days only slightly altered LAB counts, antioxidant activity, and TPC of paprika yogurt. These results indicate that paprika could be used as a natural food additive for the development of functional yogurts.

Fermentation of Foods and Beverages as a Tool for Increasing Availability of Bioactive Compounds. Focus on Short-Chain Fatty Acids

Emerging evidence suggests that fermentation, historically used for the preservation of perishable foods, may be considered as a useful tool for increasing the nutritional value of fermented products, in terms of increases in bioactive compound content, including short-chain fatty acids (SCFAs), as bacteria end-products, whose beneficial effects on human health are well-established. The purpose of the present manuscript is to summarize studies in this field, providing evidence about this novel potential of fermentation. A limited number of studies directly investigated the increased SCFA levels in fermented foods. All studies, however, agree in confirming that levels of SCFAs in fermented products are higher than in unfermented products, recognizing the key role played by the microorganisms in metabolizing food matrices, producing and releasing bioactive substances. According to the available literature, fermentation might be taken into account by the food industry as a natural strategy with no environmental impacts to produce functional foods and beverages with a higher nutritional value and health-promoting compounds.

Nutritional management of lactose intolerance: the importance of diet and food labelling

Worldwide, 70% of the adult population has limited expression of lactase enzyme with a wide variation among different regions and countries. Lactase deficiency may lead to lactose intolerance (LI). Depending both on the amount of lactose ingested and on the lactase activity, people who suffer from lactose malabsorption might experience numerous gastrointestinal and extra-intestinal symptoms and manifestations. Treatment of LI mainly consists of reducing or eliminating lactose from the diet until the symptoms disappear as well as supplementing lactase, and inducing colon microbiome adaptation by probiotics. Cow’s milk is one of the major source of calcium and several other vitamins and minerals. Thus, a complete exclusion of dairy products may favor the development of bone diseases such as osteopenia and osteoporosis. Therefore, the dietetic approach has a crucial role in the management of LI patients. Additionally, the use of lactose and milk-derived products in non-dairy products (e.g., baked goods, breakfast cereals, drinks, and processed meat) has become widespread in the modern industry (the so-called “hidden lactose”). In this regard, a strict adherence to the lactose-free diet becomes challenging for LI patients, forced to continuous check of all products and food labels. In fact, lactose-free product labeling is still controversial. Considering that nowadays a specific cut-off value establishing “lactose-free” labeling policy is lacking and that there is no universal law regulating the production and commercialization of “delactosed” products, identification of specific safe and suitable products with a well-recognized lactose-free logo might help consumers. This narrative review aims to identify the dietary management for lactose intolerant people, avoiding symptoms and nutrients deficiencies, helped by the use of specific labelling to guide them to choose the safer product on the market.

Why and when was lactase persistence selected for? Insights from Central Asian herders and ancient DNA

The genetic adaptation of humans to the consumption of milk from dairying animals is one of the most emblematic cases of recent human evolution. While the phenotypic change under selection, lactase persistence (LP), is known, the evolutionary advantage conferred to persistent individuals remains obscure. One informative but underappreciated observation is that not all populations whose ancestors had access to milk genetically adapted to become lactase persistent. Indeed, Central Asian herders are mostly lactase nonpersistent, despite their significant dietary reliance on dairy products. Investigating the temporal dynamic of the -13.910:C>T Eurasian mutation associated with LP, we found that, after its emergence in Ukraine 5,960 before present (BP), the T allele spread between 4,000 BP and 3,500 BP throughout Eurasia, from Spain to Kazakhstan. The timing and geographical progression of the mutation coincides well with the migration of steppe populations across and outside of Europe. After 3,000 BP, the mutation strongly increased in frequency in Europe, but not in Asia. We propose that Central Asian herders have adapted to milk consumption culturally, by fermentation, and/or by colonic adaptation, rather than genetically. Given the possibility of a nongenetic adaptation to avoid intestinal symptoms when consuming dairy products, the puzzle then becomes this: why has LP been selected for at all?

Toward Healthy Diets from Sustainable Food Systems

This article is based on a session at ASN 2019 entitled "Addressing the Four Domains of Sustainable Food Systems Science (Health, Economics, Society and the Environment): What Will It Take to Harmonize the Evidence to Advance the Field?" A summary of presentations is included. The presentations addressed the 4 principal domains of sustainability defined as nutrition/health, economics, environment, and society and the ways in which they are represented in current research. The session also introduced metrics and measures that are specific to each domain. Participants discussed next steps to move toward consensus and collaboration among scientific communities, especially those of health/nutrition science and environmental science. Food systems may need to be restructured to ensure that the global food supply provides adequate calories and nutrients at an affordable cost. Finally, the session addressed strategies to implement research concepts and move toward policies that encourage consumers to choose healthy diets from sustainable food systems.

Effects of Prebiotic and Probiotic Supplementation on Lactase Deficiency and Lactose Intolerance: A Systematic Review of Controlled Trials

Lactose intolerance (LI) is characterized by the presence of primarily gastrointestinal clinical signs resulting from colonic fermentation of lactose, the absorption of which is impaired due to a deficiency in the lactase enzyme. These clinical signs can be modified by several factors, including lactose dose, residual lactase expression, concurrent ingestion of other dietary components, gut-transit time, and enteric microbiome composition. In many of individuals with lactose malabsorption, clinical signs may be absent after consumption of normal amounts of milk or, in particular, dairy products (yogurt and cheese), which contain lactose partially digested by live bacteria. The intestinal microbiota can be modulated by biotic supplementation, which may alleviate the signs and symptoms of LI. This systematic review summarizes the available evidence on the influence of prebiotics and probiotics on lactase deficiency and LI. The literature search was conducted using the MEDLINE (via PUBMED) and SCOPUS databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and included randomized controlled trials. For each study selected, the risk of bias was assessed following the Cochrane Collaboration methodology. Our findings showed varying degrees of efficacy but an overall positive relationship between probiotics and LI in relation to specific strains and concentrations. Limitations regarding the wide heterogeneity between the studies included in this review should be taken into account. Only one study examined the benefits of prebiotic supplementation and LI. So further clinical trials are needed in order to gather more evidence.

Routine disaccharidase testing: are we there yet?

PURPOSE OF REVIEW

Disaccharidase testing, as applied to the evaluation of gastrointestinal disturbances is available but it is not routinely considered in the diagnostic work-up. The purpose of this review was to determine if disaccharidase testing is clinically useful and to consider how the results could alter patient management.

RECENT FINDINGS

Indicate that carbohydrate maldigestion could contribute functional bowel disorders and negatively impact the fecal microbiome. Diagnostic techniques include enzyme activity assays performed on random endoscopically obtained small intestinal biopsies, immunohistochemistry, stable isotope tracer and nonenriched substrate load breath testing, and genetic testing for mutations. More than 40 sucrase--isomaltase gene variants coding for defective or reduced enzymatic activity have been reported and deficiency conditions are more common than previously thought.

SUMMARY

The rationale for disaccharidase activity testing relates to a need to fully assess unexplained recurrent abdominal discomfort and associated symptoms. All disaccharidases share the same basic mechanism of mucosal expression and deficiency has far reaching consequences. Testing for disaccharidase expression appears to have an important role in symptom evaluation, but there are accuracy and logistical issues that should be considered. It is likely that specific recommendations for patient management, dietary modification, and enzyme supplementation would come from better testing methods.

The impact of raw fermented milk products on perceived health and mood among Dutch adults

Purpose

The purpose of this paper was to evaluate health conditions prior to and at least two months after the start of consuming raw fermented milk (RFM) products.

Design/methodology/approach

One-Item health score, 1-item immunity score, immune status (ISQ), mood, bowel and skin conditions were rated for the period prior and post switching to RFM products. A linear mixed model was used to evaluate the post to prior RFM health and mood scores, taking into account gender, location of living and health group. Data from 390 participants (mean age of 54 years old) were included for the analysis, of which 277 (45 per cent) were allocated to the poor health group. Participants were allocated to the poor health group if they reported being immune depressed or suffering from a chronic disease prior to RFM; otherwise, they were allocated to the normal health group.

Findings

The highest intake of RFM was from RF kefir. Post RFM, people consumed around 1 glass (200 ml) of RF kefir per day. After switching to RFM, significant improvements on health and mood scores were reported. The strongest improvements after switching to RFM consumption were seen in subjects from the poor health group. With the exception of skin score, all measured health items significantly improved (p < 0.001). Health, immunity, bowel and mood scores increased with around 20 per cent in the poor health group and around 8 per cent in the normal health group. Women had more health complaints prior to RFM and had stronger health improvement post RFM compared to men. Bowel and mood scores were overall lower in women than in men. Living location had no significant impact on RFM-related health changes. This consumer survey suggests that positive health and mood changes are associated with the consumption of RFM products.

Originality/value

The consumption of RFM products improved the self-reported health status of adults. Immune-depressed people or people suffering from a chronic disease prior to RFM reported the strongest impact on their health, immunity, bowel and mood scores post switching RFM consumption compared to people with a normal health.

The role of yogurt in food-based dietary guidelines

In the modern food technology era, one of the aims of food safety and quality is to eliminate or reduce the number of microorganisms in food. This may now be changing. In particular, the importance of live microorganisms as beneficial food constituents is now being recognized. Microorganisms present in food that contribute to the human diet include not only viable bacteria but also metabolites and bioactive components. Yogurt is one of the most biologically active foods consumed by humans. It is an excellent source of proteins, vitamins, and minerals. Additionally, the nutritional value is especially high relative to cost. Potential nutritional benefits are also associated with the ingestion of the bacteria that are ordinarily present at the time of consumption. Thus, yogurt serves as a major source of live bacteria in the human diet, as well as a delivery vehicle for added probiotic bacteria. Yogurt may provide a simple and affordable solution for enhancing the nutritional value of the diet, including the intake of live bacteria and their metabolites. A further benefit may be obtained when yogurt is used as a carrier for specific probiotic bacteria and/or prebiotic compounds. These factors suggest that yogurt could have a more visible role in food-based dietary guidelines.

Is vitamin D-fortified yogurt a value-added strategy for improving human health? A systematic review and meta-analysis of randomized trials

Yogurt is a good source of probiotics, calcium, and proteins, but its content of vitamin D is low. Therefore, yogurt could be a good choice for vitamin D fortification to improve the positive health outcomes associated with its consumption. The primary aim of this systematic review and meta-analysis was to investigate the effect of vitamin D-fortified yogurt compared with plain yogurt on levels of serum 25-hydroxy vitamin D (25OHD). The secondary aim was to evaluate the effect of fortified yogurt on parathyroid hormone, anthropometric parameters, blood pressure, glucose metabolism, and lipid profile. We searched PubMed, Scopus, and Google Scholar for eligible studies; that is, randomized controlled trials (RCT) that compared vitamin D-fortified yogurt with control treatment without any additional supplement. Random-effects models were used to estimate pooled effect sizes and 95% confidence intervals. Findings from 9 RCT (n = 665 participants) that lasted from 8 to 16 wk are summarized in this review. The meta-analyzed mean differences for random effects showed that vitamin D-fortified yogurt (from 400 to 2,000 IU) increased serum 25OHD by 31.00 nmol/L. In addition, vitamin D-fortified yogurt decreased parathyroid hormone by 15.47 ng/L, body weight by 0.92 kg, waist circumference by 2.01 cm, HOMA-IR by 2.18 mass units, fasting serum glucose by 22.54 mg/dL, total cholesterol by 13.38 mg/dL, and triglycerides by 30.12 mg/dL compared with the controlled treatments. No publication bias was identified. Considerable between-study heterogeneity was observed for most outcomes. Vitamin D-fortified yogurt may be beneficial in improving serum 25OHD, lipid profile, glucose metabolism, and anthropometric parameters and decreasing parathyroid hormone level in pregnant women and adult and elderly subjects with or without diabetes, prediabetes, or metabolic syndrome.

Bioactive molecules of probiotic bacteria and their mechanism of action: a review

The bacteria residing in the gut environment do play a pivotal role in metabolic activities of the host. The metabolites produced by these bacteria affect the physiology and health of the host. The gut bacteria are exposed to environmental conditions where multiple factors such as lifestyle, stress, antibiotics, host genetics and infections have an influence on them. In case of pathogenesis of a disease, the gut bacterial composition is altered which leads to a diseased state. This stage is due to colonization of bacterial pathogens in the gut environment. The pathological condition can be alleviated by administering probiotic strains into the gut environment. The probiotic strains produce therapeutic molecules such as amino acids, vitamins, bacteriocins, enzymes, immunomodulatory compounds and short-chain fatty acids. This review discusses recent evidences of the impact of bioactive molecules produced by probiotic bacteria and their mechanism of action in the gut environment to maintain homeostasis and health of the host without any effect on beneficial bacteria sharing the same niche. In addition, the manufacturing challenges of probiotic products for various applications are discussed here.

Dairy foods and positive impact on the consumer's health

The objective of the present chapter was to demonstrate the state of the art in the recent advances in nutritional and functional components of dairy products research. In this chapter, the main mechanisms responsible and essential for a better understanding of nutritional and functional values of the components of milk and dairy products are highlighted. It also includes a discussion about the positive impacts of fermented milk, cheese, butter, ice cream, and dairy desserts components on the consumer's health.

Lactose-Free Dairy Products: Market Developments, Production, Nutrition and Health Benefits

Lactose-free dairy is able to provide the essential nutrients present in regular dairy products, like calcium and vitamins, to those that are not able to digest lactose. This product category currently has a wide and growing health appeal to consumers. In recent years, the quality and product variety in the lactose-free dairy segment has been increasing significantly, giving consumers more tempting products to decide from. As a result, lactose-free dairy is now the fastest growing market in the dairy industry. This review discusses the market developments and production possibilities and issues related to the wide variation of lactose-free dairy products that are currently available. Additionally, the health benefits that lactose-free dairy may offer compared to dairy avoidance are illustrated.

Lactose intolerance: what is a correct management?

SUMMARY Individuals with Lactose Intolerance (LI) tend to exclude milk from their diet since this behavior seems to relieve the symptoms caused by the disease. However, milk is a food of high nutritional value, and complete exclusion of dairy products may favor the development of bone diseases such as osteopenia and osteoporosis. The objective of this review was to evaluate the scientific evidence on the adequate management of patients with LI. This study was carried out from the review of the scientific literature in PubMed and SciELO databases. Complete exclusion of conventional dairy products is not necessary since most individuals with LI can tolerate up to 12 grams of lactose daily in a single dose. Yogurts and cheeses matured for having low amounts of lactose are part of the strategy that allows consumption of dairy products by patients with LI. Currently, there is a diversity of products considered as “milk substitutes” and supplements aimed at individuals with LI. However, these strategies still require better-designed studies.

Streptococcus macedonicus strains isolated from traditional fermented milks: resistance to gastrointestinal environment and adhesion ability

In this study, Streptococcus macedonicus (S. macedonicus) strains were identified from Algerian traditional fermented milks (Lben and Rayeb). Important prerequisites of probiotic interest such as acidity, bile salts tolerance, and adhesion ability to epithelial cells were investigated. A combination of phenotypic (ability to grow on Bile Esculin Azide medium, BEA; on high salt content medium NaCl 6.5%; on alkaline medium pH 9.6) and genotypic approaches (16S rRNA, ITS genes sequencing and MLST technique) allowed to identify four genetically distinct strains of S. macedonicus. These four strains and two references, Streptococcus thermophilus LMD-9 and Lactobacillus rhamnosus GG (LGG), were tested for their capacity to survive at low pH values, and at different concentrations of an equimolar bile salts mixture (BSM). Two different cell lines, Caco-2 TC7 and HT29-MTX, were used for the adhesion study. The results show that S. macedonicus strains selected constitute a distinct genetic entity from the Greek strain S. macedonicus ACA-DC-198. They were able to survive up to pH 3 and could tolerate high concentrations of bile salts (10 mM), unlike LMD-9 and LGG strains. Our strains also display in vitro adhesion similar to the LGG strain on Caco-2 TC7 and higher adhesion than the LMD-9 strain to Caco-2 TC7 and HT29-MTX cell models. This first characterization allows considering S. macedonicus as a potential candidate for possible probiotic effects that need to be investigated.

Concepts, benefits and perspectives of functional dairy food products

The rising awareness of the consumers towards the health benefits of food has resulted in the development of the so-called functional foods. These added value products which refer to prevention and/or therapeutic effects of food beyond its nutritional value, are especially useful for health improvement and reduction of medical care costs. The combination between health and nutrition and its potential to improve the quality of life has become one of the key attention points of consumers who are aware of and are seeking nutritional solutions to their health concerns. Milk and dairy products have been used in human nutrition for thousands of years, providing important nutrients for the human body such as proteins, fats and calcium. It is now widely recognized that in addition to their basic nutritive role they also exert functional properties beneficial for human health, so the development of functional dairy products is one of the fastest growing areas in the dairy industry as well as one of the largest sectors in the global market of functional foods. This review provides a brief overview of the health benefits and the natural functionality of dairy products as well as the challenges together with the future perspectives of their application as delivery vehicles for beneficial compounds to the human body. Keywords: functional foods, milk, dairy products

Lactose Intolerance, Dairy Avoidance, and Treatment Options

Lactose intolerance refers to symptoms related to the consumption of lactose-containing dairy foods, which are the most common source for this disaccharide. While four causes are described, the most common is the genetically-determined adult onset lactose maldigestion due to loss of intestinal lactase governed by control of the gene by a 14,000 kb promoter region on chromosome 2. Gastrointestinal symptoms from lactose have expanded to include systemic effects and have also been confounded by other food intolerances or functional gastrointestinal disorders. Partly because lactose maldigestion is often interpreted as lactose intolerance (symptoms), focus of therapy for these symptoms starts with lactose restriction. However, withholding of dairy foods completely is not appropriate due to a more favorable impact on health. Industrial efforts to substitute with plant-based products is not completely successful at this time. This narrative article reviews the complexities of the perception of lactose intolerance, its epidemiology, and pathogenesis. Treatments are discussed, including the inappropriateness of dairy avoidance. In conjunction, effects of dairy products on 19 common diseases are reviewed. Different methods of treatment, lactose-reduced products, plant-based dairy substitutes, adaptation, prebiotics, exogenous lactase, probiotics, and some other dietary interventions are further discussed.

A Mini Review on Antidiabetic Properties of Fermented Foods

In general, fermented foods (FFs) are considered as functional foods. Since the awareness about the health benefits of FFs has increased, the consumption of FF also improved significantly in recent decades. Diabetes is one of the leading threats of the health span of an individual. The present manuscript details the general methods of the production of FFs, and the results of various studies (in vitro, in vivo, and clinical studies) on the antidiabetic properties of FFs. The fermentation method and the active microbes involved in the process play a crucial role in the functional properties of FFs. Several in vitro and in vivo studies have been reported on the health-promoting properties of FFs, such as anti-inflammation, anticancer, antioxidant properties, improved cognitive function and gastrointestinal health, and the reduced presence of metabolic disorders. The studies on the functional properties of FFs by randomized controlled clinical trials using human volunteers are very limited for several reasons, including ethical reasons, safety concerns, approval from the government, etc. Several scientific teams are working on the development of complementary and alternative medicines to improve the treatment strategies for hyperglycemia.

Novel perspectives on fermented milks and cardiometabolic health with a focus on type 2 diabetes

This review will explore the observational and mechanistic evidence supporting the hypothesis that fermented milk consumption has beneficial effects on metabolism. Live cultures in fermented dairy are thought to contribute to gut microbial balance, which is likely an instrumental mechanism that protects the host against gut dysbiosis and systemic inflammation associated with cardiometabolic diseases. Lactic acid bacteria (LAB) release bioactive metabolites, such as exopolysaccharides and peptides, that have the potential to exert a wide range of metabolic and regulatory functions. In particular, peptides derived from fermented dairy products are likely to exert greater cardiometabolic and anti-inflammatory effects than nonfermented dairy. It is hypothesized that LAB-derived bioactive peptides have the potential to protect the host against cardiometabolic diseases through antimicrobial actions and to effect changes in gene expression of glucose regulatory and anti-inflammatory signaling pathways. The peptides released through fermentation may explain some of the health effects of fermented dairy products on cardiometabolic disease risk observed in epidemiological studies, particularly type 2 diabetes; however, mechanisms have yet to be explored in detail.

Lactose Maldigestion, Malabsorption, and Intolerance: A Comprehensive Review with a Focus on Current Management and Future Perspectives

Milk is a fundamental component of the diet of every mammal; nevertheless, not every individual can tolerate this kind of food, especially in adulthood. However, lactose intolerance has only been recognized in the last 50 years, and currently, lactose intolerance is defined as a clinical syndrome characterized by pain, abdominal distention, flatulence, and diarrhoea that occur after lactose consumption. Lactose is currently a common disaccharide in human nutrition, both in breastfed infants and in adults, but its digestion requires a specialized enzyme called lactase. The genetically programmed reduction in lactase activity during adulthood affects most of the world’s adult population and can cause troublesome digestive symptoms, which may also vary depending on the amount of residual lactase activity; the small bowel transit time; and, especially, the amount of ingested lactose. Several diagnostic tests are currently available for lactose intolerance, but the diagnosis remains challenging. The treatment for lactose intolerance mainly consists of reducing or eliminating the dietetic amount of lactose until the symptoms disappear, but this is hard to achieve, as lactose is present in dairy products and is even commonly used as a food additive. In addition to dietetic restriction of lactose-containing foods, lactase can be administered as an enzymatic food supplement, but its efficacy is still controversial. Recently, probiotics have been proposed for the management of lactose intolerance; certain probiotic strains have shown specific β-galactosidase activity, thus aiding in the digestion of lactose. The aim of this paper was to review the current knowledge about lactose intolerance and to discuss the potential for the use of specific probiotic strains such as dietary supplements in lactose-intolerant patients.