The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on fermented foods

CoNSeNSuS Statement The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on fermented foods Maria L. Marco1, Mary Ellen Sanders 2, Michael Gänzle 3, Marie Claire Arrieta4, Paul D. Cotter 5,6,7, Luc De Vuyst8, Colin Hill 9, Wilhelm Holzapfel10, Sarah Lebeer11, Dan Merenstein12, Gregor Reid 13, Benjamin E. Wolfe14 and Robert Hutkins 15 ✉ Abstract | An expert panel was convened in September 2019 by The International Scientific Association for Probiotics and Prebiotics (ISAPP) to develop a definition for fermented foods and to describe their role in the human diet. Although these foods have been consumed for thousands of years, they are receiving increased attention among biologists, nutritionists, technologists, clinicians and consumers. Despite this interest, inconsistencies related to the use of the term ‘fermented’ led the panel to define fermented foods and beverages as “foods made through desired microbial growth and enzymatic conversions of food components”. This definition, encompassing the many varieties of fermented foods, is intended to clarify what is (and is not) a fermented food. The distinction between fermented foods and probiotics is further clarified. The panel also addressed the current state of knowledge on the safety, risks and health benefits, including an assessment of the nutritional attributes and a mechanistic rationale for how fermented foods could improve gastrointestinal and general health. The latest advancements in our understanding of the microbial ecology and systems biology of these foods were discussed. Finally, the panel reviewed how fermented foods are regulated and discussed efforts to include them as a separate category in national dietary guidelines. ✉e-mail: https://doi.org/10.1038/ s41575-020-00390-5 Fermented foods and beverages accompanied and likely facilitated the transition from hunter-gatherer communities to sessile agricultural communities in the Neolithic revolution about 14,000 years ago1,2. They have remained staples of human diets for centuries and are an increasingly popular food category. Yet, their emergent popularity in the past 20 years has led to numerous misunderstandings and questions. What constitutes fermentation? Do fermented foods necessarily contain live microorganisms? Are fermented foods the same as probiotic foods? Do microorganisms in fermented foods become established in the gut or influence the gut microbiota? Do fermented foods provide health benefits and, if so, how? Accordingly, the International Scientific Association for Probiotics and Prebiotics (ISAPP) organized a meeting of clinical and scientific experts in family medicine, microbiology, food science and technology, ecology, immunology, and microbial genetics held in September 2019 to develop a consensus report on fermented foods 196 | March 2021 | volume 18 (a category that includes fermented beverages). The main goals of this Consensus Statement are to provide researchers, health-care providers, industry, regulators and consumers with a clear and concise definition of fermented foods, to differentiate between fermented foods and probiotics, and to summarize what is known about the health effects and safety of fermented foods. This Consensus Statement also discusses the mechanistic rationale for how fermented foods could improve gastrointestinal and systemic health, the advancements in knowledge on the microbial ecology and systems biology of those foods, and the current regulatory considerations and position of these foods in dietary guidelines. Methods The consensus panel was organized under the auspices of ISAPP, which is a non-profit organization governed by a volunteer board of directors. Although funded by member companies, ISAPP’s activities are not stipulated by industry. The mission is to provide objective, www.nature.com/nrgastro C o n S e n S u S S tat e m e n t science-based information on probiotics, prebiotics and related health topics. Panel members were identified and invited based on their subject matter expertise and experience. An outline was developed and each expert was asked to address specific topics. The panel discussed each issue until consensus was reached. Following the meeting, each panellist wrote relevant sections and the assembled draft was reviewed and approved by all authors. The authors thank members of the ISAPP board of directors who did not directly participate in this consensus panel but who reviewed, provided comments and approved this manuscript: G. Gibson, E. Quigley, S. Salminen, K. Scott and H. Szajewska. Historical context Humans must have learned early in their history that fermentation provided many important advantages for managing precious food resources. Fermentation can improve the functional properties of agricultural crops and transform bland raw materials into nutritious, palatable or intoxicating products. Certainly, fermentation would have been regarded as one of the most effective ways to preserve foods owing, in part, to the formation of organic acids, alcohols, bacteriocins and other antimicrobial end-products as a result of fermentation microorganisms3. Fermentation-associated microorganisms usually out-compete potential pathogenic and spoilage organisms, further enhancing food safety and stability. In the absence of potable water, fermented beverages, such as beer, wine, sour milk and cereal gruels, provided a safe and transportable source of liquids4. These qualities, along with the fermentationmediated transformation of perishable raw food materials into organoleptically satisfying products, led to their adoption by nearly every culture worldwide. One particular example of how fermented foods and human culture co-evolved is through dairy fermentations5. The consumption of fermented milk products, including Author addresses Department of Food Science and Technology, University of California-Davis, Davis, CA, USA. 2 International Scientific Association for Probiotics and Prebiotics, Centennial, CO, USA. 3 University of Alberta, Department of Agricultural, Food and Nutritional Science, Edmonton, Canada. 4 Department of Physiology and Pharmacology, International Microbiome Center, University of Calgary, Calgary, Canada. 5 Teagasc Food Research Centre, Moorepark, Ireland. 6 APC Microbiome Ireland, University College Cork, Cork, Ireland. 7 VistaMilk, Cork, Ireland. 8 Research Group of Industrial Microbiology and Food Biotechnology, Faculty of Sciences and Bioengineering Sciences, Vrije Universiteit Brussel, Brussels, Belgium. 9 APC Microbiome Ireland and School of Microbiology, University College Cork, Cork, Ireland. 10 Advanced Green Energy and Environment Institute, Handong Global University, Pohang, Gyeongbuk, South Korea. 11 Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium. 12 Department of Family Medicine, Georgetown University, Washington, DC, USA. 13 Lawson Health Research Institute, and Departm (...truncated)