Fermented Foods

Background and aimsThe benefits of the Mediterranean diet (MedDiet) are well established. However, one component, wine, remains controversial. This study assessed the association between MedDiet (with or without wine consumption) and major cardiovascular disease (CVD) or all-cause mortality.MethodsThe PREDIMED trial included 7447 high-risk participants. Adherence to MedDiet was measured using a validated 14-item questionnaire, including one item on wine (cut-off: seven glasses/week). The CVD events were recorded over a 4.8-year follow-up, while all-cause mortality was tracked for 17 years. A younger Spanish cohort (the SUN project), including 23,133 participants followed up for 22 years, was also evaluated.ResultsIn PREDIMED, compared with poor compliers with MedDiet (excluding wine), good compliers (excluding wine), had a multivariable-adjusted hazard ratio (HR) of 0.84 [95% confidence interval (CI) 0.61-1.15] for CVD. For good compliers with MedDiet (including wine), the HR for CVD was 0.55 (95% CI 0.36-0.83). For all-cause mortality, MedDiet compliers (excluding wine) had HR of 0.77 (95% CI 0.68-0.87), which was 0.67 (95% CI 0.57-0.78) for MedDiet compliers (including wine). In exploratory dose-response analyses, reduced risk for death was not present in PREDIMED participants who drank three or more glasses of wine/day. Additionally, analyses least vulnerable to threats of abstainer bias were not significant and neither were multiplicative interaction terms for the wine item in the questionnaire. In the SUN cohort, no significant associations were observed between MedDiet compliance, wine, and CVD. However, for all-cause mortality, the HR was 0.94 (95% CI 0.71-1.26) for MedDiet compliers (excluding wine) and 0.54 (95% CI 0.28-1.04) for MedDiet compliers (including wine). When pooling both cohorts, wine consumption within the MedDiet was associated with lower all-cause mortality (P = .01).ConclusionsIn PREDIMED, moderate wine consumption, as part of the MedDiet, appeared to be associated with lower mortality and CVD risk. Some non-significant associations and interactions advise caution in interpretation of these findings.

Background/Objectives: Soy foods and isoflavones are inversely associated with cognitive decline; however, randomized controlled trials (RCTs) show mixed results. Fermented soy contains bioactive compounds not found in unfermented soybeans, such as peptides and aglycone isoflavones, which may support cognition by reducing neuroinflammation and oxidative stress. Fermented soy RCTs on older adults with mild cognitive impairment show cognitive benefits; however, the effects of fermented soy on cognitively healthy older adults are not known. Methods: We investigated the effects of a non-probiotic fermented soy powder, added to the usual diet, compared to a placebo matched for energy on global cognition, memory, verbal fluency, processing speed, and executive function in a 12-week RCT on 61 adults aged 65 years and older (74 ± 5 y; 47 completers). Results: The fermented soy group showed significant improvement (p = 0.041) in memory scores (1.81%, 95% CI: -2.10, 5.72) vs. placebo (1.16%, 95% CI: -3.64, 5.97) using analysis of variance, adjusted for sex and baseline scores. Post hoc analyses on women 70 years and older (n = 29) found significant improvement in global cognition (p = 0.028) and memory (p = 0.049) in the fermented soy group. Global cognition mean change adjusted for baseline scores was 2.86% (95% CI: 1.52, 4.21) for fermented soy and 0.06% (95% CI: -1.43, 1.55) for placebo. Memory mean change adjusted for baseline scores was 8.47% (95% CI: 5.05, 11.89) in the fermented soy group, compared to 2.05% (95% CI: -1.75, 5.84) for placebo. Conclusions: These outcomes suggest that fermented soy has the potential to slow age-related cognitive decline, especially memory for women 70 and older. Further research to confirm these findings in older women, and in males and other age categories is warranted.

Background/Objectives: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a prevalent condition defined by hepatic fat accumulation, inflammation, and metabolic dysregulation. Current evidence demonstrates that gut microbiota and their metabolites are associated with MASLD pathogenesis. Fermented foods, rich in live microbes and bioactive compounds, actively modulate the gut-liver axis and influence disease progression. This narrative review provides a comprehensive summary of current evidence on the impact of fermented foods on gut microbiota, intestinal barrier function, and gut-liver interactions, and demonstrates their potential role in preventing or mitigating MASLD. Methods: A comprehensive literature search of preclinical and clinical studies was conducted. Specifically, the review focused on fermented-food interventions, modulation of gut microbiota, metabolite production, and effects on hepatic metabolism and inflammation. Results: This review found that fermented foods provide probiotics, prebiotics, short-chain fatty acid (SCFAs), and bioactive compounds that enhance microbial diversity, improve intestinal barrier integrity, reduce endotoxemia, and modulate bile acid and lipid metabolism. Evidence from animal and human studies indicates that fermented food consumption can attenuate hepatic steatosis, inflammation, and metabolic dysregulation, with variability depending on individual microbiome composition. Conclusions: Altogether, these findings suggest that fermented foods represent a promising adjunctive dietary strategy for MASLD by modulating the gut-liver axis and supporting metabolic and hepatic health. Personalized approaches and further long-term clinical trials are required to optimize interventions and establish evidence-based recommendations.