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  • Fermented milks: a historical food with modernapplications a review

    AY Tamime1*

    1Dairy Science and Technology Consultant, Ayr, Scotland, UK

    Background: This paper was presented at the symposium which was organized by Instituto Danone Mexico in May 2001, and itprovides an overview of the current scientific knowledge on fermented milks concerning the historical developments,manufacturing stages, classification of such products, and nutritional aspects. Particular attention has been paid to thehuman health benefits associated with the consumption of these products, the use of probiotic starter cultures and theirindustrial applications, and the significance of using a trained sensory panel for the evaluation of probiotic fermented milks madewith different commercial blends of starter cultures. The paper also highlights the future research areas for the exploitation ofstarter microflora (Lactobacillus, Bifidobacterium and Enterococcus species) in fermented milk products.Conclusion: This review indicates that the complex metabolism of the starter cultures is well established; however, moreinformation is still needed on specific microbial metabolites such as polymerization of milk sugars for the production ofexopolysaccharides and the modification of the milk peptides and secretion of bacteriocins. More clinical studies are stillrequired to establish the functional health benefits of probiotic fermented milks to humans.Sponsorship: The visit to Mexico City was supported by Instituto Danone Mexico.European Journal of Clinical Nutrition (2002) 56, Suppl 4, S2 S15. doi:10.1038/sj.ejcn.1601657

    Descriptors: review; fermented milks; starter cultures; probiotic microflora; health benefits

    IntroductionFermented milks are widely produced in many countries.

    This type of process is one of the oldest methods used to

    extend the shelf-life of milk, and has been practised by

    human beings for thousands of years. The exact origin(s) of

    the manufacture of fermented milks is difficult to establish,

    but it is safe to assume that it could date to more than

    10 000 y ago as the way of life of humans changed from food

    gathering to food producing (Pederson, 1979). This change

    also included the domestication of certain mammals such as

    the cow, sheep, goat, buffalo and camel; it is most likely that

    the transition occurred at different dates in different

    countries. However, archaeological evidence of certain

    civilizations (Sumerians, Babylonians, Pharos and Indians)

    suggests that they were well advanced in agriculture and in

    the production of fermented milks.

    It is likely that the origin of these products was the Middle

    East and the Balkans, and the evolution of fermented milks

    through the ages could be attributed to the culinary skills of

    the inhabitants living in these regions. Todays fermented

    milk products are manufactured in many countries, and the

    stages of manufacture, which is still a complex process,

    combine the art of such ancient craft and science (micro-

    biology and enzymology, physics and engineering, and

    chemistry and biochemistry) together.

    This article summarizes the research findings on yoghurt

    and probiotic fermented milk products made from cows

    milk over the past century.

    Diversity of fermented milksFermented milks are manufactured throughout the world,

    and approximately 400 generic names are applied to tradi-

    tional and industrialized products (Kurmann et al, 1992), but

    in actual essence the list may only include few varieties. In

    the 1980s, Kurmann (1984) attempted, in part, the classifica-

    tion of fermented milks into a family tree (see Figure 1;

    Bylund, 1995), which was based primarily on the optimum

    *Correspondence: AY Tamime, Dairy Science and Technology Consultant,

    24 Queens Terrace, Ayr KA7 1DK, Scotland, UK.

    E-mail: [email protected]

    European Journal of Clinical Nutrition (2002) 56, Suppl 4, S2S15 2002 Nature Publishing Group All rights reserved 09543007/02 $25.00

    www.nature.com/ejcn

  • growth requirements of the starter cultures (ie mesophilic

    and thermophilic microflora).

    Nevertheless, taking into account the microorganisms

    that dominate the product, including their principle

    metabolites, Robinson and Tamime (1990) proposed a

    scheme for the classification of fermented milks as follows:

    lactic fermentations (a) mesophilic type, eg culturedbuttermilk, filmjolk, tatmjolk and langofil; (b) thermo-

    philic type, eg yoghurt, Bulgarian butter-milk, zabadi,

    dahi; and (c) therapeutic or probiotic type, eg acidophilus

    milk, Yakult, ABT, Onka, Vifit); products within this

    group constitute by far the largest number known

    worldwide;

    yeast lactic fermentations (kefir, koumiss, acidophilusyeast milk); and

    mould lactic fermentations (villi).Tamime and Marshall (1997) have detailed the manufac-

    turing stages of these types of fermentations. However, the

    so-called fermented milk drinks and=or beverages including

    the carbonated products should be classified separately

    rather than being known as fermented milks; such an

    approach will minimize confusion among consumers. Never-

    theless, some closely related products are manufactured from

    fermented milks by de-wheying, and some examples are

    labneh, skyr and ymer. The different methods available to

    manufacture concentrated fermented milks are as follows:

    (a) cloth bag or Berge system; (b) mechanical or nozzle

    separators; (c) ultrafiltration (UF); and (d) product formula-

    tion (Tamime & Robinson, 1999).

    Patterns of consumptionUntil the 1950s, production and=or consumption of yoghurt

    (ie natural type) was confined to communities in the Middle

    East, the Balkans, India, Eastern Europe, to ethnic groups

    living in different parts of the world, and to those who

    perceived that the product was beneficial to health. How-

    ever, consumers attitudes towards yoghurt have changed,

    possibly for the following reasons: (a) as refrigeration became

    widespread worldwide, the product became widely distribu-

    ted and readily available on the market; (b) the introduction

    of a new generation of yoghurts (eg addition of fruits and

    sugar) gave the product an entirely fresh image and it

    became an inexpensive snack or dessert; and (c) the advent

    of incorporation of probiotic bacteria into the product have

    enhanced the health benefits of fermented milks.

    Consumption figures reflect the expanding markets in

    some selected countries between 1970 and 1999 (Table 1).

    Until the early 1990s, fermented milks were classified as

    buttermilk, yoghurt and others according to the statistical

    data published by the International Dairy Federation, and

    such information provided consumption preferences of con-

    sumers in different countries; the current approach of

    Figure 1 The family tree of fermented milk types. Adapted from Kurmann (1984).

    Fermented milks a reviewAY Tamime

    S3

    European Journal of Clinical Nutrition

  • per capita consumption figures covers milk drinks and fer-

    mented milks including yoghurt. It could be argued, how-

    ever, that this classification of these products may not

    provide a clear picture or patterns of consumption. Further-

    more, in some countries, the consumption of buttermilk is

    not properly defined because:

    traditional=natural buttermilk is the by-product of buttermaking from ripened or cultured butter;

    cultured buttermilk is the fermentate of skimmed milkfollowed by the addition of butter flakes; and

    sweet buttermilk is not fermented; hence the data forbuttermilk in such statistical tables have to be assessed in

    a cautious manner.

    It is safe to conclude that fermented milk products that

    fall within the category of lactic fermentations (mesophilic

    type) are widely consumed in northern European countries,

    whilst the yeast lactic fermented milks are popular in the

    Russian Federation, eastern European countries and Mongo-

    lia. Conversely, natural yoghurt is popular in countries

    between the Balkans and the Indian sub-continent, while

    the fruit flavoured and=or flavoured products are normally

    consumed in the rest of the world.

    Little data is available on the world production figures of

    probiotic-fermented milks but during the last decade produc-

    tion has increased dramatically in some selected countries.

    For example, the French market of fermented milk

    containing Bifidobacterium spp. and Lactobacillus acidophilus

    increased from 1500 to >91 000 tonnes between 1986 and

    1990 (Renard, 1998).

    Definition and terminology of fermented milksincluding yoghurtThe existing legal standards or the provisional regulations of

    yoghurt in many countries classify the product on the basis

    of chemical composition or fat content (full, semi-

    skimmed=medium or skimmed=low); the reviews by Robin-

    son and Tamime (1976), Pappas (1988), Anonymous (1989,

    1996), FAO=WHO (1990), and Tamime and Robinson (1999)

    are recommended for further reading.

    The International Dairy Federation (IDF, 1992a,b) pub-

    lished general standards of identity of fermented milks that

    could be briefly defined as follows: Fermented milks are

    prepared from milk and=or milk products (eg any one or

    combinations of whole, partially or fully skimmed, concen-

    trated or powdered milk, buttermilk powder, concentrated or

    powdered whey, milk protein (such as whey proteins, whey

    protein concentrates, soluble milk proteins, edible casein

    and caseinates), cream, butter or milkfat all of which

    have been manufactured from raw materials that have

    been at least pasteurized) by the action of specific

    microorganisms, which results in a reduction of the pH

    and coagulation. It is of interest that in some countries the

    fortification of milk components with dried dairy ingredi-

    ents during the manufacture, of yoghurt for example, is

    against the existing legal standards.

    Other IDF specifications include the following aspects: (a)

    the starter cultures shall be viable, active and abundant

    (107 cfu=g) in the finished products at all times of sale forconsumption; (b) these products may or may not be homo-

    genized, must at least be pasteurized, contain certain per-

    mitted additives (optional), and have a shelf-life up to 30

    days at 4 7C; (c) post-fermentation heat treatment shallnot be allowed; and (d) de-wheying after fermentation is

    only permitted during the manufacture of concentrated

    fermented milk products such as labneh, ymer, skyr and

    stragisto. Furthermore, the identity of the starter cultures is

    also detailed and, in the case of yoghurt, Streptococcus thermo-

    philus (formerly known as S. salivarius subsp. thermophilus)

    and Lactobacillus delbrueckii subsp. bulgaricus are normally

    used because of the associative growth that exists between

    these two microorganisms, whilst in some countries, Lacto-

    bacillus helveticus and Lactobacillus delbrueckii subsp. lactis (ie

    non-traditional organisms) are sometimes mixed with the

    starter culture. However, the name(s) of the so-called bio,

    therapeutic and=or probiotic fermented milks is not well

    established and should be addressed because consumers

    and=or some manufacturers in different countries consider

    all these products to be yoghurt (for more details refer to

    subsequent section).

    The milk fermentates by mesophilic microorganism

    include the products that are grouped under lactic and

    yeast lactic fermentations. The starter microorganisms of

    Table 1 Per capita annual consumption (kg=head) of milk drinksand fermented products including yoghurt

    Country 1975 1980 1990 1999

    Australia 1.0 1.8 3.5 5.8

    Austria 7.9 9.8 10.4 15.1

    Belgium 11.8 7.7 8.4 20.3

    Canada 5.1 2.3 3.7 4.2

    Chile NRa

    1.4 3.9 6.7

    Czech=Slovakia 3.9 7.3 NR 20.0

    Denmark 36.1 26.7 21.6 29.8

    Federal Germany 16.5 10.1 14.2b 25.5b

    Finland 32.6 41.0 38.3 NR

    France 9.6 9.3 16.4 27.4

    Iceland 1.7 5.7 24.6 NR

    Israel 14.1 14.3 NR 29.3

    Italy NR 1.3 4.0 NR

    Japan 2.5 2.4 7.8 NR

    Netherlands 24.7 27.3 32.5 NR

    Norway 9.8 10.1 14.9 19.9

    Poland 3.2 2.0 NR 7.9

    Spain 3.4 6.0 8.0 15.4

    Sweden 24.1 23.5 29.1 30.2

    Switzerland 16.4 14.8 19.0 NR

    UK 1.7 2.8 4.4 NR

    USA 9.9 3.1 3.5c NR

    aNRnot reported.

    bData includes German Democratic Republic.cData for 1993.

    Data compiled from Tamime and Robinson (1999) and IDF (2000).

    Fermented milks a reviewAY Tamime

    S4

    European Journal of Clinical Nutrition

  • the former group belong to the genera of Lactococcus(Lac. lactis

    subsp. lactis, Lac. lactis subsp. lactis biovar diacetylactis and Lac.

    lactis subsp. cremoris) and Leuconostoc (Leu. mesenteroides

    subsp. cremoris and Leu. mesenteroides subsp. dextranicum),

    and they are normally used as mixed cultures. However, the

    microflora of the latter products is complex and not always

    constant; numerous species of lactic acid bacteria, yeasts and

    moulds have been found, for example, in the kefir grains.

    Tamime and Marshall (1997) have detailed the organisms that

    have been identified by many researchers in many countries.

    Traditionally, many products are made from natural

    yoghurt in the Balkans and the Middle Eastern countries

    and these can be briefly described as follows: (a) dilution of

    the fermentate with water for the production of drinking

    yoghurt; (b) concentration of the yoghurt by de-wheying for

    the manufacture of strained yoghurt and yoghurt cheese; the

    latter product is formed into small balls and preserved in

    olive oil; (c) cultured butter and=or ghee can be made by

    churning full-fat yoghurt, and the aqueous phase is either

    utilized as drinking yoghurt or mixed with parboiled cracked

    wheat which is later sun-dried and milled into powder (such

    product is known as Kishk); and (d) surplus of yoghurt is

    preserved by drying or gently heating yoghurt for few hours

    over low and smokey fires (the end product is known as

    smoked yoghurt). Nevertheless, at present the classical

    approach to categorize yoghurt products is based on its

    physical characteristics as shown in Table 2 and, in particu-

    lar, yoghurt is further sub-divided into different groupings

    based on the following aspects:

    legal and=or proposed standards classify the product, forexample, on the fat content (full, medium or low);

    physical nature of the product (ie set or stirred; drinkingyoghurt is normally considered as stirred-type of low

    viscosity);

    flavours of yoghurt are divided into plain=natural,fruit or flavoured; the latter two products are normally

    sweetened;

    probiotic, bio and=or therapeutic yoghurts containnon-traditional organisms beside Lb. delbrueckii subsp.

    bulgaricus and S. thermophilus (see Table 5);

    miscellaneous yoghurts include pre-fermentation proces-sing (lactose hydrolysis or replacement of the animal fat

    with vegetable oil) or post-fermentation processing (vita-

    min fortification or heat treatment).

    Technology of manufactureCurrently, the technological aspects of fermented milks are

    well established and extensively reviewed (Rasic & Kur-

    mann, 1978; IDF, 1984, 1986, 1988, 1992c; Chandan,

    1989; Tamime & Marshall, 1997; Tamime & Robinson,

    1999). The principal manufacturing stages and=or processes

    for all fermented milk products (set- or stirred-type) have

    many features in common, which can be briefly described

    as follows:

    Preparation of the milk base

    The fat and the non-fat solid (SNF) contents of the milk are

    standardized and fortified to ensure compliance with exist-

    ing legal standards. The fat level may range between

  • Heat treatment

    Different temperatures are used for the heat treatment of the

    milk base during the manufacture of fermented milk, and

    can vary depending on the time and temperature combina-

    tions. Some examples are: (a) 85C for 30 min; (b) 90 95Cfor 5 min; and (c) 105C for 10 s. Thermal treatment of themilk base induces numerous physical and chemical changes

    that are complex and multi-functional; the topic has been

    extensively studied (see the reviews by IDF, 1995; Tamime &

    Marshall, 1997; Tamime & Robinson 1999), and in the

    context of fermented milks the effects of heat treatment are:

    destruction and=or elimination of pathogens and othermicroorganisms present in the milk base and, hence, the

    processed milk provides a good growth medium for the

    starter cultures;

    changes in the physical chemical properties of themilk constituents, mainly the denaturation of the b-lactoglobulin, which forms a complex with k-casein;such interaction minimizes syneresis and improves the

    firmness of the gel; the protein=fat interaction in milk

    should not be overlooked;

    production of components that are stimulatory to thestarter cultures.

    Starter culture

    The heated milk base is cooled to the desired incubation

    temperature of the product; some examples are: (a) yoghurt

    at 40 45C for up to 3 h, at 30C for 18 h or 5 h whenusing direct-to-vat inoculation (DVI) starter culture; (b) pro-

    biotic products at 37C for a few hours or up to 5 7 daysdepending on the organism(s) used; (c) buttermilk at 20

    30C for up to 10 20 h; and (d) kefir at 22C for 16 24 hdepending on the type of kefir grains used (Tamime &

    Marshall, 1977; Wszolek et al, 2001).

    Gel formation in milk is mediated by acid coagulation

    due to the activity of the starter cultures and their enzymes

    to hydrolyse the lactose and to a lesser degree the proteins.

    The mechanisms involved of casein dissociation and aggre-

    gation during acid-induced gelation of milk are pH-, ion

    concentration- and temperature-dependant, and these

    aspects of gelation are similar for set- or stirred-type fer-

    mented milks; in the former type, the milk is incubated in

    the retail container, whilst for the stirred product the milk

    is incubated in large fermentation tanks.

    Cooling and miscellaneous handling

    Cooling is only method used to control the metabolic

    activity of the starter cultures and their enzymes in order

    to retain an abundant count of these organisms in fermen-

    ted milks. The primary objective is to cool the product to

    5C, and the process of cooling commences at 4.6 pH,which is carried out using a one- or two-phase cooling. The

    latter method is widely applied during the manufacture of

    fruit-flavoured fermented milk products; the first stage of

    cooling, for example for yoghurt, reduces the temperature

    from 45 to 20 25C prior to the addition of fruit and packa-ging, and the second phase of cooling takes place in the cold

    store (chill tunnel is optional), where the product is cooled to

  • countries. Nevertheless, who could have imagined in the

    1950s that these products would be used successfully for the

    treatment of certain human diseases in the 1980s or 1990s?

    (See also Shortt, 1999.)

    Probiotic microorganismsThe current definition of probiotics, as agreed by European

    scientists, is a live microbial feed supplement that is

    beneficial to health (Salminen et al, 1998a). However, the

    microflora of the human intestinal tract in both infants and

    adults is highly complex and many bacterial species have been

    identified; the topic has been extensively researched, and the

    following selected reviews provide relevant information with

    specific emphasis on probiotic microorganisms and their

    health applications to humans (Robinson, 1991; Fuller,

    1992, 1997; Sanders, 1994; Salminen et al, 1996a, 1998b, c;

    Marshall & Tamime, 1997a; Holzapfel et al, 1998; Salminen &

    von Wright, 1998; Dunne et al, 1999; Hirayama & Rafter, 1999;

    Lee et al, 1999; Tannock, 1999; Fuller & Perdigon, 2000;

    Salminen, 2001). Periodically, Danone Vitapole Recherche

    publishes monographs (Capron et al, 2000; Malagelada et al,

    1999; Denariaz et al, 1999; Gibson et al, 2000; Hartley et al,

    2001) and World Newsletter (23 issues have been published)

    updating the health aspects associated with fermented milks.

    As mentioned earlier, lactic acid bacteria, yeast, moulds or

    combinations of these are widely used in the production of

    fermented milks and cheeses. The characteristics of these

    microorganisms have been recently reviewed by Tamime

    (2002), and only the relevance of probiotic microflora in

    fermented milks will be discussed. It is evident that these

    bacterial species have to withstand the acidic and bile salts

    conditions in the gastro-intestinal tract of humans when

    compared with traditional dairy starter cultures, and reach

    and=or colonize the large intestine. Researchers in different

    countries have identified many probiotic microorganisms,

    and Table 3 illustrates some examples.

    The recent taxonomy and physiology of probiotic lacto-

    bacilli species have been reported by Klein et al (1998), and

    these species belonged to: (a) Lb. acidophilus group; (b) Lb. casei

    group; and (c) Lb. reuteri=Lb. fermentum group; most Lb.

    acidophilus strains used in the manufacture of probiotic

    fermented milks have been identified as Lb. johnsonii or

    Lb. gasseri; both species are members of the Lb. acidophilus

    group. Hence, the issue of health-promoting properties of

    such products is questionable, and it cannot be assumed that

    all strains of Lb. acidophilus have or possess the desirable

    properties of probiotic microorganisms (Salminen et al,

    1996b; Hamilton-Miller & Gibson, 1999; Ouwehand et al,

    1999); furthermore, not all the commercial probiotic fer-

    mented milk products disclose the strain or species used or

    the actual numbers (Hamilton-Miller, 1999; Sanders & Huis

    int Veld, 1999). In some instances, researchers have referred

    to Lb. rhamnosus GG as Lb. acidophilus, Lb. casei subsp. casei

    or Lb. paracasei subsp. paracasei.

    Until the mid 1980s, the genus Bifidobacterium was classi-

    fied as Lactobacillus spp. and currently 30 different species of

    bifidobacteria have been identified. The six organisms that

    have been used in dairy products are shown in Table 3 but,

    according to Klein et al (1998), most of the strains used in

    Table 3 Examples of probiotic micro-organisms thatare used during the manufacture of fermented milks

    Genera Microbial species

    Lactobacillus Lb. acidophilus

    Lb. acidophilus strains LC1,

    La5, La1, La7, Gilliland

    Lb. casei strains Shirota, GGa

    or LGG,a Imunitass, NCC208

    Lb. rhamnosus strain GG

    Lb. johnsonii

    Lb. helveticus

    Lb. delbrueckii subsp. bulgaricus

    Lb. gasseri

    Lb. plantarum

    Lb. paracasei subsp. paracasei

    and subsp. tolerans

    Lb. reuteri

    Pediococcus P. acidilactici

    Bifidobacterium B. bifidum, breve, longum,

    adolescentis, infantis,

    lactis, animalis

    Lactococcus Lc. lactis subsp. lactis

    Enterococcus E. faecium, faecalis

    Saccharomyces S. boulardiib

    aThis strain could be confused with Lb. rhamnosus GG due

    to latest nomenclature classification.bMost likely application is during the manufacture of kefir.

    Data compiled from Tamime et al (1995), Tamime and

    Marshall (1997), Shortt (1997), Lee et al (1999) and

    Sanders and Huis int Veld (1999).

    Table 4 A summary of some health-promoting activities inhumans associated with probiotic fermented milks

    Action=effect Alleged health benefit

    In digestive tract Active against Helicobacter pylori

    Enhanced lactose digestion

    Stimulation of the intestinal immunity

    Stabilization of Crohns disease

    Stimulation of intestinal peristalsis

    On intestinal

    microflora

    Improves balance between

    microbial populations

    (eg increase in faecal bifidobacteria)

    Decrease in faecal enzyme activity

    Colonisation of the intestinal tract

    Reduced carrier time for Salmonella spp.

    On diarrhoea Prevention=treatment of

    acute and of Rotavirus diarrhoeas

    Prevention of antibiotic-induced diarrhoea

    Treatment of relapsing Clostridium difficile

    diarrhoea

    Other effects Improved immunity to disease

    Suppression of some cancers

    Reduction in serum cholesterol

    Reduction in hypertension

    Adopted from Tamime and Robinson (1999).

    Fermented milks a reviewAY Tamime

    S7

    European Journal of Clinical Nutrition

  • probiotic fermented milks are B. animalis, although they

    are declared on some labels as B. longum. B. animalis was

    renamed B. lactis in the late 1990s (Meile et al, 1997), and

    now it is re-classified as B. animalis (Cai et al, 2000). In my

    view, the term bifidus should not be used because it is old

    terminology (Lactobacillus bifidus), and can cause some con-

    fusion to the reader.

    The 16S rRNA sequencing within the genus Entrococcus

    has revealed the presence of three species groups: E. faecium

    and E. durans are found in the first group, whilst E. faecalis

    forms an individual line of descent. However, the pathogeni-

    city of these organisms should not be overlooked when they

    are used in probiotic fermented milk products.

    Limited data are available on the use of the probiotic yeast

    (Saccharomyces boullardii) in fermented milks (Lourens-

    Hattingh & Viljoen, 2001a), and the most likely application

    is Kefir and Koumiss making. Other non-lactic acid bacteria

    that have been used in probiotic products around the world

    include Bacillus cereus, Escherichia coli and Clostridum

    butyricum (Shortt, 1999).

    Therapeutic properties of bio-fermented milksIt is well established that the probiotic microorganisms

    shown in Table 3 have therapeutic properties, and when

    they are added with traditional starter cultures during the

    manufacture of fermented milks (see later), such products

    have certain health-promoting activities in humans; Table 4

    attempts to highlight the possible advantages. However, up-

    to-date reports on some of the clinical=nutritional studies on

    humans using probiotic fermented milks and their successful

    applications in the treatment of certain human diseases,

    include the following: (a) adherence of probiotic microor-

    ganisms to human intestinal cells; (b) decreasing faecal

    mutagenecity; (c) improvement of constipation; (d) produc-

    tion of bacteriocins; (e) effects on superficial bladder cancer;

    and (f) effect on the human salivary microflora (Mattila-

    Sandholm & Salminen, 1998; Salminen et al, 1998b; Mattila-

    Sandholm et al, 1999a,b; Ouwehand et al, 1999; Petti et al,

    2001). Some selected studies on nutritional aspects relating

    to humans have been reported by Oberhelman et al (1999),

    Alander et al (1999), Lee et al (1999), Kar (1999), Ashar and

    Table 5 Some examples of probiotic fermented milk products available in different countries

    Product Country Microorganismsa

    I. Fermented milks

    ABT, Biogarde1, Philus Germany Lb. acidophilus B. lactisb or bifidum S. thermophilusUK

    Denmark

    Sweden

    ACT4 Austria Similar to ABT Lb. caseiVifit, Gefilus Germany Yogurtc B. bifidum Lb. acidophilus Lb. rhamnosus GG

    UK

    Netherlands

    Belgium

    Finland

    SymBalance Switzerland Lb. casei Lb. reuterix Lb. acidophilus BifidobacteriadActimel France Yogurt Lb. casei strain ImunitasseBiola Norway B. lactis Lb. rhamnosus Lb. acidophilusGaio Denmark S. thermophilus E. faecium

    UK

    Germany

    Finland

    BRA Sweden B. infantis Lb. reuteri Lb. acidophilusII. Fermented milk beverages

    Onaka He GG Japan Yogurt Lb. rhamnosus GGYakult Japan Lb. casei strain Shirota

    Brazil

    Some Asian countries

    Caldus Japan B. longum Lb. acidophilusVitagen Malaysia Lb. acidophilus

    Singapore

    Aktifit Switzerland Similar to ABT Lb. rhamnosus GGfLC1 or LC1 GO Many European countries Lb. acidophilusg or Lb. helveticus

    aLb. Lactobacillus; S. Streptococcus; B.Bifidobacterium; E. Enterococcus.

    bCurrently it is reclassified as B. animalis (Cai et al, 2000).

    cYogurt Lb. delbrueckii subsp. bulgaricus S. thermophilus.dYogurt starter cultures have been found in the product rather than bifidobacteria (Sanders & Huis int Veld, 1999).eLb. casei Lb. delbrueckii subsp. bulgaricus were the only organisms identified in the product (Sanders & Huis int Veld, 1999).fLb. rhamnosus was the only organism present in the product (Sanders & Huis int Veld, 1999)gLb. johnsonii S. thermophilus were found in the product (Sanders & Huis int Veld, 1999).

    Data compiled from Tamime et al (1995), Tamime (1998), Sanders and Huis int Veld (1999) and Lee et al (1999).

    Fermented milks a reviewAY Tamime

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    European Journal of Clinical Nutrition

  • Prajpati (1999), Arunachalam (1999), Barone et al (2000),

    Heyman (2000), Arunachalam et al (2000), Ahn et al (2000),

    Chiang et al (2000), Meydani and Ha (2000), Armuzi et al

    (2001), Collins (2001), Volpe et al (2001), Kawase et al (2001),

    Perdigon et al (2001) and Reid et al (2001).

    Another aspect, which has links with gut health, involves

    prebiotics; they are defined as non-digestible food ingredi-

    ents that beneficially affect the host by selectively stimulat-

    ing the growth and=or activity of one or limited number of

    bacteria in the colon, that have the potential to improve the

    host health (Gibson & Roberfroid, 1995). Most potential

    prebiotic food ingredients are carbohydrate-based compo-

    nents such as oligosaccharides (Hartemink, 1999; Gibson &

    Angus, 2000). However, a mixture of probiotic microorgan-

    isms and prebiotic food ingredient is known as synbiotic.

    Commercial probiotic fermented milk productsSome of the critical aspects that can affect the quality of

    fermented milks are: (a) good make which is attributed to

    fast acid development using traditional starter cultures; acid

    development of probiotic starter cultures is poor in compar-

    ison with Lb. delbrueckii subsp. bulgaricus and S. thermophilus;

    (b) stable product after manufacture where few undesirable

    microorganisms can withstand the rapid acid development

    or initiate growth at pH 4.6; and (c) the lactic and sour

    flavour is the characteristic flavour acidity of majority of

    traditional types of mesophilic and thermophilic fermented

    milks, and the action of acid on the milk proteins (mainly

    the casein) is important in texture formation of the product.

    However, the heterofermentation by the bifidobacteria

    results in lactic and acetic acid production; the latter acid

    has a harshness which is undesirable for milk products

    (Marshall & Tamime, 1997b).

    As a consequence, the majority of commercially avail-

    able probiotic fermented milks in different markets of the

    world (ca 80 100) are made with a mixture of non-tra-

    ditional and traditional starter cultures, and detailed exam-

    ples have been reported by Hoier (1992), Tamime et al

    (1995), Tamime & Marshall (1997), Holzapfel et al (1997)

    Table 6 Some selected bacteriocins produced by dairy starter cultures and probiotic microflora

    Genera=microorganisms Bacteriocins Molecular mass range (kDa)

    I. Lactococcus

    Lac. lactis subsp. lactis Lactostrepcin, Nisin, Lacticin, Bacteriocin,

    Dricin, Lactococcin

    1.3 >10

    Lac. lactis subsp. lactis biovar diacetylactis Bacteriocin, Lactococcin, Lactocin, Diacetin 3.4 5.8

    Lac. lactis subsp. cremoris Lactococcin, Bacteriocin, Diplococcin 3.4 8.5

    II. Leuconostoc

    Leu. mesenteroides subsp. mesenteroides Mesenterocin, Leucocin 2.5 100

    IV. Lactobacillus

    Lb. acidophilus Lactacin, Acidophilin, Acidophilicin,

    Acidocin, Acidolin, Bacteriocin

    0.2 50

    Lb. johnsonii Lactacin 2.5 > 300

    Lb. gasseri Bacteriocin, Gassericin 4.5 5.6

    Lb. reuteri Reutericyclin, Reutericin 0.4 > 200

    Lb. casei Caseicin 41Lb. plantarum Plantaricin 1 5.9

    Lb. rhamnosus Bacteriocin

  • and Tamime (1998) (see Table 5); hence, probiotic micro-

    organisms are used as therapeutic adjuncts in fermented

    milk products (see also the review by Lourens-Hattingh &

    Viljoen, 2001b).

    Exopolysaccharides (EPS) productionMicrobial EPS material is synthesized by certain strains of

    lactic acid bacteria, and it can enhance the rheological

    properties (ie minimize syneresis, improve the texture and

    modify the structure) and sensory perception (ie firmness

    and creaminess) of fermented milks and other dairy pro-

    ducts. The topic has been extensively reviewed (IDF, 1998;

    Cerning & Marshall, 1999), and illustrations of the micro-

    structure of both mesophilic and thermophilic fermented

    milks have been reported by Tamime and Marshall (1997)

    and Tamime and Robinson (1999).

    Quantitative and qualitative properties of EPS material are

    influenced by the following aspects: (a) microbial strain; (b)

    composition of the growth medium and=or growth factors;

    and (c) processing conditions that include the growth tem-

    perature and time of fermentation. In 2001, the scientific

    papers presented at the first Symposium on EPS from Lactic

    Acid Bacteria provided an up-to-date review of this field,

    including their applications in the dairy industry and the

    structures of EPS (Monsan et al, 2001; de Vuyst et al, 2001;

    Boels et al, 2001; Jolly & Stingele, 2001; Degeest et al, 2001;

    Duboc & Mollet, 2001; Marshall et al, 2001). However, some

    of these EPS materials contain gluco- and=or fructo-oligosac-

    charides and may generate short-chain fatty acids upon

    hydrolysis in the intestinal tract by the colonic microflora,

    and may have potential health (eg an anti-tumor effect,

    cholesterol-lowering effects or immune-modulators effects)

    and nutritional benefits as a prebiotic to the intestinal

    microflora.

    Bacteriocin productionBacteriocins are antibacterial substances produced by

    certain groups of microorganisms including probiotic and

    lactic acid bacteria; they are also known as colicin-like

    inhibitory substances. Incidentally, bacteriocins are usually

    segregated from antibiotic compounds, and such naturally

    produced metabolites inhibit the growth of undesirable

    microorganisms in food and dairy products. In the case

    of lactic acid bacteria, the bacteriocins produced could be

    used to replace added chemical preservatives and, hence,

    the shelf-life of the product could be extended by natural

    means; however, these inhibitors can also affect certain

    strains of starter cultures.

    At present more than 70 different types of bacteriocins

    have been identified as produced by lactic acid bacteria.

    Table 6 summarizes some selected characteristics (for further

    information refer to de Vuyst & Vandamme, 1994; Holzapfel

    et al, 1995; Desmazeaud, 1994; Nes et al, 1996; Richard, 1996;

    Marshall & Tamime, 1997a).

    Partial characterization of the quality ofprobiotic fermented milksMany diversified probiotic dairy products are currently avail-

    able to consumers in many markets, and some examples are:

    pasteurized liquid milk, cheeses, ice-cream, milk powder feed

    for infants and fermented milks (Tamime & Marshall, 1997).

    However, fermented milk products are the most popular

    vehicle used in the industry for the implantation of the

    probiotic microflora in humans. In the mid 1990s, a colla-

    borative research programme was established between the

    Scottish Agricultural College (SAC) and the Hannah Research

    Institute (HRI) to evaluate the quality (chemical composi-

    tion, microbiological analysis, rheological properties and

    sensory perception) of different types of newly developed

    Table 7 The microorganisms used in commercial mixed starter cultures

    Bifidobacterium spp. Lactobacillus spp.

    Streptococcus

    Code Supplier Typea bifidum lactisb longum infantis acidophilus bulgaricusc thermophilus

    AB Chr. Hansen FD P P PAC=BL Rhodia FD P P PDVB-100 SBId FD P P PMSK 2 Visby DF P P PABT 1

    eChr. Hansen FD P P P P

    ABT 3 Chr. Hansen FD P P P PMSKB 2

    eVisby FD P P P P

    MY 087f Rhodia FD P P

    aFD freeze dried, DFdeep frozen.

    bCurrently it is reclassified as B. animalis (see text).

    cLb. delbrueckii subsp. bulgaricus.dSBI Systems Bio-Industries Ltd.eThe starter cultures produces exopolysaccharide (EPS) materialfThis is a yoghurt starter culture, which is used as a control.

    The symbol (P) denotes the presence of the microorganism in the starter culture.

    Fermented milks a reviewAY Tamime

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    European Journal of Clinical Nutrition

  • fermented milk products (eg vegetable oil yoghurt, kishk,

    yoghurt made with fat substitutes, kefir and probiotic fer-

    mented milks). In this paper, some aspects of the quality of

    probiotics fermented milks will be reported, and for further

    details refer to La Torre (1997), Hartley et al (2001) and La

    Torre et al (2002).

    In the first instance, single strains of Bifidobacterium spp.

    (B. adolescentis NCFB 2230, B. bifidum NCFB 2715, B. breve

    NCFB 2258, B. infantis NCFB 2205 and B. longum NCFB 2259,

    were obtained from National Collection of Food Bacteria;

    B. longum BB 46 and B. bifidum BB11 B. longum BBL and BL

    and B. infantis 410 B. longum 2 and 913 were obtained from

    Chr. Hansen, Rhodia and Visby, respectively) were used to

    manufacture fermented milks. The quality of the products

    made with the NCFB strains did not satisfy the minimum

    requirements, the pH values were borderline (eg between 4.8

    and 5.4), excessive whey separation was evident, the coagu-

    lum was extremely week and, in some cases, the odour and

    taste were unpleasant. However, slight improvement in the

    quality of the product was evident, especially when the milk

    bases were fortified with Raftaline1 or Jerusalem artichoke,

    but the overall pHs ranged between 4.79 and 5.91 after 24 h

    of incubation (with the exception of strains of B. longum BBL

    and 2; pH 4.6). As the results were not satisfactory, it wasdecided that commercial mixed blends of starter cultures

    containing lactic acid bacteria and different Bifidobacterium

    species would be used (see Table 7).

    The quality of the fermented milks was superior to those

    made with single strains of bifidobacteria, and the results

    could be summarized as follows:

    Acidification of the milk base (total solids, protein and fatwere 14.5, 5.5 and 1.5 g=100 g, respectively) ranged

    between 6 and 10 h or 13 and 22 h for pH 4.4. Organic acid profiling indicated that the starter cultures

    produced appreciable quantities of lactic acid, and only

    two cultures (AB and AC=BL) produced the high levels of

    acetic acid (3229 and 2794 mg=g, respectively; figures areaverages of three trials and of fresh and stored products).

    The viable cell counts in fresh and stored products forbifidobacteria varied (eg two cultures (AB and AC=BL)

    showed an increase, three cultures (DVB-100, ABT 3 and

    MSKB 2) remained constant, and two cultures (ABT 1 and

    MSK 2) exhibited a slight decline); Lb. acidophilus

    increased during production but, in some products (DVB-

    100, MSK 2, ABT 1 and 3 and MSKB 2), the counts were

    Figure 2 Sensory space maps for probiotic fermented milks, factorscores on first two dimensions are shown. For starter cultures symbolsrefer to Table 7. After La Torre (1997).

    Figure 3 Interpretation of sensory results for fermented milk products. After La Torre (1997).

    Fermented milks a reviewAY Tamime

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    European Journal of Clinical Nutrition

  • decreased after storage; S. thermophilus counts of all starter

    cultures showed a remarkable increase during production

    and survival during storage.

    Syneresis values of fermented milks ranged between 2.5and 3.0 ml for fresh products and decreased to 1.5 2.5 ml

    after 20 days storage at 5C; the rate of decrease wasdependent on the starter culture used.

    The firmness measurements of all fermented milksincreased over time, and the rate was independent

    of the starter culture used; after the storage period, the

    firmness values ranged between 1.8 and 2.5 N for the EPS

    cultures MSKB 2 and ABT 1, respectively.

    Sensory analysis indicated the following: (a) acid,creamy and=or other characters (for the odour, flavour

    and after-taste attributes) were significant (P

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