A systematic review of prospective evidence linking non-alcoholic fermented food consumption with lower mortality risk

Paveljšek, Diana (author), Pertziger, Eugenia (author), Fardet, Anthony (author), Panagiotakos, Demosthenes Basilis (author), Savary-Auzeloux, Isabelle (author), Adamberg, Signe (author), Peñas, Elena (author), Frias, Juana (author), Ntantou, Anastasia (author), Diamantoglou, Ioannis (author), Domínguez-Soberanes, Julieta (author), Louis, Sandrine (author), Chassard, Christophe (author), Praćer, Smilja (author), Vergères, Guy (author), Matalas, Antonia-Leda (author)

Fermented foods are consumed worldwide and are increasingly being studied for their potential health benefits. Although their consumption is widespread, their association with long-term health outcomes such as mortality risk remains unclear. The aim of this systematic review was to assess the association between the consumption of fermented foods and risk of all-cause, cardiovascular, and cancer-related mortality in generally healthy adult populations in accordance with the European Food Safety Authority (EFSA) framework for the substantiation of health claims. A comprehensive literature search identified prospective cohort studies from 1970 to 2025 that investigated the association between fermented food consumption and mortality outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale, and strength of evidence was evaluated based on study quality, sample size, and precision within a structured narrative framework that also classified the direction of association across categories. A complementary non-systematic review examined the compositional characteristics, mechanisms of action, and potential health risks associated with fermented foods. Fifty-two cohort studies were included. Fermented milk products (including yogurt), chocolate, and fermented soy products (particularly natto) suggested a modest inverse association with all-cause and cardiovascular mortality. Cheese was associated with reduced all-cause mortality in some studies, but it showed inconsistent effect on cardiovascular mortality. The evidence for cancer-related mortality was weaker, although yogurt and fermented milk displayed some protective trends. Evidence from a single cohort suggested a potential reduction in all-cause mortality with fermented vegetable consumption, whereas fermented meat suggested no clear association with mortality. Biological plausibility was supported by fermentation-derived compounds such as bioactive peptides, polyphenols, isoflavones, natto-kinase, and vitamin K2. Habitual consumption of certain fermented foods may be associated with modest reductions in mortality risk, but the current evidence remains insufficient to support EFSA-approved health claims. Randomized controlled trials are essential to demonstrate causality. While long-term trials with mortality endpoints are not feasible, studies targeting intermediate outcomes linked to mortality offer a practical alternative. These should be complemented by observational studies to capture long-term, real-world associations. Together, such efforts support the objectives of the COST Action PIMENTO (CA20128) in building a more robust evidence base on fermented foods and health.

• Language: English
• Keywords: fermented foods, all-cause mortality, cardiovascular mortality, cancer mortality, fermented dairy products, fermented soy, fermented meat, fermented vegetables
• Work type: Article
• Typology: 1.02 - Review Article
• Organization: BF - Biotechnical Faculty
• Publication status: Published
• Publication version: Version of Record
• Publication date: 03.11.2025
• Year: 2025
• Number of pages: 24 str.
• Numbering: Vol. 12, [article no.] ǂ1657100
• PID: 20.500.12556/RUL-176049
• UDC: 613.2
• ISSN on article: 2296-861X
• DOI: 10.3389/fnut.2025.1657100
• COBISS.SI-ID: 257738243
• Publication date in RUL: 19.11.2025

Record is a part of a journal

• Title: Frontiers in nutrition
• Shortened title: Front. nutr.
• Publisher: Frontiers Media S.A.
• ISSN: 2296-861X
• COBISS.SI-ID: 4431992

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.

Secondary language

• Language: Slovenian
• Keywords: prehrana ljudi, fermentirana živila, zdravje, umrljivost

Projects

• Funder: Other - Other funder or multiple funders
• Funding programme: European Cooperation in Science and Technology
• Project number: CA20128
• Name: PIMENTO CA20128