JOURNAL OF FUNCTIONAL FOODS 5 ( 2 0 1 3 ) 1 5 4 2 –1 5 5 3

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Prebiotics as functional foods: A review

Sadeq Hasan Al-Sherajia,e, Amin Ismaila,d,*, Mohd Yazid Manapb, Shuhaimi Mustafac,d,
Rokiah Mohd Yusofa, Fouad Abdulrahman Hassana,e
a
Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor,
Malaysia
b
Department of Food Technology, Faculty of Food Science and Technology, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
c
Department of Microbiology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor,
Malaysia
d
Laboratory of Halal Science Research, Halal Products Research Institutes, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor,
Malaysia
e
Department of Food Science, Faculty of Agriculture, Ibb University, Ibb, Yemen

A R T I C L E I N F O A B S T R A C T

Article history: Prebiotics are short chain carbohydrates that are non-digestible by digestive enzymes in
Received 7 September 2012 humans and selectively enhance the activity of some groups of beneficial bacteria. In the
Received in revised form intestine, prebiotics are fermented by beneficial bacteria to produce short chain fatty acids.
5 August 2013 Prebiotics also render many other health benefits in the large intestine such as reduction of
Accepted 19 August 2013 cancer risk and increase calcium and magnesium absorption. Prebiotics are found in sev-
Available online 19 September 2013 eral vegetables and fruits and are considered functional food components which present
significant technological advantages. Their addition improves sensory characteristics such
Keywords: as taste and texture, and enhances the stability of foams, emulsions and mouthfeel in a
Prebiotics large range of food applications like dairy products and bread. This contribution reviews
Digestibility and fermentability bioactives from food sources with prebiotic properties. Additionally, food application of
Functional food application bioactive prebiotics, stimulation of the viability of probiotics, health benefits, epidemiolog-
Health benefits
ical studies, and safety concerns of prebiotics are also reviewed.
Ó 2013 Elsevier Ltd. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1543
2. Types and sources of prebiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1544
3. Fermentability and selectivity of prebiotics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1544
4. Digestibility of prebiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1544
5. Industrial production of prebiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1546
6. Applications of prebiotics in food products. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1546
7. Prebiotics as fat replacers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1546
7.1. Effects of prebiotics on the chemical characteristic of yoghurt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1546

* Corresponding author at: Laboratory of Halal Science Research, Halal Products Research Institutes, Universiti Putra Malaysia, 43400 UPM
Serdang, Selangor, Malaysia. Tel.: +60 3 89472435; fax: +60 3 89426769.
E-mail address: amin@medic.upm.edu.my (A. Ismail).
1756-4646/$ - see front matter Ó 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jff.2013.08.009
 JOURNAL OF FUNCTIONAL FOODS 5 ( 2 01 3 ) 15 4 2–15 5 3 1543

7.2. Effects of prebiotics on rheological measurements of yoghurt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1546

7.3. Effects of prebiotics on the sensory evaluation of yoghurt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1547
8. Effect of prebiotics on the growth of probiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1547
8.1. Breast milk and the bifidus factor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1547
8.2. Effect of prebiotics on probiotic viable counts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1547
9. Health benefits of prebiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1547
9.1. Acute gastroenteritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1547
9.2. Reduction of cancer risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1548
9.3. Mineral absorption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1548
9.4. Lipid regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1548
10. Toxicity and safety of prebiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1549
11. Epidemiological studies on prebiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1549
12. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1550
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1550

1. Introduction

‘‘Health Canada defines functional foods as products that
resemble traditional foods but possess demonstrated physio-
logical benefits’’ (Shahidi, 2009). Many unique traditional
functional foods have been developed by combining food with
herbal medicines. In some countries traditional herbal prod-
ucts are widely used as medicine in dietary supplements, dai-
ly foods and functional foods, for replenishment and health
promotion purposes. The concept is connected with immuno-
potentiation, the improvement of system circulation, disease
prevention, and control of aging (Shi, Ho, & Shahidi, 2011).
According to the definition, functional food is a part of human
diet and is demonstrated to provide health benefits and to de-
crease the risk of chronic diseases beyond those provided by
adequate nutrition. The functional foods include: (i) usual
foods with naturally occurring bioactive substances (e.g., die-
tary fibre), (ii) foods supplemented with bioactive substances
(e.g., probiotics, antioxidants), and (iii) derived food ingredi-
ents introduced to conventional foods (e.g., prebiotics). Func-
tional food should have a novel prospective, rather than a
food product. It should also be mentioned that functional
foods are not medicines such as pills or capsules but are con-
sumed as part of a normal daily diet (Grajek, Olejnik, & Sip,
2005).
Epidemiological studies and randomized clinical experi-
ments conducted have confirmed or at least suggested many
health benefits for functional foods. The health benefits such
as decrease of cancer risk, improvement of heart health,
enhancement of immune system (Shahidi, 2004), reducing
of menopause symptoms, enhancement of gastrointestinal
health, preservation of urinary tract health, anti-inflamma-
tory influences, diminution of blood pressure, protection of
vision, antibacterial and antiviral activities, decline of osteo-
porosis and antiobese influences.
Prebiotics are short-chain carbohydrates (SCCs) that are
non-digestible by digestive enzymes in humans and that have
been called resistant SCCs (Quigley, Hudson, & Englyst, 1999).
They are sometimes referred to as non-digestible oligosac-
charides (NDOs) which are soluble in 80% ethanol. Prebiotic
is a non-active food constituent that shifts to the colon and
is then selectively fermented. The benefit to the host is
mediated during selective stimulation of the growth and/or
activity of one or a limited number of bacteria (Gibson & Rob-
erfroid, 1995). The definition of prebiotics overlaps signifi-
cantly with the dietary fibre definition; with the exception
of its selectivity for several genus or kinds of indigenous bac-
teria. Currently, only non-digested carbohydrate (CHO) mole-
cules, a range of di-, oligo- and polysaccharides, resistant
starches and sugar polyols have been claimed to have prebi-
otic properties.
Prebiotics pass by the small intestine to the lower gut and
become accessible for probiotic bacteria without being uti-
lised by other intestinal bacteria. Lactulose, galactooligosac-
charides, fructooligosaccharides, inulin and its hydrolysates,
maltooligosaccharides, and resistant starch are prebiotics
normally used in the human diet. The essential end compo-
nents of carbohydrate metabolism are short-chain fatty acids,
particularly acetic acid, propionic acid and butyric acid, which
are used by the host organism as an energy source. They can
also be found in different sources such as chicory, onion, gar-
lic, asparagus, artichoke, leek, bananas, tomatoes and many
other plants. Generally, oligosaccharides are combinations
of sugars with a different degree of polymerization (Critten-
den & Playne, 1996). Prebiotic oligosaccharides can be manu-
factured by three different methods: isolation from plant
resources, microbiological production or enzymatic synthe-
sis, and enzymatic degradation of polysaccharides (Critten-
den & Playne, 1996; Gulewicz et al., 2003). Most of prebiotic
oligosaccharides are manufactured and are generally avail-
able in the markets. A large number of patents regarding pre-
biotic oligosaccharides have been filed and their number is
growing (Grajek et al., 2005).
Actually, the mixtures of probiotics and prebiotics are of-
ten used in order to take advantage of their synergic effects
in application to food products. Thus, these mixtures are
called synbiotics. Prebiotics such as RaftilosesP95 when com-
bined with Lactobacillus rhamnosus, Bifidobacterium spp., Lacto-
bacillus acidophilus, and Lactobacillus casei improve their
viabilities at 4 °C for 4 weeks of storage (Capela, Hay, & Shah,
2006). Pear and apple fibres, raffinose extracted from seeds of
lupin, Mangifera pajang fibrous and its polysaccharides in-
creased the viability and activity of probiotics (Al-Sheraji, Is-
mail, Manap, Mustafa, & Yusuf, 2012b; Al-Sheraji et al.,
1544 JOURNAL OF FUNCTIONAL FOODS 5 ( 2 0 1 3 ) 1 5 4 2 –1 5 5 3

Table 1 – Types and sources of prebiotics.

Type of prebiotic Sources of prebiotic References

Fructooligosaccharides
Isomaltulose
Xylooligosaccharides
Galactooligosaccharides
Cyclodextrins
Raffinose oligosaccharides
Soybean oligosaccharide
Lactulose
Lactosucrose
Isomaltulose
Palatinose
Maltooligosaccharides
Isomaltooligosaccharides
Arabinoxylooligosaccharides
Enzyme-resistant dextrin
Asparagus, sugar beet, garlic, chicory, onion, Jerusalem Sangeetha et al. (2005)
artichoke, wheat, honey, banana, barley, tomato and rye
Honey, sugarcane juice Lina, Jonker, and Kozianowsky (2002)
Bamboo shoots, fruits, vegetables, milk, Vázquez, Alonso, Domı́nguez, and Parajó (2000)
honey and wheat bran
Human’s milk and cow’s milk Alander et al. (2001)
Water-soluble glucans Singh, Sharma, and Banerjee (2002)
Seeds of legumes, lentils, peas, beans, Johansen, Glitso, and Knudsen (1996)
chickpeas, mallow composite, and mustard
Soybean Mussatto and Mancilha (2007)
Lactose (Milk) Villamiel, Corzo, Foda, Montes, and
Olano (2002)
Lactose Kawase, Pilgrim, Araki, and Hashimoto (2001)
Sucrose Lina et al. (2002)
Sucrose Lina et al. (2002)
Starch Kaneko et al. (1994)
Starch Kaneko et al. (1994)
Wheat bran Eeckhaut et al. (2008), Grootaert et al. (2007)
Potato starch Barczynska, Slizewska, Jochym, Kapusniak,
and Libudzisz (2012)

2012a; Kourkoutas et al., 2006; Martinez-Villaluenga, Frias, Vi-
dal-Valverde, & Gomez, 2005; Perez-Conesa, Lopez, & Ros,
2005). This review provides information about bioactive car-
bohydrates with emphasis on their prebiotic properties. Areas
covered include the types and sources of prebiotics, non-
digestibility and fermentability of prebiotics, polysaccharides,
the significance to human health, the application in food for-
mulation, increasing the probiotics viable count, safety of pre-
biotics and the epidemiological studies related to prebiotics.
2. Types and sources of prebiotics
Non-digestible carbohydrates can be considered as prebiotic if
they achieve the following criteria (A) resistance to gastric acid-
ity and mammalian enzymes; (B) susceptibility to fermenta-
tion by gut bacteria; and (C) ability to enhance the viability
and/or activity of beneficial microorganisms (Rastall & Gibson,
2006). Galactooligosaccharides (GOS), fructooligosaccharides
(FOS) and inulin are the prebiotics most commonly known.
GOS are non-digestible and are derived from lactose that oc-
curs naturally in mammalian milk and consist of chains of gal-
actose monomers. Inulin and inulin-type fructans, are known
soluble dietary fibres (Roberfroid, 2005). Additionally, dietary fi-
bre containing several non-starch polysaccharides, such as
cellulose, dextrins, pectins, beta-glucans, waxes, and lignin
can adjust the transfer time through the gut, thus offering
the same useful effects as those of inulin-type fructans (Napo-
litano et al., 2009). Naturally occurring prebiotic can be found in
various foods, including asparagus, chicory, tomatoes and
wheat, and it is a natural constituent of breast milk. Several
types of prebiotics and their sources are summarised in Table 1.
supports this principle. In a number of human feeding stud-
ies, inulin and FOS in faeces were not detectable (Molis, Lou-
rie, & Ouarne, 1996). Certainly, there are data from both
in vitro and in vivo experiments about fermentation of these
carbohydrates by bacteria of the large intestine. In vitro exper-
imental studies indicate that several short chain fatty acids
(SCFAs) enhance bacterial survival and activity (Van Laere,
Bosveld, Schols, Beldman, & Voragen, 1997).
Special strains of bifidobacteria grow well on oligofructose
(Gibson, Beatty, Wang, & Cummings, 1995). Van Laere et al.
(1997) extracted several prebiotics with extensively different
sugar composition and molecular size and examined their
fermentation by different strains of Bifidobacterium, Clostrid-
ium, Bacteroides and Lactobacillus. They found that fermenta-
tion of oligosaccharides was changed based on their
structure that could either be linear or branched. Linear oligo-
saccharides break down to a larger extent than those with
branched structures and bifidobacteria use low degree of
polymerization carbohydrates first whereas bacteroides uti-
lised those with a high degree of polymerization (Cummings,
Macfarlane, & Englyst, 2001).
Prebiotic is a selective substrate for one or a limited num-
ber of probiotics. Probiotics are stimulated to grow and pro-
duce short chain fatty acids by prebiotic. Consequently,
prebiotic will be able to alter the colonic microbiota of the
host toward a healthier composition. In order to confirm
selectivity of a prebiotic it is important to accurately monitor
the changes in the faecal microbiota during prebiotic supple-
mentation both in vitro and in vivo (Kolida & Gibson, 2011).
4. Digestibility of prebiotics

3. Fermentability and selectivity of prebiotics Prebiotics reach the cecum without being digested because of
their chemical nature. A part of the material is not digested by
Carbohydrates that arrive at the cecum are possible sub- pancreatic and small-bowel enzymes in the human gut and
strates for fermentation by the bacteria, and much evidence therefore reaches the large bowel. Studies have reported that
 JOURNAL OF FUNCTIONAL FOODS
Table 2 – Industrial production of prebiotics.
Type of prebiotic
Raffinose oligosaccharides
Galactooligosaccharides
Lactulose
Lactosucrose
Fructooligosaccharides
Isomaltulose, also referred to as
palatinose
Glycosylsucrose
Maltooligosaccharides
Isomaltooligosaccharides
Cyclodextrins
Gentiooligosaccharides
Soybean oligosaccharides
Xylooligosaccharides
5 ( 2 01 3 ) 15 4 2–15 5 3 1545
Industrial production of prebiotic References
Can be directly extracted from plant materials using water Johansen et al. (1996)
or aqueous methanol or ethanol solutions
Are commercially produced from lactose by the action of Sako et al. (1999)
b-galactosidases. In the industrial production process of
galactooligosaccharides, a highly concentrated solution of
lactose, which is usually purified from cow’s milk whey
Is also manufactured from lactose, but in this case, an Villamiel et al. (2002)
alkali isomerization process is used to convert the glucose
moiety of lactose to a fructose residue
Is produced using lactose and sucrose as raw material Kawase et al. (2001)
Production can be divided into two classes: in the first one, Crittenden and Playne (1996)
they are produced from the disaccharide sucrose using the
transfructosylation activity of the enzyme b-
fructofuranosidase. The second method is the controlled
enzymatic hydrolysis of the polysaccharide, which can be
extracted from chicory roots
Is a natural occurring disaccharide Manufactured from Lina et al. (2002)
sucrose by enzymatic rearrangement of the glycosidic
linkage from a (1, 2)-fructoside to a (1, 6)-fructoside
followed by crystallization
Is a trisaccharide manufactured from the disaccharides Crittenden and Playne (1996)
maltose and sucrose through the transglycosylation
action catalysed by the enzyme cyclomaltodextrin
glucanotransferase
Contain a-D-glucose residues linked by a (1:4) glycosidic Crittenden and Playne (1996)
linkage. They are produced commercially from starch by
the action of debranching enzymes such as pullulanase
and isoamylase, combined with hydrolysis by various a-
amylases
Are also produced using starch as the raw material, but Kaneko et al. (1994)
they require a combination of immobilized enzymes in a
two-stage reactor. In the first stage, starch is liquefied
using a-amylase. The liquefied starch is then processed in
a second- stage that involves reactions catalysed by both
b-amylase and a-glucosidase. The b-amylase first
hydrolyses the liquefied starch to maltose. The
transglucosidase activity of a-glucosidase then produces
isomaltooligosaccharides
Are composed of 6, 7, and 8 glucose units, respectively. On Munro, Newberne, Young, and Bär
a commercial scale, they are produced from starch using (2004)
cyclodextrin glucosyltransferases, a group of amylolytic
enzymes produced naturally by different strains of bacilli
and other species of bacteria. The cyclodextrin
glycosyltransferase enzyme catalyses intramolecular
(cyclizing) and intermolecular (coupling,
disproportionation) transglycosylation as well as having a
hydrolytic action on starch
Consist of several glucose residues linked by b (1:6) Crittenden and Playne (1996)
glycosidic bounds. They are produced from acid or
enzymatic hydrolysis of starch and subsequent
transglycosylation action of the obtained glucose syrup
catalysed by b-glycosidase enzyme
Are extracted directly from the raw material. Soybean Karr-Lilienthal, Kadzere, Grieshop, and
whey, a by-product from the production of soy protein Fahey (2005)
isolate and concentrate, contain the oligosaccharides
raffinose, stachyose, and verbascose. The oligosaccharide
found in the highest concentration is stachyose, followed
by raffinose and verbascose
Production from these feed stocks: (a) enzyme treatments Vázquez, Alonso, Domı́nguez, and
of native xylan-containing lignocellulosic material; (b) Parajó (2000)
chemical fractionation of a suitable lignocellulosic
material to isolate xylan, with further enzymatic
hydrolysis of this polymer to xylooligosaccharides; and (c)
hydrolytic degradation of xylan to xylooligosaccharides by
steam, water or dilute solutions of mineral acids
1546 JOURNAL OF FUNCTIONAL FOODS
when either inulin or oligofructose was fed to ileostomy sub-
jects, normal recovery at the terminal ileum was between 86%
and 89% of the material fed (Ellegard, Andersson, & Bosaeus,
1997). Likewise, when gut substances were aspirated from the
terminal ileum after experimental foods were eaten, 89% of
oligofructose was recovered (Molis et al., 1996).
Additional evidence of non-digestibility was conditional as
some studies demonstrated that after ingestion of prebiotics,
breath-hydrogen secretion was enhanced. Kestose (GF2) and
nystose (GF3) were hardly digested when they were incubated
in vitro with either human saliva or rat pancreatic enzymes
they (Hidaka, Eida, Takizawa, Tokunaga, & Tashiro, 1986).
Blood glucose did not change when 25 g fructooligosaccha-
ride combination of GF2, GF3, and fructofuranosyl nystose
(GF4) was provided to healthy humans (Hidaka et al., 1986). A
similar observation was made when fructans were extracted
from Jerusalem artichokes (30% inulo-eptaose (GF7)) when (5,
10, or 20 g) were eaten either alone or with other carbohydrates
(Rumessen, Bode, Hamberg, & Gudmand-Hoyer, 1990). Cereal
fructan fractions were incubated with fresh human gastric juice
from 12 subjects, for 1 h and demonstrated that at pH 1.0 around
10–15% was hydrolysed. Whereas when they were incubated
with homogenized rat intestinal mucosa, the percentage of
hydrolysis was <1% (Nilsson, Oste, Jagerstad, & Birkhed, 1988).
5. Industrial production of prebiotics
Numerous attempts have been made to separate and purify
inulin and oligofructose for utilisation as nutritional supports
(Table 2). At the present time, inulin and oligofructose are uti-
lised in the pure form as ingredients in many food products
(Franck, 2002). Industrial production methods have been used
to produce non-digestible carbohydrates (NDCs) from natural
sources by hydrolysing polysaccharides, enzymatic and chem-
ical synthesis from disaccharide, direct extraction to produce
soybean oligosaccharides and raffinose, and is somerization
reaction to produce lactulose (Mussatto & Mancilha, 2007).
6. Applications of prebiotics in food products
The utilisation of prebiotics as food components has multiple
advantages, since they improve sensory features and provide
a more well-balanced nutritional composition (Franck &
Coussement, 1997). When prebiotics are used in bakery prod-
ucts and breakfast cereals, this represents major progress in
comparison with classical dietary fibre. Prebiotics provide
more freshness in snacks and cereals and they prolong shelf
life. They also keep breads and cakes moist and fresh for a
long time. Their solubility allows fibre incorporation in liquid
systems such as drinks, dairy products and table spreads. Pre-
biotics are also often utilised as dietary fibre in tablets and in
functional foods, particularly in entire ranges of dairy prod-
ucts and breads, as prebiotic ingredients enhance the viability
of healthy intestinal bacteria (Walter, 1999).
Because of their gelling properties, prebiotics improve low-
fat foods without any adverse effect on taste or texture. This
is important in products such as table spreads, butter-like
products, dairy spreads, cream cheeses, and processed
cheeses. The addition of prebiotics allows for the replacement
5 ( 2 0 1 3 ) 1 5 4 2 –1 5 5 3
of a considerable quantity of fat and the maintenance of the
emulsion, while offering a spreadable texture. Exceptional re-
sults have been found in water-in-oil spreads (Zimeri & Koki-
ni, 2003). The addition of prebiotics to fat-reduced meat
products leads to a creamier, juicier mouthfeel and constancy
because water hold is maintained. Prebiotics have also been
added as low energy ingredients and as fibre in chocolate
products without added sugar. In the dairy market, dietary
products have shown the strongest development, especially
for diet yoghurts with fruit (Miremadi & Shah, 2012). The
addition of prebiotics in the recipe during fruit preparation
develops mouthfeel, diminishes syneresis and presents a
synergistic taste result in combination with aspartame and
acesulfame K, without any significant increase in the caloric
content (Franck, 2002).
7. Prebiotics as fat replacers
Prebiotics which decrease the caloric value of food can be
used to solve some physical and sensory problems originating
from low fat levels in the final products. Fat replacers consist
of mixtures of lipid-originated fat substitutes, protein-, or car-
bohydrate-originated fat mimetics, or their combinations.
7.1. Effects of prebiotics on the chemical characteristic of
yoghurt
The addition of inulin into yoghurt did not influence acetalde-
hyde, pH and titratable acidity (Guven, Yasar, Karaca, & Hayalo-
glu, 2005). Tyrosine and volatile fatty acidity levels were
negatively affected by inulin addition. Fat replacers are also
used to reduce the fat content of yoghurt such as Simplesseâ
and Dairy-Loä. Simplesseâ is a microparticulated spray-dried
powder that mimics emulsified fat by forming a dispersed
phase of particles that are free to move independently. Dairy-
Loä is classified as a protein based fat replacer and derived from
whey protein concentrate. It is a modified whey protein con-
centrate that forms a gelled network when heated above the
protein denaturation temperature (Yazici & Akgun, 2004). The
sample that supplemented with it had higher titratable acidity,
fat, and ash than Simplesseâ supplemented samples. The pre-
biotic containing yoghurt had a significantly lower pH than the
other yoghurts (Aryana, Plauche, Rao, McGrew, & Shah, 2007).
7.2. Effects of prebiotics on rheological measurements of
yoghurt
The addition of inulin at more than 1% increased whey sepa-
ration from yoghurt and consistency (Guven et al., 2005). The
amount of fat replacer and storage time had a significant ef-
fect on the physical, chemical, textural, and sensory proper-
ties of strained yoghurts (Yazici & Akgun, 2004). Yoghurts
containing inulin had less syneresis than the control and
had a better body and texture than other yoghurts (Aryana
et al., 2007).
The analysis showed that stickiness, airiness, and thick-
ness contributed to the creamy mouthfeel of the yoghurts.
Thickness was significantly affected by inulin (Kip, Meyer, &
Jellema, 2006). Rheological characterisation was performed
 JOURNAL OF FUNCTIONAL FOODS
by dynamic, shear, and compression–extrusion assays and
did not show any differences (Dello Staffolo, Bertola, Martino,
& Bevilacqua, 2004). Fibre incorporation increased the consis-
tency of the yoghurts, especially if the fibre was ethanol ex-
tracted and lyophilised. However, there were no significant
changes in the viscoelastic behaviour for any of the fibre types
(Sanz, Salvador, Jiménez, & Fiszman, 2008).
7.3. Effects of prebiotics on the sensory evaluation of
yoghurt
With respect to the sensory quality of yoghurt, inulin addition
caused a decrease in sensory scores: the control yoghurt had
the highest score, and the lowest score was obtained in yo-
ghurt samples containing 3% inulin. Overall, the yoghurt con-
taining 1% inulin was similar in quality characteristics to the
control yoghurt made from whole milk (Guven et al., 2005).
The inulin containing yoghurt had comparable flavour scores
to that of the control (Aryana et al., 2007).
Inulin can be used successfully to improve the creamy
mouthfeel of low-fat yoghurts (Kip et al., 2006). Only apple fi-
bre yoghurt showed colour differences compared to the con-
trol. Even though fibres modified certain rheological
characteristics of the plain yoghurt, panellists found the sup-
plemented yoghurts acceptable (Dello Staffolo et al., 2004). Fi-
bre diminished the clarity and imparted a yellow-greenish
colour to the yoghurt, which also varied depending on the
method of extraction and drying, the yoghurts with water-ex-
tracted fibres being more colourful. The sample most liked
according to a consumer test was the yoghurt containing
water-extracted and oven-dried fibre for aroma, taste, texture,
and overall acceptance, and ethanol-extracted and lyophi-
lised for colour. Fibre obtained by all methods was equally
compatible with yoghurt enrichment (Sanz et al., 2008).
8. Effect of prebiotics on the growth of
probiotics
8.1. Breast milk and the bifidus factor
The faeces of breastfed babies contain 99% bifidobacteria in
their microbiota, while in formula-fed babies; there is a much
more variable gut microflora. Breast milk has oligosaccha-
rides and additional materials that encourage the viability
and activity of bifidobacteria, and this has been termed ‘‘bifi-
dus factor’’ or ‘‘nature’s prebiotic’’. Breastfed babies show sev-
eral gut and respiratory benefits compared to bottle-fed
babies; in developing countries, hygiene problems with bottle
feeding are the main cause for this dissimilarity. However,
this dissimilarity is still found in developing countries where
the anti-infective properties of breast milk are thought to be
the major cause (Filteau & Tomkins, 1994). The ‘‘bifidus fac-
tor’’ in breast milk is one of many ways in which breast milk
may directly or indirectly render anti-infective properties.
8.2. Effect of prebiotics on probiotic viable counts
Successful bifidogenic doses differ according to different oli-
gosaccharide types. The majority of oligosaccharides have
5 ( 2 01 3 ) 15 4 2–15 5 3 1547
been confirmed to enhance bifidobacteria numbers in the co-
lon (Crittenden & Playne, 1996). Several authors have recom-
mended that the ingestion of 10 g/day of
galactooligosaccharides is adequate to cause a bifidogenic ef-
fect. Daily ingestion of 2.5 g prebiotics/day is sufficient to in-
crease faecal bifidobacteria levels (Gibson, 1999; Sako,
Matsumoto, & Tanaka, 1999). The amounts of other non-
digestible oligosaccharides (NDOs) essential to for bifidogenic
effects are similar to that of galactooligosaccharides. For
xylooligosaccharides, 2 g/day is considered enough to incur
bifidogenic effect (Sako et al., 1999). Rivero-Urgell and San-
tamaria-Orleans (2001) reported that the fructo-oligosaccha-
ride (FOS) intake necessary to perform as a bifidogenic
stimulus is between 2 and 10 g/day in adults. Nevertheless,
at least 4 g FOS/day would be required to raise the bifidobac-
teria levels in the human gut (Manning & Gibson, 2004). The
daily amount needed for isomaltooligosaccharides is in the
range of 8–10 g (Goulas, Fisher, Grimble, Grandison, & Rastall,
2004). The addition of inulin to food products as a prebiotic
could improve the viability and activity of probiotic bacteria
(Nazzaro, Fratianni, Coppola, Sada, & Orlando, 2009), such
as L. casei LC-01 (Paseephol & Sherkat, 2009). Populations of
Bifidobacterium genus, the Lactobacillus–Enterococcus group and
the Atopobium group are all significantly increased after kon-
jac glucomannan hydrolysate and inulin fermentation (Con-
nolly, Lovegrove, & Tuohy, 2010). Kiwifruit pectin and inulin
also enhance the adhesion of L. rhamnosus and decrease the
adhesion of Salmonella typhimurium to Caco-2 cells. Inulin
and citrus pectin significantly enhance the adhesion of Bifido-
bacterium bifidum to Caco-2 cells (Parkar et al., 2010).
Prebiotics are substrates that can only be consumed by a
small number of bacteria, motivating probiotic growth be-
cause of the prebiotic chemical structure. Among the group
of bacteria present in the gastrointestinal tract, the bifidobac-
teria and lactobacilli are those that most use oligosaccharides
and are considered to be the only microorganisms able to
beneficially influence the host’s health (Bielecka, Biedrzycka,
Majkowska, Juskiewicz, & Wroblewska, 2002). The rate of fer-
mentation of oligosaccharides is based on the degree of poly-
merisation, sugar and glycosidic linkage, degree of branching,
synergy between bacteria during fermentation, the relation-
ship between the substrate for bacteria and fermentation
products, the nature of the fermentation, and saccharolytic
capacity (Bielecka et al., 2002; Manning & Gibson, 2004; Rive-
ro-Urgell & Santamaria-Orleans, 2001; Sangeetha, Ramesh,
& Prapulla, 2005).
9. Health benefits of prebiotics
9.1. Acute gastroenteritis
Acute gastroenteritis is a disease that probably affects every-
one at one time or another. Usually, it involves the ingestion
of food or water contaminated with pathogenic microorgan-
isms and/or their toxins. Typical causative agents include Shi-
gellae, Salmonellae, Yersinia enterocolitica, Campylobacter jejuni,
Escherichia coli, Vibrio cholera, and Clostridium perfringens. Patho-
gens may either colonise and grow within the gastrointestinal
tract and then invade host tissue, or they may secrete toxins
1548 JOURNAL OF FUNCTIONAL FOODS
contaminating food prior to its ingestion. Such toxins disrupt
the function of the intestinal mucosa, causing nausea, vomit-
ing and diarrhoea (Hui, Gorham, Murrell, & Cliver, 1994). The
possibility exists, therefore, that increased levels of beneficial
bacteria in the large intestine may, along with other factors
such as immune status, offer improved protection. This is
in a similar manner to probiotics, but may well be more effi-
cacious given the comparative survivability issues.
The idea of combining prebiotic properties with anti-adhe-
sive activities is currently under investigation. This would add
major functionality to the approach of altering gut pathogen-
esis. Many intestinal pathogens utilise monosaccharides or
short oligosaccharide sequences as receptors, and knowledge
of these receptor sites has relevance for biologically enhanced
prebiotics. Binding of pathogens to these receptors is the first
step of the colonisation process (Karlsson, 1989). There are
currently several pharmaceutical preparations based upon
such oligosaccharides in clinical trials. These agents are mul-
tivalent derivatives of sugars and act as blocking factors, dis-
lodging the adherent pathogen (Jayaraman, Nepogodiev, &
Stoddart, 1997). There is much potential for developing prebi-
otics, which incorporate such a receptor monosaccharide or
oligosaccharide sequence. These molecules should have en-
ough anti-adhesive activity to inhibit binding of low levels
of pathogens. The prebiotic concept may be extrapolated fur-
ther by considering an attenuation of virulence in certain
food-borne pathogens. For example, the plant derived carbo-
hydrate cellobiose is able to repress the pathogenicity of Liste-
ria monocytogenes through the downregulation of virulence
factors (Park & Kroll, 1993). As such, this organism is avirulent
in its natural habitat of soil, where it is exposed to rotting veg-
etation and therefore cellobiose. In the human body, the ab-
sence of cellobiose may allow the virulence factors to be
expressed, and it is possible that further incorporation of this
disaccharide to foods susceptible to Listeria contamination
could reduce this virulence.
9.2. Reduction of cancer risk
Genotoxic enzyme activity has been found to decrease upon
the administration of prebiotics. An early study on feeding
GOS to humans resulted in a decrease in nitroreductase (a
metabolic activator ormutaganic/carcinogenic substances)
and also decreased levels of indole and isovaleric acid (pro-
duced as products of proteolysis and deamination and mark-
ers of putrefaction) (Ito et al., 1990). When a model system of
the human gut was used to investigate the effect of galactool-
igosaccharides on genotoxic enzymes, it was found that b-
glucosidase, b-glucuronidase, and arylsulphatase were
strongly inhibited (McBain & Macfarlane, 2001). As these ef-
fects occurred rapidly upon the addition of GOS to the system,
changes attributable to population levels can be ruled out and
it is more feasible that direct inhibition by GOS or the produc-
tion of repressors or deactivators by bacteria was responsible.
However, increasing the proportion of bifidobacteria and lac-
tobacilli at the expense of bacteroides and clostridia may also
decrease genotoxic enzyme production, as the former pro-
duces lower levels of such enzymes than the latter (Burns &
Rowland, 2000). Another study looked at the effects of resis-
tant starch administration to human flora-associated rats
5 ( 2 0 1 3 ) 1 5 4 2 –1 5 5 3
(Silvi, Rumney, Cresci, & Rowland, 1999). Although b-glucosi-
dase increased, b-glucuronidase and ammonia levels de-
creased. A further observation important to the reduction of
cancer was a high level of caecal butyrate. Not only is butyrate
the major source of energy for colonocytes and helps main-
tain a healthy epithelium (Topping & Clifton, 2001), it can also
play an important role in preventing cancer. Several cellular
processes are affected by butyrate, largely by interactions
with DNA and its surrounding proteins. These processes in-
clude the induction of apoptosis, a process which is deacti-
vated in cancer cells which would normally lead to their
elimination, and an increase in the immunogenicity of cancer
cells due to an increase in the expression of cell surface pro-
teins (Bornet, Brouns, Tashiro, & Duviller, 2002). However, it
should be pointed out that the usual target bacteria for prebi-
otic use (bifidobacteria and lactobacilli) are not butyrate pro-
ducers. Hence, there could be a rationale for fortifying other
gut flora components (e.g. eubacteria).
9.3. Mineral absorption
Uptake of calcium and magnesium is crucial for bone struc-
ture and increasing absorption can prevent conditions such
as osteoporosis. Chonan, Takahashi, and Watanuki (2001)
have shown that adding galacto-oligosaccharides (GOS) to
the diet of rats can increase calcium and magnesium absorp-
tion. The mechanism for this is unclear, but in this case, the
presence of a colonic flora is required for GOS to have this ef-
fect, though the authors acknowledge that microbial medi-
ated and non-microbial mediated mechanisms probably
exist. Fructo-oligosaccharides (FOS) can also affect mineral
absorption, and in human studies, 15 g per day of oligofruc-
tose or 40 g per day of inulin increased the apparent calcium
absorption (Roberfroid, 2002). Magnesium absorption has
been found to be increased following ingestion of FOS (Bornet
et al., 2002).
9.4. Lipid regulation
Prebiotics may also have an effect on lipid regulation.
Although the mechanism is currently unknown, studies have
shown positive results and mechanistic hypotheses have
been developed. A study on diabetic rats found that when
xylooligosaccharides (XOS) replaced simple carbohydrates in
the diet, the serum cholesterol and triglyceride increases ob-
served in diabetes were reduced and liver triacylglycerols in-
creased to a comparable level to that seen in healthy rats
(Imaizumi, Nakatsu, Sato, Sedaranawati, & Sugano, 1991).
Other studies have examined FOS, which was also found to
reduce blood lipids (Bornet et al., 2002; Roberfroid, 2002). This
was thought to be due to the inhibition of a lipogenic enzyme
in the liver, which may be a result of the action of propionate
produced from the fermentation of prebiotics by gut bacteria.
While prebiotics can be of use in correcting hyperlipidaemia
brought about by diabetes and other conditions, decreases
in lipids have not been observed in healthy subjects (Bornet
et al., 2002), which is a useful safety feature as misuse or over-
dose does not seem to have negative effects.
There are many possible mechanisms by which prebiotics
may lower cholesterol, such as:
 JOURNAL OF FUNCTIONAL FOODS
1. Increased viscosity in the upper intestinal tract. This vis-
cosity may act as a physical barrier and decrease the
(re)absorption of fats, including cholesterol and bile acids.
This would lead to increased faecal output of cholesterol
and bile acids would result in greater cholesterol catabo-
lism in the liver, which would lead to lower plasma choles-
terol concentrations (Vanhoof & De Schrijver, 1995).
2. Reduced cecal pH. This was observed in rats consuming
inulin (Vanhoof & De Schrijver, 1995). At low pH, the
amount of soluble bile acids decreases, and as a result,
lipid absorption decreases and faecal bile acid excretion
increases.
3. Altered hepatic triacylglycerol synthesis. The lipid-lower-
ing action of inulin is possibly due to changes hepatic tri-
acylglycerol synthesis, very low density lipoprotein
cholesterol (VLDL-C) secretion and decreased reabsorption
of circulating bile acids (Trautwein, Rieckhoff, & Erbersdo-
bler, 1998). Thus, higher bile acid excretion leads to
increased utilisation of liver cholesterol to re-synthesise
bile acids, and as hepatic pools of free cholesterol decrease
to reach a new steady state, endogenous cholesterol syn-
thesis will increase. This leads to increased activities of
7-a-hydroxylase and 3-hydroxy-3-methylglutaryl-coen-
zyme A reductase (HMG-CoA reductase) to compensate
for the loss of bile acids and cholesterol from liver stores.
Furthermore, hepatic low density lipoprotein cholesterol
(LDL-C) receptors become upregulated to restore hepatic
cholesterol stores, which will lead to decreased serum
(LDL-C) cholesterol concentrations (Ellegard & Andersson,
2007; Theuwissen & Mensink, 2007).
4. Fermentation of prebiotics. The hypocholesterolemic
effect of prebiotics is derived from a metabolic effect (Lev-
rat et al., 1994), as these compounds are fermented in the
lower intestinal tract (Adam et al., 2001). Oligosaccharides
are rapidly and completely fermented (Gibson, 1999); this
increases the synthesis of fermentation byproducts such
as propionate, which reaches the liver by the portal vein
and inhibits cholesterol pathways by the inhibition of
HMG-CoA reductase (Levrat et al., 1994), similar to the
mechanism of action of statins.
5. Reduced serum insulin and glucose. Oligofructose and inu-
lin cause a reduction in hepatic fatty acid and triacylglyc-
erol synthesis through a coordinated reduction in the
activity of all lipogenic enzymes. Kok, Roberfroid, Robert,
and Delzenne (1996) concluded that the triacylglycerol-
lowering effect of oligofructose observed in rats was
caused by its antilipogenic action in the liver, that is, by
reducing the activity and possibly the expression of all lip-
ogenic enzymes, because prebiotic intake significantly
reduces serum insulin and glucose (Kok et al., 1996), which
induce lipogenic enzymes (Delzenne & Kok, 1999).
6. LDL-C receptor expression could also contribute to the
increase in serum total cholesterol occurring in rats receiv-
ing resistant starch extracted from beans in their diet for
four weeks (Fukushima et al., 2001). Moreover, several
studies have reported a decrease in total serum cholesterol
after dietary supplementation with prebiotics in vivo (Fava,
Lovegrove, Gitau, Jackson, & Tuohy, 2006; Mortensen, Poul-
sen, & Frandsen, 2002).
5 ( 2 01 3 ) 15 4 2–15 5 3 1549
10. Toxicity and safety of prebiotics
Inulin and oligofructose are natural food ingredients present
in edible plants and are part of the traditional diet. Based on
data from the United States Department of Agriculture, it
was estimated that the average daily intake of chicory fruc-
tooligosaccharides ranges between 1 and 4 g/d, with the
90th percentile consuming 2–8 g/d (Moshfegh, Friday, Gold-
man, & Ahuja, 1999). The daily reference value for fibre (solu-
ble or insoluble) is 25 g/d. The average daily intake of inulin or
oligofructose, naturally present in food, has been determined
be 1–4 g/d in the United States (Moshfegh et al., 1999) and 3–
11 g/d in Europe (Van Loo, Coussement, de Leenheer, Hoeb-
regs, & Smits, 1995).
Safety, as traditionally defined, is not an issue in the case
of inulin and oligofructose (Carabin & Flamm, 1999). This no-
tion is supported by a critical review of toxicological studies
showing that chicory fructooligosaccharides do not increase
morbidity or mortality or cause reproductive or target-organ
toxicity. These compounds are not mutagenic, carcinogenic,
or teratogenic (Carabin & Flamm, 1999). Numerous animal
and human investigation studies have been carried out to
identify the physiological and potential health benefits of
these fructans and to assess their possible intolerance. The
only biological effects observed have been attributed to their
action as non-digestible, fermentable carbohydrates causing
self-limited gastrointestinal distress. As demonstrated by var-
ious studies, the ensuing gastrointestinal symptoms are dose-
dependent (Briet et al., 1995). The results indicate that these
fructans are well-tolerated at amounts up to 20 g/d; diarrhoea
can develop with intake of 30 g/d or more (Den Hond, Gey-
pens, & Ghoos, 2000).
11. Epidemiological studies on prebiotics
Although convincing lipid-lowering effects of the fructooligo-
saccharide inulin have been demonstrated in animals (Wil-
liams & Jackson, 2002), attempts to reproduce similar effects
in humans have produced conflicting findings. This may be
because of the much lower doses which can be used due to
the adverse gastrointestinal symptoms exhibited by most
subjects consuming inulin in excess of 15 g/d. There are nine
studies reported in the literature which have investigated the
response of blood lipids (usually total and LDL-cholesterol
and triacylglycerol) to inulin or oligofructose supplementa-
tion in human volunteers (Williams & Jackson, 2002). Luo
et al. (1996), studied effects of oligofructose (20 g/d) fed as
100 g cookies every day in a randomised cross-over design
for four weeks. No changes in serum triacylglycerol, choles-
terol, or apolipoproteins were observed in either the treat-
ment or placebo groups. Pedersen, Sandstrom, and Van
Amelsvobrt (1997) reported no effect on blood lipids with a
daily intake of 14 g inulin added to a low fat spread for a per-
iod of four weeks in young healthy women. Alles et al. (1999)
conducted a study using 15 g/d oligofructose (fed as a powder
in low fat yoghurt), in twenty male and female non-insulin
dependent diabetic (NIDDM) subjects; no effects on blood lip-
1550 JOURNAL OF FUNCTIONAL FOODS
ids or glucose were observed over a three-week treatment
period.
Davidson, Synecki, Maki, and Drennan (1998), in a ran-
domised cross-over trial in subjects with modest hyperlipida-
emia, showed significantly lower total and LDL-C
concentrations during inulin treatment compared with the
placebo phase, but no effects on HDL-C cholesterol or serum
triacylglycerol concentrations. Brighenti, Casiraghi, Canzi,
and Ferrari (1999) also observed significantly lower triacyl-
glycerol and cholesterol concentrations in young males who
consumed 9 g of inulin added to a rice breakfast cereal for a
period of four weeks; levels remained significantly lower four
weeks after the end of the inulin phase. Total and low density
lipoprotein cholesterol levels were reduced by 5% and 7%,
respectively, with inulin treatment compared with placebo.
Causey, Feirtag, Gallaher, Tungland, and Slavin (2000) ob-
served a significant reduction in serum triacylglycerol in sub-
jects with moderate hyperlipidaemia given 18 g/d inulin for
three weeks. In a prospective, double-blind, randomised, pla-
cebo-controlled trial of 259 infants at risk for atopy, bottle
feeding with 0.8 g 100/mL prebiotics or maltodextrin (placebo)
led to a 9.8% incidence of atopy versus 23.1% in the control
group (Moro et al., 2006). Prebiotic use was associated with a
significantly higher number of faecal bifidobacteria compared
with controls, but there was no significant difference in lacto-
bacilli counts, and no examination of Clostridium or other
species.
There is evidence that prebiotics can influence newborn
health. Using duplex 50 nuclease assays, targeted on rRNA
intergenic spacer regions to enumerate L. acidophilus, L. casei,
Lactobacillus delbrueckii, Lactobacillus fermentum, Lactobacillus
paracasei, Lactobacillus plantarum, Lactobacillus reuteri, and L.
rhamnosus. The faecal presence of these lactobacilli was de-
tected after feeding for six weeks with a standard formula,
breast milk, or a standard formula supplemented with galac-
to- and fructooligosaccharides in a ratio 9–1 (Haarman &
Knol, 2006). The Lactobacillus species distribution in the prebi-
otic supplemented formula was comparable to breast-fed in-
fants, with relatively higher levels of L. acidophilus, L. paracasei,
and L. casei. However, as with many other studies, the long-
term impact of the treatment was not reported. Microbes
associated with the vagina, faeces, skin, and mouth clearly
contribute to the early infant microbiota (Stappenbeck, Hoo-
per, & Gordon, 2002).
Breast milk not only provides a range of substrates for bac-
terial growth (Ward, Ninonuevo, Mills, Lebrilla, & German,
2006), but it also appears to be a reservoir for some of the bac-
teria we inherit, including lactobacilli (Martin et al., 2005).
Although this needs to be verified, an explanation given,
and the mechanism uncovered as to how lactobacilli reach
the mammary gland and if other bacteria do likewise, the
end result is that infants are colonised predominantly by lac-
tic acid bacteria. These organisms appear to be responsible
for a less diverse microbiota and mainly acetic acid and lactic
acid production, compared to formula-fed infants who have
higher levels of acetic acid and propionic acid in the faeces
(Edwards & Parrett, 2002).
Supplementation of milk with probiotics confers immuno-
modulatory effects, leading to a Th1 response and reduced
allergic tendencies (Viljanen et al., 2005). Likewise, adding
5 ( 2 0 1 3 ) 1 5 4 2 –1 5 5 3
specific prebiotics (usually fructooligosaccharides and galac-
tooligosaccharides) to formula milk implies that their effect
on the microbiota is beneficial. A first step would be to try
and determine if an optimal microbiota exists, when and
how it forms, and at what stages in life it changes signifi-
cantly. These tedious, labour-intensive studies are necessary
and now possible with molecular probing. An interesting clin-
ical trial showed that prebiotic galactooligosaccharides and
fructooligosaccharides (6 g per day) caused a similar effect
on the metabolic activity of the gut (faecal acetate ratio, lac-
tate concentration, and lower pH) as that found in breast-
fed infants (Bakker-Zierikzee et al., 2005).
12. Conclusions
Prebiotics have a significant effect on human health and have
greater possibilities for incorporation into a wide range of
common foodstuffs. Their role is played by fermentable car-
bohydrates, which stimulate, preferentially, the growth of
probiotic bacteria (bifidobacteria and lactic acid bacteria),
thus enhancing the gastrointestinal and immune systems.
In addition, prebiotics have been shown to increase the
absorption of calcium and magnesium, influence blood glu-
cose levels and improve plasma lipids. Long terms clinical tri-
als are required to confirm the health benefits of prebiotics in
human.
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