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PUMS 99: 1 UNlVERSITI MALAYSIA SABAH
------------------------~~~~~~~~~~~~~~~---------------------BORANG PENGESAHAN STATUS TESIS
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Saya. ___ H_D_W ____ N_H_BE~-~~SI~M~ __ ~~~~~------------------------(HURUF BESAR)
ittlengakti membenarkan tesis (LPS/ Srujana/ Doktor Falsafah) ini di simp an di Perpustakaan Universiti Malaysia Sabah Qengan syarat-syarat kegunaan seperti berikut:
1. Tesis adalah hakmilik Universiti Malaysia Sabah. 2. Perpustakaan Universiti Malaysia Sabah dibenarkan membuat salinan UDtuk tujuan pengajian sahaja. 3. Perpustakaan dibenarkan membuat salin an tesis ini sebagai bahan pertukaran antara institusi pengajian tinggi. 4. ** Sila tandakan (I)
(Mengandungi maklumat yang berdarjah keselamatan atau kepentingan Malaysia seperti yang termaktub di
SULIT dalam AKTA RAHSIA RASMI 1972)
(Mengandungi maklumat TERHAD yang telah ditentukakan TERHAD oleh organisasilbadan di man~ penyelidikan dijalankan)
TIDAK TERHAD .lA~~~
GAN PENULIS)
lamat Tetap: "~I /..o""oY\.~ tJAl.. r to,:,!) I
, 31 'leo
A. TAT AN: * Potong yang tidak berkenaan.
LIBRARIAN LIBRARY
I.lNTVERSITI MALAY~~
Nama Penyelia
Tarikh: __ 1-,-6/-#-t 1_10 ____ _
* Jika tesis ini SULIT atau TERHAD, sila lampiran surat daripada pihak berkuasalorgansasi berkenaan dengan menyatakan sekalj sebab dan tempoh tesis ini periu dikelaskan sebagai SULIT dan TERHAD.
* Tesis dimaksudkan sebagai tesis bagi Ijazah Doktor Falsafah dan Srujana secara penyelidikan, at disertasi bagi pengajian secara keIja kursus dan penyelidikan, atau Laporan Projek SaIjana Muda (LPSM)
CONSUMERS' PERCEPTION AND ATTITUDE
TOWARDS PROBIOTIC FOOD
HOWWHEESIM
THESIS SUBMITTED IN PARTIAL
FULFILMENT FOR THE DEGREE OF
BACHELOR OF FOOD SCIENCE WITH
HONOURS
SCHOOL OF FOOD SCIENCE AND NUTRITION
UNIVERSITI MALAYSIA SABAH
2010
DECLARATION
I hereby declare that the material in this thesis is my own except for quotations,
excerpts, equations, summaries and references, which have been duly
acknowledged.
14 JUNE 2010 ~ How Whee Sim
HN2006-3446
ii
NAME
MATRIC NO.
TITLE
DEGREE
VIVA DATE
CERTIFICATION
: HOW WHEE SIM
: HN2006-3446
: CONSUMERS' PERCEPTION AND ArrrrUDE
TOWARDS PROBIOTIC FOOD
: BACHELOR OF FOOD SCIENCE WITH HONOURS
(FOOD SCIENCE AND NUTRmON)
: 12th MAY 2010
DECLAREO BY
1. SUPERVISOR
ASSOC. PROF. DR. CHYE FOOK YEE
2. EXAMINER 1
SHALAWATI @ SALWA IBRAHIM
3. EXAMINER 2
FAN HUI YIN
4. DEAN
ASSOC. PROF. DR. MOHD. ISMAIL ABDULLAH
iii
,-l}d-.
ACKNOWLEDGEMENT
Firstly, I deeply appreciate the help and guidance my supervisor Assoc. Prof. Dr
Chye Fook Vee has given me. I am thankful to the support given by my parents. A
sincere thank you to all respondents who had taken their time to answer my
questionnaires. I am also thankful to my friends Talissa, Seow Chia Chia, Lim Hui
San, Melissa Tan, Jacqueline Joana, and Choong Jian Ming. Lastly, I offer my
blessings to all those who supported me in any aspect which lead to the conclusion
of this thesis.
iv
ABSTRACT
Consumers' perception and attitude towards probiotic food were studied with a
quantitative questionnaire. The objective of this study was to determine the
consumers' perception and attitude towards probiotic food. Most consumer was
found aware of probiotic food. These consumers perceived probiotic food as food
that can provide health benefit. Television and internet were the most popular
information source for probiotic information found in this study. This study also
found that most of the users of probiotic food were female, older, highly educated
and with high income. Consumers' willingness to try new probiotic product was
skewed to the right. This pattern suggest that the consumers' willingness to try
new probiotic food tends to the positive side. Five attitudes dimensions towards
probiotic food were found in this study, namely "rewarding aspect from using
probiotic food", "necessity of probiotic food", "confidence in probiotic food", "safety
of probiotic food" and "probiotic food as medicine". Statistically significant
association with the scoring of these attitudinal items were found between gender,
age group, ethnic group and education level.
v
A BSTRAK
SIKAP DAN PERSEPSI PENGGUNA TERHADAP MAKANAN PROBIOTIK
Sikap dan persepsi pengguna dikaji dengan menggunakan soal selidik kuantitatif.
Obektif kajian ini adalah untuk menentukan persepsi dan mengkaji sikap terhadap
makanan probiotik. Kebanyakan pengguna didapati mengetahui tentang malanan
probiotic. Pengguna -pengguna tersebut mempunyai tanggaan bahawa makanan
probiotik merupakan makanan yang sihat. Television dan internet merupakan
sumber informasi yang paling popular dalam kajian ini. Kajian ini juga mendapati
bahawa kebanykan pengguna makanan probiotic merupakan perempuan lebih
tua, tahap pendidikan tinggi san menpunyai pendapatan yang tinggi. Kesanggupan
pengguna untuk memcuba makanan probiotik yang baru cenderung kepada sangat
sanggup. Lima dimensi sikap pengguna terhadap makanan probiotic te/ah
diperhatikan dalam kajian ini. Sikap -sikap tersebut adalah "Kebaikan
menggunakan makanan probiotik '~ "Keper/uan makanan probiotik'; "Keselamatan
makanan probiotlk"," Makanan probiotik sebagai ubat" dan" Kebolehpercayaan
makanan probiotik'~ Perkaitan signifikan telah didapati antara skor dimensi sikap
dengan jantina, umur, kumpulan etnik dan tahap pendidikan.
vi
TABLE OF CONTENTS
TITLE
DECLARATION
VERIFICATION
ACKNOWLEDGEMENT
ABSTRACT
ABSTRAK
TABLE OF CONTENTS
LIST OF FIGURES
LIST OF TABLES
LIST OF APPENDICES
CHAPTER 1 INTRODUCTION
CHAPTER 2 LITERATURE REVIEW
2.1 Overview Of Functional Food
2.2 Overview Of Probiotics
2.3 Commercially Available Human Probiotic Microorganisms
2.3.1 Lactobacillus Acidophilus, LA-S®
2.3.2 Lactobacillus Acidophilus NCDO 1748
2.3.3 Lactobacillus Acidophilus NCFM®
2.3.4 Lactobacillus Casei Shirota
vii
Page
ii
iii
iv
v
vi
vii
x
xi
xii
1
4
4
5
6
6
7
7
9
2.3.5 Lactobacillus Gasseri OLL2716 (LG21) 10
2.3.6 Lactobacillus Paracasei Ssp. Paracasei, F19® 11
2.3.7 Lactobacillus Paracasei Ssp. Paracasei, L. casei 431 ® 11
2.3.8 Lactobacillus Rhamnosus GG, LGG® 12
2.3.9 Lactobacillus Rhamnosus,GR-1 ® & Lactobacillus Reuteri RC-14 13
®
2.3.10 Lactobacillus Rhamnosus HN001 And Bifidobacterium Lactis 14
HN019
2.3.11 Lgg_Extra, A Multispecies Probiotic Combination 15
2.3.12 Bifidobaeterium Animalis Ssp. Lactis, BB-12 16
2.3.13 Bifidobacterium Longum BB536 16
2.3.14 Bifidobacterium Longum Strains BL 46 And BL2C-Probiotics 17
For Adults And Ageing Consumers
2.4 Probiotic Foods 17
2.4.1 Fermented Milk Products 18
2.4.2 Infant Formula Fortified With Probiotic 19
2.5 Consumers' perception towards probiotic food 21
2.5.1Consumer awareness of probiotic foods 21
2.5.2 Consumer familiarity of probiotic foods 22
2.6 Consumer Attitudes Towards Probiotic Products 23
2.6.1 Preceived Benefits From Using Probiotic Products 24
2.6.2 Confidence In Probiotic Products Affecting Consumer 24
Behavior
2.6.3 Necessiy For Probiotic Food Affecting Consumer Behavior 25
viii
2.6.4 Safety Affecting Consumer Behavior Towards Probiotic 25
Products
CHAPTER 3 METHODOLOGY 26
3.1 Location 27
3.2 Sampling 27
3.3 Research Method 27
3.3.1 Questionnaire 27
3.4 Collecting Data 27
3.5 Data Analysis 27
3.6 Pilot test 28
CHAPTER 4 RESULTS AND DISCUSSION 29
4.1 Respondent Demographic 29
4.2 Consumer's Food Purchasing Concerns And Perception Towards 33
Functional Food
4.3 Consumers' Perception Towards Probiotic Food 39
4.4 Consumers' Attitude Towards Probiotic Food 46
CHAPTER 5 CONCLUSION 51
5.1 Limitations And Suggestions 52
REFERENCES 53
APPENDIX 73
ix
LIST OF FIGURES
Page
Figure 4.1 Consumers' Food Purchasing Concern 33
Figure 4.2 Relationship Between Age Group And Food Purchasing 35 Concern
Figure 4.3 Consumers' Perception Towards Functional Food 37
Figure 4.4 Consumers' Awareness And Source Of Information On 39 Probiotic Food.
Figure 4.5 Consumers' Familiarity Towards Probiotic Food 41
Figure 4.6 Probiotic Product In The Market That Commonly Purchase 43 Or Consumed
Figure 4.7 Reasons For Consuming Probiotic Food 44
Figure 4.8 Consumers' Willingness To Try New Probiotic Food. Mean Is 45 5.46 And Stardard Deviation Is 1.406
Figure 4.9 Elements That Consumer Perceived Lacking From Probiotic 45 Food Currently Sold In The Market
x
Taple 2.1
Table 2.2
Table 2.3
Table 4.1
Table 4.2
Table 4.3
Table 4.4
Table 4.5
Table 4.6
LIST OF TABLES
Identification And Safety Of L. Acidophilus NCDO 1748
Health Effects Of Lactobacilus GG As Seen In Human Intervervention Studies
Health Effects Of LGG_Extra In Human Intervention Studies
Respondents Demographic Statics
Association Between Consumers' Food Purchasing Concern With Demographic Component
Association Between Consumers' Awareness Toward Functional Food With Gender, Age, Highest Education Level And Monthly Income
Association Between Gender, Age, Highest Education Level And Monthly Income With The Respondents' Awareness Towards Probiotic Food
Association Between Consumers' Familiarity Towards Probiotic Food With Demographic Component
Attitudinal Dimension Of Consumer Towards Probiotic Food
xi
Page
8
12
15
31
34
38
40
42
59
LIST OF APPENDICES
Page APPENDIX A Questionnaire 74
APPENDIX B Chi-square tables 80
APPENDIX C SPSS output for Factor Analysis and Kruskal Wallis tables 86
xi i
CHAPTER 1
INTRODUCTION
1.1. Introduction
Food has been considered essential and indispensable to human life since ancient
times. Food provides necessary nutrient for not only physical, but also intellectual
activities. However, in the last decade consumer demands in the field of food
production has changed considerably. Consumers are becoming more and more
believe that foods contribute directly to their health (Mollet and Rowland, 2002;
Young, 2000). The general public began more aware that there was a link between
a series of medical condition such as (cardiovascular diseases, obesity and
hypertension) and the intake of excessive amount of certain food ingredient, and
the stress inherent to modern life results in health consequences due to bad eating
habit and poor diet (Bello, 1995). Consumers today therefore no longer only
consider food in terms of taste and immediate nutritional needs but also in terms of
their ability to provide specific health benefits beyond their basic nutritional value
(Saarela et al., 2002). Thus, functional food becomes the new trendy product.
Typically a food marketed as functional contains added technologically
developed ingredients with a specific health benefit (Niva, 2007). To date, a
number of national authorities, academic bodies and the industry have proposed
definitions for functional foods. These definition ranges from the very simple to the
more complex. Good examples for the two approaches are "Foods that may provide
health benefits beyond basic nutrition" and "Food similar in appearance to
conventional food that is intended to be consumed as part of a normal diet, but has
been modified to sub-serve physiological roles beyond the provision of simple
nutrient requirements" (Bech-Larsen and Grunert, 2003). The growing interest in
recognition of the link between diet and health has results in flourishing growth of
the market for functional foods, or foods that promote health beyond providing
basic nutrition. (Khan and Ansari, 2007"
Global functional food market is experiencing steady growth and the future of
functional foods looks quite optimistic (Gary et al., 2003). The world market for
functional foods and beverages is highly dynamic. According to an Euromonitor
survey, Japan is the world's largest market at US$11.7 billiolJ, then US is the
second one market with around US$10.5 billion while the European market is less
developed with an estimated market of US$7.5, the "big four" European markets
being UK (US$2.6 billion), Germany (US$2.4 billion), France (US$1.4 billion), and
Italy (US$1.2 billion) (Bech Larsen and Scholderer, 2007). In order to cater to the
increasing demand in the developed countries, developing countries such as Brazil,
Peru, Kenya have started to emerge as active ingredients exporters (Williams et aI.,
2006). Besides emerging as active ingredient, demand for functional foods within
the developing countries is also growing, presenting a lucrative opportunity to
develop domestic markets.
Developing country such as immediate neighbor of Malaysia, China has
approximately a total of US$6 billion per year functional foods market and the
figure is expected to double by 2010. Even though detailed information on the size
of functional food market is relatively little due to the difference in how the
category is defined, one thing that all studies seem to agree on is that functional
markets grow steadily each year, with annual growth rate estimates varying
between 8% and 14%. This trend is likely to continue as changing population
demographics (e.g . an ageing population) and the effects of lifestyle diseases
create greater demand for food products targeting health and well ness (FAO, 2007) .
Probiotic food is generally being defined as a subset of functional food
believes to be good for health that are produced by or that contain live
microorganisms (Wildman, 2007). Based on World Health Organization (2001) the
term "probiotics" are defined as "live micro-organisms that when administered in
adequate amounts confer a health benefit on the host". In recent years, there has
been an upsurge in research into probiotics, as well as a growing commercial
interest in the probiotic food concept (Senok et aI., 2005). Euromonitor analyst
valued the global market for functional yogurts and drinking yogurts at $11.3bn in
2
2004 and by 2009, this figure grew to $20.4bn. After breaking down the different
product applications within this category, the figures reveal a 128 percent growth in
pre-and probiotic spoonable yogurt during the period, from $3.3bn in 2004 to
$7.6bn in 2009 (18 percent CAGR). The global probiotics market is estimated to
reach US$ 31.2 billion in 2014 growing at a CAGR of 11.7% from 2009 to 2014
(MarketsandMarkets.com, 2009).
From the literature above, the global market for functional food and probiotic
food is growing steadily and positive growth was expected in the near future.
Although different kind of functional food can be seen in the market in Malaysia
however the concept of probiotic foods is still new and only limited amount of
probiotic food can be found in the market. Functional food markets change
continuously and the competition to win consumers' favor is becoming more
intense (Menrad, 2003). Since the consumer acceptance of a functional foods
concept and a better understanding of its determinants, are widely recognized as
key success factor for market orientation, consumer-led product development and
successfully negotiating market opportunities (Gilbert, 1997; Grunert et al, 2000)
the need for further research into the insights on consumer dynamics within the
food industry becomes a top priority to understand and investigate the potential
market for probiotic food.
1.2 Objectives
The aim of this research is:
1. To determine the perception of consumers towards probiotic food and the
factors that influenced the consumers' perception.
2. To investigate the attitude of consumers towards probiotic food and the factors
that influenced the consumers' attitude.
3. To determine the relationship between the demographic characteristics and the
perception and attitude of consumer towards probiotic food.
3
CHAPTER 2
LITERATURE REVIEW
2.1 Overview Of Functional Food
The term "Functional Foods' was first introduced in Japan in the mid-1980s and
refers to processed foods containing ingredients that aid specific body functions, in
addition to being nutritious (FAO, 2007). Since then functional foods have been
given a range of definitions. These definitions includes "Foods that may provide
health benefits beyond basic nutrition" "Foods that encompass potentially helpful
products, including any modified food or food ingredient that may provide a health
benefit beyond that of the traditional nutrient it contains" "Food similar in
appearance to conventional food that is intended to be consumed as part of a
normal diet, but has been modified to sub-serve physiologic roles beyond the
provision of simple nutrient requirements" (Frewer et aI., 2003). Until today, there
is still no universally accepted definition for functional foods (FAO, 2007).
Besides definition, there is still no universally accepted term for functional
foods. A variety of terms have appeared world-wide such as nutraceuticals,
medifoods, vitafoods and the more traditional dietary supplements and fortified
foods. Even so the term functional foods were used to describe a range of novel
foods under development, which are designed to deliver some benefit beyond
nutrition to the person consuming them (Frewer et aI., 2003). Some of the example
of these foods includes functional foods that may improve the general conditions of
the body (e.g. pre- and probiotics); functional food that may decrease the risk of
some diseases (e.g. cholesterol-lowering products) and functional food that could
even be used for curing some illnesses (Mark- Herbert, 2004; Menrad, 2003).
According to FAO (2007) functional foods are generally considered as those
foods which are intended to be consumed as part of the normal diet and that
contain biologically active components which offer the potential of enhanced health
or reduced risk of disease. Examples of functional foods include foods that contain
specific minerals, vitamins, fatty acids or dietary fibre, foods with added biologically
active substances such as phytochemicals or other antioxidants and probiotics that
have live beneficial. According to this definition, un-modified whole foods such as
fruits and vegetables represent the simplest form of functional foods. Regarding
this issue, the American Dietetic Association emphasis that the term functional
foods should not be used to imply that there are good foods and bad foods
because incorporating all foods into a healthful eating plan is the key of being
moderation and variety (ADA Reports, 2004).
2.2 Overview Of Probiotics
There are a few different definitions for the term "probiotic". The term probiotic,
meaning 'for life', was first coined in the 1960s by Lilly and Stillwell. Probiotics can
be defined as live microorganisms that, when administered in adequate amounts,
confer a beneficial effect on the health of the host. According to Fuller (1989) the
probiotic is defined as biopreparations containing living cells or metabolites that
stabilize the autochthonous microbiota that colonize and make up the microflora of
the animal and human gastrointestinal tract and exert a stimulating effect on both
digestive processes and the immune system of the host.
More recent research claims that the term "probiotic" refers to culture of live
microorganisms that , when administered to humans or animals through
dehydrated cells or fermented foods, benefit the host by improving properties of
indigenous microflora. However, the most widely accepted definition of probiotics is
from the World Health Organization which defines probiotics as "live
microorganisms that when administered in adequate amounts confer a health
benefit on the host.", with ongoing controversy as to whether cultures must be
viable for efficacy in all cases (Charalampopoulos et al., 2003; Charalampopoulos et
al., 2002; Stanton et aI., 2005). It is clear that these definitions have (1) restricted
the use of the word probiotic to products which contain live microorganisms. (2)
pointed out the need for providing an adequate dose of probiotic bacteria in order
to exert the desirable effects.
5
2.3 Commercially Available Human Probiotic Microorganisms
2.3.1 Lactobacillus acidophilus, LA-S®
Lactobacillus acidophilus LA-S has many probiotic features. Lactobacillus acidophilus
has been used in dietary supplements and fermented milk products worldwide. LA
S is clinically well documented. It is able to survive passage through the stomach
and upper small intestine due to its tolerance of stomach and bile acid and
resistance to digestive enzymes (Noh and Gilliland, 1993). Good recovery rate in
the feces following oral administration shows that LA-S is able to adhere to the
intestinal mucosa (Juntunen et aI., 2001) and survive in the intestine (Saarela et aI.,
2007).
Lactobacillus acidophilus helps maintain intestinal microbial balance. Glucose
fermentation by Lactobacillus acidophilus produce metabolites lactic acid, acetic
acid, and H202 which can control intestinal pH and thus make the environment less
favorable for the growth of potentially pathogeniC microorganisms (Gorbach, 1990).
Besides that LA-S also produces bacteriocin CHS that is characterized not only by a
particularly wide antibacterial range, but also by inhibitory action against certain
yeasts and moulds (Plockova et aI., 1997). Lactobacillus acidophilus also help in
treating diarrhea. Studies have shown that volunteers treated with ampicillin or
clindamycin and those supplemented with LA-S and Bifidobacterium animalis ssp.
lactis (BB-12®) experienced a faster normalization of the intestinal flora than those
receiving placebo (Black etal., 1991; Nord etal., 1997).
LA-S also has shown effect on other gastrointestinal effect such as
constipation and lactose digestion. Elderly patients suffering from chronic
constipation were randomized to receive either unfermented milk or fermented milk
with LA-S and BB-12. The probiotic group experienced a significant improvement in
frequency of bowel movement, and reported no negative side effects (Hove et al.,
1994). For lactose intolerant cases supplementing LA-S in milk significantly
decreased breath hydrogen values of lactose intolerant subjects when comparing
with milk alone, indicating improved lactose degradation (Lin et al., 1991).
6
Administration of LA-5 also has been associated with nonspecific stimulatory
effects on the production of cytokines and phagocytic activity as well as more
specific immune reactions such as antibody production. an in vitro study with a
murine macrophage-like cell line that was cultured in the presence of cell-free
extracts of LA-5, LA-5 enhanced phagocytosis of inert particles or viable Salmonella
(Hatcher and Lambrecht, 1993). In another study Higher concentrations of cholera
toxin-specific antibodies were found in the feces and serum of LA-5, and BB-12 fed
mice compared with the yogurt and milk group (Tejada-Simon et al., 1999). Other
health effects of LA-5 in humans seem to include inhibited growth of cancer breast
cells (Biffi et al., 1997).
2.3.2 Lactobacillus acidophilus NCDO 1748
Lactobacillus acidophilus NCDO 1748' was selected as the strain to be used in food
products during 1970 due to its growth in milk and its survival through the GI
(Petterson et aI., 1983; Matto et a/., 2006). Table 1 shows the identification and
safety of Lactobacillus acidophilus NCDO 1748. For over 25 years Lactobacillus
acidophil us NCDO 1748 was used for on its own or in combinations with other
probiotics in fermented milk products that produced by a patented process from
Aria Foods and in natural remedies from Semper (Fonden and Holgersson, 1985;
Fonden and Holgersson 1989).
7
Table 2.1: Identification and Safety of L. acidophil us NCDO 1748
Area Data Data Reference
Identification Type strain isolated from human pharynx Hansen and
Available at NCIMB, UK as strain 8690 Mocquot, 1970
(originally named NCD01748, later NCFB
1748)
Safety Confirmation
Antibiotic resistance Inherited antibiotic resistance of NCDO Charteris et a/.,
1748 is in accordance with L. acidophil us 1998a;
group
Virulence The virulence in a rabbit infective Asahara et a/.,
endocarditis model was negligible 2003
Hospitalized Minor presence of L. acidophilus in Cannon et a/.,
persons isolates from hospitalized persons 2005
Bacteraemia 1748 not found in 44 persons suffering Sullivan and
from bacteraemia caused by lactobacillus Nord,2006
group including 4 infected with L.
acidophilus
Production of No D-Iactate was produced when milk Aim, 1982
lactate isomer was fermented
Source: Lee and Salminen (2009)
In human studies, lactobacillus acidophilus NCDO 1748 survives when
exposed to low pH and/or bile acids as well as in vivo in humans (Petterson et aI.,
1983; Draz et al., 2007). It binds several food mutagens and decreases their levels
in internal organs and has a high antioxidative capacity (Lidbeck et aI., 1992; Lin et
al., 2000). Lactobacillus acidophil us NCDO 1748 was well tolerated in all the human
studies investigated groups, and no side effects were reported during the 25 years
8
of use even when daily intake was well above 1011 cfu. Lactobacillus acidophilus
NCDO 1748 was also proven to be able to counteract the negative impact of
antibiotics on the normal GI flora when taken together with bifidobacteria or with
two complementary probiotics (Hansen and Mocquot, 1970; Orrhage at el., 1994).
2.3.3 Lactobacillus acidophilus NCFM®
Lactobacillus acidophilus NCFM was isolated from a human fecal sample in the early
1970s. The strain is marketed by Danisco (Danisco Cultures Division, Paris) . L.
acidophilus NCFM is to date the only strain of this species for which the genome
has been sequenced, annotated, and published (Altermann et al., 2005). In vitro
studies have shown that L. acidophilus NCFM has the necessary prerequisites to
survive gastrointestinal transit; resistance to bile, low pH, and digestive enzymes
(Daniel et al., 2006). Furthermore, L. acidophilus NCFM has been shown to adhere
to human epithelial cell lines (Greene and Klaehammer, 1994; Kleeman and
Klaehammer, 1982) and human intestinal mucus (Collado et at.; 2007).
Lactobacillus acidophilus NCFM was found to be able to help in lactose
intolerance cases, relief of intestinal pain and prevention of common respiratory
infections and effects on immunity. According to Montes et al. (1995) although L.
acidophilus NCFM does not always show a reduction in breath H2, it has been
shown to reduce lactose intolerance symptoms in children. Rousseaux et a/. (2007)
in animal model of irritable bowel syndrome, L. acidophilus NCFM has been shown
to be effective, but this requires further confirmation in humans. Recent study
found that immune modulator effects of L. acidophilus NCFM on serum immune
. globulins were observed in healthy adults following oral vaccination (Paneau et a/.,
2008). The observed improvement of immune responses in healthy volunteers may
partly explain the efficacy of L. acidophilus NCFM in the prevention of common
respiratory infections (Ouwehand et aI., 2007).
2.3.4 Lactobacillus casei Shirota
Several studies have shown that consuming lactobacillus casei Shirota will affect
the intestinal environment in several ways. Studies done by Yamagishi et al. (1974)
found that fecal microbiota will change by continuous ingestion of fermented milk.
9
Randomized crossover study done by Preter et al. (2008) found that lactobacillus
casei Shirota able to decrease the intestinal bacterial enzyme activity in feces. A
randomized placebo-controlled crossover study done by (Geboes et a/./ 2004) found
that lactobacillus casei Shirota can suppress the toxic fermentation metabolites.
Lacrobacillus casei Shirota was found to have beneficial effect on gastrOintestinal
symptom towards patients with chronic constipation through a double blind,
placebo-controlled, randomized study (Koebnick et a/., 2003). Case reports done by
Kanarmori et al. (2001) found that Lacrobacillus casei Shirota can improve the
intestinal function in a short bowel syndrome patient by symbiotic therapy.
As for immunomodulation, positive effect can be shown on NK-cell activity
by daily intake of Lacrobacillus casei Shirota through controlled clinical trial (Takeda
and Okumura, 2007). Furthermore, Lacrobacillus casei Shirota also found to have
effect on cancer. A randomized, controlled double-blind trial done by (Aso et a/./
1995) found that oral administration of Lactobacillus casei preparation is a safe and
effective prevention of recurrence of superficial bladder cancer and habitual intake
of lactobacillus casei strain Shirota can reduces the risk of bladder cancer (Ohashi
et a/., 2002). Finally, extract of autologous Lactobacillus casei cell lysate were
found to lowered the blood pressure and showed beneficial effects on glucose and
lipid metabolism in patients with hypertension (Nakajima et aI., 1995) .
2.3.5 Lactobacillus gasseriOLL2716 (LG21)
The effects of yogurt containing Lactobacillus gasseriOLL2716 on H. pylori infection
in humans were examined (Sakamoto et al./ 2001). Results from studies (Uemura
et al./ 2001; Kimura, 2004) suggest that the ingestion of LG21 yogurt decreases the
number of H. pylori and alleviates the mucosal inflammation in the stomach. For
patients who are H. pylori-positive and have peptic ulcers normally they should
receive eradication therapy, however for healthy people that are infected with H.
pylori, probiotic therapy may be a safe and simple alternative to antibiotic therapy.
Besides that, it was reported that there was a correlation between H. pylori density
and gastric inflammation or duodenal ulceration (Atherton et a/./ 1996; Furuta et a/.,
1997). Since ingestion of LG21 yogurt suppresses H. pylori, Lactobacillus gasseri
OLL2716 may reduce the risk of the H. pylori-induced gastrointestinal diseases.
10
2.3.6 Lactobacillus paracasei ssp. paracasei, F19®
Lactobacillus paracasei occurs naturally in foods and humans and F19 has been
isolated from cheese and several humans (Bjeorneholm et a/., 2002; Crittenden et
a/., 2002). Human studies show that F19 influences favorably the gut microbiota,
and gut function of the healthy adults, children, and elderly (Crittenden et aI., 2002;
Sullivan et a/., 2001). The numbers of secondary infections were noticed to
decrease when children given Lactobacillus paracasei ssp. paracasei during weaning
need less antibiotic treatment. When given to women it reduces symptoms of
vaginosis. Stabilization of a healthy gut flora and stool frequency, relieve from ISS
symptoms and a lower rate of infections inimmuno comprimized patients and
children were shown by the influence of Lactobacillus paracasei ssp. Paracasei
(Crittenden et a/., 2002). alone or in combination with other probiotic bacteria on
gut microbiota. Human studies have confirmed that Lactobacillus paracasei ssp.
Paracasei was well tolerated in all groups investigated and that the bacterium had
good survival in the gut, as analyzed from biopsies and in fecal samples (Simren et
a/., 2007; Sullivan et a/., 2001). Therefore, Lactobacillus paracasei ssp. Paracasei is
used in fermented milks in the market, e.g. Cultura® in Sweden and Denmark, in
cheese, food products for children, and in health remedies.
2.3.7 Lactobacillus paracasei ssp paracasei, L. casei 431 ®
Lactobacillus paracasei ssp paracasei, L. casei 431 has been used for more than 10
years by the dairy industry showing good survival properties in fermented milk
products. L. casei 431 has been found to benefit in intestinal microbial balance and
diarrhea. In a human study with healthy children ingesting fermented milk
containing L. casei 431 and L. acidophilus, an inverse relation between the level of
Lactobacilli in feces and the risk of developing diarrhea was observed (Gonzales et
a/., 1990). The effect of using Lactobacilli for children hospitalized with post
gastroenteritis syndrome was examined in a small study. Use of fermented milk for
a maximum of 4 days was effective in eliminating diarrhea symptoms in 11 of the
children. L. casei 431 also has been shown to influence the immune system by
modulating functions such as phagocytosis, production of antibodies, and
cytokines.(Maldonado and Perdigon, 2004).
11
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