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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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