Modern dietary patterns consisting of excess sugar, salt, and saturated fat, as well as unhealthy lifestyles, have contributed to global epidemics of type 2 diabetes mellitus, obesity, hormonal imbalances, depression, and mental health concerns around the world [10, 11]. Incorporating fermented foods into the diet could help with these lifestyle disorders, as there is now strong evidence of the effect of fermented foods on overall health [10]. The importance of the latter has motivated us to investigate and provide insight into the use and knowledge of the health benefits of fermented foods in Slovenia. As far as we know, this is the first study in Slovenia dealing with this topic, although we do not want to exclude the possibility that there are smaller, preliminary studies or projects whose results are not publicly available.
We included people of all ages, as children and young adults often assist in household fermentation practices and are involved in the process to some degree. We also included people regardless of their level of education, as it is often the case that people with lower levels of education and people living in rural areas know more about food preservation and practice it more often. In Slovenia, as in other countries, people have used fermentation to preserve and conserve food for thousands of years, even if they did not know much about the process and used fermentation to preserve food and increase its nutritional value according to a “recipe” they had in their family for generations. This has led to an extensive and heterogeneous list of fermented foods following traditions and cultural preferences in different geographic areas around the world [10, 31]. Children in Slovenia grew up eating local fermented foods, including sauerkraut, sour turnip and sour milk in rural areas, etc. They accepted them as part of their traditional dishes and learned to like them because they were told that they were good and healthy for them. Moreover, fermentation was of great importance in Slovenia during the famines in the first half of the last century. More recently, renewed interest in the health-promoting potential of fermented foods, especially in developed countries, has motivated many people to try preparing fermented foods at home (most commonly kombucha, kefir, sourdough, etc.) and to make fermented foods part of their diet [32].
Our results showed that although participants reported being familiar with the term fermentation and using it in their daily lives, less than one-fifth of participants knew the correct definition of fermentation. Our results are consistent with the findings of the study by Hekmat and Koba [28], in which almost two-thirds of 233 students at the College of Brescia were unfamiliar with the term fermentation. In the same study, about the same percentage was unsure whether cultured dairy products were fermented [28]. In our study, participants were mostly aware of the role of lactic acid bacteria, which is not surprising since they are commonly referred to as probiotics and are heavily promoted, especially for intestinal health [33]. Our study population demonstrated a better knowledge of the presence and role of LAB in fermented foods than the population in the study by Suahoo et al. [25]. In addition, our respondents were aware of the role of yeasts used in the fermentation of alcoholic beverages such as wine, beer, and cider. The latter are traditionally performed with Saccharomyces cerevisiae strains, the most common and commercially available yeast [34]. However, most respondents were unaware of the role of molds used in the production of many Asian fermented foods (e.g., Aspergillus oryzae and Aspergillus sojae) and in the aging of cheeses (e.g., Penicillium camemberti and Penicillium roqueforti) [35].
A generational difference was evident in the understanding of the fermentation process. Our respondents in their 30 s were the age group most likely to have the correct understanding and knowledge of the process. This age group and the younger participants were also the ones who were familiar with and tried various foreign fermented foods (e.g., kimchi, natto, skyr, etc.). This is not so surprising, as many commercially produced varieties of fermented foods that were once rather unknown in our region are now widely available, including kefir, kimchi, skyr, miso, tempeh, kombucha, etc. Our findings are in contrast to Sahoo et al. [25], where the middle or older age group prefer to consume fermented foods compared to the younger age group. The food market for fermented products has proven to be increasingly popular and growing its offer responding to the global trend. Our study participants, especially the younger ones, are predominantly not afraid to try new fermented foods, they are looking for new taste and texture experiences and experimenting with international cuisines. This is reflected in the finding that only about a quarter of our participants have become acquainted with preparing fermented foods at home. More participants became acquainted with fermented foods at school, on the Internet, or through advertisements. On the other hand, important aspects of fermented food consumption by retired people compared to younger respondents were observed by Camire et al. [26], with retired respondents having a greater interest in food fermentation due to a limited food budget and food insecurity, interest in health-promoting foods, or availability of more time for food preservation.
Regular consumption of yogurt is often included in dietary guidelines, but recommendations for other fermented foods are usually lacking [36]. In Slovenia, however, the most recent dietary guidelines and food pyramid recommend consumption of fermented foods such as sauerkraut and sour turnip in addition to yogurt and cheese, although the term “fermented foods” is not used [37].
Yogurt and other cultured dairy products are generally perceived by consumers as a good source of live and health-promoting organisms [38]. In our study, yogurt, fresh and semi-hard cheese were most commonly consumed by respondents (i.e., several times per week). Both yogurt and soft cheese serve as a source of live bacteria, as many studies have shown that these products contain relevant amounts of various LAB, ranging from 104 to 109 cfu/g [36]. Milk kefir and hard cheese were consumed less frequently by the respondents, while sauerkraut and sour tournip were consumed seasonally by most respondents. In addition, blue cheese, sourdough bread, water kefir, and kombucha were the least consumed of the fermented foods.
Recently, a new trend has been established towards minimally processed foods that can have a positive effect on our physical and mental well-being. In this context, fermented foods with potential health benefits gained much attention [6]. Because of these health-promoting properties, many people are motivated to try, consume, and even prepare fermented foods at home. Our results showed that almost one-third of the study participants were preparing fermented foods at home. We subsequently assessed the opinion of participants regarding the health benefits of fermented foods. More than half of the participants were aware of the health benefits of fermented foods, especially in terms of their positive effects on intestinal health and the immune system. Less was known about the potential positive effects of fermented foods on allergy and depression symptoms. This lack of knowledge about the potential benefits of fermented foods in other domains of human health is an area for improvement. This is especially important considering that more than 80% of study population declared they would consume more fermented foods if they knew more about the health benefits of such foods. Similarly, the study by Sobharani Devi et al. [29] found that although respondents preferred fermented foods in their diets, they lacked knowledge about fermented foods and their health benefits. However, participants in our study were much more knowledgeable about the health benefits of fermented foods than in the study by Sahoo et al. [25].
The ability of diet to modulate the gastrointestinal microbiota, improve or prevent dysbiosis, and improve human health is now well established [39,40,41]. In addition to supplementation with probiotics and food components known to influence the composition of the gut microbiota, fermentable fibers and prebiotics that enrich certain members of the gut microbiota [36]. Numerous studies have demonstrated the potential health benefits of fermented foods associated with either improved health or reduced disease risk [27, 42,43,44,45]. For this reason, consumption of fermented foods should be encouraged, as it may be the easiest way to introduce beneficial microorganisms into the gastrointestinal tract and represents an investment in future health.