Kefir: A Multifaceted Fermented Dairy Product

Probiotics and Antimicrobial Proteins

Volumn 6, Issue 3-4, 2014, Pages 123-135

  Nielsen, Barbara ^a   Gürakan, G Candan ^b   Ünlü, Gülhan ^a  

^a UNIVERSITY OF IDAHO   (United States)

^b MIDDLE EAST TECHNICAL UNIVERSITY   (Turkey)

Author keywords

Fermented dairy product; Kefir; Kefir grain; Kefiran; Lactic acid bacteria; Probiotic

Indexed keywords

HIGH DENSITY LIPOPROTEIN CHOLESTEROL; IMMUNOGLOBULIN E; IMMUNOGLOBULIN G1; IMMUNOGLOBULIN G2; INTERLEUKIN 10; INTERLEUKIN 1BETA; KEFIR; LOW DENSITY LIPOPROTEIN CHOLESTEROL; RNA 16S; TRIACYLGLYCEROL; TUMOR NECROSIS FACTOR ALPHA; PROBIOTIC AGENT;

AMPLIFIED RIBOSOMAL DNA RESTRICTION ANALYSIS; BACTERIUM IDENTIFICATION; BACTERIUM ISOLATE; BACTERIUM ISOLATION; DAIRY PRODUCT; DENATURING GRADIENT GEL ELECTROPHORESIS; FERMENTED PRODUCT; FOOD INDUSTRY; FOOD INTAKE; HUMAN; IMMUNOMODULATION; INDUSTRIAL PRODUCTION; LACTOBACILLUS; MICROBIAL COMMUNITY; MULTIPLEX POLYMERASE CHAIN REACTION; NONHUMAN; PRIORITY JOURNAL; PROTEIN EXPRESSION; RANDOM AMPLIFIED POLYMORPHIC DNA; RESTRICTION FRAGMENT LENGTH POLYMORPHISM; REVIEW; SCANNING ELECTRON MICROSCOPY; SPECIES DIFFERENTIATION; ANIMAL; CHEMISTRY; CLASSIFICATION; FERMENTATION; GENETICS; ISOLATION AND PURIFICATION; LACTOBACILLACEAE; METABOLISM; MICROBIOLOGY;

ANIMALS; CULTURED MILK PRODUCTS; FERMENTATION; HUMANS; LACTOBACILLACEAE; PROBIOTICS;

EID: 84921936301     PISSN: 18671306     EISSN: 18671314     Source Type: Journal    
DOI: 10.1007/s12602-014-9168-0     Document Type: Review

References (135)

1. James F (1975) Yogurt: its life and culture. Exped Fall 11(1):32–38
2. Kabak B, Dobson A (2011) An introduction to the traditional fermented foods and beverages of Turkey. Crit Rev Food Sci 51(3):248–260
3. Ötles S, Çagindi Ö (2003) Kefir: a probiotic dairy-composition, nutritional and therapeutic aspects. Pak J Nutr 2(2):54–59
4. Farnworth ER (2006) Kefir: a complex probiotic. Food Sci Technol B 2:1–17
5. Marshall VM, Cole WM, Brooker B (1984) Observations on the structure of kefir grains and the distribution of the microflora. J Appl Bacteriol 57:491–497
6. Yamin H, Elmali M, Karadagoglu G, Cetinkaya A (2006) Observations of kefir grains and their structure from different geographical regions: Turkey and Germany. Ataturk Universitesi Vet Bil Derg 1(1–2):11–15
7. Garrote GL, Abraham AG, de Antoni GL (2001) Chemical and microbiological characteristization of kefir grains. J Dairy Res 68:639–652
8. Simova E, Beshkova D, Angelov A, Hristozova T, Frengova G, Spasov Z (2002) Lactic acid bacteria and yeasts in kefir grains and kefir made from them. J Ind Microbiol Biotechnol 28:1–6
9. Beshkova DM, Simova E, Simov Z, Frengova G, Spasov Z (2002) Pure cultures for making kefir. Food Microbiol 19:537–544
10. Witthuhn R, Schoeman T, Britz T (2005) Characterization of the microbiological population at different stages of kefir production and kefir grain mass cultivation. Int Dairy J 15:383–389
11. Dobson A, O’Sullivan O, Cotter PD, Ross P, Hill C (2011) High- throughput sequence-based analysis of the bacterial composition of kefir and an associated kefir grain. FEMS Microbiol Lett 320:56–62
12. Ertekin B, Guzel-Seydim ZB (2010) Effect of fat replacers on kefir quality. J Sci Food Agric 90:543–548
13. Cui X, Chen S, Wang Y, Han J (2013) Fermentation conditions of walnut milk beverage inoculated with kefir grains. LWT Food Sci Technol 50:349–352
14. Puerani C, Magalhães KT, Schwan RF (2012) New cocoa pulp-based kefir beverages: microbiological, chemical composition and sensory analysis. Food Res Int 48:634–640
15. Liu J, Lin C (2000) Production of kefir from soymilk with or without added glucose, lactose, or sucrose. J Food Microbiol Saf 65(4):716–719
16. Liu J, Chen M, Lin C (2005) Antimutagenic and antioxidant properties of milk-kefir and soymilk-kefir. J Agric Food Chem 53:2467–2474
17. Bensmira M, Jiang B (2011) Organic acids formation during the production of a novel peanut-milk kefir beverage. Br J Dairy Sci 2(1):18–22
18. Farnworth ER (1999) Kefir: from folklore to regulatory approval. J Nutraceut Funct Med Foods 1(4):57–68
19. Margulis L (1995) From kefir to death. In: Brockman J, Matson K (eds) How things are: a science tool-kit for the mind. William Morrow, New York, pp 69–78
20. Trenev N (1998) Probiotics: nature’s internal healers. Avery, Garden City Park, p 11
21. Pintado ME, DaSilva JL, Fernandes PB, Malcata CX, Hogg TA (1996) Microbiological and rheological studies on Portuguese kefir grains. Int J Food Sci Technol 31:15–36
22. Santos A, San Mauro M, Sanchez A, Torres J, Marquina D (2003) The antimicrobial properties of different strains of Lactobacillus spp. isolated from kefir. Syst Appl Microbiol 26:434–437
23. Rea M, Lennartsson T, Dillon P, Drinan F, Reville W, Heapes M, Cogan T (1996) Irish kefir-like grains: their structure, microbial composition and fermentation kinetics. J Appl Bacteriol 81:83–94
24. Thompson J, Johnson D, Murphy R, Collins M (1990) Characteristics of a milk fermentation from rural northern Ireland which resembles kefir. Ir Food Sci Technol 14:35–49
25. Irwin F (1949) The cookin’ woman. Oliver and Boyd, London, pp 210–211
26. Farnworth ER, Mainville I (2003) Kefir: a fermented milk product. In: Farnworth ER (ed) Handbook of fermented functional foods. CRC Press, Boca Raton, pp 78–111
27. Kolakowski P, Ozimkiewicz M (2012) Restoration of kefir grains subjected to different treatments. Int J Dairy Technol 65(1):140–145
28. Angulo L, Lopez E, Lema C (1993) Microflora present in kefir grains of the Galician region (north-west of Spain). J Dairy Res 60:263–267
29. Irigoyen A, Arana I, Castiella M, Torre P, Ibáñez F (2005) Microbiological, physiochemical, and sensory characteristics of kefir during storage. Food Chem 90:613–620
30. Urdaneta E, Barrenetxe J, Aranguren P, Irigoyen A, Marzo F, Ibáñez FC (2007) Intestinal beneficial effects of Kefir-supplemented diet in rats. Nutr Res 27:653–658
31. Guzel-Seydim Z, Wyffels JT, Seydim AC, Greene AK (2005) Turkish kefir and kefir grains: microbial enumeration and electron microscobic observation. Int J Dairy Technol 58:25–29
32. Motaghi M, Moazami M, Farkhondeh A, Fooladi M, Goltapeh E (1997) Short Communication: kefir production in Iran. World J Microb Biotechnol 13:578–581
33. Ghasemlou M, Khodaiyan F, Oromiehie A, Yarmand M (2011) Development and characterization of a new biodegradable edible film made from kefiran, an exopolysaccharide obtained from kefir grains. Food Chem 127:1495–1502
34. Xie N, Zhou T, Li B (2012) Kefir yeasts enhance probiotic potentials of Lactobacillus paracasei H9: the positive effects of coaggregation between the two strains. Food Res Int 45:394–401
35. Huang Y, Wu F, Wang X, Sul Y, Yang L, Wang J (2013) Characterization of Lactobacillusplantarum Lp27 isolated from Tibetan kefir grains: a potential probiotic bacterium with cholesterol-lowering effects. J Dairy Sci 96:2816–2825
36. Wang Y, Xu N, Xi A, Ahmed Z, Zhang B, Bai X (2009) Effects of Lactobacillus plantarum MA2 isolated from Tibet kefir on lipid metabolism and intestinal microflora of rats fed on high-cholesterol diets. Appl Microbiol Biotechnol 84:341–347
37. Shiomi M, Sasaki K, Murofushi M, Aibara K (1982) Antitumor activity in mice of orally administered polysaccharide from kefir grain. Jpn J Med Sci Biol 35:75–80
38. Chen T, Wang S, Chen K, Liu J, Chen M (2009) Microbiological and chemical properties of kefir manufactured by entrapped microorganisms isolated from kefir grains. J Dairy Sci 92:3002–3013
39. Liu JR, Wang SY, Chen MJ, Yeuh PY, Lin CW (2006) The anti-allergenic properties of milk and soymilk kefir and their beneficial effects on the intestinal microflora. J Sci Food Agric 86:2527–2533
40. Leite A, Leite D, DelAguila E, Alvares T, Peixoto R, Miguel M, Silva J (2013) Microbiological and chemical characterization of Brazilian kefir during fermentation and storage processes. J Dairy Sci 96:4149–4159
41. Silva KR, Rodrigues SA, Filhom LX, Lima AS (2009) Antimicrobial activity of broth fermented with kefir grains. Appl Biochem Biotechnol 152:316–325
42. Rimada PS, Abraham AG (2001) Polysaccharide production by kefir grains during whey fermentation. J Dairy Res 68:653–661
43. Witthuhn RC, Cilliers A, Britz TJ (2005) Evaluation of different preservation techniques on the storage potential of kefir grains. J Dairy Res 72:125–128
44. Powell JE, Witthuhn RC, Todorov SD, Dicks LMT (2007) Characterization of bacteriocin ST8KF produced by a kefir isolate Lactobacillus plantarum ST8KF. Int Dairy J 17:190–198
45. Mayo B, Ammor MS, Delgado S, Alegria Á (2010) Fermented milk products. In: Tamang JP, Kailasapathy K (eds) Fermented foods and beverages of the world. CRC Press, Boca Raton, pp 278–280
46. Marsh AJ, O’Sullivan O, Hill C, Ross RP, Cotter PD (2013) Sequencing-based analysis of the bacterial and fungal composition of kefir grains and milks from multiple sources. PLoS One 8(7):e69171. doi:10.1371/journal.pone0069371
47. Margulis L (1994) Sex, death and kefir. Sci Am 271(2):96
48. Bottazzi V, Bianchi F (1980) A note on scanning electron microscopy of micro-organisms associated with the kefir granule. J Appl Bacteriol 48:265–268
49. Magalhães KT, Pereira GVDM, Campos CR, Dragone G, Schwan RF (2011) Brazilian Kefir: structure, microbial communities and chemical composition. Braz J Microbiol 42:693–702
50. Leite AMO, Miguel MOL, Peixiti RS, Rosado AS, Silva JT, Paschoalin VMF (2013) Microbiological, technological and therapeutic properties of kefir: a natural probiotic beverage. Braz J Microbiol 44(2):341–344
51. Wang SY, Chen KN, Lo YM, Chiang ML, Chen HC, Liu JR, Chen MJ (2012) Investigation of microorganisms involved in biosynthesis of the kefir grain. Food Microbiol 32:274–285
52. Tamine A, Muir D, Wszolek M (1999) Kefir, koumiss, and kishk. Dairy Ind Int 64(5):32–33
53. Bolla PA, de los Serradell A, de Urraza PJ, De Antoni GL (2011) Effect of freeze-drying on viability and in vitro probiotic properties of a mixture of lactic acid bacteria and yeasts isolated from kefir. J Dairy Res 78:15–22
54. Wszolek M, Kupiec-Teahan B, Guldager HS, Tamine A (2006) Production of kefir, koumiss, and other related products. In: Tamime AY (ed) Fermented milks. Blackwell Science, Oxford, pp 174–216
55. Chen HC, Lin CW, Chen MJ (2006) The effects of freeze drying and rehydration on survival of microorganisms in kefir. Asian Aust J Anim Sci 19(1):126–130
56. Muyzer G, DeWaall E, Uitterlinden A (1993) Profiling of complex microbial populations by denaturing gradient gel electrophoresis analysis of polymerase chain reaction-amplified genes coding for 16S rRNA. Appl Environ Microbiol 59:695–700
57. Fasoli S, Marzotto M, Rizzotti L, Dellaglio F, Torriani S (2003) Bacterial composition of commercial probiotic products as evaluated by PCR-DGGE analysis. Int J Food Microbiol 82:59–70
58. Masoud W, Cesar L, Jespersen L, Jakobsen M (2004) Yeast involved in fermentation of Coffea arabica in East Africa determined by genotyping and by direct denaturating gradient gel electrophoresis. Yeast 21:549–556
59. Theunissen J, Britz T, Torriani S, Witthuhn R (2005) Identification of probiotic microorganisms in South African products using PCR-based DGGE analysis. Int J Food Microbiol 98:11–21
60. Leite A, Mayo B, Rachid C, Peixoto RS, Silva JT, Paschoalin V, Delgado S (2012) Assessment of the microbial diversity of Brazilian kefir grains by PCR-DGGE and pyrosequencing analysis. Food Microbiol 31:215–221
61. Chagnaud P, Machinis K, Coutte L, Marecat A, Mercenier A (2001) Rapid PCR-based procedure to identify lactic acid bacteria: application to six common Lactobacillus species. J Microbiol Methods 44:139–148
62. Kullen M, Sanozky-Dawes R, Crowell D, Klaenhammer T (2000) Use of the DNA sequence of variable regions of the 16S rRNA. J Appl Microbiol 89:511–516
63. Walter J, Tannock GW, Tilsala-Timisjarvi A, Rodtong S, Loach DM, Munro K, Alatossava T (2000) Detection and identification of gastrointestinal Lactobacillus species by using denaturing gradient gel electrophoresis and species-specific PCR primers. Appl Environ Microbiol 66:297–303
64. Delfederico L, Hollmann A, Martinez M, Iglesias NG, DeAntoni G, Semorile L (2006) Molecular identification and typing of lactobacilli isolated from kefir grains. J Dairy Res 73:20–27
65. Golowczyc MA, Gugliada MJ, Hollmann A, Delfederico L, Garrote GL, Abraham AG, Semorile L, De Antoni G (2008) Characterization of homofermentative lactobacilli isolated from kefir grains: potential use as probiotic. J Dairy Res 75:211–217
66. Dobson A, O’Sullivan O, Cotter P, Ross P, Hill C (2011) High-throughput sequence-based analysis of the bacterial composition of kefir and an associated kefir grain. FEMS Microbiol Letters 320:56–62
67. Kök Tas T, Ekinci F, Guzel-Seydim Z (2011) Identification of microbial flora in kefir grains produced in Turkey using PCR. Int J Dairy Technol 65:126–131
68. Singh S, Goswami P, Singh R, Heller K (2009) Application of molecular identification tool for Lactobacillus, with a focus on discrimination between closely related species: a review. LWT Food Sci Technol 42:448–457
69. Song Y, Kato N, Liu C, Matsumiya Y, Kato H, Watanabe K (2000) Rapid identification of 11 human intestinal Lactobacillus species by multiplex PCR assays using group and species-specific primers derived from the 16S–23S rRNA intergenic spacer region and its flanking 23S rRNA. FEMS Microbiol Lett 187:167–173
70. Wang S, Chen H, Liu J, Lin Y, Chen M (2008) Identification of yeasts and evaluation of their distribution in Taiwanese kefir and viili starters. J Dairy Sci 91:3798–3805
71. Magalhães K, Pereira M, Nicolau A, Dragone G, Domingues L, Teixeira J, Silva J, Schwan R (2010) Production of fermented cheese whey-based beverage using kefir grains as starter culture: evaluation of morphological and microbial variations. Bioresour Technol 101:8843–8850
72. Marshall V (1987) Fermented milks and their future trends I. Microbial aspects. J Dairy Res 54:559–574
73. Nambou K, Gao C, Zhou F, Guo B, Ai L, Wu ZJ (2014) A novel approach of direct formulation of defined starter cultures for different kefir-like beverage production. Int Dairy J 34(2):237–246
74. Sarkar S (2008) Biotechnological innovations in kefir production: a review. Br Food J 110(3):283–295
75. Guzel-Sedam ZB, Kok-Tas T, Greene AK, Seydim AC (2011) Review: Functional properties of kefir. Crit Rev Food Sci 51(3):261–268
76. Ahmed Z, Wang Y, Ahmad A, Khan ST, Nisa M, Ahmad H, Afreen A (2013) Kefir and health: a contemporary perspective. Crit Rev Food Sci 53(5):422–434
77. Fuller R (1992) Probiotics: the scientific basis. Chapman and Hall, London, p 1
78. FAO/WHO (2001) Report of a joint FAO/WHO expert consultation on evaluation of health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria. Available at: http://www.who.int/foodsafety/publications/fs_management/en/probiotics.pdf. (Accessed 14 July 2014)
79. Salminen S, Isolauri E, Salminen E (1996) Clinical uses of probiotics for stabilizing the gut mucosal barrier: successful strains and future challenges. Antonie von Leewenhoek 70:347–358
80. Ötles S, Çagindi Ö, Akçiçek ES, Cagindi O, Akcicek E (2003) Probiotics and health. Asian Pac J Cancer Prev 4:369–372
81. Metchnikoff É (1908) The prolongation of life: optimistic studies. In: Mitchell PC (ed) Arno press, literature of death and dying, 1977th edn. The Knickerbocker Press, New York
82. Sezer G, Güven A (2009) Investigation of bacteriocin production capability of lactic acid bacteria isolated from foods. Kafkas Univ Vet Fak Derg 15(1):45–50
83. Bolla PA, Carasi P, de los Serradell A, De Antoni GL (2013) Kefir-isolated Lactococcuslactis subsp. lactis inhibits the cytotoxic effects of Clostridium difficile in vitro. J Dairy Res 80:96–102
84. Kakisu E, Abraham AG, Farinati CT, Ibarra C (2013) Lactobacillus plantarum isolated from kefir protects vero cells from cytotoxicity by type II shiga toxin from Escherichia coli O157:H7. J Dairy Res 80:64–71
85. Kakisu E, Irigoyen A, Torre P, DeAntoni G (2011) Physicochemical, microbial and sensory profiles of fermented milk containing probiotic strains isolated from kefir. J Dairy Res 78:456–463
86. Liu Z, Shen T, Zhang P, Ma Y, Qin H (2011) Lactobacillus plantarum surface layer adhesive protein protects internal epithelial cells against tight junction injury induced by enteropathogenic Escherichia coli. Mol Biol Rep 38:3471–3480
87. Lin WH, Wu CR, Fang TJ, Guo SYH, Lee MS, Yang HL (2011) Anti Helicobacter pylori activity of fermented milk with lactic acid bacteria. J Sci Food Agric 91:1424–1431
88. Oh Y, Osato M, Han X, Bennett G, Hong W (2002) Folk yoghurt kills Helicobacter pylori. J Appl Microbiol 93:1083–1088
89. Zubillaga M, Weill MR, Postaire E, Goldman C, Caro R, Boccio J (2001) Effect of probiotics and functional foods and their uses in different diseases. Nutr Res 21:569–579
90. Quirós A, Hernández-Ledesma M, Ramos M, Amigo L, Reclo I (2005) Angiotensin-converting enzyme inhibitory activity of peptides derived from caprine kefir. J Dairy Sci 88:3480–3487
91. Nakamura Y, Yamamoto N, Sakai K, Takano T (1995) Antihypertensive effect of sour milk and peptides isolated from it that are inhibitors to angiotensin I-converting enzyme. J Dairy Sci 78:1253–1257
92. Gilliland G, Nelson C, Maxwell C (1985) Assimilation of cholesterol by Lactobacillus acidophilus. Appl Enviro Microbiol 49(2):377–381
93. Vujičić I, Vulić M, Könyves T (1992) Assimilation of cholesterol in milk by kefir cultures. Biotechnol Lett 14(9):847–850
94. Klaver FA, van der Meer R (1993) The assumed assimilation of cholesterol by Lactobacilli and Bifidobacterium is due to their bile salt-deconjugating activity. Appl Environ Microbiol 59(4):1120–1124
95. Tahri K, Grill JP, Schneider F (1996) Bifidobacteria strain behavior towards cholesterol: coprecipitation with bile salts and assimilation. Curr Microbiol 33(3):187–193
96. Madani G, Mirlohi M, Yahay M, Hassanzadeh A (2013) How much in vitro cholesterol reducing activity of Lactobacilli predicts their in vivo cholesterol function? Int J Prev Med 4(4):404–413
97. St-Onge M, Farnworth E, Savard T, Chabot D, Mafu A, Jones P (2002) Kefir consumption does not alter plasma lipid levels or cholesterol fractional synthesis rates relative to milk in hyperlipidemic men: a randomized controlled trial. BMC Complement Altern Med 2:1
98. Liu JR, Wang SY, Chen MJ, Chen HL, Yueh PY, Lin CW (2006) Hypocholesterolaemic effects of milk-kefir and soyamilk-kefir in cholesterol-fed hamsters. Br J Nutr 95:939–946
99. Zheng Y, Lu Y, Wang J, Yang L, Pan C, Huang Y (2013) Probiotic properties of Lactobacillus strains isolated from Tibetan kefir. PLoS One 8(7):e698680
100. Maeda H, Zhu X, Suzuki S, Suzuki K, Kitamura S (2004) Structural characterization and biological activities of an exopolysaccharide kefiran produced by Lactobacillus kefiranofaciens WT-2B. J Agric Food Chem 52:5533–5538
101. Maeda H, Zhu Z, Omura K, Suzuki S, Kitamura S (2004) Effects of an exopolysaccharide (kefiran) on lipids, blood pressure, blood glucose, and constipation. BioFactors 22:197–200
102. Vinderola CG, Duarte J, Thangavel D, Perdigón G, Farnworth E, Matar C (2005) Immunomodulating capacity of kefir. J Dairy Res 72:195–202
103. Vinderola G, Perdigon G, Duarte J, Thangavel D, Farnworth E, Matar C (2006) Effects of kefir fractions on innate immunity. Immunobiology 21:149–156
104. Romanin D, Serradell M, Maciel DG, Lausada N, Garrote GL, Rumbo M (2010) Down-regulation of intestinal epithelial innate response by probiotic yeasts isolated from kefir. Int J Food Microbiol 140:102–108
105. Chen Y, Hsiao P, Hong W, Dai T, Chen M (2012) Lactobacillus kefiranofaciens M1 isolated from milk kefir grains ameliorates experimental colitis in vitro and in vivo. J Dairy Sci 95:63–74
106. Lee MY, Ahn KS, Kwon OK, Kim MJ, Kim MK, Lee IY, Oh SR, Lee HK (2007) Anti-inflammatory and anti-allergenic effects of kefir in a mouse asthma model. Immunobiology 212:647–654
107. de Moreno de LeBlanc A, Matar C, Farnworth E, Perdigón G (2006) Study of immune cells involved in the antitumor effect of kefir in a murine breast cancer model. J Dairy Sci 90:1920–1928
108. Maalouf K, Baydoun E, Rizk S (2011) Kefir induces cell-cycle arrest and apoptosis in HTLV-1-negative malignant T-lymphocytes. Cancer Manag Res 3:39–47. doi:10.2147/CMR.S15109
109. Gao J, Gu F, Ruan H, Chen Q, He J, He G (2012) Induction of apoptosis of gastric cancer cells SGC7901 In Vitro by a cell-free fraction of Tibetan kefir. Int Dairy J 30:14–18
110. Can C, Topuz E, Derin D, Durna Z, Aydinar A (2009) Effect of kefir on the quality of life of patients being treated for colorectal cancer. Oncol Nurs Forum 36(6):E335–E342
111. Topuz E, Derin D, Can G, Kürklü E, Çinar S, Aykan F, Çevikbaş A, Dişçi R, Durna Z, Şakar B, Saglam S, Tanyeri H, Deniz G, Gürer Ü, Taş F, Guney N, Aydinar A (2008) Effect of oral administration of kefir on serum proinflammatory cytokines on 5-FU induced oral mucositis in patients with colorectal cancer. Invest New Drugs 26:567–572
112. Alm L (1982) Effect of fermentation on lactose, glucose, and galactose content in milk and suitability of fermented milk products for lactose intolerant individuals. J Dairy Sci 65:346–352
113. Hertzler SR, Clancy SM (2003) Kefir improves lactose digestion and tolerance in adults with lactose maldigestion. J Am Diet Assoc 103:582–587
114. Alm L (1982) Effect of fermentation on L(+) and D(−) lactic acid in milk. J Dairy Sci 65:515–530
115. De Vrese M, Keller B, Barth CA (1992) Enhancement of intestinal hydrolysis of lactose by microbial β-galactosidase (EC 3.2.1.23) of kefir. Br J Nutr 67:67–75
116. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) (2012) Scientific opinion on the substantiation of health claims related to a combination of Lactobacillus acidophilus BCCM/LMG P-18806, Lactobacillus delbrueckii BCCM/LMG P-18805 and Streptococcus thermophilus BCCM/LMG P-18807 and reduction of gastro-intestinal. EFSA J 10(8):2855. Available online: www.efsa.europa.eu/efsajournal
117. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA (2012) Scientific opinion on the substantiation of health claims related to non-characterized microorganisms (ID 2936, 2937,2938, 2941, 2944,2965, 2968, 2969, 3035, 3047, 3056, 3059, further assessment) pursuant to article 13(1) of regulation (EC) no. 1924/2006. EFSA J 10(8):2854
118. Chen K, Kuo C, Shiu J, Chen M (2011) Process optimization for a novel kefir candy with high probiotic viability. J Food Process Eng 34:427–443
119. Serafini F, Turroni F, Ruas-Madiedo P, Lugli GA, Milani C, Margolles A, Ventura M (2014) Kefir fermented milk and kefiran promote growth of Bifidobacterium bifidum PRL2010 and modulate its gene expression. Int J Food Microbiol 178:50–59
120. Patel S, Majumder A, Goyal A (2012) Potentials of exopolysaccharides from lactic acid bacteria. Indian J Microbiol 52(1):3–12
121. Rodrigues KL, Caputo LRG, Carvalho JCT, Evangelista J, Schneedorf JM (2005) Antimicrobial and healing activity of kefir andf kefiran extract. Int J Antimicrobial Agents 25:404–408
122. Rodrigues KL, Carvalho CT, Schneedorf JM (2005) Anti-inflammatory properties of kefir and its polysaccharide extract. Inflammopharmacology 13(5–6):485–492
123. Huseini H, Rahimzadeh G, Fazeli M, Mehrazma M, Salehi M (2012) Evaluation of wound healing activities of kefir products. Burns 38:719–723
124. Marshall VM, Rawson H (1999) Effects of exopolysaccharide-producing strains of thermophilic lactic acid bacteria on the texture of stirred yoghurt. Int J Food Sci Technol 34(2):137–143
125. Piermaria J, de la Cana IM, Abraham A (2008) Gelling properties of kefiran, a food grade polysaccharide obtained from kefir grains. Food Hydrocoll 22:1520–1527
126. Zajšek K, Goršek A, Kolar M (2013) Cultivating conditions effects on kefiran production by the mixed culture of lactic acid bacteria imbedded within kefir grains. Food Chem 139:970–977
127. Kourkoutas Y, Kandylis P, Panas P, Dooley J, Nigam P, Koutinas A (2006) Evaluation of freeze-dried kefir coculture as starter in feta-type cheese production. Appl Environ Microbiol 72(9):6124–6135
128. Goncu A, Alpkent Z (2005) Sensory and chemical properties of white pickled cheese produced using kefir, yoghurt, or a commercial cheese culture as a starter. Int Dairy J 15:771–776
129. Katechak IE, Panas P, Rapti K, Kandilogiannakis L, Koutinas A (2008) Production of hard-type cheese using free or immobilized freeze-dried kefir cells as a starter culture. J Agric Food Chem 56:5316–5323
130. Motedayen AA, Khodaiyan F, Saleh EA (2013) Development and characterization of composite films made of kefiran and starch. Food Chem 136:1231–1238
131. Piermaria JA, Pinotti A, Garcia MA, Abraham AG (2009) Films based on kefiran, an exopolysaccharide obtained from kefir grain: development and characterization. Food Hydrocoll 23:684–690
132. Piermaria J, Bosch A, Pinotti A, Yantorno O, Garcia MA, Abraham AG (2011) Kefiran films plasticized with sugars and polyols: water vapor barrier and mechanical properties in relation to their microstructure analyzed by ATR/FT-IR spectroscopy. Food Hydrocoll 25:1261–1269
133. Plessas S, Pherson L, Bekatorou A, Nigam P, Koutinas A (2005) Bread making using kefir grains as baker’s yeast. Food Chem 93:585–589
134. Plessas S, Trantallidi M, Bekatorou A, Kanellaki M, Nigam P, Koutinas AA (2007) Immobilization of kefir and Lactobacillus casei on brewery spent grains for use in sourdough wheat bread making. Food Chem 105:187–194
135. Mantzourani I, Plessas S, Saxami G, Alexopoulos A, Galanis A, Bezirtzoglou E (2014) Study of kefir grains application in sourdough bread regarding rope spoilage caused by Bacillus spp. Food Chem 143:17–21