Health benefits of fermented foods: a strategic roadmap from the PIMENTO initiative.

Fermented foods are receiving increasing attention as potentially beneficial components of healthy diets because they provide live microorganisms, fermentation-derived metabolites, and food matrices modified by microbial activity. However, the evidence supporting their health effects remains heterogeneous, making it difficult to translate current knowledge into clear regulatory or public health guidance. Here we present a Strategic Research and Policy Roadmap developed within Working Group 3 of the COST Action "Promoting Innovation of ferMENTed fOods" (PIMENTO) CA20128 to identify priorities for fermented foods research and policy directions in the near future. Using an approach informed by the European Food Safety Authority framework for health claim substantiation, the PIMENTO WG3 initiative synthesised evidence from a dedicated series of 17 published reviews, comprising systematic reviews, meta-analyses, systematic narrative reviews, narrative reviews, and a scoping review, preceded by a position paper setting out the WG3 strategy, covering human studies, mechanistic evidence, food characterisation, bioavailability, and safety. Across these reviews, fermented foods were associated with generally modest, and sometimes neutral, effects on diverse health outcomes. The collective evidence also highlighted recurring strengths of the field, including biological plausibility, broad health relevance, and promising functional targets for selected fermented food categories, alongside persistent challenges related to food characterisation, study heterogeneity, dose-response assessment, mechanistic validation, and long-term human evidence. Safety findings were broadly reassuring in the populations studied, although reporting was inconsistent. We translate these findings into a strategic roadmap for research and policy, reflecting the expert judgement of the author panel rather than a formal consensus procedure, organised across short-, medium-, and long-term horizons, to harmonise fermented food definitions and exposure assessment, standardise product dossiers and analytical methods, strengthen trial design, incorporate mechanistic validation, and align evidence generation with regulatory and public health needs while remaining relevant to diverse stakeholders. Overall, this work provides a structured foundation for the next phase of fermented food research by identifying evidence gaps, methodological priorities, and policy needs required to advance the field toward greater scientific and regulatory maturity. To our knowledge, this represents the first effort of its kind to consolidate evidence and knowledge gaps across the full breadth of fermented foods research into a single, actionable strategic framework.