The pathogenesis of non-communicable diseases (NCDs) worldwide is closely linked to the global nutrition transition. Functional foods play a crucial role in the prevention and control of NCDs, making them an active area of research. Fermentation, which involves the biotransformation of food, enhances its digestibility and nutritional properties by releasing bioactive molecules. The increased bioactivity during fermentation can be attributed to the liberation of compounds trapped in the food matrix, the generation of metabolites, or the metabolic products of the microorganisms involved. Additionally, fermented foods can serve as a vehicle to deliver live beneficial microbes to the gastrointestinal tract, promoting gut homeostasis. While most studies demonstrate an increase in bioactivity during fermentation, some investigations yield contradictory results, likely due to the complexity of the food matrix, microbial strains utilized, and environmental conditions during the fermentation process. Further research is needed to address conflicting findings, and epidemiological studies are recommended to examine the impact of fermented vegetables on human health. This review discusses changes in antioxidant, antidiabetic, antihyperlipidemic, anticancer, and antihypertensive activities of fermented vegetables, both in vitro and in vivo using animal models. Moreover, the drawbacks associated with vegetable fermentation, their management, and the future prospects of vegetable fermentation are also discussed.
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