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Fermentation is the anaerobic metabolism of carbohydrates by microorganisms and was utilized as a method of food preservation and storage long before its microbiology and chemistry were understood. A starter culture is a preparation of a microbiological culture that performs or initiates fermentation through several chemical means. Developments in understanding microbiota genetics and metabolism have led to an ability to select and propagate starter cultures that yield consistent and desired characteristics, which is a common practice today. This article describes lactic acid fermentation, acetic acid fermentation, alkaline fermentation, and traditional versus industrial fermentation and the role of starter cultures as well as health benefits, risks, and future possibilities.