Abstract
Metabolic syndrome is a cluster of cardiometabolic risk factors in which modifiable dietary factors play a substantial role. This structured narrative review summarizes evidence on biotechnological food reformulation, defined as the modification of the composition or functional properties of foods already present in the diet using enzymes, microorganisms, fermentation, and bioconversion. Approaches to reducing free sugar and sodium content, modifying lipid and protein components, and increasing micronutrient content and bioavailability are reviewed. The data were analyzed with a distinction between experimental systems (in vitro, animal, and human intervention and observational studies) and study populations (healthy individuals, individuals with risk factors, and patients with diagnosed metabolic diseases). Mechanistic and animal data support the biological plausibility of the effects of several reformulated products on individual cardiometabolic markers. However, human intervention studies are few and mostly short-term. They rely on surrogate markers and are often conducted in patients with established disorders; therefore, they do not allow conclusions to be drawn about preventive efficacy. Consumer acceptance, safety, regulatory status, and industrial scalability are discussed on the basis of limited and heterogeneous data and require separate assessment for each technology. Biotechnological reformulation may be considered a promising approach to improving the nutrient profile of mass-market foods. However, its impact on the risk of metabolic syndrome has not yet been established and should be evaluated in long-term randomized trials in individuals without diagnosed metabolic diseases.