Disorders of gut-brain interaction (DGBI): clinical features and prevalence in the population
Disorders of gut-brain interaction (DGBI) are conditions in which gastrointestinal discomfort originates from an alteration in the bidirectional communication between the central nervous system and the gut. There is not necessarily an organic lesion: clinical presentation is guided by function, visceral sensitivity and motility, with symptoms that often fluctuate over time and are influenced by stress, nutrition and lifestyle.
According to the Rome IV criteria [1], this group includes: functional dyspepsia, irritable bowel syndrome (IBS), functional abdominal pain, defecation disorders, gastrointestinal motility disorders and other non-specific functional conditions. Diagnosis is primarily symptom-based.
In this context, intestinal regularity is a key element: acting on frequency, consistency and the sensation of complete evacuation means intervening on the physiological functioning of the colon. Patient education, targeted diet, stress management and dietary supplements can help restore balance in the gut-brain network.
Disorders of gut-brain interaction (DGBI) are far more common than generally perceived. The scale of the phenomenon is now well documented. International epidemiological studies conducted using harmonised criteria across 33 countries — including Italy — show that approximately four out of ten people meet the criteria for at least one DGBI [2].
Green kiwifruit: the first fresh fruit with an EU health claim on regularity
From iconic shelf product to a ‘fruit with a health message’ officially recognised at European level [3]. With Implementing Regulation (EU) 2025/1560 [4], the European Commission has authorised a health claim for green kiwifruit (Actinidia deliciosa, ‘Hayward’ variety) related to intestinal function. The consumer-facing wording is simple and measurable: “Consumption of green kiwifruit contributes to normal intestinal function by increasing stool frequency”.
This is not a catchy phrase: it is the result of a scientific dossier submitted to the European Food Safety Authority (EFSA) and an evaluation focused on the general population [5]. The approval follows a procedure initiated by Zespri International under Article 13(5) of Regulation (EC) No. 1924/2006 and the corresponding EFSA opinion, which recognised a cause-effect relationship between regular consumption of green kiwifruit and the maintenance of normal defecation in the general population.
Labelling and compliance: when the claim can be used
The claim is applicable only to fresh product. The regulation is very clear: the claim may be used for green kiwifruit sold whole, or for green kiwifruit that is peeled and/or sliced, provided the portion delivers at least 200 g of pulp. It is also mandatory to inform consumers that the beneficial effect is obtained with a daily intake of 200 g of fresh green kiwifruit pulp (approximately two medium-sized fruits).
This point is especially relevant for operators in the ‘ready-to-eat’ segment: trays and fruit salads containing only green kiwifruit pulp may refer to the claim only if they meet the 200 g per portion threshold and include the required information. The claim cannot be extended to juices, heat-treated purées, extracts, powders or composite products: the EFSA panel emphasised that studies conducted with foods other
Scientific evidence
The dossier evaluated by EFSA [5] includes clinical studies conducted in healthy subjects, showing that regular consumption of green kiwifruit increases stool frequency and, in some cases, also improves stool consistency, without relevant adverse effects. The mechanism is likely multifactorial: fibre and water content, as well as bioactive components typical of the ‘Hayward’ cultivar, which together promote intestinal motility and faecal bulk.
Nutritional profile supporting regularity
According to the USDA database [5], 100 g of raw green kiwifruit pulp provide 61 kcal (255 kJ), 1.14 g of protein, 14.7 g of carbohydrates (including 9.0 g of sugars), 0.52 g of fat and 3.0 g of fibre. Increasing the portion to 200 g — the amount required to achieve the claimed effect — results in approximately 6 g of fibre with just over 120 kcal.
Green kiwifruit contains around 3% total fibre, divided into one-third soluble (mainly pectins) and two-thirds insoluble (mostly cellulose and hemicellulose). Insoluble fibres are not broken down by the microbiota: they retain water within their structure and increase faecal bulk. Soluble fibres are fermented by intestinal bacteria, stimulating microbial growth and also contributing to faecal mass.
It is well known that greater faecal bulk improves peristalsis by increasing the diameter of the colonic lumen, reducing intraluminal pressure and facilitating stool flow — a physiological, non-pharmacological mechanism.
Beyond the nutritional profile: the nutraceutical role of kiwifruit
The applicant proposed — and the supporting literature discusses — a series of plausible mechanisms through which green kiwifruit may contribute to the observed effect [5]:
- Improved intestinal motility: not only due to the fibre content, but also to the presence of the enzyme actinidin, which can modulate gastric emptying and intestinal transit time.
- Permeability and mucus: fibres, phenols, raphides (naturally occurring microcrystals in the pulp) and the kiwi-derived peptide kissper can influence mucus secretion and the function of the intestinal barrier.
- Stool properties: fibre intake alters consistency and increases stool volume — factors directly linked to intestinal regularity.
- Microbiota: fibres, phenolic compounds and raphides promote microbial abundance, further increasing faecal bulk and potentially influencing short-chain metabolites
Communication guidelines
For operators, the authorisation opens up an interesting opportunity — provided it is managed in accordance with regulatory discipline:
- Use the approved wording (or its national equivalent) and include the condition of use: 200 g/day of fresh pulp.
- Limit the claim to whole fresh fruits or peeled/sliced pulp that reaches 200 g per portion.
- Do not extend the claim to juices, heat-treated purées, extracts, powders or composite products: the evidence does not support these formats.
- Avoid therapeutic promises (e.g. ‘against constipation’) or claims of disease risk reduction: these fall outside the authorised scope.
For healthcare professionals, the message becomes a practical and transparent recommendation: integrating two green kiwifruits per day into a balanced diet is a safe, nutritionally sound strategy aligned with the definition of normal intestinal function
Bibliography
[1] «Rome IV Criteria,» [Online]. Available: https://theromefoundation.org/rome-iv/rome-iv-criteria/.
[2] A. D. Sperber, «Highlights of the Findings From the Rome Foundation Global Epidemiology Study,» 2023.
[3] «Commission authorizes a health claims related to the normal functioning of the intestine for the green kiwi,» luglio 2025. [Online]. Available: https://foodcomplianceinternational.com/industry-insight/news/5565-commission-authorizes-a-health-claims-related-to-the-normal-functioning-of-the-intestine-for-the-green-kiwi.
[4] Commission Implementing Regulation (EU) 2025/1560 of 30 July 2025 authorising a health claim made on foods, other than those referring to the reduction of disease risk and to children’s development and health, and amending Regulation (EU) No 432/2012, 2025.
[5] «Kiwi verde (lat. Actinidia deliciosa Var. Hayward) emantenimento della defecazione normale: valutazione di unrichiesta di risarcimento a norma dell’articolo 13, paragrafo 5, del regolamento (CE)n. 1924/2006,» EFSA journal, 2021.
Edited by Riccardo Muscatello, graduate in MSc Human Nutrition Sciences at UniCamillus