Loading ...

Food additives are ubiquitous in ultraprocessed foods. Three new studies conducted by researchers from the French National Institute of Health & Medical Research; France’s National Research Institute for Agriculture, Food and Environment; Université Sorbonne Paris Nord; Université Paris Cité; and the Conservatoire National des Arts et Métiers, Paris, France, suggested that certain food colorings may be associated with an increased risk for type 2 diabetes (T2D) and cancer, while several preservatives have been linked to a higher risk for hypertension and cardiovascular disease.

According to data from the Open Food Facts World database, more than 139,000 food and beverage products available in 2024 had at least one food coloring additive (E100-E199), while more than 700,000 had at least one preservative (E200-E399).

Researchers noted that despite the widespread use of food additives, epidemiologic data evaluating associations between additives and chronic diseases remain limited.

To address this gap, researchers from the NutriNet-Santé cohort, an ongoing, web-based prospective study launched in France in 2009 to investigate the complex relationship between nutrition and human health. It features over 100,000 adult participants who track their food consumption and lifestyle habits using repeated 24-hour dietary records.

Dietary intake was assessed through repeated 24-hour dietary records, including commercial brands. Exposure to food additives was then assessed using multiple compositional databases and ad hoc laboratory assays of food matrices.

Among 37 colorants and 58 preservatives identified, researchers analyzed 10 colorings and 17 preservatives that were consumed by at least 10% of participants.

Diabetes Risk

One study evaluated associations between exposure to food coloring additives and T2D incidence among 108,723 participants followed from 2009 to 2023. Results showed that participants with the highest intake of food colorings had a 38% higher risk for T2D than those with the lowest exposure (hazard ratio [HR], 1.38; 95% CI, 1.17-1.63).

Certain categories of colorings showed particularly strong associations. Caramels were associated with a 43% higher risk for T2D (HR, 1.43; 95% CI, 1.21-1.67), as were carotenoids (E160) at 39% (HR, 1.39; 95% CI, 1.19-1.62), beta-carotene (E160a) at 44% (HR, 1.44; 95% CI, 1.23-1.68), plain caramel (E150a) at 46% (HR, 1.46; 95% CI, 1.26-1.70), curcumin (E100) at 49% (HR, 1.49; 95% CI, 1.29-1.73), and anthocyanins (E163) at 40% (HR, 1.40; 95% CI, 1.17-1.68). The authors noted that these colorings are commonly found in ultraprocessed foods.

Cancer Risk

A second study examined associations between food colorings, additives, and cancer incidence in 105,260 adults followed between 2009 and 2023. During follow-up, researchers found 4226 new cancer cases, including 1208 breast cancers, 508 prostate cancers, and 352 colorectal cancers.

High consumption of food colorings was associated with a 14% higher risk for overall cancer (HR, 1.14; 95% CI, 1.05-1.24), a 21% higher risk for breast cancer (HR, 1.21; 95% CI, 1.03-1.42), and a 32% higher risk for postmenopausal breast cancer (HR, 1.32; 95% CI, 1.09-1.61) than low or no intake. In analyses of individual additives, beta-carotene (E160a) was associated with a 16% higher risk for overall cancer (HR, 1.16; 95% CI, 1.07-1.25) and a 41% higher risk for breast cancer (HR, 1.41; 95% CI, 1.23-1.62), while plain caramel (E150a) was associated with a 15% higher risk for overall cancer (HR, 1.15; 95% CI, 1.07-1.25).

Cardiovascular Findings

The third study focused on food preservatives and included 112,395 participants, followed from 2009 to 2024. Participants with the highest preservative intake had a 24% higher risk for hypertension (HR, 1.24; 95% CI, 1.16-1.34) and a 29% higher risk for hypertension associated with non-antioxidant preservatives (HR, 1.29; 95% CI, 1.20-1.39) than those with little or no exposure. Non-antioxidant preservatives were also associated with a 16% higher risk for cardiovascular disease (HR, 1.16; 95% CI, 1.04-1.29), while antioxidant preservatives were linked to a 22% higher risk for hypertension (HR, 1.22; 95% CI, 1.13-1.31).

When individual preservatives were analyzed, potassium sorbate (E202) was associated with a 39% higher risk for hypertension (HR, 1.39; 95% CI, 1.28-1.50), citric acid (E330) with a 25% higher risk (HR, 1.25; 95% CI, 1.16-1.34), and ascorbic acid (E300) with a 15% higher risk for cardiovascular disease (HR, 1.15; 95% CI, 1.04-1.28). These findings build on two earlier NutriNet-Santé studies that also reported associations between food preservatives and increased risks for cancer and T2D.

Safety Reassessment

The authors noted that these are the first large-scale epidemiologic studies to evaluate a broad range of food colorings and preservatives. The analyses accounted for numerous potential confounders, including sociodemographic characteristics, smoking, alcohol consumption, physical activity, and overall dietary quality.

Pending a reassessment of additive safety by health authorities, the researchers said the findings support recommendations from the National Nutrition and Health Program to limit exposure to nonessential food additives and prioritize minimally processed foods.

This story was translated from Univadis France, part of the Medscape Professional Network.