Food additive emulsifiers and risk of cardiovascular disease in the NutriNet-Santé cohort: prospective cohort study
Authors: Sellem Laury , Srour Bernard , Javaux Guillaume , Chazelas Eloi , Chassaing Benoit , Viennois Emilie , Debras Charlotte , Salamé Clara , Druesne-Pecollo Nathalie , Esseddik Younes , de Edelenyi Fabien Szabo , Agaësse Cédric , De Sa Alexandre , Lutchia Rebecca , Louveau Erwan , Huybrechts Inge , Pierre Fabrice , Coumoul Xavier , Fezeu Léopold K , Julia Chantal , Kesse-Guyot Emmanuelle , Allès Benjamin , Galan Pilar , Hercberg Serge , Deschasaux-Tanguy Mélanie , Touvier Mathilde 
Published: September 2023

Abstract

Objective
To assess the associations between exposure to food additive emulsifiers and risk of cardiovascular disease (CVD).

Design
Prospective cohort study.

Setting
French NutriNet-Santé study, 2009-21.

Participants
95 442 adults (>18 years) without prevalent CVD who completed at least three 24 hour dietary records during the first two years of follow-up.

Main outcome measures
Associations between intake of food additive emulsifiers (continuous (mg/day)) and risk of CVD, coronary heart disease, and cerebrovascular disease characterised using multivariable proportional hazard Cox models to compute hazard ratios for each additional standard deviation (SD) of emulsifier intake, along with 95% confidence intervals.

Results
Mean age was 43.1 (SD 14.5) years, and 79.0% (n=75 390) of participants were women. During follow-up (median 7.4 years), 1995 incident CVD, 1044 coronary heart disease, and 974 cerebrovascular disease events were diagnosed. Higher intake of celluloses (E460-E468) was found to be positively associated with higher risks of CVD (hazard ratio for an increase of 1 standard deviation 1.05, 95% confidence interval 1.02 to 1.09, P=0.003) and coronary heart disease (1.07, 1.02 to 1.12, P=0.004). Specifically, higher cellulose E460 intake was linked to higher risks of CVD (1.05, 1.01 to 1.09, P=0.007) and coronary heart disease (1.07, 1.02 to 1.12, P=0.005), and higher intake of carboxymethylcellulose (E466) was associated with higher risks of CVD (1.03, 1.01 to 1.05, P=0.004) and coronary heart disease (1.04, 1.02 to 1.06, P=0.001). Additionally, higher intakes of monoglycerides and diglycerides of fatty acids (E471 and E472) were associated with higher risks of all outcomes. Among these emulsifiers, lactic ester of monoglycerides and diglycerides of fatty acids (E472b) was associated with higher risks of CVD (1.06, 1.02 to 1.10, P=0.002) and cerebrovascular disease (1.11, 1.06 to 1.16, P<0.001), and citric acid ester of monoglycerides and diglycerides of fatty acids (E472c) was associated with higher risks of CVD (1.04, 1.02 to 1.07, P=0.004) and coronary heart disease (1.06, 1.03 to 1.09, P<0.001). High intake of trisodium phosphate (E339) was associated with an increased risk of coronary heart disease (1.06, 1.00 to 1.12, P=0.03). Sensitivity analyses showed consistent associations.

Conclusion
This study found positive associations between risk of CVD and intake of five individual and two groups of food additive emulsifiers widely used in industrial foods.

Trial registration

ClinicalTrials.gov
NCT03335644
.