Food additive emulsifiers and risk of cardiovascular disease in the NutriNet-Santé cohort: prospective cohort study

Laury Sellem (1) , Bernard Srour (1) , Guillaume Javaux (1) , Eloi Chazelas (1) , Benoit Chassaing (2) , Émilie Viennois (3) , Charlotte Debras (1) , Clara Salamé (1) , Nathalie Druesne-Pecollo (4) , Younes Esseddik (1) , Fabien Szabo de Edelenyi (1) , Cédric Agaësse (1) , Alexandre de Sa (1) , Rebecca Lutchia (1) , Erwan Louveau (1) , Inge Huybrechts (5) , Fabrice H.F. Pierre (6) , Xavier Coumoul (7) , Léopold K Fezeu (1) , Chantal Julia (1, 8) , Emmanuelle Kesse-Guyot (1) , Benjamin Allès (1) , Pilar Galan (1) , Serge Hercberg (1) , Mélanie Deschasaux-Tanguy (1) , Mathilde Touvier (1)

1 EREN [CRESS - U1153 / UMR_A 1125] - Nutritional Epidemiology Research Team | Equipe de Recherche en Epidémiologie Nutritionnelle
2 Interactions microbiote/mucus dans les maladies inflammatoires chroniques = Mucosal microbiota in chronic inflammatory diseases
3 CRI (UMR_S_1149 / ERL_8252 / U1149) - Centre de recherche sur l'Inflammation
4 CRESS (U1153 / UMR_A 1125) - Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques
5 CIRC - IARC - Centre International de Recherche contre le Cancer - International Agency for Research on Cancer
6 ToxAlim-PPCA - Prévention et promotion de la cancérogénèse par les aliments
7 T3S - UMR_S 1124 - Toxicité environnementale, cibles thérapeutiques, signalisation cellulaire
8 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)

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.

Domaines: Sciences du Vivant [q-bio]

Laury Sellem, Bernard Srour, Guillaume Javaux, Eloi Chazelas, Benoit Chassaing, et al.. Food additive emulsifiers and risk of cardiovascular disease in the NutriNet-Santé cohort: prospective cohort study. BMJ - British Medical Journal, 2023, 382, pp.e076058. ⟨10.1136/bmj-2023-076058⟩. ⟨hal-04205056⟩