Summary:
Background:
Experimental studies have suggested that emulsifiers may have adverse effects on the gut microbiota, inflammation and metabolic disturbances. Our aim was to investigate the associations between exposure to food additive emulsifiers and the risk of type 2 diabetes in a large prospective cohort of French adults.
Methods:
We analysed data from 104,139 adults enrolled in the French prospective cohort study NutriNet-Santé between 1 May 2009 and 26 April 2023; 82,456 (79.2 per cent) were women and the mean age was 42.7 years (SD 14.5). Dietary intakes were assessed using three 24-hour dietary records collected on three non-consecutive days, every six months. Exposure to food additive emulsifiers was assessed using several food composition databases and ad hoc laboratory tests. Associations between cumulative time-weighted exposure to food additive emulsifiers and the risk of type 2 diabetes were characterised using multivariable proportional hazards Cox models adjusted for known risk factors. The NutriNet-Santé study is registered on ClinicalTrials.gov (NCT03335644).
Results:
Of the 104,139 participants, 1,056 were diagnosed with type 2 diabetes during the follow-up period (mean follow-up duration 6.8 years [SD 3.7]). Intake of the following emulsifiers was associated with an increased risk of type 2 diabetes: total carrageenans (hazard ratio [HR] 1.03 [95% CI 1.01–1.05] per 100 mg increase per day, p <0 ·0001), carrageenan gum (E407; HR 1.03 [1.01–1.05] per 100 mg increase per day, p<0.0001), tripotassium phosphate (E340; HR 1.15 [1.02–1.31] per 500 mg daily increase, p=0.023), acetyltartaric esters of monoglycerides and diglycerides of fatty acids (E472e; HR 1.04 [1.00–1.08] per 100 mg daily increment, p=0.042), sodium citrate (E331; HR 1.04 [1.01–1.07] per 500 mg per day increment, p=0.0080), guar gum (E412; HR 1.11 [1.06–1.17] per 500 mg per day increment, p<0.0001), gum arabic (E414; HR 1.03 [1.01–1.05] per 1,000 mg daily increase, p=0.013) and xanthan gum (E415, HR 1.08 [1.02–1.14] per 500 mg daily increase, p=0.013).
Interpretation:
In a large prospective cohort of French adults, we found direct associations between the risk of type 2 diabetes and exposure to various food additive emulsifiers widely used in processed foods. Further research is needed to prompt a reassessment of the regulations governing the use of emulsifier additives in the food industry, with a view to better protecting consumers.
Funding: European Research Council, National Cancer Institute, French Ministry of Health, IdEx Université de Paris and the Bettencourt-Schueller Foundation.
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