Food Additive Emulsifiers Linked to Increased CVD Risk


Additive emulsifiers commonly found in processed foods are associated with increased risks of cardiovascular disease (CVD), results from a large prospective cohort study suggest.


  • Studies have linked high intake of ultraprocessed foods with elevated risks of CVD, possibly because of negative effects of additives used as thickening agents and to improve texture and lengthen shelf life.

  • Research also suggests food additives such as emulsifiers, which are found in more than half of industrial food or beverage products in France, may have deleterious effects on the gut microbiota and gut inflammation, and impact CVD.

  • The analysis included 95,442 mostly female volunteer participants in the NutriNet-Santé prospective study, mean age 43.1 years, who did not have CVD at baseline and completed at least 3 days of web-based 24-hour dietary records.

  • Researchers used various databases to collect information and assess the association between intake of food additives consumed by at least 5% of participants and risks of CVD, coronary heart diseases, and cerebrovascular diseases.


  • During a mean follow-up of 7.4 years, there were 1995 incident CVD events, 1044 coronary heart disease events, and 974 cerebrovascular disease events.

  • After adjusting for sociodemographic, health, and lifestyle factors as well as for intake of food elements possibly affecting CVD risk such as sugar, sodium, saturated fatty acids, fiber, and artificial sweeteners, higher intake of total celluloses was associated with increased risks of CVD (hazard ratio [HR] for an increase of 1 standard deviation, 1.05; 95% CI, 1.02 – 1.09; P = .004) and coronary heart disease (HR, 1.07; 95% CI, 1.02 – 1.12; P = .004).

  • Higher intakes of total monoglycerides and diglycerides of fatty acids were associated with higher risks of all three outcomes: CVD (HR, 1.07; P < .001), coronary heart disease (HR, 1.08; P = .001), and cerebrovascular disease (HR, 1.07; P = .02).

  • Trisodium phosphate was associated with higher risks of coronary heart disease (HR, 1.06; P = .03).

  • Results of multiple sensitivity analyses were consistent with those from the main models, suggesting consistency and robustness of the findings, the researchers say.


The study may have important public health implications given food additives are used in thousands of commonly consumed ultraprocessed food products, the authors write, adding that the results “will contribute to the reevaluation of regulations around food additive usage in the food industry to protect consumers.”


The study was carried out by Laury Sellem, Université Sorbonne and Université Paris Cité, Center of Research in Epidemiology and Statistics (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France. It was published online September 6 in The BMJ.


The study population was mostly women (79.0%), and participants were better educated and had more healthy behaviors compared with the general French population, which may limit the generalizability of the results. As women tend to have healthier diets with lower emulsifier intakes than men, and a lower absolute risk of CVD, the study is likely to have underestimated the strength of the associations. The study did not capture emulsifier intakes in foods exempt from food labelling (for example, bakery items), and nonadditive emulsifiers occurring naturally in foods such as eggs. Residual confounding in the associations can’t be entirely ruled out.


The study was supported by the Ministère de la Santé, Santé Publique France, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche pour l’agriculture, l’alimentation et l’environnement, Conservatoire National des Arts et Métiers, and Université Sorbonne Paris Nord. The authors have disclosed no relevant financial relationships.

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