Food additives up risk of CVD

Intake of additive emulsifiers, which is widely used in industrial foods, appears to increase the risk of cardiovascular disease (CVD), suggests a recent study.

“Despite the moderate magnitude of the associations, these findings may have important public health implications given that these food additives are used ubiquitously in thousands of widely consumed ultra-processed food products,” the investigators said.

“The results will contribute to the re-evaluation of regulations around food additive usage in the food industry to protect consumers,” they added.

This prospective cohort study included 95,442 adults (mean age 43.2 years, 79 percent women) from the French NutriNet-Santé study (2009‒2021) without prevalent CVD, who completed at least three 24-hour dietary records during the first 2 years of follow-up.

A total of 1,995 incident CVD, 1,044 coronary heart disease (CHD), and 974 cerebrovascular disease events had been diagnosed over a median follow-up of 7.4 years. [BMJ 2023;382:e076058]

Greater consumption of celluloses (E460-E468) contributed to increased risks of CVD (hazard ratio [HR] for an increase of 1 standard deviation, 1.05, 95 percent confidence interval [CI], 1.02‒1.09; p=0.003) and CHD (HR, 1.07, 95 percent CI, 1.02‒1.12; p=0.004).

Higher intake of cellulose E460, in particular, showed a positive association with greater risks of CVD (HR, 1.05, 95 percent CI, 1.01‒1.09; p=0.007) and CHD (HR, 1.07, 95 percent CI, 1.02‒1.12; p=0.005). Greater intake of carbodymethylcellulose (E468) also correlated with increased risks of CVD (HR, 1.03, 95 percent CI, 1.01‒1.05; p=0.004) and CHD (HR, 1.04, 95 percent CI, 1.02‒1.06; p=0.001).

In addition, higher intakes of monoglycerides and diglycerides of fatty acids (E471 and E472) contributed to greater risks of all outcomes.

Ultra-processed foods

Among these food additives, lactic ester of monoglycerides and diglycerides of fatty acids (E472b) was linked to increased CVD (HR, 1.06, 95 percent CI, 1.02‒1.10; p=0.002) and cerebrovascular disease risks (HR, 1.11, 95 percent CI, 1.06‒1.16; p<0.001).

Citric acid ester of monoglycerides and diglycerides of fatty acids (E472c) also significantly correlated with higher risk of CVD (HR, 1.04, 95 percent CI, 1.02‒1.07; p=0.004) and CHD (HR, 1.06, 95 percent CI, 1.03‒1.09; p<0.001). Additionally, high intake of trisodium phosphate (E339) resulted in a higher CHD risk (HR, 1.06, 95 percent CI, 1.00‒1.12; p=0.03).

Such associations persisted in sensitivity analyses.

“These findings should be replicated in future epidemiological cohorts and mechanisms should be further elucidated by experimental approaches,” the researchers said.

“Meanwhile, several public health authorities recommend limiting the consumption of ultra-processed foods as a way of limiting exposure to nonessential controversial food additives,” they added. [www.hcsp.fr/explore.cgi/avisrapportsdomaine?clefr=632; www.fao.org/3/ca5644en/ca5644en.pdf]

In Europe and North America, ultra-processed foods provide 30‒60 percent of dietary energy intakes in adults. These products are usually formulated using cosmetic food additives and ingredients of “rare culinary use.” [Nutrients 2021;13:682; Eur J Nutr 2022;61:1521-1539; BMJ Open 2016;6:e009892]

In recent epidemiological studies, high intakes of ultra-processed foods have been linked to greater risks of obesity and mortality, as well as noncommunicable diseases, such as cancers, CVD, and type 2 diabetes. [Lancet Gastroenterol Hepatol 2022;7:1128-1140]

“One major hypothesis proposed to explain these associations is the potential deleterious properties of some food additives, which are used ubiquitously in ultra-processed foods,” the researchers said. [Lancet Gastroenterol Hepatol 2022;7:1128-1140; Sci Rep 2020;10:3980]