SEARCHCOHORTcardiology, nutrition

cohort·cardiology, nutrition, epidemiology, public health, observational study·PMC10480690

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

The BMJ · 26 authors, 7 centres

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Cox proportional hazards models were used to assess associations between emulsifier intake and incident CVD, coronary heart disease, and cerebrovascular disease.

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Cox proportional hazards models were used to assess associations between emulsifier intake and incident CVD, coronary heart disease, and cerebrovascular disease. The central results showed that higher intake of cellulose emulsifiers (E460-E468, specifically E460 and E466) was associated with increased risks of CVD and coronary heart disease. Higher intake of monoglycerides and diglycerides of fatty acids (E471/E472, specifically E472b and E472c) was associated with increased risks of CVD, coronary heart disease, and cerebrovascular disease. The study was limited by its observational design, potential residual confounding, a predominantly female and health-conscious sample, and the lack of validation for emulsifier intake against biomarkers.

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cohort

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cardiology

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ORIGINAL PAPER

PMC10480690

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

The BMJ

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ABSTRACT

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 .

CITATION EXPORT

Laury Sellem, Bernard Srour, Guillaume Javaux et al.. Food additive emulsifiers and risk of cardiovascular disease in the NutriNet-Santé cohort: prospective cohort study. The BMJ. (2023). https://doi.org/10.1136/bmj-2023-076058

AUTHORS

26 · 7 CENTRES

Laury Sellem, Bernard Srour, Guillaume Javaux, Eloi Chazelas, Benoit Chassaing, Emilie Viennois, Charlotte Debras, Clara Salamé, Nathalie Druesne-Pecollo, Younes Esseddik, Fabien Szabo de Edelenyi, Cédric Agaësse, Alexandre De Sa, Rebecca Lutchia, Erwan Louveau, Inge Huybrechts, Fabrice Pierre, Xavier Coumoul, Léopold K Fezeu, Chantal Julia, Emmanuelle Kesse-Guyot, Benjamin Allès, Pilar Galan, Serge Hercberg, Mélanie Deschasaux-Tanguy, Mathilde Touvier

1Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
2INSERM U1016, team “Mucosal microbiota in chronic inflammatory diseases,” Université Paris Cité, Paris, France
3INSERM U1149, Centre for Research on Inflammation, Université de Paris, Paris, France
4International Agency for Research on Cancer, World Health Organization, Lyon, France
5Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France
6INSERM UMR-S 1124, Université Paris Cité, Paris, France
7Public Health Department, Groupe Hospitalier Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France