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Researchers in a large French epidemiological study found that certain food additive emulsifiers were individually associated with slight increases in cardiovascular disease (CVD) risk. Emulsifiers are commonly used to blend oils and water in processed foods, extending their shelf-life. The NutriNet-Santé study revealed positive links between various emulsifiers and higher risks of CVD and coronary heart disease. After adjusting for multiple factors, carboxymethylcellulose, citric acid ester of monoglycerides, and diglycerides of fatty acids remained associated with increased CVD and coronary heart disease risks over more than 7 years of follow-up.
Lactic ester of monoglycerides and diglycerides of fatty acids were also linked to an elevated risk of CVD. However, due to the observational nature of the study, causality couldn’t be confirmed. The researchers took steps to isolate the role of emulsifiers by considering factors like the proportion of ultra-processed foods in the diet and various dietary features impacting CVD risk.
While processed foods have been previously linked to obesity, CVD, cancer, and mortality, the specific effects of food additives were less clear. Emulsifiers are widely used, with over half of processed foods worldwide containing at least one.
Although studies in animals and laboratories suggest emulsifiers can impact the microbiome and cause gut inflammation, there’s limited research in humans. Therefore, it’s not yet advised for everyone to avoid emulsifiers. Identifying cause and effect would require clinical trials, but in the meantime, adopting a healthier diet, including fruits and vegetables, cooking from scratch, exercising, and avoiding smoking, are important steps.
The study authors, nonetheless, suggest that their findings support the need for new food regulations to safeguard consumers, considering the widespread use of emulsifiers in many commonly consumed ultra-processed food products.
This study was based on the French NutriNet-Santé cohort, spanning from 2009 to 2021, including over 95,000 adults without baseline CVD. Participants provided at least three 24-hour food diaries in the first two years of participation, enabling the collection of data on specific commercial brands of industrial food consumed, as well as exposure to individual food additives.
The most consumed emulsifiers were modified starches, sodium bicarbonate, and pectins. Emulsifiers were most often found in processed fruits and vegetables, cakes and cookies, and dairy products. The follow-up lasted a median of 7.4 years, during which participants self-reported any major health events, supported by medical records.
However, the study had limitations, including an overrepresentation of women and highly educated individuals in the French cohort, potentially affecting generalizability. Additionally, emulsifier consumption might have been underestimated due to the study’s inability to capture them in non-labeled and naturally occurring settings. The researchers noted that future studies would further strengthen the plausibility of causal associations.
