People who consume large amounts of some emulsifiers – E numbers – could be at greater risk of developing cardiovascular disease, researchers report today.
A French study, published in The BMJ, led by a team at Université Sorbonne Paris Nord and Université Paris Cité, says the findings “contribute to the re-evaluation of regulations around food additive usage in the food industry to protect consumers”.
Emulsifiers are often added to processed and packaged foods and include celluloses, mono- and diglycerides of fatty acids, modified starches, lecithins, phosphates, gums and pectins.
Recent research has suggested emulsifiers can disrupt gut bacteria and increase inflammation, leading to potentially increased susceptibility to cardiovascular problems.
To explore this further, the researchers set out to assess the associations between exposure to emulsifiers and risk of cardiovascular disease, including coronary heart disease and cerebrovascular disease.
They examined 95,442 French adults who were taking part in the NutriNet-Santé cohort study between 2009 and 2021. Their average age was 43 years and 79% of whom were women. None had a history of heart disease.
During the first two years of follow-up, participants completed between three and 21 24-hour online dietary records.
Each food and beverage item consumed was matched at the brand level against three databases to identify the presence and the dose of any food additive. Laboratory tests were also performed to provide quantitative data.
Participants were also asked to report any major CVD event and these were validated by an expert committee after reviewing the participants’ medical records.
After an average follow-up of seven years, higher intake of total celluloses (E460-E468), cellulose (E460) and carboxymethylcellulose (E466) were found to be associated with higher risks of CVD and specifically coronary heart disease.
High intakes of monoglycerides and diglycerides of fatty acids (E471 and E472) were associated with increased risks of all studied outcomes. Among these emulsifiers, lactic ester of monoglycerides and diglycerides of fatty acids (E472b) was associated with increased risks of CVD and cerebrovascular diseases, and citric acid ester of monoglycerides and diglycerides of fatty acids (E472c) was associated with raised risks of CVD and coronary heart disease.
High intake of trisodium phosphate (E339) was also associated with an increased risk of coronary heart disease.
There was no evidence of an association between the other studied emulsifiers and any of the cardiovascular outcomes.
Although this was an observational study, with some limitations, the authors say they used a large sample and adjusted for a wide range of potentially influential factors. Nevertheless, they added their results need to be assessed in other large-scale studies.
Sellem M, Srour B, Javaux G et al. Food additive emulsifiers and risk of cardiovascular disease in the NutriNet-Santé cohort: prospective cohort study. BMJ 7 September 2023; doi: 10.1136/bmj-2023-076058
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