Food Additive Emulsifiers and the Risk of Type 2 Diabetes: Analysis of Data from the NutriNet-Santé Prospective Cohort Study

Background Experimental studies have suggested potential detrimental effects of emulsifiers on gut microbiota, inflammation, and metabolic perturbations. We aimed to investigate the associations between exposures to food additive emulsifiers and the risk of type 2 diabetes in a large prospective cohort of French adults. Methods We analysed data from 104 139 adults enrolled in the French NutriNet-Sant & eacute; prospective cohort study from May 1, 2009, to April 26, 2023; 82 456 (79 center dot 2%) were female and the mean age was 42 center dot 7 years (SD 14 center dot 5). Dietary intakes were assessed with three 24 h dietary records collected over three non-consecutive days, every 6 months. Exposure to additive emulsifiers was evaluated through multiple food composition databases and ad-hoc laboratory assays. Associations between cumulative time-dependent exposures to food additive emulsifiers and the risk of type 2 diabetes were characterised with multivariable proportional hazards Cox models adjusted for known risk factors. The NutriNet-Sant & eacute; study is registered at ClinicalTrials.gov (NCT03335644). Findings Of 104 139 participants, 1056 were diagnosed with type 2 diabetes during follow-up (mean follow-up duration 6 center dot 8 years [SD 3 center dot 7]). Intakes of the following emulsifiers were associated with an increased risk of type 2 diabetes: total carrageenans (hazard ratio [HR] 1 center dot 03 [95% CI 1 center dot 01-1 center dot 05] per increment of 100 mg per day, p<0 center dot 0001), carrageenans gum (E407; HR 1 center dot 03 [1 center dot 01-1 center dot 05] per increment of 100 mg per day, p<0 center dot 0001), tripotassium phosphate (E340; HR 1 center dot 15 [1 center dot 02-1 center dot 31] per increment of 500 mg per day, p=0 center dot 023), acetyl tartaric acid esters of monoglycerides and diglycerides of fatty acids (E472e; HR 1 center dot 04 [1 center dot 00-1 center dot 08] per increment of 100 mg per day, p=0 center dot 042), sodium citrate (E331; HR 1 center dot 04 [1 center dot 01-1 center dot 07] per increment of 500 mg per day, p=0 center dot 0080), guar gum (E412; HR 1 center dot 11 [1 center dot 06-1 center dot 17] per increment of 500 mg per day, p<0 center dot 0001), gum arabic (E414; HR 1 center dot 03 [1 center dot 01-1 center dot 05] per increment of 1000 mg per day, p=0 center dot 013), and xanthan gum (E415, HR 1 center dot 08 [1 center dot 02-1 center dot 14] per increment of 500 mg per day, p=0 center dot 013). Interpretation We found direct associations between the risk of type 2 diabetes and exposures to various food additive emulsifiers widely used in industrial foods, in a large prospective cohort of French adults. Further research is needed to prompt re-evaluation of regulations governing the use of additive emulsifiers in the food industry for better consumer protection. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC-BY-NC 4.0 license.