Preservative Food Additives, Hypertension, and Cardiovascular Diseases: the NutriNet-Santé Study.

BACKGROUND AND AIMS:Experimental studies suggest that some preservative food additives may exert adverse cardiovascular effects, yet human data are lacking. The associations between exposure to these compounds and incidence of hypertension and cardiovascular diseases (CVD) were investigated in the NutriNet-Santé cohort (France, 2009-2024). METHODS:Dietary intakes were assessed using repeated 24-h dietary records (up to 96), including commercial brands. Exposure to food additives was evaluated through multiple composition databases and ad hoc laboratory assays in food matrices. Associations between cumulative time-dependent exposures to preservative food additives during follow-up and outcomes were characterized using multi-adjusted Cox models. RESULTS:Overall, 112 395 participants were included (78.7% women, mean age 42.8 ± 14.7 years) with a median follow-up of 7.9 years. The sum of total preservatives encompassed 58 substances consumed by at least one participant. Total non-antioxidant preservatives were positively associated with higher incidences of hypertension [n = 5544; hazard ratio (HR) higher vs. lower consumers: 1.29, 95% confidence interval (CI) 1.20-1.39] and CVD (n = 2450; HR 1.16, 95% CI 1.04-1.29), while total antioxidant preservatives were associated with higher incidence of hypertension (HR 1.22, 95% CI 1.13-1.31). Out of the 17 individual preservative food additives consumed by at least 10% of the study population, eight were associated with higher incidence of hypertension and one with higher incidence of CVD, after multiple test correction. CONCLUSIONS:Multiple associations between exposure to preservative food additives widely used in industrial foods and higher incidence of hypertension or CVD were observed in this large prospective cohort. Experimental research is needed to gain insight into underlying mechanisms. If confirmed, these new data call for the re-evaluation of regulations governing the use of these additives to improve consumer protection. TRIAL REGISTRATION:ClinicalTrials.gov NCT03335644.