ArticleBMJ (Clinical research ed.)2023
Food additive emulsifiers and risk of cardiovascular disease in the NutriNet-Santé cohort: prospective cohort study.
Article in BMJ (Clinical research ed.), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03335644 (The NutriNet-Santé Study. A Web-based Prospective Cohort Study of the Relationship Between Nutrition and Health and of Dietary Patterns and Nutritional Status Predictors), which is not on this map. Cited by 44 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The NutriNet-Santé Study. A Web-based Prospective Cohort Study of the Relationship Between Nutrition and Health and of Dietary Patterns and Nutritional Status Predictors
Who cites it
44 citing papers in PubMed, 59 citations in OpenAlex.
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- Ultra-Processed Foods and Food Additives in CKD: Unveiling Hidden Risks and Advocating Smarter Food Choices.Clinical journal of the American Society of Nephrology : CJASN · 2026Review
- Metabolomic pattern of ultraprocessed food intake and its association with colorectal cancer risk.Gut · 2025Article
- Plant Proteins as Alternative Natural Emulsifiers in Food Emulsions.Foods (Basel, Switzerland) · 2025Article
- Food additive mixtures in French children and adults: the nationally representative Esteban study.Scientific reports · 2025Article
- Vitamin DMolecular nutrition & food research · 2025Article
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- Food additives in Latin America: a descriptive analysis of the packaged food supply in five countries.Globalization and health · 2025Article
- A multilayer network analysis of cardiovascular-depression comorbidity reveals symptom-specific molecular biomarkers.Psychological medicine · 2025Article
- Ultra-Processed Food Consumption and Subclinical Cardiac Biomarkers: A Cross-Sectional Analysis of U.S. Adults in NHANES 2001-2004.Nutrients · 2025Article
- Food as Medicine for Hypertension: Microbiota as Mediators.Hypertension (Dallas, Tex. : 1979) · 2025Review
- Association of 37 markers of ultra-processing with all-cause mortality: a prospective cohort study in the UK Biobank.EClinicalMedicine · 2025Article
- Development of low-sodium mayonnaise using vegetable extract and high internal phase double emulsion.Food science and biotechnology · 2025Article
Corrections and comments
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Authors and funding
26 authors at 4 institutions in 1 country.
Funding
Abstract
objectiveTo assess the associations between exposure to food additive emulsifiers and risk of cardiovascular disease (CVD).
designProspective cohort study.
settingFrench NutriNet-Santé study, 2009-21.
participants95 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 measuresAssociations 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.
resultsMean 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.
conclusionThis 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 registrationClinicalTrials.gov NCT03335644.
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