Food emulsifiers and risk of type 2 diabetes: results from the prospective NutriNet-Santé cohort

BACKGROUND: Emulsifiers are the most ubiquitous food additives. Experimental studies showed an emulsifier-induced gut microbiota dysbiosis stimulating inflammation. This study is the first to investigate the association between food additive emulsifiers and type 2 diabetes risk in a large population-based cohort. METHODS: Repeated 24h dietary records with brand-specific information were administered within the French NutriNet-Santé cohort (2009-2022), allowing qualitative and quantitative assessment of food additive exposures. Multi-adjusted cox models were used for statistical analysis. RESULTS: This study included 104,168 adults (79.2% women, mean age at baseline=42.7y (SD 14.5)). 1,057 incident T2D were diagnosed. Intakes of total emulsifiers (HR = 1.18[1.00-1.39] for tertile 3 vs 1, p-trend=0.049), total carrageenan (HR = 1.20[1.01-1.42], p = 0.04), tripotassium phosphate (E340, HR = 1.45[1.10-1.91], p < 0.001), triphosphates (E451, HR = 1.39[1.16-1.67], p < 0.001), polyphosphates (E452, HR = 1.36[1.14-1.62], p < 0.001), total polyglycerol esters of FAs (HR = 1.34[1.10-1.63], p < 0.001), polyglycerol esters of interesterified ricinoleic acid (E476, HR = 1.26[1.03-1.54], p < 0.001), sodium citrate (E331, HR = 1.19[1.02-1.40], p = 0.03), carob bean gum (E410, HR = 1.19[1.01-1.40], p = 0.03), guar gum (E412, HR = 1.35[1.14-1.59], p < 0.001), xanthan gum (E415, HR = 1.29[1.09-1.52], p < 0.001) and ammonium salts of phosphatidic acid (E442, HR = 1.31[1.03-1.66], p = 0.01) were positively associated with T2D risk. The only inverse association was observed for sodium bicarbonate (E500, HR = 0.84[0.71-1.00], p = 0.047). CONCLUSIONS: This study revealed direct associations between T2D risk and exposures to nine individual and two groups of food additive emulsifiers widely used in industrial foods in a large prospective cohort of French adults. If confirmed, these findings could lead to a reevaluation of regulations governing the use of food additive emulsifiers in the food industry for a better consumer protection. KEY MESSAGES: • Study finds positive associations between certain emulsifiers and type 2 diabetes risk in French adults. • Results highlight the need for re-evaluation of regulations for food additive emulsifiers to protect consumer health.