Food additive emulsifiers linked to increased risk of type 2 diabetes

By Priyanjana Pramanik, MSc.Reviewed by Benedette Cuffari, M.Sc.Apr 25 2024

In a recent study published in The Lancet Diabetes & Endocrinology, researchers investigate the association between food additive emulsifier exposure and risk of type 2 diabetes (T2D).

The study results indicate that the intake of several emulsifiers, including carrageenans, tripotassium phosphate, and guar gum, was associated with a raised T2D risk. Thus, the results demonstrate the need to reevaluate regulations that govern the use of these additives for strengthened consumer protection.

Study: Food additive emulsifiers and the risk of type 2 diabetes: analysis of data from the NutriNet-Santé prospective cohort study. Image Credit: Helge Hoepfner / Shutterstock.com

The health risks of emulsifiers

Food additives, including emulsifiers, are extensively used to produce ultra-processed foods to enhance texture and prolong shelf-life. These additives, which can be found in a wide range of products like chocolate, ice cream, and pastries, have been linked to cardiovascular disease, metabolic disorders, and inflammation, as well as chronic conditions like T2D, obesity, and hypertension.

The NutriNet-Santé study in France observed a correlation between high intake of ultra-processed foods and increased T2D risk, a trend reported in studies from other countries. Despite experimental evidence suggesting emulsifiers can disrupt gut microbiota and promote inflammation, few epidemiological studies have examined their association with T2D risk.

About the study

The current study was conducted as part of the NutriNet-Santé cohort study, a population-based prospective study in France that aimed to investigate the relationship between nutrition and health. Study participants were recruited from the general population and asked to provide detailed information through questionnaires covering lifestyle, health status, dietary habits, anthropometric data, and physical activity.

Dietary data, including emulsifier intake, were collected through three non-consecutive 24-hour dietary records every six months. Emulsifier intakes were quantified based on participants' dietary records, which were linked to food composition databases.

T2D cases were identified through self-reports, health questionnaires, national health insurance databases, and mortality registries.

The analyses conducted using Cox models assessed the association between emulsifier intake and T2D risk. Several confounding factors, such as age, sex, body mass index (BMI), smoking status, and dietary factors,s were considered. Additional sensitivity analyses were performed and adjusted for common cardiometabolic diseases and artificial sweeteners.

Study findings

Data from 104,139 individuals, 79.2% female, were obtained between 2009 and 2023. The average age of the study participants was 42.7 years during baseline data collection.

Data were collected on participants' characteristics, including demographics, health status, and dietary habits. A total of 1,056 cases of T2D with an average follow-up duration of 6.8 years were identified.

Each participant completed a mean of 5.7 dietary records, with 99.7% showing exposure to one or more food additive emulsifiers. The mean energy intake without alcohol was 1,846.2 kcal per day, whereas the average intake of total emulsifiers was 4,191.9 mg per day.

The primary sources of exposure to food additive emulsifiers were ultra-processed fruits and vegetables, cakes and biscuits, and dairy products, which accounted for 18.5%, 14.7%, and 10% of overall emulsifier intake, respectively. The intake of several emulsifiers was positively correlated with the risk of developing T2D.

Total carrageenans were associated with the highest risk, with increasing consumption by 100 mg daily, increasing the risk of T2D by 3%. Moreover, carrageenans gum, xanthan gum, tripotassium phosphate, acetyl tartaric acid esters of monoglycerides and diglycerides of fatty acids, sodium citrate, guar gum, and gum arabic were associated with significantly higher hazard ratios.

Conclusions

A total of seven individual emulsifiers and one group of emulsifiers were positively associated with the risk of T2D. The current study also distinguished between emulsifiers associated with cardiovascular disease and those linked to T2D. These observations suggest unique risk profiles associated with each condition, which may be due to different biological pathways affected by these compounds.

Although authorized emulsifiers are considered safe based on acceptable daily intake (ADI) levels, recent evidence has increased concerns about the importance of revising these ADIs, particularly considering their potential adverse effects on gut microbiota and inflammation. Thus, the study findings indicate the potential need to revise regulations governing the use of emulsifiers in food products, considering their widespread consumption and potential impact on public health.

Further research, including mechanistic epidemiology and experimental studies, is needed to understand better the biological mechanisms underlying these associations.