Food additive preservatives and antioxidants and risk of type 2 diabetes - NutriNet-Santé cohort

Abstract Background Experimental studies suggested potential detrimental effects of some food additive preservatives and antioxidants (PA) on metabolic health, but epidemiological data is lacking. This study aimed to investigate for the first time the associations between exposures to a wide range of PA and type 2 diabetes (T2D) risk in a large population-based cohort. Methods Participants (n = 108,723, 79.2% women, mean age=42.5y, SD = 14.6) from the French NutriNet-Santé prospective cohort (2009-2023) completed repeated 24h-dietary records including specific brands of industrial products. PA exposure was assessed using composition databases and laboratory assays. We characterised associations between time-dependent exposures to PA and risk of T2D using multivariable Cox models adjusted for known confounders. Results 1131 T2D cases were identified during follow-up. Exposures to the following PA were associated with a higher risk of T2D: potassium sorbate E202 (HR per a 25 mg/d increment=1.12, 1.08-1.17, p < 0.001), sodium nitrite E250 (HR 0.25 mg/d = 1.06, 1.00-1.12, p = 0.04), calcium propionate E282 (HR 25 mg/d =1.07, 1.02-1.12, p = 0.008), lecithins E322 (HR 100 mg/d =1.02, 1.01-1.04, p = 0.008), citric acid E330 (HR 500 mg/d=1.08, 1.04-1.12, p < 0.001), and phosphoric acid E338 (HR 50 mg/d=1.11, 1.05-1.18, p < 0.001). Conclusions This large prospective cohort revealed positive associations between T2D risk and exposures to several PA widely used in industrial foods. Key messages • This large prospective cohort revealed positive associations between T2D risk and exposures to several PA widely used in industrial foods. • If these results are confirmed, regulations governing PA’s use by the food industry could be re-evaluated for better short- and long-term consumer protection.