Food additive mixtures in French children, adolescents and adults: the Esteban national study

Abstract Background Billions of people consume daily mixtures of food additives, yet safety assessments ignore “cocktail” effects due to limited exposure and effect data. This study aimed to identify food additive mixtures in a representative sample of the French population (cross-sectional Esteban survey, 2016). Methods Dietary intake and additive consumption were assessed via three non-consecutive 24-h recalls for adults and adolescents (≥11 y) and dietary records for children (≤10 y), including brand-specific industrial products. Additive composition was determined using food composition databases combined with laboratory analyses of food matrixes. Non-negative matrix factorization (NMF) identified additive mixtures. Associations with socio-demographic, anthropometric, lifestyle, and dietary variables were examined using survey-weighted regression. Results The study included 2,177 adults (18-74 y; mean 47.6 ± 0.4 y; 52.4% women) and 1,279 children/adolescents (6-17 y; mean 11.3 ± 0.1 y; 50.4% girls). Mean daily additive intake was 5.11 g/day in adults and 4.92 g/day in children/adolescents. Sixty additives were consumed by ≥ 5% of adults and 71 by children/adolescents. Frequently consumed additives included mono- and diglycerides of fatty acids, carrageenan, sodium nitrite, acesulfame K, aspartame, sulphite ammonia caramel, monosodium glutamate, sucralose, carboxymethylcellulose, and titanium dioxide. NMF detected three main mixtures in adults and four in children/adolescents, each with distinct sociodemographic and lifestyle profiles. Conclusions This first quantitative, brand-specific assessment of additive exposure and mixtures in a nationally representative survey reveals widespread consumption of numerous additives, including controversial ones, across age groups. Further research is needed to clarify health impacts of additive interactions. These findings support public health strategies to reduce ultra-processed food intake and non-essential additives. Key messages • This study provides novel insights into the food additives most frequently consumed by French children, adolescents and adults. • These results advocate for public health strategies aimed at reducing the consumption of ultra-processed foods and their non-essential additives.