Food packaging/processing contaminants and risk of Cardiovascular Disease – NutriNet-Santé cohort

Abstract Background The food items we consume are contaminated by several substances (e.g., Polycyclic aromatic hydrocarbons - PAHs, Brominated Flame Retardants - BFRs) throughout their lifecycle. This study aims to investigate the associations between exposure to contaminants originating from food processing and food packaging and cardiovascular diseases risk (CVD) in the NutriNet-Santé cohort. Methods We assessed cumulative time-dependent exposures to food contaminants from repeated 24h-dietary records using food composition databases for 110,356 participants (79.2% women, mean age=42.5 y, SD = 14.6) from the French prospective cohort NutriNet-Santé (2009-2024) and quantitative analysis from the French total diet study 2 (2006-2009). We characterised associations between exposures to these contaminants (sex-specific tertiles) and CVD risk using multivariable proportional hazards Cox models adjusted for known risk factors. Results Over a median follow-up time of 7.93 years, 2,450 cases of CVD were ascertained. Higher dietary exposures to PAHs (e.g., benzo(a)anthracene and benzo(k)fluoranthene) were associated with a higher CVD risk as well as the exposure to the sum of the eight main PAHs representative of dietary exposure (HRT3 vs. T1=1.13, 95%CI [1.01-1.25], p-trend=0.03). Among the BFRs, the sum of Brominated Diphenyl Ethers (BDEs) was associated with a higher CVD risk (1.12 [1.01-1.25], 0.03), together with individual BDEs such as BDE28 or BDE47. Some contaminants were also positively associated with higher cerebrovascular disease or coronary heart disease risks. Conclusions This large prospective cohort study suggests a potential role for food contaminants such as PAHs and BFRs, in CVD etiology, which is consistent with their metabolic disrupting potential suggested by previous in vivo/in vitro studies. Our findings need to be replicated in other epidemiological studies and if confirmed, these elements advocate for stronger regulations on these food contaminants. Key messages • Some substances found in food contact material and/or generated during food processing might be associated with a higher risk of cardiovascular diseases. • If corroborated by further studies, our study underscores the necessity for stricter regulations on food contaminants.