Two mixtures of food additives are associated with the development of type 2 diabetes

This study analyses the association between the consumption of different combinations of additives used in the food industry and the risk of developing diabetes. The researchers examined the information of more than 100,000 people in France, who reported their usual consumption of processed foods, and from this they calculated the additives consumed. The main results are that combinations of additives found in broths and sauces, and combinations of sweetened drinks, both with artificial sweeteners and sugars, were associated with an increased risk of diabetes seven years after the start of the study.

This work is very relevant because it identifies specific combinations of food additives that have a harmful effect and that explain previous findings that associated the consumption of ultra-processed food with an increased risk of diabetes. The data comes from a population study, with real information on what the participants consume on a regular basis. This is an advantage because it examines foods that the population actually consumes and looks at their effect years after this consumption, which is assumed to be regular.

The limitations of this study have to do with the fact that it is possible that the participants changed their diet over the years of follow-up and this information has not been collected. The other limitation is that, as it is a population study, it cannot be assured that other factors that are also associated with the consumption of these additives may have a role in the development of diabetes and, therefore, the additives may not be the real cause of the disease.

The implications of the results are that it is possible that additives that have been approved as meeting safety criteria in accordance with food legislation, in certain combinations used to prepare processed foods, could be really harmful to health.

Today, scientific evidence supports a harmful effect of the consumption of ultra-processed foods on health. A high consumption of these foods increases the risk of mortality and chronic diseases. In addition to having an unhealthy nutritional profile with a high salt, fat and sugar content, ultra-processed foods also contain mixtures of additives used in the food industry, such as emulsifiers, flavourings, sweeteners and colourings. There are more than 300 authorised food additives in Europe. They are regulated by regulation EC/1333/2008. Their safety has been previously evaluated by the European Food Safety Authority (EFSA), which proposes acceptable daily intakes for some of them. However, the safety assessment of food additives is carried out from a predominantly toxicological perspective based mainly on the cytotoxicity and genotoxicity of a single additive without taking into account the effects of long-term joint consumption of additives.

The study published in Plos Medicine is based on a prospective observational cohort study, the NutriNet Santé cohort, which has detailed information on food consumption, including brands and trade names of the products consumed using three non-consecutive 24-hour recalls. For the first time, the authors of the study have identified the main mixtures of additives consumed by the French population based on the frequency of consumption of the participants and have evaluated how these mixtures of additives are associated with the risk of developing type 2 diabetes.

The authors identified five main additive mixtures. One additive mixture was characterised by several emulsifiers (starches, pectins, guar gum, carrageenan, polyphosphates, xanthan gum), a preservative (potassium sorbate) and a colouring agent (curcumin), a mixture typical of a variety of ultra-processed foods such as soups, dairy desserts and sauces, as well as another mixture of additives consisting of acidifiers and acidity regulators (citric acid, sodium citrates, phosphoric acid, malic acid), colourings (ammonium sulphite caramel, anthocyanins, paprika extract), artificial sweeteners (acesulfame potassium, aspartame, sucralose), and emulsifiers (gum arabic, pectin, guar gum) a typical mixture of sugary and sweetened drinks. Both mixtures were associated with an increased risk of type 2 diabetes even when taking into account the nutritional quality of the food consumed by the participants.

It remains to be seen whether these mixtures of additives are also associated with other chronic diseases or with higher mortality rates but, while more epidemiological studies are being carried out, these results suggest that mixtures of food additives should be considered in order to evaluate their safety and to reassess the laws that regulate them in order to protect the health of the population. Furthermore, these findings continue to support the Public Health recommendation to limit the consumption of ultra-processed foods and promote the consumption of minimally processed foods typical of a Mediterranean diet.