Thousands of widely consumed food products could raise your heart disease risk

French researchers following a largely female group of nearly 100,000 participants found those with higher intakes of E-numbers were more likely to suffer from diseases of the heart or blood vessels.

The study, published in the BMJ, looked at the crossovers between consumption of highly processed foods containing emulsifiers – part of the E-numbers group – and cardiovascular disease (CVD).

Several emulsifiers are used “ubiquitously” in processed foods such as pastries, cakes, ice creams, desserts, chocolate, bread, margarine and ready meals to enhance their texture, taste and appearance and extend their shelf lives.

These processed products, while unhealthy, are also often far more affordable than healthier foods as they can be produced more efficiently.

The emulsifying E-numbers are used in thousands of widely consumed food products – making their health implications highly important.

They include celluloses, mono- and diglycerides of fatty acids, modified starches, lecithins, carrageenans – derived from red seaweed and used to thicken foods – phosphates, gums and pectins.

Their safety is regularly assessed, with recent research suggesting emulsifiers can disrupt gut bacteria and increase inflammation, potentially making people more susceptible to cardiovascular problems.

The French research team, led by biomedical expert Dr Bernard Srour, insisted further studies were needed, but reiterated public health advice to limit the consumption of ultra-processed foods in order to stay healthy.

The team set out to assess the associations between exposure to emulsifiers and the risk of cardiovascular disease, including coronary heart disease and cerebrovascular disease – conditions affecting blood flow and blood vessels in the heart and brain.

They used data relating to 95,442 French adults from the NutriNet-Santé cohort study held between 2009 and 2021.

The majority of the cohort – 79 per cent – were women, and the group had an average age of 43.

During the initial two years of follow-up, participants were asked to complete between three and 21 24-hour online dietary records.

Each item of food and drink was then matched at brand level against three databases, to identify the dosage of any food additives present.

Laboratory tests were also performed to provide quantitative data.

The participants also reported any major CVD events – such as a heart attack or stroke – which were then validated by an expert committee after a reviewal of the relevant participants’ medical records.

Deaths linked to CVD events were also recorded using the French national death register, whilst risk factors for heart disease including age, sex, weight, educational level, family history, smoking, physical activity levels and diet quality were also taken into account.

After an average follow-up of seven years, the study team found a higher intake of total celluloses (E460-E468), cellulose (E460) and carboxymethylcellulose (E466) was associated with a higher risk of CVD and, specifically, coronary heart disease.

Higher intakes of monoglycerides and diglycerides of fatty acids (E471 and E472) were also associated with higher risks of all studied outcomes.

Amongst these emulsifiers, lactic ester of monoglycerides and diglycerides of fatty acids (E472b) was associated with higher risks of CVD and cerebrovascular diseases, whilst citric acid ester of monoglycerides and diglycerides of fatty acids (E472c) was associated with higher risks of CVD and coronary heart disease.

High intakes of trisodium phosphate (E339) were also associated with an increased risk of coronary heart disease.

However, there was no evidence of an association between the other studied emulsifiers and any of the cardiovascular outcomes.

The authors of the study acknowledged several limitations to their project, including the high proportion of women, higher educational background and the overall more health-conscious behaviour displayed among the NutriNet-Santé participants in comparison to the general French population.

But the authors also pointed out that they had used a large study group, were able to adjust for a wide range of potentially influential factors, and that their results remained unchanged following extended testing.

Dr Srour, a Nutritional Epidemiology scientist at the Université Sorbonne Paris Nord, said: “Results from this large prospective cohort suggest that additive emulsifiers may be associated with an increased risk of CVD.

“These findings should be replicated in future epidemiological cohorts and mechanisms should be further elucidated by experimental approaches.

“Despite the moderate magnitude of the associations, these findings may have important public health implications given that these food additives are used ubiquitously in thousands of widely consumed ultra-processed food products.

“The results will contribute to the re-evaluation of regulations around food additive usage in the food industry to protect consumers.

“Meanwhile, several public health authorities recommend limiting the consumption of ultra-processed foods as a way of limiting exposure to non-essential controversial food additives.”