Emulsifiers popular in ultraprocessed foods ‘might have a role in cardiovascular health’

Key takeaways:

• Researchers found positive connections between CVD risk and higher intake of some emulsifiers.
• PCPs should tell patients to reduce their consumption of ultraprocessed foods to avoid exposure to food additives.

Several food emulsifiers were linked to cardiovascular disease in French adults, according to the results of research published in The BMJ.

Previous research has connected ultraprocessed foods with higher risks for mortality, obesity and noncommunicable diseases like type 2 diabetes, CVD and some cancers, according to the study. One hypothesis that has emerged to explain these connections is the possible deleterious properties of certain food additives — particularly, emulsifiers, which extend shelf-life and improve the texture of industrially processed foods.

Bernard Srour, PharmD, PhD, MPH, and Mathilde Touvier, PhD — both scientists at the Nutritional Epidemiology Research Team, part of the University of Paris — told Healio in an email that “emulsifiers are widely used in processed packaged foods worldwide.”

“To our knowledge, no epidemiological study ever investigated associations between various food additive emulsifier intakes and CVD risk, which is why we chose to study them,” they said.

Srour, Touvier and colleagues analyzed data from 95,442 adults enrolled in the French NutriNet-Santé study who did not have CVD and completed a minimum of three 24-hour dietary records during the first 2 years of follow-up.

They found positive connections between CVD risk and higher intake of two emulsifier groups: total monoglycerides and diglycerides of fatty acids, which were linked to higher risks for every outcome, and total cellulose, which was linked to higher CVD risk (HR = 1.05; 95% CI, 1.02-1.09), specifically coronary heart disease, or CHD (HR = 1.07; 95% CI, 1.02-1.12).

There were also positive associations for several specific emulsifiers:

• carboxymethylcellulose (HR for CVD = 1.03; 95% CI, 1.01-1.05; HR for CHD = 1.04; 95% CI, 1.02-1.06);
• lactic ester of monoglycerides and diglycerides of fatty acids (HR for CVD = 1.06; 95% CI, 1.02-1.1; HR for cerebrovascular disease = 1.11; 95% CI, 1.06-1.16);
• citric acid ester of monoglycerides and diglycerides of fatty acids (HR for CVD = 1.04; 95% CI, 1.02-1.07; HR for CHD = 1.06; 95% CI, 1.03-1.09); and
• trisodium phosphate (HR for CHD = 1.06; 95% CI, 1-1.12).

“Our results remained significant despite adjusting for a series of confounding factors, [including] overall diet quality and the (portion) of ultraprocessed foods in the diet — suggesting that emulsifiers might have a role in cardiovascular health, regardless of the other components of ultraprocessed foods and diet,” Srour and Touvier said.

Srour and Touvier said their results “provide novel epidemiological insights into the role of food additive emulsifiers on CVD risk,” and, if confirmed by further research, could even “lead to a modification in the regulation of emulsifier use by the food industry.”

“Given the recently established links between ultraprocessed food — the main dietary source of emulsifiers — and human health, the role of emulsifiers in the development of other long-term noncommunicable diseases should also be explored through epidemiological research, as well as experimental approaches on humans and animal models whenever feasible,” they said. “In the meantime, several public health authorities recommend limiting the consumption of foods containing ‘cosmetic’ additives — ie, not essential for consumer safety. Reducing the consumption of ultraprocessed foods is good precautionary advice to avoid exposure to emulsifiers and other food additives.”