Food additive emulsifiers and cancer risk: results from the French prospective NutriNet-Santé cohort

Abstract Background Food additive emulsifiers are found in thousands of industrial foods and may exert deleterious effects on gut microbiota and carcinogenesis according to experimental studies. However, their associations with cancer risk has not been investigated yet. This study aimed to investigate these associations in a large population-based prospective cohort. Methods This study included 102,485 French adults from the NutriNet-Santé cohort (42.1y [14.5], 78.8% female, 2009-2021). Food additive emulsifier intakes were estimated using repeated 24h dietary records linked to brand-specific food composition databases on food additives. Associations with incident cancer risk were assessed using Multivariable Cox models. Results 3,511 incident cancer cases were diagnosed during follow-up (1,026 breast, 431 prostate, and 279 colorectal cancers). Intakes of sodium citrate (E331, HR = 1.12 [1.02-1.23], p-trend=0.009), xanthan gum (E415, HR = 1.11 [1.02-1.21], p-trend=0.02), and mono- and diglycerides of fatty acids (E471, HR = 1.17 [1.06-1.28], p-trend=0.001 and total: E471, E472a-b-c-e, HR = 1.11, [1.02-1.22], p-trend=0.02) were associated with increased overall cancer risk. Higher intakes of E331 (p-trend = 0.046), sodium stearoyl-2-lactylate (E481, p-trend=0.01), total lactylates (E481-482, p-trend=0.01), total celluloses (E460-468, p-trend=0.03), carob bean gum (E410, p-trend=0.01), and E471 (p-trend=0.006) were associated with increased overall breast cancer risk. Higher intakes of carrageenan (E407, p-trend=0.04), E415 (p-trend=0.02), and triphosphates (E451, p-trend=0.03) were associated with increased post-menopausal breast cancer risk. Conclusions These results are the first to investigate and report direct associations between cancer risk and exposures to seven individual and three groups of food additive emulsifiers. If replicated, they may have an important public health impact, considering the omnipresence of these additives in industrial foods globally. Key messages • This study is the first to precisely assess exposures to food additive emulsifiers in a population-based study. • Intakes of food additive emulsifiers were associated with increased risk of cancer.


Introduction:
Evidence on the incidence and risk factors of frailty in low-and middle-income countries is very limited.We aimed to compare the incidence of frailty and explore its determinants in rural and urban areas in six Latin American countries and China.

Methods:
The 10/66 is a multi-site cohort study in older adults.We conducted baseline and follow-up surveys in 2003-2006, and 2007-2010.We assessed frailty using a modified Fried frailty phenotype criterion, and adjudicated frailty (yes/no) when two or more of the following indicators were present: exhaustion, low physical activity, slow gait speed, and weight loss.We excluded frail participants at baseline and calculated personyears as the time interval between baseline and follow-up for frailty-free people who were survived and reinterviewed or the midpoint of it for incident frailty cases.We used Poisson and Cox regressions to model the incidence of frailty and its risk factors.

Conclusions:
The incidence of frailty varied substantially in Latin America and China, and between urban and rural areas.The identified risk factors could be potential intervention targets to decrease the global burden of frailty.

Key messages:
In Latin America and China, the incidence of frailty varied from 21.9 to 110.5 cases per 1000 person-years.
We identified 9 risk factors and 1 protective factor for developing frailty, and the most relevant risk factors were living in the rural area, dementia, and depression.

Conclusions:
These results are the first to investigate and report direct associations between cancer risk and exposures to seven individual and three groups of food additive emulsifiers.If replicated, they may have an important public health impact, considering the omnipresence of these additives in industrial foods globally.

Key messages:
This study is the first to precisely assess exposures to food additive emulsifiers in a population-based study.
Intakes of food additive emulsifiers were associated with increased risk of cancer.