The French NutriNet-Santé study has published another paper relating disease in this prospective study to the intake of an additive group, in this case preservatives. This is the first prospective epidemiological study investigating the links between a wide range of preservative food additives and cardiovascular health. It relied on a large cohort (over 112,000 participants) with highly detailed, brand-specific, and repeatedly collected 24-hour dietary records over 15 years of follow-up, enabling time- dependent cumulative exposure assessment. Multiple food composition databases, laboratory analysis of food as well as accounting for reformulations provided unique information on exposure to preservative food additives.
Total preservatives, total non-antioxidant preservatives, total sorbates, potassium sorbate (E202), potassium metabisulphite (E224), total nitrites, sodium nitrite (E250), total antioxidant preservatives, total ascorbates, ascorbic acid (E300), sodium ascorbate (E301), total erythorbates, sodium erythorbate (E316), citric acid (E330), and extracts of rosemary (E392) were all associated with increased hypertension. In addition, total non-antioxidant preservatives, total ascorbates, ascorbic acid (E300), total erythorbates, and sodium erythorbate (E316) were associated with cardiovascular risk.
This is however an observational study so cause and effect data cannot be inferred. However, models were adjusted for a wide range of potential confounders and remained robust across multiple sensitivity analyses. Although some preservatives are more prevalent in certain food groups, most are ubiquitous rather than specific to a single category. Models were therefore adjusted for major food groups associated with cardiovascular risk or protection (e.g. fruits and vegetables, red and processed meats, ultra-processed foods), and associations remained statistically significant. Experimental research is however needed to gain insight into underlying mechanisms.
Anaïs Hasenböhler, Guillaume Javaux, Marie Payen de la Garanderie, Fabien Szabo de Edelenyi, Paola Yvroud-Hoyos, Cédric Agaësse, Alexandre De Sa, Inge Huybrechts, Fabrice Pierre, Xavier Coumoul, Léopold K Fezeu, Pilar Galan, Jacques Blacher, Chantal Julia, Benjamin Allès, Serge Hercberg, Benoit Chassaing, Mélanie Deschasaux-Tanguy, Bernard Srour, Mathilde Touvier (2026).
Preservative food additives, hypertension, and cardiovascular diseases: the NutriNet-Santé study, European Heart Journal, ehag308, https://doi.org/10.1093/eurheartj/ehag308
