Preservative Food Additives, Cardiovascular Disease & Hypertension Incidence - NutriNet-Santé Cohort

Abstract Background Experimental studies suggest that some preservative food additives may exert properties related to hypertension and oxidative stress, yet human data are lacking. For the first time, we studied the associations between exposure to a wide range of preservative food additives and cardiovascular disease (CVD) (incl. cerebrovascular (CVA) and coronary heart disease (CHD)) and hypertension (HTN) incidence in a large population-based cohort. Methods Participants (n = 112,395; 78.7% women; mean age=42.8, SD = 14.7) from the French NutriNet-Santé prospective cohort (2009-2024) completed repeated 24h dietary records (mean=24, SD = 21), including industrial brands. Cumulative time-dependent exposure to food additives was evaluated using multiple composition databases and ad hoc laboratory assays in food matrices. Associations between exposure (3 categories: sex-specific tertiles or non-/lower/higher exposed participants based on the sex-specific median) and pathology incidence were characterised using proportional hazards Cox models adjusted for potential confounders. Results 2450 CVD (incl. 1142 CVA and 1308 CHD) and 5544 HTN incident cases were identified (mean follow-up=7.96y; SD = 4.90). Higher intakes of the following additives were associated with higher pathology incidence: potassium sorbate with CHD (Hazard Ratio (HR)cat3vs.1=1.23[1.04-1.44]), and HTN (1.39[1.28-1.50]); potassium metabisulphite with HTN (1.16[1.08-1.25]); sodium nitrite with HTN (1.16[1.08-1.25]); ascorbic acid with CVD (1.15[1.04-1.28]), CVA (1.18[1.01-1.38]), and HTN (1.14[1.06-1.22]); sodium ascorbate with HTN (1.12[1.04-1.20]); sodium erythorbate with CVD (1.13[1.01-1.26]), CVA (1.22[1.04-1.43]), and HTN (1.14[1.06-1.22]); citric acid with HTN (1.25[1.16-1.34]); and extracts of rosemary with HTN (1.10[1.02-1.18]). Conclusions This large prospective cohort revealed multiple positive associations between exposure to widely used preservatives and higher incidence of CVD, CVA, CHD, and HTN. Key messages • Nine widely used food additive preservatives from industrial foods were associated with higher cardiovascular disease and/or hypertension incidence in the NutriNet-Santé cohort (n = 112,395). • These results call for a re-evaluation of the safety of these additives and support recommendations to favour freshly-made and minimally processed foods.