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D’Angelo Campos A, Ng SW, McNeel K, Hall MG. How Promising Are "Ultraprocessed" Front-of-Package Labels? A Formative Study with US Adults. Nutrients 2024; 16:1072. [PMID: 38613105 PMCID: PMC11013171 DOI: 10.3390/nu16071072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
High levels of food processing can have detrimental health effects independent of nutrient content. Experts and advocates have proposed adding information about food processing status to front-of-package labeling schemes, which currently exclusively focus on nutrient content. How consumers would perceive "ultraprocessed" labels has not yet been examined. To address this gap, we conducted a within-subjects online experiment with a convenience sample of 600 US adults. Participants viewed a product under three labeling conditions (control, "ultraprocessed" label, and "ultraprocessed" plus "high in sugar" label) in random order for a single product. The "ultraprocessed" label led participants to report thinking more about the risks of eating the product and discouraging them from wanting to buy the product more than the control, despite not grabbing more attention than the control. The "ultraprocessed" plus "high in sugar" labels grabbed more attention, led participants to think more about the risks of eating the product, and discouraged them from wanting to buy the product more than the "ultraprocessed" label alone. "Ultraprocessed" labels may constitute promising messages that could work in tandem with nutrient labels, and further research should examine how they would influence consumers' actual intentions and behaviors.
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Affiliation(s)
- Aline D’Angelo Campos
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA;
| | - Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA;
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Katherine McNeel
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA
| | - Marissa G. Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA;
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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2
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Morales-Berstein F, Biessy C, Viallon V, Goncalves-Soares A, Casagrande C, Hémon B, Kliemann N, Cairat M, Blanco Lopez J, Al Nahas A, Chang K, Vamos E, Rauber F, Bertazzi Levy R, Barbosa Cunha D, Jakszyn P, Ferrari P, Vineis P, Masala G, Catalano A, Sonestedt E, Borné Y, Katzke V, Bajracharya R, Agnoli C, Guevara M, Heath A, Radoï L, Mancini F, Weiderpass E, Huerta JM, Sánchez MJ, Tjønneland A, Kyrø C, Schulze MB, Skeie G, Lukic M, Braaten T, Gunter M, Millett C, Agudo A, Brennan P, Borges MC, Richmond RC, Richardson TG, Davey Smith G, Relton CL, Huybrechts I. Ultra-processed foods, adiposity and risk of head and neck cancer and oesophageal adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition study: a mediation analysis. Eur J Nutr 2024; 63:377-396. [PMID: 37989797 PMCID: PMC10899298 DOI: 10.1007/s00394-023-03270-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/10/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To investigate the role of adiposity in the associations between ultra-processed food (UPF) consumption and head and neck cancer (HNC) and oesophageal adenocarcinoma (OAC) in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. METHODS Our study included 450,111 EPIC participants. We used Cox regressions to investigate the associations between the consumption of UPFs and HNC and OAC risk. A mediation analysis was performed to assess the role of body mass index (BMI) and waist-to-hip ratio (WHR) in these associations. In sensitivity analyses, we investigated accidental death as a negative control outcome. RESULTS During a mean follow-up of 14.13 ± 3.98 years, 910 and 215 participants developed HNC and OAC, respectively. A 10% g/d higher consumption of UPFs was associated with an increased risk of HNC (hazard ratio [HR] = 1.23, 95% confidence interval [CI] 1.14-1.34) and OAC (HR = 1.24, 95% CI 1.05-1.47). WHR mediated 5% (95% CI 3-10%) of the association between the consumption of UPFs and HNC risk, while BMI and WHR, respectively, mediated 13% (95% CI 6-53%) and 15% (95% CI 8-72%) of the association between the consumption of UPFs and OAC risk. UPF consumption was positively associated with accidental death in the negative control analysis. CONCLUSIONS We reaffirmed that higher UPF consumption is associated with greater risk of HNC and OAC in EPIC. The proportion mediated via adiposity was small. Further research is required to investigate other mechanisms that may be at play (if there is indeed any causal effect of UPF consumption on these cancers).
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Affiliation(s)
- Fernanda Morales-Berstein
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Carine Biessy
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Vivian Viallon
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Ana Goncalves-Soares
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Corinne Casagrande
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Bertrand Hémon
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Nathalie Kliemann
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
- Cancer Research Center of Santa Catarina, CEPON, Florianópolis, Brazil
| | - Manon Cairat
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
- Paris-Saclay University, UVSQ, Inserm "Exposome, Heredity, Cancer and Health" Team, CESP U1018, Gustave Roussy, Villejuif, France
| | - Jessica Blanco Lopez
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Aline Al Nahas
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Kiara Chang
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Eszter Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Fernanda Rauber
- Preventive Medicine Department of the Medical School, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil
| | - Renata Bertazzi Levy
- Preventive Medicine Department of the Medical School, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil
| | - Diana Barbosa Cunha
- Hésio Cordeiro Institute of Social Medicine, Department of Epidemiology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Paula Jakszyn
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Spain
- Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Spain
- Blanquerna Faculty of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Pietro Ferrari
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Paolo Vineis
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Italian Institute of Technology, Genoa, Italy
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Alberto Catalano
- Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, 10043, Orbassano, TO, Italy
| | - Emily Sonestedt
- Nutrition Epidemiology, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden
| | - Yan Borné
- Nutrition Epidemiology, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden
| | - Verena Katzke
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rashmita Bajracharya
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marcela Guevara
- Instituto de Salud Pública y Laboral de Navarra, 31003, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Navarra Institute for Health Research (IdiSNA), 31008, Pamplona, Spain
| | - Alicia Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Loredana Radoï
- Paris-Saclay University, UVSQ, Inserm "Exposome, Heredity, Cancer and Health" Team, CESP U1018, Gustave Roussy, Villejuif, France
| | - Francesca Mancini
- Paris-Saclay University, UVSQ, Inserm "Exposome, Heredity, Cancer and Health" Team, CESP U1018, Gustave Roussy, Villejuif, France
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - José María Huerta
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council-IMIB, Murcia, Spain
| | - María-José Sánchez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Escuela Andaluza de Salud Pública (EASP), 18011, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012, Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Cancer and Health, Strandboulevarden 49, DK-2100, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, DK-2200, Copenhagen, Denmark
| | - Cecilie Kyrø
- Danish Cancer Society Research Center, Diet, Cancer and Health, Strandboulevarden 49, DK-2100, Copenhagen, Denmark
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marko Lukic
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tonje Braaten
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marc Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Spain
- Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Paul Brennan
- Genetic Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - M Carolina Borges
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tom G Richardson
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Caroline L Relton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
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Lane MM, Gamage E, Du S, Ashtree DN, McGuinness AJ, Gauci S, Baker P, Lawrence M, Rebholz CM, Srour B, Touvier M, Jacka FN, O'Neil A, Segasby T, Marx W. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ 2024; 384:e077310. [PMID: 38418082 PMCID: PMC10899807 DOI: 10.1136/bmj-2023-077310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes. DESIGN Systematic umbrella review of existing meta-analyses. DATA SOURCES MEDLINE, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews, as well as manual searches of reference lists from 2009 to June 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Systematic reviews and meta-analyses of cohort, case-control, and/or cross sectional study designs. To evaluate the credibility of evidence, pre-specified evidence classification criteria were applied, graded as convincing ("class I"), highly suggestive ("class II"), suggestive ("class III"), weak ("class IV"), or no evidence ("class V"). The quality of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, categorised as "high," "moderate," "low," or "very low" quality. RESULTS The search identified 45 unique pooled analyses, including 13 dose-response associations and 32 non-dose-response associations (n=9 888 373). Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health parameters spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic health outcomes. Based on the pre-specified evidence classification criteria, convincing evidence (class I) supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease related mortality (risk ratio 1.50, 95% confidence interval 1.37 to 1.63; GRADE=very low) and type 2 diabetes (dose-response risk ratio 1.12, 1.11 to 1.13; moderate), as well as higher risks of prevalent anxiety outcomes (odds ratio 1.48, 1.37 to 1.59; low) and combined common mental disorder outcomes (odds ratio 1.53, 1.43 to 1.63; low). Highly suggestive (class II) evidence indicated that greater exposure to ultra-processed foods was directly associated with higher risks of incident all cause mortality (risk ratio 1.21, 1.15 to 1.27; low), heart disease related mortality (hazard ratio 1.66, 1.51 to 1.84; low), type 2 diabetes (odds ratio 1.40, 1.23 to 1.59; very low), and depressive outcomes (hazard ratio 1.22, 1.16 to 1.28; low), together with higher risks of prevalent adverse sleep related outcomes (odds ratio 1.41, 1.24 to 1.61; low), wheezing (risk ratio 1.40, 1.27 to 1.55; low), and obesity (odds ratio 1.55, 1.36 to 1.77; low). Of the remaining 34 pooled analyses, 21 were graded as suggestive or weak strength (class III-IV) and 13 were graded as no evidence (class V). Overall, using the GRADE framework, 22 pooled analyses were rated as low quality, with 19 rated as very low quality and four rated as moderate quality. CONCLUSIONS Greater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes. These findings provide a rationale to develop and evaluate the effectiveness of using population based and public health measures to target and reduce dietary exposure to ultra-processed foods for improved human health. They also inform and provide support for urgent mechanistic research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023412732.
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Affiliation(s)
- Melissa M Lane
- Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia, 3220
| | - Elizabeth Gamage
- Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia, 3220
| | - Shutong Du
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Deborah N Ashtree
- Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia, 3220
| | - Amelia J McGuinness
- Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia, 3220
| | - Sarah Gauci
- Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia, 3220
- Chronic Disease and Ageing, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Phillip Baker
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Lawrence
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Casey M Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Bernard Srour
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), F-93017 Bobigny, France
| | - Mathilde Touvier
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), F-93017 Bobigny, France
| | - Felice N Jacka
- Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia, 3220
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- James Cook University, College of Public Health, Medical & Veterinary Sciences, Townsville, Queensland, Australia
| | - Adrienne O'Neil
- Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia, 3220
| | - Toby Segasby
- School of Biotechnology, Dublin City University, Dublin, Ireland
| | - Wolfgang Marx
- Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia, 3220
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4
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Whelan K, Bancil AS, Lindsay JO, Chassaing B. Ultra-processed foods and food additives in gut health and disease. Nat Rev Gastroenterol Hepatol 2024:10.1038/s41575-024-00893-5. [PMID: 38388570 DOI: 10.1038/s41575-024-00893-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/24/2024]
Abstract
Ultra-processed foods (UPFs) and food additives have become ubiquitous components of the modern human diet. There is increasing evidence of an association between diets rich in UPFs and gut disease, including inflammatory bowel disease, colorectal cancer and irritable bowel syndrome. Food additives are added to many UPFs and have themselves been shown to affect gut health. For example, evidence shows that some emulsifiers, sweeteners, colours, and microparticles and nanoparticles have effects on a range of outcomes, including the gut microbiome, intestinal permeability and intestinal inflammation. Broadly speaking, evidence for the effect of UPFs on gut disease comes from observational epidemiological studies, whereas, by contrast, evidence for the effect of food additives comes largely from preclinical studies conducted in vitro or in animal models. Fewer studies have investigated the effect of UPFs or food additives on gut health and disease in human intervention studies. Hence, the aim of this article is to critically review the evidence for the effects of UPF and food additives on gut health and disease and to discuss the clinical application of these findings.
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Affiliation(s)
- Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK.
| | - Aaron S Bancil
- Department of Nutritional Sciences, King's College London, London, UK
| | - James O Lindsay
- Blizard Institute, Queen Mary University of London, Barts and the London School of Medicine, London, UK
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Sellem L, Srour B, Javaux G, Chazelas E, Chassaing B, Viennois E, Debras C, Druesne-Pecollo N, Esseddik Y, Szabo de Edelenyi F, Arnault N, Agaësse C, De Sa A, Lutchia R, Huybrechts I, Scalbert A, Pierre F, Coumoul X, Julia C, Kesse-Guyot E, Allès B, Galan P, Hercberg S, Deschasaux-Tanguy M, Touvier M. Food additive emulsifiers and cancer risk: Results from the French prospective NutriNet-Santé cohort. PLoS Med 2024; 21:e1004338. [PMID: 38349899 PMCID: PMC10863884 DOI: 10.1371/journal.pmed.1004338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 12/20/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Emulsifiers are widely used food additives in industrially processed foods to improve texture and enhance shelf-life. Experimental research suggests deleterious effects of emulsifiers on the intestinal microbiota and the metabolome, leading to chronic inflammation and increasing susceptibility to carcinogenesis. However, human epidemiological evidence investigating their association with cancer is nonexistent. This study aimed to assess associations between food additive emulsifiers and cancer risk in a large population-based prospective cohort. METHODS AND FINDINGS This study included 92,000 adults of the French NutriNet-Santé cohort without prevalent cancer at enrolment (44.5 y [SD: 14.5], 78.8% female, 2009 to 2021). They were followed for an average of 6.7 years [SD: 2.2]. Food additive emulsifier intakes were estimated for participants who provided at least 3 repeated 24-h dietary records linked to comprehensive, brand-specific food composition databases on food additives. Multivariable Cox regressions were conducted to estimate associations between emulsifiers and cancer incidence. Overall, 2,604 incident cancer cases were diagnosed during follow-up (including 750 breast, 322 prostate, and 207 colorectal cancers). Higher intakes of mono- and diglycerides of fatty acids (FAs) (E471) were associated with higher risks of overall cancer (HR high vs. low category = 1.15; 95% CI [1.04, 1.27], p-trend = 0.01), breast cancer (HR = 1.24; 95% CI [1.03, 1.51], p-trend = 0.04), and prostate cancer (HR = 1.46; 95% CI [1.09, 1.97], p-trend = 0.02). In addition, associations with breast cancer risk were observed for higher intakes of total carrageenans (E407 and E407a) (HR = 1.32; 95% CI [1.09, 1.60], p-trend = 0.009) and carrageenan (E407) (HR = 1.28; 95% CI [1.06, 1.56], p-trend = 0.01). No association was detected between any of the emulsifiers and colorectal cancer risk. Several associations with other emulsifiers were observed but were not robust throughout sensitivity analyses. Main limitations include possible exposure measurement errors in emulsifiers intake and potential residual confounding linked to the observational design. CONCLUSIONS In this large prospective cohort, we observed associations between higher intakes of carrageenans and mono- and diglycerides of fatty acids with overall, breast and prostate cancer risk. These results need replication in other populations. They provide new epidemiological evidence on the role of emulsifiers in cancer risk. TRIAL REGISTRATION ClinicalTrials.gov NCT03335644.
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Affiliation(s)
- Laury Sellem
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
- Nutrition And Cancer Research Network (NACRe Network), Jouy-en-Josas, France
| | - Bernard Srour
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
- Nutrition And Cancer Research Network (NACRe Network), Jouy-en-Josas, France
| | - Guillaume Javaux
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Eloi Chazelas
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
- Nutrition And Cancer Research Network (NACRe Network), Jouy-en-Josas, France
| | - Benoit Chassaing
- Nutrition And Cancer Research Network (NACRe Network), Jouy-en-Josas, France
- INSERM U1016, team “Mucosal microbiota in chronic inflammatory diseases”, CNRS UMR 8104, Université Paris Cité, Paris, France
| | - Emilie Viennois
- INSERM U1149, Center of Research on Inflammation, Université Paris Cité, Paris, France
| | - Charlotte Debras
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
- Nutrition And Cancer Research Network (NACRe Network), Jouy-en-Josas, France
| | - Nathalie Druesne-Pecollo
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
- Nutrition And Cancer Research Network (NACRe Network), Jouy-en-Josas, France
| | - Younes Esseddik
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Fabien Szabo de Edelenyi
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Nathalie Arnault
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Cédric Agaësse
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Alexandre De Sa
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Rebecca Lutchia
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Inge Huybrechts
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Augustin Scalbert
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Fabrice Pierre
- Nutrition And Cancer Research Network (NACRe Network), Jouy-en-Josas, France
- Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Xavier Coumoul
- Nutrition And Cancer Research Network (NACRe Network), Jouy-en-Josas, France
- INSERM UMR-S 1124, Université Paris Cité, Paris, France
| | - Chantal Julia
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
- Public Health Department, Groupe Hospitalier Paris-Seine-Saint-Denis, Assistance Publique-hôpitaux de Paris (AP-HP), Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
- Nutrition And Cancer Research Network (NACRe Network), Jouy-en-Josas, France
| | - Benjamin Allès
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Pilar Galan
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
- Nutrition And Cancer Research Network (NACRe Network), Jouy-en-Josas, France
| | - Serge Hercberg
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
- Nutrition And Cancer Research Network (NACRe Network), Jouy-en-Josas, France
- Public Health Department, Groupe Hospitalier Paris-Seine-Saint-Denis, Assistance Publique-hôpitaux de Paris (AP-HP), Bobigny, France
| | - Mélanie Deschasaux-Tanguy
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
- Nutrition And Cancer Research Network (NACRe Network), Jouy-en-Josas, France
| | - Mathilde Touvier
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
- Nutrition And Cancer Research Network (NACRe Network), Jouy-en-Josas, France
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6
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Okus F, Yuzbasioglu D, Unal F. Molecular docking study of frequently used food additives for selected targets depending on the chromosomal abnormalities they cause. Toxicology 2024; 502:153716. [PMID: 38159899 DOI: 10.1016/j.tox.2023.153716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
Food additives (FAs) (flavor enhancers, sweeteners, etc.) protect foods during storage and transportation, making them attractive to consumers. Today, while the desire to access natural foods is increasing, the chemicals added to foods have started to be questioned. In this respect, genotoxicity tests have gained importance. Studies show that some food additives may have genotoxic risks. Previous studies carried out in our laboratory also revealed genotoxic effects of Monopotassium glutamate (MPG), Monosodium glutamate (MSG), Magnesium diglutamate (MDG) as flavor enhancers; Potassium benzoate (PB), Potassium sorbate (PS), Sodium benzoate (SB), Sodium sorbate (SS) as preservatives; Acesulfame potassium (ACE-K), Xylitol (XYL) as sweeteners. In this study, we determined the interactions of these food additives with ATM and p53 proteins, which are activated in the cell due to genotoxic effects, and with DNA by employing the molecular docking method for the first time. Among the food additives, SB (-4.307) for ATM, XYL (-4.629) for p53, and XYL (-4.927) for DNA showed the highest affinity. Therefore, flexible docking (IFD) scores were determined for SB, XYL, and MDG from flavor enhancers. The potential binding modes of the food additives to target molecules' possible inhibition mechanisms were determined by molecular docking. Thus, new information was obtained to show how these additives cause chromosomal abnormalities.
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Affiliation(s)
- Fatma Okus
- Graduate School of Natural and Applied Sciences, Gazi University, Teknikokullar, Ankara, Türkiye
| | - Deniz Yuzbasioglu
- Genetic Toxicology Laboratory, Department of Biology, Science Faculty, Gazi University, Teknikokullar, Ankara, Türkiye.
| | - Fatma Unal
- Genetic Toxicology Laboratory, Department of Biology, Science Faculty, Gazi University, Teknikokullar, Ankara, Türkiye
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7
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Tahiri M, Johnsrud C, Steffensen IL. Evidence and hypotheses on adverse effects of the food additives carrageenan (E 407)/processed Eucheuma seaweed (E 407a) and carboxymethylcellulose (E 466) on the intestines: a scoping review. Crit Rev Toxicol 2023; 53:521-571. [PMID: 38032203 DOI: 10.1080/10408444.2023.2270574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023]
Abstract
This scoping review provides an overview of publications reporting adverse effects on the intestines of the food additives carrageenan (CGN) (E 407)/processed Eucheuma seaweed (PES) (E 407a) and carboxymethylcellulose (CMC) (E 466). It includes evidence from human, experimental mammal and in vitro research publications, and other evidence. The databases Medline, Embase, Scopus, Web of Science Core Collection, Cochrane Database of Systematic Reviews and Epistemonikos were searched without time limits, in addition to grey literature. The publications retrieved were screened against predefined criteria. From two literature searches, 2572 records were screened, of which 224 records were included, as well as 38 records from grey literature, making a total of 262 included publications, 196 on CGN and 101 on CMC. These publications were coded and analyzed in Eppi-Reviewer and data gaps presented in interactive maps. For CGN, five, 69 and 33 research publications on humans, experimental mammals and in vitro experiments were found, further separated as degraded or native (non-degraded) CGN. For CMC, three human, 20 animal and 14 in vitro research publications were obtained. The most studied adverse effects on the intestines were for both additives inflammation, the gut microbiome, including fermentation, intestinal permeability, and cancer and metabolic effects, and immune effects for CGN. Further studies should focus on native CGN, in the form and molecular weight used as food additive. For both additives, randomized controlled trials of sufficient power and with realistic dietary exposure levels of single additives, performed in persons of all ages, including potentially vulnerable groups, are needed.
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Affiliation(s)
- Mirlinda Tahiri
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Celine Johnsrud
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Inger-Lise Steffensen
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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8
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Sandall A, Smith L, Svensen E, Whelan K. Emulsifiers in ultra-processed foods in the UK food supply. Public Health Nutr 2023; 26:2256-2270. [PMID: 37732384 DOI: 10.1017/s1368980023002021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Ultra-processed foods (UPF), including those containing food additive emulsifiers, have received research attention due to evidence implicating them in the pathogenesis of certain diseases. The aims of this research were to develop a large-scale, brand-level database of UPF in the UK food supply and to characterise the occurrence and co-occurrence of food additive emulsifiers. DESIGN A database was compiled sampling all products from the food categories contributing to energy intake from UPF in the UK from the National Diet and Nutrition Survey (2008-2014). Every food in these categories were identified from online supermarket provision from the 'big four' supermarkets that dominate the market share in the UK, comprising Tesco, Sainsbury's, Asda and Morrisons. SETTING Major supermarkets in the UK. RESULTS A total of 32 719 food products in the UK supermarket food supply were returned in searches. Of these, 12 844 products were eligible and manually reviewed for the presence of emulsifiers. Emulsifiers were present in 6642 (51·7 %) food products. Emulsifiers were contained in 95·0 % of 'Pastries, buns and cakes', 81·9 % of 'Milk-based drinks', 81·0 % of 'Industrial desserts' and 77·5 % of 'Confectionary'. Fifty-one per cent of all emulsifier-containing foods contained multiple emulsifiers. Across emulsifier-containing foods, there were a median of two emulsifiers (IQR 2) per product. The five most common emulsifiers were lecithin (23·4 % of all products), mono- and diglycerides of fatty acids (14·5 %), diphosphates (11·6 %), and xanthan gum and pectin (8·0 %). CONCLUSIONS Findings from this study are the first to demonstrate the widespread occurrence and co-occurrence of emulsifiers in UPF in the UK food supply.
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Affiliation(s)
- Alicia Sandall
- King's College London, Department of Nutritional Sciences, Franklin Wilkins Building, London, SE1 9NH, UK
| | - Leanne Smith
- King's College London, Department of Nutritional Sciences, Franklin Wilkins Building, London, SE1 9NH, UK
| | - Erika Svensen
- King's College London, Department of Nutritional Sciences, Franklin Wilkins Building, London, SE1 9NH, UK
| | - Kevin Whelan
- King's College London, Department of Nutritional Sciences, Franklin Wilkins Building, London, SE1 9NH, UK
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9
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Laatikainen R, Lehto M, Mäkelä-Salmi N, Hillilä M, Groop PH, Salmenkari H. Randomized controlled pilot study: effect of carrageenan emulsifier on inflammation and gastrointestinal symptoms in quiescent ulcerative colitis. Food Nutr Res 2023; 67:9575. [PMID: 37920677 PMCID: PMC10619385 DOI: 10.29219/fnr.v67.9575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 11/04/2023] Open
Abstract
Background Animal models have provided some evidence of the pro-inflammatory effects of the commonly used emulsifier carrageenan. However, the effects of food-grade carrageenan among people with ulcerative colitis (UC) are largely unknown. Methods A randomized, placebo-controlled cross-over study comparing high molecular carrageenan and oat-based beta-glucan preparation (placebo) among patients (n = 7) with quiescent UC was performed. Primary endpoint was Simple Clinical Colitis Activity Index (SCCAI) at the end of the treatment (7th day). Secondary analyses included biochemical biomarkers of inflammation, intestinal permeability, detoxification of intestinal lipopolysaccharide (LPS), and gastrointestinal symptoms measured by visual analog scale. Results There were no statistically significant differences in SCCAI or any biochemical markers between carrageenan and placebo periods, nor were there any significant differences when comparing either period to baseline. Gastrointestinal symptoms were higher during the placebo period; the sum of all symptoms and borborygmi was statistically significantly higher at the end of the placebo period than at the end of the carrageenan period (20.8 ± 18.6 vs. 13.3 ± 16.4; P = 0.031, and 29.7 ± 28.6 vs. 17.9 ± 23.6; P = 0.016). Conclusions Our study suggests that at least short-term usage of food-grade carrageenan is safe among people with UC, but given the limitations of the current study, robust human studies are still urgently needed.
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Affiliation(s)
| | - Markku Lehto
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
| | - Noora Mäkelä-Salmi
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Markku Hillilä
- Clinic of Gastroenterology, University of Helsinki and Helsinki University, Hospital Jorvi, Espoo, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - Hanne Salmenkari
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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10
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Khatib MA, Saleemani HH, Kurdi NB, Alhibshi HN, Jastaniah MA, Ajabnoor SM. Low Emulsifier Diet in Healthy Female Adults: A Feasibility Study of Nutrition Education and Counseling Intervention. Healthcare (Basel) 2023; 11:2644. [PMID: 37830680 PMCID: PMC10572653 DOI: 10.3390/healthcare11192644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
Emulsifiers are food additives commonly found in processed foods to improve texture stabilization and food preservation. Dietary emulsifier intake can potentially damage the gut mucosal lining resulting in chronic inflammation such as Crohn's disease. This study investigates the feasibility of a low-emulsifier diet among healthy female adults, as no previous reports have studied the feasibility of such a diet on healthy participants. A quasi-experimental study for a nutrition education and counseling intervention was conducted over 14 days among healthy Saudi participants aged 18 years and over. Assessment of dietary intake using 3-day food records was conducted at the baseline and 2-week follow-up. Participants attended an online educational session using the Zoom application illustrating instructions for a low-emulsifier diet. Daily exposure to emulsifiers was evaluated and nutrient intake was measured. A total of 30 participants completed the study. At baseline, 38 emulsifiers were identified, with a mean ± SD exposure of 12.23 ± 10.07 emulsifiers consumed per day. A significant reduction in the mean frequency of dietary emulsifier intake was observed at the end of the intervention (12.23 ± 10.07 vs. 6.30 ± 7.59, p < 0.01). However, intake of macronutrients and micronutrients was significantly reduced (p < 0.05). Good adherence to the diet was achieved by 40% of the participants, and 16.66% attained a 50% reduction of emulsifier intake. The study demonstrates that a low-emulsifier diet provided via dietary advice is feasible to follow and tolerable by healthy participants. However, the diet still needs further investigation and assessment of it is nutritional intake and quality before implementing it in patients with inflammatory bowel disease who are at high risk of poor nutritional intake.
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Affiliation(s)
- Mai A. Khatib
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia
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Sellem L, Srour B, Javaux G, Chazelas E, Chassaing B, Viennois E, Debras C, Salamé C, Druesne-Pecollo N, Esseddik Y, de Edelenyi FS, Agaësse C, De Sa A, Lutchia R, Louveau E, Huybrechts I, Pierre F, Coumoul X, Fezeu LK, Julia C, Kesse-Guyot E, Allès B, Galan P, Hercberg S, Deschasaux-Tanguy M, Touvier M. Food additive emulsifiers and risk of cardiovascular disease in the NutriNet-Santé cohort: prospective cohort study. BMJ 2023; 382:e076058. [PMID: 37673430 PMCID: PMC10480690 DOI: 10.1136/bmj-2023-076058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To assess the associations between exposure to food additive emulsifiers and risk of cardiovascular disease (CVD). DESIGN Prospective cohort study. SETTING French NutriNet-Santé study, 2009-21. PARTICIPANTS 95 442 adults (>18 years) without prevalent CVD who completed at least three 24 hour dietary records during the first two years of follow-up. MAIN OUTCOME MEASURES Associations between intake of food additive emulsifiers (continuous (mg/day)) and risk of CVD, coronary heart disease, and cerebrovascular disease characterised using multivariable proportional hazard Cox models to compute hazard ratios for each additional standard deviation (SD) of emulsifier intake, along with 95% confidence intervals. RESULTS Mean age was 43.1 (SD 14.5) years, and 79.0% (n=75 390) of participants were women. During follow-up (median 7.4 years), 1995 incident CVD, 1044 coronary heart disease, and 974 cerebrovascular disease events were diagnosed. Higher intake of celluloses (E460-E468) was found to be positively associated with higher risks of CVD (hazard ratio for an increase of 1 standard deviation 1.05, 95% confidence interval 1.02 to 1.09, P=0.003) and coronary heart disease (1.07, 1.02 to 1.12, P=0.004). Specifically, higher cellulose E460 intake was linked to higher risks of CVD (1.05, 1.01 to 1.09, P=0.007) and coronary heart disease (1.07, 1.02 to 1.12, P=0.005), and higher intake of carboxymethylcellulose (E466) was associated with higher risks of CVD (1.03, 1.01 to 1.05, P=0.004) and coronary heart disease (1.04, 1.02 to 1.06, P=0.001). Additionally, higher intakes of monoglycerides and diglycerides of fatty acids (E471 and E472) were associated with higher risks of all outcomes. Among these emulsifiers, lactic ester of monoglycerides and diglycerides of fatty acids (E472b) was associated with higher risks of CVD (1.06, 1.02 to 1.10, P=0.002) and cerebrovascular disease (1.11, 1.06 to 1.16, P<0.001), and citric acid ester of monoglycerides and diglycerides of fatty acids (E472c) was associated with higher risks of CVD (1.04, 1.02 to 1.07, P=0.004) and coronary heart disease (1.06, 1.03 to 1.09, P<0.001). High intake of trisodium phosphate (E339) was associated with an increased risk of coronary heart disease (1.06, 1.00 to 1.12, P=0.03). Sensitivity analyses showed consistent associations. CONCLUSION This study found positive associations between risk of CVD and intake of five individual and two groups of food additive emulsifiers widely used in industrial foods. TRIAL REGISTRATION ClinicalTrials.gov NCT03335644.
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Affiliation(s)
- Laury Sellem
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Bernard Srour
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Guillaume Javaux
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Eloi Chazelas
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Benoit Chassaing
- INSERM U1016, team "Mucosal microbiota in chronic inflammatory diseases," Université Paris Cité, Paris, France
| | - Emilie Viennois
- INSERM U1149, Centre for Research on Inflammation, Université de Paris, Paris, France
| | - Charlotte Debras
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Clara Salamé
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Nathalie Druesne-Pecollo
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Younes Esseddik
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Fabien Szabo de Edelenyi
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Cédric Agaësse
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Alexandre De Sa
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Rebecca Lutchia
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Erwan Louveau
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Inge Huybrechts
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Fabrice Pierre
- Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France
| | | | - Léopold K Fezeu
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Chantal Julia
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
- Public Health Department, Groupe Hospitalier Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Benjamin Allès
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Pilar Galan
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Serge Hercberg
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
- Public Health Department, Groupe Hospitalier Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France
| | - Mélanie Deschasaux-Tanguy
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Mathilde Touvier
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France
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12
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Debras C, Deschasaux-Tanguy M, Chazelas E, Sellem L, Druesne-Pecollo N, Esseddik Y, Szabo de Edelenyi F, Agaësse C, De Sa A, Lutchia R, Julia C, Kesse-Guyot E, Allès B, Galan P, Hercberg S, Huybrechts I, Cosson E, Tatulashvili S, Srour B, Touvier M. Artificial Sweeteners and Risk of Type 2 Diabetes in the Prospective NutriNet-Santé Cohort. Diabetes Care 2023; 46:1681-1690. [PMID: 37490630 PMCID: PMC10465821 DOI: 10.2337/dc23-0206] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/09/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To study the relationships between artificial sweeteners, accounting for all dietary sources (total and by type of artificial sweetener) and risk of type 2 diabetes (T2D), in a large-scale prospective cohort. RESEARCH DESIGN AND METHODS The analyses included 105,588 participants from the web-based NutriNet-Santé study (France, 2009-2022; mean age 42.5 ± 14.6 years, 79.2% women). Repeated 24-h dietary records, including brands and commercial names of industrial products, merged with qualitative and quantitative food additive composition data, enabled artificial sweetener intakes to be accurately assessed from all dietary sources. Associations between artificial sweeteners (total, aspartame, acesulfame potassium [K], and sucralose) and T2D were investigated using Cox proportional hazard models adjusted for potential confounders, including weight variation during follow-up. RESULTS During a median follow-up of 9.1 years (946,650 person-years, 972 incident T2D), compared with nonconsumers, higher consumers of artificial sweeteners (i.e., above the sex-specific medians of 16.4 mg/day in men and 18.5 mg/day in women) had higher risks of developing T2D (hazard ratio [HR] 1.69; 95% CI 1.45-1.97; P-trend <0.001). Positive associations were also observed for individual artificial sweeteners: aspartame (HR 1.63 [95% CI 1.38-1.93], P-trend <0.001), acesulfame-K (HR 1.70 [1.42-2.04], P-trend <0.001), and sucralose (HR 1.34 [1.07-1.69], P-trend = 0.013). CONCLUSIONS Potential for reverse causality cannot be eliminated; however, many sensitivity analyses were computed to limit this and other potential biases. These findings of positive associations between artificial sweetener intakes and increased T2D risk strengthen the evidence that these additives may not be safe sugar alternatives. This study provides important insights in the context of on-going reevaluation of artificial sweeteners by health authorities worldwide.
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Affiliation(s)
- Charlotte Debras
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Mélanie Deschasaux-Tanguy
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Eloi Chazelas
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Laury Sellem
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Nathalie Druesne-Pecollo
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Younes Esseddik
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Fabien Szabo de Edelenyi
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Cédric Agaësse
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Alexandre De Sa
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Rebecca Lutchia
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Chantal Julia
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
- Public Health Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Benjamin Allès
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Pilar Galan
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Serge Hercberg
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
- Public Health Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Inge Huybrechts
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Emmanuel Cosson
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
- Diabetology, Endocrinology and Nutrition Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Sopio Tatulashvili
- Diabetology, Endocrinology and Nutrition Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Bernard Srour
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Mathilde Touvier
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
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13
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Pirttiniemi A, Adeshara K, Happonen N, Einarsdottir E, Katayama S, Salmenkari H, Hörkkö S, Kere J, Groop PH, Lehto M. Long-chain polyphosphates inhibit type I interferon signaling and augment LPS-induced cytokine secretion in human leukocytes. J Leukoc Biol 2023; 114:250-265. [PMID: 37224571 DOI: 10.1093/jleuko/qiad058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 04/20/2023] [Accepted: 05/12/2023] [Indexed: 05/26/2023] Open
Abstract
Inorganic polyphosphates are evolutionarily conserved bioactive phosphate polymers found as various chain lengths in all living organisms. In mammals, polyphosphates play a vital role in the regulation of cellular metabolism, coagulation, and inflammation. Long-chain polyphosphates are found along with endotoxins in pathogenic gram-negative bacteria and can participate in bacterial virulence. We aimed to investigate whether exogenously administered polyphosphates modulate human leukocyte function in vitro by treating the cells with 3 different chain lengths of polyphosphates (P14, P100, and P700). The long-chain polyphosphates, P700, had a remarkable capacity to downregulate type I interferon signaling dose dependently in THP1-Dual cells while only a slight elevation could be observed in the NF-κB pathway with the highest dose of P700. P700 treatment decreased lipopolysaccharide-induced IFNβ transcription and secretion, reduced STAT1 phosphorylation, and downregulated subsequent interferon-stimulated gene expression in primary human peripheral blood mononuclear cells. P700 also augmented lipopolysaccharide-induced secretion of IL-1α, IL-1β, IL-4, IL-5, IL-10, and IFNγ. Furthermore, P700 has previously been reported to increase the phosphorylation of several intracellular signaling mediators, such as AKT, mTOR, ERK, p38, GSK3α/β, HSP27, and JNK pathway components, which was supported by our findings. Taken together, these observations demonstrate the extensive modulatory effects P700 has on cytokine signaling and the inhibitory effects specifically targeted to type I interferon signaling in human leukocytes.
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Affiliation(s)
- Anniina Pirttiniemi
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Clinical and Molecular Metabolism, Faculty of Medicine Research Programs, University of Helsinki, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Krishna Adeshara
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Clinical and Molecular Metabolism, Faculty of Medicine Research Programs, University of Helsinki, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Natalie Happonen
- Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Aapistie 5A, 90220 Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Aapistie 5A, 90220 Oulu, Finland
- Nordlab, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
| | - Elisabet Einarsdottir
- Science for Life Laboratory, Department of Gene Technology, KTH-Royal Institute of Technology, Tomtebodavägen 23A, 17165 Solna, Sweden
| | - Shintaro Katayama
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
- Stem Cells and Metabolism Research Program, University of Helsinki, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
- Department of Biosciences and Nutrition, Karolinska Institutet, Neo, Blickagången 16, Flemingsberg, SE-14183 Huddinge, Sweden
| | - Hanne Salmenkari
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Clinical and Molecular Metabolism, Faculty of Medicine Research Programs, University of Helsinki, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Sohvi Hörkkö
- Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Aapistie 5A, 90220 Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Aapistie 5A, 90220 Oulu, Finland
| | - Juha Kere
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
- Stem Cells and Metabolism Research Program, University of Helsinki, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
- Department of Biosciences and Nutrition, Karolinska Institutet, Neo, Blickagången 16, Flemingsberg, SE-14183 Huddinge, Sweden
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Clinical and Molecular Metabolism, Faculty of Medicine Research Programs, University of Helsinki, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
- Department of Diabetes, Central Clinical School, Monash University, Alfred Centre, 99 Commercial Road, Melbourne 3004, VIC, Australia
| | - Markku Lehto
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Clinical and Molecular Metabolism, Faculty of Medicine Research Programs, University of Helsinki, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
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14
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Homem RV, Arisseto-Bragotto AP, Rodrigues E, Cladera-Olivera F. Theoretical estimation of nitrates and nitrites intake from food additives by the Brazilian population. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2023; 40:1147-1163. [PMID: 37549245 DOI: 10.1080/19440049.2023.2240439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
Sodium and potassium nitrates and nitrites are preservatives widely used in meat products and some cheese. They are important toxicologically but there is a lack of data on the exposure of the Brazilian population to these additives. This study aimed to verify the frequency of the use of nitrates and nitrites in processed foods in Brazil and to estimate their theoretical intake by the Brazilian population. A database was built of supermarket products containing nitrates, nitrites, and antioxidants. The Theoretical Maximum Daily Intake (TMDI) and TMDI balanced by the prevalence of food consumption (TMDI BPFC) were determined using consumption data from the Household Budget Surveys (2008/2009 and 2017/2018). The TMDI for nitrates and nitrites was lower than the Acceptable Daily Intake (ADI) for all population groups. Considering the prevalence of food consumption (consumers only), the TMDI BPFC values were lower than the ADI for nitrates (between 0.4 and 0.9 times the ADI) but very high values were obtained for nitrites (between 10 and 24 times the ADI). Our results suggest that the Brazilian population, especially some population groups, may be consuming unsafe amounts of nitrite. As a consequence, their health may be at risk.
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Affiliation(s)
- Raísa Vieira Homem
- Department of Food Science, Federal University of Rio Grande do Sul - Institute of Food Science and Technology, Porto Alegre, RS, Brazil
| | - Adriana Pavesi Arisseto-Bragotto
- Department of Food Science and Nutrition, Faculty of Food Engineering, FEA UNICAMP Rua Monteiro Lobato, State University of Campinas, Campinas, SP, Brazil
| | - Eliseu Rodrigues
- Department of Food Science, Federal University of Rio Grande do Sul - Institute of Food Science and Technology, Porto Alegre, RS, Brazil
| | - Florencia Cladera-Olivera
- Department of Food Science, Federal University of Rio Grande do Sul - Institute of Food Science and Technology, Porto Alegre, RS, Brazil
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15
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Abstract
Food-based dietary guidelines have been the basis of public health recommendations for over half a century, but more recently, there has been a trend to classify the health properties of food not by its nutrient composition, but by the degree to which it has been processed. This concept has been supported by many association studies, narrative reviews and the findings from one randomised controlled feeding trial, which demonstrated the sustained effect of ultra-processed diets on increasing both energy intake and body weight. This has led to widespread speculation as to specific features of ultra-processed foods that promote increased energy intakes. Rising interest in the ultra-processed topic has led to proposals to include guidance and restrictions on the consumption of processed foods in national dietary guidelines, with some countries encouraging consumers to avoid highly processed foods completely, and only choose minimally processed foods. However, there remains a lack of consensus on the role of processed foods in human health when faced with the challenges of securing the food supply for a growing global population, that is, healthy, affordable and sustainable. There has also been criticism of the subjective nature of definitions used to differentiate foods by their degree of processing, and there is currently a lack of empirical data to support a clear mechanism by which highly processed foods promote greater energy intakes. Recommendations to avoid all highly processed foods are potentially harmful if they remove affordable sources of nutrients and will be impractical for most when an estimated two-thirds of current energy purchased are from processed or ultra-processed foods. The current review highlights some considerations when interpreting the dietary association studies that link processed food intake to health and offers a critique on some of the mechanisms proposed to explain the link between ultra-processed food and poor health. Recent research suggests a combination of higher energy density and faster meal eating rates are likely to influence meal size and energy intakes from processed foods and offers new perspectives on how to manage this in the future. In going beyond the ultra-processed debate, the aim is to summarise some important considerations when interpreting existing data and identify the important gaps for future research on the role of processed food in health.
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Affiliation(s)
- Ciarán G Forde
- Sensory Science and Eating Behaviour, Division of Human Nutrition and Health, Wageningen University and Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands
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16
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Calvo MS, Dunford EK, Uribarri J. Industrial Use of Phosphate Food Additives: A Mechanism Linking Ultra-Processed Food Intake to Cardiorenal Disease Risk? Nutrients 2023; 15:3510. [PMID: 37630701 PMCID: PMC10459924 DOI: 10.3390/nu15163510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
The consumption of ultra-processed food (UPF) keeps rising, and at the same time, an increasing number of epidemiological studies are linking high rates of consumption of UPF with serious health outcomes, such as cardiovascular disease, in the general population. Many potential mechanisms, either in isolation or in combination, can explain the negative effects of UPF. In this review, we have addressed the potential role of inorganic phosphate additives, commonly added to a wide variety of foods, as factors contributing to the negative effects of UPF on cardiorenal disease. Inorganic phosphates are rapidly and efficiently absorbed, and elevated serum phosphate can lead to negative cardiorenal effects, either directly through tissue/vessel calcification or indirectly through the release of mineral-regulating hormones, parathyroid hormone, and fibroblast growth factor-23. An association between serum phosphate and cardiovascular and bone disease among patients with chronic kidney disease is well-accepted by nephrologists. Epidemiological studies have demonstrated an association between serum phosphate and dietary phosphate intake and mortality, even in the general American population. The magnitude of the role of inorganic phosphate additives in these associations remains to be determined, and the initial step should be to determine precise estimates of population exposure to inorganic phosphate additives in the food supply.
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Affiliation(s)
- Mona S. Calvo
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Elizabeth K. Dunford
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia;
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jaime Uribarri
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
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17
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Gibney MJ. Ultra-processed foods in public health nutrition: the unanswered questions. Public Health Nutr 2023; 26:1380-1383. [PMID: 36514812 PMCID: PMC10346070 DOI: 10.1017/s1368980022002105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 12/15/2022]
Abstract
There is a growing interest in the study of the degree of food processing and both health and nutritional outcomes. To that end, several definitions of the degree of processing have been proposed. However, when each of these is used on a common database of nutritional, clinical and anthropometric variables, the observed effect of high intakes of highly processed food, varies considerably.. Moreover, assigning a given food by nutritional experts, to its appropriate level of processing, has been shown to be variable. Thus, the subjective definitions of the degree of food processing and the coding of foods according to these classifications is prone to error is prone to error. Another issue that need resolution is the relative importance of the degree of food processing and the formulation of a processed food. Although correlational studies linking processed food and obesity abound, there is a need for more investigative studies.
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Affiliation(s)
- Michael J Gibney
- Institute of Food and Health, University College Dublin, Belfield, DublinD04 V1W8, Ireland
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18
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Calvo MS, Uribarri J. Food Additive Use in Ultraprocessed Foods: Can Processing Use of Industrial Additives Contribute to Adverse Health Outcomes in Children? J Acad Nutr Diet 2023; 123:861-864. [PMID: 36682684 DOI: 10.1016/j.jand.2023.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Affiliation(s)
- Mona S Calvo
- The Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Jaime Uribarri
- The Icahn School of Medicine at Mount Sinai, New York, New York.
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19
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Srour B, Chazelas E, Fezeu LK, Javaux G, Pierre F, Huybrechts I, Hercberg S, Deschasaux‐Tanguy M, Kesse‐Guyot E, Touvier M. Nitrites, Nitrates, and Cardiovascular Outcomes: Are We Living "La Vie en Rose" With Pink Processed Meats? J Am Heart Assoc 2022; 11:e027627. [PMID: 36533633 PMCID: PMC9798789 DOI: 10.1161/jaha.122.027627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Abstract
Background Nitrates and nitrites are used as food additives in processed meats. They are also commonly ingested from water and several foods. Several short-term clinical studies suggested beneficial effects of dietary nitrates on blood pressure, while deleterious effects on oxidative damage have been suggested in some experimental studies. However, there is a lack of evidence from longitudinal epidemiological studies linking foods and water-originated and additives-originated nitrites and nitrates, separately, to hypertension and cardiovascular diseases risk. We aimed to study these associations in a large population-based cohort. Methods and Results Overall, 106 288 adults from the French NutriNet-Santé cohort (2009-2022) were included. Associations between nitrites and nitrates intakes and hypertension and cardiovascular disease risks were assessed using multi-adjusted Cox proportional hazard models. During follow-up, 3810 incident cases of hypertension and 2075 cases of cardiovascular diseases were ascertained. Participants with higher intakes of additives-originated nitrites (sodium nitrite in particular [European code e250]) had a higher hypertension risk compared with nonconsumers (hazard ratio, 1.19 [95% CI, 1.08-1.32], P=0.001, and 1.19 [95% CI, 1.08-1.32], P=0.002), respectively. No association was detected between foods and water-originated nitrites, or nitrates with hypertension risk (all P values >0.3). We found no association between nitrites or nitrates and risks of cardiovascular diseases (all P values >0.2). Conclusions These results do not support a protective role of nitrites or nitrates in cardiovascular health. Instead, they suggest a positive association between nitrites from food additives and hypertension risk, which needs confirmation in other large-scale studies. These findings provide new evidence in the context of current discussions about updating regulations on the use of nitrites as food additives.
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Affiliation(s)
- Bernard Srour
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center – University of Paris‐Cité (CRESS)BobignyFrance
- Nutrition And Cancer Research Network (NACRe Network)Jouy‐en‐JosasFrance
| | - Eloi Chazelas
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center – University of Paris‐Cité (CRESS)BobignyFrance
- Nutrition And Cancer Research Network (NACRe Network)Jouy‐en‐JosasFrance
| | - Léopold K. Fezeu
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center – University of Paris‐Cité (CRESS)BobignyFrance
| | - Guillaume Javaux
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center – University of Paris‐Cité (CRESS)BobignyFrance
| | - Fabrice Pierre
- Nutrition And Cancer Research Network (NACRe Network)Jouy‐en‐JosasFrance
- Toxalim (Research Centre in Food Toxicology)Université de Toulouse, INRAE, ENVT, INP‐Purpan, UPSToulouseFrance
| | - Inge Huybrechts
- Nutrition And Cancer Research Network (NACRe Network)Jouy‐en‐JosasFrance
- International Agency for Research on Cancer, World Health OrganizationLyonFrance
| | - Serge Hercberg
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center – University of Paris‐Cité (CRESS)BobignyFrance
- Nutrition And Cancer Research Network (NACRe Network)Jouy‐en‐JosasFrance
- Public Health Department, Avicenne Hospital, AP‐HPBobignyFrance
| | - Mélanie Deschasaux‐Tanguy
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center – University of Paris‐Cité (CRESS)BobignyFrance
- Nutrition And Cancer Research Network (NACRe Network)Jouy‐en‐JosasFrance
| | - Emmanuelle Kesse‐Guyot
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center – University of Paris‐Cité (CRESS)BobignyFrance
- Nutrition And Cancer Research Network (NACRe Network)Jouy‐en‐JosasFrance
| | - Mathilde Touvier
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center – University of Paris‐Cité (CRESS)BobignyFrance
- Nutrition And Cancer Research Network (NACRe Network)Jouy‐en‐JosasFrance
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20
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Gibney MJ. Ultra-processed foods in public health nutrition: the unanswered questions. Br J Nutr 2022; 129:1-4. [PMID: 36514809 PMCID: PMC10197074 DOI: 10.1017/s0007114522002793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 12/15/2022]
Abstract
There is a growing interest in the study of the degree of food processing and both health and nutritional outcomes. To that end, several definitions of the degree of processing have been proposed. However, when each of these is used on a common database of nutritional, clinical and anthropometric variables, the observed effect of high intakes of highly processed food, varies considerably.. Moreover, assigning a given food by nutritional experts, to its appropriate level of processing, has been shown to be variable. Thus, the subjective definitions of the degree of food processing and the coding of foods according to these classifications is prone to error is prone to error. Another issue that need resolution is the relative importance of the degree of food processing and the formulation of a processed food. Although correlational studies linking processed food and obesity abound, there is a need for more investigative studies.
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Affiliation(s)
- Michael J. Gibney
- Institute of Food and Health, University College Dublin, Belfield, DublinD04 V1W8, Ireland
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21
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Srour B, Kordahi MC, Bonazzi E, Deschasaux-Tanguy M, Touvier M, Chassaing B. Ultra-processed foods and human health: from epidemiological evidence to mechanistic insights. Lancet Gastroenterol Hepatol 2022; 7:1128-1140. [PMID: 35952706 DOI: 10.1016/s2468-1253(22)00169-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
Epidemiological studies have suggested a role for ultra-processed foods in numerous chronic inflammatory diseases such as inflammatory bowel diseases and metabolic syndrome. Preclinical and clinical studies are accumulating to better decipher the effects of various aspects of food processing and formulation on the aetiology of chronic, debilitating inflammatory diseases. In this Review, we provide an overview of the current data that highlight an association between ultra-processed food consumption and various chronic diseases, with a focus on epidemiological evidence and mechanistic insights involving the intestinal microbiota.
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Affiliation(s)
- Bernard Srour
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, Centre of Research in Epidemiology and Statistics, Université Paris Cité, Paris, France; NACRe Network-Nutrition and Cancer Research Network, Jouy-en-Josas, France
| | - Melissa C Kordahi
- INSERM U1016, Mucosal microbiota in chronic inflammatory diseases, CNRS UMR 8104, Université de Paris, Paris, France; NACRe Network-Nutrition and Cancer Research Network, Jouy-en-Josas, France
| | - Erica Bonazzi
- INSERM U1016, Mucosal microbiota in chronic inflammatory diseases, CNRS UMR 8104, Université de Paris, Paris, France; NACRe Network-Nutrition and Cancer Research Network, Jouy-en-Josas, France
| | - Mélanie Deschasaux-Tanguy
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, Centre of Research in Epidemiology and Statistics, Université Paris Cité, Paris, France; NACRe Network-Nutrition and Cancer Research Network, Jouy-en-Josas, France
| | - Mathilde Touvier
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, Centre of Research in Epidemiology and Statistics, Université Paris Cité, Paris, France; NACRe Network-Nutrition and Cancer Research Network, Jouy-en-Josas, France
| | - Benoit Chassaing
- INSERM U1016, Mucosal microbiota in chronic inflammatory diseases, CNRS UMR 8104, Université de Paris, Paris, France; NACRe Network-Nutrition and Cancer Research Network, Jouy-en-Josas, France.
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22
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Debras C, Chazelas E, Sellem L, Porcher R, Druesne-Pecollo N, Esseddik Y, de Edelenyi FS, Agaësse C, De Sa A, Lutchia R, Fezeu LK, Julia C, Kesse-Guyot E, Allès B, Galan P, Hercberg S, Deschasaux-Tanguy M, Huybrechts I, Srour B, Touvier M. Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort. BMJ 2022; 378:e071204. [PMID: 36638072 PMCID: PMC9449855 DOI: 10.1136/bmj-2022-071204] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To study the associations between artificial sweeteners from all dietary sources (beverages, but also table top sweeteners, dairy products, etc), overall and by molecule (aspartame, acesulfame potassium, and sucralose), and risk of cardiovascular diseases (overall, coronary heart disease, and cerebrovascular disease). DESIGN Population based prospective cohort study (2009-21). SETTING France, primary prevention research. PARTICIPANTS 103 388 participants of the web based NutriNet-Santé cohort (mean age 42.2±14.4, 79.8% female, 904 206 person years). Dietary intakes and consumption of artificial sweeteners were assessed by repeated 24 h dietary records, including brand names of industrial products. MAIN OUTCOMES MEASURES Associations between sweeteners (coded as a continuous variable, log10 transformed) and cardiovascular disease risk, assessed by multivariable adjusted Cox hazard models. RESULTS Total artificial sweetener intake was associated with increased risk of cardiovascular diseases (1502 events, hazard ratio 1.09, 95% confidence interval 1.01 to 1.18, P=0.03); absolute incidence rate in higher consumers (above the sex specific median) and non-consumers was 346 and 314 per 100 000 person years, respectively. Artificial sweeteners were more particularly associated with cerebrovascular disease risk (777 events, 1.18, 1.06 to 1.31, P=0.002; incidence rates 195 and 150 per 100 000 person years in higher and non-consumers, respectively). Aspartame intake was associated with increased risk of cerebrovascular events (1.17, 1.03 to 1.33, P=0.02; incidence rates 186 and 151 per 100 000 person years in higher and non-consumers, respectively), and acesulfame potassium and sucralose were associated with increased coronary heart disease risk (730 events; acesulfame potassium: 1.40, 1.06 to 1.84, P=0.02; incidence rates 167 and 164; sucralose: 1.31, 1.00 to 1.71, P=0.05; incidence rates 271 and 161). CONCLUSIONS The findings from this large scale prospective cohort study suggest a potential direct association between higher artificial sweetener consumption (especially aspartame, acesulfame potassium, and sucralose) and increased cardiovascular disease risk. Artificial sweeteners are present in thousands of food and beverage brands worldwide, however they remain a controversial topic and are currently being re-evaluated by the European Food Safety Authority, the World Health Organization, and other health agencies. TRIAL REGISTRATION ClinicalTrials.gov NCT03335644.
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Affiliation(s)
- Charlotte Debras
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
- French network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Eloi Chazelas
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
- French network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Laury Sellem
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
- French network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Raphaël Porcher
- Université de Paris, CRESS UMR1153, INSERM, INRA, Paris, France
- Centre d'Épidémiologie Clinique, AP-HP, Hôtel-Dieu, Paris, France
| | - Nathalie Druesne-Pecollo
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
- French network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Younes Esseddik
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
| | - Fabien Szabo de Edelenyi
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
| | - Cédric Agaësse
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
| | - Alexandre De Sa
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
| | - Rebecca Lutchia
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
| | - Léopold K Fezeu
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
- French network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Chantal Julia
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
- Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
- French network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Benjamin Allès
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
| | - Pilar Galan
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
- French network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Serge Hercberg
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
- French network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
- Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Mélanie Deschasaux-Tanguy
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
- French network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Inge Huybrechts
- French network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Bernard Srour
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
- French network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Mathilde Touvier
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France
- French network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
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Trakman GL, Lin WYY, Hamilton AL, Wilson-O’Brien AL, Stanley A, Ching JY, Yu J, Mak JWY, Sun Y, Niu J, Miao Y, Lin X, Feng R, Chen M, Shivappa N, Hebert JR, Morrison M, Ng SC, Kamm MA. Processed Food as a Risk Factor for the Development and Perpetuation of Crohn's Disease-The ENIGMA Study. Nutrients 2022; 14:nu14173627. [PMID: 36079885 PMCID: PMC9460819 DOI: 10.3390/nu14173627] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Developing countries have experienced a rapid recent rise in Inflammatory Bowel Disease (IBD) incidence and emerging evidence suggests processed foods and food additives may predispose one to the development and perpetuation of Crohn’s disease (CD). The aim of this study was to evaluate processed food and food additive intake in CD patients and controls, in Australia (high CD incidence), Hong Kong (intermediate incidence) and mainland China (emerging incidence). (2) Methods: In 274 CD patients (CD), 82 first-degree relatives (FDR), 83 household members (HM) and 92 healthy unrelated controls (HC) from Australia (n = 180), Hong Kong (HK) (n = 160) and mainland China (n = 191) we estimated early life (0–18 years), recent (12 months), and current processed and food additive intake, using validated questionnaires and a 3-day-food diary. (3) Results: Early life processed food intake: Combining all regions, CD were more likely to have consumed soft drinks and fast foods than HM, more likely to have consumed processed fruit and snacks than their FDR, and more likely to have consumed a range of processed foods than HC. HK and China CD patients were more likely to have consumed a range of processed foods than HC. Recent food-additive intake (12-months): Combining all regions, CD patients had significantly higher intakes of aspartame and sucralose, and polysorbate-80, than HC, and more total emulsifiers, artificial sweeteners, and titanium dioxide than FDR and HC. HK and China CD patients had a higher intake of almost all food additives than all controls. Current additive intake (3-days): Australian and HK CD patients had higher total food-additive intake than FDR, and HK CD patients had a higher intake of total food-additives and emulsifiers than HM. (4) Conclusions: CD patients have been exposed to more processed food and food additives than control groups, which may predispose them to CD development and ongoing inflammation.
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Affiliation(s)
- Gina L. Trakman
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne 3065, Australia
- Department of Medicine, The University of Melbourne, Melbourne 3065, Australia
- Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne 3086, Australia
| | - Winnie Y. Y. Lin
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Microbiota I-Center (MagIC), The Chinese University of Hong Kong, Hong Kong, China
| | - Amy L. Hamilton
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne 3065, Australia
- Department of Medicine, The University of Melbourne, Melbourne 3065, Australia
| | - Amy L. Wilson-O’Brien
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne 3065, Australia
- Department of Medicine, The University of Melbourne, Melbourne 3065, Australia
| | - Annalise Stanley
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne 3065, Australia
| | - Jessica Y. Ching
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Jun Yu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce W. Y. Mak
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Yang Sun
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming 650032, China
| | - Junkun Niu
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming 650032, China
| | - Yinglei Miao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming 650032, China
| | - Xiaoqing Lin
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510060, China
| | - Rui Feng
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510060, China
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510060, China
| | - Nitin Shivappa
- The Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, Norman J Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29201, USA
| | - James R. Hebert
- The Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, Norman J Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29201, USA
| | - Mark Morrison
- The University of Queensland Diamantina Institute, Faculty of Medicine, Translational Research Institute, Brisbane 4102, Australia
| | - Siew C. Ng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Microbiota I-Center (MagIC), The Chinese University of Hong Kong, Hong Kong, China
- Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, China
- Centre for Gut Microbiota Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Michael A Kamm
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne 3065, Australia
- Department of Medicine, The University of Melbourne, Melbourne 3065, Australia
- Correspondence: ; Tel.: +61-3 9417-5064
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Scrinis G, Monteiro C. From ultra-processed foods to ultra-processed dietary patterns. NATURE FOOD 2022; 3:671-673. [PMID: 37118150 DOI: 10.1038/s43016-022-00599-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Gyorgy Scrinis
- School of Agriculture and Food, University of Melbourne, Melbourne, Victoria, Australia.
| | - Carlos Monteiro
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
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25
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Chassaing B, Gewirtz AT, Lewis JD. Reply. Gastroenterology 2022; 163:781-782. [PMID: 35595123 DOI: 10.1053/j.gastro.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Benoit Chassaing
- INSERM U1016, Team "Mucosal microbiota in chronic inflammatory diseases", Université de Paris, Paris, France
| | - Andrew T Gewirtz
- Institute for Biomedical Sciences, Center for Inflammation Immunity and Infection, Digestive Disease Research Group, Georgia State University, Atlanta, Georgia
| | - James D Lewis
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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26
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De Siena M, Raoul P, Costantini L, Scarpellini E, Cintoni M, Gasbarrini A, Rinninella E, Mele MC. Food Emulsifiers and Metabolic Syndrome: The Role of the Gut Microbiota. Foods 2022; 11:foods11152205. [PMID: 35892789 PMCID: PMC9331555 DOI: 10.3390/foods11152205] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 12/04/2022] Open
Abstract
The use of emulsifiers in processed foods and the rapid epidemic development of metabolic syndrome in Western countries over the past 20 years have generated growing interest. Evidence for the role of emulsifiers in metabolic syndrome through gut microbiota has not been clearly established, thus making it challenging for clinical nutritionists and dietitians to make evidence-based associations between the nature and the quantity of emulsifiers and metabolic disorders. This narrative review summarizes the highest quality clinical evidence currently available about the impact of food emulsifiers on gut microbiota composition and functions and the potential development of metabolic syndrome. The state-of-the-art of the different common emulsifiers is performed, highlighting where they are present in daily foods and their roles. Recent findings of in vitro, in vivo, and human studies assessing the effect of different emulsifiers on gut microbiota have been recently published. There is some progress in understanding how some food emulsifiers could contribute to developing metabolic diseases through gut microbiota alterations while others could have prebiotic effects. However, there are still many unanswered questions regarding daily consumption amounts and the synergic effects between emulsifiers’ intake and responses by the microbial signatures of each individual.
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Affiliation(s)
- Martina De Siena
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.S.); (A.G.)
| | - Pauline Raoul
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (P.R.); (M.C.); (M.C.M.)
| | - Lara Costantini
- Department of Ecological and Biological Sciences (DEB), Tuscia University, 01100 Viterbo, Italy;
| | - Emidio Scarpellini
- Nutrition and Internal Medicine Unit, “Madonna del Soccorso” General Hospital, 63074 San Benedetto del Tronto, Italy;
- T.A.R.G.I.D., Gasthuisberg University Hospital, KU Leuven, Herestraat 49, 3000 Lueven, Belgium
| | - Marco Cintoni
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (P.R.); (M.C.); (M.C.M.)
| | - Antonio Gasbarrini
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.S.); (A.G.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Emanuele Rinninella
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (P.R.); (M.C.); (M.C.M.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-3015-7386
| | - Maria Cristina Mele
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (P.R.); (M.C.); (M.C.M.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
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Rego RA. Ultra-Processed: The Search of Positioning From the Food Industry Regulatory Authorities. Front Nutr 2022; 9:906561. [PMID: 35734375 PMCID: PMC9207195 DOI: 10.3389/fnut.2022.906561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
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28
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Exploring the Probiotic Potential of Dairy Industrial-Relevant Lactobacilli. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12104989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Usually, the search for new candidate probiotics starts from strain isolation, followed by genotypic and phenotypic characterisations. For the best candidates, the final selection criteria, i.e., an efficient biomass production and the survival to stressful conservation processes, may often represent a bottleneck. The aim of this study is to reverse this classic bottom-up approach, thereby evaluating the in vitro probiotic properties of microbes that are already commercialized and employed in the dairy sector. The major advantage of reversing the traditional scheme is to deal with strains that are already suitable for the scale-up at the industrial level. In this work, four lactobacilli strains were analysed, belonging to the species of Lactiplantibacillus plantarum (strains PLA and PLA2) and Lacticaseibacillus rhamnosus (strains PAR4 and RHM). Both L. plantarum strains showed the best survival under simulated oro-gastrointestinal stress; PLA and PAR4 had the strongest inhibitory activity against all the tested harmful bacteria, with the latter strain showing also the highest percentage of Caco-2 adhesion; RHM was the best biofilm producer on abiotic surface. Finally, cell-free surnatants from all the strain cultures exhibited anti-inflammatory action on THP-1 macrophages. For all the studied strains, it is possible to claim beneficial functional properties other than the technological ones for which they are already marketed. The possible use of the four strains in a mixture could represent a strategy to diversify and maximize their beneficial potential. Nonetheless, future studies are necessary to validate in vivo the observed beneficial properties and to evaluate any effect of the vehicle product on the probiotic aptitude.
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Chassaing B, Compher C, Bonhomme B, Liu Q, Tian Y, Walters W, Nessel L, Delaroque C, Hao F, Gershuni V, Chau L, Ni J, Bewtra M, Albenberg L, Bretin A, McKeever L, Ley RE, Patterson AD, Wu GD, Gewirtz AT, Lewis JD. Randomized Controlled-Feeding Study of Dietary Emulsifier Carboxymethylcellulose Reveals Detrimental Impacts on the Gut Microbiota and Metabolome. Gastroenterology 2022; 162:743-756. [PMID: 34774538 PMCID: PMC9639366 DOI: 10.1053/j.gastro.2021.11.006] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/20/2021] [Accepted: 11/02/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Epidemiologic and murine studies suggest that dietary emulsifiers promote development of diseases associated with microbiota dysbiosis. Although the detrimental impact of these compounds on the intestinal microbiota and intestinal health have been demonstrated in animal and in vitro models, impact of these food additives in healthy humans remains poorly characterized. METHODS To examine this notion in humans, we performed a double-blind controlled-feeding study of the ubiquitous synthetic emulsifier carboxymethylcellulose (CMC) in which healthy adults consumed only emulsifier-free diets (n = 9) or an identical diet enriched with 15 g per day of CMC (n = 7) for 11 days. RESULTS Relative to control subjects, CMC consumption modestly increased postprandial abdominal discomfort and perturbed gut microbiota composition in a way that reduced its diversity. Moreover, CMC-fed subjects exhibited changes in the fecal metabolome, particularly reductions in short-chain fatty acids and free amino acids. Furthermore, we identified 2 subjects consuming CMC who exhibited increased microbiota encroachment into the normally sterile inner mucus layer, a central feature of gut inflammation, as well as stark alterations in microbiota composition. CONCLUSIONS These results support the notion that the broad use of CMC in processed foods may be contributing to increased prevalence of an array of chronic inflammatory diseases by altering the gut microbiome and metabolome (ClinicalTrials.gov, number NCT03440229).
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Affiliation(s)
- Benoit Chassaing
- INSERM U1016, team "Mucosal microbiota in chronic inflammatory diseases,'' CNRS UMR 8104, Université de Paris, Paris, France.
| | - Charlene Compher
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brittaney Bonhomme
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Qing Liu
- Center for Molecular Toxicology and Carcinogenesis, Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, Pennsylvania
| | - Yuan Tian
- Center for Molecular Toxicology and Carcinogenesis, Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, Pennsylvania
| | - William Walters
- Department of Microbiome Science, Max Planck Institute for Developmental Biology, Tübingen, Germany
| | - Lisa Nessel
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Clara Delaroque
- INSERM U1016, team “Mucosal microbiota in chronic inflammatory diseases,” CNRS UMR 8104, Université de Paris, Paris, France
| | - Fuhua Hao
- Center for Molecular Toxicology and Carcinogenesis, Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, Pennsylvania
| | - Victoria Gershuni
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lillian Chau
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Josephine Ni
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Meenakshi Bewtra
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lindsey Albenberg
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexis Bretin
- Institute for Biomedical Sciences, Center for Inflammation, Immunity and Infection, Digestive Disease Research Group, Georgia State University, Atlanta, Georgia
| | - Liam McKeever
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ruth E. Ley
- Department of Microbiome Science, Max Planck Institute for Developmental Biology, Tübingen, Germany
| | - Andrew D. Patterson
- Center for Molecular Toxicology and Carcinogenesis, Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, Pennsylvania
| | - Gary D. Wu
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew T. Gewirtz
- Institute for Biomedical Sciences, Center for Inflammation, Immunity and Infection, Digestive Disease Research Group, Georgia State University, Atlanta, Georgia
| | - James D. Lewis
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Debras C, Chazelas E, Srour B, Druesne-Pecollo N, Esseddik Y, Szabo de Edelenyi F, Agaësse C, De Sa A, Lutchia R, Gigandet S, Huybrechts I, Julia C, Kesse-Guyot E, Allès B, Andreeva VA, Galan P, Hercberg S, Deschasaux-Tanguy M, Touvier M. Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study. PLoS Med 2022; 19:e1003950. [PMID: 35324894 PMCID: PMC8946744 DOI: 10.1371/journal.pmed.1003950] [Citation(s) in RCA: 85] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/23/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The food industry uses artificial sweeteners in a wide range of foods and beverages as alternatives to added sugars, for which deleterious effects on several chronic diseases are now well established. The safety of these food additives is debated, with conflicting findings regarding their role in the aetiology of various diseases. In particular, their carcinogenicity has been suggested by several experimental studies, but robust epidemiological evidence is lacking. Thus, our objective was to investigate the associations between artificial sweetener intakes (total from all dietary sources, and most frequently consumed ones: aspartame [E951], acesulfame-K [E950], and sucralose [E955]) and cancer risk (overall and by site). METHODS AND FINDINGS Overall, 102,865 adults from the French population-based cohort NutriNet-Santé (2009-2021) were included (median follow-up time = 7.8 years). Dietary intakes and consumption of sweeteners were obtained by repeated 24-hour dietary records including brand names of industrial products. Associations between sweeteners and cancer incidence were assessed by Cox proportional hazards models, adjusted for age, sex, education, physical activity, smoking, body mass index, height, weight gain during follow-up, diabetes, family history of cancer, number of 24-hour dietary records, and baseline intakes of energy, alcohol, sodium, saturated fatty acids, fibre, sugar, fruit and vegetables, whole-grain foods, and dairy products. Compared to non-consumers, higher consumers of total artificial sweeteners (i.e., above the median exposure in consumers) had higher risk of overall cancer (n = 3,358 cases, hazard ratio [HR] = 1.13 [95% CI 1.03 to 1.25], P-trend = 0.002). In particular, aspartame (HR = 1.15 [95% CI 1.03 to 1.28], P = 0.002) and acesulfame-K (HR = 1.13 [95% CI 1.01 to 1.26], P = 0.007) were associated with increased cancer risk. Higher risks were also observed for breast cancer (n = 979 cases, HR = 1.22 [95% CI 1.01 to 1.48], P = 0.036, for aspartame) and obesity-related cancers (n = 2,023 cases, HR = 1.13 [95% CI 1.00 to 1.28], P = 0.036, for total artificial sweeteners, and HR = 1.15 [95% CI 1.01 to 1.32], P = 0.026, for aspartame). Limitations of this study include potential selection bias, residual confounding, and reverse causality, though sensitivity analyses were performed to address these concerns. CONCLUSIONS In this large cohort study, artificial sweeteners (especially aspartame and acesulfame-K), which are used in many food and beverage brands worldwide, were associated with increased cancer risk. These findings provide important and novel insights for the ongoing re-evaluation of food additive sweeteners by the European Food Safety Authority and other health agencies globally. TRIAL REGISTRATION ClinicalTrials.gov NCT03335644.
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Affiliation(s)
- Charlotte Debras
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Eloi Chazelas
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Bernard Srour
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Nathalie Druesne-Pecollo
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Younes Esseddik
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Fabien Szabo de Edelenyi
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Cédric Agaësse
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Alexandre De Sa
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Rebecca Lutchia
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | | | - Inge Huybrechts
- French Network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Chantal Julia
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
- Public Health Department, Avicenne Hospital, Assistance Publique–Hôpitaux de Paris, Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Benjamin Allès
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Valentina A. Andreeva
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Pilar Galan
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Serge Hercberg
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
- Public Health Department, Avicenne Hospital, Assistance Publique–Hôpitaux de Paris, Bobigny, France
| | - Mélanie Deschasaux-Tanguy
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
| | - Mathilde Touvier
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
- French Network for Nutrition and Cancer Research (NACRe network), Jouy-en-Josas, France
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Gibney MJ, Forde CG. Nutrition research challenges for processed food and health. NATURE FOOD 2022; 3:104-109. [PMID: 37117956 DOI: 10.1038/s43016-021-00457-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/22/2021] [Indexed: 04/30/2023]
Abstract
Existing highly processed food (HPF) classification systems show large differences in the impact of these foods on biochemical risk factors for disease. If public health nutrition is to consider the degree of food processing as an important element of the link between food and health, certain gaps in research must be acknowledged. Quantifying the food additive exposure derived from HPFs is a task made challenging by the lack of data available on the occurrence and concentration of additives in food and the degree to which the natural occurrence of additives in unprocessed foods confounds exposure estimates. The proposed role of HPFs in health outcomes could also be associated with altered nutrient profiles. Differences exist within and between HPF classification systems in this regard and there are conflicting data on the impact of controlling for nutrient intake. Furthermore, research is needed on how the sensory aspects of HPFs contribute to energy intake. Current data suggest that high energy intake rate may be the mechanism linking HPFs and increased energy intake. A high priority now is to clarify the basis of definitions used to categorize foods as highly processed and, in a constructive sense, to distinguish between the contributions of nutrients, additives and sensory properties to health.
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Affiliation(s)
- Michael J Gibney
- Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Ciarán G Forde
- Sensory Science and Eating Behaviour, Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
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More SJ, Bampidis V, Benford D, Bragard C, Hernandez‐Jerez A, Bennekou SH, Halldorsson TI, Koutsoumanis KP, Lambré C, Machera K, Naegeli H, Nielsen SS, Schlatter JR, Schrenk D, Silano V, Turck D, Younes M, Benfenati E, Crépet A, Te Biesebeek JD, Testai E, Dujardin B, Dorne JLCM, Hogstrand C. Guidance Document on Scientific criteria for grouping chemicals into assessment groups for human risk assessment of combined exposure to multiple chemicals. EFSA J 2021; 19:e07033. [PMID: 34976164 PMCID: PMC8681880 DOI: 10.2903/j.efsa.2021.7033] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
This guidance document provides harmonised and flexible methodologies to apply scientific criteria and prioritisation methods for grouping chemicals into assessment groups for human risk assessment of combined exposure to multiple chemicals. In the context of EFSA's risk assessments, the problem formulation step defines the chemicals to be assessed in the terms of reference usually through regulatory criteria often set by risk managers based on legislative requirements. Scientific criteria such as hazard-driven criteria can be used to group these chemicals into assessment groups. In this guidance document, a framework is proposed to apply hazard-driven criteria for grouping of chemicals into assessment groups using mechanistic information on toxicity as the gold standard where available (i.e. common mode of action or adverse outcome pathway) through a structured weight of evidence approach. However, when such mechanistic data are not available, grouping may be performed using a common adverse outcome. Toxicokinetic data can also be useful for grouping, particularly when metabolism information is available for a class of compounds and common toxicologically relevant metabolites are shared. In addition, prioritisation methods provide means to identify low-priority chemicals and reduce the number of chemicals in an assessment group. Prioritisation methods include combined risk-based approaches, risk-based approaches for single chemicals and exposure-driven approaches. Case studies have been provided to illustrate the practical application of hazard-driven criteria and the use of prioritisation methods for grouping of chemicals in assessment groups. Recommendations for future work are discussed.
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