Food additive emulsifiers and cancer risk: tremble, good people!

2024-02-23 08:59:52

Food additive emulsifiers and cancer risk: tremble, good people!

The study undoubtedly meets the canons of epidemiological research, but what regarding the real value of the results and the cost-benefit ratio? In any case, it includes a conclusion which denotes a militant approach and has – once more – been the subject of questionable media coverage based on fear.

The NutriNet-Santé cohort team has just published a new study – in PLOS Medicine – which should make us tremble with fear… well, I’m exaggerating, but just a little.

It is “Food additive emulsifiers and cancer risk: Results from the French prospective NutriNet-Santé cohort” from a cohort of researchers whose first mentioned is Laury Sellem and the last Mathilde Touvier.

Here is the summary (cut):

Résumé

Context

Emulsifiers are food additives widely used in industrially processed foods to improve texture and shelf life. Experimental research suggests that emulsifiers have deleterious effects on the gut microbiota and metabolome, leading to chronic inflammation and increasing susceptibility to carcinogenesis.

However, there are no human epidemiological data on their association with cancer. This study aimed to evaluate the associations between food additive emulsifiers and cancer risk in a large prospective population-based cohort.

Methods and results

This study involved 92,000 adults from the French NutriNet-Santé cohort without prevalent cancer at enrollment (44.5 years [SD [écart-type] : 14.5]78.8% women, 2009 to 2021). They were followed for an average of 6.7 years [SD : 2,2].

Emulsifying food additive intakes were estimated for participants who provided at least 3 repeated 24-hour dietary records linked to comprehensive food additive food composition databases based on brand.

Multivariable Cox regressions were performed to estimate associations between emulsifiers and cancer incidence.

In total, 2,604 cases of cancer were diagnosed during follow-up (including 750 breast cancers, 322 prostate cancers and 207 colorectal cancers).

Higher intakes of mono- and diglycerides of fatty acids (FA) (E471) were associated with higher risks of overall cancer (high vs. low HR category [hazard ratio, rapport des risques]= 1,15 ; IC à 95 % [intervalle de confiance à 95 %] [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).

Furthermore, 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 they were not confirmed by sensitivity analyses.

The main limitations are possible exposure measurement errors in emulsifier consumption and potential residual confounding related to the observation design.

Conclusions

In this large prospective cohort, we observed associations between higher intakes of carrageenan and mono- and diglycerides of fatty acids and overall risk of breast and prostate cancer. These results need to be replicated in other populations. They provide new epidemiological evidence on the role of emulsifiers in cancer risk.

Recording the test

ClinicalTrials.gov NCT03335644.

Author summary

Why was this study carried out?

In vivo/in vitro experimental research as well as a pilot clinical trial on healthy individuals suggest that consumption of emulsifiers as food additives has deleterious effects on the gut microbiota, metabolome, inflammation of the host and susceptibility to carcinogenesis.

To our knowledge, due to the difficulties encountered in accurately estimating exposure to food additive emulsifiers through diet, there has until now been no available epidemiological evidence from prospective cohorts on food consumption. Food additive emulsifiers in relation to cancer risk.

What did the researchers do and find?

Higher intakes of mono- and diglycerides of fatty acids (FA) (E471), total carrageenan (E407, E407a), and carrageenan (E407) were associated with higher risks of overall cancer, breast cancer and/or prostate cancer.

What do these results mean?

These results provide important epidemiological information on the role of emulsifiers in cancer risks and need to be confirmed by further epidemiological and experimental research.

We can imagine the excess of energy that had to be deployed to fill out detailed statements and use them, then to crunch the figures.

For what results? Correlations between, not the consumption of emulsifiers, but the consumption of three days (at least) during the two years following enlistment, and the occurrence of cancers.

This is certainly consubstantial with certain forms of epidemiological studies, but we must be aware of it when we analyze the results.

And what did we find? Some statistically significant results following a fantastic trawl fishery, but which do not seem to go beyond chance correlation.

(Source)

We can easily be convinced of this in light of the results announced. Why would there be significant associations for breast and prostate cancers, and not for the colon-rectum, a priori more exposed to emulsifiers than other organs? What mechanism would be likely to support a causal link?

The statistically significant associations are undoubtedly linked to the number of total cancers: sufficient for the breast and prostate, insufficient for the others. But this requires moderation of interpretations.

The authors rightly concluded their summary with: “These results need to be replicated in other populations. » But they came forward rashly in our opinion by asserting: “They provide new epidemiological evidence on the role of emulsifiers in the risk of cancer. »

New data are certainly being added to the body of knowledge, but we can question here their value, the cost-interest ratio and, above all, the media coverage.

Was it appropriate to produce a press release (here for INSERM, here for INRAE), with a catchy title and an introduction that is really open to criticism due to its emphasis on ultra-processed foods? Certainly, so-called “ultra-processed” foods are the bane of the team that operates the NutriNet-Santé cohort.

It sparked a media frenzy, like this “Food additives associated with an increased risk of cancer” from Le Monde or, worse, “Yoghurts, soups, cereals… in which foods are we found the no more unhealthy additives? » from RMC, or even worse, “A study reveals a worrying link between emulsifiers and several cancers”.

A previous exercise from basically the same team, “Food additive emulsifiers and risk of cardiovascular disease in the NutriNet-Santé cohort: prospective cohort study” prospective), had not given rise to drum rolls. There was indeed a press release, but with the rather bald title, “Association between the consumption of emulsifying food additives and the risk of cardiovascular diseases”

It is true that the results were not “sexy” for general public communication: the highest risk ratio for an increase of one standard deviation was 1.11 (why, here, the results reported to standard deviations, rather than tertiles as for cancers?).

The conclusion of the article (on cardiovascular diseases) nevertheless insisted on “policy implications” that were as insistent as they were fallacious:

“Despite the moderate magnitude of associations, these findings may have important public health implications, given that these food additives are used ubiquitously in thousands of widely consumed ultra-processed food products.” The results will contribute to the re-evaluation of regulations relating to the use of food additives in the food industry in order to protect consumers. Meanwhile, several public health authorities recommend limiting consumption of ultra-processed foods to limit exposure to controversial non-essential food additives. »

We are in the same vein for cancers, but more verbose.

This also illustrates an asymmetry – and the associated irresponsibility – of communication: discretion when we have found results that are ultimately reassuring; fuss when results can be presented in a way that arouses anxiety.

The title of the press releases (we are the ones who grease): “The consumption of certain emulsifying food additives is associated with an increased risk of cancer”. At the conclusion of the press releases, a quote:

“If these results are to be replicated in other studies around the world, they bring key new knowledge to the debate on the re-evaluation of regulations relating to the use of additives in the food industry, in order to better protect consumers””, explain Mathilde Touvier, research director at Inserm, and Bernard Srour, junior professor at INRAE, main authors of the study. »

We are clearly in the domain of militant “science”.

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