Food colouring additives, hypertension & cardiovascular disease incidence: NutriNet-Santé cohort

Background

Experimental studies have shown some food colouring additives promote oxidative stress, inflammation, and vascular dysfunction, yet human data are lacking. We investigated associations between food colouring additive exposure and hypertension and cardiovascular disease (CVD) incidence, incl. cerebrovascular disease (CVA) and coronary heart disease (CHD).

Methods

112,395 participants (78.7% female) from the NutriNet-Santé cohort (2009-2024) were included. Dietary data were assessed using repeated 24h-dietary records, including industrial brands. Cumulative time-dependent exposure to food additives was evaluated through multiple composition databases and ad-hoc laboratory assays in food matrices. Associations between exposure (sex-specific tertiles or non-exposed/lower/higher exposed based on sex-specific median) and hypertension and CVD incidence were assessed using Cox models.

Results

5,544 incident hypertension (mean follow-up 7.6 ± 4.9y) and 2,450 incident CVD (1,142 CVA & 1,308 CHD;7.9 ± 4.9y) were identified. Higher total food colouring additives intake was associated with higher hypertension (HRT3 vs T1=1.36, 95%CI: 1.26–1.47), CVD (1.18, 1.05–1.31), and CHD (1.19, 1.02–1.38) but not CVA incidence (1.17, 0.99–1.37). Several individual colouring additives were associated with higher hypertension incidence: plain caramel (1.15, 1.07–1.23), carotenoids (1.15, 1.07–1.23), beta-carotene (1.18, 1.10–1.26), paprika-capsanthin-capsorubin (1.17, 1.09–1.25), lutein (1.17, 1.09–1.26), curcumin (1.15, 1.08–1.23), cochineal-carminic acid-carmines (1.13, 1.05–1.21), and anthocyanins (1.14, 1.05–1.25). Carotenoid additives were also associated with higher CVD (1.13, 1.02–1.25) and CHD incidence (1.23, 1.07–1.42). Hypertension mediated 19% (9%–72%) of the association between total food colouring additive intake and CVD incidence.

Conclusions

Exposure to widely used food colouring additives was associated with higher incidence of hypertension and CVD, including CHD.

Key messages

• We showed, for the first time, that several widely used food colouring additives from industrial foods were associated with higher hypertension and/or cardiovascular disease incidence.

• These results support re-evaluating safety assessments of these additives and reinforce recommendations to limit exposure to non-essential “cosmetic” additives.