Food processing/contact materials and hypertension/type 2 diabetes risk – NutriNet-Santé cohort

Background

Food items are contaminated by various substances (e.g. Per- and polyfluoroalkyl substances – PFAS, Polycyclic aromatic hydrocarbons – PAHs, Brominated Flame Retardants – BFRs) throughout their lifecycle. This study investigated the associations between exposure to contaminants originating from food processing/contact materials and hypertension and type 2 diabetes (T2D) risk in the NutriNet-Santé cohort.

Methods

We assessed cumulative time-dependent exposures to 51 food contaminants using repeated 24h-dietary records from 108,758 participants (78.6% women, mean age=42.8y (SD = 14.7)) of the NutriNet-Santé cohort (2009-2024), and quantitative analyses in food matrices from the French total diet study 2 (2006-2009). Associations between contaminant exposures (sex-specific tertiles) and hypertension/T2D incidence were characterized using multivariable Cox proportional hazards models adjusted for known risk factors. Mixtures effects were explored using sparse PLS-Cox models.

Results

During a median 8y follow-up, 1,958 incident hypertension and 1,202 incident T2D cases were ascertained. 12 BFRs (e.g. total BDEs: HRT3 vs. T1=1.12,95%CI[1.04–1.21],ptrend= 0.005), 7 PAHs and 10 PFAS (e.g. PFOS: HRT3 vs. T1=1.15 [1.06-1.25], poverall<0.001) were associated with increased risk of hypertension. 5 BFRs, 2 PAHs (e.g. benzo[b]fluoranthene: HRT3 vs. T1=1.20[1.03-1.39],ptrend=0.02) and 1 PFAS (e.g. PFDS: HRT3 vs. T1=1.30 [1.04-1.63], ptrend=0.03) were associated with higher T2D incidence. Sparse PLS-Cox models identified contaminants mixtures most associated with each outcome.

Conclusions

This large prospective cohort study suggests a potential role for food contaminants such as BFRs, in hypertension and T2D etiology, which is consistent with their metabolic disrupting potential suggested by previous in vivo/in vitro studies. If replicated and confirmed in other epidemiological studies, our findings advocate for stronger regulations on these food contaminants.

Key messages

• Some substances found in food contact material and/or generated during food processing might be associated with a higher risk of hypertension and type 2 diabetes.

• If corroborated by further studies, our study underscores the necessity for stricter regulations on food contaminants.