Mixture of food additives and risk of type 2 diabetes

Mixtures of food additives have been tested on more than 100,000 adults. Emulsifiers, sweeteners, colourings and acidifiers consumed in highly processed products such as bouillons, milk-based desserts and soft drinks are associated with a higher incidence of type 2 diabetes.

Until now, research and safety assessments of these additives have been carried out on a substance-by-substance basis.

The novelty of the analysis was to investigate possible links between exposure to mixtures of commonly consumed food additives and the onset of type 2 diabetes.

An analysis of health data with:

• an average follow-up period of 7.7 years for more than 100,000 adults (French NutriNet-Santé cohort),
• online reporting of food and drink consumed over at least two days (up to 15 days for some),
• identification of five main mixtures of food additives, representing groups of substances frequently ingested together,
• two of the five mixtures tested were associated with a higher incidence of type 2 diabetes.

1st blend with emulsifiers > broths, milk-based desserts, fats, sauces

• – emulsifiers: modified starches, pectin, guar gum, carrageenan, polyphosphates, xanthan gum
• – preservative: potassium sorbate
• – colouring agent: curcumin

2nd mixture with sweeteners, colourings and acidifiers > sweetened drinks and sodas

• – acidifiers and acidity regulators: citric acid, sodium citrates, phosphoric acid, malic acid
• – colourings: ammonium sulphite caramel, anthocyanins, paprika extract
• – sweeteners: acesulfame K, aspartame, sucralose
• – emulsifiers: gum arabic, pectin, guar gum
• – coating agent: carnauba wax

Further studies are needed to elucidate the underlying mechanisms and deepen our understanding of the potential synergies and antagonisms between these food additives. This observational study alone is not sufficient to establish a causal link. However, our results are consistent with recent in vitro experimental work suggesting possible ‘cocktail effects’ (1). They indicate that the evaluation of food additives should take into account their interactions and support public health recommendations to limit non-essential additives," explains Mathilde Touvier, research director at Inserm and coordinator of the study.

(1) Publication involving members of Toxalim : Cynthia Recoules, Mathilde Touvier, Fabrice Pierre, Marc Audebert. Food Chem Toxicol. 2025. Evaluation of the toxic effects of food additives, alone or in mixture, in four human cell models.