Ultra-processed foods (UPFs) account for 15–60% of the daily energy intake in Western diets and are increasingly linked to metabolic disorders and other health concerns. Apart from the poor nutritional quality of these UPF, the use of food additives (added to improve the color, texture, taste, or palatability as well as to prolong the shelf life, in the form of emulsifiers, artificial sweeteners, colors, preservatives) may account for the health effects of these UPF.
Over 300 such food additives have been deemed safe by the European Food Safety Authority (EFSA). While earlier safety assessments focused on limited toxicological endpoints, emerging studies suggest that these additives may adversely affect health—contributing to metabolic diseases, gut microbiota disruption (resulting in intestinal inflammation), and chronic inflammation.
Insights from the NutriNet-Santé cohort study, which collected detailed dietary exposure data including specific brands and commercial products, provided new human evidence linking high consumption of commonly used additives—particularly certain artificial sweeteners and emulsifiers—with an increased risk of chronic diseases, especially type 2 diabetes. A key limitation of the past evaluations is the lack of data on the combined effects of multiple additives. UPFs often contain additive mixtures, leading to complex exposures that may impact metabolism and health more than individual additives. A recent in vitro study using four human cell models confirmed that additive combinations caused greater toxic effects than single substances.
A study by Payen de la Garanderie et al., published in the journal “PLOS Medicine”, investigated whether exposure to widely consumed food additive mixtures is associated with the incidence of type 2 diabetes. Using data from 108,643 adults (mean age 42.5 years) in the French NutriNet-Santé cohort over a mean follow-up of 7.7 years, five additive mixtures were identified. Two of these five addirive mixtures were significantly associated with increased type 2 diabetes risk. These findings highlight the potential impact of additive combinations on health and underscore the need for revised safety assessments (See Graphic).
(Source: Payen de la Garanderie M, Hasenbohler A, Dechamp N, Javaux G, Szabo de Edelenyi F, Agaësse C, De Sa A, Bourhis L, Porcher R, Pierre F, Coumoul X. Food additive mixtures and type 2 diabetes incidence: Results from the NutriNet-Santé prospective cohort. PLoS medicine. 2025;22(4):e1004570. Doi: 10.1371/journal.pmed.1004570.)