Food choices characterized by the Nutri-Score nutrient profile and risk of cardiovascular diseases

Background

Nutrition is a well-established risk factor for cardiovascular diseases (CVD) that can be leveraged by public health prevention strategies. In addition to dietary guidelines, front-of-pack nutrition labels (FoPNL) can help consumers make healthier food choices. Nutri-Score, a scientifically validated 5-color FopNL based on the nutrient profile FSAm-NPS has been adopted by several European countries but remains optional under current EU labeling regulation, which is to be revised end of 2022. Scientific evidence is therefore needed on the relevance of the Nutri-Score at the European level. Our objective was to study the association between the consumption of food as graded by the FSAm-NPS and CVD risk in a large European population.

Methods

This prospective analysis was conducted on a case-cohort comprising 13,308 participants without CVD risk factors at baseline, among which 5,326 first incident cases of CVD from the EPIC-CVD study (8 European countries). Food intakes were assessed using country-specific dietary questionnaires. The FSAm-NPS was calculated for each food based on its 100g content in energy, sugar, saturated fatty acid, sodium, fibre, protein, and fruits/vegetables/legumes/nuts. Multi-adjusted Cox models were computed.

Results

Overall, associations were observed between the consumption of foods with a higher FSAm-NPS score (lower nutritional value) and a higher risk of myocardial infarction (MI; HR1-SD=1.12 [1.05,1.21]; HRQ5/Q1=1.23 [1.00,1.52]). Associations with stroke were not significant. Overall, associations were more particularly observed in men.

Conclusions

In this large European population, a higher risk of MI was observed in individuals consuming on average a diet with higher FSAm-NPS foods (reflecting consumption of foods with a lower nutritional value/less favourable Nutri-Score). This adds to the evidence on the relevance of Nutri-Score as a public health tool to help consumers choose healthier food products.

Key messages

• The consumption of foods with a lower nutritional quality as graded by the Nutri-Score was associated with a higher risk of myocardial infarction in the large European EPIC-CVD case-cohort study.

• This adds to the evidence supporting the relevance of the Nutri-Score as a complementary tool to dietary guidelines to help consumers make healthier food choices.

Nitrites and nitrates from additives and natural sources and risk of cardiovascular outcomes

 

Nitrates and nitrites are used as food additives in processed meats. They are also commonly ingested from water and several foods. Evidence suggests a beneficial role of dietary nitrites and nitrates in lowering blood pressure. However, associations between exposure to nitrites and nitrates from natural sources and food additives, separately, and risks of hypertension and cardiovascular disease (CVD) have not been investigated. We aimed to study these associations in the French population based prospective cohort NutriNet-Santé. Overall, 104,817 adults were included. Associations between exposure to nitrites and nitrates (evaluated using repeated dietary records, linked to a food composition database accounting for commercial brands of industrial products) and risks of hypertension and cardiovascular disease were assessed using multivariable Cox proportional hazard models. During follow-up, 3810 incident cases of hypertension were ascertained, and 2075 cases of CVD, 1004 of cerebrovascular diseases and 1079 or coronary heart diseases were diagnosed. Participants with higher exposure to nitrites from food additives and specifically those highly exposed to sodium nitrite (e250) had a higher hypertension risk compared with those who are not exposed to nitrites from food additives (HR = 1.19 (95% CI 1.08-1.31), P = 0.002, and 1.19 (95% CI 1.07-1.31), P = 0.002, P < 0.001), respectively). There was no evidence for an association between total nitrites or nitrites from natural sources, or dietary nitrates with hypertension risk (all P-values>0.3). There was no evidence for associations between dietary nitrites, or nitrates with risks of cardiovascular, cerebrovascular or coronary heart diseases (all P-values>0.2). In conclusion, we found that higher exposure to nitrites from food additives was associated with higher risk of hypertension. Our results do not support a potential protective association between dietary nitrites or nitrates and cardiovascular outcomes.

Key messages

• These results provide additional evidence in the context of current discussions about updating regulations on the use of nitrites as food additives.

• Our findings do not support any protective impact of nitrites and nitrates on cardiovascular health.

Nitrites and nitrates dietary exposure from natural sources and additives and type-2 diabetes risk

 

Nitrates and nitrites occur naturally in water and soil and are commonly ingested from drinking water and dietary sources. They are also used as food additives. The epidemiological evidence linking exposure to nitrites/nitrates with type-2 diabetes (T2D) risk is scarce. We aimed to study these associations in a large population based prospective cohort study. Overall, 104,168 adults from the French NutriNet-Santé cohort study (median follow-up time 6.7 years) were included. Associations between intakes of nitrites and nitrates (evaluated using repeated 24h dietary records, linked to a comprehensive food composition database and accounting for details of commercial names/brands of industrial products) and risk of T2D were assessed using cause-specific multivariable Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors). During follow-up, 969 incident T2D cases were ascertained. Total nitrites and nitrites from natural sources were both positively associated with higher T2D risk (HRtertile 3 vs.1=1.29 (95% CI 1.06-1.56), Ptrend=0.004, and 1.27 (95% CI 1.05-1.54), Ptrend=0.01, respectively). Participants with higher exposure to nitrites from food additives (i.e. above the sex-specific median), and specifically those having higher exposure to sodium nitrite (e250) had a higher T2D risk compared with those who were not exposed to food additive nitrites (HRtertile 3 vs.1=1.58 (95% CI 1.28-1.94), Ptrend<0.001, and 1.59 (95% CI 1.30-1.96), Ptrend<0.001), respectively). There was no evidence for an association between nitrates of any source and T2D risk (all Ptrend>0.4). In this large prospective cohort, a higher dietary exposure to nitrites (from both natural sources and food additives) was associated with higher T2D risk. These results provide additional evidence in the context of current discussions about updating regulations on the use of nitrites as food additives.

Key messages

• A high exposure to dietary nitrites (from both natural and food additive sources) is associated with an increased risk of type-2 diabetes.

• These findings support further regulations concerning the use of nitrites as food additives in processed meats.

Artificial sweeteners and risk of cardiovascular diseases in the prospective NutriNet-Santé cohort

Background

Artificial sweeteners are widely used today by the food industry as sugar alternatives. Potential adverse effects of these food additives on cardiovascular disease (CVD) have been suggested in experimental studies, but data from studies involving humans remain very limited. Previous cohorts have focused on artificially sweetened beverages. Our objective was to study the associations between artificial sweeteners from all dietary sources, overall and by molecule (aspartame, acesulfame-potassium and sucralose), and risk of CVDs (overall, coronary heart and cerebrovascular).

Methods

The study included 103,388 participants of the web-based NutriNet-Santé cohort (2009-2021). Artificial sweetener intakes were assessed using repeated 24h dietary records including names and brands of industrial products consumed. Multi-adjusted Cox proportional hazard models were performed. Exposure to artificial sweeteners were coded as 3-category variables: non-consumers, lower consumers (artificial sweetener intake below the sex-specific median) and higher consumers (above the sex-specific median).

Results

Compared to non-consumers, higher consumers of total artificial sweeteners had increased risk for CVD (n = 1502 incident cases, HR = 1.17 [1.01-1.35], P-trend=0.04) and more specifically cerebrovascular diseases (n = 777, HR = 1.34 [1.10-1.62], P = 0.004). Higher consumption of aspartame was associated with increased cerebrovascular diseases (HR = 1.29 [1.03-1.60], P = 0.01). Higher consumption of acesulfame-K was associated with a higher risk of CVD (HR = 1.24 [1.04-1.47], P = 0.02) and cerebrovascular diseases (HR = 1.29 [1.02-1.64], P = 0.1). No association was detected for coronary heart diseases (n = 730 incident cases).

Conclusions

These findings suggest a direct association between higher artificial sweetener consumption and increased CVD risk, in particular cerebrovascular. These results provide key novel information for the ongoing re-evaluation of sweeteners by the European Food Safety Authority.

Key messages

• In this large-scale prospective cohort (n = 103,388), artificial sweeteners (especially aspartame and acesulfame-K) were associated with increased risks of cardiovascular and cerebrovascular diseases.

• These results provide key insights to feed EFSA’s expertise for the ongoing risk assessment of artificial sweeteners.

Trans fatty acid intake and risk of type 2 diabetes in the NutriNet-Santé prospective cohort

 

Type 2 diabetes (T2D) is one of the most common noncommunicable diseases worldwide, with an increasing prevalence and a considerable global health burden. Substantial evidence has linked consumption of trans fatty acids (TFAs) to an increased risk of cardiovascular disease. However, the effects of T2D remain unclear. We aimed to investigate the associations between different types of TFAs (total, ruminant, industrial and corresponding specific isomers) and risk of T2D in the NutriNet-Santé prospective cohort. Overall, 105,551 participants aged 18 years or older from the French NutriNet-Santé cohort (2009-2021) were included (mean age at baseline=42.7y (SD = 14.6y), 79.2% women). Dietary intake data, including usual TFA intake, were collected using repeated 24-hour dietary records (n = 5.7 [SD = 3.1]). Associations between sex-specific quartiles of dietary intake of TFAs and type 2 diabetes risk were assessed using multivariable Cox proportional hazard models adjusted for known risk factors. A total of 969 incident type 2 diabetes cases occured during follow-up. Total TFAs was associated with higher T2D risk (HRfor quartile 4 versus 1=1.38; 95% CI = 1.11-1.73; Ptrend<0.001). This association, specifically observed for industrial TFAs (HR = 1.45; 95% CI = 1.15-1.83; Ptrend<0.001), was mainly driven by elaidic acid (HR = 1.37; 95% CI = 1.09-1.72; Ptrend<0.001) and linolelaidic acid (HR = 1.29; 95% CI = 1.04-1.58; Ptrend=0.07). In contrast, ruminant trans fatty acids were not significantly associated with the risk of T2D. In this large prospective cohort, higher dietary intakes of total and industrial TFAs were associated with increased T2D risk. These findings support WHO's recommendation to eliminate industrially-produced TFAs from the food supply worldwide. As such, consumers should be advised to limit the consumption of food products containing partially hydrogenated oils (main vector of iTFAs) as this, specifically, may contribute to lower the substantial global burden of T2D.

Key messages

• Higher dietary intakes of total and industrial trans fatty acids were associated with increased type 2 diabetes risk.

• Our findings support WHO’s recommendation to eliminate industrially-produced TFAs from the food supply worldwide.

Dietary exposure to acrylamide and breast cancer risk: results from the NutriNet-Santé cohort

Background

Acrylamide is classified as a probable human carcinogen by the IARC but epidemiological evidence on the carcinogenicity of acrylamide from dietary sources is limited. This study aimed to investigate the associations between dietary acrylamide and breast cancer risk in the NutriNet-Santé cohort.

Methods

This prospective cohort study included 80,597 French women (mean [SD] age at baseline: 40.8 [14] years) during a mean (SD) follow-up of 8.8 (2.3) years. Acrylamide intake was evaluated using repeated 24h dietary records (n = 5.5 [SD 3.0]), linked to a comprehensive food composition database. Associations between acrylamide intake and breast cancer risk (overall, premenopausal and post-menopausal) were assessed by Cox hazard models adjusted for known risk factors.

Results

The mean (SD) dietary acrylamide intake was 30.1 (21.9) µg/d (main contributors: coffee, potato fries and chips, pastries and cakes, and bread). During follow-up, 1016 first incident breast cancer cases were diagnosed (431 premenopausal, 585 postmenopausal). A borderline significant positive association was observed between acrylamide intake and breast cancer risk overall (HRQ4 vs Q1= 1.21 [95% CI: 1.00-1.47]) and a positive association was observed with premenopausal cancer (HRQ4 vs Q1= 1.40 [95% CI: 1.04-1.88]). Restricted cubic spline analyses suggested evidence for non-linearity of these associations, with higher HR for intermediate (Q2) and high (Q4) exposures. Receptor-specific analyses revealed a positive association with estrogen receptor-positive breast cancer, which represented 86% of total cancer cases. Acrylamide intake was not associated with post-menopausal breast cancer.

Conclusions

Results from this large prospective cohort study suggest the potential deleterious role of dietary acrylamide in breast cancer etiology, especially in premenopausal women, and provide new insights that should encourage further mitigation strategies to reduce the content of acrylamide in food.

Key messages

Food additive emulsifiers and cancer risk: results from the French prospective NutriNet-Santé cohort

Background

Food additive emulsifiers are found in thousands of industrial foods and may exert deleterious effects on gut microbiota and carcinogenesis according to experimental studies. However, their associations with cancer risk has not been investigated yet. This study aimed to investigate these associations in a large population-based prospective cohort.

Methods

This study included 102,485 French adults from the NutriNet-Santé cohort (42.1y [14.5], 78.8% female, 2009-2021). Food additive emulsifier intakes were estimated using repeated 24h dietary records linked to brand-specific food composition databases on food additives. Associations with incident cancer risk were assessed using Multivariable Cox models.

Results

3,511 incident cancer cases were diagnosed during follow-up (1,026 breast, 431 prostate, and 279 colorectal cancers). Intakes of sodium citrate (E331, HR = 1.12 [1.02-1.23], p-trend=0.009), xanthan gum (E415, HR = 1.11 [1.02-1.21], p-trend=0.02), and mono- and diglycerides of fatty acids (E471, HR = 1.17 [1.06-1.28], p-trend=0.001 and total: E471, E472a-b-c-e, HR = 1.11, [1.02-1.22], p-trend=0.02) were associated with increased overall cancer risk. Higher intakes of E331 (p-trend = 0.046), sodium stearoyl-2-lactylate (E481, p-trend=0.01), total lactylates (E481-482, p-trend=0.01), total celluloses (E460-468, p-trend=0.03), carob bean gum (E410, p-trend=0.01), and E471 (p-trend=0.006) were associated with increased overall breast cancer risk. Higher intakes of carrageenan (E407, p-trend=0.04), E415 (p-trend=0.02), and triphosphates (E451, p-trend=0.03) were associated with increased post-menopausal breast cancer risk.

Conclusions

These results are the first to investigate and report direct associations between cancer risk and exposures to seven individual and three groups of food additive emulsifiers. If replicated, they may have an important public health impact, considering the omnipresence of these additives in industrial foods globally.

Key messages

• This study is the first to precisely assess exposures to food additive emulsifiers in a population-based study.

• Intakes of food additive emulsifiers were associated with increased risk of cancer.

Les traits psychologiques positifs sont associés aux changements de comportement alimentaire liés au confinement du COVID-19 dans la cohorte NutriNet-Santé

Introduction et but de l’étude

La propagation du coronavirus (COVID-19) a eue pour conséquence la mise en place de mesures strictes de confinement, ayant entraîné des changements dans les comportements alimentaires. Les traits psychologiques sont des déterminants bien connus du comportement alimentaire. L’objectif de cette étude était donc d’étudier les associations entre les traits psychologiques positifs et les changements dans le grignotage et la consommation de groupes alimentaires pendant la période du confinement.

Méthodes

En 2016, les niveaux d’optimisme, de résilience, d’estime de soi, de satisfaction de la vie, de pleine conscience et de maîtrise ont été mesurés chez 33 766 adultes de la cohorte NutriNet-Santé. Le grignotage et la consommation de groupes d’aliments ont été évalués en avril–mai 2020. L’association entre les traits psychologiques et les changements dans le grignotage et la consommation de groupes alimentaires a été évaluée à l’aide de régressions logistiques, ajustées sur les caractéristiques sociodémographiques et le mode de vie, l’anxiété et la symptomatologie dépressive.

Résultats

Les participants présentant des niveaux plus élevés d’optimisme, de résilience, d’estime de soi, de satisfaction de la vie, de pleine conscience ou de maîtrise étaient moins susceptibles d’avoir des changements dans leur comportement de grignotage et leur consommation de divers groupes alimentaires.

Conclusion

Les personnes présentant des niveaux de traits psychologiques plus élevés ont été moins affectées par le confinement en termes de comportement alimentaire, alors que les personnes ayant des niveaux plus faibles ont montré des changements favorables et défavorables dans leur comportement alimentaire global.

Fermentable Oligo-, Di-, Monosaccharides and Polyols and cancer risk in the NutriNet-Santé cohort

Background

Fermentable Oligosaccharides, Disaccharides and Monosaccharides And Polyols (FODMAPs), which are found in a variety of foods (dairy products, fruit, legumes, refined grains, sugary beverages, etc.) have been involved in risk for gastrointestinal disorders. In view of their pro-inflammatory potential and their interactions with the gut microbiota, their contribution to the etiology of other chronic diseases such as cancer has been postulated. However, no epidemiological study has investigated this hypothesis so far. Our objective was to investigate the associations between FODMAP intake (total and by type) and cancer risk (overall, breast, prostate and colorectal).

Methods

104,909 French adults from the NutriNet-Santé prospective cohort (2009-2020) were included (median follow-up time=7.7y). FODMAP intakes were obtained from repeated 24h-dietary records linked to a detailed food composition table. Associations between FODMAPs and cancer risks were assessed by Cox proportional hazard models adjusted for a large range of lifestyle, sociodemographic and anthropometric variables.

Results

Total FODMAP intake was associated with increased overall cancer risk (n = 3,374 incident cases, Hazard Ratio for quintile 5 vs quintile 1=1.21, 95% confidence interval 1.02-1.44, P-trend=0.04). Oligosaccharides seemed to be the FODMAP type particularly associated with cancer risk: a trend was observed for overall cancer (HR = 1.10 (0.97-1.25) P-trend=0.04) and colorectal cancer (n = 272, HR = 1.78 (1.13-2.79) P-trend=0.02). Associations remained stable across a series of sensitivity analyses.

Conclusions

Our findings suggest a potential role of FODMAPs in cancer onset. Further epidemiological and experimental studies are needed to confirm these results and provide data on the potential underlying mechanisms.

Key messages

In this large-scale prospective cohort of French adults, FODMAP intake was associated with increased cancer risk. These associations need to be studied in other prospective cohorts, in order to clarify FODMAPs role in cancer development.

Nutritional risk factors for SARS-CoV-2 infection: prospective study from the NutriNet-Santé cohort

Background

Many hypotheses were raised regarding a role of nutrition in COVID-19 (susceptibility to infection, disease severity) based on the importance of macronutrients, vitamins or minerals for a proper functioning of the immune system. Our objective was to study the associations between dietary intakes and the seroprevalence SARS-CoV-2 infection in a large population-based sample.

Methods

Our analyses included 7766 adults from the French NutriNet-Santé cohort who provided at least 6 valid 24h dietary records in the two years preceding the start of the COVID-19 pandemic in France (February 2020). An ELISA assay was used to detect anti-SARS-CoV-2 antibodies: 311 participants were positive and 7455, negative. Associations between dietary intakes and the seroprevalence of anti-SARS-CoV-2 antibodies were investigated using multi-adjusted logistic regressions.

Results

A lower seroprevalence of SARS-CoV-2 infection was associated to higher intakes of vitamin B9 (HR = 0.84 (0.72-0.98)), vitamin C (HR = 0.85 (0.75-0.97)), vitamin K (HR = 0.86 (0.74-0.99)), dietary fibres (HR = 0.84 (0.72-0.97)), and fruit and vegetables (HR = 0.84 (0.74-0.97)). Higher intakes of calcium (HR = 1.17 (1.01-1.35)) and dairy products (HR = 1.19 (1.06-1.33)) associated to a higher seroprevalence of SARS-CoV-2 infection. No association was observed with other food groups or nutrients or with the overall diet.

Conclusions

Based on exhaustive seroprevalence data in a large population-based sample, our results suggested that higher intakes of vitamin C, folates, vitamin K, dietary fibres and fruit and vegetables were associated with a lower susceptibility to SARS-CoV-2 infection.

Key messages

Higher intakes of vitamin C, folates, vitamin K, dietary fibres and fruit and vegetables were associated to a lower susceptibility to SARS-CoV-2 infection, assessed with exhaustive seroprevalence data. Beyond its established role in the prevention of non-communicable diseases, nutrition could also contribute to prevent some infectious diseases such as COVID-19.

Body weight, body composition and risk of SARS-CoV-2 infection in a large population-based sample

Background

Obesity has been identified as an important risk factor for COVID-19 severity. Besides, several reports also suggested that obesity (or a higher BMI) may also be associated with a higher susceptibility to SARS-CoV-2 infection although this remains unclear. Going beyond BMI, our objective was to study several anthropometric characteristics in relation to the seroprevalence of SARS-CoV-2 infection in a large population-based sample.

Methods

21,376 participants from the French NutriNet-Santé cohort study were included in the main analyses. An ELISA assay was used to detect anti-SARS-CoV-2 antibodies: 1027 participants were positive and 20,349, negative. Associations between a wide range of anthropometric characteristics (body mass index but also waist and hip circumference and body composition) and the seroprevalence of anti-SARS-CoV-2 antibodies were investigated using multi-adjusted logistic regressions.

Results

A positive yet unclear association was observed between BMI and SARS-CoV-2 seroprevalence in women (positive linear trend (P = 0.07) that was significant using restricted cubic splines (P = 0.04), but no association with standard categories of BMI). No association was observed in men. Waist circumference (P = 0.04) and waist-to-hip ratio (P = 0.01) associated with a higher seroprevalence in women while opposite trends were observed in men (P = 0.08 and 0.03 respectively). Body, trunk and visceral fat (all P < 0.05), but not lean or muscle mass, associated with higher seroprevalence, especially in women.

Conclusions

Our results highlight a higher susceptibility to SARS-CoV-2 infection in women with higher body fat, suggesting that central adiposity may be an important factor to consider for risk stratification in the population.

Key messages

A higher seroprevalence of SARS-CoV-2 infection was observed in women with a higher body fat, but not in men. Central adiposity may be a risk factor for SARS-CoV-2 infection and not only for COVID-19 severity.

Diet and physical activity during the first COVID-19 lockdown in France (March-May 2020)

Background

To counter the spread of COVID-19 and avoid overwhelmed health-care systems and numerous deaths, strict lockdown measures were adopted by many countries, causing an unprecedented disruption of daily life. Our objective was to explore the changes in dietary intakes, physical activity, body weight, and food supply occurring during the first lockdown in France (March-May 2020), in light of individual characteristics.

Methods

37,252 adults from the French web-based NutriNet-Santé cohort completed lockdown-specific questionnaires. Nutrition-related changes and their sociodemographic and lifestyle correlates were investigated using multi-adjusted logistic regressions. Clusters of participants were defined combining multiple correspondence analyses and an ascending hierarchical classification.

Results

During the lockdown, trends of unfavorable changes were observed: decreased physical activity (53% of the participants), increased sedentary time (63%), increased snacking, decreased consumption of fresh food (especially fruit and fish), and increased consumption of sweets, cookies, and cakes. Yet, the opposite trends were also observed: increased home cooking (40%) and increased physical activity (19%). Additionally, 35% of the participants gained weight (mean weight gain in these individuals:1.8kg (SD:1.3) and 23% lost weight (2kg (SD:1.4)). All of these trends displayed associations with sociodemographic and lifestyle characteristics.

Conclusions

These results suggest that nutrition-related changes occurred during the lockdown in both unfavorable and favorable directions, and differed according to individual characteristics.

Key messages

COVID-19-related lockdown in France led to nutritional changes in both unfavorable and favorable directions, linked to sociodemographic and lifestyle inequalities.

Unfavorable changes should be considered to inform future lockdown decisions and monitored to prevent a future increase in the nutrition-related burden of disease.

Artificial sweeteners and cancer risk in the prospective NutriNet-Santé cohort

Background

Added sugars' deleterious effects have been established for several chronic diseases, leading food industries to turn towards high-intensity sweeteners. Their safety is debated and findings remain contrasted regarding their role in the etiology of various diseases. In particular, their carcinogenicity has been suggested by several experimental studies but epidemiological data are lacking.

Thus, our objective was to investigate the associations between sweetener intakes (total from all dietary sources, and most frequently consumed: acesulfame-K e950, aspartame e951 and sucralose e955) and cancer risk (overall and by sites).

Methods

Overall, 102,046 adults from the French NutriNet-Santé prospective cohort (2009-2021) were included. Consumption of sweeteners was obtained by repeated 24h-dietary records including brands and commercial names of industrial products. Associations between sweeteners and cancer incidence were assessed by multi-adjusted Cox hazard models.

Results

Compared to non-consumers, high-consumers had higher risk of overall cancer (n = 2527, hazard ratio=1.12, 95% confidence interval=1.00-1.25, P-trend=0.005). In particular, acesulfame-K (HR = 1.18 [1.04-1.34] P = 0.003) and aspartame (HR = 1.20 [1.05-1.38] P = 0.001) were associated with increased cancer risk. Similarly, higher risks were observed for breast (n = 723, HR = 1.25 [1.02-1.53] P = 0.01, HR = 1.39 [1.11-1.74] P = 0.003 and HR = 1.33 [1.05-1.69] P = 0.007 for total sweeteners, e950 and e951, respectively) and obesity-related cancers (n = 1509, HR = 1.16 [1.00-1.33] P = 0.02, HR = 1.23 [1.04-1.45] P = 0.01 and HR = 1.22 [1.02-1.45] P = 0.01 for total sweeteners, e950 and e951, respectively).

Conclusions

These results suggest that artificial sweeteners (especially e950 and e951), which are found in > 12,000 foods and beverage references worldwide, may be associated with increased cancer risk. These findings provide important and novel insights for the ongoing re-evaluation of sweeteners by the European Food Safety Authority.

Key messages

In this large-scale prospective cohort of French adults, intake of high-intensity artificial sweetener intake (especially acesulfame-K and aspartame) was associated with higher risk of cancer. These results provide novel insights to feed EFSA’s expertise for the ongoing risk assessment of artificial sweeteners.

Dietary trans fatty acid intakes and cancer risk: results from the NutriNet-Santé cohort

 

Dietary trans fatty acids (TFAs) are either natural (ruminant sources) or industrially generated by partial hydrogenation of vegetable oils. Increasing evidence demonstrated their role as cardiovascular risk factors. Their involvement in cancer etiology is suspected, but epidemiological evidence is limited so far. We aimed to investigate the associations between different types of TFAs (total, ruminant [rTFAs], industrial [iTFAs] and corresponding specific isomers) and the risk of cancer in the NutriNet-Santé prospective cohort (2009-2020). Overall, 104,909 participants were included. Usual TFA intake was estimated from validated repeated 24-h dietary records. Associations between sex-specific quartiles of dietary intake of TFA and cancer risk were assessed using multi-adjusted Cox proportional hazard models. A total of 3,374 incident cancer cases occured during follow-up (including 982 breast and 405 prostate cancers). Total TFAs was associated with higher prostate cancer risk (1.34[1.25;1.87] Ptrend=0.005). rTFAs were associated with increased overall cancer risk (HRfor quartile 4 versus 1: 1.21[1.06;1.39] Ptrend=0.03), in particular the conjugated linoleic acid isomer (CLA) (1.19[1.04;1.36] Ptrend=0.04). These associations were specifically observed for breast cancer, in particular before menopause (rTFAs: 1.78[1.11;2.87] Ptrend=0.006; CLA: 2.013[1.25;3.23] Ptrend=0.003). Several iTFAs were associated with overall (1.18[1.06;1.31] Ptrend=0.02 for transdocosenoic acid), breast (isomer 18:2t: 1.30[1.06;1.58] Ptrend=0.01; hexadecenoic acid: 1.28[1.05-1.56] Ptrend=0.02) and prostate (transdocosenoic acid: 1.52[1.09;2.12] Ptrend=0.07) cancer risks. In this large prospective study, several types of TFAs were associated with increased overall, breast and prostate cancer risks. Although further studies are needed to better understand underlying mechanisms, these results support the WHO's goal of achieving industrially produced TFAs elimination from food supplies.

Key messages

Higher intake of dietary trans fatty acids is associated with an increased risk of various cancers. Our findings support WHO’s global recommendation of eliminating industrially produced TFAs by 2023.

Nitrites and nitrates from food additives and cancer risk: results from the NutriNet-Santé cohort

 

Nitrates and nitrites occur naturally in water and soil and are commonly ingested from water and dietary sources. They are also frequently used as food additives mainly in processed meats. Experimental data consistently suggest their involvement in carcinogenesis but human data is still limited. The aim was to investigate the relationship between nitrate and nitrite intakes and the risk of cancer in a large prospective cohort with detailed and up-to-date dietary assessment. Overall, 101,056 adults from the French NutriNet-Santé cohort study (2009-ongoing) were included. Consumption of nitrites and nitrates was evaluated using repeated 24h dietary records, linked to a comprehensive food composition database which includes details of commercial names/brands of industrial products. Prospective associations between nitrite and nitrate exposures and the risk of cancer were assessed by multivariable Cox hazard models. During follow-up, 3311 first incident cancer cases were diagnosed. Compared with non-consumers, higher consumers of nitrates as food additives had higher risk of breast cancer (HR = 1.24 (1.03-1.48), P = 0.02); this was more specifically observed for potassium nitrate e252, P = 0.01). Higher consumers of nitrites as food additives, and specifically for sodium nitrite (e250), had a higher risk of prostate cancer (HR = 1.58 (1.14-2.18), P = 0.008 and HR = 1.62 (1.17-2.25), P = 0.004, respectively). No significant association was observed for nitrates and nitrites from natural sources. In this large prospective cohort, nitrates as food additives were positively associated with breast cancer risk and nitrites as food additives were positively associated with prostate cancer risk. While these results need confirmation in other large-scale prospective studies, they provide new insights in a context of lively debate around the ban of nitrite additives in food products.

Key messages

Nitrates as food additives were positively associated with breast cancer risk. Nitrites as food additives were positively associated with prostate cancer risk.