A prospective cohort study published last month in The BMJ reported positive links between five individual and two groups of commonly used emulsifiers and the risk of cardiovascular disease (CVD). The findings of the study suggest that the widespread use of emulsifiers, mainly in ultra-processed food (UPFs) products, could have significant public health implications and may require further assessment from food safety authorities.
Commonly found on the ingredient lists of UPFs, emulsifiers are used as additives for their texture-enhancing and shelf-life-extending qualities. In food products, they are mainly used to keep combinations of ingredients that would otherwise separate, like oil and vinegar in dressings and mayonnaise, evenly blended.
Consuming emulsifiers may threaten cardiovascular health
The study reported positive correlations between the higher intake of certain food additive emulsifiers and the risk of CVD, coronary heart disease, and cerebrovascular disease across a range of ingredients.
Notably, increased intake of total celluloses (E460 to E468) was linked to a higher risk of CVD and coronary heart disease compared to those with a lower emulsifier intake. These include cellulose, methyl cellulose, ethyl cellulose, hydroxypropyl cellulose, hydroxypropyl methyl cellulose, ethyl methyl cellulose, carboxymethyl cellulose, and crosslinked sodium carboxymethyl cellulose.
The highest concentration of these additives was found in products such as cakes and biscuits, fats and sauces, and processed fruits and vegetables.
High consumption of total monoglycerides and diglycerides of fatty acids (E471 and E472) showed the strongest correlation with an increased risk of CVD and coronary heart disease. These emulsifiers appeared most commonly in product categories including confectionery, cakes and biscuits, and refined grains and cereals.
High intake of citric (E472c) and lactic (E472b) acid esters of monoglycerides and diglycerides of fatty acids was also reported to have a clear association with the risk of CVD. Frequently included in cake, biscuit, dairy, and refined grain and cereal products, intake of trisodium phosphate (E339) was linked to an increased risk of coronary heart disease.
On the other hand, certain emulsifiers, including carrageenans (E407, E407a) and lecithins, showed no significant associations with any of the cardiovascular outcomes observed.
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Young adults are consuming the most emulsifiers
Taken from the NutriNet-Sante e-cohort, a research group formed in 2009 to investigate the links between nutrition and health, the study involved over 95,000 French adults with an average age of 43. Most of the participants (79%) were women.
Participants’ intake of various emulsifiers was measured by an average of six self-reported dietary records and health questionnaires, over an approximate period of seven years. More than 60 emulsifiers were identified in the participant reports and proportional hazard Cox models were used to analyse the associations between emulsifier consumption and CVD risk.
Those with higher intakes of emulsifiers tended to be younger and had higher sugar, salt, fat, and fibre-rich diets, containing more red and processed meats and ultra-processed foods, and less alcohol, fruits, vegetables, and whole grains.
Replacing emulsifiers to appeal to the health-conscious consumer
Consumers are growing increasingly health-conscious and are looking to replace processed products containing additives such as emulsifiers with healthier alternatives. More than half (55%) of modern consumers try to avoid additives when buying food, according to the results of a nationwide survey conducted by the German Federal Institute for Risk Assessment (BfR).
Several startups and scientists are developing healthier and more sustainable alternatives to replace emulsifiers in food and drink products, using ingredients such as seaweed and upcycled grains, and tapping into the circular principles of green chemistry.
Are further safety evaluations of emulsifier intake needed?
Ultra-processed foods are quickly growing in popularity globally. Across Europe, UPFs account for over a quarter (27%) of the average daily calorie intake, rising to more than half in the UK, US, and Canada.
According to the study published in the BMJ, emulsifier use is widespread in the food industry, with some of these additives being consumed by more than nine in ten participants.
Safety evaluations conducted by the European Food Safety Authority (EFSA) in the past did not find the need to establish acceptable daily intakes for several emulsifiers. These include: sodium citrates (E331), mono- and diglycerides of fatty acids (E471), celluloses (E460 to E468), and lactic acid esters of mono- and diglycerides of fatty acids (E472b). However, given the positive links between high emulsifier intake and CVD risk reported, the researchers suggest that there is perhaps a need for more regular safety assessments of these additives to be conducted.