Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France.
Nutrition And Cancer Research Network (NACRe Network), Jouy-en-Josas, France.
PLoS Med. 2024 Feb 13;21(2):e1004338. doi: 10.1371/journal.pmed.1004338. eCollection 2024 Feb.
Emulsifiers are widely used food additives in industrially processed foods to improve texture and enhance shelf-life. Experimental research suggests deleterious effects of emulsifiers on the intestinal microbiota and the metabolome, leading to chronic inflammation and increasing susceptibility to carcinogenesis. However, human epidemiological evidence investigating their association with cancer is nonexistent. This study aimed to assess associations between food additive emulsifiers and cancer risk in a large population-based prospective cohort.
This study included 92,000 adults of the French NutriNet-Santé cohort without prevalent cancer at enrolment (44.5 y [SD: 14.5], 78.8% female, 2009 to 2021). They were followed for an average of 6.7 years [SD: 2.2]. Food additive emulsifier intakes were estimated for participants who provided at least 3 repeated 24-h dietary records linked to comprehensive, brand-specific food composition databases on food additives. Multivariable Cox regressions were conducted to estimate associations between emulsifiers and cancer incidence. Overall, 2,604 incident cancer cases were diagnosed during follow-up (including 750 breast, 322 prostate, and 207 colorectal cancers). Higher intakes of mono- and diglycerides of fatty acids (FAs) (E471) were associated with higher risks of overall cancer (HR high vs. low category = 1.15; 95% CI [1.04, 1.27], p-trend = 0.01), breast cancer (HR = 1.24; 95% CI [1.03, 1.51], p-trend = 0.04), and prostate cancer (HR = 1.46; 95% CI [1.09, 1.97], p-trend = 0.02). In addition, associations with breast cancer risk were observed for higher intakes of total carrageenans (E407 and E407a) (HR = 1.32; 95% CI [1.09, 1.60], p-trend = 0.009) and carrageenan (E407) (HR = 1.28; 95% CI [1.06, 1.56], p-trend = 0.01). No association was detected between any of the emulsifiers and colorectal cancer risk. Several associations with other emulsifiers were observed but were not robust throughout sensitivity analyses. Main limitations include possible exposure measurement errors in emulsifiers intake and potential residual confounding linked to the observational design.
In this large prospective cohort, we observed associations between higher intakes of carrageenans and mono- and diglycerides of fatty acids with overall, breast and prostate cancer risk. These results need replication in other populations. They provide new epidemiological evidence on the role of emulsifiers in cancer risk.
ClinicalTrials.gov NCT03335644.
乳化剂是在工业加工食品中广泛使用的食品添加剂，以改善质地并延长保质期。实验研究表明，乳化剂对肠道微生物群和代谢组有有害影响，导致慢性炎症并增加致癌风险。然而，人类流行病学研究中尚无关于它们与癌症之间关联的证据。本研究旨在评估大型基于人群的前瞻性队列中食品添加剂乳化剂与癌症风险之间的关联。
这项研究包括法国 NutriNet-Santé 队列中的 92000 名成年人，他们在入组时没有患癌症（44.5 岁[SD：14.5]，78.8%为女性，2009 年至 2021 年）。他们的平均随访时间为 6.7 年[SD：2.2]。对于提供至少 3 次重复 24 小时饮食记录的参与者，估计了食品添加剂乳化剂的摄入量，这些记录与全面的、品牌特定的食品添加剂成分数据库相关联。使用多变量 Cox 回归来估计乳化剂与癌症发病率之间的关联。总的来说，在随访期间诊断出 2604 例癌症病例（包括 750 例乳腺癌、322 例前列腺癌和 207 例结直肠癌）。较高的单脂肪酸和二脂肪酸（FA）甘油酯（E471）摄入量与整体癌症风险增加相关（高摄入量与低摄入量相比的 HR = 1.15；95%CI [1.04，1.27]，p 趋势= 0.01），乳腺癌（HR = 1.24；95%CI [1.03，1.51]，p 趋势= 0.04）和前列腺癌（HR = 1.46；95%CI [1.09，1.97]，p 趋势= 0.02）。此外，总卡拉胶（E407 和 E407a）（HR = 1.32；95%CI [1.09，1.60]，p 趋势= 0.009）和卡拉胶（E407）（HR = 1.28；95%CI [1.06，1.56]，p 趋势= 0.01）摄入量与乳腺癌风险之间也存在关联。但在敏感性分析中，没有观察到任何乳化剂与结直肠癌风险之间的关联。还观察到与其他几种乳化剂之间存在关联，但在整个敏感性分析中并不稳健。主要限制包括乳化剂摄入量的可能暴露测量误差和与观察性设计相关的潜在残余混杂。
在这项大型前瞻性队列研究中，我们观察到卡拉胶和单脂肪酸和二脂肪酸甘油酯摄入量与整体、乳腺癌和前列腺癌风险之间存在关联。这些结果需要在其他人群中复制。它们为乳化剂在癌症风险中的作用提供了新的流行病学证据。
ClinicalTrials.gov NCT03335644。
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