Representing the first national assessment of food additive exposure in French children and adults, a new study has demonstrated that food additives are consumed as mixtures—underscoring the importance of considering combined exposures in food safety evaluations. The study was published in Nature Scientific Reports and was authored by researchers with the French Nutritional Epidemiology Research Team (EREN) and the Network for Nutrition And Cancer Research (NARCe Network).

The assessment was conducted as part of the cross-sectoral Esteban Study, which is a health study on environment, biomonitoring, physical activity, and nutrition led by the French Public Health Agency (Santé Publique France). A total of 3,456 participants (2,177 adults and 1,279 children) were included in the study. Data was collected between 2014 and 2016. Participants completed a questionnaire, three 24-hour dietary recalls, and a health examination with clinical and biochemical measurements.

UPF and Additive Consumption by the French Population

Ultra-processed foods (UPFs) accounted for 34.2 percent of daily energy intake in adults and 49.3 percent in children. The study defined UPFs according to the NOVA Group 4 definition, which refers to industrially produced foods formulated mostly with substances extracted from foods (i.e., sugar, oils, fats and salt), derived from food constituents (e.g., hydrogenated fats and modified starch), or synthesized in laboratories (e.g., stabilizers, flavor enhancers, colors, and other additives). Most of the food additives characterizing the mixtures identified in the study were markers of UPFs, but not all (e.g., preservatives such as potassium sorbate and antioxidants such as tocopherols).

Overall, 125 food additives were detected in the diet of at least one adult participant, while 122 were identified among children. The mean daily intake of food additives was 113.1 milligrams per kilogram of bodyweight per day (mg/kg BW/day) or 5.1 grams (g)/day among children and 56.7 mg/kg of bodyweight per day or 4.4 g/day among adults.

Additionally, 60 food additives were consumed by more than 5 percent of adults, compared to 71 among children. The Acceptable Daily Intake (ADI) was only exceeded by children for one additive, rosemary extract. Adults exceeded the ADI for rosemary extract and sucralose.

Most Consumed Food Additive Mixtures

Considering additives consumed by more than 5 percent of the French population, the study identified three main food additive mixtures consumed by adults and four by children. Adults were most exposed to the following additive mixtures:

• Food additives mainly found in industrial cakes and biscuits, savory snacks, and salty processed and highly processed foods: Acidity regulators (i.e., sodium carbonates, ammonium carbonates), emulsifiers and thickeners (i.e., diphosphates, glycerol, diacetyl tartaric acid esters of mono- and diglycerides of fatty acids, polyphosphates, locust bean gum, sodium alginate), and food colors (i.e., carminic acid, carotenoids). Participants most exposed to this mixture skewed male, 18–30 years old, with a higher educational level and not employed in manual work.
• Food additives mainly found in ready-to-eat (RTE) dishes, dairy desserts, salty processed and highly processed foods, savory snacks, dairy products, and fats and sauces: Emulsifiers (i.e., modified starches, guar gum, pectin, cellulose, carrageenan, locust bean gum, sodium alginate), several food colors (i.e., curcumin, lutein, carotenoids, paprika extract), a preservative (potassium sorbate) and a flavor enhancer (monosodium glutamate, also known as MSG). Higher exposure to this mixture was observed among participants with greater body mass index (BMI).
• Food additives mainly found in sweetened and artificially sweetened beverages and pastries: Emulsifiers (i.e., acacia gum), acidity regulators (i.e., sodium citrates, phosphoric acid, citric acid, malic acid), sweeteners (i.e., acesulfame-K, aspartame), a glazing agent (i.e., carnauba wax), and several food colors (i.e., titanium dioxide, sulfite ammonia caramel, paprika extract, carminic acid, and brilliant blue FCF). Those most exposed to this mixture skewed male, 30–50 years of age, employed in manual labor.

Children were most exposed to the following additive mixtures, which are not identical to the mixtures consumed by adults:

• Food additives mainly found in industrial cakes and biscuits, savory snacks, and salty processed and highly processed foods: This mixture most closely resembled the mixture found in adults, comprising acidity regulators (i.e., sodium carbonates, ammonium carbonates, potassium carbonates), emulsifiers and thickeners (i.e., diphosphates, glycerol, polyphosphates, modified starches), and a texture agent (lecithin). Children most exposed to this mixture were more likely to be 6–10 years old and to come from households with a monthly income between €1,900 and €3,100.
• Food additives mainly found in ready-to-eat (RTE) dishes, dairy desserts, salty processed and highly processed foods, and fats and sauces: Emulsifiers (i.e., modified starches, guar gum, pectin, cellulose, carrageenan, locust bean gum, sodium alginate), several food colors (i.e., curcumin, lutein, carotenoids, paprika extract), a preservative (potassium sorbate) and a flavor enhancer (MSG). Higher exposure to this mixture was observed among those with greater BMI.
• Food additives mainly found in sweetened soft drinks, cakes and biscuits, confectioneries, and artificially sweetened beverages: An emulsifier (acacia gum), food colors (i.e., paprika extract, titanium dioxide, anthocyanin, calcium carbonate), antioxidants (i.e., citric acid, lecithin, tocopherols, sodium citrate), a glazing agent (carnauba wax), an acidity regulator (ammonium carbonate), and a food additive sweetener (acesulfame K). This mixture was predominantly consumed by female children aged 11–14 years, who were more likely to have never smoked and to come from a lower educational background.
• Food additives mainly found in artificially sweetened beverages and pastries: Intense (aspartame) and bulk (isomalt, maltitol, sorbitol) sweeteners, and an emulsifier (polyglycerol esters of fatty acids). Children from households where the referent parent was employed in an intermediate profession were more likely to be exposed to this mixture.

Demographics Associated with Additive Mixture Consumption

The researchers pointed out that additive exposure is the highest among teenagers and young adults, supporting the need to target future prevention campaigns toward limiting highly processed food consumption in this particularly exposed population group. In addition, the consumption of food additive mixtures is also substantial among young children aged 6–10 years, raising health concerns for this vulnerable population.

Overall, the findings suggested that higher consumption of food additive mixtures was associated with less favorable health and socio-demographic profiles (e.g., obesity, smoking).

Potential Adverse Effects of Additive Mixtures Consumption

Some food additives included in the study have been associated with potential adverse health effects, say the researchers; for example, the French NutriNet-Santé cohort linked sodium nitrite to cardiovascular outcomes, type 2 diabetes, and prostate cancer risk. Additionally, the International Agency for Research on Cancer (IARC) classified aspartame as “possibly carcinogenic” in 2023—although the determination is controversial.

Moreover, titanium dioxide (E171), which is now banned as a food additive in France and the EU due to suspected genotoxicity but was permitted at the time of the Esteban study, was consumed by 7.5 percent of adults and 12 percent of children.

In a separate study analyzing the the NutriNet-Santé cohort, the researchers linked two food additive mixtures—one characterized by emulsifiers, preservatives, and a food color, and the other by acidifiers, acid regulators, food colors, food additives sweeteners, and emulsifiers—with an increased type 2 diabetes incidence. Exploratory analyses suggested potential interactions between food additives emblematic of the mixtures. 

Overall, the study provides evidence that food additives are consumed as mixtures and, together with emerging data on synergistic effects, it underscores the importance of considering combined exposures in future safety evaluations.