FRANCE – Food additives are not consumed in isolation but as overlapping combinations linked largely to ultra-processed foods, according to a new national assessment of dietary exposure in France.
The findings come from a study published in Nature Scientific Reports by researchers from the French Nutritional Epidemiology Research Team and the Network for Nutrition and Cancer Research.
The analysis represents the first nationwide evaluation of combined food additive exposure among both children and adults in France.
Researchers examined how additives appear together in everyday diets, raising questions for food safety assessments that traditionally evaluate substances one at a time.
Data drawn from France’s Esteban health study
The assessment used dietary and health data collected through the Esteban Study, a cross-sector national health survey led by Santé Publique France. The study included 3,456 participants, comprising 2,177 adults and 1,279 children, with data gathered between 2014 and 2016.
Participants completed detailed questionnaires, three non-consecutive 24-hour dietary recalls, and a clinical health examination that included biochemical measurements. This approach allowed researchers to estimate individual exposure levels to food additives across a typical diet.
Ultra-processed foods dominate additive exposure
Ultra-processed foods accounted for 34.2 percent of daily energy intake among adults and 49.3 percent among children.
These foods were classified using the NOVA Group 4 definition, which includes industrial formulations made largely from extracted, modified, or synthetic ingredients, such as emulsifiers, colors, flavor enhancers, and stabilizers.
Most additive combinations identified in the study were closely linked to ultra-processed foods, although some additives, including certain preservatives and antioxidants, were also found in other food categories.
Across the population, researchers detected 125 different food additives in adult diets and 122 in children’s diets. Average daily intake reached 113.1 milligrams per kilogram of body weight per day, equivalent to 5.1 grams per day, in children, compared with 56.7 milligrams per kilogram of body weight per day, or 4.4 grams per day, in adults.
Intake levels and regulatory thresholds
Sixty additives were consumed by more than 5 percent of adults, while 71 exceeded that threshold among children.
Acceptable Daily Intake limits were exceeded for rosemary extract in children, and for both rosemary extract and sucralose in adults. The study notes that these exceedances were limited in scope but observable at the population level.
Distinct additive mixtures identified by age group
Rather than focusing on single additives, the researchers identified recurring mixtures of additives that tend to be consumed together. Three main additive combinations were observed in adults, while four distinct mixtures were identified among children.
In adults, the most common mixtures were associated with industrial baked goods, savory snacks, ready-to-eat meals, dairy desserts, processed sauces, and sweetened or artificially sweetened beverages.
These mixtures typically included combinations of emulsifiers, thickeners, acidity regulators, food colors, preservatives, flavor enhancers, and sweeteners.
Among children, similar but not identical mixtures were observed. Certain combinations were more common in younger children aged 6 to 10 years, while others were more frequently consumed by adolescents aged 11 to 14 years.
Some mixtures were linked to sweetened beverages, confectionery, and pastries, while others were tied to ready-to-eat meals and processed savory foods.
Socio-demographic and health patterns emerge
The study found that exposure to additive mixtures varied by age, sex, income level, educational background, and body mass index. Teenagers and young adults showed the highest overall exposure, followed closely by children aged 6 to 10 years.
Higher exposure to several additive mixtures was associated with less favorable health and socio-demographic profiles, including higher body mass index and smoking status. Researchers highlighted these patterns as relevant for future public health monitoring and dietary guidance.
Additives under scientific and regulatory scrutiny
Some additives included in the analysis have been examined in previous research for possible health associations.
Separate analyses from the NutriNet-Santé cohort have linked sodium nitrite exposure to cardiovascular outcomes, type 2 diabetes, and prostate cancer risk.
In 2023, the International Agency for Research on Cancer classified aspartame as “possibly carcinogenic,” a determination that remains debated within the scientific community.
Titanium dioxide (E171), which was authorized during the Esteban data collection period but has since been banned as a food additive in France and across the European Union due to concerns about genotoxicity, was consumed by 7.5 percent of adults and 12 percent of children included in the study.
Growing focus on combined exposure in food safety research
In a separate investigation using NutriNet-Santé data, researchers identified associations between two additive mixtures and increased incidence of type 2 diabetes.
These mixtures included combinations of emulsifiers, preservatives, acidifiers, sweeteners, and food colors. Exploratory analyses suggested that interactions between additives within these mixtures may play a role, though mechanisms remain under investigation.
Together, these findings add to a growing body of research indicating that real-world dietary exposure involves multiple additives consumed together, rather than isolated compounds evaluated independently.