Highlights
- Higher intake of total non-antioxidant preservatives was associated with a 16% increased risk of overall cancer and a 22% increased risk of breast cancer.
- Specific additives, including potassium sorbate, sodium nitrite, and potassium nitrate, showed significant correlations with site-specific malignancies, notably breast and prostate cancers.
- Absolute risk assessments indicate that by age 60, individuals with higher preservative intake have a higher cumulative incidence of cancer compared to low or non-consumers.
- The study highlights the potential health impact of ultra-processed food components, calling for more stringent regulatory oversight of industrial food additives.
Background: The Ubiquity of Food Preservatives
In the modern food landscape, ultra-processed foods (UPFs) constitute a significant portion of the daily caloric intake in high-income and middle-income countries. These products are often characterized by the presence of cosmetic and functional additives, including preservatives designed to extend shelf life and prevent microbial spoilage. While regulatory bodies like the European Food Safety Authority (EFSA) and the U.S. Food and Drug Administration (FDA) establish acceptable daily intakes (ADIs), there is growing concern regarding the long-term health implications of chronic, low-dose exposure to multiple chemical additives. Previous epidemiological studies have hinted at the carcinogenic potential of certain additives, such as nitrites in processed meats, but comprehensive data on a wider array of preservatives and their cumulative impact on cancer incidence have been lacking. This study from the NutriNet-Santé cohort aims to bridge that gap by providing granular, longitudinal data on preservative consumption and its association with cancer risk.
Study Design and Methodology
The NutriNet-Santé study is a large-scale, web-based prospective cohort initiated in France in 2009. For this specific analysis, researchers included 105,260 participants aged 15 and older who were free of cancer at baseline. Dietary intake was meticulously assessed using repeated 24-hour dietary records, which allowed for the identification of specific industrial food brands and their corresponding ingredient lists. To ensure high precision, the researchers utilized multiple composition databases and ad hoc laboratory assays to quantify preservative concentrations in frequently consumed products.
The primary outcome was the incidence of cancer, including overall, breast, prostate, and colorectal cancers. Participants were followed for a mean of 7.57 years. Statistical analysis employed multivariable proportional hazards Cox models, adjusted for a wide range of potential confounders such as age, sex, body mass index (BMI), physical activity, smoking status, alcohol consumption, and educational level. Exposure was categorized into sex-specific thirds or divided into non-consumers and low/high consumers based on consumption frequency.
Key Findings: Preservatives and Site-Specific Cancer Risk
During the follow-up period, 4,226 incident cancer cases were recorded, including 1,208 breast cancers and 508 prostate cancers. The analysis revealed that higher intakes of several preservative categories were significantly associated with increased cancer risk.
Total Non-Antioxidant Preservatives
Participants with higher consumption of total non-antioxidant preservatives exhibited a 16% higher risk of overall cancer (Hazard Ratio [HR] 1.16; 95% Confidence Interval [CI] 1.07 to 1.26). The association was even more pronounced for breast cancer, with a 22% increased risk (HR 1.22; 95% CI 1.05 to 1.41). In terms of absolute risk at age 60, the incidence was 13.3% for higher consumers compared to 12.1% for lower or non-consumers.
Sorbates and Sulfites
Total sorbate intake, and specifically potassium sorbate (E202), was associated with an increased risk of overall cancer (HR 1.14) and breast cancer (HR 1.26). Sulfites also showed a positive correlation with overall cancer risk (HR 1.12), with potassium metabisulfite specifically linked to both overall and breast cancer incidence.
Nitrites and Nitrates
The study reinforced existing concerns regarding nitrogenous additives. Sodium nitrite (E250) intake was significantly associated with a 32% increased risk of prostate cancer (HR 1.32; 95% CI 1.02 to 1.70). Potassium nitrate (E252) was linked to overall cancer (HR 1.13) and breast cancer (HR 1.22). These findings are particularly relevant given the common use of these additives in cured and processed meats.
Acetates and Other Additives
Total acetates, including acetic acid (E260), were associated with higher risks of overall and breast cancers. Interestingly, sodium erythorbate (E316), often used as an antioxidant and color stabilizer in meats, was also associated with increased overall cancer (HR 1.12) and breast cancer risk (HR 1.21). It is important to note that 11 of the 17 individually studied preservatives did not show a statistically significant association with cancer incidence, suggesting that the risks are specific to certain chemical classes.
Expert Commentary and Mechanistic Insights
The biological plausibility of these findings involves several potential pathways. Nitrites and nitrates are known precursors to N-nitroso compounds, which are potent carcinogens. Sorbates have been investigated in vitro for potential genotoxicity, although results have historically been mixed. The association with acetates might involve alterations in the gut microbiota or metabolic pathways related to acetate signaling, which can influence tumor microenvironments.
While the NutriNet-Santé cohort provides robust data, several limitations must be considered. As an observational study, it cannot definitively establish causality. Residual confounding remains a possibility, despite extensive adjustments for lifestyle factors. Furthermore, the cohort consists of volunteers who are generally more health-conscious than the general population, which might affect the generalizability of the findings. However, the use of detailed, brand-specific dietary records is a significant strength that minimizes exposure misclassification compared to standard food frequency questionnaires.
Clinical Implications and Public Health Recommendations
For clinicians and public health experts, these results suggest that the cumulative intake of industrial food additives is a relevant factor in cancer epidemiology. While individual additives are tested for safety, the “cocktail effect” of consuming multiple preservatives daily is less understood. These findings support current dietary guidelines that emphasize the reduction of ultra-processed food consumption in favor of minimally processed or fresh foods.
Health policy experts may use these data to advocate for a re-evaluation of regulatory frameworks. If these associations are confirmed in other large-scale prospective cohorts and supported by experimental research into biomarkers of effect, it may be necessary to lower the ADIs for certain preservatives or restrict their use in specific food categories to better protect consumer health.
Conclusion
This comprehensive analysis from the NutriNet-Santé cohort provides compelling evidence that the consumption of specific food preservatives widely used in industrial food production is linked to a higher incidence of overall, breast, and prostate cancers. While further research is needed to elucidate the underlying biological mechanisms, the study reinforces the importance of dietary patterns in cancer prevention. Encouraging patients to transition toward whole-food-based diets remains a prudent clinical and public health strategy.
Funding and Trial Registration
The NutriNet-Santé study is supported by the French Ministry of Health, the National Institute for Health and Medical Research (INSERM), and other public institutions. The study is registered at ClinicalTrials.gov (NCT03335644).
References
Hasenböhler A, Javaux G, Payen de la Garanderie M, et al. Intake of food additive preservatives and incidence of cancer: results from the NutriNet-Santé prospective cohort. BMJ. 2026 Jan 7;392:e084917. doi: 10.1136/bmj-2025-084917. PMID: 41500678.
