Food colouring additives, hypertension & cardiovascular disease incidence: NutriNet-Santé cohort
Abstract
Background: Experimental studies have shown some food colouring additives promote oxidative stress, inflammation, and vascular dysfunction, yet human data are lacking. We investigated associations between food colouring additive exposure and hypertension and cardiovascular disease (CVD) incidence, incl. cerebrovascular disease (CVA) and coronary heart disease (CHD).
Methods: 112,395 participants (78.7% female) from the NutriNet-Santé cohort (2009-2024) were included. Dietary data were assessed using repeated 24h-dietary records, including industrial brands. Cumulative time-dependent exposure to food additives was evaluated through multiple composition databases and ad-hoc laboratory assays in food matrices. Associations between exposure (sex-specific tertiles or non-exposed/lower/higher exposed based on sex-specific median) and hypertension and CVD incidence were assessed using Cox models.
Results: 5,544 incident hypertension (mean follow-up 7.6 ± 4.9y) and 2,450 incident CVD (1,142 CVA & 1,308 CHD;7.9 ± 4.9y) were identified. Higher total food colouring additives intake was associated with higher hypertension (HRT3 vs T1=1.36, 95%CI: 1.26–1.47), CVD (1.18, 1.05–1.31), and CHD (1.19, 1.02–1.38) but not CVA incidence (1.17, 0.99–1.37). Several individual colouring additives were associated with higher hypertension incidence: plain caramel (1.15, 1.07–1.23), carotenoids (1.15, 1.07–1.23), beta-carotene (1.18, 1.10–1.26), paprika-capsanthin-capsorubin (1.17, 1.09–1.25), lutein (1.17, 1.09–1.26), curcumin (1.15, 1.08–1.23), cochineal-carminic acid-carmines (1.13, 1.05–1.21), and anthocyanins (1.14, 1.05–1.25). Carotenoid additives were also associated with higher CVD (1.13, 1.02–1.25) and CHD incidence (1.23, 1.07–1.42). Hypertension mediated 19% (9%–72%) of the association between total food colouring additive intake and CVD incidence.
Conclusions: Exposure to widely used food colouring additives was associated with higher incidence of hypertension and CVD, including CHD.
Key messages: • We showed, for the first time, that several widely used food colouring additives from industrial foods were associated with higher hypertension and/or cardiovascular disease incidence.
• These results support re-evaluating safety assessments of these additives and reinforce recommendations to limit exposure to non-essential “cosmetic” additives.
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BibTeX
@article{shah2026food,
title = {{Food colouring additives, hypertension & cardiovascular disease incidence: NutriNet-Santé cohort}},
author = {S Shah and A Hasenböhler and MPDL Garanderie and I Huybrechts and F Pierre and X Coumoul and B Chassaing and M Deschasaux-Tanguy and B Srour and M Touvier},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.551},
url = {https://doi.org/10.1093/eurpub/ckag169.551},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Food colouring additives, hypertension & cardiovascular disease incidence: NutriNet-Santé cohort
AU - S Shah
AU - A Hasenböhler
AU - MPDL Garanderie
AU - I Huybrechts
AU - F Pierre
AU - X Coumoul
AU - B Chassaing
AU - M Deschasaux-Tanguy
AU - B Srour
AU - M Touvier
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.551
UR - https://doi.org/10.1093/eurpub/ckag169.551
AB - Background: Experimental studies have shown some food colouring additives promote oxidative stress, inflammation, and vascular dysfunction, yet human data are lacking. We investigated associations between food colouring additive exposure and hypertension and cardiovascular disease (CVD) incidence, incl. cerebrovascular disease (CVA) and coronary heart disease (CHD). Methods: 112,395 participants (78.7% female) from the NutriNet-Santé cohort (2009-2024) were included. Dietary data were assessed using repeated 24h-dietary records, including industrial brands. Cumulative time-dependent exposure to food additives was evaluated through multiple composition databases and ad-hoc laboratory assays in food matrices. Associations between exposure (sex-specific tertiles or non-exposed/lower/higher exposed based on sex-specific median) and hypertension and CVD incidence were assessed using Cox models. Results: 5,544 incident hypertension (mean follow-up 7.6 ± 4.9y) and 2,450 incident CVD (1,142 CVA & 1,308 CHD;7.9 ± 4.9y) were identified. Higher total food colouring additives intake was associated with higher hypertension (HRT3 vs T1=1.36, 95%CI: 1.26–1.47), CVD (1.18, 1.05–1.31), and CHD (1.19, 1.02–1.38) but not CVA incidence (1.17, 0.99–1.37). Several individual colouring additives were associated with higher hypertension incidence: plain caramel (1.15, 1.07–1.23), carotenoids (1.15, 1.07–1.23), beta-carotene (1.18, 1.10–1.26), paprika-capsanthin-capsorubin (1.17, 1.09–1.25), lutein (1.17, 1.09–1.26), curcumin (1.15, 1.08–1.23), cochineal-carminic acid-carmines (1.13, 1.05–1.21), and anthocyanins (1.14, 1.05–1.25). Carotenoid additives were also associated with higher CVD (1.13, 1.02–1.25) and CHD incidence (1.23, 1.07–1.42). Hypertension mediated 19% (9%–72%) of the association between total food colouring additive intake and CVD incidence. Conclusions: Exposure to widely used food colouring additives was associated with higher incidence of hypertension and CVD, including CHD. Key messages: • We showed, for the first time, that several widely used food colouring additives from industrial foods were associated with higher hypertension and/or cardiovascular disease incidence. • These results support re-evaluating safety assessments of these additives and reinforce recommendations to limit exposure to non-essential “cosmetic” additives.
SN - 1101-1262
SN - 1464-360X
ER -