Food additive mixtures and incident elevated depressive symptoms in the NutriNet-Santé cohort
Abstract
Background: Current safety evaluations assess food additives individually and do not account for real-world mixture exposures or chronic disease endpoints. We assessed associations between food additive mixture exposure and incident elevated depressive symptoms.
Methods: We analysed 36,516 participants (50 ± 14 years; 77% women) from the French NutriNet-Santé cohort (2009–2022) with ≥2 24-hour dietary records, no depression at baseline, and ≥1 follow-up CES-D. Incident elevated depressive symptoms were defined using sex-specific CES-D cut-offs (≥17 men; ≥23 women). Additive intakes (mg/d) were estimated from 24-hour dietary records with brand-specific data, linked to composition databases and laboratory analyses. Mixtures were derived using nonnegative matrix factorisation, and associations assessed using multivariable Cox models (age timescale) per 1-SD increase.
Results: Over a median 6 years, 4,605 cases occurred. Five mixtures were identified. Higher exposure to mixture 5 (characterised mainly by acidity regulators, sweeteners, colours, and selected emulsifying, stabilising, texturising, glazing, and preservative agents) was associated with higher incidence of elevated depressive symptoms (HRper 1-SD 1.06, 95% CI 1.03–1.08; P < 0.001), while mixtures 1–4 were not. Exploratory analyses suggested interactions between mixture 5 constituents, and associations persisted after accounting for individual additives.
Conclusions: Higher exposure to a commonly consumed food additive mixture was associated with a higher incidence of elevated depressive symptoms, with evidence consistent with a mixture effect beyond individual additives. These findings suggest that additive mixtures may represent a modifiable risk factor, warranting replication and experimental studies to clarify causality and mechanisms, and informing future safety evaluations and early policy consideration to reduce unnecessary exposure to nonessential additives.
Key messages: • This global-first prospective study quantified population exposure to food additive mixtures and found higher exposure to one mixture was linked to higher incidence of elevated depressive symptoms.
• Findings suggest additive mixtures, not just individual additives, may be a modifiable risk factor for depressive symptoms and relevant to food safety frameworks, helping guide early policy action.
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BibTeX
@article{lane2026food,
title = {{Food additive mixtures and incident elevated depressive symptoms in the NutriNet-Santé cohort}},
author = {MM Lane and S Shah and J Chapman and J Challender and MP De La Garanderie and A Hasenböhler and E Kesse-Guyot and B Srour and M Touvier and W Marx},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.446},
url = {https://doi.org/10.1093/eurpub/ckag169.446},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Food additive mixtures and incident elevated depressive symptoms in the NutriNet-Santé cohort
AU - MM Lane
AU - S Shah
AU - J Chapman
AU - J Challender
AU - MP De La Garanderie
AU - A Hasenböhler
AU - E Kesse-Guyot
AU - B Srour
AU - M Touvier
AU - W Marx
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.446
UR - https://doi.org/10.1093/eurpub/ckag169.446
AB - Background: Current safety evaluations assess food additives individually and do not account for real-world mixture exposures or chronic disease endpoints. We assessed associations between food additive mixture exposure and incident elevated depressive symptoms. Methods: We analysed 36,516 participants (50 ± 14 years; 77% women) from the French NutriNet-Santé cohort (2009–2022) with ≥2 24-hour dietary records, no depression at baseline, and ≥1 follow-up CES-D. Incident elevated depressive symptoms were defined using sex-specific CES-D cut-offs (≥17 men; ≥23 women). Additive intakes (mg/d) were estimated from 24-hour dietary records with brand-specific data, linked to composition databases and laboratory analyses. Mixtures were derived using nonnegative matrix factorisation, and associations assessed using multivariable Cox models (age timescale) per 1-SD increase. Results: Over a median 6 years, 4,605 cases occurred. Five mixtures were identified. Higher exposure to mixture 5 (characterised mainly by acidity regulators, sweeteners, colours, and selected emulsifying, stabilising, texturising, glazing, and preservative agents) was associated with higher incidence of elevated depressive symptoms (HRper 1-SD 1.06, 95% CI 1.03–1.08; P < 0.001), while mixtures 1–4 were not. Exploratory analyses suggested interactions between mixture 5 constituents, and associations persisted after accounting for individual additives. Conclusions: Higher exposure to a commonly consumed food additive mixture was associated with a higher incidence of elevated depressive symptoms, with evidence consistent with a mixture effect beyond individual additives. These findings suggest that additive mixtures may represent a modifiable risk factor, warranting replication and experimental studies to clarify causality and mechanisms, and informing future safety evaluations and early policy consideration to reduce unnecessary exposure to nonessential additives. Key messages: • This global-first prospective study quantified population exposure to food additive mixtures and found higher exposure to one mixture was linked to higher incidence of elevated depressive symptoms. • Findings suggest additive mixtures, not just individual additives, may be a modifiable risk factor for depressive symptoms and relevant to food safety frameworks, helping guide early policy action.
SN - 1101-1262
SN - 1464-360X
ER -