A recent study, published in The BMJ, has suggested that greater consumption of food preservatives widely used in processed foods and beverages was associated with an increased risk of cancer.
Most of the preservatives linked to this risk were non-antioxidants, reports Medpage Today, with the study team saying the results from the NutriNet-Santé prospective cohort may have important health implications.
Among more than 105 000 participants, higher intake of several preservatives, including potassium sorbate, potassium metabisulfite, sodium nitrite, potassium nitrate, acetic acid and sodium erythorbate, was associated with an increased risk of overall, breast, and prostate cancers, reported Mathilde Touvier, MSc, MPH, PhD, of Université Sorbonne Paris Nord and Université Paris Cité, and colleagues.
"These findings may have major public health implications, given the ubiquitous use of these additives in a wide range of foods and beverages,” they wrote in The BMJ.
“If confirmed, these new data call for the re-evaluation of regulations governing the food industry’s use of these additives, to improve consumer protection,” they noted. “In the meantime, the findings support recommendations for consumers to favour freshly made, minimally processed foods.”
The authors found that intake of non-antioxidant preservatives was associated with an increased risk of overall cancer, with a hazard ratio of 1.16 when comparing higher intake versus no or low intake (95% CI 1.07-1.26). Specifically, they found that intake of the following preservatives was associated with increased overall, breast, and prostate cancer risks:
Total sorbates, specifically potassium sorbate: overall cancer (HR 1.14, 95% CI 1.04-1.24) and breast cancer (HR 1.26, 95% CI 1.07-1.49)
Total sulfites: overall cancer (HR 1.12, 95% CI 1.02-1.24)
Potassium metabisulfite: overall cancer (HR 1.11, 95% CI 1.03-1.20) and breast cancer (HR 1.20, 95% CI 1.04-1.38)
Sodium nitrite: prostate cancer (HR 1.32, 95% CI 1.02-1.70)
Potassium nitrate: overall cancer (HR 1.13, 95% CI 1.05-1.23) and breast cancer (HR 1.22, 95% CI 1.05-1.41)
Total acetates: overall cancer (HR 1.15, 95% CI 1.06-1.25) and breast cancer (HR 1.25, 95% CI 1.07-1.45)
Acetic acid: overall cancer (HR 1.12, 95% CI 1.01-1.25)
Among antioxidant preservatives, sodium erythorbate was associated with an increased risk of overall cancer (HR 1.12, 95% CI 1.04-1.22) and breast cancer (HR 1.21, 95% CI 1.04-1.41).
In an accompanying editorial, Xinyu Wang, MBBS, and Edward Giovannucci, MD, ScD, both of the Harvard TH Chan School of Public Health, pointed out that preservatives offer clear benefits by extending shelf life and lowering food costs, which can be particularly important for populations with lower incomes.
“However, the widespread and often insufficiently monitored use of these additives, with uncertainties of their long-term health effects, call for a more balanced approach,” they wrote.
“Findings from NutriNet-Santé may prompt regulatory agencies to revisit existing policies, such as setting stricter limits on use, requiring clearer labelling, and mandating disclosure of additive contents.”
The study included 105 260 participants in the NutriNet-Santé cohort from 2009 to 2023. Mean age was 42 years, and 78.7% were women. Of these participants, 4 226 received a diagnosis of incident cancer over a mean follow-up of 7.57 years, including 1 208 breast cancers (387 premenopausal and 821 postmenopausal), 508 prostate cancers, 352 colorectal cancers, and 2 158 other cancers.
Preservative intake was assessed through repeated 24-hour dietary records. Health questionnaires and official medical and death records were then used to track cancer cases up until the end of 2023.
On average, participants completed a total of 21 24-hour dietary records. Compared with lower consumers (lowest third), higher consumers of total food preservatives (upper third) tended to be younger, less physically active, less likely to have a family history of cancer, and more likely to consume less alcohol and more ultra-processed foods and drinks.
The authors considered 58 preservatives for inclusion in the study, 17 of which were consumed by at least 10% of the participants and individually evaluated in association with cancer incidence.
The most commonly consumed preservatives were citric acid (91.7%), lecithins (87.1%), total sulfites (83.5%), ascorbic acid (83.5%), sodium nitrite (73.8%), potassium sorbate (65.5%), sodium erythorbate (52.7%), sodium ascorbate (50.3%), potassium metabisulfite (44.5%), and potassium nitrate (32.6%).
Touvier and colleagues acknowledged that the study had several limitations, including its observational design, which meant that residual confounding could not be fully ruled out.
Study details
Intake of food additive preservatives and incidence of cancer: results from the NutriNet-Santé prospective cohort
Anaïs Hasenböhler, Guillaume Javaux, Marie Payen de la Garanderie et al.
Published in The BMJ on 7 January 2026
Abstract
Objective
To investigate the association between intake of food additive preservatives and cancer incidence in a large prospective cohort.
Design
Prospective cohort.
Setting
French NutriNet-Santé cohort, 2009-23.
Participants
105 260 participants (≥15 years) without prevalent cancer who completed at least two 24 hour dietary records at baseline.
Main outcome measures
Cumulative time dependent intake of preservatives, including those in industrial food brands, assessed using repeated 24 hour dietary records and evaluated through multiple composition databases and ad hoc laboratory assays in food products for the most frequently consumed additive-food pairs. Associations between intake of three categories of preservatives (defined as sex specific thirds if preservative was consumed by at least a third of participants, otherwise defined as non-consumers and lower or higher consumers separated by the sex specific median) and cancer incidence were characterised using multivariable proportional hazards Cox models adjusted for potential confounders.
Results
Mean age of participants was 42.0 years (standard deviation (SD 14.5) years), and 78.7% were women. 4226 participants received a diagnosis of incident cancer (mean follow-up 7.57 (SD 4.56) years), comprising 1208 breast, 508 prostate, 352 colorectal, and 2158 other cancers). Higher intakes of several preservatives were associated with higher cancer incidence: total non-antioxidants with overall cancer (hazard ratio for higher v non-consumers or lower consumers 1.16 (95% confidence interval (CI) 1.07 to 1.26); absolute risk of cancer at age 60 years, respectively, 13.3%, 12.1%) and breast cancer (1.22 (1.05 to 1.41); 5.7%, 4.8%); total sorbates, specifically potassium sorbate, with overall cancer (1.14 (1.04 to 1.24); 13.4%, 11.8%) and breast cancer (1.26 (1.07 to 1.49); 5.7%, 4.6%); total sulfites with overall cancer (1.12 (1.02 to 1.24); 13.4%, 11.9%); potassium metabisulfite with overall cancer (1.11 (1.03 to 1.20); 13.5%, 12.0%) and breast cancer (1.20 (1.04 to 1.38); 5.7%, 4.9%); sodium nitrite with prostate cancer (1.32 (1.02 to 1.70); 4.2%, 3.4%); potassium nitrate with overall cancer (1.13 (1.05 to 1.23); 14.0%, 12.0%) and breast cancer (1.22 (1.05 to 1.41); 5.9%, 4.8%); total acetates with overall cancer (1.15 (1.06 to 1.25); 14.3%, 12.2%) and breast cancer (1.25 (1.07 to 1.45); 6.1%, 4.9%); acetic acid with overall cancer (1.12 (1.01 to 1.25); 14.4%, 12.4%); and sodium erythorbate with overall cancer (1.12 (1.04 to 1.22); 13.5%, 11.9%) and breast cancer (1.21 (1.04 to 1.41); 5.7%, 4.8%). 11 of the 17 individually studied preservatives were not associated with cancer incidence.
Conclusion
Multiple positive associations between intake of preservatives widely used in industrial foods and higher cancer incidence (overall, breast, and prostate) were observed in this large prospective cohort. Epidemiology based on health effect biomarkers and experimental research are needed to gain insight into outcome pathways. If confirmed, these new data call for the re-evaluation of regulations governing the food industry’s use of these additives, to improve consumer protection. In the meantime, the findings support recommendations for consumers to favour freshly made, minimally processed foods.
Medpage Today article – Common Food Additive Linked to Cancer Risk (Open access)
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