Food additive mixtures in French children and adults: the nationally representative Esteban study

This study aimed to identify exposures to food additives and their mixtures in a nationally representative sample of French adults and children. Using repeated 24-hour dietary recalls and food records (including commercial brand information) from the cross-sectional Esteban survey (France, 2016), additive intake was estimated by merging with multiple food composition databases, and laboratory assays in food matrices. Non-negative matrix factorisation was used to identify additive mixtures. Their associations with sociodemographic, lifestyle, and dietary factors were assessed using survey-weighted regressions. A total of 2,177 adults (18-74 years old) and 1,279 children (6-17 years old) were included. Mean daily additive intake was 4.42 g/day in adults and 5.08 g/day in children. Sixty additives were consumed by at least 5% of adults, and 71 by children, including several with suspected adverse health effects (e.g., carrageenan, acesulfame K, aspartame, titanium dioxide). Three main mixtures were identified in adults and four in children, and were correlated with distinct socio-demographic profiles. In conclusion, this first nationally representative assessment of food additive exposure in French children and adults provides the evidence that food additives are consumed as mixtures and, together with emerging data on synergistic interactions, it underscores the importance of considering combined exposures in future safety evaluations.Trial registration: The Esteban health survey is registered in the French National Agency for Medicines and Health Products Safety (No. 2012-A00456-34).