Exposure to food additives has emerged as an area of growing interest in metabolic health research, although data linking food coloring additives with type 2 diabetes mellitus (T2DM) risk remain limited. A prospective analysis published in Diabetes Care evaluated associations between food coloring additive exposure and incident T2DM in participants from the French NutriNet-Santé cohort.

The analysis included 108,723 participants followed between 2009 and 2023, with a median follow-up of 8.05 years. Dietary exposure was assessed using repeated 24-hour dietary records linked to industrial food brands, composition databases, and laboratory assays. Multivariable Cox proportional hazards models were used to evaluate associations between food coloring additive exposure and T2DM incidence.

Findings

• During follow-up, 1,131 incident T2DM cases were documented.
• Higher exposure to total food coloring additives was associated with increased T2DM incidence (hazard ratio [HR] 1.38; 95% CI 1.17-1.63; P = 0.0002).
• Total caramel exposure was associated with higher T2DM incidence (HR 1.43; 95% CI 1.21-1.67), including plain caramel (HR 1.46; 95% CI 1.26-1.70) and sulfite ammonia caramel (HR 1.30; 95% CI 1.07-1.59).
• Higher exposure to total carotene (HR 1.27; 95% CI 1.08-1.48), carotenoids (HR 1.39; 95% CI 1.19-1.62), and β-carotene (HR 1.44; 95% CI 1.23-1.68) was also associated with increased T2D incidence.
• Positive associations were additionally observed for paprika-capsanthin-capsorubin (HR 1.26; 95% CI 1.08-1.46), lutein (HR 1.20; 95% CI 1.02–1.40), curcumin (HR 1.49; 95% CI 1.29-1.73), cochineal-carminic acid-carmines (HR 1.27; 95% CI 1.10-1.48), and anthocyanins (HR 1.40; 95% CI 1.17-1.68).

Higher exposure to several natural and synthetic food coloring additives was associated with increased T2DM incidence in this cohort analysis. Further studies are needed to confirm these findings and clarify potential underlying mechanisms.