Eight Common Food Preservatives Linked to Hypertension and Cardiovascular Risk in Large French Cohort Study
Key Insights
A study of over 112,000 French adults found higher intake of certain food preservatives was associated with up to a 39% higher incidence of hypertension (search) over a 7.9-year follow-up period.
Eight specific preservatives—including potassium sorbate, sodium nitrite, citric acid, and ascorbic acid—were linked to elevated blood pressure risk after adjusting for diet quality and lifestyle factors.
Ascorbic acid (vitamin C) was the only individual preservative significantly associated with a 15% higher incidence of cardiovascular disease (search) when consumed as a food additive rather than in whole foods.
A new analysis from the NutriNet-Santé cohort, published in the European Heart Journal, has identified eight common food preservatives associated with a higher incidence of hypertension (search), raising fresh concerns about the cardiovascular safety of additives found in ultra-processed foods. The study, which followed more than 112,000 French adults for an average of 7.9 years, also linked ascorbic acid—widely known as vitamin C—to a 15% higher incidence of cardiovascular disease (search) when consumed as an additive rather than in its naturally occurring form.
The findings arrive amid growing scrutiny of ultra-processed foods and their ingredients. In 2019, roughly one-third of products purchased in the United States contained at least one preservative, and during the first two years of the current study, 99.5% of participants consumed something with at least one preservative.
Preservatives Under the Microscope
The researchers, led by Anaïs Hasenböhler and Mathilde Touvier of the Nutritional Epidemiology Research Team at the French National Institute for Health and Medical Research (search), analyzed dietary data from 112,395 participants—more than two-thirds of whom were female, with an average age of 42.8. From 58 different preservatives consumed by the cohort, the team focused on 17 that were ingested by at least 10% of participants.
The ten most commonly consumed preservatives included citric acid (91.3% of participants, largely from processed fruit and vegetables), lecithins (86.4%), total sulphites (83.5%, mostly from alcoholic drinks), ascorbic acid (83.0%), and sodium nitrite (73.3%, largely from processed meat products).
After adjusting for age, sex, height, body mass index, physical activity, smoking status, educational level, family history of cardiometabolic disorders, and dietary factors including macronutrient consumption and intake of alcohol, salt, meat, and dairy, the researchers found that higher intakes of total non-antioxidant preservatives were associated with a higher incidence of both cardiovascular disease (search) and coronary heart disease (search).
Quantifying the Risk
The study reported that higher consumption of total preservatives was associated with a 24% higher incidence of hypertension (search). When broken down by preservative type, total non-antioxidant preservatives—those that kill microbes—were linked to a 29% higher incidence, while total antioxidant preservatives—which prevent chemical spoiling—were associated with a 22% higher incidence.
When the scientists examined individual compounds, eight preservatives emerged with statistically significant associations to hypertension (search):
- Total sorbates and potassium sorbate: 39% higher incidence each
- Citric acid: 25% higher
- Potassium metabisulfite: 16% higher
- Total nitrites and sodium nitrite: 16% higher each
- Ascorbic acid and sodium erythorbate: 14% higher each
- Total ascorbates and total erythorbates: 13% higher each
- Sodium ascorbate: 12% higher
- Total sulphites: 11% higher
- Extracts of rosemary: 10% higher
For cardiovascular disease (search) specifically, only ascorbic acid remained significant, with a 15% higher incidence.
Importantly, the researchers found no statistical interaction between diet quality or intake of ultra-processed foods, suggesting the observed effect is not solely attributable to people who consumed more preservatives having an overall poorer diet.
Mechanisms and Clinical Context
Experts consulted on the findings offered several hypotheses for the observed associations. Scott Keatley, R.D., co-owner of Keatley Medical Nutrition Therapy, noted that certain preservatives may raise inflammation levels, increase oxidative stress, impact blood vessel function, or alter the gut microbiome. "Nitrites, for example, have been linked to oxidative damage in laboratory studies," he said.
Katherine N. Balantekin, Ph.D., R.D., assistant professor in the Department of Exercise and Nutrition Sciences at the University at Buffalo, pointed out that these preservatives tend to be found in shelf-stable, ultra-processed foods that are typically higher in added fats, sugar, and sodium—ingredients themselves associated with cardiovascular risk.
Cheng-Han Chen, M.D., interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center, cautioned that the underlying mechanism remains uncertain: "It's probably a combination of all of these factors."
Study Limitations and Regulatory Implications
As an observational study, the research cannot prove causation, and the authors acknowledge that other confounding factors may explain the relationship between preservatives and heart health. Nevertheless, the investigators concluded their paper with a call for regulatory action: "This study provides new insights for revisiting the evaluation of the safety of these food additives, which should consider the benefit/risk balance between food preservation with these additives and their potential impact on cardiovascular health."
The authors specifically called on the Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA (search)) to re-evaluate the risks. The study builds on earlier findings from the same NutriNet-Santé cohort, which previously linked preservative intake to an increased incidence of type 2 diabetes (search) and certain cancers.
Practical Dietary Guidance
For individuals seeking to reduce preservative intake, Dr. Federica Amati, a research fellow at Imperial College London and registered nutritionist, recommended prioritizing whole foods. "In the U.S., around 57% of foods are ultra-processed, and the majority of these products contain preservatives. It's virtually impossible to reduce your preservative intake to zero, but cutting down on UPFs is a great place to start," she said.
Amati emphasized that whole foods—including fruit, whole grains, vegetables, nuts, seeds, herbs, and spices—are rich in fiber, "an essential nutrient that supports good gut health, immune function, and heart health." She also advised focusing first on reducing processed meat products, which often contain nitrate and nitrite preservatives, and replacing sodas with water, unsweetened tea and coffee, or fermented beverages like kombucha or kefir.
Keatley echoed this perspective: "The practical takeaway isn't that consumers need to memorize additive names. This study adds to growing evidence that diets centered on minimally processed foods are associated with better cardiovascular health."