Published Feb 04, 2026 | 3:05 PM ⚊ Updated Feb 04, 2026 | 3:05 PM
Food preservatives. (iStock)
Synopsis: A 14-year study revealed alarming associations between widely used food preservatives and type 2 diabetes. For India, the findings raise urgent questions about the “hidden” ingredients in everyday foods sitting on kitchen shelves across the country.
A 14-year study tracking over 1,00,000 people revealed alarming associations between widely used food preservatives and type 2 diabetes. For India — often called the “diabetes capital of the world” — the findings raise urgent questions about the “hidden” ingredients in everyday foods sitting on kitchen shelves across the country.
The NutriNet-Santé prospective cohort study, published in Nature Communications, found that higher consumption of preservative additives was associated with a staggering 47 percent increased incidence of type 2 diabetes. Non-antioxidant preservatives showed a 49 percent increase, whilst antioxidant additives were linked to a 40 percent rise compared to the lowest consumption levels.
Between 2009 and 2023, researchers from Inserm, INRAE, Sorbonne Paris Nord University, Paris Cité University and Cnam identified 1,131 cases of type 2 diabetes among 1,08,723 participants.
The study individually examined 17 preservatives consumed by at least 10 percent of participants, finding that 13 were associated with increased diabetes risk— and worryingly, most are explicitly permitted in India.
The study identified several widely used preservatives now under scrutiny, many of which are staples in the Indian food industry and permitted by the Food Safety and Standards Authority of India (FSSAI).
Sorbates and sulphites: Potassium sorbate (E202) and potassium metabisulphite (E224) are widely used in India to prevent spoilage in beverages, fruit juices, and dehydrated products.
Nitrites: Sodium nitrite (E250) is a common Class II preservative used in India for processed meats like ham and pickled meat.
Propionates and acetates: Used in bakery items and ketchups, these include calcium propionate (E282) and sodium acetates (E262).
Antioxidants: Surprisingly, the list also includes compounds often perceived as safe, such as sodium ascorbate (E301) and alpha-tocopherol (E307) — forms of vitamins C and E — when used as industrial additives. Other flagged compounds include citric acid (E330), phosphoric acid (E338), and rosemary extracts (E392).
“This is the first study in the world on the links between preservative additives and the incidence of type 2 diabetes,” explained Mathilde Touvier, Inserm research director and coordinator of the work. “Although the results need to be confirmed, they are consistent with experimental data suggesting the harmful effects of several of these compounds.”
In India, FSSAI divides preservatives into Class I (natural substances such as salt and spices) and Class II (chemical preservatives such as sorbates and sulphites). Whilst FSSAI mandates these additives must be “safe for a lifetime of consumption” based on current toxicological evaluations, the NutriNet-Santé study suggests cumulative exposure may be more harmful than previously understood.
The study highlights a concerning shift in the Indian food landscape. Whilst traditional Indian cuisine relies heavily on Class I preservatives such as spices, honey, and edible vegetable oils, the rise of the food industry has led to the ubiquitous use of Class II chemical preservatives.
According to FSSAI guidelines, these preservatives are now commonly found in Indian consumer staples:
Among the three and a half million foods and beverages listed in the Open Food Facts World database in 2024, more than 700,000 contain at least one of these preservative substances.
The research suggests these additives are not merely passive ingredients but may actively disrupt the body’s metabolic balance. Experimental data indicate these compounds can cause pancreatic inflammation, insulin resistance, and metabolic disruption.
The study notes that certain sorbates act as “AGE activators” — advanced glycation end products linked to the onset of diabetes — whilst nitrites can interfere with insulin signalling pathways. Mouse model studies showed that co-administration of sorbate and fructose leads to altered liver function, including steatosis, inflammation, and fibrosis, associated with altered expression of genes involved in lipid metabolism.
Research on rat models revealed the particular role of N-nitroso compounds in the development of insulin resistance via disruption of both insulin and IGF pathways and dysfunction of pancreatic β-cells. Studies also reported that propionate impaired insulin action.
The research found that 17 percent of the association between ultra-processed food and type 2 diabetes was mediated by exposure to these preservatives. In the study population, 34.6 percent of food additive preservatives were consumed through ultra-processed foods.
Notably, whilst no participant exceeded acceptable daily intakes (ADIs) set by the European Food Safety Authority for sorbates, erythorbates, or nitrates, 90 participants exceeded the ADI for sulphites, and 55 exceeded it for nitrites.
The study’s findings are based on robust methodology. Participants had a mean age at baseline of 42.5 years and completed an average of 21 detailed 24-hour dietary records over the follow-up period. The median follow-up time was 8.05 years, totalling 841,296 person-years of observation.
A total of 99.7 percent of participants exhibited non-zero intake of food additive preservatives in the first two years of follow-up. Out of 58 preservative food additives detected and quantified in the databases, 17 were consumed by at least 10 percent of participants.
In terms of proportion of consumers, the main preservative food additives were citric acid (E330) at 91.8 percent, lecithins (E322) at 87.1 percent, total sulphites at 83.6 percent, ascorbic acid (E300) at 83.5 percent, sodium nitrite (E250) at 73.7 percent, and potassium sorbate (E202) at 65.5 percent.
The results showed that higher intakes of total preservatives were associated with a significantly elevated diabetes risk, with a hazard ratio of 1.47. Individual preservatives showed even stronger associations: Potassium sorbate (E202) showed a hazard ratio of 2.15, representing more than double the risk at higher consumption levels.
“More broadly, these new data add to others in favour of a reassessment of the regulations governing the general use of food additives by the food industry in order to improve consumer protection,” said Anaïs Hasenböhler, a doctoral student at EREN who conducted the studies.
The researchers emphasise that their findings call for a safety re-evaluation of these substances. For FSSAI, which states that food additives must be “safe for a lifetime of consumption,” the study suggests that even “safe” limits might need reconsideration in light of long-term metabolic health impacts.
“This work once again justifies the recommendations made by the National Nutrition and Health Programme to consumers to favour fresh, minimally processed foods and to limit unnecessary additives as much as possible,” concluded Mathilde Touvier.
The study’s implications for India are particularly significant given the country’s diabetes burden. The researchers note that several preservative food additives are ubiquitously used across many food groups, with huge variability in ingredient lists depending on brands for the same generic food item.
This has two critical public health implications, according to the study.
First, recommendations to the public should focus on a general guideline aimed at limiting unnecessary preservative additives by choosing preservative-free alternatives whenever possible. This applies to all food groups, including processed and ultra-processed fruit and vegetables. For example, cooking at home and consuming only unprocessed or minimally processed fruit and vegetables would avoid around 25 percent of total food preservatives.
Second, measures targeting individuals alone will not be sufficient. Policy actions must be implemented in parallel to deeply transform the food supply and reduce exposure, including re-evaluating these additives and amending regulations on authorised substances and doses.
To reduce exposure to certain food additive preservatives such as sulphites or nitrites, for which the primary sources are specific food groups with no particular nutritional value — alcoholic beverages and processed meats, respectively — the study says, it is advisable to limit consumption of these food and beverage groups.
The research was funded by the European Research Council, the National Cancer Institute, and the French Ministry of Health. Whilst the observational design does not allow causal interpretation based on this study alone, the researchers note their findings are consistent with experimental data and warrant urgent attention from food safety regulators worldwide.
The study authors acknowledge that no other cohort study has investigated the associations between intakes of preservative food additives and type 2 diabetes incidence, probably due to a lack of data regarding specific industrial foods consumed and their additive content, which varies greatly from one brand to another.
However, they emphasise that many mechanisms may underpin the associations detected in their study, including metabolic and inflammatory disruption and altered insulin signalling pathways. An in vitro study on hepatic cells revealed that whilst lecithins showed no cytotoxicity or genotoxicity, potassium sorbate, sodium nitrite, sodium ascorbate, and sodium erythorbate were cytotoxic.
For Indian consumers, the message is clear: Whilst FSSAI continues to monitor additive safety, choosing fresh, minimally processed foods and reading ingredient labels carefully may be prudent steps towards reducing exposure to these potentially harmful preservatives. The study suggests that what’s hiding in your kitchen cabinet might be more consequential for long-term health than previously imagined.
(Edited by Muhammed Fazil.)
