Forskning visar att både naturliga och syntetiska livsmedelsfärgämnen kan öka risken för typ 2-diabetes.
Detta väcker viktiga frågor om våra kostvanor och hur vi kan skydda oss.
Studier har visat att konsumtion av vissa livsmedelsfärgämnen, som ofta finns i snacks och läskedrycker,
är kopplade till en högre förekomst av typ 2-diabetes.
Det är viktigt att vi blir medvetna om vad vi äter och hur det påverkar vår hälsa.
Ultraprocessade livsmedel har kopplats till ökad förekomst av typ 2-diabetes, oberoende av energiintag och graden av kroppsfett (adipositet). Livsmedelsfärgämnen är viktiga markörer för ultraprocessad mat och kan påverka molekylära signalvägar som är involverade i insulinsignalering och inflammation. Trots den ökade användningen av färgämnen är sambandet mellan intag av dessa tillsatser och förekomsten av diabetes fortfarande okänt.
Denna studie undersökte därför sambandet mellan exponering för livsmedelsfärgämnen och förekomsten av typ 2-diabetes. Studien var en prospektiv kohortstudie som följde deltagare ur den franska NutriNet-Santé-kohorten (över 15 års ålder) under perioden 2009–2023; deltagarna hade vid studiens början inte diagnostiserats med typ 1- eller typ 2-diabetes.
Kostdata samlades in genom upprepade kostregistreringar över 24 timmar. Bland de 108 723 deltagarna i studiegruppen (genomsnittlig ålder [standardavvikelse]: 42,5 år; 86 085 (79,2 % kvinnor) diagnostiserades 1 131 nya fall av typ 2-diabetes (medianuppföljningstid: 8,05 år).
Jämfört med deltagare som inte alls eller i liten utsträckning konsumerade livsmedelstillsatser i form av färgämnen, var ett högre intag av följande färgämnen förknippat med en högre incidens av typ 2-diabetes:
• total mängd färgämnen 1,17-1,63,
• total mängd sockerkulör 1,21-1,67,
• sockerkulör (typ I) 1,26-1,70,
• ammoniak-sulfitprocessad sockerkulör (typ III) 1,07-1,59,
• total mängd karotener 1,08-1,48, karotenoider 1,19-1,62,
• betakaroten 1,23-1,68, paprikaextrakt/kapsantin/kapsorubin 1,08–1,46,
• lutein 1,02–1,40, kurkumin 1,29–1,73,
• karminsyra/karmin 1,10–1,48 samt
• antocyaniner 1,17–1,68.
Osötade (49,6 %) och sötade drycker (32,2 %) stod för den största delen av det totala intaget av färgämnen. Sammanfattningsvis visade studien att flera vanligt förekommande naturliga och syntetiska färgämnen var förknippade med en högre incidens av typ 2-diabetes. Framtida studier behövs för att undersöka de bakomliggande mekanismerna och avgöra om nuvarande bestämmelser för färgämnen i livsmedel bör omprövas för att skydda konsumenternas hälsa.
Original Article| May 20 2026 Diab Care
Food Coloring Additives and Incidence of Type 2 Diabetes in the NutriNet-Santé Prospective Cohort Free
Sanam Shah Corresponding et al
OBJECTIVE
To investigate potential association between exposure to food coloring additives and type 2 diabetes incidence.
RESEARCH DESIGN AND METHODS
The study followed 108,723 participants (79.2% female, mean age 42.5 [SD 14.6] years) from the French NutriNet-Santé cohort (2009–2023). Dietary data were assessed using repeated 24-h dietary records, including industrial food brands. Cumulative time-dependent exposure to food additives was evaluated through multiple composition databases and ad hoc laboratory assays in food matrices. Associations between exposures to food coloring additives (sex-specific tertiles if proportion of exposed participants was more than two-thirds, or nonexposed/lower/higher exposed based on sex-specific median otherwise) and type 2 diabetes incidence were assessed using multivariable Cox proportional hazards models.
RESULTS
There were 1,131 incident type 2 diabetes cases diagnosed (median follow-up, 8.05 years). After false discovery rate correction, intakes of the following colors were associated with higher type 2 diabetes incidence: total food coloring additives (hazard ratio [HR]higher vs. non/lower consumers 1.38 [95% CI 1.17–1.63], P = 0.0002), total caramel (1.43 [1.21–1.67], P = 0.0002), plain caramel (1.46 [1.26–1.70], P = 0.0002), sulfite ammonia caramel (1.30 [1.07–1.59], P = 0.007), total carotene (1.27 [1.08–1.48], P = 0.007), carotenoids (1.39 [1.19–1.62], P = 0.0002), β-carotene (1.44 [1.23–1.68], P = 0.0002), paprika-capsanthin-capsorubin (1.26 [1.08–1.46], P = 0.004), lutein (1.20 [1.02–1.40], P = 0.0002), curcumin (1.49 [1.29–1.73], P = 0.0002), cochineal-carminic acid-carmines (1.27 [1.10–1.48], P = 0.003), and anthocyanins (1.40 [1.17–1.68], P = 0.0002).
CONCLUSIONS
Several positive associations were observed between exposure to natural and synthetic food coloring additives and type 2 diabetes incidence. Further studies are needed to gain insights into underlying mechanisms, and if confirmed, call for reevaluation of food coloring additives to protect consumer health.
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https://diabetesjournals.org/care/article/49/6/1067/164756/Food-Coloring-Additives-and-Incidence-of-Type-2?__cf_chl_f_tk=CQo7sk_T4wCJvU2W5X3WEPOza.zxWW9S8_OUtItOG50-1783417353-1.0.1.1-0bXrnk2aWgjOaIX9Nb5P8knxff3SOC.ZrjtUxPUx.UE
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Conclusions
Our findings revealed associations between several food coloring additives and higher type 2 diabetes incidence for plain caramel, sulfite ammonia caramel, carotenoids, β-carotene, paprika-capsanthin-capsorubin, lutein, curcumin, cochineal extract-carminic acid-carmines, and anthocyanins, as well as total food coloring additives, total caramel, and total carotene, after adjustment for most known or potential risk factors or confounders.
To our knowledge, this is the first epidemiological study to investigate associations between coloring additives and incidence of type 2 diabetes in a large prospective setting. The qualitative and quantitative exposures to coloring additives were assessed for the first time in the NutriNet-Santé cohort by considering different commercial brands of products, which is necessary to identify specific colors consumed by participants at the individual level, given the huge variability of food additives content in commercial products. Thus, directly comparing our findings with previous epidemiological literature is not possible. For coloring additives with available EFSA data, lower mean intakes were observed in NutriNet-Santé versus EFSA estimates, reflecting differences in assessment dates, study populations, and methods—NutriNet-Santé used precise brand-specific repeated 24-h records versus generic items and limited data on which EFSA estimates are based.
Our findings for several coloring additives are supported by mechanistic evidence. In a recent in vitro study (24) from our consortium, cochineal-carminic acid-carmines—red colors used in confectionery, beverages, and processed meats—significantly increased DNA damage markers and reduced cell viability. Moreover, paprika-capsanthin-capsorubin—dark red color in sauces, snacks, and spice blends—caused decreased cell viability at higher levels. These findings suggest coloring additives may induce cellular stress in metabolically active tissues, providing biological plausibility for their role in chronic disease pathogenesis.
Total food coloring additives include azo dyes, synthetic compounds with diazotized amine combined with another amine or phenol characterized by azo linkages and aromatic amine precursors. Aromatic amines are biotransformed by azo reductases of intestinal microflora, with adverse health effects largely associated with this biotransformation (25). In rats, tartrazine—a yellow color used in bread, beverages, candies, snacks, dairy products, and sauces— increased serum glucose by 15.8% versus control individuals and elevated protein kinase C (9), which is linked to secondary insulin resistance via hyperinsulinemia and/or hyperglycemia (26).
Recent evidence shows that tartrazine induces mitochondrial dysfunction in zebrafish (27), notable given that type 2 diabetes has been linked to impaired mitochondrial genome integrity, mitochondrial RNA expression, and mitophagy in pancreatic β-cells (28). Evidence also links dysbiotic gut microbiota to metabolic disease, with certain food additives exacerbating this via increased intestinal permeability; sunset yellow, in particular, caused intestinal histopathological alterations in mice, compromising mucosal integrity (10).
Some coloring additives may have potential obesogenic effects by disrupting cellular redox balances critical for energy metabolism (29). Certain colors, notably erythrosine—red color used in candies, bakery products, popsicles, and beverages— and tartrazine, show endocrine-disrupting effects in in vivo studies (30). These effects may have potential to trigger insulin resistance and dysregulation of metabolic homeostasis, with implications in the pathogenesis of type 2 diabetes.
In our study, azo dyes—brilliant blue, tartrazine, sunset yellow, erythrosine, carmoisine, and allura red—counted toward total food coloring additives but could not be assessed individually due to low consumption reflecting limited use in the French market. Although numerous artificial food colors are permitted, many are rarely used as the food industry increasingly favors natural colors for functional and marketing purposes. Natural colors are often perceived by consumers as inherently safer, though this assumption is not consistently supported by toxicological evidence, and regulatory and public health attention (particularly in the U.S.) remains primarily focused on artificial colors. We observed significant associations between both natural and artificial food colors and incident type 2 diabetes, consistent with literature suggesting potential health risks across both classes (31).
Coloring additives may exert adverse metabolic effects via embedded chemical constituents. In vivo evidence shows 4-methylimidazole, a byproduct of caramel coloring (notably ammonia caramel and ammonia sulfite caramel) induces pancreatic β-cell hyperplasia and hyperinsulinemia, leading to enhanced glucose clearance and reduced fasting glucose and HbA1c (32). This persistent overstimulation suggests potential for long-term β-cell exhaustion or insulin resistance, hallmarks of type 2 diabetes. Furthermore, chronic exposure to allura red AC—used in beverages, confectionery, breakfast cereals, and baked goods—in mice at doses present in diet produces colitis by promoting serotonin synthesis and inflammation via microbiota-dependent and -independent pathways (12). Nevertheless, many common coloring additives remain unexplored for metabolic effects, warranting further experimental and epidemiological research.
Isolating the effect of the studied food coloring additive from its food vector is challenging. Sensitivity analyses adjusting for UPF characteristics (overall UPF intake, other additives associated with diabetes, trans fats) and main food vectors (e.g., beverages for caramel colors) found attenuated (which may be due to overadjustment) but overall similar results, supporting a potential effect of the studied substance itself, that should be confirmed in future experimental studies. Extensive evidence shows substances exert different effects depending on the matrix in which they are ingested (33). Indeed, the food matrix properties—composition, structure, pH—affect absorption and metabolism by microbiota and host, and physical and chemical interactions of substances with other elements of the environment play modulatory roles (34,35). For instance, while no association was detected for natural β-carotene in fruit and vegetables, high dose β-carotene isolated in dietary supplements, in interaction with tobacco/asbestos exposure, causally increases lung cancer risk (36). In vitro experiments showed that β-carotene upregulates inflammation-related genes under hyperglycemic conditions, with histone modifications suggesting epigenetic regulation (37). Similarly, while dietary fibers within complex natural fruit, vegetable, and legume matrices are protective, isolated purified fibers (e.g., inulin) exacerbated colitis in mice models (38). In recent studies, we observed associations of multiple food additive preservatives, but not natural food-born substances, with higher type 2 diabetes and cancer risks (39,40). Thus, experimental studies should explore differential health effects of chemicals by source and nature (additives vs. naturally occurring). Moreover, coloring additives–type 2 diabetes associations exhibited both linear and nonlinear patterns. Departures from linearity were observed for several colors, suggesting threshold or plateau effects. Further mechanistic and epidemiological investigations are needed to better understand these findings.
Our study’s strengths include a large prospective population-based cohort with a long follow-up, regularly updated brand-specific 24HDRs linked to multiple food composition databases, ad hoc laboratory assays for the most frequently consumed additive-food pairs in food products, and dynamic matching accounting for reformulations.
There are also some limitations. Although we controlled for multiple confounding factors, unmeasured or residual confounding cannot be excluded. Measurement errors in dietary assessment and additive exposure might occur; however, records were validated against dietitian interviews and blood and urinary biomarkers for energy and nutrients. Nevertheless, specific exposure to coloring additives has not been validated against blood or urine assays because of absence of specific biomarkers for most additives. Coloring additives exposure was restricted to substances permitted in the European Union, and several coloring additives were not ingested by a sufficient number of participants for individual investigation. The cohort consists of a high proportion of women and health-conscious individuals; thus, caution is warranted when extrapolating findings. Last, although it may be inherently challenging to disentangle the independent effects of coloring additives from those of other food additives and food composition parameters, our results were stable when adjusting models for artificial sweeteners, nitrites, emulsifiers, preservatives, trans fats, energy, and nutrients.
In conclusion, our findings revealed positive associations between widely consumed food coloring additives and type 2 diabetes incidence. To our knowledge, this is the first study to provide insights into the role of coloring additives in the development of diabetes. Further long-term epidemiological and experimental research is needed to understand underlying mechanisms. If confirmed, these results call for a reevaluation of regulations governing the use of food coloring additives by the food and beverage industry to better protect public health.
Clinical trial reg. no. Link to The NutriNet-Santé StudyNCT03335644, Link to ClinicalTrials.gov is a place to learn about clinical studies from around the worldclinicaltrials.gov
This article contains supplementary material online at Link to Food Coloring Additives and Incidence of Type 2 Diabetes in the NutriNet-Santé Prospective Cohorthttps://doi.org/10.2337/figshare.31807444.
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