Cohort studyindependent cross-checkfull text checked★ key study I-UPF-117 in-depth review
Food preservatives and cancer in a French cohort
Intake of food additive preservatives and incidence of cancer: results from the NutriNet-Santé prospective cohort.
Overview
Hasenböhler A et al.. BMJ 2026 · PMID 41500678 · DOI 10.1136/bmj-2025-084917
Higher intake of several common preservatives was linked to slightly more cancer (about 1-2 more cases per 100 people by age 60); most preservatives studied showed no link.
Does the study support the specific claim? No · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
To link preservative intake to cancer.
- How was the study done?
Cohort with detailed food-brand records.
- How many people, animals or samples were studied?
105,260 adults.
- What was actually found?
Several preservatives linked to more cancer; 11 of 17 not.
- How large was the observed effect?
HR 1.16 (1.07-1.26) for non-antioxidant preservatives.
- What do the results mean in everyday life?
Preservatives may not be as harmless as assumed, but the evidence is not conclusive.
- What are the study's limitations?
Observational; one cohort.
- What does it say about Elawady's specific claim?
Contradicts the blanket view in C-UPF-11.
- Do the results apply to Germany and Europe?
High.
- What can explicitly not be concluded from this study?
Cannot prove that preservatives cause cancer.
Scientific in-depth review
1. Full reference
- Authors
- Hasenböhler A et al.
- Journal
- BMJ
- Year
- 2026
- Identifier
- PMID 41500678 DOI 10.1136/bmj-2025-084917 · PMC12776923
- Verification
- verified – PubMed efetch 2026-10-26; Crossref works API 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- full text
- Conflicts of interest and funding
COI statement in record: Competing interests: All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare: support from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme, French National Cancer Institute; funding listed: World Health Organization
2. Research question
Is intake of preservative food additives associated with cancer incidence?
3. Study design and population
- Study design
- Cohort study – Prospective cohort (NutriNet-Sante) with brand-specific additive exposure
- Population
French adults >=15 years without prevalent cancer (78.7% women)
- Country
France
- Period
2009-2023; mean follow-up 7.57 years
- Sample size
105,260; 4,226 incident cancers
- Inclusion and exclusion criteria
>=2 24-h dietary records at baseline; no prevalent cancer
4. Methods and endpoints
- Exposure / intervention
Cumulative time-dependent intake of 58 preservatives (17 analysed individually, those consumed by >=10%)
- Comparator
Non-consumers or lower consumers
- Endpoints
Overall, breast, prostate, colorectal cancer
- Statistical methods
Multivariable Cox models adjusted for sociodemographic, lifestyle and nutritional factors (energy, saturated fat, sodium, fibre, sugar)
5. Actual results
- Results
Total non-antioxidant preservatives: overall cancer HR 1.16 (1.07-1.26), breast 1.22 (1.05-1.41); potassium sorbate overall 1.14 (1.04-1.24), breast 1.26 (1.07-1.49); total sulfites 1.12 (1.02-1.24); potassium metabisulfite 1.11 (1.03-1.20); sodium nitrite prostate 1.32 (1.02-1.70); potassium nitrate 1.13 (1.05-1.23); acetates 1.15 (1.06-1.25); sodium erythorbate 1.12 (1.04-1.22). 11 of 17 individually studied preservatives not associated. Sodium benzoate (E211) consumed by only 3.5% of participants (consumers' mean 5.2 mg/day) and therefore not analysed individually.
- Absolute risks
Cumulative cancer risk at age 60: 13.3% vs 12.1% (non-antioxidant preservatives); 13.4% vs 11.8% (sorbates); NNH about 62-83 (stats/C-UPF-11_preservatives.py)
- Authors' conclusion
Multiple positive associations between widely used preservatives and cancer incidence; if confirmed, regulations should be re-evaluated; consumers may favour fresh, minimally processed foods.
6. Strengths
- Brand-specific exposure with laboratory assays
- Repeated 24-h records
- Full text read; detailed limitations; independent public funding
7. Weaknesses
- Observational; residual confounding
- Many comparisons
- Predominantly female, health-conscious volunteers
- Single cohort (no replication yet)
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Observational; multiple testing; confounding addressed but not excluded.
9. Assessment of the statistical interpretation
Small HRs (1.11-1.32) and absolute differences of 1-2 percentage points by age 60; many tests.
10. Relevance to the specific claim
Directly challenges a blanket statement that preservatives are of little concern; does not address sodium benzoate specifically (too few consumers).
11. Independent contrary findings
Regulatory toxicology (ADIs) supports safety at permitted levels; associations not yet replicated.
12. Transferability to Germany and Europe
High (EU additives).
13. Overall methodological judgement
Important new signal; not proof of harm.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | not replicated |
| Consistency with the overall evidence | unknown |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Replication in other cohorts; mechanisms.