Additives with Emerging Health Concerns in Ultra-Processed Sweetened Beverages Sold in the United States: Preservatives, Artificial Sweeteners, and Added Sugars

Background: Consumption of ultra-processed foods (UPFs) continues to rise alongside a growing body of epidemiological evidence linking high UPF intake to adverse health outcomes, including cardiovascular disease and type 2 diabetes, in the general population. However, the factors underlying these associations remain incompletely understood, underscoring the need to examine components beyond traditional nutrient composition. In particular, food-processing additives are increasingly recognized as defining features of industrially formulated UPFs.

Objective/Methods: In this study, we used a large food label database to cross-sectionally examine the presence and co-occurrence of selected additives (sorbates, benzoates, phosphate additives, and non-nutritive sweeteners [NNSs]) in sweetened beverages sold by the 25 top-selling U.S. food and beverage manufacturers in 2020.

Results: We found that sweetened beverages marketed in the U.S. frequently contain multiple additive classes concurrently, supporting the concept that these products represent complex chemical exposure mixtures rather than simple combinations of water and sweeteners. Formulations containing multiple additives were substantially more common than simpler formulations, with many beverages simultaneously containing combinations of sweeteners, preservatives, and phosphate additives. Products containing NNS exhibited higher additive clustering compared to products containing added sugar.

Conclusions: Collectively, these findings support the need for broader consideration of beverage formulation complexity in nutrition research, dietary guidance, and policy regulation.