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2 Minute Medicine Rewind June 8, 2026
Food Coloring Additives and Incidence of Type 2 Diabetes in the NutriNet-Santé Prospective Cohort
1. Several widely consumed natural and synthetic food coloring additives were associated with higher type 2 diabetes incidence.
Evidence Rating Level: 2 (Good)
Ultraprocessed foods (UPFs) have been linked to increased type 2 diabetes incidence independent of energy intake and adiposity. Food coloring additives are key markers of UPFs and may alter molecular pathways involved in insulin signaling and inflammation. Despite the increase in use of coloring, the relationship between dietary exposures to these additives and diabetes incidence remains unknown. This study thus examined the association between exposure to food coloring additives and type 2 diabetes incidence. The prospective cohort study followed participants from the French NutriNet-Santé cohort (>15 years of age) from 2009–2023 who were not diagnosed with Type 1 or 2 diabetes. Dietary data were assessed using repeated 24-h dietary records. Among the 108,723 participants in the study cohort (mean [SD] age, 42.5 [14.6] years; 86,085 [79.2%] female), 1,131 incident type 2 diabetes cases were diagnosed (median follow-up, 8.05 years). Compared to participants who were non- or low consumers of food coloring additives, intake of the following food coloring additives among higher consumers was associated with higher type 2 diabetes incidence: total food coloring additives (adjusted hazard ratio [aHR] 1.38 [95% CI 1.17–1.63]), total caramel (1.43 [1.21–1.67]), plain caramel (1.46 [1.26–1.70]), sulfite ammonia caramel (1.30 [1.07–1.59]), total carotene (1.27 [1.08–1.48]), carotenoids (1.39 [1.19–1.62]), β-carotene (1.44 [1.23–1.68]), paprika-capsanthin-capsorubin (1.26 [1.08–1.46]), lutein (1.20 [1.02–1.40]), curcumin (1.49 [1.29–1.73]), cochineal-carminic acid-carmines (1.27 [1.10–1.48]), and anthocyanins (1.40 [1.17–1.68]). Unsweetened (49.6%) and sweetened drinks (32.2%) were the main contributors to total food coloring exposure. Overall, this study found that several widely consumed natural and synthetic food coloring additives were associated with higher type 2 diabetes incidence. Future studies are needed to investigate the underlying mechanisms and to determine whether current regulations for food coloring additives should be reevaluated to protect consumer health.
1. After accounting for plurality, children conceived through infertility treatments showed similar growth trajectories to those conceived naturally.
Evidence Rating Level: 2 (Good)
Compared to children conceived naturally, children conceived through medically assisted reproduction (MAR) may experience different birth outcomes and growth patterns. However, evidence on long-term growth trajectories remains inconsistent. This study thus compared childhood growth trajectories from birth to 12 years of age between children conceived via infertility treatments and those conceived naturally. This retrospective cohort study analyzed data of children from 6 months to 12 years of age in the Taiwan Birth Cohort Study. The main outcomes were growth trajectories for weight, height, and body mass index (BMI). Methods of conception were categorized as natural conception (NC), intrauterine insemination (IUI), or in vitro fertilization (IVF). This study included 20,507 singletons (20,306 via NC, 104 via IUI, 97 via IVF) and 950 multiples (670 NC, 212 IVF, 68 IUI). In the pooled analysis, children conceived via IUI or IVF showed lower weight, height, and BMI compared to children conceived naturally. However, these differences were attributed to the higher proportion of multiple births in the infertility treatment groups. After stratifying by plurality, the associations were no longer significant, except for slightly lower weight (−0.353 kg; p = 0.039) among IUI-conceived multiples. Overall, this study found that after accounting for plurality, children conceived through infertility treatments showed similar growth trajectories to those conceived naturally. These findings provide reassurance for families using infertility treatments and highlight the need to minimize multiple births following MAR to optimize child health outcomes.
1. Ring-augmented one-anastomosis gastric bypass (OAGB) is comparable in safety to conventional OAGB at 1 year.
Evidence Rating Level: 1 (Excellent)
Recurrent weight gain is a major challenge following metabolic bariatric surgery (MBS). There is evidence that adding a ring to sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) is safe and may improve long-term weight stability. However, it is unclear whether ring augmentation in one-anastomosis gastric bypass (OAGB) results in similar benefits. This study thus examined whether ring-augmented OAGB improved surgical outcomes compared to conventional OAGB. The study was a 1-year interim analysis of the RiMini trial, a single-center, non-blinded, prospective randomized controlled trial that included adults eligible for primary OAGB. Patients were randomized 1:1 to receive either ring-augmented (Minimizer Ring) or conventional OAGB. The primary outcome of this study was short-term safety of the procedure, including peri- and postoperative complications and adverse events, and secondary outcomes were total and excess weight loss percentages (%TWL and %EWL). In total, 214 patients underwent the intended surgical procedure (mean [SD] age, 43 [11] years; 165 [77%] female; mean [SD] BMI on operation day, 41.6 [6.1] kg/m2). A perioperative complication was reported for one patient in each group (p = 1.00; 0.9%). There was no significant difference in postoperative minor (Clavien Dindo [CD] 1–2) (p = 0.68) or major (CD3–5) (p = 0.77) complications. Additionally, there was no direct causal link to Minimizer ring among patients with adverse events. At 1 year, mean BMI was comparable in both groups (~28kg/m2). There was no significant difference between ring-augmented and conventional OAGB in %TWL (33% vs 31%; p = 0.30), and %EWL (86% vs 84%; p = 0.45). Overall, this study found that ring-augmented OAGB was comparable in safety to conventional OAGB, with no significant difference in weight loss at 1 year.
Lymph Node Dissection and Postoperative Complications After Lung Cancer Resection
1. Lymph node sampling with the 3 + 1 rule was not associated with increased postoperative complications after lung cancer resection.
Evidence Rating Level: 2 (Good)
Non–small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for about 80-85% of all lung cancers. Surgical removal of the tumor with lymph node sampling (LNS) is the standard of care for patients with early-stage NSCLC. Current guidelines recommend LNS with the 3 + 1 rule, which involves station-based sampling with at least 3 N2 (mediastinal) and 1 N1 (hilar) nodal stations. However, the potential negative impacts of this method on surgical outcomes remain unclear. This study thus evaluated whether satisfying the 3 + 1 rule is associated with increased postoperative complications. This retrospective cohort study used the Society of Thoracic Surgeons General Thoracic Database. Patients with clinical stage T1 to T3, N0, M0 NSCLC who underwent surgical resection with known LNS between July 1, 2021, and January 1, 2023 were included. Patients were propensity-matched to compare postoperative complication rates by 3 + 1 LNS status. The primary outcomes were postoperative complications. Of the 28,439 patients in the study cohort (median [IQR] age, 69 [66-75] years; 4,791 [59.5%] female), 18,939 patients (66.6%) satisfied the 3 + 1 rule. In the unadjusted analyses, patients who underwent 3 + 1 LNS had longer median (IQR) operating room duration (224 [178-281] vs 210 [161-273] minutes, P < .001) and rates of pathologic upstaging (2,520 [13.3%] vs 922 [9.7%], P < .001) compared to those who did not. In the propensity-matched cohort, these associations were no longer significant. Overall, this study found that the 3 + 1 rule was not associated with increased postoperative complications in patients with early-stage NSCLC who underwent lung resection, supporting its continued use.
Statin Use and Survival in Early Breast Cancer According to Different Intrinsic Subtypes
1. Prediagnostic statin use was not associated with higher survival among patients with early breast cancer.
2. Postdiagnostic statin use was associated with lower all-cause and breast cancer–specific mortality among early breast cancer patients with hormone receptor–positive intrinsic subtypes.
Evidence Rating Level: 2 (Good)
Although statins are commonly prescribed drugs to reduce the risk of cardiovascular diseases, there is evidence that statin use before or after breast cancer diagnosis is associated with improved survival in patients with breast cancer. However, research on outcomes of statin use in patients with different intrinsic breast cancer subtypes is lacking. This study thus examined the associations between prediagnostic and postdiagnostic statin use and survival in patients with early breast cancer of different intrinsic subtypes. This retrospective population-based cohort study used data from Finnish national registries and included female patients with invasive breast cancer diagnosed in Finland between 1995 and 2013. The primary outcomes were all-cause and breast cancer–specific mortality during follow-up. In total, 7,389 female patients with early breast cancer were included in the study (median [range] age at diagnosis, 60 [21-102] years). Prediagnostic statin use was not associated with breast cancer–specific or all-cause mortality. Independent of blood cholesterol levels, postdiagnostic statin was associated with lower breast cancer–specific (adjusted hazard ratio [aHR], 0.59; 95% CI, 0.48-0.71) and all-cause (aHR, 0.68; 95% CI, 0.61-0.76) mortality in the whole cohort. Postdiagnostic statin use was also associated with higher breast cancer–specific survival in all hormone receptor–positive subtypes (luminal A-like, luminal B-like [HER2-negative], and luminal B-like [HER2-positive]). Furthermore, postdiagnostic statin use was associated with lower all-cause mortality among statin users in patients with hormone receptor–positive and triple-negative subtypes. Overall, this study found that prediagnostic statin use was not associated with higher survival, while postdiagnostic statin use was associated with lower all-cause and breast cancer–specific mortality among early breast cancer patients with hormone receptor–positive intrinsic subtypes. These results suggest that statin therapy may be more beneficial for patients with early hormone receptor–positive subtypes.
Image: PD
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