In industrial settings, people can be exposed to titanium dioxide through inhalation. Inhalation exposure to titanium dioxide is exceedingly rare for most people. 

Overall, the Food Directorate's comprehensive review of the available science of TiO₂ as a food additive showed:

For a review published in 2023 in the journal Environmental Pollution, researchers examined E171 as a possible factor promoting obesity-related metabolic disorders. Because gut microbiota play an important role in immune function maintenance and development, and because titanium dioxide as a food additive has been shown to alter gut microbiota, researchers wanted to review “the dysregulations along the gut microbiota-immune system axis after oral TiO2 exposure compared to those reported in obese or diabetic patients, and to highlight potential mechanisms by which foodborne TiO2 nanoparticles may increase the susceptibility to develop obesity-related metabolic disorders.” The study authors discovered recurrent changes in the gut microbiota composition when exposed to titanium dioxide nanoparticles, with an imbalance of intestinal symbiotic microbiota. These changes and imbalances were also reported and played a role in the development of obesity, the authors wrote. This highlights “foodborne TiO2 nanoparticles as an endocrine disruptor-like chemical promoting obesity-related disorders,” the authors concluded.

In their role as risk managers, the European Commission and Member States will now reflect on EFSA’s scientific advice and decide upon any appropriate regulatory measures or advice for consumers.

Though the regulated use of titanium dioxide in food products is legal in the U.S. and Canada, it's banned in some other countries, notably throughout Europe. In May 2021, the European Food Safety Authority announced that titanium dioxide can no longer be considered safe as a food additive.