No acute effects of nano-sized TiO₂ were observed in Danio rerio (zebrafish) embryos. Exposure of rainbow trout to TiO₂ NPs triggered lipid peroxidation, influence on the respiratory tract, disturbance in the metabolism of Cu and Zn, induction of intestinal erosion  and accumulation in kidney tissue. Linhua et al. exposed juvenile carp to 100 and 200 mg/ml of particles and TiO₂ observed no mortality. However, the fish suffered from oxidative stress and pathological changes in gill and liver. In the infaunal species Arenicola marina, exposure to TiO₂ NPs in sediment caused sub-lethal effects including decrease in casting rate and increase in cellular and DNA damage. Aggregated particles were visible in the lumen of the gut, but no uptake through the gut or the skin was observed.

In a review published in 2022 in the journal Archives of Toxicology, researchers found that the ingestion of E171 is a “a definite health risk for consumers and their progeny.” After reviewing dozens of in vivo, ex vivo and in vitro studies on the toxicity of E171, the researchers wrote that two facts must be noted: “First, reprotoxicity studies show that animals of both sexes are impacted by the toxicity of these nanoparticles, underlining the importance of conducting in vivo studies using both male and female animals. Second, human exposure begins in utero via maternal-fetal transfer and continues after birth by breastfeeding. Children are then chronically re-exposed due to their food preferences. To be relevant to the human in vivo situation, experimental studies should therefore consider nanoparticle exposure with respect to the age or life period of the studied population.”

The FDA first approved the use of titanium dioxide in food in 1966, following its 1960 removal (along with the removal of other color additives) from the agency's original Generally Recognized as Safe list. In 1977, titanium dioxide joined the list of color additives that are exempt from certification, which means titanium dioxide doesn't have to be listed on the packaging of every product it's used in, Faber noted.