Consumption of low‐calorie sweetened beverages is associated with higher total energy and sugar intake among children, NHANES 2011–2016

Abstract

Summary Objective To examine associations between consumption of low‐calorie sweetened beverages (LCSBs), sugar, and total energy intake in children in the United States. Methods We used 24‐hour dietary recalls from 7026 children enrolled in the National Health and Nutrition Examination Survey (NHANES) 2011 to 2016 to assess energy and macronutrient intake among LCSB (≥4 oz LCSB, <4 oz SB), SB (≥4 oz SB, <4 oz LCSB), and LCSB + SB consumers (≥4 oz each) compared with water consumers (≥4 oz water, <4 oz LCSB and SBs). Sample weights and complex survey procedures were used for all analyses. Results Adjusting for body mass index (BMI) percentile, LCSB, SB, and LCSB + SB consumption was associated with 196, 312, and 450 more total calories and 15, 39, and 46 more grams of added sugar, which amounts to 60, 156, 184 more calories from added sugar, compared with water consumers (P < .05 for all pairwise comparisons). No differences in energy intake were observed between LCSB and SB consumers. [Correction added on 28 May 2019, after first online publication: In the preceding sentence, quantities of added sugar reported are in grams. The corresponding calories have also been specified in this version.] Conclusions These findings challenge the utility of LCSB for weight management in children and adolescents.

Intense Sweeteners, Taste Receptors and the Gut Microbiome: A Metabolic Health Perspective

“…A cross sectional study on 7026 children in the US assessed differences in energy and macronutrient intake between consumers of IS-sweetened beverages, sugar-sweetened beverages or both, compared to water consumers. All three groups of sweetened beverage consumers reported significantly higher energy intake (p < 0.05), and a significantly higher intake of total sugars and added sugars (p < 0.05) [71]. Additionally, a study in 64 Canadian women, which grouped subjects based on regular sweetener intake (both IS and nutritive sweeteners), found that people who regularly consume larger amounts of sweeteners had a significantly greater preference for sweeter beverages (p < 0.05), which correlates with a higher intake of sugar [72].…”

Dietary and Health Correlates of Sweetened Beverage Intake: Sources of Variability in the National Health and Nutrition Examination Survey (NHANES)

“…Drewnowski and Rehm [ 12 ] used a “custom coding algorithm” to identify items containing LCS “based on their description, energy density (kcal/100 g), and total and added sugars content (g) per average consumption report;” they did not provide specific information about the values used for their energy or sugar criteria or report the number of foodcodes or their identities. In two recent publications [ 7 , 21 ], we identified foodcodes as LCSBs if the FNNDS main foodcode description contained terms associated with low-calorie sweeteners, such as “diet”, “dietetic”, “low-calorie”, “no sugar added”, “light or lite”, “sugar-free”, “sugar substitute”, “low-calorie sweetener”, “no-calorie sweetener”, “reduced sugar”, “less sugar”, “zero calorie”, or “no sugar added.” For cycles spanning 2009–2012, this approach identified a total of 136 LCSB foodcodes [ 21 ], with 148 LCSB foodcodes identified for NHANES cycles 2011–2016 [ 7 ], although we also did not report the number or the identity of those foodcodes in those publications. In addition to the wide variance in the number of foodcodes identified as LCSBs, like caloric density-based approaches, text-based approaches can incorrectly identify foodcodes as LCSBs when they do not in fact contain any LCS.…”

“…We hypothesized that there would be broad heterogeneity in the approaches used to identify and categorize LCSBs, and that the number of beverages classified within beverage groups would vary substantially across studies, potentially leading to widespread misclassification of sweetened beverages. We also aimed to provide an example of how changing beverage foodcode classifications and correcting errors in WWEIA/NHANES can affect the outcomes of analyses, by re-analyzing previously published findings [ 7 ] from our group. We conducted this study in three separate phases.…”

Environmental Exposures during Puberty: Window of Breast Cancer Risk and Epigenetic Damage

“…In recent studies, the consumption of artificially sweetened soft drinks was associated with an increased risk of death from cardiovascular disease [83]. Children who consumed artificially sweetened beverages consumed more calories than children who drank sugar-sweetened beverages [84]. There are also concerns that non-nutritive sweeteners may also alter the gut microbiota and increase obesity-associated inflammation and innate and cell-mediated immunity [85].…”