Topical Area: Nutritional Epidemiology
Low-calorie sweetened beverages (LCSBs) are an increasingly consumed alternative to sugary beverages (SBs), yet their impact on children's overall diet is unclear. We aimed to compare total energy, macronutrient intake, and diet quality assessed by the Healthy Eating Index (HEI-2015), among consumers of LCSBs (alone or concurrently with SB use) with those reporting SB (sugar-sweetened beverages plus fruit juices) or water consumption, using national-level data collected during the five most recent 2-year cycles of the National Health and Nutrition Examination Survey (NHANES).
Methods : We used 24-hour dietary recalls from 10,257 children enrolled in NHANES 2007-2016 to assess energy and macronutrient intake and calculate adjusted mean HEI-2015 scores among children and adolescents categorized by their beverage intake over the previous 24 hours as follows: LCSB consumers (≥4oz. LCSB, < 4oz SB), SB consumers (≥4oz SB, < 4oz LCSB), and LCSB+SB consumers (≥4oz each) compared to water consumers (≥4oz water, < 4oz LCSB and < 4 oz SBs). Sample weights and complex survey procedures were used for all analyses.
Results : Adjusting for socio-demographic factors and BMI percentile, LCSB, SB, and LCSB+SB total energy intake was 184, 348, and 413 kcal higher and added sugar intake was 40, 164, and 180 kcal higher, respectively, compared to among water consumers (p< 0.05 for all pairwise comparisons). Overall diet quality was also significantly lower for LCSB, SB, and LCSB+SB consumers compared to water consumers (HEI-2015 scores of 49.0 ± 0.9, 49.1 ± 0.3, 48.9 ± 0.6, and 51.7 ± 0.6 for LCSB, SB, LCSB+SB, and water, respectively, p< 0.05 for all pairwise comparisons).
While cross-sectional analyses cannot establish causation, these findings challenge the utility of LCSB for weight management in children and adolescents. Our results align with current recommendations that water is the best alternative to SBs in children.
Funding Sources : This work was funded by the Sumner M. Redstone Global Center for Prevention and Wellness Pilot Studies Program.