Cross-sectional associations between consumption of non-nutritive sweeteners and diet quality among U.S. adults in the Cancer Prevention Study-3

Document Type

Journal Article

Publication Date

11-25-2024

Journal

The American journal of clinical nutrition

DOI

10.1016/j.ajcnut.2024.11.023

Keywords

artificial sweeteners; beverages; cancer prevention; diet soda; low-calorie sweeteners; non-nutritive sweeteners; nutrition; obesity; sugar substitutes; weight

Abstract

BACKGROUND: Non-nutritive sweeteners (NNS) are used to replace added sugar, yet whether NNS consumers have better or worse diet quality compared to non-consumers is unclear. OBJECTIVE: Investigate cross-sectional associations between NNS consumption and diet quality. METHODS: Data from participants in the American Cancer Society (ACS) Cancer Prevention Study-3 cohort were used for this analysis. NNS intake was estimated using self-reported consumption of NNS-containing beverages, packets, and yogurt from a validated food frequency questionnaire. Participants were categorized into non-consumers, <1 serving, 1-<2 servings and ≥2 servings per day. Diet quality was assessed using the ACS Diet Score (2020) and Healthy Eating Index (HEI-2015). ANOVA was used to compare diet quality scores across NNS consumption groups, and multivariable linear regression was used to examine associations between NNS consumption and diet quality. Multivariable logistic regression was used to evaluate odds of low diet quality across NNS consumption groups. RESULTS: Data from 163,679 participants (median age 53 years (IQR 45-60), 78.9% women, mean NNS intake 1.0 ± 1.5 servings per day, mean HEI-2015 score 75.4 ± 10.2) were included. NNS consumers had lower diet quality for ACS Diet Score (6.8 ± 0.03 among non-consumers versus 6.5 ± 0.03, 6.3 ± 0.03 and 6.1± 0.03 for consumers of <1 serving, 1-<2 servings, and ≥2 servings of NNS per day, respectively, p-trend <0.0001) and HEI-2015 (76.3 ± 0.1 among non-consumers versus 76.7 ± 0.1, 75.6 ± 0.2, and 72.7± 0.2 for consumers of <1 serving, 1-<2 servings, and ≥2 servings of NNS per day, respectively, p-trend <0.0001). Odds of low diet quality were higher among NNS consumers and were higher with higher NNS consumption (3%, 17%, and 43% higher odds of low diet quality among those who consumed <1 serving, 1-<2 servings and ≥2 servings of NNS beverages per day). CONCLUSIONS: NNS consumers had lower diet quality in a large cohort of U.S. adults.

Department

Exercise and Nutrition Sciences

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