Low-calorie- and calorie-sweetened beverages: diet quality, food intake, and purchase patterns of US household consumers

Abstract

Background: Few studies have investigated the diet quality of consumers of low-calorie-sweetened (LCS) and calorie-sweetened (CS) beverages.

Objective: The objective was to examine the dietary quality and adherence to dietary purchasing and consumption patterns of beverage consumers from 2000 to 2010.

Design: We analyzed purchases for 140,352 households from the Homescan longitudinal data set 2000-2010 and dietary intake from NHANES 2003-2010 (n = 34,393). We defined mutually exclusive consumer profiles as main exposures: LCS beverages, CS beverages, LCS & CS beverages, and non/low consumers. As main outcomes, we explored dietary quality by using total energy and macronutrients (kcal/d). We performed factor analyses and applied factor scores to derive dietary patterns as secondary outcomes. Using multivariable linear (NHANES) and random-effects (Homescan) models, we investigated the associations between beverage profiles and dietary patterns.

Results: We found "prudent" and "breakfast" patterns in Homescan and NHANES, "ready-to-eat meals/fast-food" and "prudent/snacks/LCS desserts" patterns in Homescan, and "protein/potatoes" and "CS desserts/sweeteners" patterns in NHANES. In both data sets, compared with non/low consumers, both CS- and LCS-beverage consumers had a significantly higher total energy from foods, higher energy from total and SFAs, and lower probability of adherence to prudent and breakfast patterns. In Homescan, LCS-beverage consumers had a higher probability of adherence to 2 distinct patterns: a prudent/snacks/LCS dessert pattern and a ready-to-eat meals/fast-food purchasing pattern.

Conclusions: Our findings suggest that overall dietary quality is lower in LCS-, CS-, and LCS & CS-beverage consumers relative to non/low consumers. Our study highlights the importance of targeting foods that are linked with sweetened beverages (either LCS or CS) in intervention and policy efforts that aim to improve nutrition in the United States.

FIGURE 1.

Average total daily household purchases in Homescan (A) and individual intakes in NHANES (B). A: non/low consumers, n = 221,023 observations; LCS, n = 53,955 observations; CS, n = 88,176 observations; LCS & CS, n = 138,189 observations. B: non/low consumers, n = 15,236 individuals; LCS, n = 3220 individuals; CS, n = 14,188 individuals; LCS & CS, n = 1749 individuals. Bars with different lowercase letters are significantly different at the 5% level (Bonferroni-adjusted Student's t test). bev, beverages; CS, calorie sweetened; Homescan, Nielsen Homescan Panel; LCS, low-calorie sweetened.

FIGURE 2.

Relations between beverage consumption profiles and dietary purchasing patterns, Homescan 2000–2010. A: All households (n = 501,343 observations). B: Single-person households (n = 136,011 observations). C: Multiperson households without children (n = 241,599 observations). D: Multiperson households with children (n = 123,733 observations). Values represent the predicted probability of being in the highest tertile (T3) for each dietary pattern from random-effects longitudinal logistic regression models, adjusted for household size, year, income, and race-ethnicity with interaction between the beverage profile and household type (B-D). Bars with different lowercase letters are significantly different at the 5% level (Bonferroni-adjusted Student's t test). CS, calorie sweetened; Homescan, Nielsen Homescan Panel; LCS, low-calorie sweetened RTE, ready to eat; T, tertile.

FIGURE 3.

Relations between beverage consumption profiles and dietary intake patterns, NHANES 2003–2010. A: All population >2 y old (n = 34,393). B: Adults ≥19 y old (n = 20,971). C: Children 2–18 y old (n = 13,422). Values represent the predicted probability of being in the highest tertile (T3) for each dietary pattern from logistic regression models, adjusted for age, sex, race-ethnicity, and income. Stratified models were performed to obtain estimates for adults and children separately (B and C). Bars with different lowercase letters are significantly different at the 5% level (Bonferroni-adjusted Student's t test). CS, calorie sweetened; LCS, low-calorie sweetened; T, tertile.