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

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/fastfood 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.