Low Calorie-­‐and Caloric-­‐Sweeteners: Diet Quality, Food Intake and Purchase Patterns of U.S. Household Consumers

Piernas Sanchez, Carmen M.

Low Calorie-‐and Caloric-‐Sweeteners: Diet Quality, Food Intake and Purchase Patterns of U.S. Household Consumers

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March 22, 2019

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Piernas Sanchez, Carmen M.
- Affiliation: Gillings School of Global Public Health, Department of Nutrition

Abstract

Although most food and beverage products consumed in the U.S. contain caloric-sweeteners (CS), consumption of low calorie sweeteners (LCS) such as aspartame, saccharin or stevia in foods and beverages has increased rapidly over the past 30 years. However, there is limited knowledge about the long-term determinants and consequences of LCS and CS consumption. This dissertation aimed to specifically examine consumption of products containing LCS and CS over the last decade and investigate the dietary quality and food patterns of consumers in the U.S. This research used measures of foods as purchased from the Homescan dataset 2000-2010, and dietary intake data from the National Health and Nutrition Examination Surveys (NHANES) 2003-2010. Aim 1 implemented an innovative approach based on ingredient and nutrition facts panel information to identify sweeteners in food products. Coincident with declining purchases and consumption of CS products over the last decade, we documented an important increasing trend in products containing LCS and a previously unexplored trend in products with both LCS and CS, especially important among households with children. In aim 2, we examined the dietary quality and food patterns of consumers of beverages with LCS and CS from 2000-10. Compared to non/low consumers of LCS- and CS-beverages, consumers had a significantly lower probability of adherence to a Prudent dietary pattern and higher average energy from purchases or intake of high calorie food groups such as salty snacks, fast food meals or desserts. LCS-beverage consumers also followed another different pattern of purchases consisting in fruits, vegetables, nuts and also snacks and desserts. Aim 3 used a dynamic panel model and instrumental variables to investigate the long-term effect of CS- and LCS-beverages on dietary quality and food purchasing patterns from 2000-2010. Despite overall declines in calories from all sources, we found that increasing one daily serving of either CS- or LCS-beverages is associated with significantly increased total daily energy, energy from food, and also increased daily energy from carbohydrates, total sugar, and total fat. We also found that increasing one serving of either beverage per day was mainly associated with increased purchases of caloric desserts and sweeteners. In conclusion, as consumers appear to be turning to LCS for their sweet options, our study opens up new pathways that relate consumption of both LCS- and CS-beverages to poorer dietary patterns and increased purchases of overall energy, carbohydrates, sugar, and caloric desserts and sweeteners. It is essential to understand if sweetener consumption translates into a better or worse dietary quality before continuing with more complex studies that relate sweetener intake to health outcomes. Our findings suggest that any type of sweetened beverage consumption could have a negative effect on diet, which can potentially inform future intervention strategies and nutrition policy recommendations aimed at improving diet and nutrition in the U.S.

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