Dietary and Health Correlates of Sweetened Beverage Intake: Sources of Variability in the National Health and Nutrition Examination Survey (NHANES)

Abstract

Recent studies using data from the National Health and Nutrition Examination Survey (NHANES) have used inconsistent approaches to identify and categorize beverages, especially those containing low-calorie sweeteners (LCS), also referred to as low-calorie sweetened beverages (LCSBs). Herein, we investigate the approaches used to identify and categorize LCSBs in recent analyses of NHANES data. We reviewed published studies examining LCS consumption in relation to dietary and health outcomes and extracted the methods used to categorize LCS as reported by the authors of each study. We then examined the extent to which these approaches reliably identified LCSBs using the Internet Archive Wayback Machine to examine beverage ingredients lists across three NHANES cycles (2011–2016). None of the four general strategies used appeared to include all LCSBs while also excluding all beverages that did not contain LCS. In some cases, the type of sweetener in the beverage consumed could not be clearly determined; we found 9, 16, and 18 of such “mixed” beverage identifiers in the periods 2011–2012, 2013–2014, and 2015–2016, respectively. Then, to illustrate how heterogeneity in beverage categorization may impact the outcomes of published analyses, we compared results of a previously published analysis with outcomes when “mixed” beverages were grouped either all as LCSBs or all as sugary beverages. Our results suggest that caution is warranted in design and interpretation of studies using NHANES data to examine dietary and health correlates of sweetened beverage intake.

Estimated Sweetness in US Diet Among Children and Adults Declined From 2001 to 2018: A Serial Cross-Sectional Surveillance Study Using NHANES 2001–2018

“…While producers and manufacturers are required to list LCS on product ingredients lists, the FDA and other global regulatory authorities do not require disclosure of quantities of LCS in a given product. While trends in consumption of products containing LCS in the United States (US) have been evaluated (11,12), a methodology is needed to more accurately quantify the contribution of LCS to the sweetness of the total diet. This two-part study aimed to (1) develop a pragmatic methodology for estimating sweetness of the diet that can be used in dietary surveillance and (2) evaluate trends in the sweetness (caloric or LCS) of the diet in US children and adults over the recent decades overall and stratified by food and beverage sources.…”

Soft Drink Intake in Europe—A Review of Data from Nationally Representative Food Consumption Surveys

“…The complexity of categorising and quantifying soft drink consumption for dietary assessment and epidemiological studies [ 4 , 17 ] and for informing health policy [ 18 ] has been highlighted previously and is now even more important as SSBs can contain a wide range of sugar levels. There is also public health interest in some other specific sub-categories of soft drinks such as ‘energy’ drinks, which are also increasing in market share.…”