Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Socio-demographic correlates and trends in low-calorie sweetener use among adults in the United States from 1999 to 2008

Abstract

Background/Objectives:

Replacing added sugars in beverages and foods with low-calorie sweeteners (LCSs) is one strategy to reduce calories and manage body weight. There are few studies on LCS consumption by product category and by consumer socio-demographic status.

Subjects/Methods:

Data for a representative sample of 22 231 adults were obtained from five cycles of the National Health and Nutrition Examination Survey (1999–2008 NHANES). A single 24-h recall was used to identify consumers of LCS beverages, foods and tabletop sweeteners. Time-trend analyses were conducted for total LCS consumption and for LCS beverages.

Results:

Approximately 30% of US adults consumed some type of LCS, with 19.5% consuming LCS beverages, 11.4% consuming tabletop LCS and 4.6% consuming LCS foods. LCS consumption by product category peaked at different ages, with older adults more likely to consume tabletop LCS and LCS foods. In age-adjusted analyses, LCS consumers in every product category were more likely to be women, 45–65 years old, non-Hispanic whites, US-born adults, college graduates and with higher household incomes. Predictors of LCS consumption were not altered upon adjustment for body mass index and diabetes status. LCS consumption from all sources and from LCS beverages increased between 1999 and 2008.

Conclusions:

LCS use was more common among populations with a lower burden of obesity and related chronic disease, specifically, non-Hispanic whites and those with more education/higher incomes. The reasons for this observed paradox are complex and merit additional research.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA 2004; 292: 927–934.

    Article  CAS  Google Scholar 

  2. de Koning L, Malik VS, Kellogg MD, Rimm EB, Willett WC, Hu FB . Sweetened beverage consumption, incident coronary heart disease, and biomarkers of risk in men. Circulation 2012; 125: 1735–1741. S1.

    Article  CAS  Google Scholar 

  3. Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB . Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr 2009; 89: 1037–1042.

    Article  CAS  Google Scholar 

  4. Johnson RK, Appel LJ, Brands M, Howard BV, Lefevre M, Lustig RH et al. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation 2009; 120: 1011–1020.

    Article  CAS  Google Scholar 

  5. Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB . Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Int Med 2014; 174: 516–524.

    Article  CAS  Google Scholar 

  6. Gardner C, Wylie-Rosett J, Gidding SS, Steffen LM, Johnson RK, Reader D et al. Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care 2012; 35: 1798–1808.

    Article  Google Scholar 

  7. Anderson GH, Foreyt J, Sigman-Grant M, Allison DB . The use of low-calorie sweeteners by adults: impact on weight management. J Nutr 2012; 142: 1163S–1169S.

    Article  CAS  Google Scholar 

  8. Mattes RD, Popkin BM . Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms. Am J Clin Nutr 2009; 89: 1–14.

    Article  CAS  Google Scholar 

  9. Phelan S, Lang W, Jordan D, Wing RR . Use of artificial sweeteners and fat-modified foods in weight loss maintainers and always-normal weight individuals. Int J Obes (Lond) 2009; 33: 1183–1190.

    Article  CAS  Google Scholar 

  10. Piernas C, Ng SW, Popkin B . Trends in purchases and intake of foods and beverages containing caloric and low-calorie sweeteners over the last decade in the United States. Pediatr Obes 2013; 8: 294–306.

    Article  CAS  Google Scholar 

  11. Sylvetsky AC, Welsh JA, Brown RJ, Vos MB . Low-calorie sweetener consumption is increasing in the United States. Am J Clin Nutr 2012; 96: 640–646.

    Article  CAS  Google Scholar 

  12. Welsh JA, Sharma AJ, Grellinger L, Vos MB . Consumption of added sugars is decreasing in the United States. Am J Clin Nutr 2011; 94: 726–734.

    Article  CAS  Google Scholar 

  13. Monsivais P, Aggarwal A, Drewnowski A . Are socio-economic disparities in diet quality explained by diet cost? J Epidemiol Community Health 2012; 66: 530–535.

    Article  Google Scholar 

  14. Drewnowski A, Rehm CD . Energy intakes of US children and adults by food purchase location and by specific food source. Nutr J 2013; 12: 59.

    Article  Google Scholar 

  15. Maillot M, Vieux F, Amiot MJ, Darmon N . Individual diet modeling translates nutrient recommendations into realistic and individual-specific food choices. Am J Clin Nutr 2010; 91: 421–430.

    Article  CAS  Google Scholar 

  16. Centers for Disease Control and Prevention About the National Health and Nutrition Exmaination Survey. Available at http://www.cdc.gov/nchs/nhanes/about_nhanes.htm Accessed on 1 November 2014.

  17. Centers for Diseae Control and Prevention. NCHS Research Ethics Review Board (ERB) Approval http://www.cdc.gov/nchs/nhanes/irba98.htm Accessed on 5 November 2014.

  18. Centers for Disease Control and Prevention National Center for Health Statistics. National Health and Nutrition Examination Survey. In. Hyattsville, MD: U.S. Department of Health and Human Services, Center for Disease Control and Prevention. Available from http://www.cdc.gov/nchs/tutorials/dietary/SurveyOrientation/DietaryDataOverview/Info2.htm.

  19. Ahuja JK, Montville JB, Omolewa-Tomobi G, Heendeniya KY, Martin CL, Steinfeldt LC et al. USDA Food and Nutrient Database for Dietary Studies, 5.0. In. U.S. Department of Agriculture, Agricultural Research Service. Food Surveys Research Group: Beltsville, MD, 2012.

    Google Scholar 

  20. Ogden CL, Carroll MD, Kit BK, Flegal KM . Prevalence of obesity in the United States, 2009-2010. NCHS Data Brief 2012; 1–8.

  21. Centers for Disease Control and Prevention. Crude and Age-Adjusted Rate per 100 of Civilian, Noninstitutionalized Adults with Diagnosed Diabetes, United States, 1980–2011. Available at http://www.cdc.gov/diabetes/statistics/prev/national/figageadult.htm Accessed on 20 November 2014.

  22. Stringhini S, Sabia S, Shipley M, Brunner E, Nabi H, Kivimaki M et al. Association of socioeconomic position with health behaviors and mortality. JAMA 2010; 303: 1159–1166.

    Article  CAS  Google Scholar 

  23. Lo YT, Chang YH, Lee MS, Wahlqvist ML . Health and nutrition economics: diet costs are associated with diet quality. Asia Pac J Clini Nutr 2009; 18: 598–604.

    Google Scholar 

  24. Serdula MK, Mokdad AH, Williamson DF, Galuska DA, Mendlein JM, Heath GW . Prevalence of attempting weight loss and strategies for controlling weight. JAMA 1999; 282: 1353–1358.

    Article  CAS  Google Scholar 

  25. Block JP, Gillman MW, Linakis SK, Goldman RE . "If it tastes good, I'm drinking it": qualitative study of beverage consumption among college students. J Adolesc Health 2013; 52: 702–706.

    Article  Google Scholar 

  26. Drewnowski A, Rehm CD, Constant F . Water and beverage consumption among adults in the United States: cross-sectional study using data from NHANES 2005-2010. BMC Public Health 2013; 13: 1068.

    Article  Google Scholar 

Download references

Acknowledgements

Analyses of the publicly available NHANES database were supported by the Calorie Control Council.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A Drewnowski.

Ethics declarations

Competing interests

AD has received grants, honoraria and consulting fees from numerous food, beverage and ingredient companies and other commercial and nonprofit entities with an interest in sweeteners, obesity and diet quality issues. CDR has no conflicts to report.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Drewnowski, A., Rehm, C. Socio-demographic correlates and trends in low-calorie sweetener use among adults in the United States from 1999 to 2008. Eur J Clin Nutr 69, 1035–1041 (2015). https://doi.org/10.1038/ejcn.2015.38

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2015.38

This article is cited by

Search

Quick links