(OR17-06-23) Associations Between Low-Calorie Sweetener Intake and Diet Quality in U.S. Adults

Objectives: Low calorie sweeteners (LCS) are commonly used to replace added sugar in foods and beverages. However, their impact on the overall diet is unclear. The objective of this study was to investigate associations between LCS consumption, diet quality, and energy intake.

Methods: This cross-sectional analysis included data from 165,876 participants in the American Cancer Society (ACS) Cancer Prevention Study-3 (CPS-3) cohort. Participants completed a validated food frequency questionnaire in 2015. LCS intake (servings per day) was estimated using self-reported consumption of LCS-containing beverages (diet drinks, diet iced tea, non-caloric sweetener packets and light yogurt). Diet quality was assessed using the ACS Diet Score (2020) and Healthy Eating Index (HEI-2015). Multivariable linear regression was used to examine associations between LCS consumption, diet quality and energy intake. Base models were adjusted for age, sex, race/ethnicity, income and education; subsequent models were further adjusted for body mass index, physical activity and following a specific diet. Models with ACS Diet Score as the outcome were also adjusted for energy intake.

Results: Over two-thirds (68%) of the participants reported consumption of foods, beverages, and/or packets with LCS. LCS consumption was inversely associated with diet quality (p < 0.0001) for both ACS Diet Score and HEI-2015 and positively associated with energy intake (p < 0.0001). LCS consumption was associated with poorer scores for ACS Diet Quality subcomponents including fruits and vegetables (p < 0.0001), red and processed meat (p < 0.0001), and sugar-sweetened beverages, highly processed foods, and refined grains (p < 0.0001), but was not associated with whole grains. LCS consumption was also associated with poorer scores for all HEI-2015 subcomponents (all p< 0.0001) except total protein foods.

Conclusions: LCS consumption was associated with poorer diet quality and higher energy intake in a large cohort of U.S. adults. These findings suggest that although LCS do not contain sugar or calories, their consumption is unlikely to improve the overall diet. Further research to elucidate mechanisms that may explain these associations is needed to inform dietary recommendations for cancer prevention and general dietary guidance.

Funding Sources: This work was funded by the American Cancer Society.