摘要：Objectives. We examined national patterns in adult diet-beverage consumption and caloric intake by body-weight status. Methods. We analyzed 24-hour dietary recall with National Health and Nutrition Examination Survey 1999–2010 data (adults aged ≥ 20 years; n = 23 965). Results. Overall, 11% of healthy-weight, 19% of overweight, and 22% of obese adults drink diet beverages. Total caloric intake was higher among adults consuming sugar-sweetened beverages (SSBs) compared with diet beverages (2351 kcal/day vs 2203 kcal/day; P = .005). However, the difference was only significant for healthy-weight adults (2302 kcal/day vs 2095 kcal/day; P < .001). Among overweight and obese adults, calories from solid-food consumption were higher among adults consuming diet beverages compared with SSBs (overweight: 1965 kcal/day vs 1874 kcal/day; P = .03; obese: 2058 kcal/day vs 1897 kcal/day; P < .001). The net increase in daily solid-food consumption associated with diet-beverage consumption was 88 kilocalories for overweight and 194 kilocalories for obese adults. Conclusions. Overweight and obese adults drink more diet beverages than healthy-weight adults and consume significantly more solid-food calories and a comparable total calories than overweight and obese adults who drink SSBs. Heavier US adults who drink diet beverages will need to reduce solid-food calorie consumption to lose weight. The trends and patterns of sugar-sweetened beverage (SSB) consumption have been well described in the literature, 1,2 but less is known about consumption of diet beverages (artificially sweetened no-calorie drinks) among US adults. Available evidence focuses on broad temporal trends or changes among demographic groups suggesting that consumption of diet beverages has increased dramatically from about 3% of adults in 1965 3 to about 20% of adults today, 4 and that diet-beverage drinkers are typically characterized as young to middle-age adults (aged 20–59 years), female, non-Hispanic White, and higher income. 4 To our knowledge, no studies to date have focused on national patterns in diet-beverage consumption and caloric intake by body-weight status. Understanding diet-beverage consumption by body weight is important as consuming these zero- or no-calorie drinks is a common weight-management strategy. Switching from SSBs to diet drinks has indeed been shown to be associated with weight loss because of differences in caloric content between the drinks. 5 However, the evidence base is far from conclusive. Some studies, mostly cross-sectional in design, have shown that diet-beverage drinkers tend to be overweight, 5,6 that they typically do not consume fewer calories on the days they consume diet beverages, 7 and that high consumers (households purchasing more than 20 12-packs of diet soda annually) generally purchase more snack foods at the grocery store and more overall calories than consumers purchasing SSBs. 8 The evidence from long-term studies is similarly mixed; some show the reduction in caloric intake promotes weight loss or maintenance, others show no effect, and some show weight gain. 9 Evidence also suggests that diet drinkers have the same caloric intake and body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) as SSB drinkers 10,11 and that consumption of diet drinks can be associated with significant weight gain. 12 The primary purpose of this study was to describe patterns in diet-beverage consumption and caloric intake (total, beverage, and solid-food calories) among US adults overall and among body-weight categories. In addition, we examined variations in dietary habits (i.e., snacking and calories per meal occasion) among adults consuming diet beverages. This analysis does not attempt to estimate the impact of diet-beverage intake on obesity incidence because of our reliance on cross-sectional data.
