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

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 inves...

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Main Authors: Susan E. Swithers, G. R. Bonanno, Janet Figueroa, Jean A. Welsh, Allison C. Sylvetsky
Format: Article
Language:English
Published: MDPI AG 2021-08-01
Series:Nutrients
Subjects:
Online Access:https://www.mdpi.com/2072-6643/13/8/2703
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spelling doaj-8b1017a05d0e42c1a81ba12adb50f57e2021-08-26T14:10:37ZengMDPI AGNutrients2072-66432021-08-01132703270310.3390/nu13082703Dietary and Health Correlates of Sweetened Beverage Intake: Sources of Variability in the National Health and Nutrition Examination Survey (NHANES)Susan E. Swithers0G. R. Bonanno1Janet Figueroa2Jean A. Welsh3Allison C. Sylvetsky4Department of Psychological Sciences, Purdue University, West Lafayette, IN 47907, USADepartment of Psychological Sciences, Purdue University, West Lafayette, IN 47907, USADepartment of Pediatrics, School of Medicine, Emory University, Atlanta, GA 30322, USADepartment of Pediatrics, School of Medicine, Emory University, Atlanta, GA 30322, USADepartment of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USARecent 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.https://www.mdpi.com/2072-6643/13/8/2703low-calorie sweetenersdiet beveragessugarobesity
collection DOAJ
language English
format Article
sources DOAJ
author Susan E. Swithers
G. R. Bonanno
Janet Figueroa
Jean A. Welsh
Allison C. Sylvetsky
spellingShingle Susan E. Swithers
G. R. Bonanno
Janet Figueroa
Jean A. Welsh
Allison C. Sylvetsky
Dietary and Health Correlates of Sweetened Beverage Intake: Sources of Variability in the National Health and Nutrition Examination Survey (NHANES)
Nutrients
low-calorie sweeteners
diet beverages
sugar
obesity
author_facet Susan E. Swithers
G. R. Bonanno
Janet Figueroa
Jean A. Welsh
Allison C. Sylvetsky
author_sort Susan E. Swithers
title Dietary and Health Correlates of Sweetened Beverage Intake: Sources of Variability in the National Health and Nutrition Examination Survey (NHANES)
title_short Dietary and Health Correlates of Sweetened Beverage Intake: Sources of Variability in the National Health and Nutrition Examination Survey (NHANES)
title_full Dietary and Health Correlates of Sweetened Beverage Intake: Sources of Variability in the National Health and Nutrition Examination Survey (NHANES)
title_fullStr Dietary and Health Correlates of Sweetened Beverage Intake: Sources of Variability in the National Health and Nutrition Examination Survey (NHANES)
title_full_unstemmed Dietary and Health Correlates of Sweetened Beverage Intake: Sources of Variability in the National Health and Nutrition Examination Survey (NHANES)
title_sort dietary and health correlates of sweetened beverage intake: sources of variability in the national health and nutrition examination survey (nhanes)
publisher MDPI AG
series Nutrients
issn 2072-6643
publishDate 2021-08-01
description 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.
topic low-calorie sweeteners
diet beverages
sugar
obesity
url https://www.mdpi.com/2072-6643/13/8/2703
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