Sugar-sweetened beverage (SSB) consumption is associated with lower quality of the non-SSB diet in US adolescents and young adults

Abstract

Background: Since 2003-4, the United States has seen large declines in sugar-sweetened beverage (SSB) intake overall, especially among non-Hispanic white (NHW) subpopulations. However, obesity prevalence has not shown comparable declines in the 2 highest SSB-consuming groups, adolescents and young adults. Little is understood about the quality of the diet excluding SSBs (non-SSB diet).

Objectives: The objective of this study was to evaluate differences in non-SSB diet quality in SSB consumers and nonconsumers in adolescents and young adults and in the 3 major race/ethnic subgroups.

Methods: This study utilized data from the NHANES, a cross-sectional, nationally representative survey of the US population. Data from 6426 participants aged 12-29 y from the NHANES (2009-2014) was included. Quality of the non-SSB diet was measured using the 2015 Healthy Eating Index (HEI). Multivariate linear regressions controlled for sociodemographic characteristics and included interactions by race/ethnicity [NHWs, non-Hispanic blacks (NHBs), Hispanics]. Individuals were classified as non-, low- (<10% of daily calories), or high-SSB consumers (≥10% of daily calories), according to the US Dietary Guidelines added sugar intake recommendation.

Results: Non-SSB HEI scores differed among SSB consumer groups (53 for adolescent nonconsumers compared with 46 for high consumers, P < 0.001; 57 for young adult nonconsumers compared with 45 for high consumers, P < 0.001), although all scores were low and require improvement. Among NHBs, significant differences in non-SSB HEI were found only between non- and low-SSB consumers. In Hispanics, associations varied by age group, with significant differences found for young adults but no association found for adolescents.

Conclusions: Low non-SSB HEI scores in SSB consumers suggest that reducing SSB consumption alone will not be a sufficient strategy for improving dietary quality in adolescents and young adults. Future policies must also consider improving the non-SSB diet.

Keywords: adolescents; diet quality; disparities; healthy eating index; sugar sweetened beverages; young adults.