Characterization of Non-nutritive Sweetener Intake Patterns in a Sample of Rural Southwest Virginian Adults

Controversy surrounds the use of artificial sweeteners (non-nutritive sweeteners [NNS]) as an effective weight-loss and/or maintenance strategy. This controversy is especially important as obesity is an epidemic in the United States. Excessive added sugar intake, primarily from sugar-sweetened beverages, has been linked to increased risk of overweight and obesity, as well as type 2 diabetes and cardiovascular disease. NNS provide minimal to no calories and thus, they have been suggested as a method to reduce added sugar intake, and consequently decrease energy intake, weight, and cardiometabolic risk. However, NNS intake has been associated with various health outcomes in observational studies and randomized controlled trials, including cancer, weight gain and loss, physiological and intestinal changes, cardiovascular disease, and diabetes. The uncertainties around the effect of NNS on health outcomes stem from a variety of limitations, one of which is inadequate dietary assessment methodology. Accuracy of dietary intake assessment methods is limited by the inability to distinguish between different types of NNS and lack of information about consumer use of NNS in a variety of beverages and foods. The purpose of this investigation is to explore NNS consumer characteristics and to characterize NNS intake in a sample of rural Southwest Virginian adults. This characterization is especially important for rural populations, as they are known to be high sugar-sweetened beverage consumers and are at an increased risk of obesity and chronic disease; thus, NNS could serve as a replacement method to facilitate cardiometabolic health. Cross-sectional data from a large randomized controlled trial, Talking Health (n=301), was utilized in this investigation to compare demographic characteristics, anthropometrics, biochemical markers, dietary quality, and dietary factors between NNS consumers and NNS non-consumers. This data was also used to characterize NNS intake (frequency, type, and source of sweetener). Of this rural sample, 33% consumed NNS, with sucralose being the most prevalent type of NNS and diet soda being the most frequently consumed source of NNS. NNS consumers had a higher BMI status than NNS non-consumers. However, NNS consumers had better overall dietary quality than NNS non-consumers. The characteristics of these NNS consumers and their intake patterns can be used to develop well-designed dietary intake assessment tools that accurately measure NNS intake, which can facilitate a better understanding of the associations of NNS with health outcomes.