Children and adolescents who drink low- or no-calorie beverages (ones sweetened with sugar substitutes) take in considerably more calories — about 200 more per day — than young people who consume mostly water, according to a study published Thursday in the journal Pediatric Obesity.
“These results challenge the utility of diet or low-calorie sweetened beverages when it comes to cutting calories and weight management,” said Allison Sylvetsky, the study’s lead author and an assistant professor of exercise and nutrition science at George Washington University, in a released statement. “Our findings suggest that water should be recommended as the best choice for kids and teens.”
As background information in the study points out, the use of low-calorie sweeteners in the diets of children and teens has risen by at least 200 percent over the past two decades. Today, 25 percent of young people consume some type of artificially sweetened food product on a given day, including 19 percent who consume an artificially sweetened beverage — a figure that’s up from 6 percent in 2000.
Yet, researchers still don’t know how artificial sweeteners affect the total amount of calories consumed by people, including children — or whether they actually help with weight management.
Meanwhile, an increasing proportion of America’s young people are topping the scales at an unhealthy weight. Today, more than a third of American children and teens, aged 2 to 19, are either overweight or obese, according to data from the federally funded National Health and Nutrition Examination Survey (NHANES).
How the study was done
For their study, Sylvetsky and her co-authors analyzed NHANES dietary data collected from 7,026 children and teens between 2011 and 2016. (Parents or guardians filled out the survey for the younger children.) The survey asks participants to provide details of what they ate and drank during a 24-hour period.
The beverages listed by the survey’s participants, which included sodas, fruits drinks, sports drinks, teas, dairy drinks and alternative dairy drinks, were divided into three groups: artificially sweetened (low-calorie) beverages, sugary beverages and water.
The young people who drank more than 4 ounces of artificially sweetened beverages, but less than 4 ounces of sugary beverages on the day of the survey were categorized as consumers of low-calorie beverages. Those who drank more than 4 ounces of sugary beverages, but less than 4 ounces of artificially sweetened beverages were categorized as consumers of sugary beverages. And those who drank less than 4 ounces of both artificially and sugar sweetened beverages were categorized as consumers of water.
Four ounces was chosen as the cut-off because it represents half of a typical 8-ounce serving of a beverage.
What the study found
When all the data were analyzed, the researchers found that the young people who were consumers of artificially sweetened beverages and those who were consumers of sugary beverages took in significantly more calories than their peers who were consumers of water — even after adjusting for body weight.
Compared to those in the water group, the children and teens in the sugary-beverage group took in, on average, 312 more calories a day (156 more calories from added sugar), while those in the artificially sweetened-beverage group took in 196 more calories a day (60 more calories from added sugars).
The young people in the study who consumed more than 4 ounces a day of both artificially sweetened and sugary beverages had the highest calorie intake. They took in an average of 450 more calories a day (184 more calories from added sugars) than their peers who were consumers of water.
“The key takeaway from our research is that drinking beverages with low-calorie sweeteners instead of sugar doesn’t necessarily add up to fewer calories in the diet,” Sylvetsky told Consumer Reports reporter Sally Wadyka. “The kids who consumed mostly low-calorie sweetened drinks still had significantly higher calorie and sugars intake than those who predominantly drank water.”
The study wasn’t designed to find out why young people who drink artificially sweetened beverages still consume higher amounts of calories than kids who drink predominantly water. But other research has suggested that artificial sweeteners may stimulate people’s appetites, particularly for sugary foods.
Water is best
The study was observational, so it can only suggest (not prove) a link between the consumption of artificially sweetened beverages and a higher intake of both calories and sugar. Furthermore, the dietary information was collected on a single day — a day that might not accurately reflect each young person’s overall eating habits.
Also, the study only looked at calories consumed by the young people — not at whether those extra calories had affected their health.
Still, the findings are troubling, given that so many parents believe that low- or no-calorie beverages are healthy options for their children (and themselves).
Experts are trying to get another message across to parents. The American Heart Association, for example, recently issued a science advisory “against prolonged consumption of low-calorie sweetened beverages by children.”
Sylvertsky agrees with that recommendation.
“Kids like sweetness, so it can be a hard sell to get children to drink plain water,” she told Consumer Reports. “But it’s clearly the best option.”
FMI: You can read (but not download) the study in full on Pediatric Obesity’s website.