Previous research on the impact of low-calorie sweeteners on diet has been conflicting. The purpose of this study was to compare total energy and added sugar intake among U.S.  who consume low-calorie sweetened beverages (LCSBs) using National Health and Nutrition Examination Survey (NHANES) data from 2011-2016. Dietary intake was estimated using in-person 24-hour recall data from children and adolescents (2 – 17 years-old).  From this information, participants were classified into four categories: 1) LCSB consumers if they reported greater than or equal to 4 oz LCSB and less than 4 oz sweetened beverages (SB), 2) SB consumers if they reported greater than or equal to  4 oz SB and less than 4 oz LCSB, 3) LCSB + SB consumers if they reported greater than or equal to 4 oz SB and greater than or equal to 4 LCSB, and 4) water consumers if they reported greater than or equal to 4 oz water and less than 4 oz LCSB and SB. Statistical analyses used sample weighting to generate national level estimates, as well as other complex procedures to account for NHANES survey design. After adjusting for age, sex, race/ethnicity, income, physical activity, and BMI percentile, results showed that LCSB, SB and LCSB + SB had were associated with higher daily energy intake (196, 312, 450 calories respectively) and more energy from added sugar (60, 156, 184 calories from added sugar) compared to water consumers (p <.05 ). Additionally, children who consumed LCSB + SB had the highest total energy and added sugar intake compared to other groups.  Energy intakes between LCSB and SB consumers were similar.

Study strengths: This study challenged the notion that LCSB are helpful for lowering sugar and energy intake. Additionally, this is the first study to examine the association between LCSB consumption and energy intake among children. Three NHANES survey cycles were used, which also strengthened the study.

Study limitations: Self-reported dietary data from one day may not be representative of the overall diet quality.  Additionally, the method of 24-hour recalls may be subject to errors due to the reliance on a participant’s or parents’ memory.

What this means for your practice: More research is needed to understand the physiologic mechanisms that explain how LCSB affects overall appetite, energy and added sugar intake. This study supports the current recommendation that water is the best choice to hydrate children.

Original citation: Sylvetsky, A. C., Figueroa, J., Zimmerman, T., Swithers, S. E., & Welsh, J. A. (2019). Consumption of low‐calorie sweetened beverages is associated with higher total energy and sugar intake among children, NHANES 2011–2016. Pediatric Obesity, 14(10), e12535.

About the Author:  Chenin Treftz, Ph.D., R.D.N., is a member of the research faculty at the University of Nevada, Reno.  Dr. Treftz has expertise in research, community nutrition, and higher education. Dr. Treftz has been a member of the Rethink Your Drink team since 2012.

The goal of Rethink Your Drink Nevada is to promote healthy beverages and reduce sugary drinks. To support this goal, free educational resources are available to eligible medical and dental care practices in Nevada.  For more information, please visit or e-mail

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