Consumption of low-calorie sweetened products and intakes of free sugar and energy among UK adults

Abstract Background Policies to reduce free sugar intake in the population often suggest alternative low or no sugar products that may contain low-calorie sweeteners (LCS). However, the health effects of LCS are controversial and little is known about whether free sugar and energy intake differ between people with varying levels of LCS product consumption. This study examines the associations between LCS product consumption and free sugar and energy intake in UK adults from 2008 to 2019. Methods Repeat cross-sectional data from the UK’s National Diet and Nutrition Survey (2008/09 to 2018/19) involve 8304 adults aged ≥18 years (mean 48.7, SD 18.3) with 58.4% being women. Consumption of LCS products (grams/day) were obtained from 4-day diet diaries and participants were categorized into four groups (No-LCS, Low-LCS, Mid-LCS, High-LCS) based on LCS consumption tertiles in 2008/09. Linear regression analysed associations with LCS group, year, their interaction, and adjusted for sociodemographic factors. Results All four groups consumed free sugar (relative to total energy intake) above recommended levels (5% kcal/day) throughout the study period. In 2008/09, the mean free sugar intake for the No-LCS group was 58.1 grams/day, and the mean total energy intake was 1855.7 kcal/day, which were not significantly different from the High-LCS group. Over time, free sugar intake declined by -1.0 g/year (95%CI: -1.4, -0.6) whereas total energy intake declined by -6.0 kcal/year (95%CI: -11.4, -2.1) in the No-LCS group. The High-LCS group showed similar declines leading to no significant difference in mean free sugar and total energy intake between the No-LCS and High-LCS groups in 2018/19. Conclusions In this representative study of UK adults, similar levels of free sugars and total energy intake were observed among those with no LCS and those with the highest LCS product consumption from 2008 to 2019. Absence of LCS product consumption in diets were not associated with higher free sugar intake. Key messages • The high level of LCS product consumption was not associated with lower free sugar intake among UK adults. These finding challenges policies promoting LCS to reduce UK adults’ free sugar intake. • The finding that UK adults consistently consumed free sugar above recommended levels highlights the ongoing need for policy interventions.