Artificially Sweetened Beverages and Weight Change: Findings from 3 Prospective Cohort Studies of United States Adults

Background: Whether habitually consuming artificially sweetened beverages (ASBs) in place of sugar-sweetened beverages (SSBs) is associated with weight changes is unclear. Objectives: To evaluate the association of increasing ASBs or water, as SSBs replacements, with changes in weight/body mass index (BMI). Methods: We analyzed data from the Nurses' Health Study (NHS), NHS II, and Health Professionals Follow-up Study. Adults aged 26-65 y were followed for 24-32 y with biennial questionnaires updating medical, lifestyle, and anthropometric data. Multivariable-adjusted linear models estimated associations between changes in ASB intake, substitution of SSBs with ASBs or water, and 4-y weight and BMI changes. Latent class growth models and multinomial logistic models estimated the odds of weight-trajectory membership based on beverage intake. Results: Among 143,409 participants (median follow-up 28 y), the mean weight gain per 4-y interval was 1.3 kg (5th-95th percentile:- 6.3 to 9.1 kg). Each 3-serving/wk increase in ASB was associated with-0.18 kg weight change [95% confidence interval (CI): -0.26 kg, -0.11 kg] and-0.06 kg/m2 BMI change (95% CI: -0.09 kg/m2, -0.03 kg/m2) over 4-y intervals, with stronger inverse associations among adults with overweight/obesity and higher SSB intake. Replacing 3 SSB servings/wk with ASB was associated with lower weight (-1.39 kg, 95% CI: -1.50 kg, -1.28 kg) and BMI gains (-0.50 kg/ m 2 95% CI: -0.54 kg/m2, -0.45 kg/m2), with larger SSB-to-ASB replacements associated with progressively less gains. Similar estimates were observed when replacing SSB with water (-1.39 kg, 95% CI: -1.48 kg, -1.30 kg and-0.49 kg/m2, 95% CI: -0.53 kg/m2, -0.46 kg/m2). Replacing ASB with water was associated with modest reductions in weight (-0.11 kg, 95% CI: -0.19 kg, -0.03 kg) and BMI gains (-0.04 kg/m2, 95% CI: -0.08 kg/m2, -0.01 kg/ m 2 ). Higher ASB or water intake were inversely associated with unhealthy weight trajectories. Conclusions: Increases in ASB intake were inversely associated with weight/BMI gains over time, particularly among adults with overweight/obesity and higher SSB intake. Replacing SSBs with ASBs-or ideally water-was associated with decreases in weight/BMI changes in a dose-dependent manner.