Abstract
BACKGROUND: Whether habitually consuming artificially sweetened beverages (ASBs) or water in place of sugar-sweetened beverages (SSBs) is associated with weight changes is unclear. OBJECTIVES: This study aimed to evaluate the association of increasing ASBs or water as replacements for SSBs 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, prospective United States cohorts. Females and males 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 average weight gain per 4-y interval was 1.3 kg (5th-95th percentile: -6.3 to 9.1 kg). Pooled estimates indicated that 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/m(2) BMI change (95% CI: -0.09 kg/m(2), -0.03 kg/m(2)) over 4-y intervals, with stronger inverse associations among adults with overweight/obesity and higher SSB intake. Replacing 3 SSB serving/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/m(2), -0.45 kg/m(2)). Similar estimates were observed when replacing SSB with water (-1.39 kg, 95% CI: -1.48 kg, -1.30 kg and -0.49 kg/m(2), 95% CI: -0.53 kg/m(2), -0.46 kg/m(2)). 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/m(2), 95% CI: -0.08 kg/m(2), -0.01 kg/m(2)). 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.