Abstract MP07: Changes in Weight From Sugar- or Artificially-Sweetened Beverages or Water Intake in a Prospective Cohort

Background: It is still unclear if sustained intake of artificially sweetened beverages (ASB) in lieu of sugar-sweetened beverages (SSB) is associated with long-term weight reduction or maintenance. This study aimed to evaluate the long-term changes in weight and BMI in relation to changes in ASB intake, and to estimate the effects of replacing SSB with ASB or water on body weight. Hypothesis: Habitual ASB intake is unrelated to weight or BMI changes. The modeled substitutions are expected to show a reduction in weight and BMI, larger for water than for ASB. Methods: We used data from the Nurses' Health Study I, a prospective cohort study conducted among female US nurses aged 39 to 65y at enrolment and assessed every four years from 1986 to 2010. Food-frequency questionnaires evaluated usual dietary intake including beverages (in 12 oz servings/day). Self-administered questionnaires collected lifestyle and anthropometric information. We excluded participants with any major disease at baseline (e.g., diabetes, cancer, cardiovascular disease), and censored those reaching 65 years during follow-up. Pregnant or lactating women were not considered during these periods. We evaluated the association between changes in ASB intake with changes in weight and BMI using generalized estimating models adjusting for multiple dietary and lifestyle risk factors. Substitution models assessed how replacing SSB with ASB, SSB with water, or ASB with water relates to weight and BMI changes, adjusting for the same covariates. Results: Among 51,805 participants, 64.6% consumed ASB at baseline averaging 0.25 ± 0.53 servings/day. Over 4-year follow-up intervals, a one-serving/day increase of ASB was associated with an estimated weight change of -0.06 kg (95% CI: -0.11, -0.02) and BMI change of -0.02 kg/m 2 (95% CI: -0.04, -0.01). Substituting SSB with ASB was associated with -0.37 kg change in weight (95% CI: -0.41, -0.33) and -0.14 kg/m 2 in BMI (95% CI: -0.17, -0.11). Similar estimates were observed when replacing SSB with water ( β =-0.35 kg, 95% CI: -0.41, -0.30 for weight and β =-0.13, kg/m 2 , 95% CI: -0.15, -0.11 for BMI). Substituting ASB with water was not associated with changes in weight ( β =-0.004 kg, 95% CI: -0.05, 0.04) or BMI ( β =-0.0002 kg/m 2 , 95% CI: -0.02, 0.02). Conclusion: A long-term daily increase in ASB intake was not associated with greater weight gain in US women. Replacing SSB with ASB was associated with significantly less weight gain, likely by reducing energy intake. Change in water was not associated with weight changes, suggesting it may help sustain weight maintenance when replacing SSB. Future studies should evaluate the roles of changes in intakes of water, ASB, and SSB in relation to changes in other weight- and metabolically-related outcomes in diverse populations of both sexes.