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Sugar-Sweetened Beverage (SSB) Consumption is Associated with Lower Quality of the Non-SSB Diet Among U.S. Adolescents and Young Adults


Doherty, Alex M.; Lacko, Allison; & Popkin, Barry M. (Online ahead of print). Sugar-Sweetened Beverage (SSB) Consumption is Associated with Lower Quality of the Non-SSB Diet Among U.S. Adolescents and Young Adults. The American Journal of Clinical Nutrition. PMCID: PMC Journal - In Process


Background: Since 2003–4, the United States has seen large declines in sugar-sweetened beverage (SSB) intake overall, especially among non-Hispanic white (NHW) subpopulations. However, obesity prevalence has not shown comparable declines in the 2 highest SSB-consuming groups, adolescents and young adults.
Little is understood about the quality of the diet excluding SSBs (nonSSB diet).
Objectives: The objective of this study was to evaluate differences in non-SSB diet quality in SSB consumers and nonconsumers in adolescents and young adults and in the 3 major race/ethnic subgroups.
Methods: This study utilized data from the NHANES, a crosssectional, nationally representative survey of the US population. Data from 6426 participants aged 12–29 y from the NHANES (2009–2014) was included. Quality of the non-SSB diet was measured using the 2015 Healthy Eating Index (HEI). Multivariate linear regressions controlled for sociodemographic characteristics and included interactions by race/ethnicity [NHWs, non-Hispanic blacks (NHBs), Hispanics]. Individuals were classified as non-, low- (<10% of daily calories), or high-SSB consumers (≥10% of daily calories), according to the US Dietary Guidelines added sugar intake recommendation.
Results: Non-SSB HEI scores differed among SSB consumer groups (53 for adolescent nonconsumers compared with 46 for high consumers, P < 0.001; 57 for young adult nonconsumers compared with 45 for high consumers, P < 0.001), although all scores were low and require improvement. Among NHBs, significant
differences in non-SSB HEI were found only between non- and lowSSB consumers. In Hispanics, associations varied by age group, with significant differences found for young adults but no association found for adolescents.
Conclusions: Low non-SSB HEI scores in SSB consumers suggest that reducing SSB consumption alone will not be a sufficient strategy for improving dietary quality in adolescents and young adults. Future policies must also consider improving the non-SSB diet.


Reference Type

Journal Article

Article Type


Year Published

Online ahead of print

Journal Title

The American Journal of Clinical Nutrition


Doherty, Alex M.
Lacko, Allison
Popkin, Barry M.


PMC Journal - In Process

Data Set/Study

NHANES (2009–2014)


United States of America