Does diet-beverage intake affect dietary consumption patterns? Results from the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial

Background: Little is understood about the effect of increased consumption of low-calorie sweeteners in diet beverages on dietary patterns and energy intake. Objective: We investigated whether energy intakes and dietary patterns were different in subjects who were randomly assigned to substitute caloric beverages with either water or diet beverages (DBs). Design: Participants from the Choose Healthy Options Consciously Everyday randomized clinical trial (a 6-mo, 3-arm study) were included in the analysis [water groups: n = 106 (94% women); DB group: n = 104 (82% women)]. For energy, macronutrient, and food and beverage intakes, we investigated the main effects of time, treatment, and the treatment-by-time interaction by using mixed models. Results: Overall, the macronutrient composition changed in both groups without significant differences between groups over time. Both groups reduced absolute intakes of total daily energy, carbohydrates, fat, protein, saturated fat, total sugar, added sugar, and other carbohydrates. The DB group decreased energy from all beverages more than the water group did only at month 3 (P-group-by-time < 0.05). Although the water group had a greater reduction in grain intake at month 3 and a greater increase in fruit and vegetable intake at month 6 (P-group-by-time < 0.05), the DB group had a greater reduction in dessert intake than the water group did at month 6 (P-group-by-time < 0.05). Conclusions: Participants in both intervention groups showed positive changes in energy intakes and dietary patterns. The DB group showed decreases in most caloric beverages and specifically reduced more desserts than the water group did. Our study does not provide evidence to suggest that a short-term consumption of DBs, compared with water, increases preferences for sweet foods and beverages. This trial was registered at clinicaltrials.gov as NCT01017783. Am J Clin Nutr 2013;97:604-11.