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Introduction: Evidence on the effects of low- and no-calorie sweetened (LCS) product consumption on overall dietary patterns remains limited, despite their frequent promotion as healthier alternatives. This study assessed the association between LCS product consumption and both the levels and temporal trends in free sugar intake and overall dietary patterns among UK adults. Methods: = 8,304) were categorized into four levels of LCS product consumption: non-consumers (No-LCS) and three tertiles of consumers (Low-LCS: ≤75.0 g/day, Mid-LCS: >75.0-216.8 g/day, and High-LCS: >216.8 g/day), as measured by four-day food diaries. The associations between LCS product consumption and intakes of free sugar, energy, and minimally processed and ultra-processed foods as determined by the Nova classification were analyzed using multivariable linear regression, adjusted for sociodemographic factors. Results: In 2008/09, 45.9% of participants consumed LCS products, and this proportion remained stable over the 11-year period. Among LCS product consumers, the median LCS product intake increased significantly from 132.0 g/d in 2008/09 to 170.0 g/d in 2018/19. In the No-LCS group, free sugar and energy intakes decreased by -1.0 g/d (95% CI, -1.4 to -0.6) and -6.7 kcal/d (95% CI, -11.4 to -2.1) per year, respectively, with similar declines observed for the High-LCS group. In 2008/09, the mean water and minimally processed food consumption was lower in the High-LCS than the No-LCS group, by -141.2 g/d (95% CI, -203.8 to -78.6) and -306.3 g/d (95% CI, -359.5 to -216.7), respectively, and this difference persisted throughout the study period. Discussion: LCS consumption does not appear to align with potentially beneficial dietary patterns regarding free sugar, ultra-processed food and beverage, and minimally processed food and beverage intakes. These findings underline the importance of policies to consider overall dietary patterns that also address LCS consumption alongside reducing free sugar intake.
Seesen et al. (Thu,) studied this question.