From the mid-1970s to the mid-1990s, consumption of milk by Americans declined, and consumption of sweetened beverages increased. The purpose of the What America Drinks study was to characterize current beverage consumption patterns in the United States using recent nationwide survey data. The analyses utilized data from more than 10,000 Americans ages 4 and older who participated in the U.S. National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2001-2002 and provided plausible dietary reports of food/beverage intakes. Relationships among selected patterns of beverage use, nutrient intakes and body mass index (BMI) were examined.
The results of the analyses indicate that more than 99% of Americans ages 4 and older consumed at least one beverage other than plain water on any particular day. Total fluid intake averaged more than 11 cups per day. On average, beverages provided nearly one-quarter (22%) of total calories in a day, along with comparable or even higher percentages of carbohydrates, added sugars and key vitamins and minerals including vitamin A, vitamin C, calcium, phosphorus, magnesium, and potassium.
Nearly 50% of people ages 4 and older consumed regular soft drinks on any given day. Soft drinks provided 6% of total calories, 13% of total carbohydrates, and 36% of all added sugars in the diet. The contributions of soft drinks to total added sugars intakes were highest among teenagers. Mean regular soft drink intake per capita (averaged across the whole population, including nonconsumers) was about 12 fluid ounces (fl oz) per day, and mean intake by users (those who drank soft drinks on the day of the survey) was about 24 fl oz per day. Teenage boys consumed regular soft drinks in the greatest quantities, with an average of 31 fl oz per day per user.
Nearly 20% of people 4 and older consumed fruit drinks (fruit-flavored beverages containing less than 100% fruit juice) and about 9% reported drinking presweetened tea. Fruit drinks provided about 2% of total calories, 10% of added sugars and 14% of total dietary vitamin C. The combination of regular soft drinks, fruit drinks and presweetened teas contributed about 9% of total calories, 18% of carbohydrates and 49% of added sugars.
Forty-five percent of Americans reported drinking plain milk (or consuming it with a ready-to-eat cereal). The mean intake by people who used plain milk was about 13 fl oz per day, and mean per capita intake was about 6 fl oz per day. Plain milk provided about 4% of total calorie intake and was a key contributor to the total daily intake of several essential nutrients, including vitamin A (13%), calcium (22%), phosphorus (12%), magnesium (7%), potassium (9%), protein (7%) and zinc (6%).
Flavored milk was used by 7% of Americans and was most often consumed by children (22%), male preteens (20%) and female preteens (19%). Flavored milk contributed less than 1% of total calorie intake for Americans ages 4 and older, but about 2-3% of the calories for children and preteens. About 6% of Americans consumed a milk-based beverage.
The flavored milk, milk-based beverages and coffee (which often contains added milk) categories also contributed to intakes of vitamin A, calcium, phosphorus, magnesium, potassium, protein and zinc for selected age/gender groups. Although a relatively small amount of fat, saturated fat and cholesterol was supplied by beverages, the primary sources were milk and milk-based beverages, which included milk shakes.
Overall, nearly 90% of Americans ages 4 and older said they drank plain drinking water (tap or non-carbonated bottled water), with a mean per capita intake of about 38 fl oz per day and a per user intake of about 44 fl oz per day.
About one in six Americans drank a diet drink (diet soft drink, fruit drink, presweetened tea or other beverage that contained a non-caloric sweetener). The primary consumers of these beverages were female adults ages 19 and older, and male adults ages 50 and older.
Slightly more than one-quarter (28%) of Americans ages 4 and older reported drinking fruit or vegetable juices. Fruit/vegetable juice provided about 2% of total calories, but contributed 28% of dietary vitamin C. Fruit/vegetable juices were generally the second highest beverage source of potassium and the highest beverage source of folate.
Coffee was reported by nearly 40% of people ages 4 and older. Tea (not presweetened) was consumed by 12% of Americans ages 4 and older. Adults were the primary consumers of these beverages. Sports drinks were consumed by about 3% of people ages 4 and older, and were most likely to be consumed by males, particularly teenagers. Meal replacements were consumed by fewer than 2% of Americans ages 4 and older on the day of recall.
Alcoholic beverages, mixtures containing alcohol, and alcohol substitutes were reported by nearly 20% of the population ages 4 and older, with a mean per user intake of 31 fl oz per day and a mean per capita intake of about 6 fl oz per day. Adult males consumed between 5% and 6% of all calories in the form of alcoholic beverages, while adult females consumed about 3% of total calories from this source.
Very few Americans (about 1%) consumed beverages other than those listed above, such as soy- or rice-based beverages.
Nutrient Intakes and Body Mass Index (BMI) by Beverage Intake Pattern
Dietary intakes were evaluated to identify people with 1) high consumption of milk beverages and low consumption of sweetened beverages (high MB/low SB) and 2) low consumption of milk beverages and high consumption of sweetened beverages (low MB/high SB). Mean intakes of vitamin A, calcium, magnesium and potassium were significantly higher in the high MB/low SB groups versus the low MB/high SB groups. Vitamin C intakes were generally similar between beverage patterns. After adjusting for calorie intake and age, BMIs of female preteens, female teens and female adults (19-49 years) in the high MB/low SB group were significantly lower than BMIs of females in the low MB/high SB groups.
The results of this study show that beverages make significant contributions to calorie and nutrient intakes of Americans. Milk provided Americans with a substantial proportion of essential nutrients, while other types of beverages tended to contribute substantially to calories and added sugars intakes but provided few nutrients other than vitamin C, potassium and some folate.
By drinking more lowfat and fat-free milk in place of sweetened beverages, Americans can help enhance their intakes of essential nutrients that are typically suboptimal, including calcium, vitamin A, magnesium and potassium. These same patterns of beverage intake may have a beneficial role in weight management.