Age-related Differences in Knowledge-Attitude-Practice patterns of Non-Nutritive sweetener Consumption among adolescents and adults: A Cross-Sectional Survey in Southeast Nigeria.

Background Non-nutritive sweeteners (NNS) are increasingly incorporated into ultra-processed foods and beverages, yet psychosocial drivers of NNS consumption across age groups in low- and middle-income settings remain poorly characterized. Understanding how knowledge, attitudinal beliefs, and information sources shape NNS consumption is essential for designing effective nutrition interventions. Objectives This study examined age-related patterns of NNS consumption among adolescents and adults and evaluated how knowledge, attitudes, and sources of nutrition information interact to influence consumption practices. Methods A cross-sectional study was conducted among 2,769 adolescents (10-19 years) and adults (≥20 years) in southeast Nigeria. Data were collected using a structured questionnaire assessing sociodemographic characteristics, NNS-related knowledge, attitudinal beliefs, consumption practices, and information sources. Mediation and conditional process analyses evaluated whether attitudinal beliefs mediated the knowledge-practice relationship and whether this mediation varied by knowledge level, age group, and information source. Logistic regression identified predictors of high NNS consumption. Results Adolescents (83.1%) showed a significantly higher prevalence of NNS consumption compared to adults (16.9%) (p<0.001). Results from the logistic regression revealed that being an adolescent was strongly associated with higher NNS consumption (AOR=19.45; 95% CI: 15.43-24.51). Information sources from health professionals (AOR=0.67; 95% CI: 0.47-0.95) and presence of underlying disease (AOR=0.50; 95% CI: 0.31-0.82) were significantly associated with lower consumption. Mediation analysis indicated that positive attitudes partially mediated the relationship between knowledge and consumption practice (indirect effect p<0.05). Conclusions NNS consumption patterns exhibited significant age-related variance and are shaped by a complex interplay between knowledge, belief-based attitudes, and the prevailing information environment. Public health nutrition interventions must evolve beyond traditional knowledge dissemination and adopt a multifaceted approach that addresses information quality, food environments, and age-targeted programs.