Total and added sugar intakes among 4–13 year old children in China, Mexico, and the U.S.
Authors: Afeiche Myriam C. , Koyratty Bibi Nadia Shaheen , Wang Dantong , Jacquier Emma , Eldridge Alison L. , Lê Kim‐Anne 
Published: November 2023

Study objectivesIntake of dietary sugars is a global concern and many national and international organizations have set targets to limit consumption. It remains unclear whether the focus should be on total or added sugars, and whether country‐specific recommendations are needed based on local dietary intakes. The aim of this study was to assess the differences between total and added sugars intakes in 4–13y old children in China, Mexico and the U.S. The secondary aim was to identify main sources of total and added sugars in the diets of these children.MethodsSecondary data analysis was conducted using the 2011 China Health and Nutrition Survey (CHNS), 2012 Mexican National Health and Nutrition Survey (ENSANUT), and the 2009–2012 U.S. National Health and Nutrition Examination Survey (NHANES). For the CHNS, dietary intake was collected from three consecutive 24h recalls; energy and nutrient intakes were calculated using the latest Chinese food composition table using 3‐day averages. For ENSANUT, dietary intake was collected using one 24h recall and energy and nutrients were calculated based on a combination of pre‐existing Mexican food composition tables and the food composition tables from the U.S. Department of Agriculture (USDA). For NHANES, usual intake was calculated using the National Cancer Institute (NCI) method with two non‐consecutive 24h recalls. Energy and nutrients were calculated using USDA food composition tables.ResultsMean ± standard error (SE) intakes of total sugars were 26.4 ± 0.6 grams/capita/day among Chinese children, 92.3 ± 1.5 grams/capita/day among Mexican children, and 126.9 ± 1.2 grams/capita/day among U.S. children. The top food sources of total sugar were fruits, buns, and cakes among Chinese children; soda, chocolate milk, and fruit juices among Mexican children; and fruit drinks, soda, and cookies and brownies among U.S. children. Mean ±SE intakes of added sugars were 9.0 ± 0.3 grams/capita/day among Chinese children, 54.8 ± 1.1 grams/capita/day among Mexican children, and 76.9 ± 1.3 grams/capita/day among U.S. children. Added sugar among Chinese children came primarily from foods, whereas added sugar in Mexico and the U.S. came mainly from beverages. The 90th percentile of added sugars intake among Chinese children (22.5 grams/capita/day) was lower than the 10th percentile of intake among U.S. children (45.1 grams/capita/day), revealing a large variation in intake between these two countries. Added sugars contributed to different percentages of total sugars across the countries (China: 35%; Mexico: 60%; U.S.: 61%).ConclusionsThere are important differences in intakes of total and added sugars between countries.Intakes of total sugar and added sugar were substantially lower among Chinese children compared to Mexican and U.S. children. Moreover, added sugars represented only a small proportion of total sugars intake in Chinese children, while accounting for almost 2/3 of total sugars in Mexican and U.S. children. Differences in food sources of sugars explain these findings. These data highlight the heterogeneity of food patterns worldwide, and the need for adapted country‐specific dietary recommendations.Support or Funding InformationNestlé Research Center