The Association of Nativity and Time in the United States on Added Sugar Consumption

Abstract

Background

Diets high in added sugar are associated with adverse health conditions. Immigrants may have different added sugar intake than nonimmigrants, which may contribute to differential health outcomes.

Objectives

We examined 1) the cross-sectional association between added sugar intake and nativity and time in the United States and 2) prospective association between added sugar intake and all-cause mortality by nativity.

Methods

Cross-sectional analyses were based on 17,489 adults (≥18 y) from the NHANES (2011 to March 2020) and prospective analyses were based on 31,291 adults (≥18 y) from NHANES 2003–2018. Multivariable linear regression models were used to assess the association between added sugar intake as a percent of energy, nativity (US-born compared with non-US-born), and time in the United States (<5 years, 5 to <15 y, 15–30 y, ≥30 y), after adjusting for important confounders. Multivariable Cox regression models were conducted to examine the association between added sugar intake and mortality.

Results

After adjusting for sociodemographic factors and BMI, individuals not born in the United States had 3.29% lower (95% CI: –3.69, –2.90, P < 0.001) added sugar intake as a percent of energy compared with those born in the United States. These associations were consistent across all race/ethnicities. As time in the United States increased, added sugar intake increased significantly (P-trend < 0.001) among non-US-born individuals. Added sugar intake was not significantly associated with lower risk of all-cause mortality in non-US-born individuals or US-born individuals, after adjusting for confounders.

Conclusions

Added sugar intake differed by nativity and time in the United States, underscoring the need to consider place of birth and length of time when characterizing dietary intake.