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

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.