Changes in Sugar-Sweetened Beverage Intake From Before to After Nutrition Labeling Policy Implementation: A Comparison of Mexico and the United States

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Introduction: Sugar-sweetened beverages (SSBs) are a major source of added dietary sugars in Mexico and the US and contribute to chronic disease risk. In 2020, Mexico implemented mandatory front-of-package warning labels (FoPWLs), and the US implemented updated Nutrition Facts labels that increased the salience of calories and added sugars. We compared changes in SSB intake in Mexico and the US. Methods: Using 6 annual cross-sectional surveys (2018-2023) from the International Food Policy Study, we analyzed Mexican (n = 24,574) and US (n = 25,019) adults. Past-week SSB intake was summarized across 5 SSB categories. Outcomes were any SSB consumption, SSB consumption frequency, and, among SSB consumers, total volume, calories, and added sugars from SSBs. Difference-in-differences models with country-by-period interactions (2018-2019 vs 2020-2023) adjusted for sociodemographic and behavioral covariates; sex-stratified analyses were also conducted. Results: From 2018-2019 to 2020-2023, any SSB consumption and SSB consumption frequency increased in the US (adjusted odds ratio, 1.26; 95% CI, 1.17-1.36; adjusted incidence rate ratio, 1.16; 95% CI, 1.10-1.22, respectively). In Mexico, any SSB consumption also increased (adjusted odds ratio, 1.11; 95% CI, 1.00-1.22), but increases were smaller than in the US for any consumption (adjusted odds ratio, 0.88; 95% CI, 0.77-0.99) and frequency (adjusted incidence rate ratio, 0.89; 95% CI, 0.84-0.95). Among SSB consumers, changes in volume, calories, and added sugars did not differ between countries overall. In sex-stratified models, Mexican women had a greater relative reduction in SSB volume than US women (adjusted regression coefficient, -304 mL/week; 95% CI, -593 to -16). Conclusion: Compared with contemporaneous changes in the US, Mexico's FoPWL implementation was associated with more favorable trends in whether and how often adults consumed SSBs, but not in overall changes in volume, calories, or added sugars among SSB consumers.

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