Apparent consumption of caloric sweeteners increased after the implementation of NAFTA in Mexico

Abstract The consumption of sugar and sweeteners have been associated with obesity and diabetes, which are public health problems in Mexico. Since 1994, imports of sweeteners for the elaboration of ultra-processed food and beverages increased in the country. This increase in imports may have increased the apparent consumption of sweeteners which could be associated with the implementation of the NAFTA that gradually eliminated tariffs on sugars. However, no study has estimated trends in apparent consumption by type of sugar, and its association with NAFTA in Mexico. Therefore, we analyzed trends in apparent consumption of sugar and sweeteners, and its contribution to energy from 1961 to 2013. We assessed if the gradual implementation of NAFTA in 1994, 1998, 2003 and 2008 was associated with changes in the consumption of sugar and sweeteners in Mexico using the Food Balance Sheet data from the Food and Agriculture Organization of the United Nations. We estimated an interrupted time series analysis with synthetic controls using OECD countries, to assess the association between NAFTA and changes in the type of sugar consumed. We found that between 1961 and 2013, the contribution of sugars to daily energy increased from 243 to 456 (243 to 456 kcal/capita/day). Until 1993, the consumption of sweeteners was 0.20 kg/capita/year and in 2013 reached 12.9 kg/capita/year, representing 20% of total sugar consumption. The consumption of sweeteners increased 2.93 kcal/capita/day after the NAFTA was implemented in 1994. However, there was a reduction in apparent consumption of −2.95 kcal/capita/day between 1998 and 2002, concurrent with the implementation of a 12.5% ad valorem compensatory duty to high fructose corn syrup imports from the US. Consumption increased again 7.7 kcal/capita/day between 2003 and 2007 and up to 10.4 kcal/capita/day after 2008 when the NAFTA was fully implemented. We found a significant increase in the apparent consumption of sweeteners associated with NAFTA but we did not find a conclusive evidence when we estimates total sugars and sweeteners together because we lacked an adequate control group. Sweeteners are mainly used for producing beverages and processed food, so its consumption should be discouraged by improving the existing package of interventions in Mexico, including a 20–30% increase to current taxes that have proven to be effective to reduce sugar sweetened beverages and nonessential energy dense food but whose existing rates are relatively small; improving front of package labelling, monitoring compliance in school regulations for food and beverages sold and improving marketing regulations directed to children.