Dietary Sugar Intake Research Articles

Feasibility and Acceptability of ICT (Information and Communications Technologies) Based Mobile Chatbot Technology to Reduce Dietary Sugar Intake (P04-004-19)

ObjectivesA high level of dietary sugars intake is of concern because of its association with poor dietary quality, obesity, and risk of Noncommunicable diseases (NCDs). The ICT-based healthcare has been increasingly perceived to be an effective way to dietary assessment and monitoring. We engaged a mobile chat robot which can monitor dietary sugar intake after recording dietary intake and provide education message on the reduction of dietary sugar intake. Here, we examined the feasibility and acceptability of ICT based mobile chatbot to reduce dietary sugar intake. MethodsIn a two-month pre–post intervention study, 68 female college students aged 18–25 years consented and participated in this study. Participants were instructed to record all foods and beverages consumed using text mode input daily and received education message on the reduction of sugar intake once a week. At post intervention, participants were asked to answer the questionnaire about feasibility and acceptability test of chatbot by using Likert 5-point scale. ResultsThe 91.2% of subjects reported chatbot was easy to use, and the 72% of participants answered the chatbot was easy to monitor their sugar intake. Among subjects, the 88.2% reported that they realized about their own dietary sugar intake, and the 92.6% answered the education message was very helpful to reduce dietary sugar intake. Meanwhile, 64.7% reported the burdensome to use the chat robot, and the 69.1% had trouble remembering to record their food intake. ConclusionsICT based mobile chatbot technology is represented to be feasible and acceptable in this study. Almost all participants reported that it is easy to use and monitor their sugar intake, and they were able to learn about nutrition education including monitoring sugar intake. The use of chatbot, however, can sometimes be a burden. Additional research is needed to ease the burden of participants to draw better and more accurate data. Funding SourcesDepartment of Food and Nutrition, Sookmyung Women’s University, Republic of Korea.

The association between dietary sugar intake and neuromyelitis optica spectrum disorder: A case–control study

BackgroundNeuromyelitis optica spectrum disorder (NMOSD) is an uncommon autoimmune disease of the central nerves system (CNS) by inflammatory nature. The effects of high dietary sugar intake on inflammation and dysbiosis have been received more attention in recent years. The aim of the present study was to investigate the association between various types of dietary sugar intake and NMOSD odds and clinical features. MethodThe current case–control study was conducted among 70 patients with definite NMOSD diagnosis based on 2015 international consensus criteria and 164 hospital-based controls. Demographic and anthropometric information in all participants and disease characteristics just in case group were obtained. Dietary data during the past year of study attendance was collected by a validated 168-item food frequency questionnaire. Participants were stratified into 3 tertiles according to each type of sugar intake and the third tertile considered as reference in multivariate regression models. The correlation between dietary sugar and disease features were analyzed using Pearson correlation test. ResultsThe mean ± SD of total sugar intake increased from 80.73 ± 17.71 to 208.71 ± 57.93 g/day across tertiles of total sugar intake. In fully adjusted model, lower intake of sugar was associates with decreased odds of NMOSD in the first tertile vs third tertile by ORs of: 0.02(CI:0.00–0.08; p-for-trend:0.00), 0.02(CI:0.00–0.10; p-for-trend:0.00), 0.23(CI:0.08–0.61; p-for-trend:0.00), 0.19(CI:0.06–0.58; p-for-trend:0.00) and 0.16(CI:0.05–0.51; p-for-trend:0.00) for glucose, fructose, galactose, lactose and sucrose, respectively. The odds of NMOSD had a 1.72-fold (CI: 1.43–2.03; p-for-trend:0.00) significant raise per every 10 g increase for total sugar intake. There was no significant correlation between various types of dietary sugar intakes and relapse rate or patients’ disability. ConclusionThe present study proposes a possible direct association between high intake of various sugar types and odds of suffering from NMOSD. More investigations are needed to prove this results.

Влияние алиментарного фактора на развитие язвенного колита

The aim was to аssess the effect of nutritional factors on the risk of developing ulcerative colitis based on an analysis of food consumed. Assess the importance of consumption of certain nutrients in its development among the population of Western Siberia. Materials and methods: A survey of 81 patients with ulcerative colitis and 39 healthy volunteers was conducted. The profile of the eating habits of patients with ulcerative colitis (before diagnosis) in relation to healthy respondents was investigated. Results. The diet of patients with ulcerative colitis before the first signs of the disease is distinguished by the rare consumption of fresh and cooked vegetables and fruits in small portions, the consumption of more sugar with tea and / or coffee compared to healthy ones. Also, patients poorly tolerated milk and dairy products before the debut of the disease. Conclusion. Our study confirms the possible effect of a lack of dietary fiber and excessive sugar intake on the onset of ulcerative colitis.

Qualitative Study of Barriers to Adherence to Antihypertensive Medication among Rural Women in India.

Objective There is poor adherence to antihypertensive therapies among women in India. To determine its socioeconomic barriers we performed a qualitative study on Indian rural women with hypertension. Methods In-depth interviews with women having hypertension and presenting to outpatient department at a teaching hospital were performed in 30 women aged 35-65 years, using a questionnaire focused on reasons for nonadherence and poor lifestyle modification. Low to medium adherence was observed in two-thirds of women. Results Majority of women were from low socioeconomic status and were illiterate. Awareness of hypertension and its complications was poor. Knowledge and practices of cessation of smoking and tobacco use and salt restriction in hypertension were low. Efforts to increase physical activity and decrease dietary fat and sugar intake were largely absent. Local follow-up at rural community health centres was not practiced due to physician nonavailability and about half used alternative systems of medicine. None had health insurance or access to free medicines. All the women had to pay out-of-pocket for medicines and were concerned with cost of therapy as well as pill burden. Half of the women borrowed money from relatives or friends to reach the hospital and pay for medicines. Conclusions Socioeconomic barriers for low adherence to antihypertensive medication in women in India are low awareness of hypertension and complications, poor access to care, out-of-pocket payments, borrowing money, lack of insurance, and cost of medicines.

Contribution of fat, sugar and salt to diets in the Pacific Islands: a systematic review.

Pacific Island countries are experiencing a high burden of diet-related non-communicable diseases; and consumption of fat, sugar and salt are important modifiable risk factors contributing to this. The present study systematically reviewed and summarized available literature on dietary intakes of fat, sugar and salt in the Pacific Islands. Electronic databases (PubMed, Scopus, ScienceDirect and GlobalHealth) were searched from 2005 to January 2018. Grey literature was also searched and key stakeholders were consulted for additional information. Study eligibility was assessed by two authors and quality was evaluated using a modified tool for assessing dietary intake studies. Thirty-one studies were included, twenty-two contained information on fat, seventeen on sugar and fourteen on salt. Dietary assessment methods varied widely and six different outcome measures for fat, sugar and salt intake - absolute intake, household expenditure, percentage contribution to energy intake, sources, availability and dietary behaviours - were used. Absolute intake of fat ranged from 25·4 g/d in Solomon Islands to 98·9 g/d in Guam, while salt intake ranged from 5·6 g/d in Kiribati to 10·3 g/d in Fiji. Only Guam reported on absolute sugar intake (47·3 g/d). Peer-reviewed research studies used higher-quality dietary assessment methods, while reports from national surveys had better participation rates but mostly utilized indirect methods to quantify intake. Despite the established and growing crisis of diet-related diseases in the Pacific, there is inadequate evidence about what Pacific Islanders are eating. Pacific Island countries need nutrition monitoring systems to fully understand the changing diets of Pacific Islanders and inform effective policy interventions.

Consumption of low-calorie sweetened beverages and water is associated with lower intake of carbohydrates and sugars and not associated with glycemic response in U.S. non-diabetic adolescents: Results from the 2001–2014 National Health and Nutrition Examination Surveys

ObjectivesConsumption of no- and low-calorie sweetened beverages (LCSBs) in the United States appears to be on the rise. To our knowledge, the relationships between LCSB consumption and dietary intake and metabolic outcomes in adolescents have not been thoroughly investigated. The aim of this study was to evaluate possible associations between LCSB and water consumption with nutrient intake and prediabetes criteria among adolescents who were free of diabetes. MethodsThis cross-sectional study evaluated possible associations between LCSB consumption and water consumption using a 24-h diet recall from the National Health and Nutrition Examination Survey (NHANES) 2001–2014 in 8868 adolescents 12 to 18 y of age who were free of diabetes. ResultsCompared with consuming <1 serving/d, consuming ≥1 serving/d of either LCSB or water was significantly associated with lower consumption of carbohydrates (LCSB: –22 g; water: –15 g), total sugars (LCSB: –29 g; water: –20 g), and added sugars (LCSB: –5.7 tsp eq; water: –6 tsp eq). Neither LCSB nor water intake were associated with any measures of glycemic response. ConclusionsThese findings suggest that consuming ≥1 serving/d of either LCSB or water is not associated with an increased risk for prediabetes. Confirmation of these findings with a larger sample within the context of a randomized clinical trial would further suggest that LCSBs may represent an additional beverage option other than water for adolescents to help moderate overall dietary sugar intake.

Nutrition education discouraging sugar intake results in higher nutrient density in diets of pre-school children.

BACKGROUND/OBJECTIVESThe intake of sugar has increased worldwide, and it is well established that childhood experiences and food preferences affect lifelong eating habits. To discourage sugar intake, nutrition education was imparted, and the effectiveness of the nutrition education program was investigated by considering the nutrient density and major dietary sources of sugar intake.SUBJECTS/METHODSTwenty four-hour dietary recall and sugar intake frequency of 96 pre-school children (educated n = 47; non-educated n = 49) were collected on 3 consecutive days (1 weekend day, 2 weekdays) after 11 weeks of imparting nutrition education. Dietary intake of nutrients and total sugar were analyzed, and the intake frequency of sugar source foods were identified. All nutrition education programs were focused on a hands-on education program, and consisted of cooking lab, play, activity, animation, and visual materials. The difference between the two groups was verified by the Chi-square test or t-test. All statistical analysis was performed with significance level at P < 0.05.RESULTSCompared to the non-educated group, the intakes of protein (P < 0.001), fiber (P < 0.01), potassium (P < 0.05), iron (P < 0.05), zinc (P < 0.05), and iodine (P < 0.001) were significantly higher, and the intakes of carbohydrate (P < 0.01) and total sugar (P < 0.05) were significantly lower in the educated group. The cumulative percent of sugar intake of top 20 sugar source foods in the educated group (82.80%) was lower than that of the non-educated group (85.75%). The contribution of beverages on total sugar intake was lower in the educated group. The average frequency of consuming sugary foods was significantly lower in the educated group (P < 0.05).CONCLUSIONSOur results indicate that nutrition education on discouraging sugar intake is effective in reducing the amount of total sugar consumed, resulting higher nutrient density in the diets of pre-school children.

Psychometric Evaluation of the German Version of the Dietary Fat and Free Sugar-Short Questionnaire

Background: The Dietary Fat and Free Sugar-Short Questionnaire (DFS) is a cost- and time-efficient self-report screening instrument to estimate dietary intake of saturated fat and free sugar. To date, only the English version has been psychometrically evaluated. We assessed the psychometric characteristics of the German version of the DFS in individuals with normal weight, overweight, and obesity. Method: Sixty-five adult participants completed a German translation of the DFS and a validated food frequency questionnaire (FFQ). We correlated participants’ percentage of energy intake from saturated fat and free sugar from the FFQ with the DFS scores. To establish test-retest reliability, participants completed the DFS a second time. To investigate convergent validity, we correlated participants’ DFS scores with self-reported eating behavior and sensitivity to reward. Results: DFS scores correlated with percentage of energy from free sugar (rs = 0.443) and saturated fatty acids (rs =0.258) but not with non-target nutrients. The correlation between DFS scores and percentage energy from free sugar was not moderated by body mass index (BMI), whereas the correlation with percentage energy from saturated fat slightly decreased with BMI. Intra-class correlation as an indicator of test-retest reliability was 0.801. DFS scores correlated significantly with restraint of eating behavior (rs = –0.380) and feelings of hunger (rs = 0.275). Correlations of the DFS score with disinhibited eating and sensitivity to rewards failed to be significant. Conclusion: Our data indicate that the German version of the DFS might be a psychometrically sound self-report instrument to estimate saturated fat and free sugar intake of German adults.

Mobile application-based dietary sugar intake reduction intervention study according to the stages of behavior change in female college students

Mobile application-based dietary sugar intake reduction intervention study according to the stages of behavior change in female college students

Socioeconomic burden of sugar-sweetened beverages consumption in Korea.

BACKGROUND/OBJECTIVESExcessive sugar consumption may increase the risk for development of several diseases. Although average dietary sugar intake of Koreans is within the recommended level, an increasing trend has been found in all age groups. This study aimed to evaluate the population attributable fractions (PAF) to dietary sugar for disease and death in Korea, and to estimate the socioeconomic effects of a reduction in dietary sugar.MATERIALS/METHODSThe prevalence of sugar-sweetened beverages (SSB) overconsumption (≥ 20 g of sugar from beverages) was analyzed using the Korean National Health and Nutrition Examination Survey 2015. Disease-specific relative risks of excessive SSB consumption were obtained through reviewing previous studies. Using the prevalence of SSB overconsumption and each relative risk, PAFs for morbidity and mortality were calculated. Socioeconomic costs of diseases and death attributable to SSB overconsumption were estimated by using representative data on national medical expenditures, health insurance statistics, employment information, and previous reports.RESULTSDisease-specific PAF to SSB consumption ranged from 3.11% for stroke to 9.05% for obesity and dental caries, respectively. Costs from disease caused by SSB overconsumption was estimated at 594 billion won in 2015. About 39 billion won was estimated to be from SSB consumption-related deaths, and a total of 633 billion won was predicted to have been saved through preventing SSB overconsumption.CONCLUSIONSSugars overconsumption causes considerable public burdens, although the cost estimates do not include any informal expenditure. Information on these socioeconomic effects helps both health professionals and policy makers to create and to implement programs for reducing sugar consumption.

Urinary Sucrose and Fructose Excretion are Associated With Dietary Sugar Intake in Healthy Postmenopausal Women with Normal Weight and Obesity

Upon completion, participant will be able to describe the association between dietary sugars and excretion of sugars in the urine for women with healthy weight and obesity.

Serial MRI Imaging Reveals Minimal Impact of Ketogenic Diet on Established Liver Tumor Growth.

Rodent models of liver tumorigenesis have reproducibly shown that dietary sugar intake is a powerful driver of liver tumor initiation and growth. In contrast, dietary sugar restriction with ketogenic diets or calorie restriction generally prevents liver tumor formation. Ketogenic diet is viewed positively as a therapeutic adjuvant; however, most ketogenic diet studies described to date have been performed in prevention mode rather than treatment mode. Therefore, it remains unclear whether a ketogenic diet can be administered in late stages of disease to stall or reverse liver tumor growth. To model the clinically relevant treatment mode, we administered a ketogenic diet to mice after liver tumor initiation and monitored tumor growth by magnetic resonance imaging (MRI). Male C57BL/6 mice were injected with diethylnitrosamine (DEN) at 2 weeks of age and fed a chow diet until 39 weeks of age, when they underwent MRI imaging to detect liver tumors. Mice were then randomised into two groups and fed either a chow diet or switched to a ketogenic diet from 40–48 weeks of age. Serial MRIs were performed at 44 and 48 weeks of age. All mice had tumors at study completion and there were no differences in total tumor burden between diet groups. Although a ketogenic diet has marked protective effects against DEN-induced liver tumourigenesis in this mouse model, these data demonstrate that ketogenic diet cannot stop the progression of established liver tumors.

Prevention of dental caries as a non-communicable disease.

Today, dental caries is regarded as a preventable non-communicable disease (NCD) that affects a majority of the population across their lifespan. As such, it shares a number of behavioural, socio-economic, and lifestyle factors with other NCDs, such as overweight and diabetes, and should be subjected to a similar model of chronic disease management. Caries prevention has traditionally relied on fluoride exposure, diet control, thorough oral hygiene, and antibacterial measures. Prevention of caries as an NCD does certainly not disqualify these methods, but brings them into a new context. This conference paper provides a brief review on how common preventive measures can interfere with the drivers of dysbiosis and promote the growth of health-associated clusters in the oral microbiome. Besides the established routines of regular toothbrushing with fluoride products, there is an opportunity for additional technologies, based on ecological principles, to address and modify the oral biofilm. Methods to reduce dietary sugar intake, slow down plaque metabolism, and support saliva functions should be further developed and investigated in terms of efficacy, compliance, and cost-effectiveness. Furthermore, biofilm engineering through pre- and probiotics early in life to support microbial diversity seem promising in order to obtain a sustained caries-preventive effect.

Dietary sugar intake does not pose any risk of bone loss and non-traumatic fracture and is associated with a decrease in all-cause mortality among Chinese elderly: Finding from an 11-year longitudinal study of Mr. and Ms. OS Hong Kong.

The association of dietary sugar intake and skeletal health remains uncertain in the elderly. We aimed to investigate the association of sugar intake with the bone health and mortality of Chinese elderly. An analysis was conducted through an 11-year longitudinal study (Mr. and Ms. OS Hong Kong). Four thousand Chinese elderly aged 65 and older were recruited from the local community between 2001 and 2003. Sugar intake was assessed at baseline by a validated 329-item Food Frequency Questionnaire and a local sugar database. The bone mineral density (BMD) was examined at baseline and the fourth year follow-up by a dual-energy X-ray absorptiometry. Data on the incidence of non-traumatic fractures (total, hip and osteoporotic sites) and all-cause mortality were collected. The multivariable logistic and Cox regression models were used to test the associations of sugar intake with bone health and all-cause mortality. No significant association was observed between sugar intakes and BMD changes in the fourth year's follow-up. During a total 34,483 person years' follow-up, we documented 433 non-traumatic fractures and 769 deaths. Although lack of significant association with the incidence of non-traumatic fractures, high added sugar intakes were significantly associated with a low risk of all-cause mortality among the elderly with a hazard ratio of 0.750 (95% CI: 0.590-0.954, P for trend = 0.007) in the highest quintile compared with that in the lowest quintile. The amount of sugar consumed by the Chinese elderly did not pose any risk of bone loss and fracture. Moreover, high sugar intake of the elderly was associated with a low rate of all-cause mortality.

Duration of exclusive breastfeeding may be related to eating behaviour and dietary intake in obesity prone normal weight young children

Infants who are breastfed are introduced to a variety of flavours from the maternal milk, and thus the transition from maternal milk to complementary foods may be easier for these children. The aim of this study was to investigate if duration of exclusive breastfeeding was associated with pickiness or dietary intake of vegetables, fruit, starchy foods or sugar sweetened beverages among obesity prone normal weight children aged 2–6 years. This cohort study was based on data from the Healthy Start primary intervention study, the Danish Medical Birth registry and the Danish Health Visitor’s Child Health Database. Infant feeding was registered by health nurses while home-visiting the mother and child up to four times within the first year. Information on eating behaviour and diet intake at age 2–6 years was obtained by parents. Crude and adjusted logistic and general linear regression models were used to investigate associations. A total of 236 children had complete information on all variables. Data showed lower odds of picky eating behaviour when exclusively breastfed until age 4–5 months compared to exclusively breastfed for 0–1 months (OR = 0.35, 95CI = 0.16;0.76, p = 0.008). In the crude analysis only, exclusively breastfed until age 6–10 months was associated with a higher daily intake of vegetables (p = 0.04). This study suggests that exclusive breastfeeding duration seems to influence pickiness and may contribute to facilitate the consumption of more vegetables in later childhood in obesity prone normal weight children.

Eating behavior and dietary intake in obesity prone normal weight children may be related to duration of exclusive breastfeeding

Introduction Infants who are breastfed are introduced to a variety of flavors from the maternal milk and thus the transition from maternal milk to complementary foods seems easier for these children. Our aim was to investigate if duration of exclusive breastfeeding was associated with pickiness or dietary intake of vegetables, fruit, starch or sugar sweetened beverages in obesity prone normal weight children aged 2–6 years. Methods This cohort study was based on data from the Healthy Start primary intervention study, the Danish Medical Birth registry and the Danish Health Visitor's Child Health Database. Infant feeding was registered by health nurses while visiting the mother and child up to four times within the first year. Information on eating behaviour at age 2–6 years and the child's dietary intake were obtained by parents. Crude and adjusted logistic regression and general linear models were used to investigate associations. Results A total of 236 children had complete information on all variables. Data showed a tendency towards a higher risk of developing picky eating behaviour when breastfeed for Conclusions This study documents evidence that exclusive breastfeeding duration may influence pickiness and potentially facilitate the consumption of a healthier diet in later childhood in obesity prone normal weight children, which also have been reported in studies of children in general.

Effect of Dietary Sugar Intake on Biomarkers of Subclinical Inflammation: A Systematic Review and Meta-Analysis of Intervention Studies.

It has been postulated that dietary sugar consumption contributes to increased inflammatory processes in humans, and that this may be specific to fructose (alone, in sucrose or in high-fructose corn syrup (HFCS)). Therefore, we conducted a meta-analysis and systematic literature review to evaluate the relevance of fructose, sucrose, HFCS, and glucose consumption for systemic levels of biomarkers of subclinical inflammation. MEDLINE, EMBASE, and Cochrane libraries were searched for controlled intervention studies that report the effects of dietary sugar intake on (hs)CRP, IL-6, IL-18, IL-1RA, TNF-α, MCP-1, sICAM-1, sE-selectin, or adiponectin. Included studies were conducted on adults or adolescents with ≥20 participants and ≥2 weeks duration. Thirteen studies investigating 1141 participants were included in the meta-analysis. Sufficient studies (≥3) to pool were only available for (hs)CRP. Using a random effects model, pooled effects of the interventions (investigated as mean difference (MD)) revealed no differences in (hs)CRP between fructose intervention and glucose control groups (MD: −0.03 mg/L (95% CI: −0.52, 0.46), I2 = 44%). Similarly, no differences were observed between HFCS and sucrose interventions (MD: 0.21 mg/L (−0.11, 0.53), I2 = 0%). The quality of evidence was evaluated using Nutrigrade, and was rated low for these two comparisons. The limited evidence available to date does not support the hypothesis that dietary fructose, as found alone or in HFCS, contributes more to subclinical inflammation than other dietary sugars.

Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosis.

SummaryA 28-year-old male presented with 2 days of vomiting and abdominal pain, preceded by 2 weeks of thirst, polyuria and polydipsia. He had recently started risperidone for obsessive-compulsive disorder. He reported a high dietary sugar intake and had a strong family history of type 2 diabetes mellitus (T2DM). On admission, he was tachycardic, tachypnoeic and drowsy with a Glasgow Coma Scale (GCS) of 10/15. We noted axillary acanthosis nigricans and obesity (BMI 33.2 kg/m2). Dipstick urinalysis showed ketonuria and glycosuria. Blood results were consistent with diabetic ketoacidosis (DKA), with hyperosmolar state. We initiated our DKA protocol, with intravenous insulin, fluids and potassium, and we discontinued risperidone. His obesity, family history of T2DM, acanthosis nigricans and hyperosmolar state prompted consideration of T2DM presenting with ‘ketosis-prone diabetes’ (KPD) rather than T1DM. Antibody markers of beta-cell autoimmunity were subsequently negative. Four weeks later, he had modified his diet and lost weight, and his metabolic parameters had normalised. We reduced his total daily insulin dose from 35 to 18 units and introduced metformin. We stopped insulin completely by week 7. At 6 months, his glucometer readings and glycated haemoglobin (HbA1c) level had normalised.Learning points:Risperidone-induced diabetic ketoacidosis (DKA) is not synonymous with type 1 diabetes, even in young white patients and may be a manifestation of ‘ketosis-prone’ type 2 diabetes (KPD).KPD is often only confirmed after the initial presentation, when islet autoimmunity and cautious phasing out of insulin therapy have been assessed, and emergency DKA management remains the same.As in other cases of KPD, a family history of T2DM and presence of cutaneous markers of insulin resistance were important clinical features suggestive of an alternative aetiology for DKA.

여대생의 생활스트레스 요인에 따른 식생활 유형과 당류 섭취 실태에 관한 구조적 관계 연구

여대생의 생활스트레스 요인에 따른 식생활 유형과 당류 섭취 실태에 관한 구조적 관계 연구

Non-Nutritive Sweeteners in the Packaged Food Supply-An Assessment across 4 Countries.

Increased interest among consumers in the reduction of dietary sugar intake has led to the wider availability of food products containing non-nutritive sweeteners (NNS). However, the extent to which NNS are currently being used by manufacturers to sweeten processed food and beverage products, and how NNS may be displacing added sugars as a sweetener is unknown. The current study utilized branded food composition databases from Australia, Mexico, New Zealand and the US to determine the percentage of processed food and beverage products for which there are nutrition data containing NNS and to compare total sugar density (g per 100 mL for beverages and g per 100 g for foods) between products with and without NNS. Ordinary least squares regression at the country-product level was performed to examine associations between presence of NNS and total sugar. Across all countries, 5% of products contained at least one NNS, with the highest prevalence among beverages (22%). Mexico had the highest percentage of products with NNS (11%), as compared to the United States (US) (4%), New Zealand (1%), and Australia (<1%). The presence of NNS was associated with lower mean total sugar density among beverages (range across countries: 7.5 to 8.7 g per 100 mL) and among foods (23.2 to 25.5 g per 100 g). Products with both added sugar ingredients and NNS had a lower overall mean total sugar density when compared to products containing only added sugar ingredients. Due to paucity of data on sales and market shares across these countries, our results do not reflect the extent to which consumers purchase NNS containing products. Continued monitoring of NNS in the food supply, extension of work from these data, and inclusion of market shares of products will be important as more countries introduce policies to reduce sugar.