Public Health Nutrition: 12(11), 2084–2091 doi:10.1017/S1368980009005588 Sugar and total energy content of household food purchases in Brazil Renata Bertazzi Levy 1,2 , Rafael Moreira Claro 2 and Carlos Augusto Monteiro 2,3, * 1 Nu ´cleo de Investigac ¸a ˜o em Nutric ¸a ˜o, Instituto de Sau ´de, Secretaria do Estado de Sau ´de de Sa ˜o Paulo (IS/SES), Sa ˜o Paulo, Brazil: 2 Nu ´cleo de Pesquisas Epidemiolo ´gicas em Nutric ¸a ˜o e Sau ´de, Universidade de Sa ˜o Paulo (NUPENS/USP), Sa ˜o Paulo, Brazil: 3 Departamento de Nutric ¸a ˜o, Faculdade de Sau ´de Pu ´blica, Universidade de Sa ˜o Paulo (USP), Av. Dr Arnaldo 715, 2  - andar, CEP 01246-904, Sa ˜o Paulo, SP, Brazil Submitted 26 August 2008: Accepted 26 February 2009: First published online 30 April 2009 Abstract Objective: To study the role of energy derived from sugar (both table sugar and sugar added to processed foods) in the total energy content of food purchases in Brazil. Design: Food purchase data were collected during a national household budget survey carried out between June 2002 and July 2003 on a probabilistic sample representative of all households in the country. The amount of food purchased in this 12-month period was transformed into energy and energy from sugar using food composition tables. Multiple linear regression models were used to study the association between amount of energy from sugar and total energy content of food purchases, controlling for sociodemographic variables and potential inter- actions between these variables and sugar purchases. Results: There was a positive and significant association between energy from sugar and total household energy purchases. A 1 kJ increase in sugar purchase corresponded to a 3?637 kJ increase in total energy. In the absence of expenditure on meals outside the home, i.e. when household food purchases tend to approximate actual food consumption by household members, sugar purchase of 1926?35 kJ/d (the 90th percentile of the distribution of sugar purchases in Brazil) was associated, depending on income strata, with total energy purchase over 40–60 % of the recommended daily value for energy intake in Brazil. Conclusions: The present results corroborate the recommendations of the WHO and the Brazilian Ministry of Health regarding limiting the consumption of sugar. Keywords Sugar Total energy intake Food expenses Budget survey Obesity Brazil Demographic and economic changes are accelerating across the globe, and particularly in developing countries. Such changes have an especially marked effect on diet composition. Noteworthy among these effects is the increased consumption of sugar (both table sugar and sugar added by the processed food industry) and fat, along with the decrease in consumption of complex carbohydrates (1) . An analysis of global food availability showed that the per capita availability of sugar increased by 32 % between 1962 and 2000 (corresponding to a daily increase of 315 kJ). Urbanization and increased income are thought to account for 82 % of the increase in sugar intake, the remainder being attributed to factors related to changes in consumer behaviour and/or expansion of the food industry (2) . In the USA, per capita sugar intake among the population older than 2 years of age increased by 349 kJ/d between 1977 and 2000, which raised by 22 % the contribution of sugar to the total energy content of the diet in this population (from 13?0% to 15?8 %). Of this increase, 227 kJ corresponded to soft drinks and 55 kJ to sweetened fruit juice. Among adolescents, there was an increase in the intake of soft drinks at the expense of milk (2) . Brazil is the biggest sugar producer in the world, with an annual production of 26?4 million tonnes (raw sugar equivalent) in 2003. In this same year, the per capita availability of sugar in Brazil was 2310 kJ/d, which cor- responded to 17?5 % of total energy available for con- sumption. This high contribution of sugar to the total food supply, one of the highest in the world, has remained almost unchanged since the early 1960s (3) . The potential health hazards associated with increased sugar intake and the maximum limits for its contribution to the diet have been the object of intense debate in national and international forums (1,4,5) . The WHO and the FAO claim there is convincing evidence that excessive sugar intake increases the risk of at least two important public health problems: obesity (via increased energy intake) and dental caries. Based on this evidence, these *Corresponding author: Email carlosam@usp.br r The Authors 2009