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Energy density of foods and diets in Mexico and their monetary cost by socioeconomic strata: analyses of ENSANUT data 2012
  1. Alfonso Mendoza1,2,
  2. Ana E Pérez2,
  3. Anju Aggarwal1,
  4. Adam Drewnowski1
  1. 1Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
  2. 2Centro de Investigación e Inteligencia Económica (CIIE), Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla, México
  1. Correspondence to Dr Adam Drewnowski, University of Washington, Nutritional Sciences, Raitt Hall 305E, P.O. Box 353410, Seattle, WA 98195, USA; adamdrew{at}


Background In January 2014, Mexico implemented an 8% tax on non-essential foods with energy density ≥275 kcal/100 g, with a view to prevent obesity. This study explored energy density of foods and diets in Mexico and their monetary cost across population subgroups.

Methods Dietary intakes for 3057 adults (ages ≥19 years) were obtained from the nationally representative Encuesta Nacional de Salud y Nutrición (ENSANUT 2012). Energy density (kcal/g) was calculated for foods, food groups and total diets. The mean national retail prices for 153 foods were obtained from the National Institute for Geography and Statistics (INEGI). The monetary cost of total diets (MXN/day) was estimated by attaching food prices to dietary intakes from the ENSANUT food frequency questionnaire. A series of descriptive analyses and regression models examined associations among dietary energy density and diet cost by age, gender, rural or urban residence and socioeconomic status (SES).

Results Energy-dense grains, fats and sweets cost less per calorie than did milk and dairy, meat, vegetables and fruit. Lower cost diets derived more calories from tortillas, tamales, beans and sugar, whereas higher cost diets contained more non-essential energy-dense processed foods and more sugar sweetened beverages, and fruits and vegetables. At each quintile of energy intake, higher dietary energy density was associated with lower energy-adjusted diet costs. Traditional energy-dense tortillas and tamales, also characterised by lower cost, were consumed more by the rural poor. Urban dwellers had more ‘western-style’ diets.

Conclusions Food patterns in Mexico appear to be driven by monetary cost and SES.

  • Economic evaluation
  • Health inequalities
  • DIET

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  • Contributors AD, AM and AA conceptualised and designed the study. AM and AEP carried out the analyses. AD and AM drafted the initial manuscript, and approved the final manuscript as submitted. All authors reviewed and revised the manuscript, and approved the final manuscript as submitted.

  • Funding This work was supported by funds from the Mexican National Council for Science and Technology (CONACYT) (AM, grant number 203 937); NIH grant NIDDK (AD, grant number R01DK076608).

  • Disclaimer Funders had no role in the design, analysis or writing of this article.

  • Competing interests AM, AEP and AA have no conflict of interest to disclose. AD has received grants, honoraria and consulting fees from numerous food, beverage and ingredient companies and from other commercial and non-profit entities with an interest in nutrient density of individual foods, meals and total diets.

  • Ethics approval Ethics approval for the ENSANUT study was granted on 26 September 2011 (CI1033; folio H26) by the IRB at the National Institute of Public health in Cuernavaca. This study is a secondary data analysis of the ENSANUT 2012. The data for the analysis were requested and obtained from the survey’s public repository hosted at the National Institute of Public Health web page at: This repository has the data already deidentified; thus, it is not possible to trace any of the data to the actual individual. In accordance with the Internal Regulation of the Research Ethics Committee of the National Institute of Public Health, this secondary analysis was considered exempt from approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The ENSANUT 2012 data are available at: