High sugar-sweetened beverage intake predicts adverse physical, emotional, and sleep health trajectories in adolescents: a 4-year prospective cohort study.

BACKGROUND

Excessive consumption of sugar-sweetened beverages (SSBs) is a major source of added sugars among adolescents and has been associated with adverse cardiometabolic, emotional, and sleep-related outcomes. However, longitudinal evidence from Asian populations remains limited. This 4-year prospective cohort study examined the associations between SSB intake and multiple health trajectories during adolescence.

METHODS

A total of 1,204 adolescents (baseline age: 12.41 ± 0.89 years; 51.2% girls) from 12 secondary schools in Chongqing, China, were followed annually from 2021 to 2024. SSB intake was assessed using a validated food frequency questionnaire adapted for use among Chinese adolescents. Outcomes included body mass index (BMI), body fat percentage, systolic blood pressure, depressive symptoms (CES-D), academic burnout, and sleep quality (Pittsburgh Sleep Quality Index, PSQI). Longitudinal associations were examined using linear mixed-effects models adjusted for age, sex, socioeconomic status, physical activity, screen time, and baseline BMI.

RESULTS

Higher SSB intake was associated with significantly steeper increases in BMI (mean increase: +2.87 vs. +1.90 kg/m2), body fat percentage (+4.6% vs. +2.1%), systolic blood pressure (+4.8 vs. +2.1 mmHg), depressive symptoms (CES-D: +6.0 vs. +2.0 points), and sleep disturbance (PSQI: +1.3 vs. +0.4 points) compared with the lowest intake tertile (all p < 0.01). Adolescents in the highest SSB tertile exhibited a 62% greater increase in depressive symptoms over 4 years. Participants who reduced SSB intake by ≥30% showed significantly smaller increases across physical, emotional, and sleep-related outcomes.

CONCLUSION

High SSB intake is prospectively associated with unfavorable cardiometabolic, emotional, and sleep-related health trajectories during adolescence. Reducing SSB consumption represents a promising and actionable strategy for school-based health promotion and chronic disease prevention among Asian youth.