High sugar-sweetened beverage intake predicts adverse physical, emotional, and sleep health trajectories in adolescents: a 4-year prospective cohort study.
Zhang Z, Li W, Zhang M, Zhang Y • Frontiers in public health • 2026
High sugar-sweetened beverage intake is prospectively associated with unfavorable cardiometabolic, emotional, and sleep-related health trajectories during adolescence, and reducing SSB consumption by ≥30% was associated with significantly smaller increases across physical, emotional, and sleep-related outcomes.
Key Findings
Results
Higher SSB intake was associated with significantly steeper increases in BMI over 4 years compared to the lowest intake tertile.
Mean BMI increase in the highest SSB tertile was +2.87 kg/m² compared to +1.90 kg/m² in the lowest tertile.
All reported associations were statistically significant at p < 0.01.
Associations were examined using linear mixed-effects models adjusted for age, sex, socioeconomic status, physical activity, screen time, and baseline BMI.
Study followed 1,204 adolescents (baseline age: 12.41 ± 0.89 years; 51.2% girls) annually from 2021 to 2024.
Results
Higher SSB intake was associated with significantly steeper increases in body fat percentage over 4 years.
Mean body fat percentage increase was +4.6% in the highest SSB tertile compared to +2.1% in the lowest tertile.
p < 0.01 for this association.
SSB intake was assessed using a validated food frequency questionnaire adapted for use among Chinese adolescents.
Participants were recruited from 12 secondary schools in Chongqing, China.
Results
Higher SSB intake was associated with significantly steeper increases in systolic blood pressure over 4 years.
Mean systolic blood pressure increase was +4.8 mmHg in the highest SSB tertile compared to +2.1 mmHg in the lowest tertile.
p < 0.01 for this association.
This represents more than a twofold difference in systolic blood pressure trajectory between highest and lowest tertiles.
Results
Adolescents in the highest SSB intake tertile exhibited substantially greater increases in depressive symptoms over 4 years.
CES-D scores increased by +6.0 points in the highest SSB tertile compared to +2.0 points in the lowest tertile (p < 0.01).
Adolescents in the highest SSB tertile exhibited a 62% greater increase in depressive symptoms over 4 years.
Depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale (CES-D).
The association was adjusted for age, sex, socioeconomic status, physical activity, screen time, and baseline BMI.
Results
Higher SSB intake was associated with significantly greater deterioration in sleep quality over 4 years.
Pittsburgh Sleep Quality Index (PSQI) scores increased by +1.3 points in the highest SSB tertile compared to +0.4 points in the lowest tertile.
p < 0.01 for this association.
Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI).
Participants who reduced SSB intake by ≥30% showed significantly smaller increases across physical, emotional, and sleep-related outcomes.
Reductions in SSB intake of ≥30% were associated with attenuated trajectories for BMI, body fat percentage, systolic blood pressure, depressive symptoms, and sleep disturbance.
This finding was observed within the same 4-year prospective follow-up period.
The study characterized this as suggesting that reducing SSB consumption is 'a promising and actionable strategy for school-based health promotion.'
Methods
The study followed a cohort of 1,204 Chinese adolescents over 4 years with annual assessments of SSB intake and multiple health outcomes.
Baseline age was 12.41 ± 0.89 years; 51.2% of participants were girls.
Participants were recruited from 12 secondary schools in Chongqing, China.
Annual follow-up occurred from 2021 to 2024.
Outcomes included BMI, body fat percentage, systolic blood pressure, depressive symptoms (CES-D), academic burnout, and sleep quality (PSQI).
The authors noted that longitudinal evidence from Asian populations had previously been limited.
What This Means
This research suggests that teenagers who drink more sugar-sweetened beverages (like sodas and sweetened juices) experience worse health outcomes across multiple areas over time compared to those who drink less. Tracking over 1,200 middle school students in China over four years, the study found that those in the highest third of sugary drink consumption gained more body fat, had greater increases in blood pressure, developed more symptoms of depression, and had worse sleep quality than those in the lowest third. The differences were substantial — for example, the heaviest consumers showed a 62% greater rise in depression symptoms and more than double the blood pressure increase compared to the lightest consumers.
Importantly, the study also found that teenagers who cut their sugary drink consumption by 30% or more over the study period had noticeably smaller worsening in all of these health measures. This suggests that reducing sugary drink intake during adolescence may help protect against several interconnected health problems — not just physical ones like weight gain, but also mental health and sleep. The findings are notable because most prior research on this topic has come from Western populations, and this study provides evidence that similar patterns exist among Asian youth.
This research suggests that school-based programs encouraging adolescents to reduce their consumption of sugar-sweetened beverages could be a practical and effective approach to improving multiple aspects of adolescent health simultaneously, including physical, emotional, and sleep-related wellbeing.
Zhang Z, Li W, Zhang M, Zhang Y. (2026). High sugar-sweetened beverage intake predicts adverse physical, emotional, and sleep health trajectories in adolescents: a 4-year prospective cohort study.. Frontiers in public health. https://doi.org/10.3389/fpubh.2025.1754072