Abstract / Summary
Background Mental health issues among adolescents are becoming increasingly prominent, and sugar-sweetened beverage (SSB) intake and the conicity index (CI) may be associated with these issues. However, current research provides limited evidence on the combined effects of these two factors. This study aims to investigate the association between SSB intake and CI and mental health symptoms among Chinese adolescents. Methods Using a cross-sectional design, this study assessed 42,382 middle school students (21,156 males and 21,226 females) nationwide in China in 2024. A questionnaire was used to collect data on the frequency of SSB consumption, mental health symptoms (emotional problems, behavioral problems, and social adjustment difficulties), and covariates. CI was calculated using waist circumference, height, and weight. Logistic regression and joint effects analysis were employed, with stepwise adjustment for age, mode of commuting, breakfast frequency, and moderate-to-vigorous physical activity. Results Among 42,382 adolescents, the prevalence of mental health symptoms was 20.9% (males 21.4% vs. females 20.5%). SSB intake ≥5 times/week (OR = 1.66) and the highest CI quartile (OR = 1.17) were independently associated with mental health symptoms. The combined effect was strongest for high SSB with highest CI (OR = 2.12), with a stronger combined association among individuals with both exposures, particularly in females (OR = 3.41). Conclusion SSB intake and CI were both independently associated with for mental health symptoms among Chinese adolescents, and there is a synergistic effect between the two. Findings suggest that lower SSB intake and lower central adiposity are associated with adolescents’ mental health; gender differences suggest the need to develop targeted intervention strategies.