Sugar-Sweetened Beverage Intake and Children’s Physical and Mental Health: A Five-Year Cohort Study

Background Globally, the consumption of sugar-sweetened beverages (SSBs) among children has increased significantly, becoming a major public health concern. However, longitudinal evidence regarding the long-term effects of SSB intake on the physical and mental health of Chinese children remains scarce. Methods This study aimed to investigate the dynamic associations between SSB intake (frequency and dosage) and key health outcomes (myopia, depression, and maximal oxygen uptake [VO₂max]) in Chinese children over a five-year follow-up period.Methods: A prospective cohort study was conducted among 10,664 children aged 6–7 years recruited from 30 primary schools in Chongqing, China, in 2020. SSB intake was assessed using the Youth Risk Behavior Surveillance System (YRBSS) questionnaire, with “high intake” defined as ≥ 3 times/week (250 mL per serving). Health outcomes included myopia (refractive error measurement), depression (Children’s Depression Inventory), and VO₂max (20-meter shuttle run test). Covariates included demographic factors (gender, age, only-child status, left-behind status) and lifestyle factors (BMI, parental education, sleep quality, physical activity). Multivariate logistic regression (for binary outcomes: myopia, depression) and linear regression (for continuous outcome: VO₂max) were used to analyze associations, with adjustments for potential confounders. Results At baseline, the high SSB intake group (n = 2,050) had significantly higher odds of depression (adjusted OR = 1.35, 95% CI: 1.08–1.68) and myopia (adjusted OR = 1.45, 95% CI: 1.20–1.75), and lower VO₂max (adjusted mean difference = − 1.3 mL/kg/min, 95% CI: −1.9 to − 0.7) compared to the low intake group (n = 8,614). After five years of follow-up, high SSB intake was associated with a greater risk of incident depression (adjusted OR = 2.85, 95% CI: 2.44–3.33) and incident myopia (adjusted OR = 2.15, 95% CI: 1.92–2.41), as well as a smaller increase in VO₂max (adjusted mean difference = − 1.9 mL/kg/min, 95% CI: −2.5 to − 1.3). Conclusion High SSB intake is associated with increased risks of myopia and depression, and a slower increase in cardiorespiratory fitness (VO₂max) in Chinese children. These adverse effects accumulate over time, highlighting the need for targeted public health interventions to reduce SSB consumption among children.