Cardiovascular
Sugar-Sweetened Beverage Use Disorder and Dynamic Interrelationships Among Cardio-Renal-Metabolic Risk Markers in Adolescents Sharon Tsai* Yu-Ting Chin Chin Chin Chin Chin Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
Background: Excessive sugar-sweetened beverage (SSB) intake is linked to cardio-renal-metabolic (CRM) risk markers, including metabolic syndrome risk score (msRS), apolipoprotein B to apolipoprotein A1 ratio (ApoB/A1), and estimated glomerular filtration rate, which may interact across metabolic pathways. Existing assessments primarily quantify intake volume and overlook addictive-like traits that may perpetuate CRM risk. This study aimed to develop and validate a SSB use disorder (SSBUD) construct, derive related risk score, and examine its longitudinal associations with CRM outcomes, while accounting for reciprocal interrelationships among CRM risk markers in adolescents.
Methods: A cross-sectional study of representative Taiwanese adolescents (n=3089) was conducted to develop the SSBUD construct, followed by a 2.5-year cohort study (n=1736) to validate the construct and assess its impact on CRM risk. We used confirmatory factor analysis and latent trait modeling to derive SSBUD risk scores, and cross-lagged panel models to assess reciprocal interrelationships among CRM risk markers. Temporal associations between the SSBUD score and CRM outcomes were estimated within a structural equation modeling framework, adjusting for covariates.
Results: The SSBUD exhibited a unidimensional structure with excellent model fit, strong item discrimination (a=0.89–2.63) and appropriate item difficulty (b=0.14–2.15). Cross-lagged models revealed reciprocal associations between baseline msRS and follow-up ApoB/A1 in both sexes (adjusted βs: boys, msRS→ApoB/A1=0.17, ApoB/A1→msRS=0.12; girls, 0.06 and 0.07). In boys, sustained high SSBUD scores predicted subsequent increases in both msRS and ApoB/A1, whereas in girls they were associated only with subsequent higher ApoB/A1.
Conclusion: Sustained high SSBUD scores predict subsequent elevations in CRM risk markers, highlighting problematic SSB intake as a modifiable behavioral target for early CRM risk prevention in adolescents.
