Association Between Sugar-Sweetened Beverage Consumption and All-Cause Mortality in Individuals With and Without Metabolic Syndrome: A Prospective Cohort Study

Background and aims: To examine the association between sugar-sweetened beverage (SSB) intake and all-cause mortality among U.S. adults with and without metabolic syndrome (MetS), and to identify potential nonlinear dose-response relationships and high-risk subpopulations.

Methods

We analyzed data from 26,885 U.S. adults aged 20-79 years who participated in NHANES 2003-2018. MetS was defined based on the NCEP ATP III criteria. SSB intake was assessed using a single 24-h dietary recall and quantified as total beverage weight (g/day), energy intake (kcal/day), and sugar intake (g/day). Cox proportional hazards models and restricted cubic splines were used to assess the association of SSB intake and mortality in MetS and non-MetS groups.

Results

Among 8,656 participants with MetS and 18,229 without, total weight and energy intake from SSBs showed non-linear association with the risk of all-cause mortality in the MetS participants (P non-linear < 0.05), with inflection points of approximately 950 g/day and 90 kcal/day, respectively. Above this level, each standard deviation (SD) increment was associated with 14% (HR: 1.14, 95% CI: 1.01-1.29) and 18% (HR: 1.18, 95% CI: 1.08-1.30) higher mortality risk. For SSB-derived sugar, the non-linear trend missed statistical significance (p = 0.07), though risk nadir appeared at ~20 g/day, with subsequent SD increments linked to a 19% risk increase (HR: 1.19, 95% CI: 1.09-1.30). No linear or non-linear association was presented among individuals without MetS.