Epidemiology and Health

Original Articles

Behavioral and psychosocial factors associated with sugar-sweetened beverage consumption among Korean adolescents: a path analysis using the 2022 Korea Youth Risk Behavior Survey: Hye-Young Park, Soo Rack Ryu, Hoon-Ki Park, Hwan-Sik Hwang, Kye-Yeung Park; Epidemiol Health. 2025;47:e2025047. Published online August 21, 2025; DOI: https://doi.org/10.4178/epih.e2025047

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Rising obesity rates among adolescents are a major global health concern and are closely linked to the consumption of sugar-sweetened beverages (SSBs). This study aimed to identify key behavioral and psychosocial factors influencing SSB consumption among adolescents.

METHODS

This cross-sectional study analyzed data from the 2022 Korea Youth Risk Behavior Survey, which included 49,548 participants aged 12-18 years. Information on SSB consumption frequency, socio-demographic characteristics, eating habits, sedentary behaviors, and other health-related factors was collected through self-administered questionnaires. Path analysis was used to model SSB consumption and estimate the direct and indirect effects of modifiable factors.

RESULTS

Male students, current alcohol drinkers, those with higher frequencies of fast-food or late-night snack consumption, and heavy smartphone users were more likely to frequently consume SSBs. Fast-food intake had the strongest direct effect on SSB consumption (B=0.3884), while nighttime eating showed a substantial direct effect (B=0.1437) and mediated 21.7% of the relationship between fast-food intake and SSB consumption. Leisure sitting time exerted both direct (B=0.0741) and indirect effects on SSB intake, mediated through watching mukbang, smartphone use, fast-food consumption, and nighttime eating. Self-perceived health status was negatively associated with SSB consumption (B=-0.0619), with indirect effects mediated by fast-food intake and nighttime eating.

CONCLUSIONS

Among Korean adolescents, SSB consumption was strongly associated with unhealthy eating patterns and prolonged leisure sitting time. Increased fast-food consumption, nighttime eating, watching mukbang, smartphone use, and negative self-perceived health status not only directly influenced SSB intake, but also acted as mediating factors.

Summary

Korean summary
바람직하지 않은 식습관과 과도한 스마트폰 사용은 한국 청소년의 당음료 섭취와 밀접한 관련이 있습니다. 특히 패스트푸드와 야식은 주요한 매개 요인으로 작용하여, 이러한 행동을 줄이면 당음료 섭취를 효과적으로 낮출 수 있습니다. 본 연구는 청소년을 위한 맞춤형 공중보건 개입 전략 수립에 근거를 제공합니다.

Key Message
Unhealthy eating behaviors and excessive screen time are strongly linked to sugar-sweetened beverage (SSB) consumption among Korean adolescents. Fast-food intake and nighttime snacking act as major mediators, suggesting that reducing these behaviors could significantly decrease SSB intake. These findings provide evidence to guide targeted public health interventions for adolescents.

Citations

Citations to this article as recorded by

Sugar-sweetened beverage consumption, waist-to-height ratio and psychological symptoms among Chinese adolescents
Lu Li, Ting Wei, Feng Zhang, Tianyu Zhou
Scientific Reports.2026;[Epub] CrossRef

Sugar-sweetened beverage consumption and metabolic dysfunction-associated steatotic liver disease: a beverage type-specific analysis using Korea National Health and Nutrition Examination Survey: Hong Jae Jeon, Woo Sun Rou, Seok Hyun Kim, Byung Seok Lee, Ha Neul Kim, Hei-Gwon Choi, Jaehee Seo, Hyuk Soo Eun, Sukyoung Jung; Epidemiol Health. 2025;47:e2025038. Published online July 21, 2025; DOI: https://doi.org/10.4178/epih.e2025038

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease. Evidence indicates a relationship between sugar-sweetened beverage (SSB) consumption and MASLD development; however, the effects of specific SSB types on MASLD remain underexplored. This study investigated the association between consumption of 3 distinct types of SSBs and MASLD in Korean adults.
METHODS
We analyzed data from the Korea National Health and Nutrition Examination Survey 2012-2016, including 8,310 participants aged 40-64 years. SSB consumption (soft drinks, fruit drinks, and Korean traditional drinks) was assessed using a food frequency questionnaire. MASLD was defined as a hepatic steatosis index ≥36 in the presence of any cardiometabolic risk factor. Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (CIs), adjusting for relevant covariates.
RESULTS
Compared to non-drinkers, consumption of soft drinks (≥3 serving/wk) was associated with higher odds of MASLD (OR, 1.36; 95% CI, 1.02 to 1.81; p for trend=0.03), while consumption of Korean traditional drinks (≥3 serving/wk) was associated with lower odds of MASLD (OR, 0.63; 95% CI, 0.45 to 0.89; p for trend=0.01). No association was found between fruit drink consumption and MASLD. In sex-stratified analysis (p-interaction=0.38), an inverse association between Korean traditional drinks and MASLD was observed in male (OR, 0.57; 95% CI, 0.34 to 0.95; p for trend=0.03), but not in female (OR, 0.72; 95% CI, 0.45 to 1.14; p for trend=0.17).
CONCLUSIONS
Consuming soft drinks at least 3 times per week was positively associated with MASLD, whereas an equivalent intake of Korean traditional drinks was inversely associated with MASLD.; Summary

Korean summary
-본 연구는 국민건강영양조사에 참여한 40-64세 한국 성인 8,310명을 대상으로 가당 음료와 새롭게 정의된 대사기능장애 연관 지방간질환(MASLD) 간 연관성을 음료 유형별로 비교 분석하였다. - 주 3회 이상의 탄산음료 섭취는 MASLD 유병 가능성이 증가한 반면, 동일한 빈도의 한국 전통음료 섭취는 유병 가능성을 낮췄다. - 음료 유형에 따른 MASLD 유병 차이는 향후 식이 지침 개발에 중요한 근거가 될 수 있으며, 향후 개인이 건강을 위해 보다 선택적인 음료 섭취를 위한 정책 수립에 기여할 수 있다.

Key Message
Among 8,310 Korean adults aged 40-64 years, soft drink consumption (≥3 servings/week) increased the odds of MASLD, while the same intake of Korean traditional drinks decreased the odds. These findings suggest that beverage type may be an important dietary factor associated with MASLD. Given the differential associations observed, our findings may help inform dietary recommendations that enable individuals to make more selective beverage choices for better liver health.

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