High sugar-sweetened beverage intake frequency is associated with smoking, irregular meal intake and higher serum uric acid in Taiwanese adolescents

* Corresponding author: H. Y. Chang, fax [phone], email [email protected]

Overconsumption of sugar-sweetened beverages (SSB) increases the risk of non-communicable diseases including obesity, gout, CVD, fatty liver, insulin resistance and diabetes^(1,2). Past research has found that adolescents are more likely to have greater intake of SSB than children and adults^(3–5) and that SSB provide about 20–25 % of total sugar intake^(6,7). Despite a decline in SSB consumption by adolescents in a number of countries (including Austria, UK and USA)^(8–11), consumption remains high. For example, SSB still provided 9·3–9·7 % of total energy intake by US adolescents from 2011 to 2014⁽¹²⁾ and 14 % of total energy intake by UK adolescents from 2008⁽⁹⁾. The contribution of SSB could be close to or exceeding 10 % which is recommended by the 2015 WHO guidelines⁽¹³⁾. The SSB intake rate is very high in Asia; for example, it reached 38 % in Korea⁽¹⁴⁾ and reached 87·7 % in Taiwan in 2009⁽¹⁵⁾. Besides, SSB contributed 25 % of daily intakes of sugar in Japan⁽⁷⁾.

An important contributing factor to SSB consumption in Taiwan is its availability. Sweetened beverages are readily obtained from convenience stores as well as beverage shops including cafés, juice stores and tea shops. By 2017, there were an estimated 10 662 convenience stores belonging to the four major chains and 21 346 beverage shops, which equates to an average of one convenience store per 2211 persons and one beverage shop per 1104 persons^(16,17). The greater the number of such stores near schools and the shorter walking distance required, the greater the mean daily frequency of SSB purchasing by adolescents⁽¹⁸⁾.

Although a large number of studies have examined SSB intake in adolescents, most are from Western countries and have focused on intake of carbonated drinks (including soda, carbonated soda and carbonated beverages)^(3,19–21). Culture plays an important role in the types of beverages consumed by adolescents, with intake of beverages (including coffee and tea) more common in adolescents in Asia and even surpassing that of soda is some Asian countries⁽¹⁹⁾. A survey conducted in 2015 in southern Taiwan showed that SSB contributed...