Sugar-sweetened beverage consumption and attention-deficit/hyperactivity disorder symptoms in children and adolescents: a systematic review and meta-analysis of observational studies.

Authors

Bin Shi, Ming-Jun Ma, Miao Yang, Yu-Qiang Li

Published in

Frontiers in nutrition. Volume 13. Pages 1858738. Epub Sep 16, 2026.

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents. Previous studies have suggested a potential association between sugar-sweetened beverage (SSB) consumption and ADHD or related symptoms; however, existing evidence remains inconsistent, and the magnitude of the association and sources of heterogeneity have not been comprehensively evaluated. Therefore, we conducted a systematic review and meta-analysis to examine the association between SSB intake and ADHD or related symptoms in children and adolescents.
We systematically searched PubMed, Embase, Web of Science, APA PsycINFO, and the Cochrane Library from inception to January 2026 for observational studies assessing the association between SSB consumption and ADHD or related symptoms. Adjusted effect estimates, including odds ratios (ORs), hazard ratios (HRs), or risk ratios (RRs), with corresponding 95% confidence intervals (CIs) were extracted and converted to ORs as the common summary measure. Random-effects meta-analyses were performed, with 95% CIs calculated using the Hartung-Knapp adjustment. Between-study heterogeneity was assessed using the I² statistic. Potential publication bias or small-study effects were evaluated using Doi plots and the Luis Furuya-Kanamori (LFK) index. Prespecified subgroup analyses and sensitivity analyses were conducted to explore sources of heterogeneity and assess the robustness of the findings.
Nine observational studies involving 461,109 children and adolescents were included. The meta-analysis showed that higher SSB consumption was significantly associated with an increased likelihood of ADHD or related symptoms (OR = 1.23, 95% CI: 1.02-1.48). Moderate heterogeneity was observed across studies (I² = 63.3%, τ² = 0.0434, p = 0.0053), and the prediction interval crossed the null value (0.79-1.90), indicating uncertainty in effect estimates for future studies. Subgroup analyses demonstrated largely consistent effect directions across most strata but did not fully explain the observed heterogeneity. Leave-one-out sensitivity analyses showed that the direction of the association remained positive, although exclusion of Kim et al., attenuated the pooled estimate (OR = 1.16, 95% CI: 1.00-1.34) and reduced heterogeneity (I² = 42.1%), indicating some influence of this study on the magnitude and heterogeneity of the pooled association. Doi plot analysis revealed marked asymmetry, with an LFK index of 3.37, indicating possible small-study effects or publication bias.
This systematic review and meta-analysis suggests that higher consumption of sugar-sweetened beverages is associated with an increased likelihood of ADHD or related symptoms in children and adolescents. However, because all included evidence was derived from observational studies and was characterized by moderate heterogeneity, a prediction interval crossing the null, and potential publication bias, the findings should be interpreted with caution. Further high-quality prospective studies are needed to clarify the independent association and underlying mechanisms linking SSB intake to ADHD-related symptoms.
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251186577, identifier CRD420251186577.

PMID:
42818612
Bibliographic data and abstract were imported from PubMed on 01 Oct 2026.

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