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

ABSTRACT 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. Conclusion High SSB intake is associated with increased all‐cause mortality in adults with MetS, with nonlinear threshold effects.