A cross-sectional study on the associations between sugar- sweetened beverage consumption, a body shape index, and psychological symptoms among rural Chinese youth

Background The rising prevalence of psychological symptoms among adolescents has become a serious public health concern worldwide. Nevertheless, previous studies have largely focused on urban or general populations, leaving a notable gap in research on rural adolescents – particularly regarding the associations between sugar-sweetened beverage (SSB) consumption, a body shape index (ABSI, a measure of body composition), and psychological symptoms. This study aims to fill that gap by providing empirical evidence from rural China, thereby offering a locally grounded reference for developing early intervention and targeted prevention strategies. Methods In this study, a stratified cluster sampling design was adopted to carry out a cross-sectional evaluation of SSB consumption, ABSI, and psychological symptoms among 52,735 rural adolescents aged 12–18 years, of whom 26,043 were boys. To examine the associations between these variables, we applied a range of statistical tests, including t -tests, Chi-square tests, one-way ANOVA, binary logistic regression, and binary logistic regression embedded within generalized linear models. Results The overall prevalence of psychological symptoms among rural Chinese adolescents was 21.8%, with a significantly higher rate in males (22.5%) than in females (21.2%; χ 2 = 13.126, P < 0.001). Weekly SSB consumption exceeding five times was reported by 14.5% of the participants, and the mean ABSI score was 0.06 ± 0.01. After adjustment for relevant covariates, adolescents who consumed SSB > 5 times/week and fell within the 51st–75th percentile range of ABSI exhibited the highest odds of psychological symptoms (OR = 2.40, 95% CI: 2.10–2.73; P < 0.001), indicating more than twofold greater odds of psychological symptoms. Conclusion Both independent and combined associations were observed between SSB consumption, ABSI, and psychological symptoms among rural Chinese adolescents. Future interventions targeting psychological symptoms may consider SSB consumption and ABSI factors to better inform intervention strategies; however, these cross-sectional associations do not imply causation.