Howard Finster Coca-Cola Bottle
Kids who drink more soda have slightly more hyperactivity, but which comes first in unclear
STUDY: Shi B et al, Frontiers in Nutrition 2026
STUDY TYPE: Systematic review and meta-analysis of observational studies
FUNDING: Independent
Background
Parents often blame sugar for hyperactivity. Sugary drinks are a major source of added sugar for children, and some studies link them to ADHD. This review pooled the evidence.
The Study
- 9 observational studies with 461,109 children ages 1.5 to 16, mostly from China and South Korea.
- 7 were cross-sectional, 1 case-control, and 1 cohort.
- Compared high versus low intake of sugar-sweetened drinks or soda.
- Outcomes: ADHD diagnosis or hyperactivity scores, mostly on the parent-rated Behavior scale (SDQ).
Results
Children who drank more sugary beverages were 23% more likely to have ADHD or hyperactivity symptoms (odds ratio 1.23).
The signal weakened under scrutiny:
- With hyperactivity scales, the link was small (odds ratio 1.11).
- With formal ADHD diagnoses, the link was no longer statistically clear.
- Results varied widely across studies, and the range expected in future studies included no effect.
- The pattern of results suggested publication bias, with small positive studies more likely to appear.
Dropping one large Korean study shrank the overall link to 16%.
Practice Implications
- Reverse causation is likely: impulsive children reach for quick rewards, including soda.
- Randomized sugar challenge trials from the 1990s found no effect of sugar on children’s behavior.
- On the other hand, shifting to a Mediterranean style (low sugar) diet improved ADHD in a randomized trial.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
