Sugar intake trajectories in adolescents: Evaluating behavioral change with group-based trajectory modeling

Sugar intake through sugar-sweetened beverages (SSBs) remains a major public health concern among adolescents. Tailored dietary interventions have garnered interest for promoting sustainable behavior change, yet traditional pre-post designs often overlook the temporal complexity of individual adaptation. This study applied a trajectory-based approach to assess how adolescents' sugar intake trajectories evolved in response to an intake-based tailored intervention.

A secondary analysis was conducted on data from a 14-day chatbot intervention (CRIS, KCT0008114) aimed at reducing sugar intake among adolescents. Group-based trajectory modeling (GBTM) was used to identify distinct intake trajectories. A linear mixed-effects model examined the impact of tailored intervention type, time, and trajectory group membership on sugar consumption, including their interactions. Subgroup analysis compared intervention responses between native Korean and racial and ethnic adolescents.

Three trajectory groups were identified: reduction (38%), maintenance (57%), and no-intake (5%). Adolescents with higher baseline intake exhibited rapid declines in consumption, whereas those with lower intake showed gradual reductions. By the second week, reduction and maintenance groups converged. A significant three-way interaction among intervention type, time, and trajectory group was observed, indicating heterogeneous responses. No group exhibited increased consumption, suggesting sustained effects. Racial and ethnic adolescents demonstrated greater responsiveness to the tailored intervention.

Intake-based tailored interventions effectively accommodate individual variability in dietary behavior change, with particularly pronounced benefits among participants with higher baseline intake. These findings underscore the importance of adaptive intervention strategies and the need to consider individual and structural factors when designing public health interventions targeting adolescent diet.