Tibetan Butter Tea Consumption and Cognitive Performance Among Tibetan Adolescents at High Altitude

Background: Tibetan butter tea sits at a tension between the health concerns raised by its high salt and fat content and the potential cognitive benefits of its tea-derived constituents, yet whether this traditional beverage is associated with cognition in high-altitude Tibetan adolescents has not been directly examined. Methods: We conducted a school-based cross-sectional study of Tibetan students in grades 7-12 in Lhasa, Xizang, China, between June 2024 and June 2025. The analytic sample included 7967 students, with ages ranging from 10.18 to 24.82 years (mean ± SD: 16.06 ± 1.80). Butter tea consumption frequency was self-reported. Cognitive performance was assessed with Raven's Standard Progressive Matrices; low cognitive performance was defined as a score below the grade-specific 25th percentile. Logistic regression with cluster-robust standard errors estimated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for demographic, family, socioeconomic, sleep, physical activity, and lifestyle factors, both overall and in sex-specific models. Results: Among 7967 Tibetan students, 3534 were male, and 4433 were female. Low cognitive performance was most prevalent among students reporting daily (29.56%) or never (26.34%) consumption and less prevalent among those reporting occasional (22.18%) or frequent (20.39%) consumption. Compared with never consumption, occasional consumption (aOR = 0.79; 95% CI, 0.70-0.88; p < 0.001) and frequent consumption (aOR = 0.71; 95% CI, 0.55-0.90; p = 0.004) were associated with lower odds of low cognitive performance. Daily consumption was not statistically significant. In sex-stratified analyses, frequent consumption was associated with lower odds among males (aOR = 0.68; 95% CI, 0.49-0.93; p = 0.018). Among females, both occasional (aOR = 0.76; 95% CI, 0.64-0.90; p = 0.001) and frequent (aOR = 0.74; 95% CI, 0.58-0.93; p = 0.011) consumption were associated with lower odds. Conclusions: Occasional and frequent consumption of Tibetan butter tea was associated with reduced odds of low cognitive performance among Tibetan adolescents at high altitude, with modest sex differences. These findings suggest that Tibetan butter tea should be evaluated as a culturally embedded whole-dietary exposure and may inform culturally sensitive school-based nutrition education and public health guidance in high-altitude Tibetan settings; however, causal inference cannot be established from this cross-sectional study, and longitudinal validation is needed.