{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:04:14Z","timestamp":1789707854685,"version":"4.0.1"},"reference-count":32,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Science and Technology Projects of Xizang Autonomous Region, China","award":["XZ202301ZY0045G"],"award-info":[{"award-number":["XZ202301ZY0045G"]}]},{"name":"Xizang Natural Science Foundation","award":["XZ2023ZR-ZY25(Z)"],"award-info":[{"award-number":["XZ2023ZR-ZY25(Z)"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>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\u201312 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 \u00b1 SD: 16.06 \u00b1 1.80). Butter tea consumption frequency was self-reported. Cognitive performance was assessed with Raven\u2019s 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\u20130.88; p &lt; 0.001) and frequent consumption (aOR = 0.71; 95% CI, 0.55\u20130.90; 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\u20130.93; p = 0.018). Among females, both occasional (aOR = 0.76; 95% CI, 0.64\u20130.90; p = 0.001) and frequent (aOR = 0.74; 95% CI, 0.58\u20130.93; 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.<\/jats:p>","DOI":"10.3390\/nu18183017","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:23:53Z","timestamp":1789496633000},"page":"3017","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tibetan Butter Tea Consumption and Cognitive Performance Among Tibetan Adolescents at High Altitude"],"prefix":"10.3390","volume":"18","author":[{"given":"Liping","family":"Deng","sequence":"first","affiliation":[{"name":"Lhasa Center for Disease Control and Prevention, Lhasa 850005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhang","family":"Fang","sequence":"additional","affiliation":[{"name":"Shanghai-MOST Key Laboratory of Health and Disease Genomics, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai 200237, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pingcuo","family":"Pingcuo","sequence":"additional","affiliation":[{"name":"Lhasa Center for Disease Control and Prevention, Lhasa 850005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cirenyangzong","family":"Cirenyangzong","sequence":"additional","affiliation":[{"name":"Lhasa Center for Disease Control and Prevention, Lhasa 850005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhu","family":"Zhao","sequence":"additional","affiliation":[{"name":"Lhasa Center for Disease Control and Prevention, Lhasa 850005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junmei","family":"Zhao","sequence":"additional","affiliation":[{"name":"Lhasa Center for Disease Control and Prevention, Lhasa 850005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhui","family":"Wang","sequence":"additional","affiliation":[{"name":"Lhasa Center for Disease Control and Prevention, Lhasa 850005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4853-7598","authenticated-orcid":false,"given":"Simin","family":"Xu","sequence":"additional","affiliation":[{"name":"Shanghai-MOST Key Laboratory of Health and Disease Genomics, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai 200237, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8307-0116","authenticated-orcid":false,"given":"Qiguo","family":"Lian","sequence":"additional","affiliation":[{"name":"Lhasa Center for Disease Control and Prevention, Lhasa 850005, China"},{"name":"Shanghai-MOST Key Laboratory of Health and Disease Genomics, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai 200237, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1146\/annurev-psych-010213-115202","article-title":"Is Adolescence a Sensitive Period for Sociocultural Processing?","volume":"65","author":"Blakemore","year":"2014","journal-title":"Annu. Rev. Psychol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Olusanya, B.O., Wright, S.M., Nair, M.K.C., Boo, N.-Y., Halpern, R., Kuper, H., Abubakar, A.A., Almasri, N.A., Arabloo, J., and Arora, N.K. (2020). Global Burden of Childhood Epilepsy, Intellectual Disability, and Sensory Impairments. Pediatrics, 146.","DOI":"10.1542\/peds.2019-2623"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.ridd.2010.12.018","article-title":"Prevalence of Intellectual Disability: A Meta-Analysis of Population-Based Studies","volume":"32","author":"Maulik","year":"2011","journal-title":"Res. Dev. Disabil."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.jpeds.2015.10.009","article-title":"Acute and Chronic Altitude-Induced Cognitive Dysfunction in Children and Adolescents","volume":"169","author":"Rimoldi","year":"2016","journal-title":"J. Pediatr."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Ciren, Y., Gong, J., Li, F., Gong, X., Danzeng, D., Ning, Y., Wang, T., Tian, X., and Silang, Q. (2025). Education and Urbanization Improves Cognitive Function Affected by Altitude of Adolescents: A Cross-Section Study in Tibet, China. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1539922"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1152\/jn.00513.2024","article-title":"Cerebral Blood Flow in Andean Children and Adolescents Living above 5,000 m","volume":"133","author":"Howe","year":"2025","journal-title":"J. Neurophysiol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Zhou, C., Li, M., Liu, L., Zhao, F., Cong, W., and Zhang, F. (2021). Food Consumption and Dietary Patterns of Local Adults Living on the Tibetan Plateau: Results from 14 Countries along the Yarlung Tsangpo River. Nutrients, 13.","DOI":"10.3390\/nu13072444"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Xiao, Z., Sun, X., Zhaxi, D., Zhang, F., Ji, Y., Cheng, T., Li, X., and Xu, X. (2021). Distinct Nutrient Intake Style in Inhabitants of Ultra-High-Altitude Areas in North of Tibet, China: A Cross-Sectional Study Based on Newly Developed Tibetan Food Frequency Questionnaires. Front. Nutr., 8.","DOI":"10.3389\/fnut.2021.743896"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kong, C., Yang, L., Gong, H., Wang, L., Li, H., Li, Y., Wei, B., Nima, C., Deji, Y., and Zhao, S. (2022). Dietary and Food Consumption Patterns and Their Associated Factors in the Tibetan Plateau Population: Results from 73 Counties with Agriculture and Animal Husbandry in Tibet, China. Nutrients, 14.","DOI":"10.3390\/nu14091955"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"113627","DOI":"10.1016\/j.foodres.2023.113627","article-title":"Dietary Habits of Pastoralists on the Tibetan Plateau Are Influenced by Remoteness and Economic Status","volume":"174","author":"Li","year":"2023","journal-title":"Food Res. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1146\/annurev.nutr.19.1.41","article-title":"Development of Food Preferences","volume":"19","author":"Birch","year":"1999","journal-title":"Annu. Rev. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1093\/nutrit\/nuaf054","article-title":"Effects of Tea (Camellia sinensis) or Its Bioactive Compounds l-Theanine or l-Theanine plus Caffeine on Cognition, Sleep, and Mood in Healthy Participants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"83","author":"Payne","year":"2025","journal-title":"Nutr. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Manidis, A., Ayala-Aldana, N., Bernardo-Castro, S., Pinar-Mart\u00ed, A., Galkina, P., Fern\u00e1ndez-Barr\u00e9s, S., Ramirez-Carrasco, P., Lamuela-Ravent\u00f3s, R.M., Papandreou, C., and Julvez, J. (2026). Dietary Patterns and Neuropsychological Function in Adolescents: A Cross-Sectional and Longitudinal Study. BMC Med., 24.","DOI":"10.1186\/s12916-026-04658-6"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"L\u00f3pez-Gil, J.F., Cisneros-V\u00e1squez, E., Olivares-Arancibia, J., Ya\u00f1\u00e9z-Sep\u00falveda, R., and Guti\u00e9rrez-Espinoza, H. (2025). Investigating the Relationship Between Ultra-Processed Food Consumption and Academic Performance in the Adolescent Population: The EHDLA Study. Nutrients, 17.","DOI":"10.3390\/nu17030524"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1007\/s10654-023-01012-5","article-title":"Dietary Patterns, Brain Morphology and Cognitive Performance in Children: Results from a Prospective Population-Based Study","volume":"38","author":"Mou","year":"2023","journal-title":"Eur. J. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1093\/cvr\/cvae229","article-title":"Dietary Salt, Vascular Dysfunction, and Cognitive Impairment","volume":"120","author":"Faraco","year":"2025","journal-title":"Cardiovasc. Res."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Li, K., Zhang, Q., Cai, H., He, R., Nima, Q., Li, Y., Suolang, D., Cidan, Z., Wangqing, P., and Zhao, X. (2022). Association of Tibetan Habitual Food and Metabolic Syndrome Among Tibetan People in China: A Cross-Sectional Study. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.888317"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"57","DOI":"10.2188\/jea.JE20150037","article-title":"Prevalence of Brick Tea-Type Fluorosis in the Tibet Autonomous Region","volume":"26","author":"Fan","year":"2016","journal-title":"J. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Wen, C., Zhang, Q., Xie, F., and Jiang, J. (2022). Brick Tea Consumption and Its Relationship with Fluorosis in Tibetan Areas. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.1030344"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1006\/cogp.1999.0735","article-title":"The Raven\u2019s Progressive Matrices: Change and Stability over Culture and Time","volume":"41","author":"Raven","year":"2000","journal-title":"Cogn. Psychol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"149","DOI":"10.2223\/JPED.2176","article-title":"Influence of Domestic Violence on the Association between Malnutrition and Low Cognitive Development","volume":"88","author":"Silva","year":"2012","journal-title":"J. Pediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"15888","DOI":"10.3390\/ijerph121215028","article-title":"Changes in Eating Behaviours among Czech Children and Adolescents from 2002 to 2014 (HBSC Study)","volume":"12","author":"Sigmund","year":"2015","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.sleh.2015.10.004","article-title":"National Sleep Foundation\u2019s Updated Sleep Duration Recommendations: Final Report","volume":"1","author":"Hirshkowitz","year":"2015","journal-title":"Sleep. Health"},{"key":"ref_24","unstructured":"World Health Organization (2020). WHO Guidelines on Physical Activity and Sedentary Behaviour, World Health Organization."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.3233\/JAD-191339","article-title":"Link Between Dietary Sodium Intake, Cognitive Function, and Dementia Risk in Middle-Aged and Older Adults: A Systematic Review","volume":"76","author":"Mohan","year":"2020","journal-title":"J. Alzheimers Dis."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Tan, B.L., and Norhaizan, M.E. (2019). Effect of High-Fat Diets on Oxidative Stress, Cellular Inflammatory Response and Cognitive Function. Nutrients, 11.","DOI":"10.3390\/nu11112579"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1002\/alz.12421","article-title":"Mediterranean and Western Diet Effects on Alzheimer\u2019s Disease Biomarkers, Cerebral Perfusion, and Cognition in Mid-Life: A Randomized Trial","volume":"18","author":"Hoscheidt","year":"2022","journal-title":"Alzheimers Dement."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.phymed.2017.07.008","article-title":"Green Tea Effects on Cognition, Mood and Human Brain Function: A Systematic Review","volume":"34","author":"Mancini","year":"2017","journal-title":"Phytomedicine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1038\/s41398-022-01923-z","article-title":"Tea Consumption and Risk of Incident Dementia: A Prospective Cohort Study of 377 592 UK Biobank Participants","volume":"12","author":"Hu","year":"2022","journal-title":"Transl. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.bandc.2009.10.008","article-title":"Sex Differences in the Adolescent Brain","volume":"72","author":"Lenroot","year":"2010","journal-title":"Brain Cogn."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1002\/hbm.21052","article-title":"The Role of Puberty in the Developing Adolescent Brain","volume":"31","author":"Blakemore","year":"2010","journal-title":"Hum. Brain Mapp."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1177\/1073191112446655","article-title":"Development of Abbreviated Nine-Item Forms of the Raven\u2019s Standard Progressive Matrices Test","volume":"19","author":"Bilker","year":"2012","journal-title":"Assessment"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/3017\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:23:41Z","timestamp":1789705421000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/3017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":32,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["nu18183017"],"URL":"https:\/\/doi.org\/10.3390\/nu18183017","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]}}}