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      Caffeinated energy drink consumption among adolescents and potential health consequences associated with their use: a significant public health hazard

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          Caffeinated energy drinks (EDs) are increasingly popular among adolescents despite growing evidence of their negative health effects. The consumption of EDs has seen a substantial increase during the past few decades, especially in the Western and Asian countries. EDs contain high levels of caffeine, sugar, and novel ingredients, and are often marketed through youth-oriented media and venues. The known and unknown pharmacology of the constituents of EDs poses a risk of caffeine toxicity and other ill effects when consumed by young people. Caffeine intoxication may result in tachycardia, vomiting, cardiac arrhythmias, seizures, and even death. Other health concerns related to consumption of EDs include obesity and dental enamel erosion resulting from the acidity of EDs. Coingestion of caffeine and ethanol has been associated with increased risk-taking behaviors in adolescent users, impaired driving, and increased use of other illicit substances. Several researchers have demonstrated that consuming alcohol mixed with energy drinks leads to altered subjective states including decreased perceived intoxication, enhanced stimulation, and increased desire to drink/increased drinking compared to consuming alcohol alone. Caffeine’s effect on intoxication may be most pronounced when mixers are artificially sweetened, that is, lack sucrose which slows the rate of gastric emptying of alcohol. In conclusion: 1) health care providers should educate youth and their parents about the risks of caffeinated drinks; 2) emergency department clinicians should consider asking patients about ED and traditional caffeine usage and substance use when assessing patient symptoms; 3) policy makers should increase their attention on introducing regulatory policies on television food advertising to which youth are exposed; 4) failure to comply with standards for efficacious product labelling, and absence of broader education regarding guidelines, need to be addressed and 5) further studies must be done to improve our understanding of potential negative consequences of caffeinated energy drinks on health. (

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          Most cited references 44

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          American College of Sports Medicine position stand. Nutrition and athletic performance.

          It is the position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine that physical activity, athletic performance, and recovery from exercise are enhanced by optimal nutrition. These organizations recommend appropriate selection of foods and fluids, timing of intake, and supplement choices for optimal health and exercise performance. This updated position paper couples a rigorous, systematic, evidence-based analysis of nutrition and performance-specific literature with current scientific data related to energy needs, assessment of body composition, strategies for weight change, nutrient and fluid needs, special nutrient needs during training and competition, the use of supplements and ergogenic aids, nutrition recommendations for vegetarian athletes, and the roles and responsibilities of the sports dietitian. Energy and macronutrient needs, especially carbohydrate and protein, must be met during times of high physical activity to maintain body weight, replenish glycogen stores, and provide adequate protein to build and repair tissue. Fat intake should be sufficient to provide the essential fatty acids and fat-soluble vitamins and to contribute energy for weight maintenance. Although exercise performance can be affected by body weight and composition, these physical measures should not be a criterion for sports performance and daily weigh-ins are discouraged. Adequate food and fluid should be consumed before, during, and after exercise to help maintain blood glucose concentration during exercise, maximize exercise performance, and improve recovery time. Athletes should be well hydrated before exercise and drink enough fluid during and after exercise to balance fluid losses. Sports beverages containing carbohydrates and electrolytes may be consumed before, during, and after exercise to help maintain blood glucose concentration, provide fuel for muscles, and decrease risk of dehydration and hyponatremia. Vitamin and mineral supplements are not needed if adequate energy to maintain body weight is consumed from a variety of foods. However, athletes who restrict energy intake, use severe weight-loss practices, eliminate one or more food groups from their diet, or consume unbalanced diets with low micronutrient density may require supplements. Because regulations specific to nutritional ergogenic aids are poorly enforced, they should be used with caution and only after careful product evaluation for safety, efficacy, potency, and legality. A qualified sports dietitian and, in particular, the Board Certified Specialist in Sports Dietetics in the United States, should provide individualized nutrition direction and advice after a comprehensive nutrition assessment.
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            Health effects of energy drinks on children, adolescents, and young adults.

            To review the effects, adverse consequences, and extent of energy drink consumption among children, adolescents, and young adults. We searched PubMed and Google using "energy drink," "sports drink," "guarana," "caffeine," "taurine," "ADHD," "diabetes," "children," "adolescents," "insulin," "eating disorders," and "poison control center" to identify articles related to energy drinks. Manufacturer Web sites were reviewed for product information. According to self-report surveys, energy drinks are consumed by 30% to 50% of adolescents and young adults. Frequently containing high and unregulated amounts of caffeine, these drinks have been reported in association with serious adverse effects, especially in children, adolescents, and young adults with seizures, diabetes, cardiac abnormalities, or mood and behavioral disorders or those who take certain medications. Of the 5448 US caffeine overdoses reported in 2007, 46% occurred in those younger than 19 years. Several countries and states have debated or restricted energy drink sales and advertising. Energy drinks have no therapeutic benefit, and many ingredients are understudied and not regulated. The known and unknown pharmacology of agents included in such drinks, combined with reports of toxicity, raises concern for potentially serious adverse effects in association with energy drink use. In the short-term, pediatricians need to be aware of the possible effects of energy drinks in vulnerable populations and screen for consumption to educate families. Long-term research should aim to understand the effects in at-risk populations. Toxicity surveillance should be improved, and regulations of energy drink sales and consumption should be based on appropriate research.
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              Increased alcohol consumption, nonmedical prescription drug use, and illicit drug use are associated with energy drink consumption among college students.

              This longitudinal study examined the prevalence and correlates of energy drink use among college students, and investigated its possible prospective associations with subsequent drug use, including nonmedical prescription drug use. Participants were 1,060 undergraduates from a large, public university who completed three annual interviews, beginning in their first year of college. Use of energy drinks, other caffeinated products, tobacco, alcohol, and other illicit and prescription drugs were assessed, as well as demographic and personality characteristics. Annual weighted prevalence of energy drink use was 22.6%(wt) and 36.5%(wt) in the second and third year of college, respectively. Compared to energy drink non-users, energy drink users had heavier alcohol consumption patterns, and were more likely to have used other drugs, both concurrently and in the preceding assessment. Regression analyses revealed that Year 2 energy drink use was significantly associated with Year 3 nonmedical use of prescription stimulants and prescription analgesics, but not with other Year 3 drug use, holding constant demographics, prior drug use, and other factors. A substantial and rapidly-growing proportion of college students use energy drinks. Energy drink users tend to have greater involvement in alcohol and other drug use and higher levels of sensation-seeking, relative to non-users of energy drinks. Prospectively, energy drink use has a unique relationship with nonmedical use of prescription stimulants and analgesics. More research is needed regarding the health risks associated with energy drink use in young adults, including their possible role in the development of substance use problems.

                Author and article information

                Acta Biomed
                Acta Biomed
                Acta bio-medica : Atenei Parmensis
                Mattioli 1885 (Italy )
                : 88
                : 2
                : 222-231
                [1 ]Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
                [2 ]PHC, Ministry of Health, Alexandria, Egypt
                [3 ] Department of Pediatrics, Alexandria University Children Hospital, Elchatby, Alexandria, Egypt
                [4 ]Department of Pediatrics, Ain Shams University, Cairo, Egypt
                [5 ]Emeritus Director in Pediatrics, Children’s Hospital “Santobono-Pausilipon”, Naples, Italy
                [6 ]Department of Pediatrics, NYU School of Medicine, New York, USA
                Author notes
                Correspondence: Vincenzo De Sanctis, MD Pediatric and Adolescent Outpatients Clinic, Quisisana Hospital, Ferrara, Italy. E-mail: vdesanctis@

                This work is licensed under a Creative Commons Attribution 4.0 International License

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