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Proposed Actions for the US Food and Drug Administration to Implement to Minimize Adverse Effects Associated With Energy Drink Consumption
Abstract
Energy drink sales are expected to reach $52 billion by 2016. These products, often sold as dietary supplements, typically contain stimulants. The Dietary Supplement Protection Act claims an exemplary public health safety record. However, in 2011 the number of emergency department visits related to consumption of energy drinks exceeded 20 000. Nearly half of these visits involved adverse effects occurring from product misuse.
Political, social, economic, practical, and legal factors shape the landscape surrounding this issue. In this policy analysis, we examine 3 options: capping energy drink caffeine levels, creating a public education campaign, and increasing regulatory scrutiny regarding the manufacture and labeling of energy drinks.
Increased regulatory scrutiny may be in order, especially in light of wrongful death lawsuits related to caffeine toxicity resulting from energy drink consumption.
... Energy drinks, the fastest growing beverage market in the United States, contain added caffeine, herbal supplements, amino acids, vita- mins, and sweeteners. Energy drinks can be labeled as dietary supple- ments and therefore do not require premarket approval [1]. Each manufacturer of these beverages has their own proprietary blend of ad- ditives which are listed on the label, but volumes or percentages of each are not except for added caffeine. ...
... The first energy drink was intro- duced in the United States in 1997 [9] and sales continue to increase yearly with sales reaching $11 billion in 2017. Importantly, energy drink associated emergency room visits doubled between 2007 and 2011, from 10,068 to 20,783 [1,7] and are generally due to cardiac complaints ranging from rapid heart rate, palpitation, myocardial in- farctions, stroke and even cardiac arrest [10]. Recent studies have dem- onstrated an association between energy drinks and an increase in blood pressure (BP) and the prolongation of the QTc interval on the electrocardiogram (ECG) [10][11][12]. ...
... Recent studies have dem- onstrated an association between energy drinks and an increase in blood pressure (BP) and the prolongation of the QTc interval on the electrocardiogram (ECG) [10][11][12]. The aim of this study, the C-Energy- X Study, was twofold: [1] determine if alterations in physiological re- sponses (BP, heart rate, and serum potassium) occur in healthy young subjects who consume energy drinks at rest and during a standardized exercise program, and [2] examine electrocardiographic responses, QT intervals and T-wave changes from recordings of continuous 12 lead Holter ECGs. ...
... For example, the caffeine content of cola-type beverages is strictly limited to less than 71 mg per 12 fl oz. [17] For supplements, any substance which "generally recognized as safe" could be added. Most manufacturers add vitamins, herbal compounds, and other bioactive substances to facilitate the categorization of their energy drinks as dietary supplements. ...
... Most manufacturers add vitamins, herbal compounds, and other bioactive substances to facilitate the categorization of their energy drinks as dietary supplements. [17] Dietary supplement manufacturers are also not obligated to disclose the exact constituents under the proprietary blend. The effects of energy drinks are mainly attributed due to caffeine and is the best-studied ingredient [18]. ...
... Caffeine elimination varies between individuals due to polymorphisms of these enzymes which could explain the differences in individual tolerance [56]. The other variables which influence caffeine metabolism include age, gender, body weight, genetic predisposition, use of other medications, and heart and liver diseases [17,33]. Negative effects from caffeine consumption can occur either acutely from over dosage or due to chronic dependence or withdrawal [21]. ...
Purpose of review:
Energy drinks and energy shots are functional supplements with higher caffeine content marketed toward adolescents and young adults with the intention of boosting energy. Parallel to its rising popularity, there are safety concerns with the consumption of these beverages. Herein, we reviewed the impact these supplements produce on health and well-being.
Recent findings:
Most of the promoted benefits of the beverages can be attributed to caffeine. The physiologic effects, if any, of other ingredients such as vitamins and herbal extracts are unclear. The presence of a higher caffeine content as compared to soft drinks may predispose to caffeine intoxication in susceptible individuals. Also, the practice of co-ingestion of these beverages with alcohol is still prevalent and associated with serious consequences. Strict regulations (restriction of sales, clear warning labels, capping caffeine levels) and public education may help prevent the adverse outcomes from these beverages.
... These drinks are marketed as an aid to improve athletic performance, enhance concentration, and increase energy and weight loss [1,2]. The first energy drink was introduced in the United States in 1997 [3] and by 2016, sales are expected to reach $52 billion [4]. Reported emergency department visits secondary to energy drinks skyrocketed from just over 1000 in 2005 to more than 20,000 in 2011 [4,5]. ...
... The first energy drink was introduced in the United States in 1997 [3] and by 2016, sales are expected to reach $52 billion [4]. Reported emergency department visits secondary to energy drinks skyrocketed from just over 1000 in 2005 to more than 20,000 in 2011 [4,5]. Most often, these visits are due to a cardiac issue ranging from rapid heart rate, palpitations, myocardial infarction, stroke, and even cardiac arrest [6][7][8][9][10]. ...
... Manufacturers of energy drinks can label their products as dietary supplements which do not require premarket approval [4]. The FDA does require that serious adverse events be reported by the manufacturers, packers, and distributors of energy drinks within 15 business days, however, the FDA must prove that a product is unsafe before it can be removed from the market [25]. ...
... Energy drinks sales, an indicator of marketing effectiveness, are projected to reach $52 billion in 2016. 24 Energy drinks contain high concentrations of caffeine and are often marketed to adolescents as energy or mental alertness enhancers. 20,21 Energy drink marketers often proclaim health benefits associated with herbal ingredients, despite documented negative health effects associated with energy drink consumption. ...
... [25][26][27][28][29] While countries such as Mexico, France and Norway have enacted energy drink sale restrictions for potential health consequences of mixing herbal ingredients, and despite recommendations from public health professionals to regulate energy drink sales in the United States, the U.S. Food and Drug Administration has taken no official action to regulate energy drinks. 24, 30 The specific health implications of mixing herbal ingredients in energy drinks is not well understood; however, the effects of caffeine on health has been heavily studied. Currently, 71 mg/12 fl. ...
... 43,44 Despite risks associated with AmED use, the behavior appears normalized among college students. While existing literature suggests over half of [18][19][20][21][22][23][24][25] year olds use energy drinks, and AmED use is associated with risky behavior among college students, 11,40,45 little is known about energy drink use rates among high school students or the effect of AmED use on younger adolescents. It has been reported that approximately 30% of secondary school students use energy drinks, and also energy drink use was a risk factor for other substance use including alcohol and cigarettes. ...
Background and Objectives
Approximately 30% of high school students use energy drinks. Alcohol use and alcohol mixed with energy drink use (AmED) is associated with risky behavior, including non-medical prescription stimulant use. We assessed alcohol-only, AmED and non-medical prescription stimulant use among 12th grade students in the U.S. using a nationally representative secondary data from the 2012 Monitoring the Future Study. Methods
Wilcoxon-Mann-Whitney tests and logistic regression analyses were used to determine differences in non-medical prescription stimulant use by students who used alcohol-only versus AmED and to identify covariates of non-medical prescription stimulant use. Pearson-product moment coefficients were used to determine strength of variable relationships. ResultsSignificant differences were found in frequency of Ritalin (p<.001, Cohen's d=.23) and Adderall (p<.001, Cohen's d=.32) use between alcohol-only students and AmED students. Greater frequency of AmED use was also associated with greater frequency of Ritalin use (r=.293, p<.001) and Adderall use (r=.353, p<.001). Males (b=.138, OR=1.148) were more likely to use prescription stimulants non-medically than females. Discussion and Conclusions
This study highlights the need to better understand influences on non-medical prescription stimulant, energy drink and AmED use, as the combined effects of stimulants contained in energy drinks and the depressant effects of alcohol appear to be associated with increased non-medical prescription stimulant use. Scientific SignificanceResearch on the influential factors related to energy drinks, alcohol, and non-medical prescription stimulants will help practitioners to more appropriately design prevention and intervention strategies addressing these high-risk behaviors. (Am J Addict 2016;25:378-384)
... These drinks are marketed as an aid to improve athletic performance, enhance concentration, and increase energy and weight loss [1,2]. The first energy drink was introduced in the United States in 1997 [3] and by 2016, sales are expected to reach $52 billion [4]. Reported emergency department visits secondary to energy drinks skyrocketed from just over 1000 in 2005 to more than 20,000 in 2011 [4,5]. ...
... The first energy drink was introduced in the United States in 1997 [3] and by 2016, sales are expected to reach $52 billion [4]. Reported emergency department visits secondary to energy drinks skyrocketed from just over 1000 in 2005 to more than 20,000 in 2011 [4,5]. Most often, these visits are due to a cardiac issue ranging from rapid heart rate, palpitations, myocardial infarction, stroke, and even cardiac arrest [6][7][8][9][10] . ...
... Interestingly, manufacturers of energy drinks are not required to list the caffeine content from supplement additives, therefore the actual amount of caffeine in a single serving can be much higher than that listed [2] and potentially cause caffeine toxicity. Manufacturers of energy drinks can label their products as dietary supplements which do not require premarket approval [4]. The FDA does require that serious adverse events be reported by the manufacturers , packers, and distributors of energy drinks within 15 business days, however, the FDA must prove that a product is unsafe before it can be removed from the market [25]. ...
Introduction: Energy drinks are presumed to enhance energy, physical endurance, mood, and boost metabolism. Serious health risks have been reported with energy drink consumption such as myocardial infarction, cardiac arrest, stroke, seizures, and arrhythmias. More than 20,000 emergency department visits related to energy drink consumption were reported in 2011. Little is known about the possible pathophysiological mechanisms and adverse events associated with energy drinks. Unlike the tobacco and alcohol industry, there are limited restrictions regulating the purchasing and marketing of these drinks.
Purpose: To determine if consumption of energy drinks alter; vital signs (blood pressure, temperature), electrolytes (magnesium, potassium, calcium), activated bleeding time (ACT), or cardiac responses measured with a 12-lead electrocardiographic (ECG) Holter.
Method: Subjects consumed two-16 ounce cans of an energy drink within one hour and remained in the lab where data was collected at base line (BL) and then during four hours post consumption (PC). Vital signs were taken every 30 minutes; blood samples were collected at BL, one, two and four hours PC and ECG data was collected throughout the entire study period. Paired students t-test and a corresponding non-parametric test (Wilcoxon signed rank) were used for analysis of the data.
Results: Fourteen healthy young subjects were recruited (mean age 28.6 years). Systolic blood pressure (BL=132, ±7.83; PC= 151, ±11.21; p=.001); QTc interval (BL=423, ±22.74; PC=503, ±24.56; p<.001); magnesium level (BL 2.04, ± 0.09; PC=2.13, ±0.15; p=.05); and calcium level (BL=9.31, ±.28; PC=9.52, ±.22; p=.018) significantly increased from BL. While potassium and ACT fluctuated (increase and decrease) no significant changes were observed. Eight of the fourteen subjects (57%) developed a QTc >500 milliseconds PC.
Conclusions: In our sample, consumption of energy drinks increased systolic blood pressure, serum magnesium and calcium, and resulted in repolarization abnormalities. Because these physiological responses can lead to arrhythmias and other abnormal cardiac responses, further study in a larger sample is needed to determine the effects and possible consequences of energy drink consumption.
... 6 However, concerns have been raised about the safety and health risks of energy drinks consumed by children, adolescents, and young adults who may be sensitive to excessive caffeine and other ingredients when used frequently. Between 2013 and 2019, a US Senate Commerce Committee, 7,8 public health practitioners, [9][10][11][12] professional societies, [13][14][15] and advocacy organizations 16 recommended that energy drink manufacturers not market to children and adolescents up to 18 years; that the Food and Drug Administration (FDA) define energy drink products as beverages that require caffeine labeling disclosures; that US regulatory agencies investigate energy drink marketing targeted to children and adolescents; and that the public should be educated about the potential side effects of energy drinks. ...
... 40 Between 2010 and 2012, several adverse events and deaths were reported to the FDA associated with energy drinks and energy shots consumed by adolescents and young adults. 9,10 In 2012, the New York State Attorney General investigated three energy drink manufacturers for violating federal law by promoting energy drinks as dietary supplements instead of beverages that required more stringent labeling disclosures. 41 In response to the reported adverse events, a US Senate Commerce Committee conducted a public hearing on energy drinks in 2013 7 that requested 16 energy drink manufacturers to voluntarily commit to not market to young people up to 18 years. ...
Kraak VI, Davy BM, Rockwell MS, Kostelnik S, Hedrick VE. Policy recommendations to address energy drink marketing and consumption by vulnerable populations in the United States. J Acad Nutr Diet. 2020;120(5):767–777. https://doi.org/10.1016/j.jand.2020.01.013.
Full pdf available at: https://authors.elsevier.com/a/1ay0M7t0kPq7Hp
This research commentary describes the marketing strategies used to promote energy drink products, and explores the potential safety, health risks, and prevalence related to their use. It also discusses actions taken by government and other stakeholders to address energy drink marketing to vulnerable populations in the United States, and explores US progress to implement recommended actions between 2009 and 2019. Vulnerable populations are defined as individuals or groups who are at higher risk of dietary and health disparities due to economic disadvantage, age, gender, race or ethnicity, cultural identity, or common risk behaviors. Between 2013 and 2019, a US Senate Commerce Committee, public health practitioners, professional societies, and advocacy organizations recommended that energy drink manufacturers not market to children and adolescents up to 18 years; that the Food and Drug Administration (FDA) define energy drink products as beverages that require caffeine labeling disclosures; that US regulatory agencies investigate energy drink marketing targeted to children and adolescents; and that the public should be educated about the potential side effects of energy drinks.
... Energy drinks, the fastest growing beverage market in the United States, contain added caffeine, herbal supplements, amino acids, vitamins, and sweeteners. Energy drinks can be labeled as dietary supplements and therefore do not require premarket approval [1]. Each manufacturer of these beverages has their own proprietary blend of additives which are listed on the label, but volumes or percentages of each are not except for added caffeine. ...
... blood pressure (BP) and the prolongation of the QTc interval on the electrocardiogram (ECG) [10][11][12]. The aim of this study, the C-Energy-X Study, was twofold: [1] determine if alterations in physiological responses (BP, heart rate, and serum potassium) occur in healthy young subjects who consume energy drinks at rest and during a standardized exercise program, and [2] examine electrocardiographic responses, QT intervals and T-wave changes from recordings of continuous 12 lead Holter ECGs. ...
... In 2013, both the American Medical Association and the U.S. Senate Commerce Committee proposed a prohibition on marketing of energy drink products to adolescents (AMA, 2013;Mitka, 2013); yet, a recent study revealed that energy drink manufacturers continue to advertise through mediums that primarily target adolescents (Emond, Sargent, & Gilbert-Diamond, 2015). These marketing strategies have served to increase popularity of energy drinks to the degree that 2016 sales projections are anticipated to reach $52 billion (Thorlton, Colby, & Devine, 2014). In 2014, public health professionals urged the U.S. Food and Drug Administration (FDA) to regulate energy drinks due to the potential health consequences; however, the U.S. has not yet taken official action (Thorlton et al., 2014). ...
... These marketing strategies have served to increase popularity of energy drinks to the degree that 2016 sales projections are anticipated to reach $52 billion (Thorlton, Colby, & Devine, 2014). In 2014, public health professionals urged the U.S. Food and Drug Administration (FDA) to regulate energy drinks due to the potential health consequences; however, the U.S. has not yet taken official action (Thorlton et al., 2014). ...
Background:
About 30% of high school students use energy drinks. Alcohol mixed with energy drinks (AmED) has been associated with higher rates of risky driving among college students.
Objectives:
The purpose of this study was to: (a) examine AmED-use in a sample of high school students and (b) to specifically investigate differences in risky driving behaviors between 12th grade students who engaged in AmED-use and those who consumed alcohol only.
Methods:
Differences in risky driving behaviors were investigated by utilizing secondary data analyses of nationally representative data from the Monitoring the Future Study (N = 1305).
Results:
12th grade AmED users were significantly more likely to be in a motor vehicle accident (p <.001) and receive a ticket for a traffic violation (p <.05). Additionally, 12th grade AmED users were significantly less likely to wear a seatbelt as a driver or passenger (p <.001). Conclusions/Importance: Although this study does not link risky driving behaviors to specific drinking events, it does indicate a relationship between AmED-use and high-risk driving. Because traffic accidents are the highest cause of mortality among U.S. teenagers, drug education efforts to reduce high-risk driving behaviors should include information on the decision-making and synergistic effects of energy drinks when mixed with alcohol.
... 17,18 Energy drinks sales are projected to reach $52 billion in 2016 due to the efficacious marketing techniques that frequently target adolescents. 19,20 Reports have indicated that 30% of secondary school students consume energy drinks. 21 In 2013, the American Medical Association and the US Senate Commerce Committee proposed significant adolescent marketing restrictions for energy drink products; 22-24 however, restrictions have yet to take place. ...
... [25][26][27][28] In 2014, the US Food and Drug Administration (FDA) was urged to regulate energy drinks due to the potential health consequences; however, no official action has been taken to restrict adolescent energy drink access. 19 In addition to these substance use health implications, energy drink use is linked to negative health consequences among adolescents. The 2010 US Dietary Guidelines identified energy drinks as a high-sugar beverage that increases obesity and diabetes risks with elevated consumption. ...
Objective:
We assessed the relationship of energy drink, high-sugar, and low-sugar beverage consumption.
Methods:
Mann-Whitney U, Cohen's d and effect sizes were used to examine data from 1737 adolescents in the United States who participated in the 2014 FLASHE Study. Secondary analysis examined consumption of energy drinks, high- and low-sugar beverages, and adolescents' BMIs.
Results:
Among adolescents, 13.7% (N = 239) reported past 7-day energy drink consumption. Participants who did not consume energy drinks in the past 7 days were more likely to consume low-sugar beverages of water (p < .001) and milk (p = .046). Consumption of energy drinks was positively related to sweetened fruit drinks (p < .001), pure fruit juice (p = .008), soda (p < .001), and sports drinks (p < .001). Energy drink consumers also reported higher mean BMI (p = .004).
Conclusions:
Adolescents who consume energy drinks during the past 7 days are more likely to also consume other high-sugar beverages. Whereas those who report no past 7-day use of energy drinks consume higher rates of low- or no-sugar beverages. Health education and prevention efforts to reduce adolescent energy drink consumption may lead to reductions in other high-sugar beverage intake and have a positive impact on obesity rates among adolescents.
... To date, the U.S. has not regulated energy drink production or sales despite growing concern among public health researchers and practitioners. Because of the potential health implications to consumers, researchers have called upon the U.S. Food and Drug Administration to regulate energy drinks with little success (Thorlton et al., 2014). While the consumption of various herbal ingredients in energy drinks are vague and relatively unstudied, the ingredient of caffeine has been studied extensively. ...
... To measure how many energy drinks students consumed, ranged response scales were used. Because energy drinks are sold in varying sizes, content is unregulated by the U.S. Food and Drug Administration, and research has indicated the potential for mislabeling of ingredient quantity (Bailey et al., 2014;Consumer Reports, 2012;Thorlton, Colby, & Devine, 2014), a standard energy drink quantity had to be operationalized for this study. To standardize the quantity of energy drinks, the researchers used quantity parameters as described in Woolsey et al. (2014b). ...
Background: Energy drinks are popular beverages that can have adverse long-term health effects when consumed by children and adolescents. This study sought to determine if the age of first energy drink use in a U.S. military population is predictive of the maximum number of energy drinks consumed during a single day and/or single occasion (operationally defined as a couple of hours; e.g., a night out, during studying or sport session).
Method: Student U.S. naval aviator and naval flight officers who reported past-year use of energy drinks (N = 239) were surveyed to determine various measures of energy drink consumption.
Results: Age of first consumption was predictive of the maximum number of energy drinks consumed during a single occasion within the past year. Within this sample, the age range between 13 and 16 years appeared to be a critical period with results indicating that people who began consuming energy drinks during this period were 4.88 times more likely to consume high quantities (four or more) of energy drinks during a single occasion when compared to those who started consuming energy drinks between the ages of 20–23. Likewise, persons who began to consume energy drinks between the ages of 13–16 are 2.48 times more likely to consume high quantities of energy drinks during a single occasion than those who started between the ages of 17–19. There was no difference between 17 and 19 year olds and 20–23 year olds. Age of first use was not correlated to daily average intake or daily maximal intake of energy drinks.
Conclusions: A lower age of first energy drink use suggests higher risk of single-occasion heavy episodic consumption in this military population. Researchers should further explore the relationship of early onset energy drink consumption and potential future health risks.
... Reissig et al. (2009) reported that 2006 sales of energy drinks yielded more than $5 billion, and the marketplace saw more than 500 energy drink products. Projections indicate that, by 2016, energy drink sales may reach $52 billion (Thorlton et al., 2014). The number of available energy drink products and efficacious marketing strategies have led to energy drinks becoming one of the most commonly used substances among the young adult population, such that more than half of college-aged (18-25 years) adults regularly consume energy drinks (Cotter et al., 2013;Malinauskas et al., 2007;Pettit & DeBarr, 2011). ...
... Some countries, such as France, Norway, and Mexico, have restricted energy drink sales because of the lack of research on the health consequences of mixing herbal ingredients (Bradley, 2012). In addition, public health professionals have called on the U.S. Food and Drug Administration (FDA) to regulate energy drinks because of the potential health consequences (Thorlton et al., 2014). Although the health implications of mixing herbal ingredients in energy drinks are vague and relatively unstudied, one ingredient has been heavily studied: caffeine. ...
Introduction: The combined-use of alcohol and energy drinks can increase risky behaviors increase motivations to drink, reduce perceptions of impairment, and reduce users’ perceived levels of intoxication. This study examined differences in drinking and driving behaviors among combined-users and those who consumed alcohol-only.
Methods: College students (n=549) from a large mid-western university completed a web-based survey assessing drinking and driving, riding with an intoxicated driver, and energy drink use behaviors. Chi-square analyses and Mann-Whitney U tests were used to examine differences between the alcohol-only (AO; n=281) and combined-use (CU; n=268) groups.
Results: Compared to AO drinkers, in the past 30 days, combined-users were significantly more likely to drive both over the .08 blood alcohol content limit (CU 35.0% vs. AO 18.1%; p<.001) and after knowing they were too drunk to drive (CU 36.3% vs. AO 17.0%; p<.001). CU were also more likely to ride as a passenger when they knew the driver had too much alcohol to drive safely (44.1% vs. 23.6%; p<.001). Combined users also reported more indicators of high-risk alcohol use, such as larger number of drinks consumed, number of days drinking, number of days drunk, number of heavy episodic drinking episodes, greatest number of drinks on one occasion, and average hours of consumption (p<.001).
Discussion: In addition to increased high-risk alcohol consumption, combined-users exhibit an increased likelihood to drive after drinking and drive while knowingly drunk, as well as an increased likelihood to ride in a car with a driver who had too much alcohol to drive safely. Students who combine alcohol and ED are more likely to participate in multiple high-risk behaviors including frequency of drinking and driving over the .08 legal-limit. Public health professionals should target the combined use of alcohol and energy drinks in campus-based prevention efforts.
... Consumption by health-care providers, which according to Thorlton (Thorlton, Colby, & Devine, 2014), is on the rise. Garcia found in a sample population of 80 medical students that students use EDs to improve concentration and memory levels. ...
Background: The consumption of energy drinks is increasing among students of medicine and recent medical graduates. A cross-sectional study that uses a questionnaire designed to gather information on energy drinks consumption analyzes this problem.
Methods: This cross-sectional study used a questionnaire designed to gather information on energy drinks consumption of medical students and physicians. Four hundred fifty questionnaires were completed. Results: The majority of the questionnaires was completed in Colombia; the rest were completed in North American (n: 8, 1.8%), Central America (n: 17, 3.8%), South America (n: 86, 19.1%), and Europe (n: 2, 0.4%). There is a high frequency of energy drinks consumption among medical students and physicians; for every five physicians or medical students who consume energy drinks, one is not a consumer.
Conclusions: There is a great need to build awareness among physicians and medical students concerning these drinks. This study identifies a risk behavior, and it summons the international medical community, health institutions, universities, and trade associations to conduct health promotion and prevention activities, including the practice of healthy habits in medical students and physicians to deal with this problem.
... Energy drinks are commonly fruit flavored and very sweet, which appeals to teens and even children. Although there are a few cases of a caffeine reaction related to coffee, the list of caffeine overdoses and complications related to energy drink consumption is increasing (Thorlton, Colby, & Devine, 2014). ...
The energy drink consumption habits of nurses working in clinical settings is unknown. Utilizing a descriptive-comparison design, researchers examined the caffeine and energy drink habits of clinical nurses and relationships or differences that existed with their sleep quantity, sleep quality, and perceived stress levels. Data were analyzed using descriptive and inferential statistics. Significant relationships existed between energy drink consumption and sleep quality, sleep quantity, and perceived stress levels. Nurses who consumed energy drinks had poorer sleep quality and fewer sleep hours compared with caffeine-only consumers and noncaffeine consumers. Nurses who consumed energy drinks also had increased levels of perceived stress than noncaffeine consumers. Educating nurses regarding energy drink ingredients and relationships that exist between energy drink consumption, sleep, and perceived stress could be beneficial. Future studies are needed to examine motivational factors related to energy drink consumption as well as any health or safety implications that might be associated.
... Consumption by health-care providers, which according to Thorlton (Thorlton, Colby, & Devine, 2014), is on the rise. Garcia found in a sample population of 80 medical students that students use EDs to improve concentration and memory levels. ...
... To reduce the health impacts of energy drinks on vulnerable populations (ie, children, adolescents, and pregnant woman), one study incorporated a series of recommendations that included creating a public education campaign, capping caffeine levels in energy drinks to 100 mg per 250 mL, and improving label readability requirements for listing product ingredients. 28 Others have recommended the reclassification energy drinks to empower the U. S. Food and Drug Administration to monitor them with regards to caffeine levels labeling practices. 29 Regulation of caffeine in energy drinks should be a priority, because soft drinks and other over-thecounter caffeine products are subject to labeling requirements. ...
Background: College students report high levels of stress, which may be exacerbated by the psychoactive ingredients in energy drinks. Little is understood about the relationship between daily hassles and energy drink consumption. Purpose: The purpose of this study was to explore the associations between energy drink consumption patterns and daily hassles among college students. Methods: College students (n = 449) completed an online survey evaluating energy drink consumption and daily hassles using the Revised University Student Hassles Scale (RUSHS). Results: The most common reasons reported for consuming energy drinks were lack of energy (90.3%), lack of sleep (87.0%), and feeling tired (85.4%). No significant differences in daily hassles were found between energy drink consumers and nonconsumers. Energy drink consumption and daily hassles subscores varied based on demographic characteristics. Discussion: Results of this study did not support a relationship between energy drink consumption and perceived daily hassles. Further research is needed to understand the potential association between energy drink consumption and other determinants of mental health. Translation to Health Education Practice: Health Education interventions should rectify misperceptions that energy drinks are effective when students miss sleep, need energy, and need to study for exams.
... For this reason, numerous countries have banned the sale of energy drinks to minors, and others are seriously considering doing the same (Ragsdale et al., 2010;Seifert, Schaechter, Hershorin, & Lipshultz, 2011b). Both the American Academy of Pediatrics and the American Medical Association support restrictions on the sales of energy drinks to minors (AAP, 2011;Thorlton, Colby, & Devine, 2014). ...
Energy drinks are emerging as a major component of the beverage market with sales projected to top $60 billion globally in the next five years. Energy drinks contain a variety of ingredients, but many of the top-selling brands include high doses of caffeine and the amino acid taurine. Energy drink consumption by children has raised concerns, due to potential caffeine toxicity. An additional risk has been noted among college-aged consumers of energy drinks who appear at higher risk of over-consumption of alcohol when the two drinks are consumed together. The differential and combinatorial effects of caffeine and taurine on the developing brain are reviewed here with an emphasis on the adolescent brain, which is still maturing. Key data from animal studies are summarized to highlight both reported benefits and adverse effects reported following acute and chronic exposures. The data suggest that age is an important factor in both caffeine and taurine toxicity. Although the aged or diseased brain might benefit from taurine or caffeine supplementation, it appears that adolescents are not likely to benefit from supplementation and may, in fact, suffer ill effects from chronic ingestion of high doses. Additional work is needed though to address gaps in our understanding of how taurine affects females, since the majority of animal studies focused exclusively on male subjects.
... In 2011, the number of emergency department visits related to consumption of EDs exceeded 20,000 cases. 88 Nearly half of these visits involved adverse effects occurring from product misuse. Despite these potential complications from ED, there is little or no regulation of the sale or consumption of these drinks in any age group. ...
Introduction:
Energy drinks (EDs) have become an integral part of the young adult, athletic, and military culture. Many athletes are convinced that EDs enhance performance, and service members as well as college students frequently use EDs as stimulants to counter sleep deprivation, or to improve academic performance. However, concerns have been raised by some military leaders about potential adverse effects of EDs.
Materials and methods:
A needs assessment survey of a convenience sample of military health care providers was conducted and identified EDs as a top knowledge need for those providers working in the area of traumatic brain injury (TBI). The instrument demonstrated high interitem consistency (Cronbach's α > .80). To further explore the state of knowledge on EDs, and to prompt further discussion of ED use and how it may related to military treatment protocols and supporting educational products, we conducted a literature review of English language publications listed in the National Library of Medicine using the search term "energy drinks" and published during the last 5 years to determine what is known about EDs in terms of their potential benefits and health risks.
Results:
The active ingredients in most EDs are caffeine, and to a lesser extent taurine and sugars. Several reports suggest that the combination of these ingredients is more active than the caffeine alone. Despite the positive attributes of EDs, there are increasing reports of serious and potentially life-threatening side effects. Most recently there also has been a dramatic increase in the use of ED/alcohol combination drinks, and there are preliminary studies that suggest important adverse effects with this combination. A 2013 National Institutes of Health expert workshop concluded that more clinical studies are needed to clearly define the health risks associated with ED use.
Conclusion:
The needs assessment points to a desire for more ED knowledge of health providers working with TBI patients. A few key themes emerged from the exploratory literature review that can be taken into consideration when educating health providers and delivering knowledge-based resources. Adverse effects of EDs are most closely associated with the dose of caffeine consumed. In general, the combination of ED with alcohol should be avoided because the ED can mask the level of intoxication, and the combination may be associated with increased risk-taking behavior. Overall, the risks and benefits of EDs remain controversial and good-quality long-term clinical trials are needed to inform policymaking, regulation, and the development of prevention and treatment resources.
... While counties such as France and Mexico have regulated energy drinks (Bradley, 2012), the United States has been slow to enact regulations despite evidence-based reports and concerns expressed by researchers and health professionals (Arria et al., 2011;Attwood, 2012). Due to the potential health risks, the U.S. Food and Drug Administration (FDA) has been urged to explore increased regulation (Thorlton, Colby, & Devine, 2014)with particular concern regarding the relatively unstudied health implications of mixing herbal ingredients and high caffeine levels in energy drinks (Woolsey, 2010a;). Caffeine concentration within energy drinks ranges from 75 to 500 milligrams per container; however, the lack of production regulation allows for significantly higher concentrations, as seen with the product liquid caffeine concentrate, which contains 16,000 mg/32 oz (Caffeine Informer, 2014). ...
Age at first use has been extensively studied in various substances, but remains unexplored in energy drinks. Recent studies suggest adolescent energy drink consumption is linked to alcohol misuse and high-risk motor vehicle behaviors. This study examined energy drink age at first use and high-risk motor vehicle behaviors among a sample (N = 468) of college students. Consumption of energy drinks at an earlier age predicted high-risk motor vehicle behaviors including driving after having too much alcohol, driving with a perceived blood alcohol content above the .08 limit, and knowingly choosing to ride with someone who had consumed too much alcohol. However, when controlling for various 30-day drinking behaviors, age at first energy drink use significantly predicted only driving with a perceived blood alcohol content above the .08 limit (p < .05), while number of days drunk during the past 30 days was shown to be a stronger predictor (p < .05) for all three high-risk driving behaviors.
... Lastly, findings extend prior concerns raised by the public health and medical communities regarding ED consumption (Arria et al., 2014;Arria and O'Brien, 2011;Thorlton et al., 2014). College students who consume ED might represent a key target audience for drunk driving prevention activities, regardless of whether such consumption occurs before, during, or after their alcohol drinking sessions. ...
Background
Highly caffeinated energy drinks (ED) are commonly consumed and sometimes mixed with alcohol. Associations between ED consumption, risk-taking, and alcohol-related problems have been observed. This study examines the relationship between ED consumptionboth with and without alcoholand drunk driving. Methods
Data were derived from a longitudinal study of college students assessed annually via personal interviews. In Year 6 (modal age 23; n=1,000), participants self-reported their past-year frequency of drunk driving, ED consumption patterns (frequency of drinking alcohol mixed with energy drinks [AmED] and drinking energy drinks without alcohol [ED]), alcohol use (frequency, quantity), and other caffeine consumption. Earlier assessments captured suspected risk factors for drunk driving. Structural equationmodeling was used to develop an explanatory model for the association between ED consumption patterns and drunk driving frequency while accounting for other suspected risk factors. ResultsMore than half (57%) consumed ED at least once during the past year. Among ED consumers, 71% drank AmED and 85% drank ED alone; many (56%) engaged in both styles of ED consumption while others specialized in one or the other (29% drank ED alone exclusively, while, 15% drank AmED exclusively). After accounting for other risk factors, ED consumption was associated with drunk driving frequency in 2 ways. First, a direct path existed from ED frequency (without alcohol) to drunk driving frequency. Second, an indirect path existed from AmED frequency through alcohol quantity to drunk driving frequency. Conclusions
Among this sample, ED consumption with and without alcohol was common, and both styles of ED consumption contributed independently to drunk driving frequency. Results call for increased attention to the impact of different patterns of ED consumption on alcohol-related consequences, such as drunk driving.
... To reduce the health impacts of energy drinks on vulnerable populations (ie, children, adolescents, and pregnant woman), one study incorporated a series of recommendations that included creating a public education campaign, capping caffeine levels in energy drinks to 100 mg per 250 mL, and improving label readability requirements for listing product ingredients. 28 Others have recommended the reclassification energy drinks to empower the U. S. Food and Drug Administration to monitor them with regards to caffeine levels labeling practices. 29 Regulation of caffeine in energy drinks should be a priority, because soft drinks and other over-thecounter caffeine products are subject to labeling requirements. ...
This article reviews the effectiveness of HIV sexual risk prevention programs among adult prison inmates. A database search was performed to identify studies that used HIV sexual risk prevention programs with incarcerated adults. Of the 234 articles identified, 9 met the inclusion criteria. In addition, 5 articles were found containing supporting information for the 9 studies reviewed, increasing the number of articles reviewed to 14. All studies reported a significant increase in knowledge or a decrease in high-risk behaviors among the inmates at the conclusion of the interventions. Common limitations included a lack of a theoretical framework used in developing the interventions, a lack of process evaluations to measure program fidelity, and a lack of validity and reliability reporting for the study surveys. However, programs and interventions targeting HIV and sexual risk reduction appear to improve the knowledge of HIV prevention and reduce risk in the adult prison inmate population.
... In adults, the daily caffeine intake from energy drinks underwent a 10fold increase between the years 2001 and 2010 (Fulgoni, Keast, & Lieberman, 2015). Adverse effects have been associated with consumption, prompting proposed action for the United States Food and Drug Administration (US FDA) to increase regulatory scrutiny of energy drinks (Thorlton, Colby, & Devine, 2014;US FDA, 2013a). Women who are breastfeed-ing may experience disrupted sleep schedules (Doering, 2013) and be tempted to turn to popular energy drinks to self-manage sleep problems and postpartum fatigue (Smith & Forrester, 2013) prompting the question: What are the maternal and child health implications for the breastfeeding mother who consumes energy drinks? ...
Breastfeeding women may experience disrupted sleep schedules and be tempted to turn to popular energy drinks to reduce fatigue and enhance alertness, prompting the question: What are the maternal and child health implications for breastfeeding mothers consuming energy drinks? Caffeine and vitamin-rich energy drinks contain a variety of herbal ingredients and vitamins; however, ingredient amounts may not be clearly disclosed on product labels. Interactions between herbal ingredients and caffeine are understudied and not well defined in the literature. Some infants can be sensitive to caffeine and display increased irritability and sleep disturbances when exposed to caffeine from breastmilk. Breastfeeding women who consume energy drinks may be ingesting herbal ingredients that have not undergone scientific evaluation, and if taking prenatal vitamins, may unknowingly exceed the recommended daily intake. Caffeinated products are marketed in newer ways, fueling concerns about health consequences of caffeine exposure. We present implications associated with consumption of caffeine and vitamin-rich energy drinks among breastfeeding women. Product safety, labeling, common ingredients, potential interactions, and clinical implications are discussed. Healthcare providers should encourage breastfeeding women to read product labels for ingredients, carbohydrate content, serving size, and to discourage consumption of energy drinks when breastfeeding and/or taking prenatal vitamins, to avoid potential vitamin toxicity. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved
... In adults, the daily caffeine intake from energy drinks underwent a 10fold increase between the years 2001 and 2010 (Fulgoni, Keast, & Lieberman, 2015). Adverse effects have been associated with consumption, prompting proposed action for the United States Food and Drug Administration (US FDA) to increase regulatory scrutiny of energy drinks (Thorlton, Colby, & Devine, 2014;US FDA, 2013a). Women who are breastfeed-ing may experience disrupted sleep schedules (Doering, 2013) and be tempted to turn to popular energy drinks to self-manage sleep problems and postpartum fatigue (Smith & Forrester, 2013) prompting the question: What are the maternal and child health implications for the breastfeeding mother who consumes energy drinks? ...
... Measures proposed to reduce caffeine consumption in at risk subgroups include specifying a maximum retail unit volume, reducing the caffeine level in energy drinks, banning the sale of energy drinks to people under 18 years of age, restricting advertising and marketing of energy drinks to children and adolescents including events targeting this age group, and strengthening health warning advice to consumers [3,13,28,30,40,41]. In response to concerns raised in Europe, Lithuania enacted a law banning the sale and advertising of energy drinks to people under eighteen years of age [42]. ...
Dietary exposure to high caffeine is a health risk for children. Governments are considering measures to restrict the sale of formulated caffeinated beverages (FCB) to children.
Objectives.
To investigate community concern about sales of high-caffeine drinks to children among Western Australian adults and describe Australian and New Zealand regulatory processes regarding FCB.
Methods.
Data from the 2009 and 2012 Department of Health’s Nutrition Monitoring Survey Series of 2,832 Western Australians aged 18–64 years was pooled with descriptive and ordinal logistic regression analysis performed. Current regulatory processes for FCB are reported.
Results.
Most (85%) participants were concerned about the sale of high-caffeine drinks to children; 77.4% were very concerned in 2012 compared to 66.5% in 2009,
p
< .008. Females and those living with children had higher concern (odds ratio (OR) 2.11; 95% confidence interval (CI) 1.44–3.10; OR 2.16; 95% CI 1.51–3.09, resp.,
p
< .001). Concern increased with each year of age (OR 1.04; 95% CI 1.02, 1.05,
p
< .001).
Conclusions.
Community concern regarding sale of high-caffeine energy drinks to children is high and increasing. Being female and living with children were associated with greater concern. These findings support the Australian and New Zealand regulatory controls of FCB, including labelling, promotion, and advertising to children.
The purpose of this study was to assess energy drink consumption in a group of students (N = 629)who attended a public community college using the Theory of Planned Behavior. A majority of students(56.1%) reported they consumed energy drinks from rarely (once a month or less) to several times a day.Students indicated negative perceptions of energy drinks for health but positive perceptions of consumingenergy drinks for alertness. Logistic regression predicted energy drink consumers versus non-consumers withsignificant (P <.05) variables of perceived behavioral control, intention, and past behavior of consumingenergy drinks.
Energy drinks are widely used and very popular. They are touted as "harmless" energy boosters for use in professional, recreational and domestic settings. They are typically high in monosaccharides, and caffeine with other assorted products like ginseng. Careful study of the potential risks of their use is nonexistent while rigorous documentation of their touted energy boosting capacity is also meagre. We present the cautionary case of a 46-year-old Caucasian man with well-controlled type 2 diabetes and nonalcoholic fatty liver disease who developed a toxic triad syndrome of gastritis, hepatitis and pancreatitis within 4 months of commencing daily consumption of 2-3 160z cans of the energy drink Monster Energy. His clinical symptoms and biochemical derangements promptly resolved with stopping the beverage. We discuss the potential risks inherent in unsupervised liberal consumption of energy drinks and the need for both caution and vigilance among clinicians and patients.
Construction workforces' health behaviors have received little attention compared with work injury risks and management. Formulated caffeinated beverage (FCB) (energy drink) consumption is relatively new to construction sites and excessive consumption may have effects on both health and safety owing to known short- and long-term physiological responses. This study contributes to understanding drivers and deterrents of caffeine and FCB consumption in construction. Data were collected from workers at six construction sites in Queensland, Australia, using mixed-method research design involving semistructured interviews (70) and quantitative surveys (n=250). Convergent interviewing underpinned by the theory of reasoned action was used to analyze qualitative interviews. Bivariate logistic regression analyses were conducted to examine determinants of caffeine and FCB consumption. Work hours were associated with caffeine consumption >210 mg/day (β=-0.046, p=0.037). Qualitative results indicate energy drinks are consumed widely and regularly on site, with stress and attempts to manage the pace, timing, and intensity seen as drivers for consumption. In combination, these findings suggest management of FCBs on construction sites requires more attention as a potential health hazard.
College students are heavy consumers of energy beverages, yet further study is needed to better understand determinants of use. The purpose of this cross-sectional study (N=283) study was to identify beliefs explaining unsafe consumption practices. A principal components analysis revealed three eigenvalues >1 explaining approximately 55% of the variance (health & appearance, performance & fatigue, recreation & alcohol). Multiple regression analysis explained 75% of the variance for intent to consume. Standardized beta for attitude, subjective norms was p<0.001; perceived behavioral control p<0.05. Multivariate analysis of variance was used to determine the effect of gender on eight dependent variables (Wilks’ lambda = 3.78; p<0.001). Attitudes and subjective norms influenced the intent to consume energy beverages, particularly in males. Students viewed energy beverages as useful for managing health & appearance, performance & fatigue, as a way to enhance recreation & alcohol consumption.
Background:
Energy drink consumption has increased significantly over the past decade and is associated with greater than 20,000 emergency department visits per year. Most often these visits are due to cardiovascular complaints ranging from palpitations to cardiac arrest.
Objective:
To determine if energy drinks alter; blood pressure, electrolytes, activated bleeding time (ACT), and/or cardiac responses measured with a 12-lead electrocardiographic (ECG) Holter.
Methods:
Continuous ECG data was collected for five hours (30 minutes baseline and 4 hours post consumption [PC]). Subjects consumed 32 ounces of energy drink within one hour and data (vital signs and blood samples) was collected throughout the study period. Paired students t-test and a corresponding non-parametric test (Wilcoxon signed rank) were used for analysis of the data.
Results:
Fourteen healthy young subjects were recruited (mean age 28.6 years). Systolic blood pressure (baseline=132, ±7.83; PC=151, ±11.21; P=.001); QTc interval (baseline=423, ±22.74; PC=503, ±24.56; P<.001); magnesium level (baseline 2.04, ± 0.09; PC=2.13, ±0.15; P=.05); and calcium level (baseline=9.31, ±.28; PC=9.52, ±.22; P=.018) significantly increased from baseline. While potassium and ACT fluctuated (some subjects increased their levels while others decreased) these changes were not significant. Eight of the fourteen subjects (57%) developed a QTc >500 milliseconds PC. Other T-wave changes were noted in 9/14 (64.3%) subjects PC.
Conclusions:
Energy drinks increased systolic blood pressure, altered electrolytes, and resulted in repolarization abnormalities. These physiological responses can lead to arrhythmias and other abnormal cardiac responses highlighting the importance that emergency room personnel assess for energy drink consumption and potential toxicity.
With the gain in popularity and use of 'functional energy drinks' (FEDs), manufacturers of these beverages have been making greater claims as to their benefits on a number of performance factors including mental alertness, energy, and physical performance. Few experimental studies have been conducted on FEDs, and no study to date has examined their effects over time. This study looked at the effects of consumption of a 5-h ENERGY® shot (5-HES) on various cognitive functions across five hours on 24 college-aged students using a double-blind, cross-over, placebo-based design. Participants completed a series of five computer-based tests before ingesting the beverage (either 5-HES or placebo) and then completed the tests for each of the next five hours (morning to midday). One week later, they repeated the process with the other beverage. While 90% of participants subjectively thought that the 5-HES was effective at one-hour post-ingestion, no evidence was found to support an enhanced effect on recognition, reaction time, short-term and working memory, or attention capacity. In conclusion, the 5-h Energy Shot® did not significantly improve short- or long-term cognitive function for selected computer-based tasks despite a high level of perception that it was working effectively compared to a placebo with college-aged participants.
A recent study suggested that college students who combined alcohol and energy drinks were more likely than students who consumed only alcohol to drive when their blood alcohol concentration (BAC) was higher than the .08% limit and to choose to drive despite knowing they had too much alcohol to drive safely. This study sought to replicate those findings with a larger sample while also exploring additional variables related to impaired driving.
College students (N = 549) completed an anonymous online survey to assess differences in drinking and driving-related behaviors between alcohol-only users (n = 281) and combined alcohol-energy drink users (n = 268).
Combined users were more likely than alcohol-only users to choose to (a) drive when they perceived they were over the .08% BAC limit (35.0% vs. 18.1%, p < .001), (b) drive despite knowing they had too much alcohol to drive safely (36.3% vs. 17.0%, p < .001), and (c) be a passenger when they knew the driver had too much alcohol to drive safely (44.1% vs. 23.6%, p < .001). Combined users were significantly more likely (p < .001) to report indicators of high-risk alcohol use, such as larger number of drinks consumed, number of days drinking, number of days drunk, number of heavy episodic drinking episodes, greatest number of drinks on one occasion, and average hours of consumption.
Combined use of alcohol and energy drinks may place drinkers at greater risk when compared with those who consume only alcohol. College students in this sample who combined alcohol and energy drinks were more likely to participate in high-risk driving behaviors than those who consumed only alcohol.
Sleep debt and time of day/night (circadian rhythm) exert substantial effects on commercial motor vehicle (CMV) operator (e.g. truck and bus/motor coach, railroad engineer, aviation pilot) performance—and, therefore, safety. In this chapter, the influence of sleep debt and circadian effects on operator performance are described. Efficacy of various countermeasures is reviewed, and the influence of individual operator traits (genetic factors) is briefly discussed. It is concluded that sleep (napping) remains the best strategy for restoring and maintaining CMV operator neurobehavioral performance. Results from ongoing research will lead to occupation-specific and individualized strategies for managing sleepiness and fatigue in operational environments.
The market and degree of consumption of energy drinks have exponentially expanded while studies that assess their psychological effects and impact on quality of life remain in the early stages, albeit on the rise. This review aims to examine the literature for evidence of the psychological effects of energy drinks and their impact on the sense of well-being and quality of life.
Studies were identified through Pubmed, Medline, and PsycINFO searches from the dates of 1990 to 2011, published in English, using the keywords energy or tonic drinks, psychological effects, caffeine and cognitive functions, mood, sleep, quality of life, well-being, and mental illness. Three authors agreed independently on including 41 studies that met specific selection criteria.
The literature reveals that people most commonly consume energy drinks to promote wakefulness, to increase energy, and to enhance the experience of alcohol intoxication. A number of studies reveal that individuals who consume energy drinks with alcohol were more inclined to be involved in risk-taking behaviors. There was also excessive daytime sleepiness the day following energy drink consumption. Contrary to expectations, the impact of energy drinks on quality of life and well-being was equivocal.
Energy drinks have mixed psychological and well-being effects. There is a need to investigate the different contexts in which energy drinks are consumed and the impact on mental health, especially in the psychiatrically ill.
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.
This report is the 25th Annual Report of the American Association of Poison Control Centers (AAPCC; http://www.aapcc.org) National Poison Data System (NPDS). During 2007, 60 of the nation's 61 U.S. Poison Centers upload case data automatically. The median upload time is 14 [5.3, 55] (median [25%, 75%]) min creating a real-time national exposure database and surveillance system.
We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Fatalities were reviewed by a team of 29 medical and clinical toxicologists and assigned to 1 of 6 categories according to Relative Contribution to Fatality.
Over 4.2 million calls were captured by NPDS in 2007: 2,482,041 human exposure calls, 1,602,489 information requests, and 131,744 nonhuman exposure calls. Substances involved most frequently in all human exposures were analgesics (12.5% of all exposures). The most common exposures in children less than age 6 were cosmetics/personal care products (10.7% of pediatric exposures). Drug identification requests comprised 66.8% of all information calls. NPDS documented 1,597 human fatalities.
Poisoning continues to be a significant cause of morbidity and mortality in the United States NPDS represents a valuable national resource to collect and monitor U.S. poisoning exposure cases. It offers one of the few real-time surveillance systems in existence, provides useful data, and is a model for public health surveillance.
Consumers are increasingly turning towards the consumption of functional beverages containing ingredients that address specific health issues. Functional beverages serves the various lifestyles and needs like excitement, energy boost, targeting specific disease, aging, fighting fatigue and stress, and making up for lack of healthy eating. The U.S. Dept. of Agriculture released a study in 2005 disclosing that 93% of Americans are ailing from vitamin and mineral deficiency diseases like obesity. The most important ingredients consumers seek in functional beverages are calcium and antioxidants. Meanwhile, the demand for these ingredients also render effective sales growth for functional beverages containing them. Women undergo certain health problems like osteoporosis and menopause, which are addressable through functional beverage use. Manufacturers are promoting beverages both functional and non functional, depending on the strength of their health-promoting attributes.
Sports and energy drinks are being marketed to children and adolescents for a wide variety of inappropriate uses. Sports drinks and energy drinks are significantly different products, and the terms should not be used interchangeably. The primary objectives of this clinical report are to define the ingredients of sports and energy drinks, categorize the similarities and differences between the products, and discuss misuses and abuses. Secondary objectives are to encourage screening during annual physical examinations for sports and energy drink use, to understand the reasons why youth consumption is widespread, and to improve education aimed at decreasing or eliminating the inappropriate use of these beverages by children and adolescents. Rigorous review and analysis of the literature reveal that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents. Furthermore, frequent or excessive intake of caloric sports drinks can substantially inc
In 1911, under authority granted by the recently enacted Food and Drug Act, US agents seized 40 kegs and 20 barrels of Coca-Cola syrup in Chattanooga, Tennessee.1,2 The group, led by chief chemist Harvey Wiley, considered the caffeine in Coca-Cola to be a significant public health hazard (both cocaine and alcohol had been removed from the recipe in the previous decade). The case continued for years. Eventually Coca-Cola decreased the caffeine content in this product and legal action was dropped.3
The consumption of energy drinks is rapidly increasing, as demonstrated by their large market growth. The targeted demographic group is teenagers, young adults, 18 to 34 y old; although expansion into nontraditional markets is also occurring. It is claimed that energy drinks can offer an increased energy boost related to their ingredient profile of caffeine, taurine, herbal extracts, and vitamins. Research suggests that energy drink formulations, in addition to increasing energy utilization, may also improve mood, enhance physical endurance, reduce mental fatigue, and increase reaction time. However, in most cases, the corresponding mechanisms of action are not clear. In addition, concerns have been raised over their safety and with a currently weak regulatory environment, efforts need to be made to ensure consumer safety. The objective of this article is to review the current U.S. energy drink market with emphasis on its market size, target demographic, active ingredients, potential benefits, safety, and regulations.
The characteristics of U.S. military personnel who use dietary supplements have not been well described. This study aimed to determine whether deployment experience and physical activity were associated with the use of bodybuilding, energy, or weight-loss supplement among U.S. military personnel.
Self-reported data from active-duty, Reserve, and National Guard participants of the Millennium Cohort Study collected from 2007-2008 (n = 106,698) on supplement use, physical activity, and other behavioral data were linked with deployment and demographic data. We used multivariable logistic regression sex-stratified models to compare the adjusted odds of each type of supplement use among those with deployment experience in support of operations in Iraq or Afghanistan and those engaged in aerobic or strength-training activities.
Overall, 46.7% of participants reported using at least one type of supplement, and 22.0% reported using multiple supplements. Male deployers were more likely to use bodybuilding supplements, whereas female deployers were more likely to use weight-loss supplements. Physically active and younger subjects reported all types of supplement use. Men and women reporting 5 or less hours of sleep per night were more likely to use energy supplements.
The high prevalence of supplement use and important characteristics found to be associated with their use, including deployment, physical activity, and suboptimal sleep, suggest focus areas for future research and adverse event monitoring.
To explore associations between energy drink consumption and alcohol use among college students.
Participants included 585 students (m age=18.7; 47.0% White, 21% Hispanic, 25% Asian, 7% other race/ethnicity; 56.0% female). Energy drink behaviors included past month and past week consumption. Alcohol use behaviors included past month and past two week consumption, as well as heavy drinking and quantity of alcohol consumed. Consumption of energy drinks mixed with alcohol was also measured. Linear and logistic regression analyses between energy drink consumption and alcohol use were run controlling for gender, age, and race/ethnicity.
For each one unit increase in past month (i.e., additional day used) energy drink use, the likelihood of past month alcohol use increased by 80%, heavy drinking by 80% and past month energy drinks mixed with alcohol use by 90%. Similar results were found for past week energy drink use. A positive relationship between energy drink use and quantity of alcohol consumed during a single episode of drinking was also found (p<0.001). Significant gender interactions between energy drink consumption and alcohol use as well as quantity of alcohol consumed were found, with relationships stronger among males than females. There were no significant interactions by race/ethnicity.
Energy drinks are readily available to students and pose potential health risks. Students who report greater energy drink consumption also consume more alcohol, are more likely to mix energy drinks and alcohol, and experience heavy episodes of drinking, which is problematic given the potential negative consequences of these drinks.
The health consequences of energy drink use in adolescents are unknown. We discuss an adverse event in an adolescent who presented to the emergency department with his first-ever seizure after consumption of 5-Hour Energy. We review the typical presentation of caffeine toxicity, as well as the importance of screening for energy drink use in adolescents with appropriate clinical findings. We pay particular attention to the identification of energy drink-related adverse events in the emergency department and the need for subsequent reporting to the Food and Drug Administration. To our knowledge, this is the first reported case of an adolescent presenting with a new-onset seizure associated with energy drink use.
This paper is a report of a study of perceived levels of mental, physical and total fatigue, and also acute and chronic fatigue states, among registered nurses. Relationships between dimensions of fatigue and performance were investigated, as were differences in fatigue across levels of several demographic and work environment variables.
Fatigue is a factor that has been linked to performance decrements in healthcare workers. As a result of the nature of their work, nurses may be particularly susceptible to multiple dimensions of fatigue, and their performance is closely linked to patient safety.
An online survey was used to measure mental, physical, and total fatigue dimensions, acute and chronic fatigue states, and performance. Participants were recruited via convenience sampling in cooperation with professional nursing organizations; 745 registered nurses completed the survey between February 2008 and April 2009.
Reported mental fatigue levels were higher than physical fatigue levels, and acute fatigue levels were higher than chronic fatigue levels. All fatigue dimensions and states were negatively correlated with perceived performance. Longer shift lengths and hours worked per week were associated with increases in physical and total fatigue levels. Mental, physical and total fatigue levels also differed with shift schedule.
Fatigue levels were negatively correlated with performance, further supporting the role of fatigue in nurse performance. Work environment variables were strongly associated with differences in perceived levels of fatigue. By altering the work environment, it may thus be possible to reduce fatigue levels and the rates of medical errors.
Since the introduction of Red Bull in Austria in 1987 and in the United States in 1997, the energy drink market has grown exponentially. Hundreds of different brands are now marketed, with caffeine content ranging from a modest 50 mg to an alarming 505 mg per can or bottle. Regulation of energy drinks, including content labeling and health warnings differs across countries, with some of the most lax regulatory requirements in the U.S. The absence of regulatory oversight has resulted in aggressive marketing of energy drinks, targeted primarily toward young males, for psychoactive, performance-enhancing and stimulant drug effects. There are increasing reports of caffeine intoxication from energy drinks, and it seems likely that problems with caffeine dependence and withdrawal will also increase. In children and adolescents who are not habitual caffeine users, vulnerability to caffeine intoxication may be markedly increased due to an absence of pharmacological tolerance. Genetic factors may also contribute to an individual's vulnerability to caffeine-related disorders including caffeine intoxication, dependence, and withdrawal. The combined use of caffeine and alcohol is increasing sharply, and studies suggest that such combined use may increase the rate of alcohol-related injury. Several studies suggest that energy drinks may serve as a gateway to other forms of drug dependence. Regulatory implications concerning labeling and advertising, and the clinical implications for children and adolescents are discussed.
The International Olympic Committee, the World Anti-Doping Agency, and International Sport Federations have banned and restricted the use of many stimulants including prescription and over-the-counter medications and dietary supplements. In addition to elite athletes, people of all ages use stimulants in attempts to improve athletic performance, alter body composition, and increase levels of energy. Here we introduce a seven-stage model designed to facilitate informed decision-making by individuals taking or thinking of taking stimulants for sport, health, and/or appearance reasons. We review for amphetamines, over-the counter sympathomimetics, and caffeine their performance-enhancing and performance-degrading effects, health benefits and mechanisms of action, medical side effects, and legal, ethical, safety, and financial implications.
Caffeine withdrawal’s clinical significance: is prophylactic treatment warranted?
- A Canton