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Knowledge Towards Energy Drinks Consumption and Related Factors Among Young Male Athletes in the United Arab Emirates

Canadian Center of Science and Education
Global Journal of Health Science
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OBJECTIVES: We aim to investigate the knowledge towards Energy Drinks (EDs) consumption and related factors among young male athletes in the United Arab Emirates (UAE). SUBJECTS & METHODS: A cross-sectional study included 688 young male athletes from Al Ain sports club aged between 7 to 18 years. Data were collected using a modified version of a validated questionnaire from the European Food Safety Authority. RESULTS: Overall EDs consumption was 24%. About 44% of the athletes consumed EDs one to two times per month. Athletes who were training between 5-7 days per week consumed significantly more EDs compared to those who were training 3-4 days per week (81% vs. 15 %, P<0.001). Athletes aged 7-12 years were 2.4 times more likely to consume EDs than athletes aged 13-18 years (P<0.001). Moreover, athletes living with both parents were significantly less likely to consume EDs compared to those living with a single parent (P=0.01). Knowledge score about EDs consumption was significantly higher for non EDs consumers compared to EDs consumers (P<0.001). CONCLUSIONS: EDs consumption among young male athletes was moderate. Educational programs are needed to increase the awareness regarding EDs consumption and its potential adverse effects among the young athletes. A regulation policy for EDs consumption should be addressed and consideration of labels with EDs contents and age identification is highly recommended.
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Global Journal of Health Science; Vol. 11, No. 5; 2019
ISSN 1916-9736 E-ISSN 1916-9744
Published by Canadian Center of Science and Education
1
Knowledge Towards Energy Drinks Consumption and Related Factors
Among Young Male Athletes in the United Arab Emirates
Aisha A. Almulla1, Hadia Radwan2 & Nada Al Adeeb1
1 Community Nutrition Department, Tawam Hospital- in affiliation with Johns Hopkins Medicine, Abu Dhabi
Health Services Company (SEHA), Abu Dhabi, United Arab Emirates
2 Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and
Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
Correspondence: Aisha Abdalla Almulla, Community Nutrition Department- Tawam Hospital- in affiliation with
Johns Hopkins Medicine, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, United Arab Emirates. Tel:
97-137-074-603. E-mail: aialmulla@seha.ae
Received: February 18, 2019 Accepted: March 18, 2019 Online Published: March 20, 2019
doi:10.5539/gjhs.v11n5p1 URL: https://doi.org/10.5539/gjhs.v11n5p1
Abstract
Objectives: We aim to investigate the knowledge towards Energy Drinks (EDs) consumption and related factors
among young male athletes in the United Arab Emirates (UAE).
Subjects and Methods: A cross-sectional study included 688 young male athletes from Al Ain sports club aged
between 7 to 18 years. Data were collected using a modified version of a validated questionnaire from the
European Food Safety Authority.
Results: Overall EDs consumption was 24%. About 44% of the athletes consumed EDs one to two times per
month. Athletes who were training between 5–7 days per week consumed significantly more EDs compared to
those who were training 3–4 days per week (81% vs. 15 %, P<0.001). Athletes aged 7–12 years were 2.4 times
more likely to consume EDs than athletes aged 13-18 years (P<0.001). Moreover, athletes living with both parents
were significantly less likely to consume EDs compared to those living with a single parent (P=0.01). Knowledge
score about EDs consumption was significantly higher for non EDs consumers compared to EDs consumers
(P<0.001).
Conclusions: EDs consumption among young male athletes was moderate. Educational programs are needed to
increase the awareness regarding EDs consumption and its potential adverse effects among the young athletes. A
regulation policy for EDs consumption should be addressed and consideration of labels with EDs contents and age
identification is highly recommended.
Keywords: adolescent, athletes, consumption, energy drinks, knowledge
1. Introduction
Energy Drinks (EDs) has become one of the most popular beverages worldwide. They are defined as any type of
non-alcoholic beverages that contains caffeine as a main ingredient, taurine, vitamins, and other ingredients
combination (such as guarana and ginseng, etc.) (Metrology, 2015; Zucconi, 2013). They are marketed as to
relieve fatigue and improve mental alertness, in contrast with sports or isotonic drinks which are intended to help
athletes rehydrate after exercise (Campbell et al., 2013; Schneider & Benjamin, 2011). EDs marketing targets
athletics as the primary target population, but as the expanding of EDs marketing into a different niche, teenagers
and young adults are today the target population for EDs consumption as this group is more attracted to
advertisements of these type of products (Heckman, 2010; Lal, 2007).
Many reports on the adverse effects of EDs consumption have been received by poison control centers and
regulatory authorities (Ali, Rehman, Babayan, Stapleton, & Joshi, 2015; FDA, 2012; Gunja, 2012; Seifert,
Schaechter, Hershorin, & Lipshultz, 2011). These reports included cardiac, neurological and gastrointestinal
adverse effects. An excess amount of caffeine can lead to many negative health effects such as sleep disturbance,
anxiety, jitteriness, gastrointestinal effects, tachycardia, and other cardiac symptoms and in some rare cases
seizures and death (Harris & Munsell, 2015; Reissig, Strain, & Griffiths, 2009; Seifert et al., 2011). According to
the U.S. Food and Drug Administration (FDA), the higher limit of moderate caffeine consumption among healthy
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adult people is 400 mg/day (FDA, 2018). Health Canada issued recommendations for maximum caffeine intake
levels for children aged 4 to 12 years to be between 45–85 mg caffeine per day and for children aged 13 years and
above caffeine consumption should not exceed 2.5 mg/kg/day (Canada, 2012).
Data from the European Food Safety Authority (EFSA) showed that the consumption of EDs was 68% among
adolescents, 30% among adults and 18% among children (<10 years old) (Zucconi, 2013). O’Brien et al. found that
34% of EDs consumers were aged between 18 to 24 years in the USA (O'Brien, McCoy, Rhodes, Wagoner, &
Wolfson, 2008). Moreover, Gallimberti et al. reported a significant increase in EDs consumption from 18% among
sixth grade to 56% among eight-grade adolescent students (Gallimberti et al., 2013). EDs consumption among
college students in the United Arab Emirates (UAE) was reported to be 92% (Shery Jacob, 2013). There is a
scarcity of studies on EDs consumption among young athletes. We aimed to investigate the knowledge towards
EDs consumption and related factors among young male athletes in the UAE.
2. Materials and Methods
2.1 Study Protocol
This cross-sectional study was carried out during the period from May to October 2017 among young male athletes
in Al Ain Sports Club, Al Ain city, Abu Dhabi, UAE. A convenient sample of total of 688 male athletes aged
between 7 to 18 years from different sports disciplines were selected.
A structured and validated questionnaire of 37 questions was created based on a previously validated questionnaire
used for gathering consumption data on specific consumer groups of EDs by the European Food Safety Authority
(EFSA) (Zucconi, 2013). The questionnaire was modified and adapted to our culture and objectives and was
administered in both English and Arabic. It was translated from English to Arabic and back-translated. The
questionnaire was reviewed by three other nutritionists and pilot tested on 27 young athletes to ensure the validity
and clarity of the questions.
This study is approved by Al Ain Medical District Human Research Ethics Committee (CRD504/17, Protocol
No.17–27). The consent was obtained from the participant’s parent. All study data and participant’s information
were handled confidentially and coded, and no one but the research team from the Community Nutrition
Department had access to it.
2.2 Data Collection Tools
The questionnaire consisted of 6 sections: section (1) demographic data (gender, age groups (7–12 years and 13–
18 years), weight, height, general health status and family type (living with both parents, single parent, other) ,
average sleeping duration during weekdays (<7 hours, 7-9 hours, <9 hours), Type of sports: team sports (football,
basketball, handball, vollyball) or individual sports (swimming, JiuJitsu); (2) overall beverages consumption; (3)
EDs consumption frequency (during the past 3 days and the past year), can size, location, reasons for consumption,
preferred brand, choice of sugar or sugar free, parental EDs consumption; (4) Physical Activities (PA) [exercise
frequency (5–7 days per week, 3–4 days per week, 1–2 days per week), EDs consumption before/during/after
exercise and number of cans per session]; (5) Other caffeinated beverages (coffee, tea, hot chocolates, and cola)
consumption frequency, cup or can size and caffeine and sugar choice); (6) knowledge about EDs price, caffeine
and vitamins contents.
Each athlete was interviewed face-to-face by a nutritionist. Pictures and samples of EDs products with all available
sizes were used during the interview. Body Mass Index (BMI) of the athletes were measured and calculated as
weight in kilograms (kg)/ (height in meter)2 . BMI was classified according to the Centers for Disease Control and
Prevention (CDC) Growth Charts into underweight (less than 5th percentile); healthy weight (5th percentile to the
85th percentile); overweight (85th percentile to less than the 95th percentile) and obese (equal to or greater than the
95th percentile). (CDC, 2015)
2.3 Statistical Analysis
Data from all the questionnaires were coded and entered using SPSS (Statistical Package for the Social Sciences,
version 23). Descriptive and frequency analysis was used to analyze the baseline athletes characteristics. Pearson
x2 test was used to assess differences in the distribution of frequency of replies and to analyze the influence of
selected related factors (BMI categories, family type and frequency of PA) on overall EDs consumption). Logistic
regression was performed to test the effects of various factors (age group, family type, average sleeping hours per
weekdays and frequency of PA) on overall EDs consumption.
For each athlete, a knowledge score (K score) ranging from 4 to 8 was calculated based on the number of the
correct answers to four questions. The higher the score, the lower the knowledge towards EDs. Independent t-test
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was used to test if the K score means differs based on overall EDs consumption. Simple linear regression was used
to study if a K score can predict overall EDs consumption, age groups, and family type. In our study, the significant
criteria were set at P<0.05 and were used for all the statistical analysis.
3. Results
3.1 Athletes Characteristics
Table 1 describes athletes sociodemographic characteristics according to EDs consumption. The study included
688 male athletes (mean age 11.5 ± 2.5 years, mean BMI =19 ± 4.1 kg/m2). Among all athletes, 21% were either
overweight or obese. Around 87% of all the athletes lived with both parents and 12% lived with a single parent.
The majority of the Athletes reported no health problems (92%).
Table 1. Athletes characteristics as related to EDs consumption (n=688) **
Socio-Demographic data
Overall EDs consumption
Ye s
n (%)
No
n (%)
Total
n (%)
Age groups (Years)
7-12
13-18
69 (42)
94 (71)
371 (58)
150 (29)
440 (64)
244 (36)
BMI (kg/m2)
Underweight
Normal
Overweight
Obese
12 (9)
95 (69)
17 (12)
13 (10)
29 (6)
309 (68)
70 (15)
49 (11)
41 (6)
404 (59)
87 (13)
62 (9)
Family type*
Both parents
Single parent
Other
133 (82)
28 (17)
2 (1)
468 (89)
56 (11)
1 (0.2)
601 (87)
84 (12)
3 (0.4)
Average sleeping weekdays (hours)
< 7
7-9
> 9
38 (23)
101 (62)
24 (15)
50 (10)
332 (63)
142 (27)
88 (13)
433 (63)
166 (24)
Type of sports
Team sports
Individual sports
139 (85)
24 (15)
462 (88)
63 (12)
601 (87)
87 (13)
PA frequency*
1-2 days/week
3-4 days/week
5-7 days/week
7 (4)
24 (15)
132 (81)
50 (11)
120 (26)
295 (63)
57 (8)
144 (21)
427 (62)
Note. BMI= body mass index, PA= physical activities.
**Some values were missing for some variables.
*Significant P<0.05.
Interestingly, athletes living with both parents consumed significantly fewer EDs (89%) as compared to athletes
living with a single parent (11%, P=0.01). Moreover, athletes who trained between 5-7 days per week consumed
significantly more EDs compared to those who trained between 3-4 days per week (81% vs. 15%, P<0.001), Table
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1.
3.2 Energy Drinks Consumption
In our study, the overall EDs consumption among young male athletes was 24% (n=163). The majority consumed
at least one can once or twice per month (44%). 22% of athletes parents consumed EDs sometimes, the majority
(16%) were athletes fathers. In terms of the preferred brands, two brands of the tested emerged to capture market
share of over 80%. The most popular brands of EDs were Redbull (54%) and PowerGold (29%). The majority of
athletes consumed 250 ml EDs can size (87%). The main reasons for EDs consumption by the athletes were its
good taste (54%), energy/performance enhancement (19%), and friends influence (20%), Figure 1. Regarding EDs
consumption as related to PA, 17% of athletes reported never consumed EDs during PA, 5% reported sometimes
consumed before and/or after or during PA, 2% reported EDs consumption always before or after PA.
Figure 1. Reasons for Energy Drinks consumption among young male athletes
3.3 Overall EDs Consumption and Related Factors
Age and sleeping hours were significant predictors to EDs consumption, Table 2. Athletes aged 7–12 years were
2.4 times more likely to consume EDs than athletes aged 13–18 years after controlling for all other factors in the
model. Additionally, athletes sleeping between 7–9 hours and those more than 9 hours were more likely to
consume EDs compared to athletes sleeping less than 7 hours (Table 2). A Pearson correlation analysis showed a
positive correlation between EDs consumption and average weekdays sleeping hours (r = 0.186, n = 687, P <
0.001). On the other hand, a negative correlation was shown between age groups and EDs consumption (r = -0.257,
n = 684, P < 0.001).
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Table 2. Logistic regression of overall EDs consumption with selected variables (n=624)
Variables OR 95% CI
Age groups (years)
13-18 (ref)
7-12
2.38
1.56, 3.63*
Family type
Both parents (ref)
Single parent
Others
0.6
0.25
0.35, 1.02
0.02,3.6
Average sleeping weekdays (hours)
<7 (ref)
7-9
>9
1.73
2.31
1.04, 2.89*
1.19, 4.52*
PA frequency
5-7d/week (ref)
3-4d/week
1-2d/week
1.55
2.02
0.92, 2.62
0.86, 4.74
Note. OR= Odds Ratio; CI= Confidence Interval; PA= physical activities.
*Significant P<0.05.
3.4 Knowledge Towards Overall EDs Consumption
Around 82% of the athletes didn’t know that EDs contained caffeine and only 20% believed that EDs contained
vitamins. The majority of athletes (76%) assumed that EDs and soft drinks are different.
The average knowledge score (K) of EDs consumption among all the athletes was 6.5 ± 0.96 (n = 687). We found
that K score was significantly higher for non EDs consumers 6.6 ± 0.96 (n = 524) compared to K score for EDs
consumers 6.05 ± 0.88 (n=163) (P < 0.001). These results suggest that athletes who were not consuming EDs had
lower knowledge towards EDs consumption.
EDs consumption and age groups were significant predictors of K score as described in Table 3. These results
suggest that as the age increases, knowledge towards EDs increases and as the overall EDs consumption increases,
knowledge towards EDs decreases.
Table 3. Multiple linear regression of K score with related factors
Variables in the model b SE b β 95% CI
Overall EDs consumption 0.24 0.044 0.213 0.16,0.33*
Age groups -0.21 0.078 -0.102 -0.36,-0.054*
Family type -0.038 0.103 -0.014 -0.24,0.17
Note. b and SE b = unstandardized coefficient and its standardized error; β = the standardized coefficient; CI = Confidence
Interval
*Significant P<0.05.
4. Discussion
This study reported that overall EDs consumption among male athletes aged 7 to 18 years was 24%. Forty-four
percent of athletes in this study reported EDs consumption 1-2 times per month. Similarly, The EDs consumption
among adolescents in Bahrain was 2 to 3 times per week (28.8%) and 1-2 times per month (15%) (Maryam, 2015).
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While lower EDs consumption rate was reported among adolescents aged 11-13 years old in Italy (20%)
(Gallimberti et al., 2013). Musaiger et al. (Musaiger & Zagzoog, 2013) reported that about 55% of adolescents
consumed EDs once or more each week. In our study, it has been found that athletes aged 7-12 years were more
likely to consume EDs than athletes aged 13-18 years. Similar to other, our study showed that the consumption rate
decline with increased age (Simon, 2007). In contrast, Gallimberti L. et al. (Gallimberti et al., 2013) demonstrated
that EDs consumption increased steadily with age where eight graders (50%) consumed more EDs as compared to
sixth grader (18.6%).
Our study showed that athletes living with both parents were less likely to consume EDs (89%). However, some
athletes reported that 22% of their parents consumed EDs sometimes. This indicates the influence of parents on
their children’s attitudes towards EDs consumption. It was shown that parental lack of awareness about
caffeine-related health risks on young children and the differences between EDs and other soft drinks was the
reason for allowing their children to consume EDs (Oddy & O’Sullivan, 2009).
In contrast to Koivusilta L. et al. (Koivusilta, Kuoppamaki, & Rimpela, 2016), Our study showed that athletes who
slept 7 hours and more were more likely to consume EDs than athletes sleeping less than 7 hours. This could be
explained that athletes who sleep longer hours felt that they needed to drink EDs in order to feel energized for their
sports activity. Nowak D. et al (Nowak & Jasionowski, 2016) showed that 28% of respondents claimed that EDs
gave them a boost of energy. Similarly, our study showed that 19% of the athletes consumed the EDs to increase
their energy and enhance their performance. Caffeine is the primary source of energy in EDs. It has been shown
that caffeine enhances physical performance in adults by improving concentration, reduces fatigue, enhance
alertness and power (Paluska, 2003). However, these effects vary according to the consumer age, sex and caffeine
dependency (Schneider & Benjamin, 2011). Two randomized studies among elite junior athletes showed that
pre-exercise ingestion of EDs had a positive effect on participants sports performance (Abian-Vicen et al., 2014;
Gallo-Salazar et al., 2015), however both studies involved small numbers of participants thus this should further be
investigated in a bigger sample with concerns to the long-term effects of EDs on physical performance and overall
health issues.
It has been showed that some adolescents consume EDs for their perceived physiological benefits without being
aware of the potential health risks of these drinks (O'Dea, 2003). Similar to others (Maryam M. Nassaif, 2015;
Musaiger & Zagzoog, 2013; Nowak & Jasionowski, 2016; Zucconi, 2013), 54% of EDs consumers in our study
reported that the main reason for consuming EDs was its good taste. In contrast with another study, we found that
82% of the athletes didn’t know that EDs contained caffeine and 20% believed that EDs contained vitamins
(Musaiger & Zagzoog, 2013). The majority of athletes in our study believed that EDs and soft drinks are different
(76%), which was in contrast to Musaiger et al. (Musaiger & Zagzoog, 2013) who found that 67% of adolescents
considered EDs similar to soft drinks. Hardy. et al (Hardy, Kliemann, Evansen, & Brand, 2017) investigated the
association between EDs consumption and overall knowledge score and found that users of EDs scored
significantly lower on the section of food/nutrients sources and disease knowledge than did non EDs users.
Caffeine content in EDs ranges from 50-505 mg in a can or bottle depending on the capacity. This amount is equal
to or even exceeds the amount of caffeine in a cup of coffee (Clauson, Shields, McQueen, & Persad, 2008; Reissig
et al., 2009). In addition to EDs consumption, athletes in our study also consumed other caffeinated beverages such
as soft drinks (23%), and tea (39%) which can further increase their daily caffeine intake. An excess amount of
caffeine can lead to many negative health effects such as sleep disturbance, anxiety, jitteriness, gastrointestinal
effects, tachycardia, and other cardiac symptoms and in some rare cases seizures and death (Harris & Munsell,
2015; Reissig et al., 2009; Seifert et al., 2011).
Different countries have set their own regulatory policies regarding labeling, distribution, and sale of EDs with a
high content of caffeine. Regulations of the European enforced additional caffeine labeling for EDs with 150 mg/l
caffeine (Thomson, 2010). In all EU Member States, EDs can be sold but with specific regulations including
setting rules for sales to youths. For example, in Sweden, some products sales are regulated by pharmacies and
sales to children under the age of 15 years are illegal (Oddy & O’Sullivan, 2009). In Canada, EDs require warning
labels, the maximum daily consumption amount and advise against mixing EDs with alcohol (Temple, 2009). In
the UAE, the Emirates Authority for standards and Metrology (ESMA) have set regulation policies for EDs
labelling such as not allowing pregnant and lactating women, persons under the age of 16 years, persons with
sensitivity to caffeine, and those with heart and arterial problems, as well as athletics during exercises to drink EDs
(Metrology, 2015). It is necessary to amend the UAE standards for EDs for those under the age of 18 years by
placing restrictions on EDs marketing, limiting EDs sales places, active enforcement of a minimum purchase age
with age verification card. Moreover, relevant authorities should be instructed to discourage mixing EDs with
other beverages.
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5. Conclusions
EDs consumption rate was moderate among young male athletes in the UAE. Educational programs are needed to
increase awareness regarding EDs consumption and its potential adverse effects. A regulation policy for EDs
consumption should be addressed, and consideration of warning labels with EDs contents and age identification is
highly recommended.
5.1 Strength and Limitation
To our knowledge, this is the first study investigating the EDs consumption prevalence among young athletes. The
face-to-face questionnaire interview gave more accurate responses compared to self-reporting data. We used a
modified validated questionnaire from the EFSA study to examine practices of EDs with reliable measurements.
We have to acknowledge that this study has certain limitations. Our study is a cross-sectional study, so implications
of casual association cannot be accurately made. Additionally, athletes included in this study may not be
representative of all sports athletes in the UAE.
5.2 Implications
The present study gave unique information regarding the prevalence of EDs consumption among children and
adolescents in Al Ain city. The study also investigated the related influence factors of EDs consumption and
knowledge towards EDs consumption among athletes.
On October 1, 2017, the UAE Federal Tax Authority has implemented excise tax at a rate of 100% on EDs. it
would be very interesting to conduct a follow-up study after tax implementation on EDs to compare it with our
findings.
Acknowledgments
The authors are grateful to all athletes who have participated in th e study and to Al Ain sports club for their support.
A special thanks to Mr. Faisel Aziz for his contribution in double checking our statistical data analysis and Dr.
Khaled Dougman for his contribution in reviewing the preliminary results of the study.
Author Contributions
AAA contributed to conception and design, acquisition of data, data analysis and interpretation. Both AAA and HR
drafted the paper and critically reviewed the manuscript; NA contributed to study design, data collection and
reviewed the manuscript. All authors gave the final approval of the version to be published.
Competing Interests Statement
The authors declare that there are no competing or potential conflicts of interest.
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... Adolescents seem to be the age group with the highest consumption rate of EDs. 8 This could be explained as older adolescents are more exposed to ED marketing and have easier access to it. Recent studies found that even children are consuming EDs 22,23 ; this is a cause of concern as regular consumption of these beverages containing caffeine, sugar, and other stimulant ingredients showed to be related to other adverse health effects. [8][9][10]24 Moreover, we found a relationship between ED consumption and parents' educational level. ...
... 33 In our previous study, we assessed ED consumption among young athletes in Al Ain city (between May and October 2017) before implementing 100% tax on ED and found that the overall ED consumption was 24% among 688 male participants aged between 7 and 18 years. 23 Comparing with this study, which was conducted after the tax implementation, the consumption rate is 27% among 1611 participants aged between 10 and 18 years. Our results suggest that despite the tax implementation, ED consumption remains popular among young people. ...
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