Committee on Nutrition and the Council on Sports Medicine and Fitness. Sports drinks and energy drinks for children and adolescents: are they appropriate?

An Educational Intervention for Improving the Snacks and Beverages Brought to Youth Sports in the USA

OBJECTIVES

The purpose of this study was to test a small-scale intervention and its ability to decrease total sugar intake and number of calories offered at youth sports games.

METHODS

This study was a pre/post-test quasi-experimental design. A flier was developed and distributed to parents. The flier aimed to decrease the sugar-sweetened beverages and increase the nutritional quality of food brought to games. Baseline data were collected in 2018 (n = 61). The flier was distributed prior to the start of the league, once during the league, and posted online in 2019. Postintervention data were collected in the intervention group (n = 122) and a comparison group (n = 74). Nutritional information was collected through direct observation.

RESULTS

The average amount of total sugar provided per game per child was 25.5 g at baseline when snacks/beverages were provided at games. After the intervention, the average amount of total sugar provided significantly decreased (16.7 g/game/child, p < 0.001).

CONCLUSIONS

The intervention reduced total sugar offered and the number of sugar-sweetened beverages brought to games. It was low-cost and could be easily implemented by public health practitioners and/or parks and recreation administrators. Further, considerations could be made to implement policies relative to snacks and beverages at youth sports games.

The Impact of Sport Training on Oral Health in Athletes

Athletes' oral health appears to be poor in numerous sport activities and different diseases can limit athletic skills, both during training and during competitions. Sport activities can be considered a risk factor, among athletes from different sports, for the onset of oral diseases, such as caries with an incidence between 15% and 70%, dental trauma 14-70%, dental erosion 36%, pericoronitis 5-39% and periodontal disease up to 15%. The numerous diseases are related to the variations that involve the ecological factors of the oral cavity such as salivary pH, flow rate, buffering capability, total bacterial count, cariogenic bacterial load and values of secretory Immunoglobulin A. The decrease in the production of S-IgA and the association with an important intraoral growth of pathogenic bacteria leads us to consider the training an "open window" for exposure to oral cavity diseases. Sports dentistry focuses attention on the prevention and treatment of oral pathologies and injuries. Oral health promotion strategies are needed in the sports environment. To prevent the onset of oral diseases, the sports dentist can recommend the use of a custom-made mouthguard, an oral device with a triple function that improves the health and performance of athletes. During training, the sports dentist must monitor the athletes and the sports examination protocol must be implemented with the inclusion of the clinical examination, quantitative and qualitative analysis of saliva and instructions on the use, cleansing and storage of the mouthguard.

Cumulative socio-demographic risk factors and sleep outcomes in early childhood

STUDY OBJECTIVES

To examine associations between cumulative socio-demographic risk factors, sleep health habits, and sleep disorder symptoms in young children.

METHODS

Two hundred five caregiver-child dyads (child mean age ± SD: 3.3 ± 1.1 years; 53.7% girls; 62.9% black, 22.4% non-Hispanic/Latinx white, 4.4% Hispanic/Latinx; 85.4% maternal caregiver reporter) completed caregiver-rated sleep measures (Brief Child Sleep Questionnaire [BCSQ]; Pediatric Sleep Questionnaire [PSQ] snoring subscale), which were used to generate indexes of poor sleep health habits, pediatric insomnia symptoms, and obstructive sleep apnea (OSA) symptoms. A cumulative risk index was created reflecting caregiver, family, and neighborhood risks.

RESULTS

Overall, 84.5% of children had ≥ 1 poor sleep health habit, 62.9% had ≥ 1 insomnia symptom, and 40.0% had ≥ 1 OSA symptom. Poisson regression indicated that each increase in the number of cumulative risk factors was associated with a 10% increase in poor sleep health habits, a 9% increase in insomnia symptoms, and an 18% increase in OSA symptoms. Specific caregiver risks (depressive symptoms, lower educational attainment) and family risks (single caregiver, crowded home) were most predictive of poor sleep outcomes.

CONCLUSIONS

Poor sleep health habits and sleep disorder symptoms are highly prevalent in early childhood, particularly among families experiencing cumulative socio-demographic risks. Findings underscore the need for targeted screening and prevention for modifiable sleep behaviors and efforts to tailor such strategies for at-risk children and families, especially those living in crowded conditions, or with caregivers who are single or have a lower educational attainment or depressive symptoms.

Youth Beverage Intake and Reported Prediabetes: Choice and Frequency Matter

INTRODUCTION

Sugar sweetened beverage (SSB) consumption among U.S. adolescents exceeds current recommendations. This study examines relationships between SSB intake and reported prediabetes.

METHOD

Data are from the 2019 Minnesota Student Survey (N = 125,375). Logistic regression was used to examine relationships between frequencies for SSB intake and youth reported prediabetes in analytic models adjusting for demographic and other cardiometabolic indicators. Additional analyses examined relationships between consumption of fruit juice, milk, and water, and prediabetes.

RESULTS

One in four youth reported consumption of at least one SSB daily. In fully adjusted models, a range of SSB intake frequencies were significantly associated with increased odds of reported prediabetes. All intake frequencies for water were associated with reduced odds of prediabetes.

DISCUSSION

Efforts to reduce SSB intake among adolescents are warranted to support cardiometabolic health. Study findings are consistent with current guidance identifying water as the preferred drink for adolescents' hydration needs.

The Influence of Lifestyle Factors on the Burden of Pediatric Migraine

There is a gap in patient education and coaching of lifestyle factors related to pediatric migraine, which nurses are in a unique position to fill in order to provide comprehensive care to these patients. In order to help fill this gap, we conducted a targeted review of studies examining migraine and lifestyle factors in children and adolescents. Studies older than 2010, studies examining adults above the age of 18, studies not available in the English language, and secondary sources were excluded from the review. A final sample of 42 studies was included in this review. Lifestyle factors including stress, sleep, obesity, and diet were identified as playing a significant role in increasing the frequency, severity, and duration of migraine attacks in pediatric patients. Based on these findings, a framework is discussed for practical applications of this knowledge by nursing staff working in primary and specialty care clinics.

Barriers and Facilitators Associated with Physical Activity in the Middle East and North Africa Region: A Systematic Overview

Increasing physical inactivity levels in the Middle East and North Africa (MENA) region is a public health concern. We aimed to synthesize barriers and facilitators to physical activity and make appropriate recommendations to address physical inactivity. We conducted an overview of systematic reviews on physical activity barriers and facilitators in 20 MENA countries by systematically searching MEDLINE/PubMed and Google Scholar for systematic reviews published between 2008 and 2020. Our overview included four systematic reviews and 119 primary studies with data from 17 MENA countries. Lack of suitable sports facilities, time, social support and motivation, gender and cultural norms, harsh weather, and hot climate were the most commonly reported barriers to physical activity. Socio-demographic factors negatively associated with physical activity participation include advanced age, being female, less educated, and being married. Motivation to gain health benefits, losing/maintaining weight, being male, dietary habits, recreation, and increased Body Mass Index are positively associated with increased levels of physical activity. Interventions promoting physical activity in MENA should target schoolchildren, women and girls, working parents, and the elderly. Country-specific sociocultural and environmental factors influencing physical activity should be considered in the design of interventions. Current and future policies and national interventions must be consistently evaluated for effectiveness and desired outcomes.

Pediatric sleep health: It matters, and so does how we define it

In 2014, Buysse published a novel definition of sleep health, raising awareness for the importance of this construct for individuals, populations, clinical care, and research. However, the original definition focused on adults, with the recommendation that it should be adapted for children and adolescents. As children live within a complex and dynamic system, and may not always have control over their own sleep, this theoretical review will examine and apply Buysse's five dimensions of sleep health within the context of pediatrics. In addition, using examples from the pediatric sleep literature we introduce a modified definition that takes into consideration the influence of the socio-ecological system within which children live, and the sleep-related behaviors that are critical in supporting or hindering sleep health. Finally, we discuss how the proposed theoretical framework, Peds B-SATED, can be applied to clinical practice, research, and training in the field of pediatric sleep.

Caffeine-Containing Energy Shots Cause Acute Impaired Glucoregulation in Adolescents

Caffeine-containing, nutritionally fortified energy shots are consumed at high rates by adolescents, yet little is known about their metabolic impact. The purpose of this study was to examine the consequences of small format, caffeinated energy shots on glucose metabolism and gastrointestinal hormone secretion in adolescents. Twenty participants aged 13-19 years participated in a double-blind, randomized cross-over study consisting of two trials separated by 1-4 weeks. Participants consumed a volume-matched caffeinated energy shot (CAF, 5 mg/kg) or a decaffeinated energy shot (DECAF) followed by a 2 h oral glucose tolerance test. Blood samples were collected and area under the curve (AUC) calculated for glucose, insulin and gut and metabolic hormones. Consumption of CAF resulted in a 25% increase in glucose and a 26% increase in insulin area under the curve (AUC, p = 0.037; p < 0.0001) compared to DECAF. No impact on gut hormones was observed. To further characterize responses, individuals were classified as either slow or fast caffeine metabolizers based on an allele score. Glucose intolerance was greater in genetically fast vs. slow caffeine metabolizers and differences between groups were supported by distinct serum metabolomics separation. Consumption of caffeine-containing energy shots results in acute impaired glucoregulation in healthy adolescents as characterized by hyperinsulinemia following an oral glucose challenge.

Energy-drink consumption is associated with asthma, allergic rhinitis, and atopic dermatitis in Korean adolescents

BACKGROUND/OBJECTIVES

Few studies have evaluated the effects of energy drinks on allergic diseases. The purpose of this investigation was to evaluate the association between energy drinks and various allergic diseases, including asthma, allergic rhinitis, and atopic dermatitis, in a large representative Korean adolescent population.

SUBJECTS/METHODS

This cross-sectional study used data from the Korea Youth Risk Behavior Web-based Survey collected from 2015 to 2016. A total of 129,809 participants (n = 67,056 for males; n = 62,753 for females) aged 12-18 years were included and were asked about their frequency of consumption of energy drinks such as Hot6^®, Redbull^®, and Bacchus^®. Their history of asthma, allergic rhinitis, and atopic dermatitis throughout life and in the last 12 months were obtained. The association between the frequency of energy-drink consumption and allergic diseases was analyzed using multiple logistic regression with adjustment for various covariates.

RESULTS

Age, sex, physical activity, obesity, region of residence, economic level, paternal and maternal educational level, smoking, and alcohol consumption differed significantly according to the frequency of energy-drink consumption (each P < 0.001). Frequent energy-drink consumption (≥7 times a week) was significantly associated with asthma throughout life (odds ratio [OR] = 1.30, 95% confidence interval (CI) = 1.03-1.64, P = 0.025), asthma within the last 12 months (OR = 1.65, 95% CI = 1.16-2.35, P = 0.006), allergic rhinitis within the last 12 months (OR = 1.21, 95% CI = 1.02-1.44, P = 0.030), and atopic dermatitis within the last 12 months (OR = 1.49, 95% CI = 1.17-1.90, P = 0.001) compared to no energy-drink consumption in the full-adjusted model.

CONCLUSIONS

Frequent energy-drink consumption is associated with allergic diseases, including asthma, allergic rhinitis, and atopic dermatitis, in Korean adolescents.

Consumption of soft, sports, and energy drinks in adolescents. The BEENIS study

INTRODUCTION

The wide range of non-alcoholic drinks are currently grouped as soft (carbonated), sports, and energy drinks, and all of them have a high sugar content, along with their known risk of obesity. Their consumption is increasing and in inadvisable circumstances also an elevated health risk. The real consumption of sports and energy drinks is not well known.

OBJECTIVE

To determine the habits and consumption of soft, sports, and energy drinks in adolescents.

MATERIAL AND METHODS

A descriptive, cross-sectional study was performed in which questionnaires were obtained from 4769 schoolchildren from 13-18 years-old from Sabadell, Barcelona, Spain.

RESULTS

The prevalence of consuming soft drinks was observed in 92.9% of the adolescents, and was predominantly done during leisure time, during meals, or any time during the day. In sports it was 61.7%, mainly on practising the sport and in leisure time. In energy drinks, it was 49.2%, mainly in leisure time (they were mixed with alcohol in 49%) and on practising sport. The simultaneous consumption of the three types was 38%, and soft drinks were the most common.

DISCUSSION

A description is presented on the consumption of sports drinks, normally included as soft drinks, as well as the simultaneous consumption of the three types of drinks, and the time in which they are consumed. We have a diagnostic tool of consumption of these drinks by adolescents in our setting that will enable us to design and evaluate educational interventions in order to make the adolescent population and their families aware.

Non-Alcoholic Beverages, Old and Novel, and Their Potential Effects on Human Health, with a Focus on Hydration and Cardiometabolic Health

The Beverage Guidance System has established dietary recommendations for daily intake of commonly consumed beverages including water, tea, coffee, milk, non-calorically sweetened beverages, and calorically sweetened beverages. As obesity in America continues to be a growing problem, this guidance becomes of increasing importance due to many beverages' potential links to Type 2 Diabetes Mellitus (T2DM), Cardiovascular disease (CVD), and numerous other harmful health effects. However, the growing popularity of "better for you" beverages is causing a shift in the market, with consumers pushing for healthier beverage alternatives. Beverages simultaneously present advantages while posing concerns that need to be evaluated and considered. In this review, health effects of nonalcoholic beverages are discussed including various aspects of consumption and current trends of the beverage market such as the novel Soft Seltzer category as an alternative to Hard Seltzer and various mashups. A variety of advisory boards and agencies responsible for dietary guidelines in various countries suggest drinking water as the preferred practice for hydration.

Beyond taste and easy access: Physical, cognitive, interpersonal, and emotional reasons for sugary drink consumption among children and adolescents

Consumption of sugary drinks is associated with the development of obesity and cardiometabolic diseases among children and adolescents. In addition to high added sugar content, many sugary drinks also contain caffeine. However, whether the combination of sugar and caffeine uniquely influences children's sugary drink intake is presently unknown. This study aimed to evaluate contextual factors surrounding children's sugary drink consumption and investigate reasons for sugary drink intake among children and adolescents, with a specific focus on caffeinated sodas and sweet tea. We also evaluated how sugary drink consumption makes children feel and how they anticipated that they would respond if sugary drinks were restricted. Focus group discussions (n = 9, 2-8 participants per group) were conducted with 37 predominantly AfricanAmerican children and adolescents, ages 8-14 years, who consumed ≥1 caffeine-containing sugary drink(s) daily, based on parental report. Focus groups were audio-recorded and transcribed verbatim. Transcripts were independently coded by two coders, after which emergent themes were identified. Reported reasons for sugary drink consumption encompassed five themes: 1) perceived need (e.g., satisfy cravings, quench thirst); 2) physical and cognitive benefits (e.g., provide energy, improve attention); 3) emotional and interpersonal benefits (e.g., relieve anger, facilitate socializing); 4) sensory properties (e.g., taste, carbonation); and, 5) external cues (e.g., family/peer modeling, availability). Negative consequences resulting from excess intake were also reported, including gastrointestinal symptoms, headaches, fatigue, hyperactivity, and chronic disease. Perceived physical, cognitive, emotional, and interpersonal benefits encourage sugary drink consumption and exacerbate well-described challenges of sugary drink reduction, including their palatability, accessibility, and affordability. Findings also suggest that incorporation of strategies to enhance physical, cognitive, and emotional health may hold promise in reducing sugary drink consumption among children and adolescents.

Interventions to increase the consumption of water among children: A systematic review and meta-analysis

The aim of this study was to conduct a systematic review and meta-analysis on the effectiveness of interventions to increase children's water consumption. A systematic literature search was conducted in seven electronic databases. Studies published in English before 18 February 2019 that evaluated any type of intervention that measured change in water consumption among children aged 2 to 12 years by applying any type of design were included. Of the 47 interventions included in the systematic review, 24 reported a statistically significant increase in water consumption. Twenty-four interventions (17 randomized controlled trials and seven studies with other controlled designs) were included in the meta-analysis. On average, children in intervention groups consumed 29 mL/d (confidence interval [CI] = 13-46 mL/d) more water than did children in control groups. This effect was larger in eight interventions focused specifically on diet (MD = 73 mL/d, CI = 20-126 mL/d) than in 16 interventions focused also on other lifestyle factors (MD = 15 mL/d, CI = 1-29 mL/d). Significant subgroup differences were also found by study setting and socioecological level targeted but not by children's age group, intervention strategy, or study design. In conclusion, there is evidence that, on average, lifestyle interventions can lead to small increases in children's daily water consumption. More research is needed to further understand the specific intervention elements that have the greatest effect.

Physical activity, sedentary, and dietary behaviors associated with indicators of mental health and suicide risk

We used data from the 2017 national Youth Risk Behavior Survey to examine associations between physical activity, sedentary, and healthy dietary behaviors and indicators of mental health, suicidal thoughts, and suicidal attempts among a representative sample of US high school students. Sex-stratified logistic regression was used to separately model each mental health-related outcome on the health-related behaviors, while controlling for race/ethnicity, grade, and body weight status. Significant associations were found between insufficient physical activity, sedentary, and less healthy dietary behaviors and the mental health-related outcomes. Feeling sad and hopeless was associated with not eating breakfast on all 7 days (past week), drinking soda or pop (female only), not meeting the aerobic physical activity guideline (male only), not playing on at least one sports team, and playing video/computer games or using a computer more than two hours (per day). Suicidal thoughts were associated with not eating breakfast on all 7 days, drinking soda or pop, not meeting the aerobic physical activity guideline, and playing video/computer games or using a computer more than two hours per day. Attempted suicide was associated with not eating breakfast on all 7 days, drinking soda or pop, drinking sports drinks, watching television more than two hours per day, and playing video or computer games or using a computer more than two hours per day (male only). While limiting sedentary behaviors and increasing physical activity and healthy dietary behaviors is not a sole solution for improving mental health among adolescents, it could be another possible strategy used in schools to benefit all students.

Perspective: Chaos in a Bottle-A Critical Evaluation of Beverage Categorization in Nutrition Research

Beverage consumption is an important contributor to total daily calorie intake among children and adolescents. While associations between excess calories from beverages and development of obesity are well established, a standardized approach for beverage categorization does not exist. As a result, there is marked heterogeneity in assessment and categorization of beverage intake across studies. The purpose of this article is to critically review beverage categorization in recent (published since 2010) observational studies that evaluated beverage intake in relation to weight/adiposity in US youth, and to put forth an initial proposal for a standardized beverage classification system. Standardized beverage classification is critical to ensure transparency in nutrition science research and facilitate comparison of findings across studies. A systematic literature search identified 37 eligible studies, across which beverage categorization varied considerably. The most heterogeneity was observed for categorization of "sugar-sweetened beverages" and the greatest consistency was observed for categorization of 100% juices. This review provides an evidence-based starting point for urgently needed, collaborative work to determine priorities for beverage categorization and leverage existing standards of identity in order to create and disseminate a standardized beverage classification system. A standardized approach will inform meaningful assessment of beverage consumption in research studies and facilitate impactful translation of research findings into public health nutrition policy.

Energy Drinks Consumption Is Associated With Reduced Sleep Duration and Increased Energy-Dense Fast Foods Consumption Among School Students: A Cross-Sectional Study

The study aimed to investigate the prevalence of energy drinks (EDs) consumption and its relationship with sociodemographic characteristics, eating habits, sleep duration, physical activity, and screen time among school students. A cross-sectional study was carried out with a total of 1611 students aged 10 to 18 years from the United Arab Emirates. ED consumption among school students was 27%, with less than half consumed at least one can of EDs 1 to 3 days per week. ED consumers were less likely to meet recommended sleep duration (37% vs 62%, P < .001), more likely to consume high energy-dense fast foods (33% vs 20%, P < .001), and more likely to spend more than 6 hours in front of a screen (40.5% vs 32.3%, P < .001). Students aged 14 to 18 years were twice as likely to consume EDs as students aged 10 to 13 years ( P < .001). Overall, the use of EDs was associated with male sex, older age, not meeting sleep recommendations, high energy-dense fast food consumption, and spending a longer time in front of a screen. Educational intervention programs about ED consumption and healthy lifestyle habits are highly recommended.

Association between energy drink consumption, depression and suicide ideation in Korean adolescents

BACKGROUND

Suicide is the leading cause of death among adolescents in South Korea. Negative influences of the abuse of energy drinks on mental health problems have emerged.

AIMS

This study aimed to analyze the relationship between energy drink consumption, depression and suicide ideation.

METHODS

We analyzed the data of 26,346 boys and 26,966 girls who participated in the 2015 Korean Youth Risk Behavior Web-Based Survey. The independent variable was the frequency of energy drink consumption per week. Experience of depression and suicide ideation were considered as the dependent variables. Multiple logistic regression was performed.

RESULTS

An association was found between energy drink intake per week and depressive mood. Moreover, the most frequent energy drink intake (three times or more per week) group showed the highest association with depressive mood (odds ratios (ORs); boys: ORs = 1.40, 95% confidence interval (CI): 1.25-1.56; girls: ORs = 1.61, 95% CI: 1.44-1.79) and suicide ideation (boys: ORs = 1.46, 95% CI: 1.27-1.69; girls: ORs = 1.36, 95% CI: 1.20-1.55).

CONCLUSION

We observed that consumption of excessive amounts of energy drinks is associated with depression and suicide ideation. Therefore, appropriate regulation or education is needed to prevent adolescents from experiencing adverse outcomes.

Perspective: The Role of Beverages as a Source of Nutrients and Phytonutrients

The Dietary Guidelines for Americans (DGA) provide nutrition advice for Americans >2 y of age. The 2020-2025 DGA proposes a life stage approach, focusing on birth through older adulthood. Limited recommendations for beverages exist except for milk, 100% fruit juice, and alcohol. The goal of this article is to provide a better understanding of the role of beverages in the diet using current scientific evidence. A Medline search of observational studies, randomized controlled trials, and meta-analyses was undertaken using key beverage words. We highlight the role beverages can play as a part of the DGA and considered beverages not traditionally included, such as those that are phytonutrient dense. Our primary consideration for beverage consumption targeted healthy Americans aged ≥2 y. However, with the proposed expansion to the life span for the 2020-2025 DGA, we also reviewed evidence for infants and toddlers from birth to 24 mo. Examples are provided on how minor changes in beverage choices aid in meeting recommended intakes of certain nutrients. Guidance on beverage consumption may aid in development of better consumer products to meet broader dietary advice. For example, beverage products that are nutrient/phytonutrient dense and lower in sugar could be developed as alternatives to 100% juice to help meet the fruit and vegetable guidelines. Although beverages are not meant to replace foods, e.g., it is difficult to meet the requirements for vitamin E, dietary fiber, or essential fatty acids through beverages alone, beverages are important sources of nutrients and phytonutrients, phenolic acids and flavonoids in particular. When considering the micronutrients from diet alone, mean intakes of calcium (in women), potassium, and vitamins A, C, and D are below recommendations and sodium intakes are well above. Careful beverage choices could close these gaps and be considered a part of a healthy dietary pattern.

Energy Drink Consumption and Substance Use Among Middle and High School Students

This study examined the association between energy drink consumption and substance use among adolescents and tested whether sex and/or grade level (i.e., middle vs. high school) moderate the association. Data were derived from the 2017 Ontario Student Drug Use and Health Survey, a representative survey of students in 7th to 12th grade. Analyses included 10,662 students who self-reported information on energy drink consumption and substance use. Poisson regression models were used with adjustments for important covariates. Energy drink consumption was associated with tobacco cigarette smoking (incidence rate ratio (IRR): 3.74; 95% confidence interval (CI): 3.22-4.35), cannabis use (IRR: 2.90; 95% CI: 2.53-3.32), binge drinking (IRR: 2.46; 95% CI: 2.05-2.96), opioid use (IRR: 2.23; 95% CI: 1.85-2.68), and alcohol use (IRR: 1.31; 95% CI: 1.26-1.36). The associations of energy drink consumption with tobacco cigarette smoking, cannabis use, and alcohol consumption were modified by grade level (two-way interaction terms p < 0.05). The association between energy drink consumption and substance use was generally much stronger among middle school students compared with high school students. The findings suggest that middle school students may be more vulnerable to the negative effects of energy drinks in relation with substance use.

Deceptively unhealthy foods targeting parents and children

This review introduces the construct of deceptively unhealthy foods and identifies the ways that these unhealthy foods are marketed to parents and children. Deceptively unhealthy foods are foods that are high in sugar or high in fat while low in nutrient content, but which are marketed as being healthy. They are commonly marketed using these tactics (1) specific nutrient labels, (2) deceptive terms, (3) general health reputation, and (4) package design. This paper reviews the small but growing literature on this topic, highlights four tactics used to deceive health-conscious parents, and provides suggestions for how changes in marketing may help reduce the consumption of such foods.

Association of energy drink consumption with substance-use initiation among adolescents: A 12-month longitudinal study

BACKGROUND

Aggressive marketing has resulted in exponential growth of energy drink sales in recent years. Despite growing concerns about the negative health effects of energy drinks, they are increasingly popular among young people. Little is known about temporal associations between energy drink consumption and other drug use, though some researchers have suggested that energy drink consumption reflects an entry into a drug-using lifestyle.

AIMS

The purpose of this study was to evaluate whether energy drink use among adolescents who have never tried substances is associated with a risk of initiating tobacco (i.e. cigarettes, e-cigarettes, and hookah) and alcohol use.

METHODS

A school-based longitudinal study of 3071 adolescents ages 9-17 years was conducted in six federal states of Germany. Data analyses involved two assessment waves that took place approximately 12 months apart: baseline (fall-winter of school year 2016-2017), and 12-month follow-up (fall-winter of school year 2017-2018).

RESULTS

Multilevel models revealed that energy drink use at baseline was associated with cigarette (odds ratio for energy drink ever use, 3.15 (95% confidence interval, 2.07-4.78 )), e-cigarette (odds ratio, 4.32 (95% confidence interval, 2.87-6.51)), hookah smoking (odds ratio, 3.15 (95% confidence interval, 2.06-4.82)), and alcohol use (odds ratio, 2.26 (95% confidence interval, 1.75-2.93)) initiation within 12 months.

CONCLUSIONS

These results raise the possibility that energy drinks may potentially act as a gateway drug to other substances. However, inferences regarding whether this association is or is not causal cannot yet be made.

Socio-economic characteristics, acid drinking patterns and gastric alterations associated with erosive tooth wear in children: a cross-sectional study

AIMS

Assessing the influence of socio-economic characteristics, acid drinking patterns and gastric alterations considering erosive tooth experience in children.

METHODS

Cross-sectional study to assess 08-10-year-old children enrolled in the primary education in public schools in Florianopolis, Brazil (n = 1085). Caregivers have answered questionnaires comprising independent variables (head of the household education frequency consumption of sports drinks, acid juice/soda, chewing gum, recurrent vomiting, gastric disorders and vomiting after overeating). Four trained dental surgeons have examined the children for the erosive tooth wear-dependent variable (O'Sullivan index), as well as collected dental caries (DMFT) and dental crowding (DAI index) information. A two-stage cluster-sampling plan was conducted. Unadjusted and adjusted logistic regression models were applied (Odds ratio, OR; 95% Confidence interval, CI and 5% significance level).

RESULTS

The prevalence of erosive tooth wear was 15.67%. Erosive tooth wear was positively associated with high consumption of sports drinks (OR 3.42; 95% CI: 1.18-9.23). Children whose caregivers' educational level was equal or less than four years of study were less likely to have erosive tooth wear (OR 0.39; 95% CI: 0.17-0.88).

CONCLUSION

High consumption of sports drinks is positively associated with erosive tooth wear. Children whose caregivers' educational level is low are less likely to present erosive tooth wear.

Rural-Urban Differences in Dietary Behavior and Obesity: Results of the Riskesdas Study in 10-18-Year-Old Indonesian Children and Adolescents

Obesity has become a significant problem for developing countries, including Indonesia. High duration of sedentary activity and high intake of unhealthy foods were associated with high risk of overweight and obesity. The objective of this study was to compare the distributions of sedentary activity and dietary behavior with overweight/obesity risks between urban and rural areas among children and adolescents aged 10-18 years in Indonesia. This is a cross-sectional study. Data from a national survey in 33 Indonesian provinces (Basic Health Research /Riskesdas 2013) were analyzed. Multiple logistic regression models were used to calculate the odds ratio (OR) adjusted with all variables, such as age, gender, residency, education level, physical activity, and food intake. An urban-rural residence difference was found in the factors related to obesity. Daily caffeinated soft drinks and energy drinks consumption (OR = 1.12, 95% CI: 1.01-1.23) were related to risk of overweight and obesity in urban areas. Daily grilled foods (OR = 1.32, 95% CI: 1.22-1.42) and salty food (OR = 1.09, 95% CI: 1.04-1.15) consumption were significantly associated with obesity in rural areas but not in urban areas. Furthermore, sedentary activity was correlated with overweight and obesity among those who lived in urban and rural areas. Our findings suggest that education, environmental, and policy interventions may need to specifically target urban settings, where access is high to a wide range of processed and traditional high-sugar, high-fat snack foods and beverages.

An experimental study on perceptions of energy drink ads among youth and young adults in Canada

Current regulations in Canada prohibit the marketing of caffeinated energy drinks (CEDs) for use during sports, with alcohol, and by children. The study examined perceptions of CED ads in association with sports and alcohol use, as well as target age groups. An online survey was conducted in 2015 with youth and young adults aged 12-24 years (n = 2010). Participants completed three experiments in which they were randomized to view CED advertisements: 1) sports/party-themed ads, 2) sports-themed ad, and 3) party-themed ad, vs. control 'product information' ads. For each ad, participants were asked about perceived target age group, and if the ad promoted using CEDs during sports and with alcohol. Logistic regression models were fitted to test differences in outcomes between conditions. The majority of respondents reported that the ads, across all themes, targeted people their age. In experiment 1, both sports/party-themed ads were more likely to be perceived as promoting use of CEDs during sports (AOR = 13.32; 95% CI 9.90, 17.91, and AOR = 9.73; 95% CI 7.38, 12.81, respectively), and with alcohol (AOR = 8.55; 95% CI 6.37, 11.48, and AOR = 2.81; 95% CI 2.08, 3.78, respectively), compared to the control ad. In experiment 2, the sports-themed ad was more likely to be perceived as promoting use of CEDs during sports (AOR = 15.02; 95% CI 11.83, 19.08), but not with alcohol, compared to the control ad. In experiment 3, the party-themed ad was more likely to be perceived as promoting use of CEDs with alcohol (AOR = 13.79; 95% CI 10.69, 17.78), but not during sports, compared to the control ad. Ads from leading energy drink brands are perceived as targeting young people and encouraging energy drink use during sports and with alcohol, despite Canadian regulations prohibiting these marketing practices.

Soccer Injuries in Children and Adolescents

Participation in youth soccer in the United States continues to increase steadily, with a greater percentage of preadolescent participants than perhaps any other youth sport. Despite the wide-ranging health benefits of participation in organized sports, injuries occur and represent a threat to the health and performance of young athletes. Youth soccer has a greater reported injury rate than many other contact sports, and recent studies suggest that injury rates are increasing. Large increases in the incidence of concussions in youth soccer have been reported, and anterior cruciate ligament injuries remain a significant problem in this sport, particularly among female athletes. Considerable new research has identified a number of modifiable risk factors for lower-extremity injuries and concussion, and several prevention programs have been identified to reduce the risk of injury. Rule enforcement and fair play also serve an important role in reducing the risk of injury among youth soccer participants. This report provides an updated review of the relevant literature as well as recommendations to promote the safe participation of children and adolescents in soccer.

The Use of Nonnutritive Sweeteners in Children

The prevalence of nonnutritive sweeteners (NNSs) in the food supply has increased over time. Not only are more children and adolescents consuming NNSs, but they are also consuming a larger quantity of NNSs in the absence of strong scientific evidence to refute or support the safety of these agents. This policy statement from the American Academy of Pediatrics is intended to provide the pediatric provider with a review of (1) previous steps taken for approved use of NNSs, (2) existing data regarding the safety of NNS use in the general pediatric population, (3) what is known regarding the potential benefits and/or adverse effects of NNS use in children and adolescents, (4) identified gaps in existing knowledge and potential areas of future research, and (5) suggested talking points that pediatricians may use when discussing NNS use with families.

Electronic device use and beverage related sugar and caffeine intake in US adolescents

Background

Despite recent declines in consumption of sugary beverages, energy drinks (ED) and sodas continue to contribute a substantial amount of sugar and caffeine to the diet of youth. Consumption of these beverages has been linked with electronic device use, however in-depth associations between sugar and caffeine intake from energy drinks and sodas with various electronic devices are not clear.

Objective

Describe the relationship of soda and energy drink consumption and associated added sugar and caffeine intake with electronic device use among adolescents.

Methods

Secondary data from the 2013–2016 cycles of Monitoring the Future Survey, a national, repeated, cross-sectional study, were analyzed. Information on energy drink and soda consumption by students in grades 8 and 10 (n = 32,418) from 252–263 schools randomly sampled from all US states was used.

Results

Soda and energy drink consumption decreased each year from 2013–2016 while daily use of electronic devices remained stable. An additional hour/day of TV was linked to a 6.92g (6.31,7.48; p<0.001) increase in sugar intake and a 32% (OR = 1.32; 1.29,1.35; p < .001) higher risk of exceeding World Health Organization (WHO) recommended sugar intakes. Further, each hour/day of TV was linked to a 28% increased risk of exceeding caffeine recommendations (OR = 1.25–1.31; p<0.001). Each hour per day talking on a cellphone was associated with an increased risk of exceeding WHO sugar and caffeine intakes by 14% (OR = 1.11–1.16; p<0.001) and 18% (OR = 1.15–1.21; p<0.001) respectively. Video game use was only weakly linked to caffeine intake. Computer use for school was associated with lower likelihood of exceeding sugar intake cut-offs.

Conclusion

While a trend towards reduced energy drink and soda intake from 2013–2016 was evident, greater electronic device use, especially TV time, was linked to higher intake of beverage-derived added sugar and caffeine amongst adolescents. Addressing these behaviours through counselling or health promotion could potentially help to reduce excess sugar and caffeine intake from sodas and energy drinks among this population.

Factors associated with water consumption among children: a systematic review

BACKGROUND

Water is recommended as the main beverage for daily fluid intake. Previous systematic reviews have studied the consumption of sugar-sweetened beverages (SSBs) among children, but none have focused on water consumption. Insight into factors that are associated with children's water intake is needed to inform the development of interventions aimed at the promotion of water consumption. The objective of this review was therefore to summarize the current evidence on factors associated with water consumption among children aged 2 to 12 years.

METHODS

A systematic literature search in seven electronic databases was conducted in May, 2018 and retrieved 17,850 unique records. Two additional studies were identified by hand-searching references of included articles. Studies were selected if they had a cross-sectional or longitudinal study design, focused on children aged 2-12 years and published in an English language peer-reviewed journal. Participants from clinical populations, studies that included data of < 10 participants and non-human studies were excluded.

RESULTS

A total of 63 articles met inclusion criteria and were included in the analysis. We identified 76 factors that were investigated in these studies; 17/76 were investigated in a longitudinal study. There was evidence of positive associations between water consumption and child's self-efficacy, parental education level, parental self-efficacy, use of feeding practices such as restriction or encouraging healthy eating and study year. Evidence was inconsistent (< 60% of studies reported an association) for child's age, sex, BMI, consumption of SSBs and ethnic background of the parent. There was no evidence (≤33% of studies reported an association) of associations between consumption of milk or juice, parental emotional-, modelling- or instrumental feeding practices, eating school lunch or outside temperature and water consumption. The remaining 54 factors were investigated in fewer than three studies.

CONCLUSIONS

There is some evidence for an association between potentially modifiable parental and child-related factors and water consumption. However, most factors identified in this review were only studied by one or two studies and most studies were cross-sectional. More longitudinal research is necessary to investigate environmental, parental and child-related factors associated with water consumption that are currently under-studied and could further inform intervention strategies.

TRIAL REGISTRATION

PROSPERO ID# CRD42018093362 , registered May 22, 2018.

Impact of Energy Drinks on Health and Well-being

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.

Interventions for excessive energy drink use

PURPOSE OF REVIEW

Given the increased and sometimes excessive consumption of energy drinks containing caffeine and other drugs, often sugar-sweetened, especially among young people, interventions that reduce consumption are needed. We review current findings related to interventions at the individual, outlet and regulatory levels to reduce energy drink consumption.

RECENT FINDINGS

Few interventions to reduce excess energy drink consumption have been tested. Interventions to reduce consumption of sugar-sweetened beverages and caffeinated beverages are reviewed. A manual-only intervention to reduce caffeinated beverages shows promise, whereas reducing availability at outlets and in communities as a whole shows some effectiveness.

SUMMARY

Although some recent studies can provide guidance on interventions to reduce energy drink consumption, no clear 'best practice' has emerged to reduce energy drink consumption. The literature reviewed points toward interventions at different levels which need further testing and could benefit from adaptation to the youth and young adult consumer.

Trends in Energy Drink Consumption Among U.S. Adolescents and Adults, 2003-2016

INTRODUCTION

Energy drinks refer to non-alcoholic beverages that contain caffeine, amino acids, herbs, and vitamins. Although energy drinks are marketed to reduce fatigue and improve physical/mental performance, frequent consumption of these beverages has been linked to negative health consequences. The purpose of this study is to provide timely, national estimates of the percentage of energy drink consumers in the U.S. and to analyze trends in energy drink intake between 2003 and 2016.

METHODS

A total of 9,911 adolescents (aged 12-19 years); 12,103 young adults (aged 20-39 years); and 11,245 middle-aged adults (aged 40-59 years) were assessed using dietary data from the 2003-2016 National Health and Nutrition Examination Surveys. For each age group (adolescents, young adults, and middle-aged adults), logistic regression was used to estimate the proportion of energy drink consumers, and negative binomial regression was used to estimate per capita energy drink consumption, adjusting for covariates. Differences in total caffeine intake between energy drink consumers and non-consumers were examined by pooling all survey years together and using negative binomial regression. Analyses were conducted in 2018.

RESULTS

From 2003 to 2016, the prevalence of energy drink consumption increased significantly for adolescents (0.2% to 1.4%, p=0.028); young adults (0.5% to 5.5%, p<0.001); and middle-aged adults (0.0% to 1.2%, p=0.006). Per capita consumption of energy drinks increased significantly from 2003 to 2016 only for young adults (1.1 to 9.7 calories, p<0.001). Pooled across years, energy drink consumers had significantly higher total caffeine intake compared with non-consumers for adolescents (227.0 mg vs 52.1 mg, p<0.001); young adults (278.7 mg vs 135.3 mg, p<0.001); and middle-aged adults (348.8 mg vs 219.0 mg, p<0.001).

CONCLUSIONS

These findings indicate that consumption of energy drinks has grown substantially and that these drinks are a major source of caffeine among those who consume them.

Energy Drinks: Another Cause of QT Prolongation?

See Article Shah et al

Public Policies to Reduce Sugary Drink Consumption in Children and Adolescents

Excess consumption of added sugars, especially from sugary drinks, poses a grave health threat to children and adolescents, disproportionately affecting children of minority and low-income communities. Public policies, such as those detailed in this statement, are needed to decrease child and adolescent consumption of added sugars and improve health.

Consumption of energy drinks among Turkish University students and its health hazards

Objective:

To determine the awareness, consumption patterns of energy drinks (ED) and health hazards among students at a Turkish University.

Methods:

This cross-sectional descriptive study was conducted by questionnaire method between in 2017 among Erciyes University students. Total 1257 students from the Faculties of Medicine, Communication and Physical Education and Sports College participated in the study. Pearson chi-square test, binary logistic regressions were used for statistical analysis. p <0.05 values were considered significant.

Results:

Students who tried at least once and consumed regularly ED were 52.5% and 15.7% respectively. Consuming regularly and trying ED were more common among students who were studying at Physical Education and Sports High school, male, smoking, alcohol consumer, doing regular physical activity. Mean age of students to start drinking ED was 15.1 years. Most common reason for ED consumption was; staying awake. Alcohol mixed energy drinks consumption rate was 37.6% among regular ED consumers. Most declared harmful effect was palpitation.

Conclusion:

ED consumption among Erciyes University students was widespread. Students should be informed about EDs’ hazards for health. Legal regulations regarding production, marketing and advertising of EDs must be reconsidered.

Gender Differences in Any-Source Caffeine and Energy Drink Use and Associated Adverse Health Behaviors

Background: The majority of college students report caffeine use with many using caffeine daily. Energy drink (ED) use, in particular, is common among college students, and numerous studies link these heavily caffeinated drinks to a variety of adverse consequences including substance use and risky behaviors. However, little is known about correlations between any-source caffeine use and other substance use and problems. The purpose of this study was to evaluate patterns of caffeine use and examine the relationships between caffeine, in general, and EDs specifically, and adverse health behaviors in college students. Methods: We used data from a longitudinal study of alcohol use and health-related outcomes to assess caffeine, alcohol, nonprescription drug, and tobacco use and symptoms of alcohol dependence in 1958 freshmen from a mid-Atlantic university during Fall 2012. We compared adverse health behaviors between caffeine users and nonusers and ED users and nonusers. Data were evaluated separately in men and women. Results: While women reported significantly more caffeine use than men, men reported more ED use. EDs, regardless of frequency of use, were associated with all adverse health behaviors, but only in female students. Similarly, daily any-source caffeine use was significantly associated with alcohol, nonprescription drug, and tobacco use in female students, but in men, the association was less robust. Conclusions: This research shows that caffeine use is prevalent among college students, and, in female students, is associated with alcohol, nonprescription drug, and tobacco use and alcohol dependence symptoms. Interventions aimed at promoting healthy behaviors may be especially useful in this population.

Approaches to Reduce Sports Drink Consumption Among Adolescents

Sports drinks originally developed to improve performance and prevent or treat dehydration, heat stroke, and muscle cramps in elite athletes are consumed regularly by nearly 60% of the adolescent population. Sports drinks are often perceived as healthy, and marketing campaigns fail to delineate the types and amount of activity that warrant appropriate use. Current trends in adolescent consumption of sports drinks will be reviewed and approaches to reduce consumption, including counseling on the appropriate use of sports drinks, will be discussed.

Economic globalization, nutrition and health: a review of quantitative evidence

Background

Unhealthy dietary patterns have in recent decades contributed to an endemic-level burden from non-communicable disease (NCDs) in high-income countries. In low- and middle-income countries rapid changes in diets are also increasingly linked to malnutrition in all its forms as persistent undernutrition and micronutrient deficiencies continue to coexist with a rising prevalence of obesity and associated NCDs. Economic globalization and trade liberalization have been identified as potentially important factors driving these trends, but the mechanisms, pathways and actual impact are subject to continued debate.

Methods

We use a ‘rigorous review’ to synthesize evidence from empirical quantitative studies analysing the links between economic globalization processes and nutritional outcomes, with a focus on impact as well as improving the understanding of the main underlying mechanisms and their interactions.

Findings

While the literature remains mixed regarding the impacts of overall globalization, trade liberalization or economic globalization on nutritional outcomes, it is possible to identify different patterns of association and impact across specific sub-components of globalization processes. Although results depend on the context and methods of analysis, foreign direct investment (FDI) appears to be more clearly associated with increases in overnutrition and NCD prevalence than to changes in undernutrition. Existing evidence does not clearly show associations between trade liberalization and NCD prevalence, but there is some evidence of a broad association with improved dietary quality and reductions in undernutrition. Socio-cultural aspects of globalization appear to play an important yet under-studied role, with potential associations with increased prevalence of overweight and obesity. The limited evidence available also suggests that the association between trade liberalization or globalization and nutritional outcomes might differ substantially across population sub-groups.

Overall, our findings suggest that policymakers do not necessarily face a trade-off when considering the implications of trade or economic liberalization for malnutrition in all its forms. On the contrary, a combination of nutrition-sensitive trade policy and adequate regulation of FDI could help reduce all forms of malnutrition. In the context of trade negotiations and agreements it is fundamental, therefore, to protect the policy space for governments to adopt nutrition-sensitive interventions.

Electronic supplementary material

The online version of this article (10.1186/s12992-019-0456-z) contains supplementary material, which is available to authorized users.

Occult drug exposure in young children evaluated for physical abuse: An opportunity for intervention

BACKGROUND

Although screening for drug exposure is an important consideration in the evaluation of suspected child maltreatment, limited data are available on the frequency of drug exposure in children with suspected physical abuse.

OBJECTIVE

To examine occult drug and pharmaceutical exposure in young children with suspected physical abuse.

PARTICIPANTS AND SETTING

Children ages 2 weeks -59 months evaluated for physical abuse by a tertiary referral center Child Protection Team.

METHODS

Cross-sectional study of young children diagnosed with high, intermediate, or low concern for physical abuse and tested for occult drug exposure from 2013-2017. Chart review was performed to determine adherence to recommended testing and drug test results with comparison between groups.

RESULTS

Occult drug exposures were found in 5.1% (CI 3.6-7.8) of 453 children tested: 6.0% (CI 3.6-10.0) of 232 children with high concern for physical abuse, 5.0% (CI 2.7-9.3) of 179 children with intermediate concern, and 0% of 42 children with low concern. As adherence to protocol-based screening improved during the second half of the study, so did the overall rate of detection of occult drug exposures (7.9%, CI 5.2-11.9) in 252 children with intermediate or high concern for physical abuse. Most exposures were to cocaine, although non-prescribed pharmaceutical exposures were also detected.

CONCLUSIONS

Up to 7.9% of young children suspected of being physically abused also had an occult drug exposure. Given the adverse health consequences associated with exposure to a drug-endangered environment, screening for occult drug exposure should be considered in the evaluation of young children with intermediate or high concern for physical abuse.