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

Risk of Energy Drink Consumption to Adolescent Health

Energy drinks are beverages marketed to quickly increase alertness and performance of the consumer that typically contain relatively high quantities of caffeine, simple carbohydrates, and a mixture of additional ingredients. The carbohydrate sources, usually glucose and sucrose, found in the beverages supply the substrates needed for physiological energy, while the high caffeine content supplies the perceived energy through enhancing feelings of alertness during fatigued states. Although mean youth caffeine consumption as a whole has decreased over the past 2 decades, adolescent energy drink consumption has significantly increased in the past 10 years. High energy drink consumption of youth is concerning due to the range of reported adverse reactions attributed to excessive caffeine consumption, ranging from mild sleep disturbances to death. Reactions are severe enough to require reporting to the National Poison Data System and may even require emergency medical treatment. Studies have also shown that adolescents who consume energy drinks are likely to also use tobacco, alcohol, and illicit drugs. There is substantial evidence to suggest that the risk energy drinks pose to health are incredibly hazardous and should not be consumed by children and adolescents.

Role of Functional Beverages on Sport Performance and Recovery

Functional beverages represent a palatable and efficient way to hydrate and reintegrate electrolytes, carbohydrates, and other nutrients employed and/or lost during physical training and/or competitions. Bodily hydration during sporting activity is one of the best indicators of health in athletes and can be a limiting factor for sport performance. Indeed, dehydration strongly decreases athletic performance until it is a risk to health. As for other nutrients, each of them is reported to support athletes' needs both during the physical activity and/or in the post-workout. In this study, we review the current knowledge of macronutrient-enriched functional beverages in sport taking into account the athletes' health, sports performance, and recovery.

Caffeinated energy drink use by U.S. adolescents aged 13-17: A national profile

The present study examined the national prevalence and distribution of adolescent use of caffeinated energy drinks, assessing variations in sociodemographic characteristics, personality traits, lifestyles, and patterns of alcohol and caffeine use. A cross-sectional survey was conducted in May 2014, using a nationally representative sample of 1,032 U.S. early (aged 13-15; n = 602) and middle adolescents (aged 16-17; n = 430). Nearly two thirds of teens reported ever using energy drinks; 41% had done so recently, that is, in the past 3 months. Middle adolescents reported higher prevalences of both lifetime and recent use of energy drinks than early adolescents. Common situational contexts for use (e.g., compensating for lack of sleep or playing sports) differed by both gender and age cohort. In hierarchical logistic regression analyses, gender and geographic region significantly predicted both lifetime and recent use for early adolescents only, whereas age and race were significant predictors only for middle adolescents. For both age cohorts, odds of both lifetime and recent use increased with sensation-seeking score, lifetime alcohol use, and recent caffeinated soft drink use. Among early adolescents, grade point average predicted lifetime use only, whereas coffee and caffeine pill use predicted recent use only. Among middle adolescents, impulsivity and past sports participation predicted lifetime but not recent use. Our findings show that adolescent energy drink use is widespread and varies as a function of demographic, psychosocial, lifestyle, and substance use characteristics. Future research is needed to assess whether differences between early and middle adolescent use patterns are primarily developmental or cohort effects. (PsycINFO Database Record

Knowledge and Behavior of Saudi College Athletes toward Energy and Sports Drinks with an Emphasis on Microbial Quality and Safety

The aim of this study was to assess the knowledge and behavior of university athletes in Saudi Arabia regarding energy drinks (EDs) and sports drinks (SDs). In addition, the microbiological quality of available local drinks was also assessed. The presence of total bacterial coliform count, Escherichia coli, Salmonella, and Staphylococcus aureus on these drinks was also determined. Of the 120 university athletes surveyed, 69 were currently using SDs, and 51 were using EDs. The study consisted of a 10-question survey assessing the athletes’ sociodemographic characteristics, personal habits, and SD- and ED-related knowledge and habits. With regard to the question about the primary reason for using EDs, n = 26 respondents (50.98%) reported that providing energy (speed, strength, and power) was the main reason for consuming these beverages. Conversely, n = 25 respondents (36.23%) believed that recovery from injury or illnesses was the main reason for the consumption of SDs. A majority of university athletes (n = 43, 62.32%) who used SDs believed that SDs were safe to use, while n = 22 respondents (43.14%) were unaware of any adverse health effects associated with the consumption of EDs. Of the total of 26 SDs and EDs tested, microbial contamination was present in only two products. Microbial levels and the total bacterial count for most of the samples were very low (<1 log CFU/mL). However, some drinks had a slightly higher microbial level, which could be harmful or cause spoilage with improper storage. Thus, our findings suggest that improvements in microbial quality are needed for these beverages.

Nearly half of the adolescents in an Italian school-based study exceeded the recommended upper limits for daily caffeine consumption

AIM

No data are available on caffeine consumption among Italian adolescents. We investigated caffeine intake from coffee, soft drinks and energy drinks in a sample of Italian adolescents and determined if they exceeded the recommended limits.

METHODS

The study comprised 1213 adolescents with a mean age of 15.1 years (range 12-19) from four schools in Foggia, southern Italy. Caffeine intake was assessed using an anonymous self-reported questionnaire during the 2013/2014 school year. We calculated the percentage of daily caffeine consumers, their mean intake of caffeine from beverages and the contribution of each beverage category to the total caffeine intake.

RESULTS

Approximately 76% of the sample consumed caffeine every day, amounting to 125.5 ± 69.2 mg/day and 2.1 ± 1.2 mg/kg/day. When we applied the reference values from the Academy of Pediatrics, we found that 46% of the adolescents exceeded the recommended upper limits. Coffee was the most frequently consumed caffeinated drink and the main contributor to daily caffeine intake.

CONCLUSION

More than three quarters (76%) of the Italian adolescents in our study drank coffee on a daily basis and nearly half (46%) exceeded the recommended upper limits. Strategies are needed to reduce caffeine consumption by adolescents.

Adolescent Consumption of Sports Drinks

BACKGROUND

Sports drinks are aggressively marketed to teenagers to replenish fluids and/or electrolytes. According to the American Academy of Pediatrics, typical adolescent physical activity does not require sports drink rehydration. Given US obesity rates and that sugar-sweetened sports drinks add superfluous calories to the diet, it is important to assess adolescent sports drink consumption and changes over time.

METHODS

Researchers in the 2015 Youth Risk Behavior Survey and 2010 National Youth Physical Activity and Nutrition Survey collected nationally representative samples of US high school students about sports drink consumption. Respondent characteristics and health behaviors were examined relative to sports drink consumption by using multivariable survey logistic regression. χ² tests were used to compare the 2 samples and examine changes over time.

RESULTS

The 2015 Youth Risk Behavior Survey and 2010 National Youth Physical Activity and Nutrition Survey had national samples of 15 624 and 11 458 respondents, respectively. Sports drink consumption in the previous week increased from 56% (2010) to 57.6% (2015; P = .0002). However, comparisons of daily sports drink consumption revealed reductions for all age groups, sexes, race and/or ethnicity categories, and levels of physical activity. The greatest reductions were for non-Hispanic African Americans and for children with overweight. Daily sports drink consumption did not decrease for children with obesity and increased for children who watched >2 hours per day of television. In 2015, boys, non-Hispanic African Americans, Hispanics, and tobacco users exhibited higher odds of consuming sports drinks daily.

CONCLUSIONS

Although daily consumption of sports drinks has decreased overall, sugar-sweetened sports drinks remain popular, with the majority of high school students drinking them at least weekly. Of concern, daily consumption increased among teenagers watching television >2 hours per day. Pediatricians should counsel adolescents about the American Academy of Pediatrics' recommendations regarding sports drinks.

Associations Between Korean Adolescents' Energy Drink Consumption and Suicidal Ideation and Attempts

PURPOSE

This study examined associations between caffeinated energy drink consumption patterns and (1) participant characteristics and health-risk behaviors and (2) suicidal ideation and attempts in Korean adolescents.

METHODS

Participants included 8961 adolescents who consumed the drinks more than once weekly. Data were analyzed via logistic regression.

RESULTS

Rates of suicidal ideation and attempts in participants who consumed the drinks more than once daily were higher relative to those for participants who consumed the drinks 3-6 and 1-2 times weekly.

CONCLUSIONS

Further research is required to establish causality in these relationships.

Age restriction warning label efficacy and high school student consumption of highly-caffeinated products

Age restriction warning labels (ARLs) are placed on highly-caffeinated food and drinks, such as Red Bull, to deter consumption by minors who are especially vulnerable to the risks of excessive caffeine consumption. Previous studies have shown that ARLs on media like TV programs and video games fail to discourage minors. However, it is unclear how ARLs on food and drink packages affect minors' purchasing behavior. High school students aged 14 to 17 years (n = 150, M_age = 15.2, 51% male) were asked to choose between seven novel product dyads (three food/drink dyads, two movie dyads, and two video game dyads); each dyad contained one product with an ARL and one without. Participants were then asked how ARLs and parental permissiveness of ARL products influenced their decision. Roughly half of the participants selected food and drink products with ARLs. Over two-thirds (69%) of the students reported that they were not discouraged by ARLs on highly caffeinated food and drinks. Participants reported their parents as significantly less permissive of age-restricted food and drink products than of age-restricted media merchandise (p < .01). Perceived parental permissiveness was not correlated with minors' perception of ARL or simulated product choice. Current ARLs on highly caffeinated food and drink items may be ineffective for adolescents and may actually increase product appeal. Pediatricians should educate patients and parents regarding the health risks of excessive caffeine consumption.

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Age restriction warning labels are displayed on highly caffeinated products.

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Warning labels failed to effectively deter minors from choosing marked products.

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Some minors stated warning labels encouraged their product choice.

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More research is needed to determine effective warning label wording for minors.

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Clinicians must warn teens against consumption of highly caffeinated products.

Does early exposure to caffeine promote smoking and alcohol use behavior? A prospective analysis of middle school students

BACKGROUND AND AIMS

Despite the negative consequences associated with caffeine use among children and youth, its use is increasingly widespread among middle school students. Cross-sectional studies reveal links between caffeine and other substance use. The potential for caffeine use to confer increased vulnerability to substance use, however, has not been investigated using prospective designs. We hypothesized that caffeine use at baseline would be associated positively with increased alcohol use, drunkenness, smoking and e-cigarette use.

DESIGN

Prospective cohort study with 12 months separating baseline from follow-up.

SETTING

West Virginia, USA.

PARTICIPANTS

Middle school students (6th and 7th grades; n = 3932) in three West Virginia (WV) counties provided data at baseline and follow-up 12 months later.

MEASUREMENTS

Youth self-reported their use of caffeine from multiple sources (e.g. soda, energy drinks, coffee and tea), cigarette smoking, electronic cigarette use, alcohol use and drunkenness.

FINDINGS

Cross-lagged path models for individual substance use categories provided a good fit to the data. Controlling for demographic variables and other substance use at baseline, caffeine at time 1 (T1) was associated positively with T2 cigarette smoking (β = 0.27, P = 0.001), e-cigarette use (β = 0.21, P = 0.001), alcohol use (β = 0.17, P = 0.001) and drunkenness (β = 0.15, P = 0.001). Conversely, non-significant relations emerged between three of four substances at T1 and caffeine at T2. Positive relations were found between e-cigarette use at T1 and caffeine use at T2 (β = 0.07, P = 0.006). These findings were supported by an omnibus model with all substances included. Specifically, significant relations were observed between caffeine at T1 and all substance use outcomes at T2, whereas no significant relations were observed between substance use and caffeine over time.

CONCLUSIONS

Caffeine may promote early use of other types of substances among middle school-aged adolescents.

A survey of sports drinks consumption among adolescents

Background Sports drinks intended to improve performance and hydrate athletes taking part in endurance sport are being marketed to children, for whom these products are not intended. Popularity among children has grown exponentially. Worryingly they consume them socially, as well as during physical activity. Sports drinks are high in sugar and are acidic. Product marketing ignores the potential harmful effects of dental caries and erosion.Objective To investigate the use of sports drinks by children.Method One hundred and eighty-three self-complete questionnaires were distributed to four schools in South Wales. Children in high school years 8 and 9 (aged 12-14) were recruited to take part. Questions focused on use of sports drinks, type consumed, frequency of and reason for consumption and where drinks were purchased.Results One hundred and sixty children responded (87% response rate): 89.4% (143) claimed to drink sports drinks, half drinking them at least twice a week. Lucozade Sport(™) was the most popular brand. The main reason for consuming the drinks was attributed to the 'nice taste' (90%, 129/143). Most respondents purchased the drinks from local shops (80.4%, 115) or supermarkets (54.5%, 78). More boys claimed to drink sports drinks during physical activity (77.9% versus 48.6% girls, P <0.001). Whereas more girls claimed to drink them socially (51.4% versus 48.5% boys, NS).Conclusion A high proportion of children consumed sports drinks regularly and outside of sporting activity. Dental health professionals should be aware of the popularity of sports drinks with children when giving health education advice or designing health promotion initiatives.

Energy drink consumption among New Zealand adolescents: Associations with mental health, health risk behaviours and body size

AIM

With the increase in popularity of energy drinks come multiple concerns about the associated health indicators of young people. The current study aims to describe the frequency of consumption of energy drinks in a nationally representative sample of adolescents and to explore the relationship between energy drink consumption and health risk behaviours, body size and mental health.

METHODS

Data were collected as part of Youth'12, a nationally representative survey of high school students in New Zealand (2012). In total, 8500 students answered a comprehensive questionnaire about their health and well-being, including multiple measures of mental well-being, and were weighed and measured for height.

RESULTS

More than one-third (35%) of young people consumed energy drinks in the past week, and 12% consumed energy drinks four or more times in the past week. Energy drink consumption was significantly associated with greater depressive symptoms, greater emotional difficulties and lower general subjective well-being. Frequent energy drink consumption was also associated with binge drinking, smoking, engagement in unsafe sex, violent behaviours, risky motor vehicle use and disordered eating behaviours. There was no association between consumption of energy drinks and student body size.

CONCLUSIONS

Consumption of energy drinks is associated with a range of health risk behaviours for young people. Strategies to limit consumption of energy drinks by young people are warranted.

Adverse effects of caffeinated energy drinks among youth and young adults in Canada: a Web-based survey

BACKGROUND

Energy drink consumption has increased dramatically among young Canadians, with anecdotal evidence of adverse health effects. There is a lack of population-based studies to examine the prevalence of adverse events from energy drinks, particularly among young people. The current study sought to assess adverse events from energy drinks among a population-based sample of youth and young adults in Canada.

METHODS

An online survey was conducted in 2015 with a national sample of youth (aged 12-17 yr) and young adults (aged 18-24 yr) recruited from a consumer panel. Respondents reported prior consumption of energy drinks as well as adverse outcomes, concurrent activities associated with the outcomes and whether medical attention was sought or considered. Adverse events from coffee were also assessed for comparison. Weighted analyses are reported.

RESULTS

Of the 2055 respondents, 1516 (73.8%) reported having ever consumed an energy drink, and 1741 (84.7%) reported having ever consumed coffee (unweighted). Overall, 55.4% of respondents who had ever consumed an energy drink reported that they had experienced at least 1 adverse event, including fast heartbeat (24.7%), difficulty sleeping (24.1%), headache (18.3%), nausea/vomiting/diarrhea (5.1%), chest pain (3.6%) and seizures (0.2%); 3.1% had sought or had considered seeking medical help for an adverse event. The prevalence of reported adverse events was significantly greater among energy drink consumers than among coffee consumers (36.0%) (odds ratio [OR] 2.67 [95% confidence interval (CI) 2.01-2.56]), as was the proportion who reported seeking or considering seeking medical help for adverse events (3.1% v. 1.4%) (OR 2.18 [95% CI 1.39-3.41]).

INTERPRETATION

More than half of youth and young adults who had consumed energy drinks reported adverse outcomes, some serious enough to warrant seeking medical help. The adverse outcomes were consistent with the physiologic effects of caffeine but were significantly more prevalent than with other sources of caffeine such as coffee, consistent with data from national adverse event databases.

Sports drink consumption and dental erosion among amateur runners

This cross-sectional study assessed the prevalence and potential risk factors for dental erosion in amateur athletes at running events. After a sample calculation, 108 runners from the state of Rio de Janeiro, Brazil, were selected and examined for dental wear by a single trained and calibrated evaluator (kappa = 1.00). To identify risk factors, the runners were interviewed by using a standardized, semi-structured questionnaire. The average (SD) age of the runners was 34.2 (11.45), and the prevalence of dental erosion was 19.4%. Gastroesophageal reflux, running frequency per week, and time expended during competition were associated with dental erosion (P < 0.05). The association between use of isotonic drinks and dental erosion was not significant (P > 0.05). In conclusion, dental erosion was not associated with use of isotonic drinks. However, frequency of exercise per week and gastroesophageal reflux were risk factors for dental erosion.

Association between adolescents' consumption of total and different types of sugar-sweetened beverages with oral health impacts and weight status

OBJECTIVE

To examine the associations between adolescents' intake of sugar-sweetened beverages (SSBs) with oral health impacts (OHI) and weight status.

METHODS

Cross-sectional health survey with anthropometry and self-report OHI (toothache and avoiding some foods because of oral problems) and SSB intake (fruit juice, flavoured water, soft, diet, sports and energy drinks) collected in 2015.

RESULTS

A total of 3,671 adolescents participated (50% girls; mean age 13.2 years ±1.7). Drinking ≥1cup/day of SSBs was consistently associated with higher odds of OHI compared with drinking <1cup/day: diet soft drinks (AOR, 5.21 95%CI 2.67, 10.18); sports drinks (AOR 3.60 95%CI 1.93, 6.73); flavoured water (AOR 3.07 95%CI 1.55, 6.06); and energy drinks (AOR 2.14 95%CI 1.44, 3.19). Daily SSB intake was not consistently associated with weight status. The odds of overweight/obesity (AOR 1.27 95%CI 1.01, 1.59) and obesity (AOR 1.61 95%CI 1.01, 2.57) were higher for energy drink consumption, compared with not drinking energy drinks; and the odds of abdominal obesity were twice as high among adolescents who drank ≥1cup/day of sports drinks, compared with <1cup/day intake.

CONCLUSIONS

Daily consumption of SSBs is prevalent among adolescents and is consistently associated with higher odds of OHI. The most popular SSBs among adolescents were energy drinks. Different types of SSB were differentially associated with OHI and weight status. Implications for public health: Different types of SSBs were differentially associated with OHI and weight status in adolescents. Diet soft drinks and new generation SSBs such as energy and sport drinks and flavoured water had a greater impact on adolescents' OHI compared with soft drinks and fruit juice.

Exposure and perceptions of marketing for caffeinated energy drinks among young Canadians

OBJECTIVE

To examine exposure to energy drink marketing among youth and young adults, and test perceptions of energy drink advertisements (ads) regarding target audience age and promoting energy drink use during sports.

DESIGN

A between-group experiment randomly assigned respondents to view one of four energy drink ads (sport-themed or control) and assessed perceptions of the ad. Regression models examined marketing exposure and perceptions.

SETTING

Online survey (2014).

SUBJECTS

Canadians aged 12-24 years (n 2040) from a commercial panel.

RESULTS

Overall, 83 % reported ever seeing energy drink ads through at least one channel, including on television (60 %), posters/signs in stores (49 %) and online (44 %). Across experimental conditions, most respondents (70·1 %) thought the ad they viewed targeted people their age or younger, including 42·2 % of those aged 12-14 years. Two sport-themed ads were more likely to be perceived as targeting a younger audience (adjusted OR (95 % CI): 'X Games' 36·5 %, 4·16 (3·00, 5·77); 'snowboard' 19·2 %, 1·50 (1·06, 2·13)) v. control (13·3 %). Participants were more likely to believe an ad promoted energy drink use during sports if they viewed any sport-themed ad ('X Games' 69·9 %, 8·29 (6·24, 11·02); 'snowboard' 76·7 %, 11·85 (8·82, 15·92); 'gym' 66·8 %, 7·29 (5·52, 9·64)) v. control (22·0 %). Greater reported exposure to energy drink marketing was associated with perceiving study ads as promoting energy drink use during sports.

CONCLUSIONS

Energy drink marketing has a high reach among young people. Ads for energy drinks were perceived as targeting youth and promoting use during sports. Such ads may be perceived as making physical performance claims, counter to Canadian regulations.

Differences in Sleep Patterns and Problems by Race in a Clinical Sample of Black and White Preschoolers

STUDY OBJECTIVES

Community-based research indicates that Black preschoolers tend to have more bedtime difficulties and are at higher risk for obstructive sleep apnea (OSA) compared to White preschoolers. This study examined differences in sleep patterns and problems by race among a clinical sample of Black and White preschoolers at an outpatient sleep clinic.

METHODS

Data were collected from electronic medical records for 125 children ages 2-5 years (mean = 3.37 years, 64.0% White, 36.0% Black; 59.2% male) presenting at a pediatric sleep clinic in an academic medical center. Neighborhood income data were based on ZIP codes entered into the United States Census Bureau's American Fact Finder.

RESULTS

Black patients (51.1%) were significantly more likely than White patients (20.0%) to bed-share with a caregiver (χ² = 12.99, P ≤ .001). There were no other significant differences in presenting sleep patterns (bed/wake times, sleep onset latency, naps, night awakenings, or sleep opportunity). Logistic regressions showed that White patients were more likely to present with difficulty falling/staying asleep and receive an insomnia diagnosis, and Black patients were more likely to present with OSA-related concerns and receive a diagnosis of suspected OSA, even when controlling for relevant sociodemographic covariates.

CONCLUSIONS

In contrast to community-based research, Black and White children showed similar sleep patterns. However, there were differences by race in referral questions and diagnoses. Findings suggest the need to consider caregiver perceptions and other sociocultural factors that may contribute to differential rates of presentation for sleep services, as well as potential health disparities in this regard.

Heart Toxicity Related to Herbs and Dietary Supplements: Online Table of Case Reports. Part 4 of 5

BACKGROUND

The purpose of this review was to create an online research summary table of heart toxicity case reports related to dietary supplements (DS; includes herbs).

METHODS

Documented PubMed case reports of DS appearing to contribute to heart-related problems were used to create a "Toxic Table" that summarized the research (1966 to April, 2016, and cross-referencing). Keywords included "herb," "dietary supplement," and cardiac terms. Case reports were excluded if they were herb combinations (some exceptions), Chinese herb mixtures, teas of mixed herb contents, mushrooms, poisonous plants, self-harm (e.g. suicide), excess dose (except vitamins/minerals), drugs or illegal drugs, drug-herbal interactions, and confounders of drugs or diseases. The spectrum of heart toxicities included hypertension, hypotension, hypokalemia, bradycardia, tachycardia, arrhythmia, ventricular fibrillation, heart attack, cardiac arrest, heart failure, and death.

RESULTS

Heart related problems were associated with approximately seven herbs: Four traditional Chinese medicine herbs - Don quai (Angelica sinensis), Jin bu huan (Lycopodium serratum), Thundergod vine or lei gong teng (Tripterygium wilfordii Hook F), and Ting kung teng (Erycibe henryi prain); one an Ayruvedic herb - Aswagandha, (Withania somnifera); and two North American herbs - blue cohosh (Caulophyllum thalictroides), and Yohimbe (Pausinystalia johimbe). Aconitum and Ephedra species are no longer sold in the United States. The DS included, but are not limited to five DS - bitter orange, caffeine, certain energy drinks, nitric oxide products, and a calming product. Six additional DS are no longer sold. Licorice was the food related to heart problems.

CONCLUSION

The online "Toxic Table" forewarns clinicians, consumers and the DS industry by listing DS with case reports related to heart toxicity. It may also contribute to Phase IV post marketing surveillance to diminish adverse events that Government officials use to regulate DS.

Energy and sports drinks in children and adolescents

Sports drinks and caffeinated energy drinks (CEDs) are commonly consumed by youth. Both sports drinks and CEDs pose potential risks for the health of children and adolescents and may contribute to obesity. Sports drinks are generally unnecessary for children engaged in routine or play-based physical activity. CEDs may affect children and adolescents more than adults because they weigh less and thus experience greater exposure to stimulant ingredients per kilogram of body weight. Paediatricians need to recognize and educate patients and families on the differences between sport drinks and CEDs. Screening for the consumption of CEDs, especially when mixed with alcohol, should be done routinely. The combination of CEDs and alcohol may be a marker for higher risk of substance use or abuse and for other health-compromising behaviours.

Children's and parents' opinions on the sport-related food environment: a systematic review

Sport is a key setting for interventions to address child obesity given its obesogenic nature. Understanding children's and parents' opinions on the sport-related food environment is critical in developing effective programmes and policies to improve children's health. This systematic review synthesizes quantitative and qualitative research examining children's and parents' opinions on the sport-related food environment. During July 2016, a range of electronic databases of academic and grey literature were searched. Thirty-two publications (11 including children, 17 parents and 4 both) were included for review. The publications were assessed using the Analysis Grid for Environments Linked to Obesity framework to categorize the sport-related food environment into the physical, sociocultural, economic and political environments. The literature available investigating children's and parents' opinions of the sport-related food environment suggests that many children and parents consider the environment neither conducive to nor supportive of children's healthy food behaviours or wider health and well-being. Both groups would likely support actions to change and improve it. This systematic review found that original research specifically investigating children's and parents' perspectives on almost all aspects of the sport-related food environment is limited. Thus, there is scope for further investigation into this important part of children's food environments.

Health Effects and Public Health Concerns of Energy Drink Consumption in the United States: A Mini-Review

As energy drink consumption continues to grow worldwide and within the United States, it is important to critically examine the nutritional content and effects on population health of these beverages. This mini-review summarizes the current scientific evidence on health consequences from energy drink consumption, presents relevant public health challenges, and proposes recommendations to mitigate these issues. Emerging evidence has linked energy drink consumption with a number of negative health consequences such as risk-seeking behaviors, poor mental health, adverse cardiovascular effects, and metabolic, renal, or dental conditions. Despite the consistency in evidence, most studies are of cross-sectional design or focus almost exclusively on the effect of caffeine and sugar, failing to address potentially harmful effects of other ingredients. The negative health effects associated with energy drinks (ED) are compounded by a lack of regulatory oversight and aggressive marketing by the industry toward adolescents. Moreover, the rising trend of mixing ED with alcohol presents a new challenge that researchers and public health practitioners must address further. To curb this growing public health issue, policy makers should consider creating a separate regulatory category for ED, setting an evidence-based upper limit on caffeine, restricting sales of ED, and regulating existing ED marketing strategies, especially among children and adolescents.

The Safety of Ingested Caffeine: A Comprehensive Review

Caffeine is the most widely consumed psychoactive drug in the world. Natural sources of caffeine include coffee, tea, and chocolate. Synthetic caffeine is also added to products to promote arousal, alertness, energy, and elevated mood. Over the past decade, the introduction of new caffeine-containing food products, as well as changes in consumption patterns of the more traditional sources of caffeine, has increased scrutiny by health authorities and regulatory bodies about the overall consumption of caffeine and its potential cumulative effects on behavior and physiology. Of particular concern is the rate of caffeine intake among populations potentially vulnerable to the negative effects of caffeine consumption: pregnant and lactating women, children and adolescents, young adults, and people with underlying heart or other health conditions, such as mental illness. Here, we review the research into the safety and safe doses of ingested caffeine in healthy and in vulnerable populations. We report that, for healthy adults, caffeine consumption is relatively safe, but that for some vulnerable populations, caffeine consumption could be harmful, including impairments in cardiovascular function, sleep, and substance use. We also identified several gaps in the literature on which we based recommendations for the future of caffeine research.

Regular energy drink consumption is associated with the risk of health and behavioural problems in adolescents

Consumption of energy drinks has become popular and frequent among adolescents across Europe. Previous research showed that regular consumption of these drinks was associated with several health and behavioural problems. The aim of the present study was to determine the socio-demographic groups at risk for regular energy drink consumption and to explore the association of regular energy drinks consumption with health and behavioural problems and negative school experiences in adolescents. Data from the Health Behaviour in School-aged Children Study conducted in 2014 in Slovakia were analysed. We assessed socio-demographic characteristics, energy drink consumption, health and behavioural problems and negative school experiences based on self-reports from 8977 adolescents aged 11-15 years (mean age/standard deviation 13/1.33; 50.0% boys). The prevalence of regular energy drink consumption in the present sample was 20.6% (95%CI: 20%-21%). Regular energy drink consumption was more frequent among boys and older adolescents. Adolescents with a medium-level family affluence were less likely to drink energy drinks regularly. Adolescents who consumed energy drinks regularly had more health and behavioural problems and negative school experiences.

CONCLUSION

Adolescents drinking energy drinks are at risk of a wide range of negative outcomes and should be specifically addressed by preventive interventions. What is Known • Energy drink consumption has become popular and frequent among adolescents across Europe. • There is growing evidence that energy drink consumption is related to negative social, emotional and health outcomes, but only a few studies have explored this relationship in adolescents. What is New • Regular energy drink consumption was more frequent among boys and adolescents reporting low family affluence and increased with age. • Adolescents reporting regular energy drink consumption were in higher risk to suffer from health and behavioural problems and negative school experiences.

Efficacy of school-based interventions aimed at decreasing sugar-sweetened beverage consumption among adolescents: a systematic review

Objective

To verify the efficacy of school-based interventions aimed at reducing sugar-sweetened beverage (SSB) consumption among adolescents in order to develop or improve public health interventions.

Design

Systematic review of interventions targeting adolescents and/or the school environment.

Setting

The following databases were investigated: MEDLINE/PubMed, PsycINFO, CINAHL and EMBASE. Proquest Dissertations and Theses was also investigated for unpublished trials.

Subjects

Adolescents were defined as individuals between the ages of 12 and 17 years.

Results

A total of thirty-six studies detailing thirty-six different interventions tested among independent samples (n152 001) were included in the review. Twenty interventions were classified as educational/behavioural and ten were classified as legislative/environmental interventions. Only six interventions targeted both individuals and their environment. Over 70 % of all interventions, regardless of whether they targeted individuals, their environment or both, were effective in decreasing SSB consumption. Legislative/environmental studies had the highest success rate (90·0 %). Educational/behavioural interventions only and interventions that combined educational/behavioural and legislative/environmental approaches were almost equally effective in reducing SSB consumption with success rates of 65·0 and 66·7 %, respectively. Among the interventions that had an educational/behavioural component, 61·5 % were theory-based. The behaviour change techniques most frequently used in interventions were providing information about the health consequences of performing the behaviour (72·2 %), restructuring the physical environment (47·2 %), behavioural goal setting (36·1 %), self-monitoring of behaviour (33·3 %), threat to health (30·6 %) and providing general social support (30·6 %).

Conclusions

School-based interventions show promising results to reduce SSB consumption among adolescents. A number of recommendations are made to improve future studies.

Store owners as potential agents of change: energy drinks in the interior of Alaska

Childhood obesity disproportionately impacts disadvantaged communities, including Alaska Native children. In part, lack of access to fresh fruits and vegetables and over consumption of sugar sweetened beverages including energy drinks contribute to excessive weight gain in Alaska Native youth. This commentary reports the possibility of storeowners and workers partnering with community members to limit sales of nutrient-poor energy drinks through point-of-sale counselling in rural communities in the interior of Alaska. This model of intervention may be useful to implement in areas where there are limited health workers or others that can serve as health educators. This study reports preliminary evidence from rural Alaska and from other Arctic communities that store workers may effectively improve community health status by limiting or promoting specific products. Storeowners or workers may be helpful partners in the fight against childhood obesity as they are present at the point of sale of high-risk beverages to Alaska Native youth.

The effect of swimming on oral health status: competitive versus non-competitive athletes

Young swimmers are particularly susceptible to the onset of oral diseases.

Compliance of Parenting Magazines Advertisements with American Academy of Pediatrics Recommendations

This study examined 3218 advertisements from the two parenting magazines with highest circulation in the United States. The authors compared each advertisement for a product for use by children, against all the published recommendations of the American Academy of Pediatrics (AAP) on topics such as toy safety, helmet use, age-defined choking hazards, infant sleep safety, and others. Any advertisement with images or products which went against a published AAP recommendation was deemed as non-adherence and was categorized according to the statement it contradicted. Nearly one in six (15.7%) of the advertisements contained example(s) of non-adherence to AAP recommendations, with twelve categories of offense represented. Categories ranked by overall share from most to least include: non-Food and Drug Administration (FDA) approved medical treatments, age-defined choking hazards, vitamins, cold medicine, formula, oral care, screen time, toy/playground safety, infant sleep, nutrition, water safety, and fall risk. Given that repeated exposure to messages in advertisements has been associated with changes in health decision-making, and parents often turn to parenting magazines for advice and ideas regarding their children, the publishers might consider screening the content in order to prevent confusing and potentially dangerous messages from being disseminated in the media.

Consumption of energy drinks by children and young people: a rapid review examining evidence of physical effects and consumer attitudes

OBJECTIVE

To examine patterns of energy drink consumption by children and young people, attitudes towards these drinks, and any associations with health or other outcomes.

DESIGN

Rapid evidence assessment and narrative synthesis.

DATA SOURCES

9 electronic bibliographic databases, reference lists of relevant studies and searches of the internet.

RESULTS

A total of 410 studies were located, with 46 meeting the inclusion criteria. The majority employed a cross-sectional design, involved participants aged 11-18 years, and were conducted in North America or Europe. Consumption of energy drinks by children and young people was found to be patterned by gender, with boys consuming more than girls, and also by activity levels, with the highest consumption observed in the most and least sedentary individuals. Several studies identified a strong, positive association between the use of energy drinks and higher odds of health-damaging behaviours, as well as physical health symptoms such as headaches, stomach aches, hyperactivity and insomnia. There was some evidence of a dose-response effect. 2 experimental studies involving small numbers of junior athletes demonstrated a positive impact on limited aspects of sports performance. 3 themes emerged from the qualitative studies: reasons for use; influences on use; and perceived efficacy and impact. Taste and energy-seeking were identified as key drivers, and branding and marketing were highlighted as major influences on young people's consumption choices. Awareness of possible negative effects was low.

CONCLUSIONS

There is growing evidence that consumption of energy drinks is associated with a range of adverse outcomes and risk behaviours in terms of children's health and well-being. However, taste, brand loyalty and perceived positive effects combine to ensure their popularity with young consumers. More research is needed to explore the short-term and long-term impacts in all spheres, including health, behaviour and education.

TRIAL REGISTRATION NUMBER

CRD42014010192.

Sports Specialization and Intensive Training in Young Athletes

Sports specialization is becoming the norm in youth sports for a variety of reasons. When sports specialization occurs too early, detrimental effects may occur, both physically and psychologically. If the timing is correct and sports specialization is performed under the correct conditions, the athlete may be successful in reaching specific goals. Young athletes who train intensively, whether specialized or not, can also be at risk of adverse effects on the mind and body. The purpose of this clinical report is to assist pediatricians in counseling their young athlete patients and their parents regarding sports specialization and intensive training. This report supports the American Academy of Pediatrics clinical report "Overuse Injuries, Overtraining, and Burnout in Child and Adolescent Athletes."

Dietary Intakes and Supplement Use in Pre-Adolescent and Adolescent Canadian Athletes

Young athletes experience numerous dietary challenges including growth, training/competition, unhealthy food environments, and travel. The objective was to determine nutrient intakes and supplement use in pre-adolescent and adolescent Canadian athletes. Athletes (n = 187) aged 11-18 years completed an on-line 24-h food recall and dietary supplement questionnaire. Median energy intake (interquartile range) varied from 2159 kcal/day (1717-2437) in 11-13 years old females to 2905 kcal/day (2291-3483) in 14-18 years old males. Carbohydrate and protein intakes were 8.1 (6.1-10.5); 2.4 (1.6-3.4) in males 11-13 years, 5.7 (4.5-7.9); 2.0 (1.4-2.6) in females 11-13 years, 5.3 (4.3-7.4); 2.0 (1.5-2.4) in males 14-18 y and 4.9 (4.4-6.2); 1.7 (1.3-2.0) in females 14-18 years g/kg of body weight respectively. Median vitamin D intakes were below the recommended dietary allowance (RDA) and potassium was below the adequate intake (AI) for all athlete groups. Females 14-18 years had intakes below the RDA for iron 91% (72-112), folate 89% (61-114) and calcium 84% (48-106). Multivitamin-multiminerals, vitamin C, vitamin D, vitamin-enriched water, protein powder, sport foods, fatty acids, probiotics, and plant extracts were popular supplements. Canadian pre-adolescent and adolescent athletes could improve their dietary intakes by focusing on food sources of calcium, vitamin D, potassium, iron, and folate. With the exceptions of vitamin D and carbohydrates during long exercise sessions, supplementation is generally unnecessary.

Use of Performance-Enhancing Substances

Performance-enhancing substances (PESs) are used commonly by children and adolescents in attempts to improve athletic performance. More recent data reveal that these same substances often are used for appearance-related reasons as well. PESs include both legal over-the-counter dietary supplements and illicit pharmacologic agents. This report reviews the current epidemiology of PES use in the pediatric population, as well as information on those PESs in most common use. Concerns regarding use of legal PESs include high rates of product contamination, correlation with future use of anabolic androgenic steroids, and adverse effects on the focus and experience of youth sports participation. The physical maturation and endogenous hormone production that occur in adolescence are associated with large improvements in strength and athletic performance. For most young athletes, PES use does not produce significant gains over those seen with the onset of puberty and adherence to an appropriate nutrition and training program.

Impact of alcohol and alcohol mixed with energy drinks on non-medical prescription stimulant use in a nationally representative sample of 12th-grade students

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.

RESULTS

Significant 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 SIGNIFICANCE

Research 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).

Effects of Caffeine on Exercise Responses and Performance in Children and Youth

Extensive research has been performed investigating the effects of caffeine during exercise in adults with many reviews published in just the past 10 years. Limited research has been conducted in children despite the fact that they are one of the fastest growing consumers of caffeine. In light of the limited research, in writing this review no inclusion or exclusion criteria were used, as the aim of the review is to provide as wide a research base as possible. This review will present the data that has systematically investigated the acute effects of caffeine in children and youth during exercise.

Energy drink consumption and substance use risk in middle school students

OBJECTIVES

Energy drink (ED) sales have increased greatly in recent years and ED is now a common topic in health behavior research. Most studies work with samples of college students and/or young adults and to a lesser degree with high school students. Research is lacking on ED consumption in younger users. The purpose of this study was to fill this gap and assess the prevalence of ED consumption in a sample of middle school students as well to analyze the relationships between ED use and illicit and licit drug use in girls and boys of this age.

METHOD

We use cross-sectional school-survey data from 6-8th grade students in three US mid-Atlantic schools conducted in September to November 2014 (N = 1152, response rate: 82.4%).

RESULTS

Approximately 20% of participants had consumed ED and 10% had smoked cigarettes. Almost 14% had used alcohol at least once in their lifetime and 5.5% marijuana. Boys were more likely than girls to have used ED but no gender difference was observed in the prevalence of illicit substances. However, ED use was positively related to smoking and alcohol use among both genders, but also to several forms of illicit drug use among girls.

CONCLUSION

ED consuming girls are particularly prone to also use illicit substances. This is the first survey-type study which reports a positive relationship between ED consumption with both licit and illicit drug use in middle school-aged girls and boys.

A Review of Energy Drinks and Mental Health, with a Focus on Stress, Anxiety, and Depression

Background: Concerns have been expressed regarding the potential for caffeinated energy drinks to negatively affect mental health, and particularly so in young consumers at whom they are often targeted. The products are frequently marketed with declarations of increasing mental and physical energy, providing a short-term boost to mood and performance. Although a certain amount of evidence has accumulated to substantiate some of these claims, the chronic effects of energy drinks on mental health also need to be addressed.

Methods: To review the relevant literature, PubMed and PsycINFO were searched for all peer-reviewed articles published in English that addressed associations between energy drink use and mental health outcomes. Case reports were also considered, though empirical studies investigating acute mood effects were excluded as a review of such articles had recently been published. Fifty-six articles were retrieved: 20 of these (along with eight more identified through other means) were included in the current review, and, because the majority addressed aspects of stress, anxiety, and depression, particular focus was placed on these outcomes.

Results: Though a number of null findings (and one negative relationship) were observed, the majority of studies examined reported positive associations between energy drink consumption and symptoms of mental health problems.

Conclusions: Though the findings imply that energy drink use may increase the risk of undesirable mental health outcomes, the majority of research examined utilized cross-sectional designs. In most cases, it was therefore not possible to determine causation or direction of effect. For this reason, longitudinal and intervention studies are required to increase our understanding of the nature of the relationships observed.

Energy Drink Consumption Practices of Young People in Bahrain

Background

Energy drink (ED) consumption is becoming increasingly popular among young Bahrainis, who may be unaware of the health risks associated with ED consumption. To date, there have been few publications on the consumption of ED in Bahrain, particularly among adolescents. This study seeks to fill a gap in the literature on energy drink consumption practices of Bahraini adolescents.

Methods

Data were collected using a previously established European Food Safety Authority questionnaire. Cross-sectional analyses were conducted on a convenience sample of 262 Bahraini students aged 10 to 18 years.

Results

Most participants consumed energy drinks 2 to 3 times per week and consumed two or more cans at a time. Eighty percent of partcipants preferred energy drinks with sugar. Participants in the older age group and higher educational level consumed more ED. The majority (57%) consumed ED at home with friends as part of socialization. Notably, 60% of the parents of the respondents have not consumed energy drinks. Prominent reasons for consumption of energy drinks included: taste (40%), energy (30%), stay awake (13%), augment concentration (4%), and enhance sports performance (6%).

Conclusion

Energy drink consumption is a popular socialization activity among adolescents of Bahrain. The potential health risks necessitates the need for novel health promotion strategies and advocacy efforts for healthy hydration practices.

Consumption of sugar-sweetened beverages and energy drinks and adherence to physical activity and screen time recommendations among adolescents

BACKGROUND

It is recommended that youth aged 12-17 years achieve ≥60 min/day of moderate-to-vigorous physical activity (PA) and limit their recreational screen time (ST) to ≤2 h/day. However, whether unhealthy eating behavior is associated with adherence to PA and ST recommendations in youth is largely unknown.

OBJECTIVE

This study examined the associations between adherence to PA and ST recommendations with consumption of sugar-sweetened beverages (SSBs) and energy drinks (EDs) in a representative sample of adolescents.

METHODS

Data on 11-19-year-old Ottawa (Canada) students (n=1147) were analyzed using self-reported information on consumption of SSBs and EDs, and time devoted to PA and ST. Multivariable logistic regression analyses were conducted to examine the associations between adherence to PA and ST recommendations and consumption of SSBs and EDs.

RESULTS

Adherence to the ST recommendation was inversely associated with consumption of SSBs [odds ratio (OR)=0.42; 95% confidence interval (CI)=0.21-0.86] and EDs (OR=0.54, 95% CI=0.31-0.92) in females only, independent of PA and relevant covariates. However, adherence to the PA recommendation was positively associated with consumption of EDs in females (OR=1.52, 95% CI=1.07-2.17) but not males, while it was not associated with consumption of SSBs in both sexes.

CONCLUSION

Among female adolescents, adherence to the ST recommendation is inversely associated with consumption of SSBs and EDs, while adherence to the PA recommendation is positively associated with consumption of EDs. Future studies should clarify the observed sex differences and determine if decreasing ST can reduce the consumption of SSBs and EDs among adolescents.

Breakfast and Energy Drink Consumption in Secondary School Children: Breakfast Omission, in Isolation or in Combination with Frequent Energy Drink Use, is Associated with Stress, Anxiety, and Depression Cross-Sectionally, but not at 6-Month Follow-Up

A considerable amount of research suggests that breakfast omission and the frequent use of caffeinated energy drinks may be associated with undesirable effects, and particularly so in children and adolescents. The current paper presents cross-sectional and longitudinal data from the Cornish Academies Project to investigate the effects of consuming energy drinks and missing breakfast on stress, anxiety, and depression in a cohort of secondary school children from the South West of England. Questionnaires were administered at two time-points (spaced 6 months apart) to collect information relating to diet and lifestyle over the previous 6 months. Demographic and school data were acquired through the School Information Management System, and single-item measures of stress, anxiety, and depression were administered at the second time-point only. Associations between breakfast and energy drink consumption and stress, anxiety, and depression were investigated, and a multivariate approach was taken so that additional variance from diet, demography, and lifestyle could be controlled for statistically. Cross-sectional analyses showed that breakfast omission was consistently associated with negative outcomes, and that this was largely observed for both those who frequently consumed energy drinks and those who did not. However, cross-lag analyses showed that neither breakfast omission or energy drink consumption, alone or in combination, was predictive of stress, anxiety, or depression at 6-month follow-up. This suggests that associations between breakfast and mental health may be bi-directional rather than breakfast being the causal factor.

Beverage Choices of Adolescents and Their Parents Using the Theory of Planned Behavior: A Mixed Methods Analysis

BACKGROUND

Added sugar intake in the form of sugar-sweetened beverages (SSBs) has been considered a contributor to weight gain and cardiometabolic dysfunction in adults and youth. Adolescents are some of the highest consumers of added sugars, taking in ∼16% of their total calories from added sugars with ∼40% of these calories coming from SSBs. Food preferences and self-regulation of dietary intake by youth can be influenced by parents.

OBJECTIVE

To evaluate the effectiveness of the Theory of Planned Behavior (TPB) in understanding and predicting adolescents' SSB consumption, identify which constructs are the most important when evaluating SSB consumption in adolescents, and determine whether and how adolescents' beverage choices are influenced by parents' reactions to their beverage choices.

DESIGN

Measurements for this cross-sectional study included four record-assisted 24-hour dietary recalls and responses to an SSB-specific TPB questionnaire from 100 adolescents. Consenting parents completed a beverage intake questionnaire, a TPB questionnaire, and the Parent Response to Beverage Choice Questionnaire.

RESULTS

The TPB explained 34% of the variance in adolescents' and parents' intention to limit SSBs to <1cup/day. Parents' perceived behavioral control (b=1.35; P=0.002) and adolescents' subjective norms (b=0.57; P=0.001) were the strongest predictors of intention, and intention was the strongest predictor of SSB consumption in both adolescents and parents (b=-37 [P=0.026] and b=-49 [P=0.003], respectively). The TPB explained more variance in parent SSB consumption (R(2)=0.38) than adolescents (R(2)=0.22). Parents did more discouraging of SSBs and encouraging of non-SSBs. Adolescents' intention to limit SSB consumption moderated the relationship between parents' reactions encouraging SSBs and adolescents' predicted SSB consumption (P=0.021).

CONCLUSIONS

The TPB explained a small but significant amount of variance in adolescents' SSB consumption. When addressing adolescent SSB intake, people in addition to parents may influence their intentions and SSB consumption.

Negative, Null and Beneficial Effects of Drinking Water on Energy Intake, Energy Expenditure, Fat Oxidation and Weight Change in Randomized Trials: A Qualitative Review

Drinking water has heterogeneous effects on energy intake (EI), energy expenditure (EE), fat oxidation (FO) and weight change in randomized controlled trials (RCTs) involving adults and/or children. The aim of this qualitative review of RCTs was to identify conditions associated with negative, null and beneficial effects of drinking water on EI, EE, FO and weight, to generate hypotheses about ways to optimize drinking water interventions for weight management. RCT conditions that are associated with negative or null effects of drinking water on EI, EE and/or FO in the short term are associated with negative or null effects on weight over the longer term. RCT conditions that are associated with lower EI, increased EE and/or increased FO in the short term are associated with less weight gain or greater weight loss over time. Drinking water instead of caloric beverages decreases EI when food intake is ad libitum. Drinking water increases EE in metabolically-inflexible, obese individuals. Drinking water increases FO when blood carbohydrate and/or insulin concentrations are not elevated and when it is consumed instead of caloric beverages or in volumes that alter hydration status. Further research is needed to confirm the observed associations and to determine if/what specific conditions optimize drinking water interventions for weight management.