The Use of Energy Drinks, Dietary Supplements, and Prescription Medications by United States College Students to Enhance Athletic Performance

Prevalence of energy drink consumption world-wide: A systematic review and meta-analysis

BACKGROUND AND AIMS

The increasing market for energy drinks (EDs) in recent years, as well as the health risks caused by their consumption, prompt calls to estimate the prevalence of ED use among different countries. This systematic review and meta-analysis aimed to synthesize the prevalence of ED use in different continents and age groups.

METHOD

We searched two databases (i.e. PubMed and PsycInfo) on 31 March 2023 to identify studies reporting the prevalence of ED use. A total of 192 studies (196 distinct samples; n = 1 120 613; 53.37% males) from the United States, Europe, Asia, Oceania and Africa were included in the analysis. A random-effects model was applied to estimate the overall pooled prevalence at several time-periods. Subgroup analyses were performed to provide prevalence based on continent and age group. The quality of articles was assessed using Joana Brigg's Institute (JBI) critical appraisal checklist. Measurements included prevalence of ED use (i.e. life-time, past 12 months, past 30 days, past 7 days and daily use), continent and age group (i.e. children, adolescents, young adults and adults).

RESULTS

The life-time ED use world-wide-pooled prevalence was estimated to be 54.7% [95% confidence interval (CI) = 48.8-60.6; I2  = 99.80], 43.4% (95% CI = 36.1-50.6; I2  = 99.92) in the past 12 months, 32.3% (95% CI = 28.8-35.8; I2  = 99.82) in the past 30 days, 21.6% (95% CI = 18.7-24.5; I2  = 99.95) in the past 7 days and 8.82% (95% CI = 6.3-11.4; I2  = 99.95) daily ED use. Subgroups analyses showed significant differences in ED life-time use within age groups (P = 0.002) and continents (P = 0.035).

CONCLUSIONS

The world-wide prevalence of energy drink use appears to be high, particularly among adolescents and young adults.

Energy drinks, substance use, and posttraumatic stress symptoms among Palestinian athletes: the mediating role of perceived self-efficacy and resilience

The current study aimed to test the association between energy drinks, substance use, and posttraumatic stress symptoms, and the mediating role of perceived self-efficacy and resilience among Palestinian athletes. The sample of our study consisted of 480 Palestinian athletes: 160 women and 320 men, all were selected from five Palestinian universities located in the West Bank of Palestine. The findings of our study revealed that energy drinks positively correlated with substance abuse, and posttraumatic stress symptoms. In addition, a negative association was found between perceived self-efficacy, substance use, and posttraumatic stress symptoms. Moreover, a negative association was found between resilience, substance use, and posttraumatic stress symptoms. Results of Structural equation modeling (SEM) revealed that resilience and perceived self-efficacy mediated the association between energy drinks, substance use and posttraumatic stress symptoms. Our findings underline the importance of enhancing resilience and perceived self-efficacy among athletes to prevent initial substance use/misuse, as several traits found in resilient athletes such as high self-esteem, empathy, help-seeking, and self-awareness are important in deterring athletes from engaging in harmful substances like tobacco, marijuana, and alcohol.

Reducing Unhealthy Normative Behavior: The Case of Sports and Energy Drinks

American adolescents consume more sugar-sweetened beverages (SSBs) than any other age group. Sports and energy drinks consumption among adolescents is higher than other SSBs. For sports drinks, there is uncertainty about their "healthiness" and also beliefs that these drinks may provide health benefits such as hydration, enhanced athletic performance, heightened mental alertness, and rapid recovery after exercise. Confusion about relative healthiness and expectations of health benefits suggest that factors that may encourage youth to avoid drinking sports and energy drinks, such as athletic status, psychological reactance, and SSB media literacy, may necessitate different approaches to promoting avoidance of sports drinks compared with avoidance of energy drinks. Using a nationally representative U.S. probability-based web panel augmented by a volunteer nonprobability-based web panel of 500 adolescent participants aged 14 to 18 years, we used the reasoned action approach to model intention to avoid sports and to avoid energy drinks. The result show there are similarities and differences in the determinants associated with adolescents' avoidance of sports and energy drinks: attitudes and descriptive normative pressure are both related to increased avoidance for both types of drinks and perceived control over the avoidance behavior is positively associated for with intention to avoid for energy drinks. Sport identification, psychological reactance, and SSB media literacy also play a different role in the sports and energy drink models. Based on our results, the content of prevention messages in interventions to limit sports drinks will need to be quite different from those targeted at reducing energy drink consumption.

Micronutrient supplement intakes among collegiate and masters athletes: A cross-sectional study

Objective

In our cross-sectional study, we evaluated micronutrient supplementation intake among Collegiate and Masters Athletes.

Methods

We conducted a cross-sectional study to assess micronutrient supplementation consumption in Collegiate and Masters Athletes, comparing sex and sport classification within each respective group. Micronutrient supplement consumption data were measured using a Food Frequency Questionnaire. A two-way analysis of variance was used to explore the differences among Collegiate and Masters Athletes' supplement intakes of the following vitamins and minerals: vitamins A, B6, B12, C, E, D, and calcium, folate, iron, magnesium niacin, riboflavin, selenium, thiamine, and zinc. When significant differences were found, a Bonferroni post hoc test was performed to identify specific group differences. The significance level was set a priori at p < 0.05.

Results

A total of 198 athletes (105 females and 93 males) were included in the study. Participants were 36.16 ± 12.33 years of age. Collegiate male athletes had significantly greater vitamin A [1,090.51 ± 154.72 vs. 473.93 ± 233.18 mg retinol activity equivalents (RAE)/day] (p < 0.036), folate [337.14 ± 44.79 vs. 148.67 ± 67.50 mcg dietary folate equivalents (DFE)/day] (p < 0.027), and magnesium (65.35 ± 8.28 vs. 31.28 ± 12.48 mg/day) (p < 0.031) intakes compared to Collegiate female athletes. Collegiate CrossFit Athletes (940.71 ± 157.54 mg/day) had a significantly greater vitamin C intake compared to Collegiate General Athletes (156.34 ± 67.79 mg/day) (p < 0.005), Collegiate Triathletes (88.57 ± 148.53 mg/day) (p < 0.027), Collegiate Resistance Training Athletes (74.28 ± 143.81 mg/day) (p < 0.020), and Collegiate Powerlifters (175.71 ± 128.63 mg/day) (p < 0.044). Masters females had significantly greater calcium intakes compared to Masters males (494.09 ± 65.73 vs.187.89 ± 77.23 mg/day, respectively) (p < 0.002). Collegiate Runners (41.35 ± 6.53 mg/day) had a significantly greater iron intake compared to Collegiate Powerlifters (4.50 ± 6.53 mg/day) (p < 0.024). Masters Swimmers (61.43 ± 12.10 mg/day) had significantly greater iron intakes compared to Masters General Athletes (13.97 ± 3.56 mg/day) (p < 0.014), Masters Runners (17.74 ± 2.32 mg/day) (p < 0.03), Masters Triathletes (11.95 ± 3.73 mg/day) (p < 0.008), Masters CrossFit Athletes (15.93 ± 5.36 mg/day) (p < 0.043), Masters Rowers (9.10 ± 3.36 mg/day) (p < 0.003), and Masters Cyclists (1.71 ± 9.88 mg/day) (p < 0.011). Masters Powerlifters (47.14 ± 9.65 mg/day) had significantly greater zinc intakes compared to Masters General Athletes (9.57 ± 2.84 mg/day) (p < 0.015), Masters Runners (10.67 ± 1.85 mg/day) (p < 0.017), Masters Triathletes (10.24 ± 2.98 mg/day) (p < 0.020), Masters Rowers (9.33 ± 2.68 mg/day) (p < 0.013), and Masters Cyclists (1.43 ± 7.88 mg/day) (p < 0.019). There were no other significant differences among the other micronutrient supplement intakes between the sexes or among the sport classification.

Conclusion

We reported significant differences among female and male Collegiate and Masters Athletes. Additionally, we reported significant differences among Collegiate and Masters Athletes sport classifications. Further research should examine both dietary and micronutrient supplement intake among Collegiate and Masters Athletes to examine the extent that athletes exceed the Recommended Dietary Allowances (RDA), and the potential effects on health and performance.

Consumption patterns of energy drinks in university students: A systematic review and meta-analysis

OBJECTIVES

Energy drink (ED) use is promoted to stimulate mental and/or physical activity, and their popularity has increased over the years, especially among young people. However, the use of EDs is often improper, and can induce adverse effects for human health. The purpose of this systematic review and meta-analysis was to analyze the literature to characterize the prevalence of ED consumption and motivations for use among undergraduate students. Furthermore, adverse effects and health-related behaviors associated with ED consumption were explored.

METHODS

This systematic review was carried out according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, and the PubMed, Scopus, and Web of Science databases were used for data research.

RESULTS

A total of 71 articles published between 2007 and 2021 met the inclusion criteria and were included in the review. The estimated overall prevalence of ED consumption was 42.9% in undergraduate students (95% confidence interval, 42.5%-43.3%), with significant heterogeneity among studies (Q test: P < 0.001; I² = 99.4%). The main reasons for use were engagement in study, projects or examinations, stay awake or alert, and physical activity/sport engagement. Sleep disturbance and increased heart rate or blood pressure were the most commonly reported adverse effects. ED consumption was frequently associated with alcohol use and smoking.

CONCLUSIONS

These findings suggest that the inappropriate use of EDs and related unhealthy behaviors should be identified early, and addressed through effective educational interventions.<END ABSTRACT>.

Substance availability and use in ex-professional ice hockey enforcers

Some ex-professional ice hockey enforcers (players whose primary role was fighting) have experienced negative health outcomes following their careers including substance use. Some have suggested that negative post-career outcomes following a career in contact sport relate specifically to neurotrauma. The purpose of this study was to determine whether ex-professional ice hockey enforcers were negatively impacted by substance use during and/or following their careers. It was hypothesised that given their role in the sport, significant exposure to injury (including concussions) occurred, leading to challenges post-career including substance use. This study utilises a mixed methods quantitative and qualitative approach with one-on-one semi-structured interviews and questions related to substance use. This hypothesis for this study was not supported. Participants in this study reported low levels of substance use post-career. Patterns of substance use during career varied by era with a change in use from alcohol and over-the-counter stimulants to opioids, sleep aids, and anabolic androgenic steroids (AAS) estimated to occur near the mid to late 1990s. Four participants described patterns of excessive alcohol use during their careers. Stimulant use was prevalent in ice hockey pre-mid-1990s. The use of prescription opioids and sleep aids was reportedly rare before the mid to late 1990s, but eventually became easily attainable via team medical staff and prescription sharing. Two participants from the later era also reported use of AAS. This sample of ex-professional hockey enforcers experienced a significant number of concussions, continue to have challenges with chronic pain, and were exposed to several unique stressors during their careers, the effects of which may have varied based upon how the role was viewed. A combination of these factors may have resulted in substance use in some of these athletes during, but not following their careers.

Caffeinated Drinks and Physical Performance in Sport: A Systematic Review

Caffeine (1,3,7-trimethylxanthine) is one of the most common substances used by athletes to enhance their performance during competition. Evidence suggests that the performance-enhancing properties of caffeine can be obtained by employing several forms of administration, namely, capsules/tablets, caffeinated drinks (energy drinks and sports drinks), beverages (coffee), and chewing gum. However, caffeinated drinks have become the main form of caffeine administration in sport due to the wide presence of these products in the market. The objective of this systematic review is to evaluate the different effects of caffeinated drinks on physical performance in various sports categories such as endurance, power-based sports, team sports, and skill-based sports. A systematic review of published studies was performed on scientific databases for studies published from 2000 to 2020. All studies included had blinded and cross-over experimental designs, in which the ingestion of a caffeinated drink was compared to a placebo/control trial. The total number of studies included in this review was 37. The analysis of the included studies revealed that both sports drinks with caffeine and energy drinks were effective in increasing several aspects of sports performance when the amount of drink provides at least 3 mg of caffeine per kg of body mass. Due to their composition, caffeinated sports drinks seem to be more beneficial to consume during long-duration exercise, when the drinks are used for both rehydration and caffeine supplementation. Energy drinks may be more appropriate for providing caffeine before exercise. Lastly, the magnitude of the ergogenic benefits obtained with caffeinated drinks seems similar in women and men athletes. Overall, the current systematic review provides evidence of the efficacy of caffeinated drinks as a valid form for caffeine supplementation in sport.

The Relationship Between Energy Drink Consumption, Caffeine Content, and Nutritional Knowledge Among College Students

We sought to determine which demographic characteristics influence energy drink consumption habits and to examine whether caffeine content and knowledge of human nutrition affect college students' decisions to consume these beverages. We used an online survey to ask 265 college students, who did not participate in a varsity sport, to complete a survey consisting of demographic questions, the General Knowledge Questionnaire for adults, and questions about energy drink consumption habits. We found, overall, that 23.1% of our sample used energy drinks. When compared to non-consumers (76.9%), users had a significantly lower GPA, were older, and preferred drinks with a higher caffeine content. Users reported that they consumed these drinks because they wanted to feel more alert and they enjoyed the taste, even though they reported adverse effects such as trouble sleeping, shaking and tremors, and stomachaches. Knowledge of human nutrition did not affect users' choice to consume these drinks. Although the majority of college students do not consume energy drinks, room for improvement remains to curb the use of these caffeinated beverages amongst college students.

Behavior of Nutritional Supplements Use in Association With Inflammatory Skin Diseases in Chinese College Students

Objectives: It is understudied how frequently adolescents use nutritional supplements (NS) and whether the corresponding behavior is associated with skin diseases that may cause unpleasant symptoms and disfigurement. The current study aimed to investigate the prevalence of NS use in Chinese college students and its association with inflammatory skin diseases.

Methods: This was a university-based epidemiologic investigation that included 20,138 students who underwent dermatological examinations. A questionnaire survey was conducted to inquire about the use of NS along with related information. Skin diseases were diagnosed by dermatologists during the health examination. Logistic regression models were used for analysis. Adjusted odds ratios (aORs) were presented as the effect size.

Results: Survey responses from a total of 20,138 participants were analyzed. Specifically, 18.3% of the participants reported the use of NS in the past year. The use of vitamin C was most frequently reported, accounting for a proportion of 12.9%, followed by vitamin B and mineral supplements. The use of NS was found to be associated with female sex, Han ethnicity, higher annual household income, and a series of healthy lifestyles such as more physical activity, less second-hand smoke exposure, less alcohol consumption, and higher intake of milk and yogurt (p < 0.001). Participants with chronic urticaria (aOR = 1.3; 95% CI, 1.0–1.7), atopic dermatitis (aOR = 1.4; 95% CI, 1.2–1.6), or acne (aOR = 1.17; 95% CI, 1.04–1.31) were more likely to use NS, especially herbs (aOR = 2.7; 95% CI, 1.2–3.7), followed by vitamin B (aOR = 1.6; 95% CI, 1.2–2.0) and mineral supplements (aOR = 1.4; 95% CI, 1.0–2.0).

Conclusion: College students with inflammatory skin diseases are more likely to use NS.

Energy Drinks and Sports Performance, Cardiovascular Risk, and Genetic Associations; Future Prospects

The consumption of energy drinks (e.g., containing caffeine and taurine) has increased over the last decade among adolescents and athletes to enhance their cognitive level and improve intellectual and athletic performance. Numerous studies have shown that drinking moderate doses of such drinks produces beneficial effects, as they considerably boost the sporting performance of elite athletes in various sports, including both endurance and explosive events. However, apart from their ergogenic effects, the regular consumption of energy drinks also increases blood pressure and consequently incites problems such as hypertension, tachycardia, and nervousness, all of which can lead to cardiovascular disorders. A potential positive correlation between genetics and the moderate consumption of energy drinks and athletic performance has recently been reported; notwithstanding, a better understanding of the genetic variants involved in metabolism is a key area for future research to optimize the dose of energy drink consumed and obtain the maximal ergogenic effect in elite sports. The aim of this literature review, therefore, is to present the results of recent studies, classifying them according to the differences in the associations between energy drinks and: (i) Athletic performance; (ii) cardiovascular risk factors while practicing sports; and (iii) genetic associations and future prospects between the consumption of energy drinks and performance.

Self-Medication-Related Behaviors and Poland's COVID-19 Lockdown

(1) Background: The SARS-CoV-2 pandemic has changed the functioning of Polish health systems. Telemedicine has been developed and access to prescription drugs (Rx) has been facilitated. This study examined whether these changes and the imposition of a three-month lockdown caused Polish people to engage in more self-medication-related behaviors. (2) Method: After the fourth (final) stage of defrosting the Polish economy, an online survey of a quota sample of 1013 Polish respondents was conducted. (3) Results: Almost half of the respondents (45.6%) indicated that they had engaged in at least one behavior associated with inappropriate self-medication during the lockdown (e.g., 16.6% took medication as a precaution, and 16.8% took an Rx formulation without consultation). Some of these people had never engaged in such behaviors prior to the lockdown. Linear regression showed that higher values of a composite ("lockdown") index of self-medication-related behaviors occurring during lockdown were predicted by greater religiosity and the presence of children in a household. Also, independent samples t-tests showed that people who were afraid for their financial future and people who feared for their health obtained higher lockdown index scores than people not having such worries. (4) Conclusions: Self-medication-related behaviors were more common among Poles before lockdown than during the lockdown (which is unsurprising given that the lengths of the periods compared were hugely different), worryingly, many people exhibited such behaviors for the first time during the lockdown.

Prioritized Dietary Supplement Information Needs of 307 NCAA Division I Student Athletes

OBJECTIVE

To evaluate dietary supplement information needs among collegiate athletes.

METHODS

Three hundred seven (n = 154 male; n = 153 female) student athletes participating in a National Collegiate Athletic Association Division I team completed a dietary supplement survey. Qualitative coding addressed open-ended responses, and chi-square test of independence explored differences among athlete subgroups.

RESULTS

Five themes representing athletes' information needs included quality/composition (53.5%; n = 77), general information (31.9%; n = 46), nutrition information (30.6%; n = 44), performance (18.8%; n = 27), and body composition (13.2%; n = 19). Athletes with "no" or "minimal" (n = 63), vs "moderate" or "strong" (n = 195), perceived knowledge of supplement safety were more likely to list a question about supplement quality or composition (34.9% [n = 22/63] vs 21.5% [n= 42/195]; P = .03; chi-square = 4.6).

CONCLUSIONS AND IMPLICATIONS

Further research is needed to corroborate findings to inform educational efforts and promote safe and effective use of dietary supplements by student athletes.

Effects of Bang® Keto Coffee Energy Drink on Metabolism and Exercise Performance in Resistance-Trained Adults: A Randomized, Double-blind, Placebo-controlled, Crossover Study

BACKGROUND

Energy drinks are often consumed by the general population, as well as by active individuals seeking to enhance exercise performance and augment training adaptations. However, limited information is available regarding the efficacy of these products. Thus, the purpose of this study was to determine the effects of a commercially available caffeine- and protein-containing energy drink on metabolism and muscular performance.

METHODS

Sixteen resistance-trained males (n = 8; mean ± SD; age: 22.4 ± 4.9 years; body mass: 78.8 ± 14.0 kg; body fat: 15.3 ± 6.4%) and females (n = 8; age: 24.5 ± 4.8 years; body mass: 67.5 ± 11.9 kg; body fat: 26.6 ± 7.1%) participated in this randomized, double-blind, placebo-controlled, crossover study. Following a familiarization visit, participants completed two identical visits to the laboratory separated by 5-10 days, each of which consisted of indirect calorimetry energy expenditure (EE) assessments before and after consumption of the beverage (Bang® Keto Coffee; 130 kcal, 300 mg caffeine, 20 g protein) or placebo (30 kcal, 11 mg caffeine, 1 g protein) as well as after exercise testing. In addition, participants' subjective feelings of energy, fatigue, and focus as well as muscular performance (leg press one-repetition maximum and repetitions to fatigue, maximal isometric and isokinetic squat testing) were assessed. Multiple repeated measures ANOVAs with Tukey post-hoc tests were used to analyze data. Estimates of effect size were quantified via partial eta squared (ηP2) and Hedge's g.

RESULTS

A significant interaction effect was identified for EE (p < 0.001, ηP2 = 0.52) but not respiratory exchange ratio (p = 0.17, ηP2 = 0.11). Following consumption of the beverage, EE was 0.18 [corrected]  kcal·min- 1 greater than placebo at the post-beverage time point (p < 0.001) and 0.08 [corrected]  kcal·min- 1 greater than placebo at the post-exercise time point (p = 0.011). However, no between-condition differences were detected for any subjective or muscular performance outcomes.

CONCLUSIONS

The results of this study suggest that consumption of the energy drink had minimal effects on lower-body muscular performance and subjective factors in the context of a laboratory setting. However, the beverage was found to significantly increase energy expenditure compared to placebo immediately following ingestion as well as during the recovery period after an exercise bout, suggesting that active individuals may improve acute metabolic outcomes via consumption of a caffeine- and protein-containing energy drink.

TRIAL REGISTRATION

This trial was prospectively registered at ClinicalTrials.gov (Identifier: NCT04180787 ; Registered 29 November 2019).

Eating habits and dietary acculturation effects among international college students in the United States

Although the United States rates as the top host country for international students in the world, the impact of dietary acculturation on their health status is poorly understood. This study used a qualitative approach to gain an in-depth understanding of the factors related to dietary acculturation among international students in U.S. universities. Ten focus groups, of which eight were in two Midwestern U.S. universities and two in a Southern U.S. university (n = 44), were studied. Participants were international, college-aged students enrolled in U.S. universities. Grounded theory method was used for data analysis to develop themes relevant to dietary changes and factors related to dietary acculturation based on the participants' perspectives and experiences. The results showed that most of the participants faced various dietary challenges and health consequences in the United States. Access to food, religious orientation, time constraints, campus environment, and healthcare access were the main factors influencing student diets. A majority of the students reported weight gain due to eating larger portions, unstructured mealtimes, and frequent snacking. Some students reported that they do not eat fruits and vegetables in the United States because they believe that these foods are not fresh, genetically modified, and may contain pesticides. The majority of participants reported taking unprescribed dietary supplements since moving to the United States. Students who transitioned to the typical American diet reported weight gain, increased fatigue, abdominal discomfort, and other health consequences. Universities should seek to develop policies and programs aimed to reduce the impact of acculturation in order to improve the experience of international students in the United States.

An Investigation of Habitual Dietary Supplement Use Among 557 NCAA Division I Athletes

Background: Supplements may expose athletes to dangerous ingredients, banned substances, toxins or contaminants; however, few investigations assess use among collegiate athletes in the U.S.Objective: This cross-sectional study evaluated habitual dietary supplement intake, defined use ≥2 days/week over the past year, in NCAA Division I athletes.Methods: Male and female members of a NCAA Division I team, at two universities in southern California completed a 13-item survey. Among 705 eligible participants, 596 submitted surveys (84.5% response rate), 557 surveys included complete data. Chi-square (χ²) analyses evaluated differences among athletes based on sex, weight status, year in college, and sport-type. Independent t-test or ANOVA evaluated mean differences for continuous variables.Results: A total of 45.2% athletes (n = 252) reported taking supplements (≥2 days/week over the past year). Vitamin/minerals (25.5%, n = 142), protein/amino acids (24.6%, n = 137) were used most frequently. Male, vs female athletes, took more supplements overall (1.2 ± 0.1 vs 0.8 ± 0.1, p = 0.004) and indicated higher use of protein/amino acid products (34.2% vs 13.5%, p < 0.005), whereas, females reported higher use of vitamin/minerals (30.5% vs 21.1%, p < 0.05). Higher supplement use was also reported by athletes with BMI ≥ 30.0 kg/m² (vs <30 kg/m², 1.9 ± 0.3 vs 1.0 ± 0.1, p = 0.02), and athletes in ≥ third college year (vs first or second year, 1.2 ± 0.1 vs 0.9 ± 0.1, p = 0.03).Conclusions: Nearly half of NCAA athletes reported habitual supplements use, with significant variation in patterns based on sex, sport-type, year in college, and weight status.

Energy drinks and population health: consumption pattern and adverse effects among Saudi population

BACKGROUND

Caffeine containing energy drinks (EDs) are heavily consumed, particularly among young adults. The number of reports of caffeine intoxication from caffeinated EDs and problems related to caffeine dependence and withdrawal is increasing. The objective was to assess the knowledge and perceived beneficial effects of EDs consumers, to assess consumption patterns and determine the adverse effects experienced by different EDs consumer groups residing in Saudi Arabia.

METHODS

An observational cross-sectional study with data from a randomly selected Saudi population was conducted during the period of January 15th, 2015, to April 15th, 2015, using a pre-tested 43-item questionnaire. The data were obtained and collected using interview questionnaires. Sociodemographic characteristics and data on EDs consumption patterns, the level of awareness among study subjects, and the purported benefits and reported adverse effects of EDs were collected. Frequency, percentage, and arithmetic means were calculated using Chi-square and ANOVA tests, and data with p < 0.05 were considered significant.

RESULTS

Of the 816 individuals invited to participate in the study, 783 participants responded and completed interviews, response rate was 96%. Consumers attributed the popularity of EDs to massive advertising media (46.7%) and their stimulating and invigorating effects (37.5%). EDs are consumed by subjects for their effects on fatigue reduction (64.6%), increased alertness and focus (75.8%), and assistance during long driving trips (75.7%). Study subjects reported suffering from adverse effects, including mainly diuresis (53.7%), palpitations (50.7%), insomnia (50.7%). Importantly, an inverse association was identified between knowledge of EDs and consumption rate, and a proportional association was identified between experienced adverse effects and consumption frequency. Lower knowledge scores were identified in daily consumers than in 1-3 times monthly consumers; higher adverse events were experienced by daily consumers than by 1-3 times monthly consumers. The majority of consumers (84.6%) recommended that authorities should regulate EDs consumption.

CONCLUSIONS

Excessive EDs consumption is associated with an increased risk of experiencing several adverse events, which is commensurate with published studies. Increasing knowledge about EDs and their possible risks could decrease their consumption by the general public.

Prevalence and Predictors of Higher-Risk Supplement Use Among Collegiate Athletes

Sassone, J, Muster, M, and Barrack, MT. Prevalence and predictors of higher-risk supplement use among National Collegiate Athletic Association Division I athletes. J Strength Cond Res 33(2): 443-450, 2019-This study aimed to identify the prevalence and predictors associated with the use of higher-risk dietary supplements, defined as supplements containing herbal ingredients, caffeine, or those classified for weight loss, muscle-building, or as a preworkout supplement, among 557 National Collegiate Athletic Association Division I male and female collegiate athletes. Although 252 (45.2%) athletes reported the use of a dietary supplement on ≥2 days per week over the past year, 46 (8.3%) athletes met criteria for higher-risk supplement use. Twenty (3.6%) athletes reported the use of herbal, 1 (0.2%) caffeinated, 5 (0.9%) weight loss, 28 (5.0%) preworkout, and 1 (0.2%) muscle-building supplements. Body mass index status (BMI ≥30 kg·m), sport-type (sports using the phosphocreatine energy system), and college year (≥4th year) were associated with the use of preworkout, muscle-building, or herbal supplements. A multiple regression analysis identified predictors of higher-risk supplement use including the number of dietary supplements used in the past year (odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.7-2.7, p < 0.001), the reported motivation of taking dietary supplements to gain muscle and lose body fat (OR = 3.5, 95% CI = 1.1-11.7, p = 0.04), and the motivation to increase athletic endurance (OR = 3.5, 95% CI = 4.0, 95% CI = 1.6-9.9, p < 0.005). These factors may be considered as a part of a screening process to evaluate athletes with an increased risk of higher-risk supplement use and potential consequences to health or eligibility status.

Beyond health: medicines, food supplements, energetics and the commodification of self-performance in Maputo

With an increasing range of products in global and local markets, more options are available for individuals to enhance their image and their (cognitive, social and physical) performance. These 'performance consumptions' relate to ideals of well-being and improvement, and are based on constructed desires, expectations and needs that go beyond the (often blurred) dichotomy of health and illness. Drawing from mixed-methods research in Maputo, Mozambique, this paper discusses individuals' use of medicines and other substances - pharmaceuticals, food supplements, traditional herbs, cosmetics and energy drinks - for managing different aspects of their everyday lives. Through an overview of the main consumption practices, we explore the underlying purposes and strategies of users, and the perceived legitimacy and risks involved when using a variety of products accessible through formal and informal exchange channels. From tiredness to sexual and aesthetic management, we show how the body becomes the locus of experimentation and investment to perform in accordance with socially expected roles, individual aspirations and everyday tasks. With insights from individuals' accounts in Maputo, we aim to add to discussions on pharmaceuticalisation of body management by showing how the emergence of new performance consumptions is articulated with the reconfiguration of more 'traditional' consumption practices.

Recreational and ergogenic substance use and substance use disorders in elite athletes: a narrative review

BACKGROUND

Substances from various classes may be used for recreational purposes, self-treatment or to boost performance. When substance use shifts from occasional to regular, heavy or hazardous use, positive and negative effects can develop that vary by substance class and athlete. Regular use of recreational or performance enhancing substances can lead to misuse, sanctions or use disorders.

OBJECTIVE

To review the prevalence, patterns of use, risk factors, performance effects and types of intervention for all classes of recreational and performance enhancing substances in elite athletes by sport, ethnicity, country and gender.

METHODS

A comprehensive search was conducted to identify studies that compared the prevalence and patterns of substance use, misuse and use disorders in elite athletes with those of non-athletes and provided detailed demographic and sport variations in reasons for use, risk factors and performance effects for each main substance class.

RESULTS

Alcohol, cannabis, tobacco (nicotine) and prescribed opioids and stimulants are the most commonly used substances in elite athletes, but generally used at lower rates than in non-athletes. In contrast, use/misuse rates for binge alcohol, oral tobacco, non-prescription opioids and anabolic-androgenic steroids are higher among athletes than non-athletes, especially in power and collision sports. Cannabis/cannabinoids seem to have replaced nicotine as the second most commonly used substance.

CONCLUSIONS

Substance use in elite athletes varies by country, ethnicity, gender, sport and competitive level. There are no studies on substance use disorder prevalence in elite male and female athletes and few studies with direct comparison groups.

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.

Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

Effects of dietary supplements on selected hematological and biochemical parameters of Pakistani athletes

Background

CDC’s (Centers for Disease Control and Prevention) National Center for Health statistics recent reports have shown that an upsurge has occurred in the use of dietary supplements among age of 20 years since 1994 and this use shown regular increase. The purpose of our study was to investigate the effect of supplements on the reproductive health on male athletes in Pakistan.

Methods

A total of 150 adult male with mean age of 25.78 ± 0.56 years were included in this study and divided into four groups: Non-athlete control (n = 57), Non supplemental athlete control (n = 40), Supplemental athlete group I (n = 28) and supplemental athlete group II (n = 25). Blood (10 ml) was taken from each subject. Complete blood count was performed and 5 ml of blood was centrifuged to separate plasma and then analyzed for antioxidant enzyme (CAT, POD, GR and GSH) activities, Lipid peroxidation (TBARS), electrolyte, metal (sodium, potassium and zinc) and Luteinizing hormone (LH) concentration.

Results

Complete blood count results showed normal RBC, WBC, Platelets, Hemoglobin, Hematocrit, Mean corpuscular hemoglobin and Mean corpuscular hemoglobin concentration. Antioxidant enzymes (CAT, POD, GR, GSH) increased significantly in supplemental athletes as compared to control groups. Sodium and potassium showed significant increase (p < 0.001) in supplemental athlete group I, while TBARS also showed significant increase (p < 0.05) in supplemental group I and II as compared to non athlete control while non supplemental athletes showed significant increase (p < 0.05) in TBARS concentration as compared to non athlete control. LH concentration was found to be decreased significantly (p < 0.05) in supplemental group I and II as compared to control groups.

Conclusion

It is therefore concluded from the present results that oxidative stress was considerably elevated in response to supplement consumption among athletes which may affect their health haematological parameters and reproductive hormones.

The Prevalence of Dietary Supplement Use among College Students: A Nationwide Survey in Japan

To clarify the prevalence of dietary supplement use among college students, we conducted Internet-based nationwide questionnaire surveys with 157,595 Japanese college students aged between 18 to 24 years old who were registrants of Macromill Inc. (Tokyo, Japan). Among the 9066 respondents (response rate 5.8%), 16.8% were currently using dietary supplements. The prevalence of dietary supplement use did not differ significantly between males (17.1%) and females (16.7%). However, it increased according to their grade (13.1% to 20.5%), and it was higher in medical and pharmaceutical college students (22.0%) compared to others (16.7%). The main purpose of dietary supplement use was for the health benefits in both males and females. Other reasons were to build muscle in males, and as a beauty supplement and for weight loss in females. According to the purpose of dietary supplement use, the most commonly-used dietary supplements were vitamin/mineral supplements in both males and females, then protein and weight loss supplements in males and females, respectively. Although most students obtained information about dietary supplements via the Internet, they typically purchased the supplements from drug stores. Of the students surveyed, 7.5% who were currently using or used to use dietary supplements experienced adverse effects, with no significant difference between genders (8.8% in male, 7.0% in female). In conclusion, the prevalence of dietary supplement use increased with grade among college students in Japan. Some of them experienced adverse effects. Education may be important to prevent adverse effects resulting from supplement use in college.

Adverse Effects of Nutraceuticals and Dietary Supplements

Over 70% of Americans take some form of dietary supplement every day, and the supplement industry is currently big business, with a gross of over $28 billion. However, unlike either foods or drugs, supplements do not need to be registered or approved by the US Food and Drug Administration (FDA) prior to production or sales. Under the Dietary Supplement Health and Education Act of 1994, the FDA is restricted to adverse report monitoring postmarketing. Despite widespread consumption, there is limited evidence of health benefits related to nutraceutical or supplement use in well-nourished adults. In contrast, a small number of these products have the potential to produce significant toxicity. In addition, patients often do not disclose supplement use to their physicians. Therefore, the risk of adverse drug-supplement interactions is significant. An overview of the major supplement and nutraceutical classes is presented here, together with known toxic effects and the potential for drug interactions.

Effects of Energy Drinks on Economy and Cardiovascular Measures

Peveler, WW, Sanders, GJ, Marczinski, CA, and Holmer, B. Effects of energy drinks on economy and cardiovascular measures. J Strength Cond Res 31(4): 882-887, 2017-The use of energy drinks among athletes has risen greatly. Caffeine and taurine are the 2 primary performance enhancing ingredients found in energy drinks. The number of emergency department visits involving energy drinks doubled over the past 5 years. Reviews of the health complications have highlighted adverse cardiovascular events. The literature reveals that caffeine is known to moderately increase blood pressure (BP) and heart rate (HR). The purpose of this study was to determine the effect of 3 different energy drinks on cardiovascular and performance measures. Fifteen recreational runners completed 5 trials. The first trial consisted of a graded exercise protocol. The 4 remaining trials consisted of 15-minute economy trials at a treadmill speed consistent with 70% of subject's V[Combining Dot Above]O2max. An hour before subjects ingested 1 of the 3 energy drinks or a placebo. HR, BP, V[Combining Dot Above]O2, and rating of perceived exertion (RPE) were recorded during the 15-minute trial. Mean values for dependent measures were compared using repeated-measures analysis of variance. Fifteen-minute systolic BP readings were significantly lower in the placebo trials (156.93 ± 15.50) in relation to the 3 energy drink trials (163.87 ± 13.30, 166.47 ± 13.71, and 165.00 ± 15.23). There were no significant differences in diastolic BP and HR. There were no significant differences found in V[Combining Dot Above]O2 or RPE measures. Ingestion of energy drinks demonstrated no change in V[Combining Dot Above]O2 or RPE during the economy trials. The findings show no performance benefits under the conditions of this study. However, there does appear to be a significant increase in systolic BP.

Underlying Beliefs Associated With College Student Consumption of Energy Beverages

College students are heavy consumers of energy beverages, yet further study is needed to better understand determinants of use. The purpose of this cross-sectional study ( N = 283) was to identify beliefs explaining unsafe consumption practices. A principal components analysis revealed three eigenvalues >1 explaining approximately 55% of the variance (health and appearance, performance and fatigue, and recreation and alcohol). Multiple regression analysis explained 75% of the variance for intent to consume. Standardized beta for attitude and subjective norms was p < .001; perceived behavioral control was p < .05. MANOVA was used to determine the effect of gender on eight dependent variables (Wilks’s lambda = 3.78, p < .001). Attitudes and subjective norms influenced the intent to consume energy beverages, particularly in males. Students viewed energy beverages as useful for managing health and appearance and performance and fatigue, and as a way to enhance recreation and alcohol consumption.

Relationship Between Energy Drink Consumption and Nutrition Knowledge in Student-Athletes

OBJECTIVE

To identify the relationships between energy drink consumption, nutrition knowledge, and socio-demographic characteristics in a convenience sample of student-athletes.

DESIGN

Cross-sectional.

SETTING

Online survey.

PARTICIPANTS

A total of 194 student-athletes (112 female and 82 male).

MAIN OUTCOME MEASURES

Socio-demographic characteristics, knowledge of human nutrition, energy drink consumption habits.

ANALYSIS

Chi-square tests of independence, independent t tests, and hierarchical regression analyses were applied.

RESULTS

Most student-athletes in the sample (85.5%) did not consume energy drinks, but those who did tended to be male (P = .004), had lower overall knowledge of nutrition (P = .02), and had a lower grade point average (P < .001) than did nonusers. Also, energy drink consumption was associated with the overall nutrition knowledge score when adjusted for socio-demographic characteristics, with nonusers having greater nutrition knowledge (P = .007) than users.

CONCLUSIONS AND IMPLICATIONS

Student-athletes tend to refrain from energy drink use but those who use it have a tendency to have lower nutrition knowledge than do nonusers. Therefore, nutrition education targeted toward student-athletes should encompass the consumption of energy drinks because limited evidence shows the benefits of collegiate athletes consuming energy drinks.

Longitudinal trends in use of dietary supplements by U.S. Army personnel differ from those of civilians

Prevalence and patterns of dietary supplement (DS) use by U.S. Army soldiers differ from the civilian population. Longitudinal trends in use of DSs by civilians have been examined, but are unavailable in subpopulations such as military service members. The present study examined longitudinal changes in DS use by soldiers. A standardized questionnaire on DS use was administered in 2006–2007 (N = 989) and 2010–2011 (N = 1196) to convenience samples of active duty soldiers. Data were weighted for total population demographics of age, sex, and rank. Regular use of DSs by soldiers increased significantly (56% ± 1.6% vs. 64% ± 1.7%; p ≤ 0.001) over the 4 years primarily because of an increase of DS use among the youngest 18- to 24-year-old soldiers (43.0% ± 2.5% vs 62.3% ± 2.4%; p ≤ 0.01). Protein (22% ± 1.4% vs. 26% ± 1.5%; p ≤ 0.001) and combination (10.0% ± 1.0% vs. 24% ± 1.4%; p ≤ 0.001) product consumption also increased over the 4 years. Individual vitamin and mineral use — including iron, magnesium, selenium, and vitamins A, B6, B12, and D — significantly increased as well (p ≤ 0.05). In addition, expenditures on DSs by soldiers increased over time (p < 0.01). Reasons reported by soldiers for DS use suggest use increased to meet the occupational demands of military service. Educational interventions to minimize inappropriate use of DSs by soldiers are necessary to reduce adverse events resulting from unnecessary use of DSs and the financial burden associated with their use.

A Survey of Energy Drink Consumption Patterns Among College Students at a Mostly Hispanic University

Background: The purpose of this study was to determine energy drink (ED) consumption patterns among Hispanic college students. We measured the prevalence and frequency of ED consumption according to gender, degree programs, and specific university-related and social situations. In addition, we assessed the frequency of consumption of EDs mixed with alcoholic beverages. Methods: A total of 508 college students from the University of Puerto Rico, the largest Hispanic institution of higher education statewide, completed an online questionnaire. Results: Twenty-one percent of participants reported consuming EDs with the majority consuming EDs either occasionally (every 2-3 months) or at least once or twice a month. Men were found to be more likely to consume EDs than women. Undergraduate students were found less likely to consume EDs than graduate students. Most students consumed EDs while studying and during social activities. More than one-third of participants that consume EDs admitted mixing them with an alcoholic beverage. Graduate students were found to consume EDs mixed with alcohol more often. Conclusions: The majority of students consumed EDs occasionally and while studying. Most side effects reported after consuming EDs were similar to previous findings. The higher consumption of EDs and of EDs mixed with alcohol by students in graduate programs could be explained by a higher and more complex study load requiring longer periods of wakefulness and concentration. Future studies looking at the consumption patterns of EDs in more competitive graduate programs such as medical and/or dentistry school should be considered.

The Consumption of Energy Drinks Among a Sample of College Students and College Student Athletes

To assess energy drink (ED) consumption, potential ED correlates, and ED-related motivations among a sample of college students to determine differences based on athlete status (student athlete vs. non-athlete). Six hundred and ninety-two college students completed surveys at a large private university in the United States. Participants completed a paper based questionnaire assessing ED and ED-related variables. Over thirty-six percent (197 non-athletes, 58 student athletes) of participants reported ED consumption in the preceding 30 days. Multivariately, there was no difference in ED consumption based on athlete status. Heavy episodic drinking and prescription stimulant misuse were both correlated with increased ED consumption. ED motivations differed based on the frequency of ED consumption. ED use was common among student athletes and non-athletes in our sample. It is important to be aware of the correlation between heavy episodic drinking, prescription stimulant misuse, and ED consumption among college student populations because of the adverse consequences associated with these behaviors.

Acute effects of caffeine-containing energy drinks on physical performance: a systematic review and meta-analysis

PURPOSE

Caffeine-containing energy drinks (EDs) are currently used as ergogenic aids to improve physical performance in a wide variety of sport disciplines. However, the outcomes of previous investigations on this topic are inconclusive due to methodological differences, especially, in the dosage of the active ingredients and the test used to assess performance.

METHODS

We performed a systematic review and meta-analysis of published studies to evaluate the effects of acute ED intake on physical performance. The search for references was conducted in the databases PubMed, ISI Web of Knowledge and SPORTDiscus until December 2015.

RESULTS

Thirty-four studies published between 1998 and 2015 were included in the analysis. Using a random-effects model, effect sizes (ES) were calculated as the standardized mean difference. Overall, ED ingestion improved physical performance in muscle strength and endurance (ES = 0.49; p < 0.001), endurance exercise tests (ES = 0.53; p < 0.001), jumping (ES = 0.29; p = 0.01) and sport-specific actions (ES = 0.51; p < 0.001), but not in sprinting (ES = 0.14; p = 0.06). The meta-regression demonstrated a significant association between taurine dosage (mg) and performance (slope = 0.0001; p = 0.04), but not between caffeine dosage (mg) and performance (slope = 0.0009; p = 0.21).

CONCLUSION

ED ingestion improved performance in muscle strength and endurance, endurance exercise tests, jumping and sport-specific actions. However, the improvement in performance was associated with taurine dosage.

A Retrospective Study of Clinical Effects of Powdered Caffeine Exposures Reported to Three US Poison Control Centers

INTRODUCTION

Anhydrous caffeine, often sold on the Internet as a powdered caffeine product, is sold as "pure caffeine" to be used as an additive to beverages and has also been used as an ingredient in energy supplement products.

METHODS

This is a retrospective multiple-poison center chart review of calls regarding powdered caffeine to poison centers covering Oregon, Alaska, Guam, Washington, and Utah between January 1, 2013 and June 30, 2015.

RESULTS

There were 40 calls to three poison centers over 30 months for powdered caffeine exposure. The majority of patients were over age 19 (52.5 %; 21/40) and male (70 %; 28/40). Sixty percent (24/40) of the patients were symptomatic but only 10 % (4/40) required admission; 52.5 % (21/40) of the patient calls were for inadvertent overdose of powdered caffeine; one patient overdosed in a self-harm attempt.

DISCUSSION

Powdered caffeine calls to three poison centers during a 30-month study period were rare, and severe caffeine toxicity due to exposure was found in few patients. The majority of symptoms were reported after an inadvertent powdered caffeine overdose.

CONCLUSIONS

An analysis of calls to three poison centers for powdered caffeine found that exposures were uncommon, but did result in toxicity, and highlighted that the lack of clear dosing instructions on product packaging may place patients at risk of inadvertent overdose.

Impact of Four Weeks of a Multi-Ingredient Performance Supplement on Muscular Strength, Body Composition, and Anabolic Hormones in Resistance-Trained Young Men

Although multi-ingredient performance supplements (MIPS) have increased in popularity because of their array of ergogenic ingredients, their efficacy and safety remain in question. The objective of this study was to determine the impact of supplementation with T+ (SUP; Onnit Labs, Austin, TX, USA), an MIPS containing long jack root, beta-alanine, and branched-chain amino acids, and other proprietary blends, on strength, body composition, and hormones in young resistance-trained men. Subjects were randomized to consume either T+ (SUP; n = 14; age, 21 ± 3 years; body fat, 18.3 ± 4.7%) or an isocaloric placebo (PL; n = 13; age, 21 ± 3 years; body fat, 21.5 ± 6.2%) for 4 weeks. Both groups underwent a progressive, 4-week high-intensity resistance training protocol. Before and after the training protocol, mood state, body composition, blood hormones (also collected at midpoint), and maximal strength were measured. SUP had significantly greater increases in bench press (SUP, 102 ± 16 kg to 108 ± 16 kg vs. PL, 96 ± 22 kg to 101 ± 22 kg; p < 0.001) and total weight lifted (SUP, 379 ± 59 kg to 413 ± 60 kg vs. PL, 376 ± 70 kg to 400 ± 75 kg; p < 0.001) compared with PL. Additionally, deadlift strength relative to total body mass (calculated as weight lifted/body mass; kg:kg) (2.08 ± 0.18 to 2.23 ± 0.16; p = 0.036) and lean mass (2.55 ± 0.19 to 2.72 ± 0.16; p = 0.021) increased significantly in SUP but not PL (2.02 ± 0.30 to 2.15 ± 0.36 and 2.56 ± 0.31 to 2.70 ± 0.36, respectively). No other significant differences were detected between groups for the remaining variables. Supplementing with SUP enhanced resistance training adaptations independent of hormonal status, and thus SUP use may warrant inclusion into peri-workout nutrition regimens. This study was registered with clinicaltrials.gov (identifier: NCT01971723).

Energy drinks in the Gulf Cooperation Council states: A review

Energy drinks have become a popular beverage worldwide. This review was carried out to have an overview among adolescents and emerging adults in the Gulf Co-operation Council states about energy drinks consumption rates and other related issues such as starting age and patterns of energy drink consumption. The Medline and Embase databases were searched separately using different terms such as energy drinks, energy beverages, and caffeinated drinks. Data related to the rates of energy drinks use were entered in STATA for statistical analysis. Then, these data were used to conduct meta-analysis to estimate the rate of energy drink consumption. Overall, meta-analysis results showed that the estimated rates of energy drinks consumption is 46.9% (95% CIs, 33.2 -66.1; nine studies) with I-square 3.7%. Findings indicated that individuals start to consume energy drinks at approximately 16 years old, and males were found to consume energy drinks more frequently than females. Results from this review carry several recommendations for policy and enforcement, public education and research that can help policy and decision makers to achieve the goal of safer use of energy drinks.

Prevalence of Dietary Supplement Use by Athletes: Systematic Review and Meta-Analysis

BACKGROUND

Dietary supplements (DSs) are commercially available products consumed as an addition to the usual diet and are frequently ingested by athletes.

OBJECTIVE

Our objective was to examine the prevalence of DS use by athletes.

DATA SOURCES

PubMed, Ovid MEDLINE, OVID Healthstar, and Cumulative Index to Nursing and Allied Health were searched for original research articles published up to August 2014. Search terms included specific sports, specific DSs, and other terms.

STUDY SELECTION

Studies were selected if they were written in English, involved athletes, and provided a quantitative assessment of the proportion of athletes using specific DSs. Percent of athletes using specific DSs.

SYNTHESIS OF DATA

Methodological quality of studies was assessed by three reviewers using an 8-point scale that included evaluations for sampling methods, sampling frame, sample size, measurement tools, bias, response rate, statistical presentation, and description of the participant sample. Where there were at least two investigations, meta-analysis was performed to obtain summary (pooled) prevalence estimates (SPEs) on (1) DS use prevalence by sport and sex, (2) DS use prevalence by elite versus non-elite athletic status, and (3) specific DS prevalence for all athletic groups combined. Meta-analyses included evaluations of homogeneity and publication bias.

RESULTS

A total of 159 unique studies met the review criteria. Methodological quality was generally low with an average ± standard deviation of 43 ± 16% of available rating points. There was low homogeneity for SPEs when compiled by sport, athletic status, and/or specific DSs. Contributing to the lack of homogeneity were differences in studies' objectives and types of assessments used (e.g., dietary surveys, interviews, questionnaires). Despite these limitations, the data generally indicated that elite athletes used DSs much more than their non-elite counterparts. For most DSs, use prevalence was similar for men and women except that a larger proportion of women used iron while a larger proportion of men used vitamin E, protein, and creatine. No consistent change in use over time was observed because even the earliest investigations showed relatively high use prevalence.

CONCLUSION

It was difficult to generalize regarding DS use by athletes because of the lack of homogeneity among studies. Nonetheless, the data suggested that elite athletes used dietary supplements far more than their non-elite counterparts; use was similar for men and women with a few exceptions; use appeared to change little over time; and a larger proportion of athletes used DSs compared with the general US population. Improvements in study methodology should be considered in future studies especially (1) defining DSs for participants; (2) querying for very specific DSs; (3) using a variety of reporting timeframes (e.g., daily, 2-6 times/week, 1 time/week and <1 time/week); (4) reporting the sampling frame, number of individuals solicited, and number responding; (5) reporting characteristics of volunteers (and non-volunteers, if available); and (6) using similar methods on several occasions to examine possible temporal trends among athletes.

Misuse of prescription stimulant medication in a sample of college students: examining differences between varsity athletes and non-athletes

BACKGROUND

The misuse of prescription stimulants (MPS) has been identified as an adverse health behavior among college students. Because stimulant medication is often taken to increase focus and decrease reaction time, these substances have the potential to enhance athletic performance. However, the role that athlete status (varsity athlete vs. non-athlete) has on MPS has rarely been examined in the college student population.

OBJECTIVES

To examine whether there are differences in past-year MPS and MPS-related motivations between college varsity athletes and non-athletes.

METHODS

A sample of 682 (482 non-athletes; 200 athletes) college students between the ages of 18 and 25 completed a paper-based questionnaire to assess MPS, MPS-related motivations, and other potential MPS correlates (e.g., gender, energy drink consumption, tobacco use, heavy episodic drinking). Then, we conducted bivariate and multivariate analyses to examine potential correlates of MPS, including athlete status. Finally, we examined differences in MPS-related motivations between varsity athletes and non-athletes.

RESULTS

Overall, 98 (13.9%; 16.6% non-athletes v. 7.5% varsity athletes) respondents reported past-year MPS and varsity athletes were significantly less likely (p<0.05) to do so. Past-year MPS was also significantly associated with energy drink consumption, tobacco use, and heavy episodic drinking in our sample. Concerning MPS-related motivations, athletes more often cited a need to enhance athletic performance as the impetus for their misuse.

CONCLUSIONS

MPS was prevalent among the sample. Varsity athletes were significantly less likely to engage in past-year MPS and were motivated to do so for different reasons.

Acute consumption of a caffeinated energy drink enhances aspects of performance in sprint swimmers

This study investigated the effect of a caffeinated energy drink on various aspects of performance in sprint swimmers. In a randomised and counterbalanced order, fourteen male sprint swimmers performed two acute experimental trials after the ingestion of a caffeinated energy drink (3 mg/kg) or after the ingestion of the same energy drink without caffeine (0 mg/kg; placebo). After 60 min of ingestion of the beverages, the swimmers performed a countermovement jump, a maximal handgrip test, a 50 m simulated competition and a 45 s swim at maximal intensity in a swim ergometer. A blood sample was withdrawn 1 min after the completion of the ergometer test. In comparison with the placebo drink, the intake of the caffeinated energy drink increased the height in the countermovement jump (49.4 (SD 5.3) v. 50.9 (SD 5.2) cm, respectively; P<0.05) and maximal force during the handgrip test with the right hand (481 (SD 49) v. 498 (SD 43) N; P<0.05). Furthermore, the caffeinated energy drink reduced the time needed to complete the 50 m simulated swimming competition (27.8 (SD 3.4) v. 27.5 (SD 3.2) s; P<0.05), and it increased peak power (273 (SD 55) v. 303 (SD 49) W; P <0.05) and blood lactate concentration (11.0 (SD 2.0) v. 11.7 (SD 2.1) mM; P<0.05) during the ergometer test. The caffeinated energy drink did not modify the prevalence of insomnia (7 v. 7%), muscle pain (36 v. 36%) or headache (0 v. 7%) during the hours following its ingestion (P>0.05). A caffeinated energy drink increased some aspects of swimming performance in competitive sprinters, whereas the side effects derived from the intake of this beverage were marginal at this dosage.

Energy-drink consumption and its relationship with substance use and sensation seeking among 10th grade students in Istanbul

Aim of this study was to determine the prevalence and correlates of energy-drink (ED) consumption among 10th grade students in Istanbul/Turkey. Cross-sectional online self-report survey conducted in 45 schools from the 15 districts in Istanbul. The questionnaire included sections about demographic data, self-destructive behavior and use of substances including tobacco, alcohol and drugs. Also Psychological Screening Test for Adolescents (PSTA) was used. The analyses were conducted based on the 4957 subjects. Rate of those reported a ED consumption once within last year was 62.0% (n=3072), whereas rate of those reported ED consumption at least once in a month was 31.1%. There were consistent, statistically significant associations between genders, lifetime substance use (tobacco, alcohol and drug use), measures of sensation seeking, psychological problems (depression, anxiety, anger, impulsivity) and self-destructive behavior (self-harming behavior and suicidal thoughts) with ED consumption. In logistic regression models male gender, sensation seeking, life-time tobacco, alcohol and drug use predicted all frequencies of ED consumption. In addition to these predictors, anger and self-harming behavior also predicted ED consumption at least once in a month. There were no interactions between the associations of lifetime tobacco, alcohol and drug use with ED consumption. The findings suggest that the ED consumption of male students is related with three clusters of substances (tobacco, alcohol and drug) through sensation seeking and these relationships do not interact with each other.

Intentional misuse of over-the-counter medications, mental health, and polysubstance use in young adults

In recent years, the non-medical use of prescription drugs (without a doctor's prescription) has increased dramatically. Less attention has been paid to the intentional misuse of over-the-counter (OTC) medications. Misuse of OTC medications has negative health consequences similar to those of illicit drugs, including psychosis, tachycardia, seizures and agitation. When mixed with alcohol or other drugs, these medications can also be dangerous: OTC-related emergency room visits increased 70% from 2004 to 2008. This study examined the intentional misuse of OTC medications, the non-medical use of prescription drugs, the use of alcohol and illicit drugs, and psychological factors in two samples of young adults (ages 18-25) from different areas of the United States (Total N = 1,197). Overall, 18.6% of the Colorado sample and 13.0% of the Virginia sample reported lifetime misuse of an OTC medication. Participants who reported misusing OTC medications were also significantly more likely to report using marijuana, ecstasy, cocaine, and non-medical use of prescription analgesics, stimulants, anxiolytics, and sedatives. Participants who reported misusing OTC medications were more than twice as likely to report hazardous alcohol use, relative to individuals who denied misusing OTC medications. Individuals who had misused OTC medications scored significantly higher in sensation seeking and hopelessness and reported more symptoms of depression, anxiety, and somatic distress, relative to those who denied OTC misuse. Results suggest that a considerable minority of young adults are jeopardizing their health with the misuse of OTC medications as part of a pattern of polysubstance use.

Increased Energy Drink Use as a Predictor of Illicit Prescription Stimulant Use

BACKGROUND

The purpose of this study was to examine energy drink usage patterns and to investigate the relationship between energy drink use and illicit use of prescription stimulants among college students.

METHODS

A sample of 605 undergraduate and graduate students (mean age±SD: 21.96±4.216) from a large midwestern university voluntarily participated in the study.

RESULTS

Of the participants, 48.9% (n=296) reported using energy drinks in the past 30 days, whereas 25.3% (n=153) reported using prescription stimulant drugs in the past 30 days. Among prescription stimulant users without a valid medical prescription, Mann-Whitney U tests and logistic regression analysis revealed that the frequency of energy drink consumption was a significant predictor of illicit prescription stimulant use, with the odds for use increasing by 14% with each additional day of energy drink use (odds ratio for using=1.143, P≤.001). Analyses revealed statistically significant differences (P<.05) between prescription stimulant users and nonusers for all energy drink use variables, with the strongest predictors of prescription stimulant use being the number of days using energy drinks in the past 30 days and number of energy drink binges in the past 30 days.

CONCLUSIONS

Results indicate that the frequency of energy drink use was a significant predictor of the illicit use of prescription stimulants.

Energy drink usage among university students in a Caribbean country: Patterns of use and adverse effects

Objective: There has been little inquiry addressing whether or not concerns about adverse effects of energy drink usage are relevant in the Caribbean. This survey investigated energy drink usage and adverse consequences among tertiary level students in Trinidad and Tobago.

Methods: A cross-sectional survey of 1994 students from eight institutions was conducted using a de novo questionnaire based on findings from a focus group of students. Chi-squared analyses and logistic regression were used to assess relationships between energy drink usage, adverse effects and other factors affecting energy drink use, and to verify predictors of energy drink use.

Results: Prevalence of use was 86%; 38% were current users. Males were more likely to use, used more frequently and at an earlier age. Energy drinks were used most commonly to increase energy (50%), combat sleepiness (45%) and enhance academic performance (40%), and occurred during sports (23%) and mixed with alcohol (22.2%). The majority (79.6%) consumed one energy drink per sitting; 62.2% experienced adverse effects, most commonly restlessness (22%), jolt and crash (17.1%) and tachycardia (16.6%). Awareness of adverse effects was associated with no use (p = 0.004), but adverse effects were not a deterrent to continued use.

Conclusion: Energy drink usage is prevalent among students. The use is not excessive, but associated with high rates of adverse effects and occurs in potentially dangerous situations like during exercise and with alcohol. There is a need to educate students about the potential adverse effects of energy drinks.

Subjective State, Blood Pressure, and Behavioral Control Changes Produced by an "Energy Shot"

Background: Energy drinks and energy shots are popular consumer beverages that are advertised to increase feelings of alertness. Typically, these products include high levels of caffeine, a mild psychostimulant drug. The scientific evidence demonstrating the specific benefits of energy products to users in terms of subjective state and objective performance is surprisingly lacking. Moreover, there are rising health concerns associated with the use of these products. Therefore, the purpose of this study was to investigate the acute effects of a popular energy shot (5-Hour Energy^®) on subjective and objective measures that were assessed hourly for 6 hours following consumption. Methods: Participants (n=14) completed a three-session study where they received the energy shot, a placebo control, and no drink. Following dose administration, participants completed subjective Profile of Mood States ratings hourly for 6 hours. Participants also repeatedly completed a behavioral control task (the cued go/no-go task) and provided blood pressure and pulse rate readings at each hour. Results: Consumption of the energy shot did improve subjective state, as measured by increased ratings of vigor and decreased ratings of fatigue. However, the energy shot did not alter objective performance, which worsened over time. Importantly, the energy shot elevated both systolic and diastolic blood pressure. Conclusions: Consumption of one energy shot may only result in modest benefits to subjective state. Individuals with preexisting hypertension or other medical conditions should be cautious about using these new consumer products.

A case of suicide by ingestion of caffeine

Intentional or unintentional caffeine abuse due to excessive intake of beverages or energy drinks containing caffeine is relatively frequent. However, death due to caffeine intoxication is rare and case reports of fatalities from caffeine toxicity are relatively infrequent. In this report, we describe an autopsy case involving a 31 year-old man who intentionally took a large amount of caffeine tablets in the form of a weight loss supplement as part of a suicide plan. Caffeine femoral blood concentration (170 mg/l) was within the toxic and potentially lethal ranges reported in the literature in similar cases. Postmortem biochemistry results suggested depressed glomerular filtration rate and pre-renal failure at the time of death but failed to reveal myoglobinuria, glycosuria, ketonuria or ketonemia. Based on the absence of pathological findings at autopsy and the high blood caffeine level, death was attributed to acute caffeine toxicity. The case emphasizes the usefulness of performing exhaustive toxicology and searching for all potentially relevant information in order to formulate appropriate hypotheses concerning the cause and manner of death.