Review of published cases of adverse cardiovascular events after ingestion of energy drinks

Beneficial normalization of cardiac repolarization by carnitine in transgenic short QT syndrome type 1 rabbit models

AIMS

Short QT syndrome type 1 (SQT1) is a genetic channelopathy caused by gain-of-function variants in human-ether-a-go-go (HERG) underlying the rapid delayed-rectifier K+ current (IKr), leading to QT-shortening, ventricular arrhythmias, and sudden cardiac death. Data on efficient pharmacotherapy for SQT1 are scarce. In patients with primary carnitine-deficiency, acquired-short QT syndrome (SQTS) has been observed and rescued by carnitine supplementation. Here, we assessed whether carnitine exerts direct beneficial (prolonging) effects on cardiac repolarization in genetic SQTS.

METHODS AND RESULTS

Adult wild-type (WT) and transgenic SQT1 rabbits (HERG-N588K, gain of IKr) were used. In vivo electrocardiograms (ECGs), ex vivo monophasic action potentials (APs) in Langendorff-perfused hearts, and cellular ventricular APs and ion currents were assessed at baseline and during L-Carnitine/C16-Carnitine-perfusion. Two-dimensional computer simulations were performed to assess re-entry-based ventricular tachycardia-inducibility. L-Carnitine/C16-Carnitine prolonged QT-intervals in WT and SQT1, leading to QT-normalization in SQT1. Similarly, monophasic and cellular AP duration (APD) was prolonged by L-Carnitine/C16-Carnitine in WT and SQT1. As underlying mechanisms, we identified acute effects on the main repolarizing ion currents: IKr-steady, which is pathologically increased in SQT1, was reduced by L-Carnitine/C16-Carnitine and deactivation kinetics were accelerated. Moreover, L-Carnitine/C16-Carnitine decreased IKs-steady and IK1. In silico modelling identified IKr changes as the main factor for L-Carnitine/C16-Carnitine-induced APD-prolongation. 2D simulations revealed increased sustained re-entry-based arrhythmia formation in SQT1 compared to WT, which was decreased to the WT-level when adding carnitine-induced ion current changes.

CONCLUSION

L-Carnitine/C16-Carnitine prolong/normalize QT and whole-heart/cellular APD in SQT1 rabbits. These beneficial effects are mediated by acute effects on IKr. L-Carnitine may serve as a potential future QT-normalizing, anti-arrhythmic therapy in SQT1.

Acute effects of energy drink consumption on cardiovascular parameters in healthy adults: a systematic review and meta-analysis of randomized clinical trials

CONTEXT

Energy drinks (EDs) are beverages that contain ingredients that may pose a risk to consumers' cardiovascular health. But current evidence is conflicting and warrants further investigation.

OBJECTIVE

A systematic review and meta-analysis was conducted on studies that examined the acute effects of ED consumption on systolic blood pressure (SBP), diastolic blood pressure (DBP), resting heart rate, cardiac output (CO), endothelial function, and QT/QTc interval in healthy adults.

DATA SOURCES

The databases PubMed, EMBASE, Cochrane, LILACS, Web of Science, SportDiscus, and the gray literature were searched to identify randomized controlled trials (RCTs).

DATA EXTRACTION

Two independent evaluators screened 2014 studies and extracted relevant data from those selected for the analysis. A risk of bias assessment was also performed with the RoB 2 tool and a strength of evidence assessment was performed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

DATA ANALYSIS

A total of 17 RCTs were included in the meta-analysis. With regard to risk of bias, 11 studies were rated as having "some concerns" and 6 as "high risk of bias." The consumption of EDs increased SBP, DBP, and CO in different time frames. More pronounced effects were seen on SBP at 60-80 minutes (4.71 mmHg; 95% CI: 2.97-6.45; GRADE: moderate), DBP at 120 minutes (4.51 mmHg; 95% CI: 2.60-6.42; GRADE: low), and CO at 30-40 minutes after consumption (0.43 L; 95% CI: 0.08-0.77; GRADE: very low). The effects of ED consumption on resting heart rate and QT/QTc interval were not significant (P ≤ 0.05). The assessment of endothelial function effects was not performed due to the absence of any RCTs meeting the inclusion criteria.

CONCLUSIONS

Acute consumption of EDs increases SBP, DBP, and CO in healthy adults. However, no alterations were observed in other cardiovascular parameters. The results should be interpreted with caution due to the limited number of studies included in the analysis.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022295335.

Acute Cardiovascular Effects of Simultaneous Energy Drink and Alcohol Consumption in Young Adults: A Review of Case Reports

(1) Background: The aim of this review was to identify and summarize adverse cardiovascular health events associated with the simultaneous consumption of energy drinks (ED) and alcohol. Potential prevention strategies and the implementation of research toward the underlying mechanisms for these pathologies were highlighted to emphasize the need for further investigation and to encourage more attention to this field. (2) Methods: The PubMed database was searched for case reports linked with adverse cardiovascular events after simultaneous ED and alcohol consumption. Inclusion criteria were: the reported age of the patient is between 16 and 35 years and confirmed co-consumption of EDs and alcohol. All relevant articles that met the inclusion criteria were fully read and all relevant data was extracted. The extracted data was summarized and presented in this review of cases. (3) Results: In total, 10 cases were identified. The analysis showed that mainly young adults (median age = 24.5 years), in particular men (80%) were affected. The three parts of the cardiovascular system affected were heart rhythm (42%), myocardial function (33%), and coronary arteries (25%). In 3 cases the outcome was fatal. Moreover, preexisting health conditions and/or potential trigger factors were present in 60% of selected cases. (4) Conclusions: This review of case reports suggests that the simultaneous consumption of EDs and alcohol can lead to adverse cardiovascular health events and even incidents with fatal outcomes were reported. Potential trigger factors and preexisting health conditions seem to increase the probability of adverse cardiovascular health events. Consumers should be informed about the potential risks and follow responsible consumption behavior to prevent future health events. More systematic studies are needed to determine the acute effects on the cardiovascular system in young adults.

Energy drinks in Tamale: Understanding youth perceptions, consumption patterns, and related factors

Energy drinks (EDs) have become a popular choice for young people seeking physical and cognitive boosts, with ingredients such as caffeine, taurine, and B vitamins aimed at improving academic, athletic, and alertness levels. However, the popularity of these drinks is also driven by low prices, taste, brand loyalty, and gendered marketing, with boys being more likely to consume them. Despite the supposed benefits, EDs have been associated with high-risk behaviours, deaths, and adverse health effects, especially those related to cardiovascular risk. Meanwhile, in Ghana, the use of EDs is on the rise. Hence, this study aimed to examine the prevalence and consumption patterns, perceptions, and factors associated with ED consumption among the youth of the Tamale Metropolis. The study was cross-sectional, consisting of 541 participants. The group consisted of 340 males and 201 females, between the ages of 15 and 45. A questionnaire was utilized to obtain data on the respondents' consumption patterns and perceptions of EDs, as well as their socio-demographic characteristics. The results of the study indicated that a large percentage of the respondents, 98.7%, had consumed EDs before, while 78.7% currently consume them. Respondents believed that EDs provided additional energy (81.00%) and reduced stress (62.30%). However, they also perceived side effects such as insomnia (60.60%) and restlessness (51.40%). Also, the highest proportion of respondents (83.4%) had poor knowledge of EDs. They were unaware of the classification of EDs and their ingredients, side effects, and benefits. Age, marital status, level of education, work intensity, EDs served at gatherings, and knowledge of EDs was significantly associated with ED consumption (p < .05). Consumption was higher among those aged 26 to 35 years, singles, individuals with no formal education, and those with high work intensity. The high consumption was also associated with low knowledge levels. It is recommended that public health and nutrition professionals engage in further advocacy efforts to improve the youth's knowledge and perception of EDs in a positive manner. In addition, lawmakers should use legislation to influence consumption rates and safeguard the health of consumers.

Change in Caffeine Consumption after Pandemic (CCAP-Study) among University Students: A Cross-Sectional Study from Italy

(1) Background: The lockdown, imposed to limit the pandemic evolution, impacted the social habits and lifestyle of inhabitants also from many countries other than Italy. Caffeine consumption could be a useful option to improve mood, as the lockdown strongly affected mental health, particularly increasing anxiety and sleep disorders. (2) Methods: It was a cross-sectional study aimed to evaluate the change in caffeine consumption after the pandemic period in a sample of Italian University students. It investigated coffee and products containing caffeine consumption, the anxiety level by State Trait Anxiety Inventory (STAI) and sleep quality with the Insomnia Severity Index (ISS). (3) Results: A total of 404 participants were enrolled in the study. During the lockdown period, 23% of subjects consumed more coffee compared to the pre-pandemic period. Daily coffee consumption also changed after the lockdown period compared to the pre-pandemic period, with 36.1% of subjects that increased their consumption. Comparing other caffeine-based products, energizing supplement consumption showed a greater increase after the lockdown period than energy drinks. Regarding anxiety, subjects who reported increased coffee consumption reported higher STAI scores and ISS. (4) Conclusions: About a quarter of university students increased their consumption of caffeine-based products after the pandemic, reporting higher levels of anxiety and poor sleep quality.

Toxicology Screening in Sports-Related Sudden Cardiac Death: A Multinational Observational Study

BACKGROUND

Knowledge of toxicological findings among sports-related sudden cardiac death (SrSCD) is scarce.

OBJECTIVES

This study aimed to describe postmortem toxicology findings in a multinational cohort of young SrSCD.

METHODS

Patients with sudden cardiac death (SCD) aged 12 to 49 years with a complete post mortem were included from Denmark, Spain, and Australia. Postmortem findings were compared between SrSCD and non-SrSCD, and toxicology findings in SrSCD were assessed.

RESULTS

We included 3,189 SCD, of which 219 (7%) were sports-related. SrSCD patients were younger (36 years vs 41 years; P < 0.001) and of male predominance (96% vs 75%; P < 0.001), and their death was more often caused by structural cardiac disease (68% vs 61%; P = 0.038). Positive toxicology screenings were significantly less likely among SrSCD than non-SrSCD (12% vs 43%; P < 0.001), corresponding to 82% lower odds of a positive toxicology screening in SrSCD. Patient characteristics were similar between SrSCDs with positive and negative toxicology screenings, but deaths were more often unexplained (59% vs 34%). Nonopioid analgesics were the most common finding (3%), and SCD-associated drugs were detected in 6% of SrSCD. SUD was more prevalent among the SrSCD with positive toxicology (59% vs 34%).

CONCLUSIONS

Sports-related SCD mainly occurred in younger men with structural heart disease. They had a significantly lower prevalence of a positive toxicology screening compared with non-SrSCD, and detection of SCD-associated drugs was rare.

International society of sports nutrition position stand: energy drinks and energy shots

Position Statement: The International Society of Sports Nutrition (ISSN) bases the following position stand on a critical analysis of the literature regarding the effects of energy drink (ED) or energy shot (ES) consumption on acute exercise performance, metabolism, and cognition, along with synergistic exercise-related performance outcomes and training adaptations. The following 13 points constitute the consensus of the Society and have been approved by the Research Committee of the Society: Energy drinks (ED) commonly contain caffeine, taurine, ginseng, guarana, carnitine, choline, B vitamins (vitamins B1, B2, B3, B5, B6, B9, and B12), vitamin C, vitamin A (beta carotene), vitamin D, electrolytes (sodium, potassium, magnesium, and calcium), sugars (nutritive and non-nutritive sweeteners), tyrosine, and L-theanine, with prevalence for each ingredient ranging from 1.3 to 100%. Energy drinks can enhance acute aerobic exercise performance, largely influenced by the amount of caffeine (> 200 mg or >3 mg∙kg bodyweight [BW-1]) in the beverage. Although ED and ES contain several nutrients that are purported to affect mental and/or physical performance, the primary ergogenic nutrients in most ED and ES based on scientific evidence appear to be caffeine and/or the carbohydrate provision. The ergogenic value of caffeine on mental and physical performance has been well-established, but the potential additive benefits of other nutrients contained in ED and ES remains to be determined. Consuming ED and ES 10-60 minutes before exercise can improve mental focus, alertness, anaerobic performance, and/or endurance performance with doses >3 mg∙kg BW-1. Consuming ED and ES containing at least 3 mg∙kg BW-1 caffeine is most likely to benefit maximal lower-body power production. Consuming ED and ES can improve endurance, repeat sprint performance, and sport-specific tasks in the context of team sports. Many ED and ES contain numerous ingredients that either have not been studied or evaluated in combination with other nutrients contained in the ED or ES. For this reason, these products need to be studied to demonstrate efficacy of single- and multi-nutrient formulations for physical and cognitive performance as well as for safety. Limited evidence is available to suggest that consumption of low-calorie ED and ES during training and/or weight loss trials may provide ergogenic benefit and/or promote additional weight control, potentially through enhanced training capacity. However, ingestion of higher calorie ED may promote weight gain if the energy intake from consumption of ED is not carefully considered as part of the total daily energy intake. Individuals should consider the impact of regular coingestion of high glycemic index carbohydrates from ED and ES on metabolic health, blood glucose, and insulin levels. Adolescents (aged 12 through 18) should exercise caution and seek parental guidance when considering the consumption of ED and ES, particularly in excessive amounts (e.g. > 400 mg), as limited evidence is available regarding the safety of these products among this population. Additionally, ED and ES are not recommended for children (aged 2-12), those who are pregnant, trying to become pregnant, or breastfeeding and those who are sensitive to caffeine. Diabetics and individuals with preexisting cardiovascular, metabolic, hepatorenal, and/or neurologic disease who are taking medications that may be affected by high glycemic load foods, caffeine, and/or other stimulants should exercise caution and consult with their physician prior to consuming ED. The decision to consume ED or ES should be based upon the beverage's content of carbohydrate, caffeine, and other nutrients and a thorough understanding of the potential side effects. Indiscriminate use of ED or ES, especially if multiple servings per day are consumed or when consumed with other caffeinated beverages and/or foods, may lead to adverse effects. The purpose of this review is to provide an update to the position stand of the International Society of Sports Nutrition (ISSN) integrating current literature on ED and ES in exercise, sport, and medicine. The effects of consuming these beverages on acute exercise performance, metabolism, markers of clinical health, and cognition are addressed, as well as more chronic effects when evaluating ED/ES use with exercise-related training adaptions.

Comparison of the Short-Term Effect of Coffee, Energy Drink, and Water on the Eyes in Young Healthy Subjects

PURPOSE

We aim to compare the short-term effects of energy drink (ED), coffee, and water on the eyes of young healthy male subjects.

MATERIALS AND METHODS

The right eyes of 30 healthy male subjects were included in this study. We measured the intraocular pressure (IOP), mean arterial pressure (MAP), retinal thickness (RT), choroidal thickness (CT), and retinal nerve fiber layer (RNFL) thickness using spectral domain optical coherence tomography (SD OCT). The measurements for RT and CT were taken at the fovea as well as 1,500 µm nasal and temporal to the fovea. The measurements of the subjects were performed on the first day before water consumption and at 30 minutes and 60 minutes following intake of 250 mL of water. Measurements were repeated at the same regime on the second day after drinking 250 mL of coffee containing an equal concentration of caffeine in ED (37.5 mg) and on the third day after drinking 250 mL of ED. Repeated measures one-way analysis of variance test was used for statistical analysis.

RESULTS

No significant difference was found for ocular perfusion pressure (OPP), MAP, RT, and IOP between the measurements taken on three consecutive days (p>0.05 for all). The CT values for the central, nasal, and temporal segments were significantly reduced in 0-30 and 0-60 minutes following coffee and ED intake (the range of p-value was <0.001-0.027).

CONCLUSIONS

Both coffee and ED intake caused acute and significant decreases in CT that persisted for one hour in young healthy male subjects. The impact of ED intake on CT was attributed mainly to its caffeine content.

The Impact of Lockdowns on Caffeine Consumption: A Systematic Review of the Evidence

The Coronavirus disease 2019 (COVID-19) has been characterized by the World Health Organization as a pandemic in March 2020 and the lockdown measures that were implemented in an effort to limit the transmission of the virus affected the daily life of many people in all over the world. The aim of this systematic review was to investigate the changes during/after the lockdowns in caffeine consumption by coffee and energy drinks. A systematic literature search was conducted in three databases (PubMed, Embase, Web of Science) up to 31 December 2021 and out of 19,511 studies found and 12,885 screened, 16 studies were included according to eligibility criteria. Results regarding coffee consumption showed that a significant part of individuals decreased their consumption and in five studies an increase was reported, including women and seniors >60 years old. Energy drinks were also consumed less during the lockdown compared to the pre-lockdown time. Attention should be given for menopausal women where an increase in coffee consumption was found which could impair bone density, but further research is needed in order to make safe conclusions.

Consumption and effects of caffeinated energy drinks in young people: an overview of systematic reviews and secondary analysis of UK data to inform policy

BACKGROUND

This overview and analysis of UK datasets was commissioned by the UK government to address concerns about children's consumption of caffeinated energy drinks and their effects on health and behaviour.

METHODS

We searched nine databases for systematic reviews, published between 2013 and July 2021, in English, assessing caffeinated energy drink consumption by people under 18 years old (children). Two reviewers rated or checked risk of bias using AMSTAR2, and extracted and synthesised findings. We searched the UK Data Service for country-representative datasets, reporting children's energy-drink consumption, and conducted bivariate or latent class analyses.

RESULTS

For the overview, we included 15 systematic reviews; six reported drinking prevalence and 14 reported associations between drinking and health or behaviour. AMSTAR2 ratings were low or critically low. Worldwide, across reviews, from 13% to 67% of children had consumed energy drinks in the past year. Only two of the 74 studies in the reviews were UK-based. For the dataset analysis, we identified and included five UK cross-sectional datasets, and found that 3% to 32% of children, across UK countries, consumed energy drinks weekly, with no difference by ethnicity. Frequent drinking (5 or more days per week) was associated with low psychological, physical, educational and overall well-being. Evidence from reviews and datasets suggested that boys drank more than girls, and drinking was associated with more headaches, sleep problems, alcohol use, smoking, irritability, and school exclusion. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) assessment suggests that the evidence is weak.

CONCLUSIONS

Weak evidence suggests that up to a third of children in the UK consume caffeinated energy drinks weekly; and drinking 5 or more days per week is associated with some health and behaviour problems. Most of the evidence is from surveys, making it impossible to distinguish cause from effect. Randomised controlled trials are unlikely to be ethical; longitudinal studies could provide stronger evidence.

PROSPERO REGISTRATIONS

CRD42018096292 - no deviations. CRD42018110498 - one deviation - a latent class analysis was conducted.

Energy Drinks and Their Acute Effects on Heart Rhythm and Electrocardiographic Time Intervals in Healthy Children and Teenagers: A Randomized Trial

Beyond their effect on blood pressure, the effect of energy drinks on heart rate in children and teenagers has not been evaluated until now. Thus, this study aimed to investigate the acute cardiovascular effects of energy drinks in healthy children and teenagers. Twenty-six children and adolescents (mean age 14.49 years) received a commercially available energy drink (ED) and placebo on two consecutive days based on the maximum caffeine dosage as proposed by the European Food Safety Authority. Heart rhythm and electrocardiographic time intervals were assessed in a prospective, randomized, double-blind, placebo-controlled, crossover clinical study design. ED consumption resulted in a significantly increased number of supraventricular extrasystoles (SVES) compared to the placebo, whereas supraventricular tachycardia or malignant ventricular arrhythmias were not observed. The mean heart rate (HR) was significantly lower following consumption of EDs. In contrast, QTc intervals were not affected by EDs. Being the first of its kind, this trial demonstrates the cardiovascular and rhythmological effects of EDs in minors. Interestingly, EDs were associated with adverse effects on heart rhythm. Whether higher dosages or consumption in children with preexisting conditions may cause potentially harmful disorders was beyond the scope of this pilot study and remains to be determined in future trials. Trial Registration Number (DRKS-ID): DRKS00027580.

Prevalence and Amounts of Common Ingredients Found in Energy Drinks and Shots

BACKGROUND

Energy drinks are one of the most popular packaged beverage products consumed within the United States (US). Energy drinks are considered a functional beverage, a category that also includes sports drinks and nutraceutical beverages.

PURPOSE

The focus of the current study was to examine the nutrition fact panels of the top selling commercially available energy drink and energy shot products within the US to characterize common ingredient profiles to help establish a standard definition and ingredient profile of energy drinks and energy shots for consumers, health care practitioners, and researchers.

METHODS

The top 75 commercially available energy drinks and shots were identified and compiled from multiple commercial retail websites as of September 2021. For the purpose of this study, an energy drink must have met the following criteria: (A) marketed as an energy drink; (B) purported to improve energy, focus, or alertness; (C) not sold as a dietary supplement (no supplement fact panels); (D) manufactured as a pre-packaged and ready-to-drink beverage; and (E) contains at least three of (1) caffeine, (2) B-vitamins, (3) sugar, (4) taurine, (5) creatine, (6) quercetin, (7) guarana, (8) ginseng, (9) coenzyme Q10, or (10) branched chain amino acids. Energy shots must have met similar criteria to be included: (A) marketed as an energy shot; (B) purported to improve energy, focus, or alertness; (C) sold as a dietary supplement; (D) manufactured as a pre-packaged beverage with a small volume (<3.5 mL); and (E) contains at least three of the ingredients stated above.

RESULTS

Twenty energy shots and fifty-five energy drinks were included in this analysis. The number of ingredients per product (mean ± SD) was 18.2 ± 5.7, with 15 products containing proprietary blends with undisclosed ingredient amounts. The relative prevalence and average amounts of the top ingredients were as follows: caffeine (100%; 174.4 ± 81.1 mg), vitamin B6 (72%; 366.9 ± 648.1 percent daily value (%DV)), vitamin B3 (67%; 121.44 ± 69.9% DV), vitamin B12 (67%; 5244.5 ± 10,474.6% DV), vitamin B5 (37.3%; 113.6 ± 76.6% DV), and taurine (37.3%; amounts undisclosed).

CONCLUSIONS

Our findings suggest a high prevalence of caffeine and B-vitamins in these energy products, with many of the formulations containing well above the recommended daily value of B-vitamins.

Habits of Energy Drink Consumption among Teens in Slovenia - Focus Group Findings

Introduction

Teachers in Slovenia have been noticing the increased consumption of energy drinks among pupils. Therefore, the purpose of this study was to investigate habits that contribute to the frequency of energy drink consumption.

Method

36 teens participated in the study: elementary school pupils (6th and 8th grades), general upper secondary school pupils, and secondary technical school pupils (1st and 3rd year). In the course of the study 6 group interviews were held to help investigate young people’s habits and their reasons for energy drink purchase and consumption. Moreover, we investigated the influence of age on the consumption and knowledge about energy drink ingredients, as well as their influence on the body.

Results

Interview analysis showed that energy drink consumers are predominantly secondary school pupils. Their choice most frequently depends on the price, their taste, or the brand. What influences elementary school pupils’ purchasing decisions are price, packaging, and advertisements, while secondary school pupils choose their drinks according to the lack of energy and how tired they feel. The predominant factors preventing energy drink consumption are health problems among family members and friends. Secondary school pupils know more about energy drink ingredients than elementary school pupils.

Conclusion

On the basis of these findings, we will design a survey questionnaire for Slovenian teenagers and teachers, didactic material, and suggestions for improving educational programmes.

Acute effects of consumption of low-caffeine energy drinks on endothelial functions in healthy volunteers

OBJECTIVE

Energy drink consumption is increasing among the population, especially adolescents and young adults. The health effects of energy drinks are unknown. In this study, we investigate the effects of low caffeine energy drinks on endothelial functions assessed by flow-mediated dilation (FMD) of the brachial artery.

METHODS

Thirty healthy volunteers (15 men, 15 women) aged 19 to 46 years participated in the study. Flow-mediated dilation measurements of the brachial artery were performed and recorded per protocol. The volunteers were asked to drink 355 mL of energy drink containing 53.25 mg of caffeine after baseline measurements, and all measurements were repeated 60 minutes later. Baseline and post-energy drink values were compared.

RESULTS

Systolic blood pressure (p=0.592), diastolic blood pressure (p=0.714), and heart rate values (p=0.056) were similar before and after the consumption of energy drinks. Preocclusion arterial diameters (p=0.236) and blood velocities (p=0.447) did not change after energy drink consumption. FMD levels were 9.2%±4.6% and 8.1%±4.7%, respectively, before and after energy drink consumption (p=0.176). Women had a 3% increase in preocclusion arterial diameters after energy drink consumption, whereas men had a 2.6% decrease (p=0.026) Conclusion: Low caffeine energy drinks containing 53.25 mg of caffeine/355 mL can did not have any influence on blood pressure, heart rate, or endothelial functions in healthy volunteers.

Energy drinks: a narrative review of their physiological and pathological effects

The consumption of energy drinks (Edks) has increased significantly in past years, with a growing market that is estimated to reach $61 billion by 2021 worldwide. Several studies demonstrated the physiological and pathological effects of these substances contained in Edks. The most common ingredient contained in Edks is caffeine, which is commonly mixed with taurine, and B-group vitamins. Scientific evidence of potentially serious adverse health effects are known, but it would be better to acquire more information regarding these beverages. We systematically checked Medical literature on MEDLINE-Pubmed from inception to January 2020 to find studies and reports on Edks and adverse events. Edks consumption is specially related to cardiovascular effects as malignant arrhythmias. We found a significant focus on arrhythmogenic risk in patients affected by long QT syndrome or other predisposing conditions for QT elongation. Other pathological effects are known as gastrointestinal, vascular and neurological disorders. Edks, as well as all caffeinated beverages, should be taken with caution or avoided in select populations, such as patients suffering from cardiovascular or neurological illnesses; their use can unmask a sleepy life-threatening disease.

The Effects of Direct Red Bull Administration to Isolated Hearts of Trained and Untrained Rats Who Regularly Consumed or Did Not Consume Energy Drink: Focus on Cardiodynamics and Oxidative Stress

Energy drinks (EDs) contain caffeine and other active ingredients which affect cardiovascular system. The aims of this study were to examine direct effects of Red Bull (RB) on cardiodynamics and oxidative stress in isolated hearts of rats. The rats were divided into four groups: untrained rats who never consumed ED (dEDUT); untrained rats who consumed ED 5 days a week during 4 weeks (ch+dED-UT); rats trained 5 times a week for 4 weeks, but did not consume ED (dED-T); rats trained and consumed ED 5 times a week for 4 weeks (ch+dED-T). After sacrificing, hearts were isolated and perfused according to Langendorff technique. Through the isolated heart of all rats in each group, RB was administered. The parameters of cardiac function were recorded, and the levels of prooxidants were measured in the coronary effluent during coronary autoregulation. Rats in ch+dED-UT group had significantly lower rates of myocardial contraction and relaxation compared to rats in dED-UT group. The same effect was recorded in the dED-T group compared to dED-UT group. The levels of hydrogen peroxide were significantly higher in trained rats. Rats in ch+dED-T group also had significantly higher levels of superoxide anion radical and index of lipid peroxidation, as well as lower levels of nitrites when compared to ch+dED-UT group, while opposite effect was recorded in rats in dED-T group compared to dEDUT group. The RB could have a potentially negative inotropic effect in chronic consumers. Prooxidative effect of RB was most pronounced in trained chronic consumers.

The Medicinal Chemistry of Caffeine

The purine alkaloid caffeine is the most widely consumed psychostimulant drug in the world and has multiple beneficial pharmacological activities, for example, in neurodegenerative diseases. However, despite being an extensively studied bioactive natural product, the mechanistic understanding of caffeine's pharmacological effects is incomplete. While several molecular targets of caffeine such as adenosine receptors and phosphodiesterases have been known for decades and inspired numerous medicinal chemistry programs, new protein interactions of the xanthine are continuously discovered providing potentially improved pharmacological understanding and a molecular basis for future medicinal chemistry. In this Perspective, we gather knowledge on the confirmed protein interactions, structure activity relationship, and chemical biology of caffeine on well-known and upcoming targets. The diversity of caffeine's molecular activities on receptors and enzymes, many of which are abundant in the CNS, indicates a complex interplay of several mechanisms contributing to neuroprotective effects and highlights new targets as attractive subjects for drug discovery.

Caffeinated energy drinks in the Canadian context: health risk assessment with a focus on cardiovascular effects

In Canada, caffeinated energy drinks (CEDs) currently sold under Temporary Marketing Authorizations must meet strict eligibility criteria. These criteria, which include compositional and labelling requirements, were developed based on the outcome of a health risk assessment conducted by Health Canada (HC) in 2013. HC updated its assessment by reviewing new information with the focus on potential cardiovascular effects associated with the consumption of CEDs available for sale in Canada. Due to limited data on CED consumption among Canadians to derive accurate exposure information, the composition of a typical CED was characterized to assess the potential effects of single ingredients and synergistic interactions between ingredients on the cardiovascular system. Surveillance data on potential adverse effects related to CED consumption was also analyzed. After extensive review, HC's updated assessment confirms the current risk management approach for CEDs is health protective for Canadian consumers, including the potential for cardiovascular effects. The available evidence supports that moderate consumption (up to 500 mL per day) of a typical CED authorized for sale in Canada is safe for the general population of healthy adults and adolescents. It also re-confirms that vulnerable sub-populations (i.e., children, pregnant and/or breastfeeding women, and caffeine-sensitive individuals) should not consume CEDs. Novelty: Consumption up to 500 mL per day of a typical CED is not associated with an increased risk of cardiovascular effects. Children, pregnant and/or breastfeeding women, and caffeine-sensitive individuals should not consume CEDs.

The Cardiac Effects of Performance-Enhancing Medications: Caffeine vs. Anabolic Androgenic Steroids

Several performance-enhancing or ergogenic drugs have been linked to both significant adverse cardiovascular effects and increased cardiovascular risk. Even with increased scrutiny on the governance of performance-enhancing drugs (PEDs) in professional sport and heightened awareness of the associated cardiovascular risk, there are some who are prepared to risk their use to gain competitive advantage. Caffeine is the most commonly consumed drug in the world and its ergogenic properties have been reported for decades. Thus, the removal of caffeine from the World Anti-Doping Agency (WADA) list of banned substances, in 2004, has naturally led to an exponential rise in its use amongst athletes. The response to caffeine is complex and influenced by both genetic and environmental factors. Whilst the evidence may be equivocal, the ability of an athlete to train longer or at a greater power output cannot be overlooked. Furthermore, its impact on the myocardium remains unanswered. In contrast, anabolic androgenic steroids are recognised PEDs that improve athletic performance, increase muscle growth and suppress fatigue. Their use, however, comes at a cost, afflicting the individual with several side effects, including those that are detrimental to the cardiovascular system. This review addresses the effects of the two commonest PEDs, one legal, the other prohibited, and their respective effects on the heart, as well as the challenge in defining its long-term implications.

Prevalence and pattern of energy drink intake among Australian adolescents

BACKGROUND

Energy drinks (ED) are popular among young people despite evidence of associated health risks. Research into the prevalence and pattern of ED intake among young people is sparse. The present study investigates the prevalence and pattern of ED intake among a large sample of adolescents, including how many consume them, how often, for what reasons and in what contexts.

METHODS

In 2018, all students in grades 7-12 attending 25 randomly selected Western Australian schools were invited to complete an online self-report survey about EDs.

RESULTS

Of the 3688 respondents, 51.2% reported consuming an ED. Of these 'ever consumers', 23.4% drank them monthly, 19.2% weekly and 2% every day. The average age of first intake was 10.7 years. One-fifth (19.7%) of 'ever consumers' reported consuming more than two EDs in 1 day. Reasons for ED use included taste, to boost energy levels, sport performance and studying.

CONCLUSIONS

The findings add to limited international evidence about adolescent ED use and provide valuable information to help ensure interventions to reduce intake address the underlying reasons and contexts of ED consumption.

Caffeine-Containing, Adaptogenic-Rich Drink Modulates the Effects of Caffeine on Mental Performance and Cognitive Parameters: A Double-Blinded, Placebo-Controlled, Randomized Trial

Using a placebo-controlled, double-blinded, within-participants, randomized, cross-over design, we examined the neurocognitive effects of a: (a) caffeine-containing, adaptogenic herbal-rich natural energy shot (e+ shot), (b) a matched caffeine-containing shot (caffeine), and, (c) a placebo. Participants (n = 30) were low consumers of caffeine without elevated feelings of energy. Before and three times after beverage consumption, a 27-min battery was used to assess motivation to perform cognitive tasks, mood, attention ((serial subtractions of 3 (SS3) and 7 (SS7), the continuous performance task (CPT), and the rapid visual input processing tasks)), heart rate (HR), blood pressure (BP), and motor coordination (nine-hole peg test) with a 10-min break between each post-consumption battery. The procedure was repeated for each beverage for each participant at least 48 h apart and within 30 min the same time of day using a random group assignment with blinding of researchers and subjects. To evaluate for changes in outcomes, a Treatment × Time analysis of covariance controlling for hours of prior night's sleep was used. Analysis of all outcomes and all treatment comparisons indicated that compared to placebo, both e+ shot ( Δ ¯   = 2.60; η2 = 0.098) and caffeine ( Δ ¯   = 5.30, η2 = 0.098) increased systolic BP 30 min post consumption (still within normal healthy ranges). The caffeine beverage also led to an improvement in most cognitive measures and moods 30-min post-consumption with improvements tapering at 69 and 108 min, while e+ shot noted more steady improvements with no significant differences between beverages on most cognitive and mood measures at 69 and 108 min. However, compared to caffeine, e+ shot noted a significant increase in reaction time at 108 min, while caffeine noted a small change in the opposite direction. No side-effects were reported by any intervention. These results suggest that the specific blend of adaptogens in e+ shot may modulate the neurocognitive effects of caffeine on mood, and cognition.

A randomized, placebo-controlled crossover trial of a decaffeinated energy drink shows no significant acute effect on mental energy

BACKGROUND

"Energy drinks" are heavily marketed to the general public, across the age spectrum. The efficacy of decaffeinated energy drinks in enhancing subjective feelings of energy (s-energy) is controversial.

OBJECTIVE

The authors sought to test the efficacy of the caffeine-free version of a popular energy drink compared with a placebo drink.

METHODS

This study was a randomized, double-blind, placebo-controlled, crossover trial in 223 healthy men and women aged 18-70 y with intention-to-treat and completers analysis. Participants were randomly assigned to consumption of either the decaffeinated energy drink or a placebo drink on testing day 1, and the other drink a week later. A battery of computer-based mood and cognitive tests to assess s-energy was conducted at baseline and at 0.5, 2.5, and 5 h post-ingestion. The main outcome measures were 1) mood, which was assessed by using a General Status Check Scale and the Profile of Mood States 2nd edition brief form, and 2) cognitive measures, including the N-back task (reaction time and accuracy), Reaction Time test, Flanker task (distraction avoidance), and Rapid Visual Information Processing test.

RESULTS

No statistically significant or meaningful benefits were observed for any outcome measure, including mood and cognitive measures. Analyses of mean differences, slopes, and median differences were consistent.

CONCLUSIONS

No differences were detected across a range of mood/cognitive/behavioral/s-energy-level tests after consumption of the energy drink compared with a placebo drink in this diverse sample of adults. Thus, we found strong evidence that the energy drink is not efficacious in enhancing s-energy levels, nor any related cognitive or behavioral variables measured. In light of federal regulations, these findings suggest that labeling and marketing of some products which claim to provide these benefits may be unsubstantiated. This trial was registered at www.clinicaltrials.gov as NCT02727920.

Acute Effects of Red Bull Energy Drinks on Atrial Electromechanical Function in Healthy Young Adults

Energy drinks (EDs) are widely consumed by adolescents and young adults. Almost all kinds of arrhythmias have been reported following EDs consumption, most of which is atrial fibrillation (AF). Atrial conduction time prolongation and heterogeneous sinusal impulses propagation to the atriums are the key electrophysiological mechanisms leading AF. We aimed to evaluate the acute effects of Red Bull ED ingestion on atrial electromechanical conduction times in healthy young adults. After a 12-hour fasting, 54 healthy young adults consumed 330 mL of Red Bull ED. Atrial electromechanical coupling (PA), intra-atrial electromechanical delay (intra-AEMD), and interatrial electromechanical delay (inter-AEMD) were measured at baseline and 2-hour after Red Bull ED ingestion by echocardiographic tissue-Doppler imaging (TDI) method. PA-lateral (49.7 ± 11.2 vs 54.1 ± 11.0 msn, p = 0.001) and PA-septal (40.8 ± 9.1 vs 43.7 ± 10.5 msn, p = 0.032) times were statistically significantly prolonged after Red Bull ED ingestion. There was also a statistically significant increase in the duration of inter-AEMD (14.4 ± 10.6 vs 18.1 ± 8.5 msn, p = 0.010) after ED ingestion. It was showed that even a single can of ED can acutely increase atrial electromechanical conduction times in young adults. These findings may be the cause of ED-associated AF.

Cardiovascular and Autonomic Responses to Energy Drinks-Clinical Implications

There is an increasing consumption of energy drinks both in the United States and worldwide. The components of these beverages are sometimes unclear but commonly include caffeine, sugars, taurine, and B-vitamins. Young people, particularly those engaged in sports, studying, and in the military are especially likely to be consumers of energy drinks. While limited data are available regarding their autonomic and hemodynamic effects, current literature suggests that energy drink consumption is accompanied by increases in blood pressure, sympathetic drive, and also in QT prolongation. There are no systematic long term studies identifying consequences of frequent energy drink consumption. However, multiple anecdotal reports implicate energy drinks in adverse cardiovascular events including atrial fibrillation, ventricular arrhythmia, myocardial infarction, and sudden death. Events such as atrial fibrillation may even occur in otherwise healthy subjects with structurally normal hearts. It is likely that these cardiovascular outcomes are triggered by the hemodynamic, autonomic, and electrocardiographic responses to energy drink consumption. What remains unclear is how concomitant use of other stimulants such as amphetamines and nicotine may interact to potentiate neural and circulatory responses and cardiovascular consequences when combined with energy drinks.

Caffeinated Energy Drink Induced Ventricular Fibrillation: The Price for Overexcitement

An otherwise healthy 32-year-old man had an in-hospital cardiac arrest with ventricular fibrillation after a few days of consuming 48 cans of alcohol-mixed energy drinks (EDs) (250-mL per can ). He had collapsed shortly after presenting to the emergency room with complaints of lack of sleep and palpitations. Normal cardiac rhythm was restored by biphasic direct current (D/C) shock. EDs generally contain mainly caffeine, taurine, and other ingredients. Especially in high doses, caffeine can cause palpitations and ventricular arrhythmias.

European Cardiac Arrhythmia Society Statement on the cardiovascular events associated with the use or abuse of energy drinks

Energy drinks are increasingly used by young people and young athletes in order to improve their performance alone or in association of other substances, particularly alcohol. In recent years, a number of reports of reports have raised attention on the side-effects associated with the use or abuse of energy drinks particularly serious cardiovascular events. The European Cardiac Arrhythmia Society (ECAS) has undertaken a systematic and critical review of reported data on cardiovascular events including life-threatening arrhythmias with or without cardiac arrest and other cardiovascular events, and discussed in this review the possible causal effect of caffeine and other ingredients contained in energy drinks and the reported events. Twenty-two cardiovascular events were reported in association with the use or abuse of energy drinks. The European Cardiac Arrhythmia Society would like to draw attention on the possible cardiovascular complications that may occur with the consumption of these beverages and to emphasize the prevention measures to be taken particularly in the young population. Well-designed prospective studies are needed to clarify the possible role of energy drinks in inducing the cardiovascular events reported.

Impact of Energy Drinks on Health and Well-being

PURPOSE OF REVIEW

Energy drinks and energy shots are functional supplements with higher caffeine content marketed toward adolescents and young adults with the intention of boosting energy. Parallel to its rising popularity, there are safety concerns with the consumption of these beverages. Herein, we reviewed the impact these supplements produce on health and well-being.

RECENT FINDINGS

Most of the promoted benefits of the beverages can be attributed to caffeine. The physiologic effects, if any, of other ingredients such as vitamins and herbal extracts are unclear. The presence of a higher caffeine content as compared to soft drinks may predispose to caffeine intoxication in susceptible individuals. Also, the practice of co-ingestion of these beverages with alcohol is still prevalent and associated with serious consequences. Strict regulations (restriction of sales, clear warning labels, capping caffeine levels) and public education may help prevent the adverse outcomes from these beverages.

Impact of High Volume Energy Drink Consumption on Electrocardiographic and Blood Pressure Parameters: A Randomized Trial

Background Energy drinks have been linked to an increase in emergency room visits and deaths. We aim to determine the impact of energy drinks on electrocardiographic and hemodynamic parameters in young healthy volunteers. Methods and Results A randomized, double-masked, placebo-controlled, crossover study was conducted in healthy volunteers. Participants consumed 32 oz of either energy drink A, energy drink B, or placebo within 60 minutes on 3 study days with a 6-day washout period in between. The primary end point of QT c interval and secondary end points of QT interval, PR interval, QRS duration, heart rate, and brachial and central blood pressures were measured at baseline, and every 30 minutes for 240 minutes. A repeated-measures 2-way analysis of variance was performed with the main effects of intervention, time, and an interaction of intervention and time. Thirty-four participants were included (age 22.1±3.0 years). The interaction term of intervention and time was statistically significant for Bazett's corrected QT interval, Fridericia's corrected QT interval, QT , PR , QRS duration, heart rate, systolic blood pressure, diastolic blood pressure, central systolic blood pressure, and central diastolic blood pressure (all P<0.001). The maximum change from baseline in Bazett's corrected QT interval for drinks A, B, and placebo were +17.9±13.9, +19.6±15.8, and +11.9±11.1 ms, respectively ( P=0.005 for ANOVA ) ( P=0.04 and <0.01, respectively compared with placebo). Peripheral and central systolic and diastolic blood pressure were statistically significantly different compared with placebo (all P<0.001). Conclusion Energy drinks significantly prolong the QT c interval and raise blood pressure. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT03196908.

Energy Drinks: Another Cause of QT Prolongation?

See Article Shah et al

Cardiovascular prevention and at-risk behaviours in a large population of amateur rugby players

BACKGROUND AND AIM

We aimed to investigate cardiovascular risk factors and health behaviours prospectively in a large population of French amateur rugby players.

METHODS

An anonymous questionnaire was displayed to rugby players aged over 12 years enrolled in the 2014-2015 French amateur rugby championship from the Burgundy region (n = 5140). Questions addressed awareness on: (a) cardiovascular prevention; (b) tobacco, alcohol and highly caffeinated beverages consumption; and (c) adherence to prevention guidelines (ECG checks, training in basic life support, avoidance of sports practice during fever/infectious episodes).

RESULTS

Among the 640 participants who completed the questionnaires, most were male (90%) and were aged under 35 years (80%). Almost half had basic life support training (42%), but only a minority attended an ECG check-up before licensing (37%), and only a few were aware of the cardiovascular prevention information campaign (17%), similarly across the age groups. Surprisingly, playing rugby with fever was commonly reported (44%) and was even more frequent in young women (55%). A high number of respondents were current smokers (35%), of whom most reported consumption less than 2 hours before/after a rugby session. Alcohol drinkers were frequent (69%), of whom most (79%) drank alcohol less than 2 hours before/after a match. Highly caffeinated beverages consumption (34%) was high, particularly in younger players (39%). Half highly caffeinated beverages consumption was in the setting of a rugby session, even greater in women and mainly motivated by performance enhancement (34%).

CONCLUSION

Our findings from a representative regional cohort may help to identify targets for cardiovascular prevention through the development of educational programmes aiming to improve the knowledge and behaviour of amateur rugby players.

Energy Drinks Induce Acute Cardiovascular and Metabolic Changes Pointing to Potential Risks for Young Adults: A Randomized Controlled Trial

BACKGROUND

Case reports suggest a link between energy drinks (EDs) and adverse events, including deaths.

OBJECTIVES

We examined cardiovascular and metabolic effects of EDs and mixtures providing relevant ingredients of EDs compared to a similarly composed control product (CP) without these components.

METHODS

This randomized, crossover trial comprised 38 adults (19 women, mean BMI 23 kg/m2, mean age 22 y). We examined effects of a single administration of a commercial ED, the CP, and the CP supplemented with major ED-ingredients at the same concentrations as in the ED. The study products were administered at 2 volumes, 750 or 1000 mL.

RESULTS

Both volumes of the study products were acceptably tolerated with no dose-dependent effects on blood pressure (BP, primary outcome), heart rate, heart rate corrected duration of QT-segment in electrocardiography (QTc interval), and glucose metabolism. After ED consumption, 11% of the participants reported symptoms, in contrast to 0-3% caused by other study products. After 1 h, administration of an ED caused an increase in systolic BP (116.9 ± 10.4 to 120.7 ± 10.7 mmHg, mean ± SD, P < 0.01) and a QTc prolongation (393.3 ± 20.6 to 400.8 ± 24.1 ms, P < 0.01). Also caffeine, but not taurine or glucuronolactone, caused an increase in BP, but no QTc prolongation. The BP effects were most pronounced after 1 h and returned to normal after a few hours. All study products caused a decrease in serum glucose and an increase in insulin concentrations after 1 h compared to baseline values, corresponding to an elevation in the HOMA-IR (ED + 4.0, other products + 1.0-2.8, all P < 0.001).

CONCLUSION

A single high-volume intake of ED caused adverse changes in BP, QTc, and insulin sensitivity in young, healthy individuals. These effects of EDs cannot be easily attributed to the single components caffeine, taurine, or glucuronolactone. This trial was registered at clinicaltrials.gov as NCT01421979.

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.

A rare adverse effect of energy drinks: Non-ST-elevation myocardial infarction

Energy drinks are increasingly used worldwide inspite of their side effects. These drinks has been linked to case reports that present with ST-elevation myocardial infarction, but in this case we report a case that presents with non-ST-elevation myocardial infarction after energy drink intake. The patient complained about chest pain after drinking two bottles of energy drink and vodka. Cardiac catheterization subsequently confirmed left anterior descending occlusion in this patient.

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.

Use and Perceptions of Caffeinated Energy Drinks and Energy Shots in Canada

INTRODUCTION

In Canada, energy drinks and energy shots are currently classified and regulated differently (food and drugs versus natural health products, respectively), on the assumption that they are used and perceived differently. The current study examined potential differences in use and perceptions of energy drinks and shots.

METHODS

An online survey was conducted in 2015 using a national commercial online panel of youth and young adults aged 12-24 years (n=2,040 retained for analysis in 2016). Participants were randomized to view an image of an energy shot or drink, and were asked about 14 potential reasons for using the product. Past consumption of each product was also assessed. Chi-square and t-tests were conducted to examine differences in use and perceptions between products.

RESULTS

Overall, 15.6% of respondents reported using both energy shots and drinks. Of all respondents, <1% had tried only energy shots, whereas 58.0% had tried only energy drinks. For each product, the most commonly reported reasons for use were "to stay awake" and "to increase concentration or alertness." Out of 14 potential reasons for use, respondents were significantly more likely to endorse seven of the reasons for energy drinks rather than shots; however, the magnitude of these differences was modest and the ordering of the reasons for use of each product was comparable.

CONCLUSIONS

Despite differences in prevalence of ever-use of energy shots and drinks, consumption patterns and perceived reasons for using the products are similar. The findings provide little support for regulating energy shots differently than energy drinks.

Trajectories of energy drink consumption and subsequent drug use during young adulthood

BACKGROUND

Highly caffeinated energy drinks (EDs) are popular with adolescents and young adults, but longitudinal consumption patterns are poorly understood especially in relation to other substance use.

METHODS

ED and other substance use were assessed annually (modal ages 21-25) among a sample (n=1099) who were originally recruited as first-year college students (modal age 18). Trajectory groups were derived based on probability of past-year use during ages 21-24, and compared for possible differences in substance use outcomes at age 25, holding constant demographics, sensation-seeking, other caffeine consumption, and age 21 substance use.

RESULTS

From age 21-25, ED consumption declined in both annual prevalence [62.5%wt to 49.1%wt (wt=weighted)] and frequency of use among consumers (35.2-26.3 days/year). Yet individuals exhibiting a Persistent trajectory (51.4%) of consumption outnumbered those with Non-Use (20.6%), Intermediate (17.4%), or Desisting (10.6%) trajectories. Age 25 cocaine use, nonmedical use of prescription stimulants (NPS), and alcohol use disorder (AUD) risk were significantly associated with trajectory group membership, with Persistent and Intermediate groups exhibiting the highest risk for such outcomes, even accounting for prior substance use and other risk factors. Neither marijuana nor tobacco use were associated with group membership.

CONCLUSIONS

The typical pattern of ED consumption among this sample was sustained use throughout young adulthood. Such individuals appear to be at high risk for adverse substance use outcomes, and results suggest possible specificity regarding cocaine use and NPS, and AUD risk. More research is needed to understand the mechanisms underlying the connection between ED and substance use.

Consumption of Energy Drinks among Undergraduate Students in Taiwan: Related Factors and Associations with Substance Use

Background: This study aimed to investigate the consumption of energy drinks and associated factors among undergraduate students in Taiwan. Methods: Data came from a cross-sectional survey conducted in 2015. Eligible participants completed a self-administered questionnaire assessing use and perceptions of energy drinks, tobacco, alcohol, and betel nut. Results: Among 606 surveyed undergraduate students, 24.8% reported consuming energy drinks in the past 30 days. The major reasons for use included keeping alert at work (48.7%), being curious about the products (32.0%), enjoying the flavor (31.3%), or preparing for school exams (26.7%). Among energy drink users, half have never read the nutrition label, and 15.3% reported that they had ever mixed energy drinks with alcohol. Most participants showed negative attitudes toward using tobacco, alcohol, or betel nut, while 54.1% reported positive attitudes toward consuming energy drinks. Being male, living away from parents’ home, tobacco use, alcohol use, and positive perceptions of energy drink’s effects significantly predicted energy drink consumption. Conclusions: In addition to exploring motivations of energy drink consumption in undergraduate students in Taiwan, the study findings indicated that energy drink consumption might relate to the use of tobacco and alcohol, which should be taken into account in substance use prevention programs.

Energy Drinks and the Risk of Cardiovascular Disease: A Review of Current Literature

Energy drinks (EDs) are commonly used as a dietary supplement by young adolescents and adults. They are often used as a source of energy in order to enhance physical and mental performance. EDs contain a variety of substances, but caffeine is the main component. Safety has been the biggest concern associated with consuming EDs. Case reports, observational studies, and meta-analyses have been done in order to determine the effects of EDs on cardiovascular changes. The detrimental effects of EDs are cardiac arrhythmias, myocardial infarction, prolonged QT interval, aortic dissection, and death. In this article, we review case reports, observational studies, and meta-analyses of EDs and the risk of cardiovascular events and mortality. We also review active ingredients, pharmacokinetics, and the mechanism of action of EDs.