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Gualberto PIB, Benvindo VV, Waclawovsky G, Deresz LF. Acute effects of energy drink consumption on cardiovascular parameters in healthy adults: a systematic review and meta-analysis of randomized clinical trials. Nutr Rev 2024; 82:1028-1045. [PMID: 37695306 DOI: 10.1093/nutrit/nuad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
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.
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Affiliation(s)
- Pedro I B Gualberto
- Universidade Federal de Juiz de Fora (UFJF), Minas Gerais, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde da UFJF, Governador Valadares, Minas Gerais, Brazil
| | - Vinícius V Benvindo
- Universidade Federal de Juiz de Fora (UFJF), Minas Gerais, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde da UFJF, Governador Valadares, Minas Gerais, Brazil
| | - Gustavo Waclawovsky
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Rio Grande do Sul, Brazil
- Programa de Pós-Graduação em Ciências da Saúde: Cardiologia do IC/FUC, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luís F Deresz
- Universidade Federal de Juiz de Fora (UFJF), Minas Gerais, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde da UFJF, Governador Valadares, Minas Gerais, Brazil
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Farber J, Dikdan S, Ruge M, Johnson D, Shipon D. Relationship Between Caffeine Consumption and Young Athletes' Comorbidities, Exercise-Related Symptoms, and Baseline Electrocardiogram. Sports Health 2024; 16:448-456. [PMID: 37085973 PMCID: PMC11025507 DOI: 10.1177/19417381231168828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Caffeine consumption causes diverse physiologic effects that can affect athletes both positively and negatively. There is a lack of research investigating the long-term effects of caffeine intake on exercise and on overall cardiovascular health in young athletes. HYPOTHESIS Certain characteristics such as age, body mass index (BMI), race, and medical diagnoses are associated with increased caffeine use, and there is a relationship between caffeine consumption and symptoms during exercise and cardiovascular abnormalities in young athletes. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 4. METHODS This study utilized the HeartBytes National Youth Cardiac Registry to collect data related to demographics, caffeine use, and physical examination and electrocardiogram (ECG) findings of 7425 12- to 20-year-olds (60.6% male, 39.4% female) who attended a Simon's Heart cardiac screening event between 2014 and 2021. Univariable and multivariable logistic regression models were used for analysis. RESULTS Persons who consumed caffeine were more likely to have attention deficit hyperactivity disorder (ADHD) (adjusted odds ratio [aOR], 1.43; CI, 1.15-1.76]; P < 0.01) and more likely to have a BMI ≥30 kg/m2 (aOR, 1.69; CI, 1.27-2.25]; P < 0.01) compared with nondrinkers. After controlling for age, gender, race, and BMI, there were no significant differences in symptoms during exercise (aOR, 1.27; CI, 0.97-1.66; P = 0.08) or abnormal ECG findings (OR, 0.93; CI, 0.66-1.31; P = 0.70) between those who consume caffeine and those who do not. CONCLUSION Caffeine consumption was associated with increased BMI and increased likelihood of having ADHD; however, caffeine use overall was not associated with increased risk of symptoms during exercise or ECG abnormalities. CLINICAL RELEVANCE Whereas caffeine consumption overall did not increase risk of exercise-related symptoms, soda drinkers were at higher risk for symptoms during exercise, and coffee drinkers were at higher risk of syncope with exercise. Prospective studies with longitudinal follow-up and more specific outcomes data is the next step in qualifying the impact of caffeine on young athletes.
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Affiliation(s)
- Jason Farber
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Sean Dikdan
- Division of Cardiology, Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Max Ruge
- Division of Cardiology, Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Drew Johnson
- Division of Cardiology, Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David Shipon
- Division of Cardiology, Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Kaldenbach S, Hysing M, Strand TA, Sivertsen B. Energy drink consumption and sleep parameters in college and university students: a national cross-sectional study. BMJ Open 2024; 14:e072951. [PMID: 38262632 PMCID: PMC10806792 DOI: 10.1136/bmjopen-2023-072951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/08/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES To investigate the frequency of energy drink (ED) consumption, and the association between ED consumption and selected sleep characteristics and parameters in Norwegian college and university students. We also explored whether these associations varied based on sex. DESIGN Cross-sectional. SETTING Data were gathered from the SHOT2022 study (Students' Health and Well-being Study), a national survey. PARTICIPANTS 53 266 students, aged 18-35 years, enrolled in higher education in Norway (2022). MAIN OUTCOME MEASURES Estimated marginal means were computed from general linear models investigating the association between ED consumption and continuous sleep outcomes, while log-link binomial regression analysis was used for dichotomous sleep outcomes of sleep measures. All models were adjusted for age. RESULTS Among the participants, 4.7% of men and 3.3% of women reported consuming ED daily. The frequency of ED consumption was inversely associated with sleep duration and sleep efficiency, while a direct association was observed with the frequency of ED consumption and sleep patterns such as sleep onset latency and wake after sleep onset across sexes. The strongest association was found between daily ED consumption and short sleep duration where men had a risk ratio (RR) of 2.07; 95% CI 1.77 to 2.42, and women had a RR of 1.87; 95% CI 1.64 to 2.14. CONCLUSION ED consumption was a strong determinant for negative sleep outcomes. Even small amounts of ED were associated with poorer sleep outcomes, which warrant more attention towards the consequences of consuming ED among college and university students.
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Affiliation(s)
- Siri Kaldenbach
- Department of Paediatric and Adolescent Medicine, Innlandet Hospital Trust, Lillehammer, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Tor A Strand
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department of Research and Innovation, Fonna Health Trust, Haugesund, Norway
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Schwager LE, Helwig NJ, Rogers EM, Banks NF, Alpers JP, Schulte SL, Lockwood CM, Jenkins NDM. Novel Energy Drink Improves Cognitive Function and Mood, without Influencing Myocardial Oxygen Demand or Ventricular Repolarization in Adult Gamers: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2024; 43:33-47. [PMID: 37186677 DOI: 10.1080/27697061.2023.2207096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/21/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To examine the efficacy of acute consumption of a novel energy drink (C4S) versus placebo for improving cognitive and gaming performance and mood. Secondarily, we examined the cardiovascular safety profile of acute C4S consumption. METHODS Forty-five healthy, young adult video gamers completed two experimental visits in randomized order where they consumed either C4S or a placebo and then completed a validated battery of neurocognitive tests, played five video games, and completed a mood state survey. Blood pressure (BP), heart rate (HR), oxygen saturation, and electrocardiogram measurements were taken at baseline and repeated throughout each visit. RESULTS Acute consumption of C4S improved cognitive flexibility (absolute mean or median difference [95% CI] = +4.3 [2.2-6.4]; p < 0.001; d = 0.63), executive function (+4.3 [2.3-6.3]; p < 0.001; d = 0.63), sustained attention (+2.1 [0.6-3.6]; p = 0.01; d = 0.44), motor speed (+2.9 [0.8-4.9]; p < 0.001; d = 0.44), psychomotor speed (+3.9 [0.1-7.7]; p = 0.04; d = 0.32) working memory (+1.0 [0.1-1.9]; p = 0.02; d = 0.35), and performance in the two-dimensional visuospatial game Tetris (+463 [-419-2,065] pts; p = 0.049; d = 0.30) compared to placebo. C4S also improved Fatigue-Inertia (-1 [-3-0]; p = 0.004; d = 0.45), Vigor-Activity (+2.4 [1.3-3.6]; p < 0.001; d = 0.64), Friendliness (+0 [0-1]; p = 0.04; d = 0.32), and Total Mood Disturbance (-3 [-6-0]; p = 0.002; d = 0.44). BP increased slightly in C4S versus placebo, while HR decreased from baseline to post-drink in the C4S condition. Rate-pressure-product was higher in C4S versus placebo independent of time but did not increase from baseline. There was no effect on corrected QT interval. CONCLUSION Acute consumption of C4S was efficacious for cognitive performance, visuospatial gaming performance, and mood enhancement, and had no effect on myocardial oxygen demand or ventricular repolarization, despite being associated with increases in BP.
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Affiliation(s)
- Laura E Schwager
- Integrative Laboratory of Applied Physiology and Lifestyle Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Nathaniel J Helwig
- Integrative Laboratory of Applied Physiology and Lifestyle Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Emily M Rogers
- Integrative Laboratory of Applied Physiology and Lifestyle Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Nile F Banks
- Integrative Laboratory of Applied Physiology and Lifestyle Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Justin P Alpers
- Integrative Laboratory of Applied Physiology and Lifestyle Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Sydni L Schulte
- Integrative Laboratory of Applied Physiology and Lifestyle Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Nathaniel D M Jenkins
- Integrative Laboratory of Applied Physiology and Lifestyle Medicine, University of Iowa, Iowa City, Iowa, USA
- Abboud Cardiovascular Research Center, University of Iowa, Iowa City, Iowa, USA
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Jagim AR, Harty PS, Tinsley GM, Kerksick CM, Gonzalez AM, Kreider RB, Arent SM, Jager R, Smith-Ryan AE, Stout JR, Campbell BI, VanDusseldorp T, Antonio J. International society of sports nutrition position stand: energy drinks and energy shots. J Int Soc Sports Nutr 2023; 20:2171314. [PMID: 36862943 PMCID: PMC9987737 DOI: 10.1080/15502783.2023.2171314] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 03/04/2023] Open
Abstract
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.
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Affiliation(s)
- Andrew R. Jagim
- Sports Medicine, Mayo Clinic Health System, La Crosse, WI, USA
- Exercise & Sport Science, University of Wisconsin – La Crosse, La Crosse, WI, USA
| | - Patrick S. Harty
- Exercise & Performance Nutrition Laboratory, Lindenwood University, St. Charles, MO, USA
| | - Grant M. Tinsley
- Energy Balance and Body Composition Laboratory, Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Chad M. Kerksick
- Sports Medicine, Mayo Clinic Health System, La Crosse, WI, USA
- Exercise & Performance Nutrition Laboratory, Lindenwood University, St. Charles, MO, USA
| | - Adam M. Gonzalez
- Department of Allied Health and Kinesiology, Hofstra University, Hempstead, NY, USA
| | - Richard B. Kreider
- Exercise & Sport Nutrition Lab, Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, USA
| | - Shawn M Arent
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | | | - Abbie E. Smith-Ryan
- Applied Physiology Laboratory, Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - Jeffrey R. Stout
- School of Kinesiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Bill I. Campbell
- Performance & Physique Enhancement Laboratory, University of South Florida, Tampa, FL, USA
| | - Trisha VanDusseldorp
- Bonafede Health, LLC, JDS Therapeutics, Harrison, NY, USA
- Department of Health and Exercise Sciences, Jacksonville University, Jacksonville, FL, USA
| | - Jose Antonio
- Department of Health and Human Performance, Nova Southeastern University, Davie, FL, USA
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Experiences with energy drink consumption among Norwegian adolescents. J Nutr Sci 2023; 12:e30. [PMID: 36843976 PMCID: PMC9947751 DOI: 10.1017/jns.2023.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/18/2023] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
The objective of the present study was to describe adolescents' habits and experiences with energy drink (ED) consumption and the relation to the amount of ED consumed. We used the national cross-sectional study Ungdata, conducted in 2015-16 in Norway. A total of 15 913 adolescents aged 13-19 years answered questions about ED consumption related to the following topics: reasons for, experiences with, habits and parental attitudes. The sample comprised only adolescents reporting to be ED consumers. We estimated the association between the responses and the average daily consumption of ED in multiple regression models. Those who consumed ED 'to concentrate' or 'to perform better in school' consumed on average 73⋅1 (CI 65⋅8, 80⋅3) and 112⋅0 (CI 102⋅7, 121⋅2) ml more daily, respectively, than those who did not consume ED for these reasons. Up to 80 % of the adolescents reported that 'my parents think it is OK that I drink energy drink', but at the same time almost 50 % reported that 'my parents say that I shouldn't drink energy drink'. Apart from increased endurance and feeling stronger, both desired and adverse effects of ED consumption were reported. Our findings indicate that the expectation created by the ED companies have great influence on the adolescents' consumption rate and that parental attitudes towards ED have little to no influence on the adolescents' consumption rate.
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Rast J, White W, Sohinki D. Ventricular arrhythmias during electronic gaming: Sudden victory and sudden death. Heart Rhythm 2022; 19:1834-1835. [PMID: 37850596 DOI: 10.1016/j.hrthm.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 08/25/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Johnathan Rast
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | - William White
- Department of Cardiology, Augusta University, Augusta, Georgia
| | - Daniel Sohinki
- Department of Cardiology, Augusta University, Augusta, Georgia.
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Dutra RF, Marques FEM, Matos LDNJD. The Action of the Energy Drink on the Recovery Heart Rate is Independent of the Functional Capacity. Arq Bras Cardiol 2022; 119:562-563. [PMID: 36287411 PMCID: PMC9563893 DOI: 10.36660/abc.20220596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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ÇALIŞKAN ŞG, BİLGİN MD. Genç yetişkinlerde elektrofizyolojik ve hemodinamik parametreler üzerine kafeinli içeceklerin akut etkileri. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1089294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: The consumption of caffeinated beverages has significantly increased among young people in recent years. The objective of the study is to investigate the acute effects of caffeinated beverages on electrocardiographic and hemodynamic parameters of young adults.
Materials and Methods: Study was designed as a non-randomized, non-placebo controlled, three-arm parallel assignment. It was conducted on 56 individuals selected from a pool of students enrolled at Aydın Adnan Menderes University. Energy drink, coffee, cola and control groups were determined according to the results of the applicant acceptance questionnaire. Blood pressure and electrocardiogram were measured before and after consuming the drinks at 30 minutes and 60 minutes. Heart rate variability was detected from electrocardiogram signal and investigated by linear analysis.
Results: All caffeinated drinks increased the blood pressure. Only, heart rate was increased by energy drink and cola. There was a small increment in root-mean square differences of successive R-R intervals and the number of times successive heartbeat intervals exceed 50ms (NN50) values in coffee group. High frequency (HF) values were increased some for coffee and cola groups. But, low frequency (LF) and LF/HF values were decreased. These alterations were statistically significant for coffee group. PR interval and QRS complex did not alter, however, QTc interval was lower in energy drink and cola groups.
Conclusion: Caffeinated beverage consumption has the potential to induce adverse effects on cardiovascular system of young adults. Coffee appears to be more prominent than energy drink and cola.
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Oberhoffer FS, Li P, Jakob A, Dalla-Pozza R, Haas NA, Mandilaras G. Energy Drinks: Effects on Blood Pressure and Heart Rate in Children and Teenagers. A Randomized Trial. Front Cardiovasc Med 2022; 9:862041. [PMID: 35387431 PMCID: PMC8978997 DOI: 10.3389/fcvm.2022.862041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/17/2022] [Indexed: 11/27/2022] Open
Abstract
Background The consumption of Energy Drinks (ED) is very popular among children and teenagers. While potential cardiovascular side effects of these beverages are suggested, the acute impact of ED consumption on the pediatric cardiovascular system has not been systematically examined yet. The aim of this study was to investigate the acute effects of ED consumption on blood pressure and heart rate in healthy children and teenagers. Methods This study was a randomized, single-blind, placebo-controlled, crossover clinical trial. On two consecutive days, the study participants were asked to consume a weight-adjusted amount of an ED (3 mg caffeine per kg of body weight) or a placebo containing a similar amount of sugar but without conventional ED ingredients. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate were measured at the following time points: baseline as well as 30, 60, 120 and 240 min after beverage consumption. Results In total, 27 healthy children and adolescents (mean age 14.53 ± 2.40 years, 14 male) were included in the present study. Compared to placebo intake, mean SBP was demonstrated to be up to 5.23 mmHg (p < 0.0001) and mean DBP up to 3.29 mmHg (p < 0.001) increased after ED consumption. Prevalence of elevated blood pressure, stage 1 and stage 2 hypertension was higher after ED consumption. Heart rate tended to be lower after ED consumption. Conclusions The acute ED consumption is associated with a significantly increased SBP and DBP in healthy children and teenagers. Minors, particularly those with pre-existing health conditions, should be discouraged from drinking EDs. Clinical Trial Registration https://www.drks.de/drks_web/, identifier: DRKS00027580.
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Affiliation(s)
| | - Pengzhu Li
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, Munich, Germany
| | - André Jakob
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, Munich, Germany
| | - Robert Dalla-Pozza
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, Munich, Germany
| | - Nikolaus Alexander Haas
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, Munich, Germany
| | - Guido Mandilaras
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, Munich, Germany
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Energy Drinks and Their Acute Effects on Arterial Stiffness in Healthy Children and Teenagers: A Randomized Trial. J Clin Med 2022; 11:jcm11082087. [PMID: 35456180 PMCID: PMC9025458 DOI: 10.3390/jcm11082087] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 12/04/2022] Open
Abstract
Adolescents are the main consumer group of energy drinks (ED). Studies suggest that acute ED consumption is associated with increased peripheral blood pressure. Little is known of the ED-induced effects on arterial stiffness. Therefore, this study aimed to investigate the acute effects of ED consumption on arterial stiffness in healthy children and teenagers by conducting a prospective, randomized, single-blind, placebo-controlled, crossover clinical trial. Study participants (n = 27, mean age = 14.53 years) consumed a body-weight-adjusted amount of an ED or a placebo on two consecutive days. Arterial stiffness was evaluated sonographically by two-dimensional speckle tracking of the common carotid artery (CCA) at baseline and up to four hours after beverage consumption. The ED intake led to a significantly decreased peak circumferential strain of the CCA (11.78 ± 2.70% vs. 12.29 ± 2.68%, p = 0.043) compared with the placebo. The results of this study indicate that the acute ED consumption might be associated with increased arterial stiffness in healthy children and teenagers. Minors, particularly those with increased cardiovascular morbidity, should be discouraged from ED consumption.
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El Moheb M, Refaat M. The Impact of Caffeine and Taurine on Ventricular Arrhythmias. J Cardiovasc Electrophysiol 2022; 33:1298-1299. [PMID: 35304787 DOI: 10.1111/jce.15452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Mohamad El Moheb
- Department of Surgery, University of Virginia, Charlottesville, VA
| | - Marwan Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Ellermann C, Hakenes T, Wolfes J, Wegner FK, Willy K, Leitz P, Rath B, Eckardt L, Frommeyer G. Cardiovascular risk of energy drinks:Caffeine and taurine facilitate ventricular arrhythmias in a sensitive whole-heart model. J Cardiovasc Electrophysiol 2022; 33:1290-1297. [PMID: 35304782 DOI: 10.1111/jce.15458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/19/2022] [Accepted: 02/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several case reports have suggested an increased risk of sudden cardiac death due to energy drinks. Therefore, purpose of this study was to assess acute electrophysiologic effects of caffeine and taurine, two of the main ingredients of energy drinks, in an experimental whole-heart model. METHODS AND RESULTS 25 rabbit hearts were excised, retrogradely perfused and assigned to two groups. Hearts were perfused with caffeine (2, 10, 50 µM) or taurine (2, 10, 50 µM) after generating baseline data. Eight monophasic action potentials and ECG recordings showed a significant abbreviation of action potential duration (APD90 ), QT interval and effective refractory periods (ERP) after caffeine treatment. With taurine, cardiac repolarization duration and ERP were significantly shortened. Ventricular vulnerability was assessed by a predefined pacing protocol. With caffeine, we observed a trend towards more ventricular arrhythmias in a dose-dependent manner. After treatment with taurine, significantly more episodes of ventricular arrhythmias occurred. CONCLUSION In this experimental whole-heart study, treatment with caffeine and taurine provoked ventricular arrhythmias. Underlying mechanism was an abbreviation of cardiac repolarizations and effective refractory periods that may facilitate re-entry and thereby provokes arrhythmias. These findings help to understand the potentially hazardous and fatal outcomes after intoxication with energy drinks. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Christian Ellermann
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Tamara Hakenes
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Julian Wolfes
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Felix K Wegner
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Kevin Willy
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Patrick Leitz
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Benjamin Rath
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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14
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Schüttler D, Rudi WS, Bauer A, Hamm W, Brunner S. Impact of energy drink versus coffee consumption on periodic repolarization dynamics: an interventional study. Eur J Nutr 2022; 61:2847-2851. [PMID: 35266046 PMCID: PMC9279225 DOI: 10.1007/s00394-022-02853-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/22/2022] [Indexed: 01/27/2023]
Abstract
Purpose Caffeinated beverages are consumed daily throughout the world. Caffeine consumption has been linked to dysfunction of the autonomic nervous system. However, the exact effects are still insufficiently understood. Methods Sixteen healthy individuals were included in the present non-randomized cross-over interventional study. All study subjects consumed a commercial energy drink (containing 240 mg caffeine), and in a second independent session coffee (containing 240 mg caffeine). High-resolution digital ECGs in Frank-lead configuration were recorded at baseline before consumption, and 45 min after consumption of the respective beverage. Using customized software, we assessed ECG-based biomarker periodic repolarization dynamics (PRD), which mirrors the effect of efferent cardiac sympathetic activity on the ventricular myocardium. Results The consumption of energy drinks resulted in an increase in PRD levels (3.64 vs. 5.85 deg2; p < 0.001). In contrast, coffee consumption did not alter PRD levels (3.47 vs 3.16 deg2, p = 0.63). The heart rates remained unchanged both after coffee and after energy drink consumption. Spearman analysis showed no significant correlation between PRD changes and heart rate changes (R = 0.34, p = 0.31 for coffee, R = 0.31, p = 0.24 for energy drink). Conclusion Our data suggests that sympathetic activation after consumption of caffeinated beverages is independent from caffeine and might be mediated by other substances. Trial Number: NCT04886869, 13 May 2021, retrospectively registered
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Affiliation(s)
- Dominik Schüttler
- Department of Medicine I, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance (MHA), 80802, Munich, Germany.
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital, LMU Munich, Marchioninistrasse 27, 81377, Munich, Germany.
| | - Wolf-Stephan Rudi
- Department of Medicine I, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Axel Bauer
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance (MHA), 80802, Munich, Germany
- University Hospital for Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang Hamm
- Department of Medicine I, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance (MHA), 80802, Munich, Germany
| | - Stefan Brunner
- Department of Medicine I, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
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15
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Energy Drinks and Their Acute Effects on Heart Rhythm and Electrocardiographic Time Intervals in Healthy Children and Teenagers: A Randomized Trial. Cells 2022; 11:cells11030498. [PMID: 35159306 PMCID: PMC8834195 DOI: 10.3390/cells11030498] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/22/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
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.
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16
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Jagim AR, Harty PS, Barakat AR, Erickson JL, Carvalho V, Khurelbaatar C, Camic CL, Kerksick CM. Prevalence and Amounts of Common Ingredients Found in Energy Drinks and Shots. Nutrients 2022; 14:nu14020314. [PMID: 35057494 PMCID: PMC8780606 DOI: 10.3390/nu14020314] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Andrew R. Jagim
- Sports Medicine, Mayo Clinic Health System, Onalaska, WI 54650, USA; (A.R.B.); (J.L.E.); (V.C.)
- Exercise & Sport Science, University of Wisconsin—La Crosse, La Crosse, WI 54603, USA;
- Correspondence:
| | - Patrick S. Harty
- Energy Balance and Body Composition Laboratory, Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX 79409, USA;
| | - Abdelrahman R. Barakat
- Sports Medicine, Mayo Clinic Health System, Onalaska, WI 54650, USA; (A.R.B.); (J.L.E.); (V.C.)
| | - Jacob L. Erickson
- Sports Medicine, Mayo Clinic Health System, Onalaska, WI 54650, USA; (A.R.B.); (J.L.E.); (V.C.)
| | - Victoria Carvalho
- Sports Medicine, Mayo Clinic Health System, Onalaska, WI 54650, USA; (A.R.B.); (J.L.E.); (V.C.)
| | - Chinguun Khurelbaatar
- Exercise & Sport Science, University of Wisconsin—La Crosse, La Crosse, WI 54603, USA;
| | - Clayton L. Camic
- Kinesiology and Physical Education, Northern Illinois University, DeKalb, IL 60115, USA;
| | - Chad M. Kerksick
- Exercise & Performance Nutrition Laboratory, Lindenwood University, St. Charles, MO 63301, USA;
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17
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Pérez-Mañá C, Mateus JA, Díaz-Pellicer P, Díaz-Baggerman A, Pérez M, Pujadas M, Fonseca F, Papaseit E, Pujol J, Langohr K, de la Torre R. Effects of Mixing Energy Drinks With Alcohol on Driving-Related Skills. Int J Neuropsychopharmacol 2021; 25:13-25. [PMID: 34338762 PMCID: PMC8756085 DOI: 10.1093/ijnp/pyab051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 06/16/2021] [Accepted: 07/26/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Energy drinks (EDs) reduce sleepiness and fatigue and improve driving performance whereas alcohol does just the opposite. Although it is a trendy combination among young people, the effects of alcohol mixed with EDs on driving performance have been poorly studied. The aim was to assess if there is an interaction between the effects of both drinks on driving-related skills as well as perceptions about driving ability. METHODS We conducted a randomized, double-blind, and placebo-controlled 4-way crossover clinical trial. Participants were 16 healthy volunteers. Interventions of 60 g of ethanol and 750 mL of Red Bull (RB) were administered in 2 separated doses. Conditions were alcohol + RB placebo, alcohol + RB, alcohol placebo + RB, and both placebos. Objective performance was assessed using a tracking test and simple reaction time, N-Back, and movement estimation tasks. Additionally, willingness to drive, other subjective effects, and ethanol and caffeine blood concentrations were also measured. RESULTS Alcohol increased the time outside the road in the tracking test and increased simple reaction time, but the addition of RB had no main or interaction effects on performance. Nonetheless, driving-related skills after alcohol + RB were better than after alcohol alone. Willingness to drive increased with the combination of drinks. RB also reduced alcohol-induced sedation whereas drunkenness did not change. These effects were seen even though alcohol + RB increased alcohol (14.8%) and caffeine plasma concentrations (17.6%). CONCLUSIONS Mixing EDs with alcohol predisposes consumers to drive under alcohol influence, perhaps in part because EDs counteract its detrimental effects on driving-related skills. Clinicaltrials.gov: NCT02771587.
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Affiliation(s)
- Clara Pérez-Mañá
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol (HUGTP-IGTP), Badalona, Spain,Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain,Department of Pharmacology, Therapeutics and Toxicology, Autonomous University of Barcelona (UAB), Cerdanyola del Vallès, Spain,Correspondence: Clara Pérez-Mañá, MD, PhD, Carretera de Canyet, S/N, 08916 Badalona, Barcelona, Spain ()
| | - Julián Andrés Mateus
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain,Department of Pharmacology, Therapeutics and Toxicology, Autonomous University of Barcelona (UAB), Cerdanyola del Vallès, Spain
| | - Patricia Díaz-Pellicer
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | | | - Marta Pérez
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Mitona Pujadas
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Francina Fonseca
- Drug Addiction Unit, Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Esther Papaseit
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol (HUGTP-IGTP), Badalona, Spain,Department of Pharmacology, Therapeutics and Toxicology, Autonomous University of Barcelona (UAB), Cerdanyola del Vallès, Spain
| | - Jesús Pujol
- MRI Research Unit, Hospital del Mar, CIBERSAM G21, Barcelona, Spain
| | - Klaus Langohr
- Department of Statistics and Operations Research, Polytechnic University of Catalonia/BarcelonaTech, Barcelona, Spain
| | - Rafael de la Torre
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain,Pompeu Fabra University (CEXS-UPF), Barcelona, Spain,CIBER de Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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18
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Balykova LA, Makarov LM, Ivyanskiy SA, Varlashina KA. [Cardiovascular Risks Associated with the use of Performance-Enhancing Stimulants]. ACTA ACUST UNITED AC 2021; 61:105-112. [PMID: 34311694 DOI: 10.18087/cardio.2021.6.n1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/17/2020] [Indexed: 11/18/2022]
Abstract
The number of people involved in regular exercise and sports is increasing. Not infrequently, this is associated with intake of sports biologically active food supplements (BAS) and stimulators of physical ability. Data has been reported on the frequency of use of physical ability stimulators among professional athletes and on the use of the most popular food supplements among young people. Special attention is paid to the effect of such use on the cardiovascular system of athletes. This review describes negative cardiac effects and clinical cases of death of athletes due to the use of such supplements and stimulators.
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Affiliation(s)
- L A Balykova
- National Research Ogarev Mordovia State University, Saransk
| | - L M Makarov
- Center for Syncope and Cardiac Arrhythmia in Children and Adolescents of FMBA of Russia, Moscow
| | - S A Ivyanskiy
- National Research Ogarev Mordovia State University, Saransk
| | - K A Varlashina
- National Research Ogarev Mordovia State University, Saransk
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19
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Cao DX, Maiton K, Nasir JM, Estes NAM, Shah SA. Energy Drink-Associated Electrophysiological and Ischemic Abnormalities: A Narrative Review. Front Cardiovasc Med 2021; 8:679105. [PMID: 34277730 PMCID: PMC8280314 DOI: 10.3389/fcvm.2021.679105] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/12/2021] [Indexed: 11/22/2022] Open
Abstract
An increasing number of cardiovascular adverse effects, emergency room visits, and deaths have been linked to energy drinks. In this review, we summarized available published literature assessing electrophysiological and ischemic adverse effects associated with energy drink consumption. Overall, 32 case reports and 19 clinical trials are included in this review. Ventricular arrhythmia, supraventricular arrhythmia, and myocardial ischemia were amongst the most commonly reported in case reports with 3 having a fatal outcome. Although serious ischemic changes, arrhythmias, or death were not observed in clinical trials, significant electrophysiological changes, such as PR/PQ interval shortening/prolongation, QT/QTc shortening/prolongation, and ST-T changes, were noted. QT/QTc interval prolongation appears to be the most significant finding in clinical trials, and there appears to be a dose-response relationship between energy drink consumption and QTc prolongation. The exact mechanisms and the particular combination of ingredients behind energy drink-induced cardiac abnormalities require further evaluation. Until more information is available, energy drink use should be considered as part of the differential diagnosis in appropriate patients presenting with electrocardiographic changes. Further, certain patient populations should exercise caution and limit their energy drink consumption.
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Affiliation(s)
- Diana X. Cao
- Department of Pharmacy Practice, Marshall B. Ketchum University College of Pharmacy, Fullerton, CA, United States
| | - Kimberly Maiton
- Department of Pharmacy Practice, Thomas J Long School of Pharmacy, University of the Pacific, Stockton, CA, United States
| | - Javed M. Nasir
- David Grant USAF Medical Center, Fairfield, CA, United States
| | - N. A. Mark Estes
- Heart and Vascular Institute, UPMC Presbyterian, Pittsburgh, PA, United States
| | - Sachin A. Shah
- Department of Pharmacy Practice, Thomas J Long School of Pharmacy, University of the Pacific, Stockton, CA, United States
- David Grant USAF Medical Center, Fairfield, CA, United States
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20
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Piccioni A, Covino M, Zanza C, Longhitano Y, Tullo G, Bonadia N, Rinninella E, Ojetti V, Gasbarrini A, Franceschi F. Energy drinks: a narrative review of their physiological and pathological effects. Intern Med J 2021; 51:636-646. [PMID: 32369250 DOI: 10.1111/imj.14881] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/18/2020] [Accepted: 03/29/2020] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Andrea Piccioni
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marcello Covino
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christian Zanza
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Anesthesia and Critical Care, Keck Medical School of University Southern California, California, Los Angeles, USA
| | - Yaroslava Longhitano
- Department of Anesthesia and Critical Care, Keck Medical School of University Southern California, California, Los Angeles, USA
| | - Gianluca Tullo
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Bonadia
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Rinninella
- UOC Nutrizione Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Veronica Ojetti
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- UOC Nutrizione Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Franceschi
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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21
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Plumber N, Majeed M, Ziff S, Thomas SE, Bolla SR, Gorantla VR. Stimulant Usage by Medical Students for Cognitive Enhancement: A Systematic Review. Cureus 2021; 13:e15163. [PMID: 34178492 PMCID: PMC8216643 DOI: 10.7759/cureus.15163] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Stimulants have been used throughout human history for a variety of reasons. High levels of stress and the demanding nature of medical school make their usage among medical students particularly common. The most prevalent stimulant used by students is coffee, followed by tea and other forms of caffeine like sugary energy drinks. In addition, amphetamine-based medications for treating attention deficit hyperactivity disorder (ADHD) have been increasing in popularity, which many students take illicitly. Students report taking various forms of stimulants to promote cognitive enhancement, prolong wakefulness and retain focus for long periods of time. Moderate doses of caffeine and amphetamines would lead to enhanced alertness and concentration. However, large increases in dosage or frequency would lead to an increased risk of toxicity and adverse effects. The positive outcomes from stimulant consumption are often overshadowed by the negative side effects and incorrect dosage. Thus, it appears that usage of stimulants should be limited, in favor of a more sustainable approach to cognitive enhancement. This review analyzes the use of stimulants among the medical student community, consequences of misuse and discussed the healthy and organic approaches to lessen the stress and improve academic performance. This article also discusses the mechanisms of action, acceptable doses, additives, ingredients of stimulants commonly used by medical students for cognitive enhancement and the implications of long-term use as the stress of practicing medicine extends well beyond the medical school years.
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Affiliation(s)
- Noorine Plumber
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, GRD
| | - Maliha Majeed
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, GRD
| | - Shawn Ziff
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, GRD
| | - Sneha E Thomas
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, USA
| | - Srinivasa Rao Bolla
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Nur Sultan, KAZ
| | - Vasavi Rakesh Gorantla
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, GRD
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22
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La Vieille S, Gillespie Z, Bonvalot Y, Benkhedda K, Grinberg N, Rotstein J, Barber J, Krahn AD. Caffeinated energy drinks in the Canadian context: health risk assessment with a focus on cardiovascular effects. Appl Physiol Nutr Metab 2021; 46:1019-1028. [PMID: 34000209 DOI: 10.1139/apnm-2021-0245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
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.
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Affiliation(s)
| | - Zoe Gillespie
- Bureau of Chemical Safety, Food Directorate, Health Canada, Ottawa, ON, Canada
| | - Yvette Bonvalot
- Biostatistics and Modelling Division, Bureau of Food Surveillance and Science Integration, Food Directorate, Health Canada, Ottawa, ON, Canada
| | - Karima Benkhedda
- Bureau of Nutritional Sciences, Food Directorate, Health Canada, Ottawa, ON, Canada
| | - Nancy Grinberg
- Bureau of Nutritional Sciences, Food Directorate, Health Canada, Ottawa, ON, Canada
| | - Joel Rotstein
- Bureau of Chemical Safety, Food Directorate, Health Canada, Ottawa, ON, Canada
| | - Jennifer Barber
- Bureau of Nutritional Sciences, Food Directorate, Health Canada, Ottawa, ON, Canada
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, The University of British Columbia, Vancouver, BC, Canada
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Sivalokanathan S, Małek ŁA, Malhotra A. The Cardiac Effects of Performance-Enhancing Medications: Caffeine vs. Anabolic Androgenic Steroids. Diagnostics (Basel) 2021; 11:diagnostics11020324. [PMID: 33671206 PMCID: PMC7922604 DOI: 10.3390/diagnostics11020324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Sanjay Sivalokanathan
- Cardiovascular Clinical Academic Group, St. George’s University of London and St. George’s University Hospitals NHS Foundation Trust, London SW17 0RE, UK;
| | - Łukasz A. Małek
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Aneil Malhotra
- Cardiovascular Clinical Academic Group, St. George’s University of London and St. George’s University Hospitals NHS Foundation Trust, London SW17 0RE, UK;
- Division of Cardiovascular Sciences, University of Manchester and Manchester University NHS Foundation Trust, Manchester Institute of Health and Performance, Manchester M11 3BS, UK
- Correspondence:
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The impact of acute energy drink consumption on electrical heart disease: A systematic review and meta-analysis. J Electrocardiol 2021; 65:128-135. [PMID: 33631440 DOI: 10.1016/j.jelectrocard.2021.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 11/22/2022]
Abstract
AIMS Energy Drink (ED)-associated cardiovascular emergency visits have increased in recent years. Although a toxicity threshold has been established for caffeine, the safety profile of whole ED consumption has not yet been defined. METHODS This systematic review was conducted following the PRISMA guidelines. Three reviewers conducted two separate systematic searches on PubMed on October 24 and December 3, 2019. Out of 250 potential records, 43 prospective clinical studies assessing the effects of ED on heart rate (HR) and/or any electrocardiographic (ECG) parameters were included. A meta-analysis was conducted to estimate pooled p-values using metap command for STATA 10.0. RESULTS After ED consumption, resting HR increased in 71.1% of studies (pooled p-value <0.001) but was only significant in 38%; HR during and after exercise increased in 55.5% (pooled p-value <0.001) and 71.4% of studies, respectively; QRS increased in all but two protocols; evidence on PR interval was contradictory, and corrected QT interval (QTc) increased compared to baseline in all but one study, exceeding the pathological limit value in two of them. T wave changes were seen in two studies, and one study reported a ratio of 5 to 1 in the number of ectopic beats. CONCLUSION Acute consumption of ED can alter the ECG in certain risk populations, posing a risk whose magnitude is yet to be determined. Caution should be exercised among at-risk and underage individuals but further research in these populations is warranted before restrictions are made.
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Luo YS, Chen Z, Blanchette AD, Zhou YH, Wright FA, Baker ES, Chiu WA, Rusyn I. Relationships between constituents of energy drinks and beating parameters in human induced pluripotent stem cell (iPSC)-Derived cardiomyocytes. Food Chem Toxicol 2021; 149:111979. [PMID: 33450301 DOI: 10.1016/j.fct.2021.111979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/24/2022]
Abstract
Consumption of energy drinks has been associated with adverse cardiovascular effects; however, little is known about the ingredients that may contribute to these effects. We therefore characterized the chemical profiles and in vitro effects of energy drinks and their ingredients on human induced pluripotent stem cell (iPSC)-derived cardiomyocytes, and identified the putative active ingredients using a multivariate prediction model. Energy drinks from 17 widely-available over-the-counter brands were evaluated in this study. The concentrations of six common ingredients (caffeine, taurine, riboflavin, pantothenic acid, adenine, and L-methionine) were quantified by coupling liquid chromatography with a triple quadrupole mass spectrometer for the acquisition of LC-MS/MS spectra. In addition, untargeted analyses for each beverage were performed with a platform combining LC, ion mobility spectrometry and mass spectrometry (LC-IMS-MS) measurements. Approximately 300 features were observed across samples in the untargeted studies, and of these ~100 were identified. In vitro effects of energy drinks and some of their ingredients were then tested in iPSC-derived cardiomyocytes. Data on the beat rate (positive and negative chronotropy), ion channel function (QT prolongation), and cytotoxicity were collected in a dilution series. We found that some of the energy drinks elicited adverse effects on the cardiomyocytes with the most common being an increase in the beat rate, while QT prolongation was also observed at the lowest concentrations. Finally, concentration addition modeling using quantitative data from the 6 common ingredients and multivariate prediction modeling was used to determine potential ingredients responsible for the adverse effects on the cardiomyocytes. These analyses suggested theophylline, adenine, and azelate as possibly contributing to the in vitro effects of energy drinks on QT prolongation in cardiomyocytes.
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Affiliation(s)
- Yu-Syuan Luo
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, USA
| | - Zunwei Chen
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, USA
| | - Alexander D Blanchette
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, USA
| | - Yi-Hui Zhou
- Departments of Statistics and Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Fred A Wright
- Departments of Statistics and Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Erin S Baker
- Department of Chemistry, North Carolina State University, Raleigh, NC, USA
| | - Weihsueh A Chiu
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, USA
| | - Ivan Rusyn
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, USA.
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Nadeem IM, Shanmugaraj A, Sakha S, Horner NS, Ayeni OR, Khan M. Energy Drinks and Their Adverse Health Effects: A Systematic Review and Meta-analysis. Sports Health 2020; 13:265-277. [PMID: 33211984 DOI: 10.1177/1941738120949181] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT Energy drinks are the fastest growing product in the beverage industry. However, there is concern regarding potential for adverse effects with use. OBJECTIVE To evaluate the reported adverse effects of energy drink consumption. DATA SOURCES The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies from inception to November 2019, and pertinent data were abstracted. STUDY SELECTION Only clinical studies reporting adverse events after energy drink consumption were included. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Data regarding sample size characteristics, energy drink characteristics, comparators, and all adverse events were extracted in duplicate and recorded. RESULTS A total of 32 studies and 96,549 individuals were included. Frequently reported adverse events in the pediatric population were insomnia (35.4%), stress (35.4%), and depressive mood (23.1%). Frequently reported adverse events in the adult population were insomnia (24.7%), jitteriness/restlessness/shaking hands (29.8%), and gastrointestinal upset (21.6%). Alcohol mixed with energy drinks significantly reduced the likelihood of sedation effects but increased the likelihood of stimulatory effects. Energy drink consumption significantly increased the odds of insomnia (OR, 5.02; 95% CI, 1.72-14.63) and jitteriness/activeness (OR, 3.52; 95% CI, 1.28-9.67) compared with the control group. CONCLUSION The authors recommend that individuals avoid frequent energy drink consumption (5-7 energy drinks/week) and avoid co-consumption with alcohol; increased regulatory standards should be placed in the sale of energy drinks, particularly with regard to the pediatric population.
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Affiliation(s)
- Ibrahim M Nadeem
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Seaher Sakha
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nolan S Horner
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Arrhythmogenic foods – A growing medical problem. Trends Cardiovasc Med 2020; 30:310-312. [DOI: 10.1016/j.tcm.2019.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/12/2019] [Accepted: 08/20/2019] [Indexed: 11/20/2022]
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Terashima S, Muroya T, Ikegawa H, Kajino K, Sakuramoto K, Yui R, Kishimoto M, Takahashi H, Nakajima M, Nakamura F, Nakamori Y, Kuwagata Y. Propofol suppresses ventricular arrhythmias: a case report of acute caffeine intoxication. Acute Med Surg 2020; 7:e514. [PMID: 32537172 PMCID: PMC7283990 DOI: 10.1002/ams2.514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 11/18/2022] Open
Abstract
Background Caffeine is widely used as a stimulant drug throughout the world, and fatal arrhythmia is a known side‐effect. We experienced a patient with caffeine intoxication causing fatal arrhythmias who was successfully treated with the infusion of propofol. Case Presentation A 27‐year‐old woman was transferred to our hospital with nausea and poor general condition after intentional ingestion of 23.2 g of caffeine tablets. She was in cardiac arrest due to ventricular fibrillation just before hospital arrival. Advanced life support including defibrillation was started immediately, and we succeeded in resuscitating her 23 min later. Although she suffered from polymorphic ventricular premature beats and frequent transition to ventricular fibrillation, propofol administration converted her from a ventricular arrhythmia to sinus rhythm. Conclusion We report this case focusing on the cardiovascular effects of propofol and the lipid sink phenomenon. As a result, propofol could have the potential to suppress ventricular arrhythmias.
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Affiliation(s)
- Shinya Terashima
- Department of Emergency and Critical Care Medicine Kansai Medical University Medical Center Moriguchi Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Hitoshi Ikegawa
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Rintaro Yui
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Masanobu Kishimoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Hiroki Takahashi
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Mari Nakajima
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Yasushi Nakamori
- Department of Emergency and Critical Care Medicine Kansai Medical University Medical Center Moriguchi Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
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Almulla AA, Faris MAIE. Energy Drinks Consumption Is Associated With Reduced Sleep Duration and Increased Energy-Dense Fast Foods Consumption Among School Students: A Cross-Sectional Study. Asia Pac J Public Health 2020; 32:266-273. [DOI: 10.1177/1010539520931351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study aimed to investigate the prevalence of energy drinks (EDs) consumption and its relationship with sociodemographic characteristics, eating habits, sleep duration, physical activity, and screen time among school students. A cross-sectional study was carried out with a total of 1611 students aged 10 to 18 years from the United Arab Emirates. ED consumption among school students was 27%, with less than half consumed at least one can of EDs 1 to 3 days per week. ED consumers were less likely to meet recommended sleep duration (37% vs 62%, P < .001), more likely to consume high energy-dense fast foods (33% vs 20%, P < .001), and more likely to spend more than 6 hours in front of a screen (40.5% vs 32.3%, P < .001). Students aged 14 to 18 years were twice as likely to consume EDs as students aged 10 to 13 years ( P < .001). Overall, the use of EDs was associated with male sex, older age, not meeting sleep recommendations, high energy-dense fast food consumption, and spending a longer time in front of a screen. Educational intervention programs about ED consumption and healthy lifestyle habits are highly recommended.
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Srivastava S, Mennemeier M, Chaudhary JA. A Randomized Placebo Controlled Clinical Trial Demonstrating Safety & Efficacy of EnXtra ® in Healthy Adults. J Am Coll Nutr 2020; 40:224-236. [PMID: 32412358 DOI: 10.1080/07315724.2020.1753129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: The present randomized, placebo-controlled study aimed to assess the long-term safety and perceivable mental acuity benefits of EnXtra® in healthy individuals.Methods: Study participants were administered EnXtra® with or without caffeine for a period of 12 weeks. The cardiovascular safety was evaluated by assessing change in QT interval, blood pressure and heart rate. Further, other efficacy variables evaluated were change in perceived alertness and calmness by Bond and Lader mood scales, Sleep disturbance by Pittsburgh sleep quality Index and daytime sleepiness by Epworth sleepiness scale.Results: None of the study group showed any significant change in the ECG or haemodynamic parameters as compared to baseline (p > 0.05). Post consumption, alertness and calmness scores were significantly increased in the EnXtra®, and EnXtra® plus caffeine group (p < 0.001) as compared to placebo. Daytime sleep scores decreased in the EnXtra® group however change was not significant. Sleep quality remained undisturbed in all three arms.Conclusion: The findings demonstrated the psychostimulant efficacy of EnXtra® with no safety concerns on long-term usage.
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Affiliation(s)
- Shalini Srivastava
- Department of Clinical development, Enovate Biolife, Mumbai, Maharashtra, India
| | - Mark Mennemeier
- Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Garcia-Alvarez A, Cunningham CA, Mui B, Penn L, Spaulding EM, Oakes JM, Divers J, Dickinson SL, Xu X, Cheskin LJ. A randomized, placebo-controlled crossover trial of a decaffeinated energy drink shows no significant acute effect on mental energy. Am J Clin Nutr 2020; 111:719-727. [PMID: 31990972 PMCID: PMC7049526 DOI: 10.1093/ajcn/nqz343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/23/2019] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Alicia Garcia-Alvarez
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Corbin A Cunningham
- Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Byron Mui
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lia Penn
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Erin M Spaulding
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - J Michael Oakes
- Division of Epidemiology, University of Minnesota, Minneapolis, MN, USA
| | - Jasmin Divers
- Department of Biostatistics and Data Science, Division of Public Health, Wake Forest School of Medicine, Bowman Gray Center, Winston-Salem, NC, USA
| | - Stephanie L Dickinson
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University School of Public Health, Bloomington, IN, USA
| | - Xiao Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University School of Public Health, Bloomington, IN, USA
| | - Lawrence J Cheskin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
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Cardiovascular and Autonomic Responses to Energy Drinks-Clinical Implications. J Clin Med 2020; 9:jcm9020431. [PMID: 32033367 PMCID: PMC7073550 DOI: 10.3390/jcm9020431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/22/2020] [Accepted: 02/03/2020] [Indexed: 12/14/2022] Open
Abstract
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.
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Abstract
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.
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Shah SA, Szeto AH, Farewell R, Shek A, Fan D, Quach KN, Bhattacharyya M, Elmiari J, Chan W, O'Dell K, Nguyen N, McGaughey TJ, Nasir JM, Kaul S. Impact of High Volume Energy Drink Consumption on Electrocardiographic and Blood Pressure Parameters: A Randomized Trial. J Am Heart Assoc 2019; 8:e011318. [PMID: 31137991 PMCID: PMC6585360 DOI: 10.1161/jaha.118.011318] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- Sachin A Shah
- 1 Department of Pharmacy Practice Thomas J Long School of Pharmacy and Health Sciences University of the Pacific Stockton CA
| | - Andy H Szeto
- 2 Thomas J Long School of Pharmacy and Health Sciences University of the Pacific Stockton CA
| | - Raechel Farewell
- 2 Thomas J Long School of Pharmacy and Health Sciences University of the Pacific Stockton CA
| | - Allen Shek
- 1 Department of Pharmacy Practice Thomas J Long School of Pharmacy and Health Sciences University of the Pacific Stockton CA
| | - Dorothy Fan
- 2 Thomas J Long School of Pharmacy and Health Sciences University of the Pacific Stockton CA
| | - Kathy N Quach
- 2 Thomas J Long School of Pharmacy and Health Sciences University of the Pacific Stockton CA
| | - Mouchumi Bhattacharyya
- 3 Department of Mathematics College of the Pacific University of the Pacific Stockton CA
| | - Jasmine Elmiari
- 2 Thomas J Long School of Pharmacy and Health Sciences University of the Pacific Stockton CA
| | - Winny Chan
- 2 Thomas J Long School of Pharmacy and Health Sciences University of the Pacific Stockton CA
| | - Kate O'Dell
- 1 Department of Pharmacy Practice Thomas J Long School of Pharmacy and Health Sciences University of the Pacific Stockton CA
| | - Nancy Nguyen
- 1 Department of Pharmacy Practice Thomas J Long School of Pharmacy and Health Sciences University of the Pacific Stockton CA
| | - Tracey J McGaughey
- 4 Department of Pharmacy David Grant USAF Medical Center Travis Air Force Base CA
| | - Javed M Nasir
- 5 Department of Electrophysiology Heart, Lung & Vascular Center David Grant USAF Medical Center Travis Air Force Base CA
| | - Sanjay Kaul
- 6 Division of Cardiology Cedars-Sinai Medical Center Los Angeles CA.,7 David Geffen School of Medicine at UCLA Los Angeles CA
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Abstract
See Article Shah et al
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Ehlers A, Marakis G, Lampen A, Hirsch-Ernst KI. Risk assessment of energy drinks with focus on cardiovascular parameters and energy drink consumption in Europe. Food Chem Toxicol 2019; 130:109-121. [PMID: 31112702 DOI: 10.1016/j.fct.2019.05.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 01/01/2023]
Abstract
To assess the possible cardiovascular risks associated with energy drink (ED) consumption in Europe, a comprehensive literature research was performed in regard to (i) possible ED-induced dose-dependent cardiovascular outcomes, (ii) ED consumption patterns in Europe and (iii) the risks of EDs in combination with alcohol. The identified intervention studies primarily investigated acute ED effects in young healthy adults. Moderate consumption of EDs corresponding to an acute caffeine intake of up to 200 mg did not result in clinically relevant cardiovascular changes in young healthy adults. However, high intake of EDs (about 1 L) was associated with moderate to severe adverse effects in some participants (i.a. prolonged QTc interval, palpitations). Studies have indicated that on some occasions, a substantial proportion of ED consuming children and adolescents (12% in 16 EU Member States) drink EDs in high quantities (≥1 L). This could pose a possible health risk to this group since adverse effects by such high ED consumption have been observed already in young healthy adults. Among further measures that might be considered to minimize this identified risk, policy makers could develop information and educational programs with the aim of raising public awareness.
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Affiliation(s)
- Anke Ehlers
- German Federal Institute for Risk Assessment, Department of Food Safety, Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany.
| | - Georgios Marakis
- Hellenic Food Authority, Directorate of Risk Assessment and Nutrition, Kifisias Av. 124 & Iatridou Str. 2, 11526 Athens, Greece
| | - Alfonso Lampen
- German Federal Institute for Risk Assessment, Department of Food Safety, Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany
| | - Karen Ildico Hirsch-Ernst
- German Federal Institute for Risk Assessment, Department of Food Safety, Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany
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Willson C. The clinical toxicology of caffeine: A review and case study. Toxicol Rep 2018; 5:1140-1152. [PMID: 30505695 PMCID: PMC6247400 DOI: 10.1016/j.toxrep.2018.11.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 10/09/2018] [Accepted: 11/01/2018] [Indexed: 02/08/2023] Open
Abstract
Caffeine is a widely recognized psychostimulant compound with a long history of consumption by humans. While it has received a significant amount of attention there is still much to be learned with respect to its toxicology in humans, especially in cases of overdose. A review of the history of consumption and the clinical toxicology of caffeine including clinical features, pharmacokinetics, toxicokinetics, a thorough examination of mechanism of action and management/treatment strategies are undertaken. While higher (i.e., several grams) quantities of caffeine are known to cause toxicity and potentially lethality, cases of mainly younger individuals who have experienced severe side effects and death despite consuming doses not otherwise known to cause such harm is troubling and deserves further study. An attempted case reconstruction is performed in an effort to shed light on this issue with a focus on the pharmacokinetics and pharmacodynamics of caffeine.
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Energy drink exposures reported to Texas poison centers: Analysis of adverse incidents in relation to total sales, 2010–2014. Regul Toxicol Pharmacol 2018; 97:1-14. [DOI: 10.1016/j.yrtph.2018.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/18/2017] [Accepted: 05/10/2018] [Indexed: 12/21/2022]
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McGaughey TJ, Kelly SE, Williams B, Shah SA. QTc prolongation with energy drinks comparable to moxifloxacin. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Voskoboinik A, Kalman JM, Kistler PM. Caffeine and Arrhythmias. JACC Clin Electrophysiol 2018; 4:425-432. [DOI: 10.1016/j.jacep.2018.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/25/2018] [Accepted: 01/25/2018] [Indexed: 12/31/2022]
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