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Review of Evidence on the Effects and International Regulation of Caffeinated Energy Drinks

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Review of Evidence on the Effects and International Regulation of Caffeinated Energy Drinks REVIEW OF EVIDENCE ON THE EFFECTS AND INTERNATIONAL REGULATION OF CAFFEINATED ENERGY DRINKS Developed on behalf of Department of Health and Ageing by ZEST Health Strategies Final report 23 September 2011 CONTENTS EXECUTIVE SUMMARY ......................................................................................................................... 4 INTRODUCTION ................................................................................................................................... 11 1.1 Caffeinated energy drinks and energy shots.............................................................................. 11 1.2 Regulation of CEDs in Australia and New Zealand ................................................................... 12 1.3 Regulation of energy shots in Australia and New Zealand ........................................................ 13 1.4 Review of evidence about CEDs ................................................................................................ 14 2. KEY DEFINITIONS ............................................................................................................................ 16 3. METHODOLOGY .............................................................................................................................. 18 3.1 Scope and key questions ........................................................................................................... 18 3.2 Information sources used in this review ..................................................................................... 20 3.3 Search terms .............................................................................................................................. 21 3.4 Appraisal of identified articles..................................................................................................... 21 4. IDENTIFIED LITERATURE ............................................................................................................... 23 4.1 Overview of identified literature .................................................................................................. 23 5. Q1: NEGATIVE EFFECTS OF CAFFEINE IN CHILDREN, ADOLESCENTS AND ADULTS .......... 26 5.1 Summary of number and type of articles included ..................................................................... 26 5.2 Exposure to caffeine ................................................................................................................... 27 5.3 Exposure to caffeine from CEDs ................................................................................................ 29 5.4 Effects of caffeine ....................................................................................................................... 30 5.5 Incidence of negative effects of caffeine in children, adolescents and adults ........................... 41 6. Q2: NEGATIVE EFFECTS OF OTHER COMMON INGREDIENTS OF CEDs ON CHILDREN, ADOLESCENTS AND ADULTS ............................................................................................................ 42 6.1 Summary of number and type of articles included ..................................................................... 42 6.2 Effects of individual ingredients CEDs ....................................................................................... 43 6.3 Synergistic effects of caffeine with other ingredients in CEDs ................................................... 46 7. Q3: NEGATIVE EFFECTS OF CEDs ON CHILDREN, ADOLESCENTS AND ADULTS ................. 48 7.1 Summary of number and type of articles included ..................................................................... 48 7.2 Effects of CEDs .......................................................................................................................... 49 7.3 CED overconsumption in Australia, New Zealand and overseas .............................................. 51 7.4 Issues/unanswered questions .................................................................................................... 57 8. Q4: CHANGES IN CONSUMPTION OF CEDs AND DRIVERS OF CONSUMPTION ..................... 59 8.1 Summary of number and type of articles included ..................................................................... 59 8.2 CED market worldwide ............................................................................................................... 60 8.3 CED market in Australia and New Zealand ................................................................................ 60 8.4 CED consumption patterns in Australia and New Zealand ........................................................ 62 8.5 Reasons for consumption of CEDs ............................................................................................ 64 8.6 Marketing strategies ................................................................................................................... 65 Review of evidence on the effects and international regulation of caffeinated energy drinks Page 2 of 123 9. Q5: CURRENT BI-NATIONAL AND INTERNATIONAL REGULATIONS REGARDING CEDs ....... 67 9.1 Summary of number and type of articles included ..................................................................... 67 9.2 Regulatory/self-regulatory approaches in Australia and New Zealand ...................................... 68 9.3 Regulatory approaches worldwide ............................................................................................. 70 9.4 Self-regulation ............................................................................................................................ 81 9.5 Company initiatives .................................................................................................................... 84 10. ISSUES AND UNANSWERED QUESTIONS ................................................................................. 85 11. CONCLUSIONS .............................................................................................................................. 89 REFERENCES ...................................................................................................................................... 91 APPENDIX I: STANDARD 2.6.4 FORMULATED CAFFEINATED BEVERAGES ................................ 99 APPENDIX II: MINISTERIAL POLICY GUIDELINE ON THE ADDITION OF CAFFEINE TO FOODS .......................................................................................................................................... 103 APPENDIX III: ABBREVIATIONS ....................................................................................................... 104 APPENDIX IV: SEARCH STRATEGY ................................................................................................ 106 APPENDIX V: STAKEHOLDERS CONSULTED ................................................................................ 113 APPENDIX VI: CLAIMED CAFFEINE CONTENT OF ENERGY DRINKS AND ENERGY SHOTS AVAILABLE IN NEW ZEALAND, FEBRUARY 2010 ........................................................................... 114 APPENDIX VII: REGULATORY AND SELF-REGULATORY APPROACHES TO CEDs ................... 117 APPENDIX VIII: AUSTRALIAN AND NEW ZEALAND SELF-REGULATION GUIDELINES .............. 123 Review of evidence on the effects and international regulation of caffeinated energy drinks Page 3 of 123 EXECUTIVE SUMMARY This report provides a summary of available evidence to July 2011 relating to the effect of caffeinated energy drinks (CEDs) on children, adolescents and adults. The report also describes regulatory frameworks relating to CEDs in Australia and New Zealand and overseas. The report will be used to inform a review by the Australia and New Zealand Food Regulation Ministerial Council of the policy guideline that outlines principles and policy guidance for the addition of caffeine to food. CEDs are non-alcoholic beverages that may contain ingredients such as water-soluble B vitamins, amino acids, glucuronolactone and caffeine and may enhance mental performance. They are regulated in Australia and New Zealand as formulated caffeinated beverages (FCBs) under Standard 2.6.4 of the Australia New Zealand Food Standards Code (the Code). Also discussed in this review are energy shots, which are small volume ‘energy’ liquid preparations with a higher per volume concentration of caffeine and other substances compared with CEDs. Scope of review This review gathered evidence relating to five key questions. 1. What is the current state of evidence as to the negative effects of caffeine on children, adolescents and adults? 2. What is the current state of evidence as to the negative effects of ingredients such as taurine, ginseng, guarana, glucuronolactone and sugar that are commonly added to CEDs on children, adolescents and adults? 3. What is the current state of evidence as to the negative effects of CEDs on children, adolescents and adults? 4. How is consumption of CEDs changing, and what drivers influence consumption? 5. What are the current bi-national and international and regulations regarding CEDs? The scope of the review did not extend to the issue of mixing alcohol and CEDs or vitamins as ingredients of CEDs. The search periods for the review varied according to the different questions. The review aimed to capture data from Australia, New Zealand and overseas; this was deemed particularly pertinent for questions relating to CED consumption patterns, the drivers behind increasing consumption, and international regulation of CEDs. Identified literature
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