Research Article Relationship Between Energy Drink Consumption and Nutrition Knowledge in Student-Athletes Richard Hardy, MA, ATC, CSCS1; Nathalie Kliemann, MSc2; Taylor Evansen, BA3; Jefferson Brand, MD1

ABSTRACT Objective: To identify the relationships between energy drink consumption, nutrition knowledge, and socio-demographic characteristics in a convenience sample of student-athletes. Design: Cross-sectional. Setting: Online survey. Participants: A total of 194 student-athletes (112 female and 82 male). Main Outcome Measures: Socio-demographic characteristics, knowledge of human nutrition, energy drink consumption habits. Analysis: Chi-square tests of independence, independent t tests, and hierarchical regression analyses were applied. Results: Most student-athletes in the sample (85.5%) did not consume energy drinks, but those who did tended to be male (P ¼ .004), had lower overall knowledge of nutrition (P ¼ .02), and had a lower grade point average (P < .001) than did nonusers. Also, energy drink consumption was associated with the over- all nutrition knowledge score when adjusted for socio-demographic characteristics, with nonusers having greater nutrition knowledge (P ¼ .007) than users. Conclusions and Implications: Student-athletes tend to refrain from energy drink use but those who use it have a tendency to have lower nutrition knowledge than do nonusers. Therefore, nutrition education targeted toward student-athletes should encompass the consumption of energy drinks because limited evidence shows the benefits of collegiate athletes consuming energy drinks. Key Words: nutritional supplements, energy drink consumption, nutrition knowledge, student-athletes, sports, college students (J Nutr Educ Behav. 2017;49:19-26.) Accepted August 17, 2016. Published online October 6, 2016.

INTRODUCTION may enhance athletic performance. In magnesium, potassium, total fat, die- general, nutrient requirements can be tary fiber, and phosphorus) and low Gaining a competitive advantage in achieved through a healthy diet with in fruits, vegetables, and dairy prod- sports goes beyond traditional training no need for nutritional supplements ucts.2-4 Moreover, studies found that measures such as working harder in the or ergogenic aids.1 However, studies ergogenic aids such as energy drinks weight room and on the practice field exploring athletes' diet quality showed are popular among student-athletes.5 compared with competitors. There is that their diets tend to be inadequate Energy drinks are often a combina- also a need to consider athletes' dietary in nutrients (especially vitamins E and tion of caffeine (main active ingredient), behaviors, because optimal nutrition D, folate, pantothenic acid, calcium, taurine, guarana, glucuronolactone, B vitamins, and ginseng.6,7 Regulation of these highly caffeinated beverages has been challenging.8 Energy drinks contain 1Heartland Orthopedic Specialists, Douglas County Hospital, Alexandria, MN 72–300 mg caffeine/8-oz serving compared 2Department of Epidemiology and Public Health, Health Behaviour Research Centre, with 65–125 mg caffeine/8-oz serving University College London, United Kingdom of percolated coffee.7,9 Consuming 3Department of Biology, University of Minnesota Morris, Morris, MN 150–200 mg/kg caffeine can lead to Conflict of Interest Disclosure: The authors’ conflict of interest disclosures can be found online fatal caffeine overdose as a result of with this article on www.jneb.org. ventricular tachycardia.10 Although Address for correspondence: Richard Hardy, MA, ATC, CSCS, Heartland the consumption of excess caffeine can Orthopedic Specialists, Douglas County Hospital, 111 17th Ave E #101, Alexandria, be life-threatening, energy drinks man- MN 56308; Phone: (320) 760-2031; Fax: (320) 589-6428; E-mail: hardyr@morris. ufacturers tend to target young males, umn.edu claiming that their product increases Ó2016 Society for Nutrition Education and Behavior. Published by Elsevier, Inc. All rights energy and alertness and improves ath- reserved. letic performance.8,9 Emond et al11 sug- http://dx.doi.org/10.1016/j.jneb.2016.08.008 gested that adolescents are exposed to Journal of Nutrition Education and Behavior Volume 49, Number 1, 2017 19 20 Hardy et al Journal of Nutrition Education and Behavior Volume 49, Number 1, 2017 these claims by advertisements that are program budgets are lower and ath- of the 5 participating universities and run on television channels popular letic scholarships are not available to at least age 18 years. within their age group. This is concerning student-athletes.27 Overall, Division because frequent energy drink con- III athletes tend to play for the enjoy- Procedure sumption has been correlated with ment of the sport.28 Academically, higher intake of sugar-sweetened bev- Umbach et al29 reported that students Athletic directors from the partici- erages, which contributes to undesired at Division III institutions undergo a pating universities directly e-mailed weight gain and obesity.12-14 greater degree of academic challenge the survey link and informational let- It has been suggested that collegiate and have more interaction with fac- ter to their student-athletes. Student- student-athletes consume these bever- ulty than do students at Division I in- athletes received 2 separate e-mails. ages to improve athletic perfor- stitutions. Furthermore, they reported First, they received an introductory mance.15 However, there is conflicting that students at Division III institu- e-mail that explained the investigation evidence regarding whether perfor- tions engage more in active and col- and a link to the online survey. Four- mance actually improves as a result laborative learning activities than do teen days after they received the in- of consuming energy drinks.6,16-22 Per- their peers at Division I institutions. troductory e-mail, student-athletes formance improvements may result Robst and Keil30 found that student- received a follow-up e-mail that reiter- from the content of caffeine and/or athletes competing at NCAA III ated the introductory e-mail and the carbohydrates in the energy drinks, schools have higher grade point aver- link to the survey was again provided and questions exist regarding whether ages (GPAs), enroll in classes of greater to them. In total, 984 eligible stu- energy drinks are the proper mode of difficulty, and have higher graduation dent-athletes were invited to take part delivery for high doses of caffeine rates than do non–student-athletes at in this study. A cookie was placed on required to stimulate neuromuscular the same institutions. their computer to prevent respondents performance.20,23 Regardless, studies Based on that, the current re- from taking the survey more than showed that athletes have low overall searchers formulated 2 hypotheses. once. No incentives were provided. nutrition knowledge, especially con- The first hypothesis was that NCAA Di- cerning the relationship between diet vision III student-athletes who did not Survey Design and diseases.4,24 Evidence from the consume energy drinks would have literature also showed that nutrition higher knowledge of nutrition than The survey was administered using knowledge is related to dietary intake would student-athletes who consumed the online tool, Qualtrics (Qualtrics 4,25 in the general population. Studies energy drinks and competed within Labs, Provo, UT, 2014). All participants looking at this relationship within the same athletic division. The second completed the online survey consisting athletes found that fruit and vegetable hypothesis was that NCAA Division III of questions regarding gender, age, consumption seemed to be weakly student-athletes who did not consume college cumulative GPA, nutrition predicted by athletes' nutrition knowledge, energy drinks would have a higher courses taken during high school and but no study was found exploring the GPA and would more likely be female college, student-athlete status, sport(s) relationship between nutrition know- compared with student-athletes who in which they currently participated, ledge and the consumption of energy consumed energy drinks and competed the General Nutrition Knowledge Que- 4 drinks. Therefore, there is a need to within the same division. stionnaire for adults (GNKQ), and con- better understand whether nutrition sumption of energy drinks. The GNKQ knowledge is related to energy drink is a valid and reliable scale that has consumption in athletes, because con- METHODS been deemed useful for assessing the sumption of these drinks has increased Survey Design and Participants relationship between knowledge and di- in the young adult population (aged 18– etary behavior.31 The GNKQ was designed 8,26 25 years), especially among males. The University of Minnesota Institu- by Parmenter and Wardle31 for the UK This study aimed to identify the re- tional Review Board determined that adult population and consists of 4 lationships among general nutrition this investigationwasexemptfrom sections: dietary recommendations, knowledge, energy drink consump- review under federal guidelines. This sources of foods/nutrients, choosing tion, and socio-demographic charac- cross-sectional study was administered everyday foods, and diet–disease rela- teristics in a convenience sample of online to undergraduate student-ath- tionships. Some wording changes were American student-athletes who com- letes. The student-athletes competed performed on the original GNKQ to pete at the National Collegiate Ath- within the Upper Midwest Athletic adapt it for the American adult popula- letic Association (NCAA) Division III Conference, a member of the NCAA, tion; these changes did not affect the level. The NCAA consists of 3 separate at the Division III level. The survey validity of the questionnaire (Cron- levels, I, II, and III, in which differ- was available to these athletes from bach a ¼ .74 for the overall score). ences exist both athletically and aca- November 10 to December 21, 2014. This instrument was used in other demically. Performance expectations Nine colleges and universities com- published investigations that assessed are greater for NCAA I student-ath- peted within the conference, 5 of nutritional knowledge of student-ath- letes because athletic programs have which voluntarily participated in this letes.32,33 The researchers obtained higher budgets and athletic scholar- study. For athletes to be eligible for permission to use this instrument. ships are available to student-ath- this study, they had to have been un- The research team designed energy letes, whereas NCAA III athletic dergraduate student-athletes from 1 drink questions to be answered only Journal of Nutrition Education and Behavior Volume 49, Number 1, 2017 Hardy et al 21 by participants who identified them- from the current study. Therefore, the choosing everyday foods, in which selves as energy drink consumers (see final sample was 194 student-athletes. males scored 0.57 (95% confidence in- Supplementary Material). Most participants were aged 18– terval [CI], 0.93–0.21; P ¼ .002) higher 21 years (91.8%) and did not consume than females, representing a medium- d ¼ Statistical Analysis energy drinks (85.5%). The results of sized effect ( 0.47). chi-square test of independence showed that student-athletes who reported con- Analyses were performed using IBM Energy Drink Users SPSS Statistics (version 22, IBM Corp, suming energy drinks were more fre- quently male (about 68%) and had a Armonk, NY, 2013) using only com- Themajorityofenergydrinkusers lower GPA (about 61%). However, no pleted surveys. Descriptive analyses consumed Monster (61%) and/or Red differences between user and nonusers were performed to characterize the sa- Bull (57%). They identified that they were found for age, type of sport in mple size, including information ab- consumed energy drinks because they which they participated, and comple- out gender, age, sports, energy drink enjoyed the taste (54%) or that energy tion of nutrition courses in high school consumption, nutrition-related trai- drinks enhanced their focus (50%) or college (Table 1). ning, and overall GPA. Descriptive (Figure). The majority consumed < 1 analyses were also performed to As reported in Table 2,participants drink/wk (54%) or 1–2 drinks/wk (29%). characterize energy drink users. Chi- scored 58.4% on the GNKQ on average. Generally, the majority of users (64%) square test of independence was app- The section about dietary recommen- felt that they benefited from consuming lied to assess the association between dations had the highest scores (64.5%) energy drinks. Reported benefits included socio-demographic characteristics and and the section about diet and disease increased alertness (79%), increased the consumption of energy drinks. had the lowest scores (47%). There productivity (75%), and better focus The normality of sample sizes was were no significant differences in age, (67%). Only 12.5% of energy drink visually checked by plotting histo- GPA, or nutrition training regarding users reported that they felt that their grams and a P-plot and by looking at nutrition knowledge in this student- athletic performance improved by the distribution of the variables, such athlete population. No gender differ- consuming these beverages. as measures of central tendency, vari- ences were observed for most sections The majority of energy drink users ability, and shape. Independent t tests of the GNKQ apart from the area of (57%) reported that they did not assessed relationships among nutri- tion knowledge scores, socio-demogra- phic characteristics, and energy drink consumption. Table 1. Socio-Demographic Characteristics of the Total Sample and Socio- To estimate whether nutrition know- Demographic Differences Between Energy Drink Users and Nonusers ledge scores were related to the number of energy drinks consumed per week, Total, % (n) Users, % (n) Nonusers, % (n) c2 of correlations (r) between the nutrition (n ¼ 194) (n ¼ 28) (n ¼ 166) Independence knowledge score of each section and the number of drinks consumed were Gender calculated. Hierarchical regression ana- Female 57.7 (112) 32.1 (9) 62.0 (103) 8.78* lysis was performed to examine the Male 42.3 (82) 67.9 (19) 38.0 (63) relationship between energy drink Age, y consumption and nutrition know- 18–19 49.0 (95) 42.9 (12) 50.0 (83) 1.69 ledge score at each section, controlling 20–21 42.8 (83) 42.9 (12) 42.8 (71) for socio-demographic characteristics. $ 22 8.2 (16) 14.3 (4) 7.2 (12) Residuals were examined for all out- Athlete of individual sportsa comes and approximated normal dis- Yes 47.4 (92) 39.3 (11) 48.8 (81) 0.86 tribution in most cases. The presence No 52.6 (102) 60.7 (17) 51.2 (85) of outliers was checked, but because b the results were not sensitive to its in- Athlete of group sports clusion or exclusion, the full sample Yes 64.9 (126) 71.4 (20) 63.9 (106) 0.60 was used. P # .05 was considered to No 35.1 (68) 28.6 (8) 36.1 (60) be statistically significant. Nutrition classc Yes 52.1 (101) 42.9 (12) 53.6 (89) 1.11 No 47.9 (93) 57.1 (16) 46.4 (77) RESULTS College grade point average Socio-demographic # 3.2 31.4 (61) 60.7 (17) 26.5 (44) 16.03** Characteristics 3.21–3.8 40.7 (79) 35.7 (10) 41.6 (69) 3.81–4.00 27.8 (54) 3.6 (1) 31.9 (53) Initially, 208 individuals opened the survey and identified themselves as be- aAn athlete of cross-country, swimming and diving, golf, tennis, or track and ing aged $ 18 years; however, 14 field; bAn athlete of baseball, basketball, football, soccer, softball, or volleyball; stated that they were not currently a cHave taken nutrition class in high school or in college; *P < .01; **P < .001. student-athlete and were excluded Note: Users consume energy drinks; nonusers do not consume energy drinks. 2Hrye lJunlo urto dcto n Behavior and Education Nutrition of Journal al et Hardy 22 Table 2. Nutrition Knowledge, Socio-Demographic Characteristics, and Consumption of Energy Drinks

Knowledge Section

4f Overallb 1c 2d 3e Variable n (Mean [SD]) Statistic (Mean [SD]) Statistic (Mean [SD]) Statistic (Mean [SD]) Statistic (Mean [SD]) Statistic All participants Scores 194 58.4 (8.5) 7.1 (1.5) 39.1 (6.1) 4.1 (1.3) 8 (2.9) Gender Male 82 58.9 (1.0) t ¼0.56 7.1 (0.17) t ¼0.48 39.4 (0.73) t ¼0.66 4.51 (0.13) t ¼3.1** 7.73 (0.34) t ¼ 1.3 Female 112 58.2 (0.76) 7.0 (0.14) 38.8 (0.54) 3.93 (0.12) 8.31 (0.26) Age, y 18–19 95 58.1 (0.86) t ¼0.50 6.9 (0.15) t ¼1.3 39.0 (0.6) t ¼0.11 4.0 (0.13) t ¼1.3 8.0 (0.28) t ¼ 0.03 $ 20 99 58.7 (0.88) 7.2 (0.15) 39.1 (0.64) 4.3 (0.12) 8.0 (0.32) Nutrition classa Yes 101 58.9 (0.78) t ¼ 0.72 7.0 (0.15) t ¼0.43 39.6 (0.57) t ¼ 1.3 4.1 (0.13) t ¼0.46 8.0 (0.27) t ¼0.27 No 93 58.0 (0.95) 7.1 (0.15) 38.4 (0.68) 4.2 (0.13) 8.1 (0.33) College grade point average # 3.2 61 56.8 (1.1) F ¼ 2.4 7.0 (0.19) F ¼ 1.9 37.9 (0.80) F ¼ 1.8 4.21 (0.15) F ¼ 0.02 7.68 (0.40) F ¼ 1.4 3.21–3.8 79 58.3 (0.98) 7.0 (0.16) 39.2 (0.71) 4.16 (0.16) 7.97 (0.33) 3.81–4.0 54 60.4 (1.0) 7.4 (0.20) 40.1 (0.77) 4.16 (0.15) 8.6 (0.37) Energy drinks User 28 53.6 (2.2) t ¼2.4* 6.8 (0.30) t ¼1.1 36.1 (1.5) t ¼2.0* 4.21 (1.19) t ¼0.63 6.5 (0.7) t ¼2.3* Nonusers 166 59.2 (0.59) 7.1 (0.11) 39.5 (0.43) 4.2 (0.10) 8.3 (0.21) F indicates F test; t, t test. aNutrition class at school or college; bAll items, maximum score ¼ 100; cDietary Recommendations, maximum score ¼ 11; dSources of food/nutrients, maximum score ¼ 65; eHealthy food choices, maximum score ¼ 7; fDiet and disease, maximum score ¼ 17; *P < .05; **P < .01. oue4,Nme ,2017 1, Number 49, Volume Journal of Nutrition Education and Behavior Volume 49, Number 1, 2017 Hardy et al 23

ders (33%), or had trouble sleeping Enjoy the taste (n=15) at night (25%). Overall, the majority (57%) of energy drink consumers Focus your studying and/or work (n=14) indicated that the positive effects out- weighed the negative effects of Feel more alert (n=10) consuming energy drinks. Leisure and/or social reasons (n=7)

As a mixer for alcoholic beverages (n=5) Comparison of GNKQ Between

Enhance your athleƟc performance (n=4) Energy Drink Consumers and Non-consumers Other (n=2) Based on the independent t test results, 0 102030405060 student-athletes who reported consuming Percentage energy drinks had an overall knowl- edge score of 5.6 (95% CI, 10.46-0.91; Figure. Participants’ main reasons for consuming energy drinks. P ¼ .02) points lower than nonusers, which represented a medium-sized ef- fect (d ¼ 0.7). Also, energy drink users' nutrition knowledge scores were on experience side effects from they experienced shaking and/or average 3.4 (95% CI, 6.74-0.07; P ¼ .05) consuming these beverages. Those tremors (35%), experienced stomach- points and 1.74 (95% CI, 3.2-0.24; who had side effects reported that aches and/or gastrointestinal disor- P ¼ .02) points lower than nonusers'

Table 3. Multiple Regression Predicting Nutrition Knowledge Scores From Gender, Age, College Grade Point Average (GPA), Nutrition Class, and Energy Drink Consumption

Knowledge Section

Overallc 1d 2e 3f 4g

Model Model Model Model Model B b Sum B b Sum B b Sum B b Sum B b Sum Model 1 Gendera 1.3 .08 .21 .07 .94 .07 .62 .24** .41 .06 Age, y .49 .08 .10 .09 .33 .07 .007 .008 .06 .03 GPA .61 .17* .09 .14 .36 .14 .03 .05 .13 .10 Nutrition classb .50 .02 .16 .05 .93 .07 .13 .05 .14 .02 R2 .03 .027 .03 .054 .02 R2 Adj .014 .007 .01 .034 .001 F 1.6 1.31 1.5 2.70* .96 Model 2 Gendera 1.9 .11 .25 .08 1.3 .10 .66 .25** .24 .04 Age, y .53 .08 .10 .09 .35 .08 .004 .005 .07 .03 GPA .42 .11 .08 .12 .24 .09 .02 .03 .07 .06 Nutrition classb .18 .01 .18 .06 .75 .06 .15 .06 .22 .03 Energy drinksb 5.5 .22** .33 .07 3.3 .19* .34 .09 1.5 .18* R2 .08 .03 .06 .06 .05 R2 Adj .05 .007 .04 .04 .02 F 3.3** 1.2 2.5* 2.48* 2.0 DR2 .04 .005 .03 .008 .03 DF 9.5** 1.04 6.4** 1.58 6.07** B indicates the unstandardized coefficient; b, the standardized coefficient; R2, the multivariate coefficient, the overall fit of the model; R2 Adj, R2 adjusted; F, the F test; DR2, changes in R2; DF, the F statistic for R2 change. aFemale ¼ 0, male ¼ 1; bNutrition class at school or college where yes ¼ 0 and no ¼ 1; cAll items, maximum score ¼ 100; dDietary Recommendations, maximum score ¼ 11; eSources of food/nutrients, maximum score ¼ 65; fHealthy food choices, maximum score ¼ 7; gDiet and disease, maximum score ¼ 17; *P < .05; **P < .01. 24 Hardy et al Journal of Nutrition Education and Behavior Volume 49, Number 1, 2017 scores in the areas of sources of foods/ that most students-athletes did not sumption was associated with lower nutrients and diet and disease rel- consume energy drinks, but those who GPAs among college students in general. ationship, respectively. However, no didtendedtobemale,hadlesseroverall Bulutetal40 reported that students who differences in energy drink cons- knowledge of nutrition—especially in studied during nighttime hours were umption were observed in the areas the areas of sources of food/nutrients 1.6 times more likely to consume energy of dietary recommendations and cho- and the diet and disease relationship— drinks because of students' desire to osing everyday foods. and had a lower GPA than did those remain awake or seek improvements in The number of energy drinks who did not use energy drinks. mental performance. Results from the consumed per week was positively and The results of this study showed that current investigation also showed that significantly correlated to the nutrition most student-athletes scored lower in most participants tended to use energy knowledge score in the area of dietary the diet–disease relationship knowl- drinks because they liked the taste and recommendations (r ¼ .48; P < .001). edge section, which is in accordance these drinks helped them focus on their However, it was also negatively and with results from other studies con- studies or work. not significantly correlated to the nutri- ducted with athlete samples.4,24 The The results of this study also showed tion knowledge score in the areas of study also showed that most student- that users of energy drinks scored healthy food choices (r ¼.18; P ¼ athletes did not consume energy dri- significantly lower on both the section .35) and diet and disease (r ¼.23; nks, and those who did were mainly about sources of food/nutrients and P ¼ .23). No correlation was found be- motivated to do so because they en- that of diet and disease knowledge tween energy drinks consumed per joyed the taste. Curiosity about energy than did nonusers. Because health risks week and nutrition knowledge score in drink taste was a factor associated with are involved with consuming energy sources of food/nutrients (r ¼ .09) and why college students decided to try en- drinks in large quantities as a result of overall score (r ¼ .04). ergy drinks in the first place.34 Just a few to their elevated caffeine content, there To determine whether the energy students-athletes mentioned consuming is a need to educate student-athletes drinks were independently associated energy drinks to enhance their perfor- better about nutrition and energy drink with nutrition knowledge, the researchers mance. This is contrasts with results consumption. Weeden et al41 sugg- performed multiple regression anal- from previous investigations using ested that student-athletes complete a ysis. The results in Table 3 show that NCAA I or elite student-athlete samples, nutrition course in college to improve energy drink consumption was inde- which showed that most student- their nutrition knowledge. However, pendently associated with overall athletes in this program tended to with regard to the sample in the current GNKQ scores and the scores for sour- consume energy drinks to improve investigation, completion of a nutri- ces of foods/nutrients and diet–dis- their athletic performance.5,26,35-37 tion class had no effect on nutritional ease relationships, and that nonusers However, this research focused on knowledge. Karpinski42 suggested that had greater nutrition knowledge. The NCAA III student-athletes, a level a nutrition course designed specifically addition of the energy drink con- that did not get much attention within for the personal and unique needs of sumption variable to the models ac- the literature. Differences exist be- student-athletes may be more effective counting for gender, age, GPA, and tween NCAA III and NCAA I athletic for implementing behavioral changes. nutrition class (model 2) led to a sta- programs in terms of performance ex- Without this type of course, it is important tistically significant increase in the pectations, which may explain the to examine where the student-athletes multivariate coefficient (R2) of 0.047 differences in motivation and actual received their nutritional knowledge. ¼ P ¼ (F1,188 9.575; .002) in predicting consumption of energy drinks. The Further studies should explore better the overall score and an increase in NCAA I student-athletes had greater ways to promote nutrition knowledge 2 the R of 0.032 (F1,188 ¼ 6.47; P ¼ .12) performance expectations because within this population and how to in predicting sources of foods/nutri- theseprogramshavehigherbudgets incorporate a section on energy drink ents' scores. No significant increase and athletic scholarships are available consumption, because the consump- in R2 was observed in the area of to student-athletes whereas NCAA III tion of these drinks has little impact diet–disease relationships (F1,188 ¼ athletic program budgets are lower on performance and can be harmful 6.075; P ¼ .15). Most socio-demographic and athletic scholarships are not ava- to health when consumed in large characteristics did not significantly ilable to student-athletes.27 quantities.6,16,17,43 predict nutrition knowledge, with the This study also found that the exception of gender, which was inde- consumption of energy drinks was pendently associated with the area of greater among male student-athletes IMPLICATIONS FOR choosing everyday foods (P ¼ .001). and student-athletes with lower GPAs. RESEARCH AND This is in accordance with results PRACTICE from other studies; for example, Pettit DISCUSSION and DeBarr38 found that males were There are some limitations that may more likely than females to consume affect the generalizability of these re- The purpose of this study was to identify energy drinks when the researchersex- sults. This convenience sampling study relationships among general nutrition plored relationships regarding perceived had a cross-sectional design, which knowledge, energy drink consumption, stress, energy drink consumption, and cannot indicate causality. Participants and socio-demographic characteristics academic performance among college of this study were student-athletes par- in a convenience sample of collegiate students. Furthermore, Champlin et al39 ticipating in an athletic conference in student-athletes. The results showed reported that greater energy drink con- the Midwestern US. Therefore, this Journal of Nutrition Education and Behavior Volume 49, Number 1, 2017 Hardy et al 25 sample may not reflect the opinions of 2. Heaney S, O’Connor H, Gifford J, 15. Paddock R. Energy drinks’ effects on stu- other populations of student-athletes Naughton G. Comparison of strategies dent-athletes and implications for athletic who participate in different athletic for assessing nutritional adequacy in departments. 2008. http://thesportjourn conferences across the US. Furthermore, elite female athletes’ dietary intake. Int al.org/article/energy-drinks-effects-on-st only student-athletes who competed at J Sport Nutr Exerc. 2010;20:245-256. udent-athletes-and-implications-for-athle the NCAA III level were surveyed. It 3. Jonnalagadda SS, Ziegler PJ, tic-departments/. Accessed September 9, would be interesting to compare the re- Nelson JA. Food preferences, dieting 2016. sults of the survey among NCAA III, behaviors, and body image perceptions 16. Astorino TA, Matera AJ, Basinger J, NCAA II, and NCAA I schools or to of elite figure skaters. Int J Sport Nutr Evans M, Schurman T, Marquez R. compare the results with those of stu- Exerc. 2004;14:594-606. Effects of red bull energy drink on dent-athletes who compete within a 4. Spronk I, Heaney SE, Prvan T, repeated sprint performance in women National Association of Intercollegiate O’Connor HT. Relationship between athletes. Amino Acids. 2012;42:1803- Athletics–sponsored conference. A further general nutrition knowledge and die- 1808. limitation of this study is that student- tary quality in elite athletes. Int J Sport 17. Umana-Alvarado~ M, Moncada- athletes self-reported energy drink Nutr Exerc. 2015;25:243-251. Jimenez J. Consumption of an ‘‘energy consumption habits, which may have 5. Gallucci AR, Martin RJ, Morgan GB. drink’’ does not improve aerobic led to underreporting. The consumption of energy drinks performance in male athletes. Int J This investigation suggested that among a sample of college students Applied Sports Sciences. 2005;17: student-athletes competing at the NCAA and college student athletes. J Commu- 26-34. III level tend to refrain from energy nity Health. 2015;41:1-10. 18. Prins PJ, Goss FL, Nagle EF, et al. drink use. However, student-athletes 6. Gwacham N, Wagner DR. Acute ef- Energy drinks improve 5-km running who consume them tended to be male fects of a caffeine-taurine energy drink performance in recreational endurance and to have a lower GPA. Furthermore, on repeated sprint performance of runners. J Strength Cond. 2016;30: student-athletes who used energy dri- American college football players. Int J 2979-2990. nks had a tendency to have lower over- Sport Nutr Exerc Metab. 2012;22:109-116. 19. Del Coso J, Portillo J, Salinero JJ, all knowledge of nutrition and lower 7. Higgins JP, Tuttle TD, Higgins CL. Lara B, Abian-Vicen J, Areces F. knowledge in areas of the sources of Energy beverages: content and safety. Caffeinated energy drinks improve food/nutrients and the diet–disease Mayo Clin Proc. 2010;85:1033-1041. high-speed running in elite field hockey relationship than did nonusers. There- 8. Reissig CJ, Strain EC, Griffiths RR. players. Int J Sport Nutr Exerc Metab. fore, there is a need for nutrition edu- Caffeinated energy drinks—a growing 2016;26:26-32. cation targeted to this population, problem. Drug Alcohol Depend. 2009; 20. Quinlivan A, Irwin C, Grant GD, et al. because optimal nutrition has an impor- 99:1-10. The effects of Red Bull energy drink tant role in athletes' performance and 9. Clauson KA, Shields KM, compared with caffeine on cycling health. Nutrition education for student- McQueen CE, Persad N. Safety issues time-trial performance. Int J Sports athletes should also encompass the associated with commercially available Physiol Perform. 2015;10:897-901. consumption of energy drinks, because energy drinks. Pharmacy Today. 2008; 21. An SM, Park JS, Kim SH. Effect of it has little impact on performance and 14:52-64. energy drink dose on exercise capac- can lead to health risks when consumed 10. Holmgren P, Norden-Pettersson L, ity, heart rate recovery and heart in large quantities. Ahlner J. Caffeine fatalities—four case rate variability after high-intensity reports. Forensic Sci Int. 2004;139:71-73. exercise. J Exerc Nutrition Biochem. 11. Emond JA, Sargent JD, Gilbert- 2014;18:31-39. ACKNOWLEDGMENTS Diamond D. Patterns of energy drink 22. Kammerer M, Jaramillo JA, GarcaA, Special thanks to all athletic directors advertising over US television net- Caldern JC, Valbuena LH. Effects of from the participating universities who works. J Nutr Educ Behav. 2015;47: energy drink major bioactive com- kindly invited their students to take 120-126.e121. pounds on the performance of young part in this study. 12. Larson N, DeWolfe J, Story M, adults in fitness and cognitive tests: a Neumark-Sztainer D. Adolescent con- randomized controlled trial. J Int Soc sumption of sports and energy drinks: Sports Nutr. 2014;11:44. SUPPLEMENTARY DATA linkages to higher physical activity, un- 23. Mora-Rodriguez R, Pallares JG. healthy beverage patterns, cigarette Performance outcomes and un- Supplementary data related to this smoking, and screen media use. J Nutr wanted side effects associated with article can be found at http://dx.doi.org/ Educ Behav. 2014;46:181-187. energy drinks. Nutr Reviews. 2014; 10.1016/j.jneb.2016.08.008. 13. Ludwig DS, Peterson KE, Gortmaker SL. 72:108-120. Relation between consumption of sugar- 24. Spendlove JK, Heaney SE, Gifford JA, sweetened drinks and childhood obesity: a Prvan T, Denyer GS, O’Connor HT. REFERENCES prospective, observational analysis. Lan- Evaluation of general nutrition knowl- cet. 2001;357:505-508. edge in elite Australian athletes. Br J 1. Rodriguez NR, DiMarco NM, 14. Malik VS, Schulze MB, Hu FB. Intake Nutr. 2012;107:1871-1880. Langley S. Nutrition and athletic per- of sugar-sweetened beverages and 25. Wardle J, Parmenter K, Waller J. formance. Med Sci Sports Exerc. 2009; weight gain: a systematic review. Am Nutrition knowledge and food intake. 41:709-731. J Clin Nutr. 2006;84:274-288. Appetite. 2000;34:269-275. 26 Hardy et al Journal of Nutrition Education and Behavior Volume 49, Number 1, 2017

26. Buxton C, Hagan JE. A survey of en- 32. Holden SL, Baghurst TM, Pugh SF, 38. Pettit ML, DeBarr KA. Perceived stress, ergy drinks consumption practices Keshock CM, Heitman RJ. Compari- energy drink consumption, and academic among student-athletes in Ghana: les- son of the nutritional knowledge of col- performance among college students. J sons for developing health education lege athletes and nonathletes. Res Q Am Coll Health. 2011;59:335-341. intervention programmes. J Int Soc Exerc Sport. 2014;85:A70. 39. Champlin SE, Pasch KE, Perry CL. Is the Sports Nutr. 2012;9:9. 33. Dunn D, Turner LW, Denny G. Nutri- consumption of energy drinks associated 27. National Collegiate Athletic Associa- tion knowledge and attitudes of college with academic achievement among col- tion. NCAA Recruiting Facts. 2014. athletes. 2008. http://thesportjournal. lege students? J Prim Prev. 2016;37:1-15. https://www.ncaa.org/sites/default/ org/article/nutrition-knowledge-and- 40. Bulut B, Beyhun NE, Topbas¸M, files/Recruiting%20Fact%20Sheet% attitudes-of-college-athletes/. Accessed C¸an G. Energy drink use in university 20WEB.pdf. Accessed September 9, September 9, 2016. students and associated factors. J Com- 2016. 34. Attila S, C¸akir B. Energy-drink con- munity Health. 2014;39:1004-1011. 28. Grites TJ, James GL. Division III— sumption in college students and associ- 41. Weeden AM, Olsen J, Batacan JM, Peter- another ballgame. NACADA Journal. ated factors. Nutrition. 2011;27:316-322. son T. Differences in collegiate athlete 1986;6:23-26. 35. Hoyte CO, Albert D, Heard KJ. The nutrition knowledge as determined by 29. Umbach PD, Palmer MM, Kuh GD, use of energy drinks, dietary supple- athlete characteristics. 2014. http:// Hannah SJ. Intercollegiate athletes and ments, and prescription medications thesportjournal.org/article/differences-in- effective educational practices: winning by United States college students to collegiate-athlete-nutrition-knowledge- combination or losing effort? Res High enhance athletic performance. J Com- as-determined-by-athlete-characteristics/. Educ. 2006;47:709-733. munity Health. 2013;38:575-580. Accessed September 9, 2016. 30. Robst J, Keil J. The relationship between 36. Woolsey C. Energy drink cocktails: a athletic participation and academic per- dangerous combination for athletes and 42. Karpinski C. Exploring the feasibility of formance: evidence from NCAA Divi- beyond. J Alcohol Drug Educ. 2010;54:41-68. an academic course that provides nutri- sion III. Appl Econ. 2000;32:547-558. 37. Huang SH, Johnson K, Pipe AL. The tion education to collegiate student-ath- 31. Parmenter K, Wardle J. Development use of dietary supplements and medica- letes. J Nutr Educ Behav. 2012;44:267-270. of a general nutrition knowledge ques- tions by Canadian athletes at the At- 43. Rath M. Energy drinks: what is all the hype? tionnaire for adults. Eur J Clin Nutr. lanta and Sydney Olympic Games. The dangers of energy drink consumption. 1999;53:298-308. Clin J Sport Med. 2006;16:27-33. J Am Acad Nurse Pract. 2012;24:70-76. Journal of Nutrition Education and Behavior Volume 49, Number 1, 2017 Hardy et al 26.e1

CONFLICT OF INTEREST

JB is the deputy editor for the Journal of Arthroscopy. The other authors have not stated any conflicts of interest.