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Clinical Report–Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?

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Clinical Report–Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate? Guidance for the Clinician in Rendering Pediatric Care Clinical Report–Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate? COMMITTEE ON NUTRITION AND THE COUNCIL ON SPORTS abstract MEDICINE AND FITNESS Sports and energy drinks are being marketed to children and adoles- KEY WORDS sport drinks, energy drinks, obesity, caffeine cents for a wide variety of inappropriate uses. Sports drinks and en- This document is copyrighted and is property of the American ergy drinks are significantly different products, and the terms should Academy of Pediatrics and its Board of Directors. All authors not be used interchangeably. The primary objectives of this clinical have filed conflict of interest statements with the American report are to define the ingredients of sports and energy drinks, cate- Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American gorize the similarities and differences between the products, and dis- Academy of Pediatrics has neither solicited nor accepted any cuss misuses and abuses. Secondary objectives are to encourage commercial involvement in the development of the content of screening during annual physical examinations for sports and energy this publication. drink use, to understand the reasons why youth consumption is wide- The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. spread, and to improve education aimed at decreasing or eliminating Variations, taking into account individual circumstances, may be the inappropriate use of these beverages by children and adolescents. appropriate. Rigorous review and analysis of the literature reveal that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents. Furthermore, frequent or ex- cessive intake of caloric sports drinks can substantially increase the risk for overweight or obesity in children and adolescents. Discussion regarding the appropriate use of sports drinks in the youth athlete who participates regularly in endurance or high-intensity sports and vigor- ous physical activity is beyond the scope of this report. Pediatrics 2011;127:1182–1189 www.pediatrics.org/cgi/doi/10.1542/peds.2011-0965 doi:10.1542/peds.2011-0965 Sports and energy drinks are a large and growing beverage industry All policy statements from the American Academy of Pediatrics now marketed to children and adolescents for a variety of uses. Mar- automatically expire 5 years after publication unless reaffirmed, keting strategies for sports drinks suggest optimization of athletic revised, or retired at or before that time. performance and replacement of fluid and electrolytes lost in sweat PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). during and after exercise, and marketing strategies for energy drinks Copyright © 2011 by the American Academy of Pediatrics purport a boost in energy, decreased fatigue, enhanced concentration, and mental alertness. Sports drinks are different products than en- ergy drinks; therefore, the terms should not be used interchangeably. Sports drinks are flavored beverages that often contain carbohy- drates, minerals, electrolytes (eg, sodium, potassium, calcium, magne- sium), and sometimes vitamins or other nutrients. Although the term “energy” can be perceived to imply calories, energy drinks typically contain stimulants, such as caffeine and guarana, with varying amounts of carbohydrate, protein, amino acids, vitamins, sodium, and other minerals. With children and adolescents, careful consideration is necessary when selecting a beverage to hydrate before, during, or after exercise and outside of physical activity to prevent excessive sugar and caloric intake that may encourage dental erosion, overweight, and obesity.1 1182 FROM THE AMERICAN ACADEMY OF PEDIATRICS Downloaded from www.aappublications.org/news by guest on September 24, 2021 FROM THE AMERICAN ACADEMY OF PEDIATRICS Pediatric athletes can benefit from us- mid environment or be subjected to DEFINITION AND CATEGORIZATION ing sports drinks that contain carbohy- prolonged, repetitive exercise, often OF SPORTS DRINKS VERSUS drates, protein, or electrolytes2; how- without adequate recovery time in be- ENERGY DRINKS ever, for the average child engaged in tween competitions), or other pro- Sports drinks are beverages that routine physical activity, the use of longed vigorous physical activities, be- may contain carbohydrates, miner- sports drinks in place of water on the cause these uses have been reviewed als, electrolytes, and flavoring and 4 sports field or in the school lunchroom elsewhere. are intended to replenish water and is generally unnecessary. Stimulant- DEVELOPMENT OF THIS REPORT electrolytes lost through sweating containing energy drinks have no during exercise. In contrast, the place in the diets of children or adoles- The American Academy of Pediatrics term “energy drink” refers to a very 3 cents. Excessive regular consumption Committee on Nutrition (CON) and different type of beverage. Today’s of carbohydrate-containing beverages Council on Sports Medicine and Fit- energy drinks also contain sub- increases overall daily caloric intake ness (COSMF) conducted a thorough stances that act as nonnutritive stim- without significant additional nutri- review of the literature from 2000 ulants, such as caffeine, guarana, tau- tional value. Therefore, frequent con- to 2009. Various approaches were rine, ginseng, L-carnitine, creatine, sumption adversely affects the appro- used, including numerous PubMed and/or glucuronolactone, with pur- priate balance of carbohydrate, fat, searches. Reference lists from related ported ergogenic or performance- and protein intakes needed for optimal studies, reviews, editorials, and posi- enhancing effects. Tables 1 and 2 list growth, development, body composi- tion statements from other profes- some popular commercially available tion, and health. This report defines sional organizations were used. sports drinks and energy drinks and and categorizes selected popular Search terms included sports drinks, their respective contents. sports and energy drinks, reviews energy drinks, children, and adoles- their contents, and examines the evi- cents. The recent Institute of Medicine COMPONENTS OF SPORTS AND dence for and against the use of sports report on school health3 and position ENERGY DRINKS AND THEIR and energy drinks in children and ad- statements on this subject from the INDICATIONS olescents. Recommendations are pro- American Dietetic Association and vided for counseling patients, parents, American College of Sports Medicine2 Water government policy-makers, and ad- were reviewed for this report. Com- Water is an essential part of the daily ministrators who run both school pro- ments were solicited from commit- diet. Adequate hydration is necessary grams and youth sports organizations tees, sections, and councils of the for maintaining normal cardiovascu- with regard to appropriate use of American Academy of Pediatrics; 7 en- lar, thermoregulatory, and many other sports drinks. It is not intended to be a tities responded. For recommenda- physiologic functions during exercise guide for the use or effectiveness of tions for which high levels of evidence and routine daily activity. In children, these drinks in children and adoles- are absent, the expert opinions and maturation and body size are the pri- cents involved in competitive endur- suggestions of the CON, the COSMF, mary determinants of the necessary ance, repeated-bout sports (such as and other groups/authorities con- daily water intake. The quantity of wa- tournaments in which the athlete may sulted were taken into consideration ter needed to maintain a euvolemic have prolonged exposure to a hot, hu- in development of this clinical report. state is influenced by a number of fac- TABLE 1 Contents of a Sampling of Sports Drinks per Serving (240 mL [8 oz]) Product Manufacturer Calories Carbohydrate, g Sodium, mg Potassium, mg Vitamins Other All Sport Body Quencher All Sport, Inc 60 16 55 60 C — All Sport Naturally Zero All Sport, Inc 0 0 55 60 B3,B5,B6,B12 — Gatorade PepsiCo Inc 50 14 110 30 — — Gatorade Propel PepsiCo Inc 10 3 35 — B3,B5,B6,B12,C,E — Gatorade Endurance PepsiCo Inc 50 14 200 90 — Calcium, magnesium Gatorade G2 PepsiCo Inc 20 5 110 30 — — Powerade Zero Coca-Cola Company 0 0 100 25 B3,B6,B12 — Powerade Coca- Cola Company 78 19 54 — — Iron Powerade Ion4 Coca-Cola Company 50 14 100 25 B3,B6,B12 — Accelerade Pacific Health Laboratories, Inc 80 15 120 15 E Calcium, protein Selection of the specific sports drinks listed was based on the most commonly available products at the time this report was under development. PEDIATRICS Volume 127, Number 6, June 2011 1183 Downloaded from www.aappublications.org/news by guest on September 24, 2021 1184 TABLE 2 Contents of a Sampling of Energy Drinks per Serving (240 mL [8 oz]) FROM THE AMERICAN ACADEMY OF PEDIATRICS Product Manufacturer Calories Carbohydrate, Sodium, Potassium, Caffeine, Calcium, Vitamins Taurine, Guarana, Other g mg mg mg mg mg mg a a Java Monster Hansen Natural Corporation 100 17 340 240 180 A, B2,B3,B6,B12, C, D 1000 Inositol, ginseng, L-carnitine, glucuronolactone, phosphorus a Java Monster Hansen Natural Corporation 50 6 230 60 90 B2,B3,B6,B12, C, D — — Inositol, ginseng, L-carnitine, Lo-Ball glucuronolactone, phosphorus a a Downloaded from Monster Energy Hansen Natural Corporation 100 27 180 — —B2,B3,B6,B12, C
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