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Risk Assessment of Energy Drinks and Caffeine

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Risk Assessment of Energy Drinks and Caffeine VKM Report 2019: 01 Risk assessment of energy drinks and caffeine Scientific Opinion of the Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food, and Cosmetics of the Norwegian Scientific Committee for Food and Environment Report from the Norwegian Scientific Committee for Food and Environment (VKM) 2019: 01 Risk assessment of energy drinks and caffeine Scientific Opinion of the Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food, and Cosmetics of the Norwegian Scientific Committee for Food and Environment 01.02.2019 ISBN: 978-82-8259-317-5 ISSN: 2535-4019 Norwegian Scientific Committee for Food and Environment (VKM) Po 222 Skøyen N – 0213 Oslo Norway Phone: +47 21 62 28 00 Email: [email protected] vkm.no vkm.no/english Cover photo: iStockphoto Suggested citation: VKM, Ellen Bruzell, Monica Hauger Carlsen, Berit Granum, Inger Therese Lillegaard, Gro Haarklou Mathisen, Josef Daniel Rasinger, Camilla Svendsen, Tove Gulbrandsen Devold, Jens Rohloff and Trine Husøy (2019). Risk assessment of energy drinks and caffeine. Scientific Opinion of the Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food, and Cosmetics of the Norwegian Scientific Committee for Food and Environment. VKM report 2019:01, ISBN: 978-82-8259-317-5, ISSN: 2535-4019. Norwegian Scientific Committee for Food and Environment (VKM), Oslo, Norway. VKM Report 2019: 01 Risk assessment of energy drinks and caffeine Authors of the opinion The Norwegian Scientific Committee for Food and Environment (Vitenskapskomiteen for mat og miljø, VKM) appointed a project group to answer the request. The project group consisted of eight persons, including a project leader from the VKM secretariat. The VKM Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food and Cosmetics (the Panel from now onward) evaluated and approved the final opinion: Members of the project group that contributed to the drafting of the opinion (in alphabetical order after chair of the project group): Ellen Bruzell – Chair of the project group and member of the Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food, and Cosmetics in VKM. Affiliation: 1) VKM; 2) Nordic Institute of Dental Materials Monica Hauger Carlsen - Member of the Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food and Cosmetics. Affiliation: 1) VKM; 2) University of Oslo Berit Granum - Member of the Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food and Cosmetics. Affiliation: 1) VKM; 2) Norwegian Institute of Public Health Trine Husøy – Member of the Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food and Cosmetics. Affiliation: 1) VKM; 2) Norwegian Institute of Public Health Inger Therese Lillegaard – VKM secretariat. Affiliation: VKM Gro Haarklou Mathisen – VKM secretariat, leader of the project. Affiliation: VKM Josef Daniel Rasinger - Member of the Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food and Cosmetics. Affiliation: 1) VKM; 2) Institute of Marine Research Camilla Svendsen - Member of the Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food and Cosmetics. Affiliation: 1) VKM; 2) Norwegian Institute of Public Health Members of the Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food and Cosmetics that contributed to and approved the opinion: In addition to Ellen Bruzell, Monica Hauger Carlsen, Berit Granum, Trine Husøy, Josef Daniel Rasinger and Camilla Svendsen, these were (in alphabetical order): VKM Report 2019: 01 Tove Gulbrandsen Devold - Member of the Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food and Cosmetics. Affiliation: 1) VKM; 2) Norwegian University of Life Sciences Jens Rohloff - Member of the Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food and Cosmetics. Affiliation: 1) VKM; 2) Norwegian University of Science and Technology Acknowledgment VKM would like to thank Bente Foss (Norwegian Institute of Public Health, the library) for valuable help in designing and performing the literature searches. VKM would like to thank Jan Alexander (Norwegian Institute of Public Health) for valuable discussions on risk assessment and expert advice on medical and health issues. VKM would like to thank Polly Boon (National Institute for Public Health and the Environment, the Netherlands), Per Ole Iversen (Institute of Basic Medical Sciences, University of Oslo, Norway), and Wim Mennes (National Institute for Public Health and the Environment, the Netherlands) for their valuable comments through critical review of the draft opinion. VKM emphasises that the three referees are not responsible for the content of the final opinion. In accordance with VKM’s routines for approval of a risk assessment (VKM 2018), VKM received their comments before evaluation and approval by the Panel, and before the opinion was finalised for publication. Competence of VKM experts Persons working for VKM, either as appointed members of the Committee or as external experts, do this by virtue of their scientific expertise, not as representatives for their employers or third party interests. The Civil Services Act instructions on legal competence apply for all work prepared by VKM. VKM Report 2019: 01 Table of Contents Risk assessment of energy drinks and caffeine ...................................................... 1 Risk assessment of energy drinks and caffeine .................................................................. 3 Competence of VKM experts ............................................................................................ 4 Short summary ..................................................................................................... 10 Kort sammendrag ................................................................................................. 13 Abbreviations and glossary .................................................................................. 16 Background as provided by the Norwegian Food Safety Authority ...................... 18 Terms of reference as provided by the Norwegian Food Safety Authority ........... 19 Assessment .......................................................................................................... 20 1 Introduction ................................................................................................. 20 1.1 Limitations of the assignment ............................................................................... 20 2 General information ..................................................................................... 22 2.1 Regulation of energy drinks and caffeine................................................................ 22 2.2 Caffeine .............................................................................................................. 23 2.2.1 Chemistry ................................................................................................. 23 2.2.2 Occurrence ............................................................................................... 23 2.2.3 Mode of action .......................................................................................... 23 2.2.4 Absorption, distribution, metabolism and excretion (ADME)........................... 23 2.2.5 Reference point for toxicity for children and adolescents ............................... 24 3 Hazard identification and characterisation .................................................. 25 3.1 Literature energy drinks ....................................................................................... 26 3.1.1 Previous evaluations and assessments – energy drinks ................................. 26 3.1.1.1 Consumption and health risks of energy drinks by Dutch children and adolescents (Bemelmans et al., 2018) ................................................................... 26 3.1.1.2 Energidrikke i Danmark. Undersøgelse af indtaget blandt 10-35-årige (Christensen LM et al., 2014) [In Danish] ............................................................... 26 3.1.1.3 Opinion of the French Agency for Food, Environmental and Occupational Health & Safety on the assessment of risks concerning the consumption of so-called “energy drinks” (ANSES, 2013) ............................................................................. 26 3.1.1.4 Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context (Rotstein et al., 2013 ) ............................................................................. 26 3.1.2 Literature search and publication selection – energy drinks ........................... 27 3.1.2.1 Literature search energy drinks ................................................................ 27 3.1.2.2 Publication selection and data extraction energy drinks .............................. 27 VKM Report 2019: 01 3.1.3 Evaluation of risk of bias for the RCTs on energy drink ................................. 35 3.1.4 Weighting the body of evidence of energy drink consumption RCTs ............... 39 3.2 Literature caffeine ................................................................................................ 45 3.2.1 Previous evaluations and assessments caffeine ............................................ 45 3.2.1.1 EFSA Scientific Opinion on Flavouring Group Evaluation 49, Revision 1 (FGE.49Rev1):
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