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Health Effects of Energy Drinks on Children, Adolescents, and Young Adults

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Health Effects of Energy Drinks on Children, Adolescents, and Young Adults SPECIAL ARTICLES Health Effects of Energy Drinks on Children, Adolescents, and Young Adults AUTHORS: Sara M. Seifert, BS, Judith L. Schaechter, MD, Eugene R. Hershorin, MD, and Steven E. Lipshultz, MD abstract Department of Pediatrics and the Pediatric Integrative Medicine OBJECTIVE: To review the effects, adverse consequences, and extent of Program, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida energy-drink consumption among children, adolescents, and young adults. KEY WORDS energy drink, caffeine, taurine, children, adolescents, overdose METHODS: We searched PubMed and Google using “energy drink,” ABBREVIATIONS “sports drink,” “guarana,” “caffeine,” “taurine,” “ADHD,” “diabetes,” FDA—Food and Drug Administration “children,” “adolescents,” “insulin,” “eating disorders,” and “poison ADHD—attention-deficit/hyperactivity disorder control center” to identify articles related to energy drinks. Manu- www.pediatrics.org/cgi/doi/10.1542/peds.2009-3592 facturer Web sites were reviewed for product information. doi:10.1542/peds.2009-3592 RESULTS: According to self-report surveys, energy drinks are con- Accepted for publication Dec 3, 2010 sumed by 30% to 50% of adolescents and young adults. Frequently Address correspondence to Steven E. Lipshultz, MD, Department containing high and unregulated amounts of caffeine, these drinks of Pediatrics (D820), Leonard M. Miller School of Medicine, University of Miami, Medical Campus MCCD-D820, 1601 NW 12th have been reported in association with serious adverse effects, espe- Ave, 9th Floor, PO Box 016820, Miami, FL 33101. E-mail: cially in children, adolescents, and young adults with seizures, diabe- [email protected] tes, cardiac abnormalities, or mood and behavioral disorders or PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). those who take certain medications. Of the 5448 US caffeine over- Copyright © 2011 by the American Academy of Pediatrics doses reported in 2007, 46% occurred in those younger than 19 FINANCIAL DISCLOSURE: The authors have indicated they have years. Several countries and states have debated or restricted their no financial relationships relevant to this article to disclose. sales and advertising. Funded by the National Institutes of Health (NIH). CONCLUSIONS: Energy drinks have no therapeutic benefit, and many ingredients are understudied and not regulated. The known and un- known pharmacology of agents included in such drinks, combined with reports of toxicity, raises concern for potentially serious adverse ef- fects in association with energy-drink use. In the short-term, pediatri- cians need to be aware of the possible effects of energy drinks in vulnerable populations and screen for consumption to educate fami- lies. Long-term research should aim to understand the effects in at-risk populations. Toxicity surveillance should be improved, and regulations of energy-drink sales and consumption should be based on appropri- ate research. Pediatrics 2011;127:511–528 PEDIATRICS Volume 127, Number 3, March 2011 511 Downloaded from www.aappublications.org/news by guest on September 26, 2021 “Energy drinks” are beverages that Given the rapidly growing market and DISCUSSION contain caffeine, taurine, vitamins, popularity among youth, we re- What Are Energy Drinks? herbal supplements, and sugar or viewed the literature to (1) deter- sweeteners and are marketed to im- mine what energy drinks are, (2) Energy drinks may contain caffeine, prove energy, weight loss, stamina, compile consumption data of energy taurine, sugars and sweeteners, athletic performance, and concen- drinks by children, adolescents, and herbal supplements, and other ingre- tration.1–3 Energy drinks are available young adults, (3) compile caffeine dients (Table 2) and are distinct from sports drinks and vitamin waters (Ta- in Ͼ140 countries and are the fastest and energy-drink overdose data, (4) ble 3).6,8 In 2008, the National Federa- growing US beverage market; in 2011, examine the physiologic effects of tion of State High School Associations, sales are expected to top $9 billion.4–10 the ingredients in energy drinks, (5) while recommending water and Half of the energy-drink market con- identify potential problems of energy sports drinks for rehydration, spe- sists of children (Ͻ12 years old), ado- drinks among children and adoles- cifically did not recommend energy lescents (12–18 years old), and young cents, (6) assess the marketing of drinks and cited potential risks, the adults (19–25 years old).7–10 energy drinks, (7) report current absence of benefit, and drug interac- Although healthy people can tolerate regulation of energy drinks, and (8) tions (Table 4).36,37 caffeine in moderation, heavy caffeine propose educational, research, and consumption, such as drinking energy regulatory recommendations. Caffeine is the main active ingredient drinks, has been associated with even in energy drinks; many of them contain more serious consequences such as METHODS 70 to 80 mg per 8-oz serving (ϳ3 times seizures, mania, stroke, and sudden the concentration in cola drinks) (Ta- We searched PubMed by using “energy 8,31 6–8,12–14 ble 5). Caffeine content can be death. Numerous reports exist drink,” “sports drink,” “guarana,” “caf- in the popular media, and there are a nearly 5 times greater than that in 8 oz feine,” “taurine,” “ADHD” (attention- of cola drinks when packaged as “en- handful of case reports in the litera- deficit/hyperactivity disorder), “diabe- ture that associate such adverse ergy shots” (0.8–3 oz) or as 16-oz tes,” “children,” “adolescents,” “insulin,” drinks.6,29,38 events with energy-drink consump- “eating disorders,” and “poison control tion; it is prudent to investigate the Energy drinks often contain additional center” singly or in combination. We lim- validity of such claims (Appendix). amounts of caffeine through additives, ited searches to English-language and Children, especially those with car- including guarana, kola nut, yerba foreign-language articles with English- diovascular, renal, or liver disease, mate, and cocoa.6,7,14,25 Guarana language abstracts and selected articles seizures, diabetes, mood and behav- (Paullinia cupana) is a plant that by relevance to energy-drink use in chil- ioral disorders, or hyperthyroidism or contains caffeine, theobromine (a dren and adolescents. We similarly those who take certain medications, chronotrope), and theophylline (an searched Google for print and trade me- may be at higher risk for adverse inotrope).39 Each gram of guarana dia. We reviewed articles and Internet events from energy-drink consump- can contain 40 to 80 mg of caffeine, sources by the above search through tion.6–8,14–24 Although the US Food and and it has a potentially longer half- June 2010 and updated sections as new Drug Administration (FDA) limits caf- life because of interactions with information became available through feine content in soft drinks, which are other plant compounds.7,14 Manufac- January 2011. categorized as food, there is no such turers are not required to list the regulation of energy drinks, which are caffeine content from these ingredi- RESULTS classified as dietary supplements.1–3 ents.7,14 Thus, the actual caffeine Despite the large, unregulated market Two-thirds of the 121 references we dose in a single serving may exceed for energy drinks and reports in the found on energy drinks were in the sci- that listed.9,29 literature and popular media of seri- entific literature, although reports by ous adverse events associated with government agencies and interest Consumption of Energy Drinks by their consumption, research into their groups also contained much useful in- Children, Adolescents, and Young use and effects has been sparse.25 formation (Table 1). Most information Adults However, schools, states, and coun- came from the United States, but Euro- In the United States, adolescent caf- tries increasingly are exploring con- pean, Canadian, Australian, New Zea- feine intake averages 60 to 70 mg/day tent and sales regulations of these land, and Chinese sources are also and ranges up to 800 mg/day.24,40 Most drinks.1,8,13,26–35 represented. caffeine comes from soda; however, 512 Seifert et al Downloaded from www.aappublications.org/news by guest on September 26, 2021 SPECIAL ARTICLES TABLE 1 Primary Literature and Media Sources Selected for Review, According to Relevance Source Description No. of Main Topics Source Country Results Primary literature 81 Systematic reviews 0 — — Review articles 36 Energy drinks are a growing problem; safety issues with energy drinks; US, Poland, United Kingdom, Germany, stimulant adverse effects; caffeine dependence; caffeine and fluid- China electrolyte balance; caffeine and exercise performance; caffeine and mental performance; caffeine and apnea of prematurity; caffeine and bronchopulmonary dysplasia; caffeine and coronary heart disease; herb adverse effects; adolescents with ADHD and misuse of medication; ADHD and substance use; cardiovascular effects of antidepressants in children and adolescents; caffeine consumption and eating disorders; caffeine and bone gain in children and adolescents; incidence of pediatric cardiomyopathy; frequency of myocardial injury in children; epidemiology of hypertrophic cardiomyopathy Randomized controlled trials 0 — — Experimental studies 16 Cognitive and physiological effects of energy drinks; caffeine and United States, United Kingdom, exercise performance, thermoregulation, and fluid-electrolyte Germany balance; energy-drink effects on hemodynamic
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