Effects of caffeine on human health

Self-reported surgeon health behaviours: A multicentre, cross-sectional exploration into the modifiable factors that impact surgical performance with the association of surgeons in training

Introduction

Surgeons regularly educate patients on health promoting behaviours including diet, sleep and exercise. No study thus far has explored surgeons’ personal compliance with these health behaviours and their relationship with surgical performance. The primary outcomes of this study were self-reported health, health related behaviours, wellbeing, fatigue and surgical performance.

Methods

A survey of validated themes on health related behaviours, workplace variables and performance was distributed to surgical trainees and consultants in the UK and Ireland through the Association for Surgeons in Training (ASiT). Non-parametric analysis was used to determine inferential associations.

Results

Ninety five surgeons (51.5% female, 39.9% registrars) completed the survey. 94% and 74% reported ‘good’ or better overall health and mental wellbeing respectively. The majority (54.7%) reported inconsistent sleep patterns. Less than a quarter engage in regular exercise. Sixty two and 64.2% reported being regularly fatigued and bothered by feelings of anxiety and/or depression respectively. Poor self-reported health and wellbeing were associated with poorer reported off-call performance (p < .01). Higher levels of fatigue negatively impacted self-reported surgical and non-surgical task proficiency (p < .01).

Discussion and conclusion

Surgeons reported high levels of overall health. However, healthy behaviours around sleep, diet and exercise were not consistently reported. Fewer reported good mental health and emotional well-being. Self-reported health behaviours including sleep and physical activity were associated with surgical performance. Strategies to improve modifiable lifestyle factors which will optimise physical health, mental wellbeing and levels of fatigue may optimise surgical performance.

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94% and 74% respectively reported having at least ‘good’ health and well-being.

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A majority reported being regularly fatigued and inconsistent sleep patterns.

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Poorer health and wellbeing were associated with poorer performance off-call (p < .01).

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Higher levels of fatigue negatively impacted technical and non-technical performance.

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Improving modifiable factors to optimise health and wellbeing may improve performance.

A comprehensive review of the effects of caffeine on the auditory and vestibular systems

Coffee, of which caffeine is a critical component, is probably the most frequently used psychoactive stimulant in the world. The effects of caffeine on the auditory and vestibular system have been investigated under normal and pathological conditions, such as acoustic trauma, ototoxicity, auditory neuropathy, and vestibular disorders, using various tests. Lower incidences of hearing loss and tinnitus have been reported in coffee consumers. The stimulatory effect of caffeine is represented by either a shorter latency or enhanced amplitude in electrophysiological tests of the auditory system. Furthermore, in the vestibular system, oculomotor testing revealed significant effects of caffeine, while other tests did not reveal any significant caffeine effects. It could be that caffeine improves transmission in the auditory and vestibular systems' central pathways. Importantly, the effects of caffeine seem to be dose-dependent. Also, inconsistent findings have been observed regarding caffeine's effects on the auditory and vestibular systems and related disorders. Overall, these findings suggest that caffeine does not strongly influence the peripheral auditory and vestibular systems. Instead, caffeine's effects seem to occur almost solely at the level of the central nervous system.

The effect of high-dose, short-term caffeine intake on the renal clearance of calcium, sodium and creatinine in healthy adults

The consumption of caffeine has been linked to osteoporosis, believed to be due to enhanced bone resorption as a result of increased calcium excretion in the urine. However, the amount of calcium in the urine may not necessarily reflect the true effect of caffeine on calcium clearance. This study therefore examined the impact of high-dose, short-term caffeine intake on renal clearance of calcium, sodium and creatinine in healthy adults. In a double-blind clinical study, participants chewed caffeine (n = 12) or placebo (n = 12) gum for 5 minutes at 2-hour intervals over a 6-hour treatment period (800 mg total caffeine). Caffeine increased renal calcium clearance by 77%. Furthermore, the effect was positively correlated with sodium clearance and urine volume, suggesting that caffeine may act through inhibition of sodium reabsorption in the proximal convoluted tubule. This study confirmed that caffeine does increase renal calcium clearance and fosters further investigation into safe consumption of caffeine.

Sex differences and considerations for female specific nutritional strategies: a narrative review

Although there is a plethora of information available regarding the impact of nutrition on exercise performance, many recommendations are based on male needs due to the dominance of male participation in the nutrition and exercise science literature. Female participation in sport and exercise is prevalent, making it vital for guidelines to address the sex-specific nutritional needs. Female hormonal levels, such as estrogen and progesterone, fluctuate throughout the mensural cycle and lifecycle requiring more attention for effective nutritional considerations. Sex-specific nutritional recommendations and guidelines for the active female and female athlete have been lacking to date and warrant further consideration. This review provides a practical overview of key physiological and nutritional considerations for the active female. Available literature regarding sex-specific nutrition and dietary supplement guidelines for women has been synthesized, offering evidenced-based practical information that can be incorporated into the daily lives of women to improve performance, body composition, and overall health.

The Effects of Caffeine on Voice: A Systematic Review

BACKGROUND

Caffeine is considered a dehydrating agent due to its diuretic effects and influences the body's fluid balance. The relationship between voice and hydration has been widely investigated and it is accepted that inadequate hydration has detrimental effects on phonation. Since dehydration negatively affects the vocal folds and caffeine is considered a dehydrating agent, it can be hypothesized that voice might be negatively affected by caffeine intake. This systematic review aims to summarize and appraise the available evidence regarding the effects of caffeine on voice.

METHODS

Randomized and non-randomized experimental studies of healthy participants were retrieved following an electronic searching of six databases in June 2020. No publication, language or date restrictions were applied. Data extraction of relevant data and risk of bias assessment was conducted independently by two reviewers.

RESULTS

Five non-randomized experimental studies were deemed eligible for inclusion. The format of the administered interventions in the included studies was either liquid (coffee) or solid (caffeine tablets). Reported outcome measures used to examine the effects of caffeine on phonation consisted of acoustic, aerodynamic and (auditory & self-) perceptual. No measures were adversely affected by caffeine consumption.

CONCLUSION

Clinicians commonly advise patients to refrain from caffeine, as caffeine intake increases diuresis with subsequent effects on fluid balance. Such imbalances can potentially induce dehydration which can be detrimental to phonation. This notion cannot be supported empirically, as the evidence is deemed unreliable and no firm conclusions can be elicited to guide clinical practice. The results of this review demonstrate the lack of research in the field and the necessity for future investigations in order to inform evidence-based practice through reliable and valid outcomes.

Risk assessment of coffees of different qualities and degrees of roasting

During the coffee beans roasting process, occurs the formation of polycyclic aromatic hydrocarbons, which are associated with the incidence of cancer in humans. This study aimed to evaluate the influence of coffee bean quality and roasting degree regarding mutagenicity, cytotoxicity and genotoxicity. Six samples of coffee drink made with roasted and ground Coffea arabica beans from different qualities and roast degrees were used after freeze-drying. Both commercial and special quality grains suffered light, medium and dark roasting. According to the Salmonella/microsome assay, the highest concentration of commercial grain sample (dark roast) significantly increased the number of revertants of the TA98 strain in the absence of metabolization. All the samples induced cytotoxicity to HepG2 cells. These effects can be ranked in the following order from most to least toxic: medium roast - special grain > light roast - special grain > dark roast - commercial grain > dark roast - special grain > light roast - commercial grain > medium roast - commercial grain. None of the samples induced genotoxicity in HepG2 cells. Our findings show that the harmful effects of coffee depend not only on the degree of roasting but also on the grain quality.

Energy Drinks and Sports Performance, Cardiovascular Risk, and Genetic Associations; Future Prospects

The consumption of energy drinks (e.g., containing caffeine and taurine) has increased over the last decade among adolescents and athletes to enhance their cognitive level and improve intellectual and athletic performance. Numerous studies have shown that drinking moderate doses of such drinks produces beneficial effects, as they considerably boost the sporting performance of elite athletes in various sports, including both endurance and explosive events. However, apart from their ergogenic effects, the regular consumption of energy drinks also increases blood pressure and consequently incites problems such as hypertension, tachycardia, and nervousness, all of which can lead to cardiovascular disorders. A potential positive correlation between genetics and the moderate consumption of energy drinks and athletic performance has recently been reported; notwithstanding, a better understanding of the genetic variants involved in metabolism is a key area for future research to optimize the dose of energy drink consumed and obtain the maximal ergogenic effect in elite sports. The aim of this literature review, therefore, is to present the results of recent studies, classifying them according to the differences in the associations between energy drinks and: (i) Athletic performance; (ii) cardiovascular risk factors while practicing sports; and (iii) genetic associations and future prospects between the consumption of energy drinks and performance.

Spectrophotometric comparison of color stability of microhybrid and nanocomposites following exposure to common soft drinks among adolescents: an in vitro study

PURPOSE

To compare the color stability of a microhybrid and two nanocomposites after exposure to common soft drinks among adolescents.

METHODS

Ninety discs were prepared from a microhybrid (Filtek Z250) and two nanocomposites (Filtek Z350 and Tetric N-Ceram) (n = 30 each). Six discs from each material were then immersed in one of five drinks (iced tea, sports drink, orange juice, cola, and distilled water) for 15 days. Color measurement was performed at baseline and after 15 days using a spectrophotometer according to the CIE L*a*b* system, and the change in color values as well as total color change (ΔE) was calculated and compared. ANOVA and Tukey's HSD test were used to analyze the data (p < 0.05).

RESULTS

Significant change in color values and total color (ΔE > 3.3) was observed in the composite materials after immersion in the soft drinks compared to immersion in distilled water (ΔE < 3.3). The highest mean values were those of Filtek Z350, being significantly different from the rest of the materials. Independent of the composite material, iced tea resulted in the highest mean values, being significantly different from the rest of the drinks (p < 0.05).

CONCLUSION

All soft drinks resulted in clinically unacceptable discoloration of the composite materials with maximum discoloration being that following immersion of composite materials, particularly Filtek Z350, in iced tea. Consequently, in dental practice, adolescents should be asked about their consumption of soft drinks, particularly iced tea, and made aware of their potential to discolor composite restorations if they are to receive them.

Severe Caffeine Intoxication Treated With Hemodialysis: A Case Report

Caffeine is well known for its central nervous system–stimulating effect. Toxicity may occur following high-dose caffeine ingestions. We describe a case of caffeine intoxication secondary to reported ingestion of a large dose of caffeine (60,000 mg in tablet form) with an initial serum caffeine level of 608 μmol/L (known lethal serum level starting from 412 μmol/L). This case demonstrates the key clinical manifestations of caffeine intoxication and the effect of its associated massive adrenergic surge with neurologic symptoms, cardiovascular instability, metabolic abnormalities, and the significant risk of mortality. We highlight important kidney management considerations, including protective measures against electrolyte disturbances such as hypokalemia and hypophosphatemia, and the use of prolonged hemodialysis for caffeine elimination. We share our practical decision making and approach to dialysis discontinuation if serum caffeine level reporting is unavailable or delayed.

Caffeine: A potential strategy to improve survival of neonatal pigs and sheep

Caffeine is commonly used to treat pre-and postnatal injuries, including apnoea in premature infants, as well as neurological impairment caused by hypoxia or asphyxiation often associated with difficult birthing. As an adenosine antagonist, caffeine is metabolised rapidly and transported into many tissues. Caffeine stimulates the brain respiratory centre, improving respiratory function in immature infants or neonates, provides neuroprotection to the fetal brain, and initiates non-shivering thermoregulation increasing metabolic rates. Recently, potential benefits of caffeine for animal production have been investigated. This has particularly occurred in pig production, where large litters are associated with relatively long parturition durations, and piglets born near the end of the parturition period have an increased risk of mortality due to asphyxia-related birthing injury. Similarly, in sheep, dystocia or prolonged parturition is a significant problem, where neonatal injury, dystocia and death in utero contributes to approximately 46 % of lamb mortalities. Within these two livestock production systems, large prevalence's of neonatal mortality is a persistent issue contributing to lost revenue, as well as being a significant animal welfare concern. Pre-partum maternal caffeine supplementation is a promising strategy to reduce neonatal mortality; however, there needs to be refinement of appropriate quantities administered, duration and administration pathway to provide producers with an efficient and cost-effective method to reduce mortality rates and increase production output. The information in this review details effects, benefits and important considerations regarding caffeine use in animal production, and identifies areas of limited knowledge where further research is needed.

A Review of Plant Extracts and Plant-Derived Natural Compounds in the Prevention/Treatment of Neonatal Hypoxic-Ischemic Brain Injury

Neonatal hypoxic-ischemic (HI) brain injury is one of the major drawbacks of mortality and causes significant short/long-term neurological dysfunction in newborn infants worldwide. To date, due to multifunctional complex mechanisms of brain injury, there is no well-established effective strategy to completely provide neuroprotection. Although therapeutic hypothermia is the proven treatment for hypoxic-ischemic encephalopathy (HIE), it does not completely chang outcomes in severe forms of HIE. Therefore, there is a critical need for reviewing the effective therapeutic strategies to explore the protective agents and methods. In recent years, it is widely believed that there are neuroprotective possibilities of natural compounds extracted from plants against HIE. These natural agents with the anti-inflammatory, anti-oxidative, anti-apoptotic, and neurofunctional regulatory properties exhibit preventive or therapeutic effects against experimental neonatal HI brain damage. In this study, it was aimed to review the literature in scientific databases that investigate the neuroprotective effects of plant extracts/plant-derived compounds in experimental animal models of neonatal HI brain damage and their possible underlying molecular mechanisms of action.

Does Drinking Coffee and Tea Affect Bone Metabolism in Patients with Inflammatory Bowel Diseases?

Patients suffering from Crohn’s disease and ulcerative colitis are at higher risk of osteoporosis due to lower bone mineral density. Risk factors of osteoporosis are divided into unmodifiable, namely, age, gender, genetic factors, as well as modifiable, including diet, level of physical activity, and the use of stimulants. Coffee and tea contain numerous compounds affecting bone metabolism. Certain substances such as antioxidants may protect bones; other substances may increase bone resorption. Nevertheless, the influence of coffee and tea on the development and course of inflammatory bowel diseases is contradictory.

Factors Associated with Insomnia Among Truck Drivers in Japan

PURPOSE

Truck drivers with insomnia are at a high risk of traffic accidents. We aimed to investigate the prevalence of insomnia and identify its associated factors among truck drivers in Japan.

METHODS

Participants were 2927 male truck drivers younger than 65 years old. Self-administered questionnaires were used to assess insomnia symptoms, State-Trait Anxiety Inventory, drinking, smoking habits, body mass index, caffeine intake, as well as daily driving hours, consecutive days away from home, and driving distance. Insomnia symptoms included difficulty initiating sleep, maintaining sleep and early morning awakening. Insomnia was defined when any of these symptoms were observed with daily tiredness.

RESULTS

The prevalence of insomnia among the subjects was 13.3% (n=356), of which 13.5% had difficulty initiating sleep, 78% had difficulty maintaining sleep, and 26.4% had early morning awakening. After adjusting for covariates, drinking habits, daily driving hours, and STAI score were significantly and linearly associated with insomnia; the adjusted odds ratio (OR) of drinking habits for insomnia was 1.74 [95% confidence interval (CI), 1.23-2.47] for heavy drinkers compared to non-drinkers (trend p<0.001); the adjusted OR of daily driving hours was 1.87 (95% CI, 1.00-3.49) for 12 hours or longer in a day compared to <8 hours in a day (trend p<0.001); the adjusted OR of STAI quartiles was 5.30 (95% CI, 3.66-7.67) for the highest quartile compared to the lowest quartile (trend p<0.001).

CONCLUSION

The present study demonstrated that insomnia is prevalent among truck drivers in Japan, and its risk factors include drinking habits, daily driving hours, and anxiety.

The Association Between Coffee and Tea Consumption During Pregnancy and Preterm Delivery: Case-Control Study

Objective

To assess a possible association between coffee and tea consumption and preterm delivery.

Methods

A case-control design was implemented on a sample of women who were admitted for delivery to a tertiary hospital in the north of Jordan. Three hundred and fourteen cases and 796 controls were evaluated. The study was conducted while women were in the hospital for delivery. They were questioned about coffee and tea consumption and relevant confounding factors. Women were asked to state the average number of coffee and tea cups they drank per day.

Results

The mean coffee consumption among women with preterm delivery was 0.75 cups/day ±1.23 and the mean tea consumption was 1.47 cups/day± 1.76. Multivariable logistic analysis revealed that increased age (OR=1.05; CI=1.02-1.08), parity (OR=3.82, CI=2.58-5.64), history of abortions (OR=1.69; CI=1.21-2.35), family history of preterm deliveries (OR=2.45, CI=1.33-4.52), having treatment for subfertility (OR=12.14, CI=2.39-61.62), diabetes mellitus (OR=2.22, CI=1.06-4.66), worsened emotional status during pregnancy (OR=2.35, CI=1.49-3.72), short inter-pregnancy interval (OR=1.72, CI=1.10-2.72), no iron consumption (OR=1.46, CI=1.06-2.03), using folic acid (OR=2.45, CI=1.33-4.52), and black colour women (OR=2.87, CI=1.35-6.10) were predictive for preterm delivery. After controlling for all significant predictors, coffee and tea consumption during pregnancy was not significantly associated with increased odds of preterm delivery.

Conclusion

These results do not support an association between coffee and tea consumption and preterm delivery.

N-Methyltransferases of Caffeine Biosynthetic Pathway in Plants

Caffeine (Cf) is one of the important components of plant-derived drinks, such as tea, coffee, and cola. It can protect soft tissues from being infected by pathogens and is also medically beneficial for human health. In this review, we first introduced the Cf biosynthesis pathways in plants and the related N-methyltransferases (NMTs), with a focus on the current research status of the substrate specificity, structural basis for substrate recognition, and catalytic mechanism in members of the caffeine synthase gene family. In addition, we addressed the expression characteristics and potential regulatory mechanisms of NMTs and also projected the future research directions. The goal was to summarize the Cf biosynthetic pathway and related NMTs in plants and to provide the molecular basis for regulating the caffeine biosynthesis, so as to effectively guide future tea and coffee breeding.

Caffeine versus antioxidant combination (Antox) and their role in modifying cadmium-induced testicular injury in adult male albino rats

The aim of the current work was to compare the roles of caffeine and antioxidants in prevention of cadmium-induced testicular damage when given, in addition to cadmium, in adult male albino rats. Histopathological and ultra-structural examination as well as biochemical and molecular assessments were done. Cadmium chloride (4 mg/kg body weight) was administered via oral gavage from day 21 to 28 of the experiment. Caffeine (25 mg/kg) via intra-peritoneal injection and antioxidant preparation (Antox) 10 mg/kg via oral gavage were given as a pre-treatment for 21 days and concomitantly with Cd from day 21 to 28. Real-time PCR was done for determination of 3, 17 β hydroxy steroid dehydrogenase steroidogenic acute regulatory protein, caspase-9 and mitofusin 1,2 gene expression. Testosterone level, glutathione S-transferase enzyme activity, reactive oxygen species, malondialdehyde and superoxide dismutase were measured spectrophotometrically by ELISA. Histological and ultra-structural evaluation revealed disturbance of normal architecture, vacuolisation and necrosis. Vascular dilatation and congestion and collagen fibre deposition were present. A statistically significant difference was seen in all parameters when caffeine and antioxidants were given against cadmium-induced testicular injury. Overall, we conclude that both caffeine and antioxidants have the ability to reverse cadmium-induced testicular injury when given as pre-treatment prior to cadmium exposure.

Anti-Platelet Aggregation and Anti-Cyclooxygenase Activities for a Range of Coffee Extracts (Coffea arabica)

Coffee is rich in caffeine (CF), chlorogenic acid (CGA) and phenolics. Differing types of coffee beverages and brewing procedures may result in differences in total phenolic contents (TPC) and biological activities. Inflammation and increases of platelet activation and aggregation can lead to thrombosis. We focused on determining the chemical composition, antioxidant activity and inhibitory effects on agonist-induced platelet aggregation and cyclooxygenase (COX) of coffee beverages in relation to their preparation method. We prepared instant coffee and brewed coffee beverages using drip, espresso, and boiling techniques. Coffee extracts were assayed for their CF and CGA contents using HPLC, TPC using colorimetry, platelet aggregation with an aggregometer, and COX activity using ELISA. The findings have shown all coffee extracts, except the decaffeinated types, contained nearly equal amounts of CF, CGA, and TPC. Inhibitory effects of coffee extracts on platelet aggregation differed depending on the activation pathways induced by different agonists. All espresso, drip and boiled coffee extracts caused dose dependent inhibition of platelet aggregation induced by ADP, collagen, epinephrine, and arachidonic acid (ARA). The most marked inhibition was seen at low doses of collagen or ARA. Espresso and drip extracts inhibited collagen-induced platelet aggregation more than purified caffeine or CGA. Espresso, boiled and drip coffee extracts were also a more potent inhibitors of COX-1 and COX-2 than purified caffeine or CGA. We conclude that inhibition of platelet aggregation and COX-1 and COX-2 may contribute to anti-platelet and anti-inflammatory effects of espresso and drip coffee extracts.

Energy-drink consumption is associated with asthma, allergic rhinitis, and atopic dermatitis in Korean adolescents

BACKGROUND/OBJECTIVES

Few studies have evaluated the effects of energy drinks on allergic diseases. The purpose of this investigation was to evaluate the association between energy drinks and various allergic diseases, including asthma, allergic rhinitis, and atopic dermatitis, in a large representative Korean adolescent population.

SUBJECTS/METHODS

This cross-sectional study used data from the Korea Youth Risk Behavior Web-based Survey collected from 2015 to 2016. A total of 129,809 participants (n = 67,056 for males; n = 62,753 for females) aged 12-18 years were included and were asked about their frequency of consumption of energy drinks such as Hot6^®, Redbull^®, and Bacchus^®. Their history of asthma, allergic rhinitis, and atopic dermatitis throughout life and in the last 12 months were obtained. The association between the frequency of energy-drink consumption and allergic diseases was analyzed using multiple logistic regression with adjustment for various covariates.

RESULTS

Age, sex, physical activity, obesity, region of residence, economic level, paternal and maternal educational level, smoking, and alcohol consumption differed significantly according to the frequency of energy-drink consumption (each P < 0.001). Frequent energy-drink consumption (≥7 times a week) was significantly associated with asthma throughout life (odds ratio [OR] = 1.30, 95% confidence interval (CI) = 1.03-1.64, P = 0.025), asthma within the last 12 months (OR = 1.65, 95% CI = 1.16-2.35, P = 0.006), allergic rhinitis within the last 12 months (OR = 1.21, 95% CI = 1.02-1.44, P = 0.030), and atopic dermatitis within the last 12 months (OR = 1.49, 95% CI = 1.17-1.90, P = 0.001) compared to no energy-drink consumption in the full-adjusted model.

CONCLUSIONS

Frequent energy-drink consumption is associated with allergic diseases, including asthma, allergic rhinitis, and atopic dermatitis, in Korean adolescents.

Energy Drinks and Their Adverse Health Effects: A Systematic Review and Meta-analysis

CONTEXT

Energy drinks are the fastest growing product in the beverage industry. However, there is concern regarding potential for adverse effects with use.

OBJECTIVE

To evaluate the reported adverse effects of energy drink consumption.

DATA SOURCES

The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies from inception to November 2019, and pertinent data were abstracted.

STUDY SELECTION

Only clinical studies reporting adverse events after energy drink consumption were included.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Data regarding sample size characteristics, energy drink characteristics, comparators, and all adverse events were extracted in duplicate and recorded.

RESULTS

A total of 32 studies and 96,549 individuals were included. Frequently reported adverse events in the pediatric population were insomnia (35.4%), stress (35.4%), and depressive mood (23.1%). Frequently reported adverse events in the adult population were insomnia (24.7%), jitteriness/restlessness/shaking hands (29.8%), and gastrointestinal upset (21.6%). Alcohol mixed with energy drinks significantly reduced the likelihood of sedation effects but increased the likelihood of stimulatory effects. Energy drink consumption significantly increased the odds of insomnia (OR, 5.02; 95% CI, 1.72-14.63) and jitteriness/activeness (OR, 3.52; 95% CI, 1.28-9.67) compared with the control group.

CONCLUSION

The authors recommend that individuals avoid frequent energy drink consumption (5-7 energy drinks/week) and avoid co-consumption with alcohol; increased regulatory standards should be placed in the sale of energy drinks, particularly with regard to the pediatric population.

Can pentoxifylline and similar xanthine derivatives find a niche in COVID-19 therapeutic strategies? A ray of hope in the midst of the pandemic

COVID-19 pandemic presents an unprecedented challenge to identify effective drugs for treatment. Despite multiple clinical trials using different agents, there is still a lack of specific treatment for COVID-19. Having the potential role in suppressing inflammation, immune modulation, antiviral and improving respiratory symptoms, this review discusses the potential role of methylxanthine drugs like pentoxifylline and caffeine in the management of COVID-19 patients. COVID-19 pathogenesis for clinical features like severe pneumonia, acute lung injury (ALI) / acute respiratory distress syndrome (ARDS), and multi-organ failures are excessive inflammation, oxidation, and cytokine storm by the exaggerated immune response. Drugs like pentoxifylline have already shown improvement of the symptoms of ARDS and caffeine has been in clinical use for decades to treat apnea of prematurity (AOP) in preterm infants and improve respiratory function. Pentoxifylline is well-known anti-inflammatory and anti-oxidative molecules that have already shown to suppress Tumor Necrosis Factor (TNF-α) as well as other inflammatory cytokines in pulmonary diseases, and this may be beneficial for better clinical outcomes in COVID-19 patients. Pentoxifylline enhances blood flow, improves microcirculation and tissue oxygenation, and caffeine also efficiently improves tissue oxygenation, asthma, decreases pulmonary hypertension and an effective analgesic. There are significant shreds of evidence that proved the properties of pentoxifylline and caffeine against virus-related diseases as well. Along with the aforementioned evidences and high safety profiles, both pentoxifylline and caffeine offer a glimpse of considerations for future use as a potential adjuvant to COVID-19 treatment. However, additional clinical studies are required to confirm this speculation.

Ultraprocessed Food: Addictive, Toxic, and Ready for Regulation

Past public health crises (e.g., tobacco, alcohol, opioids, cholera, human immunodeficiency virus (HIV), lead, pollution, venereal disease, even coronavirus (COVID-19) have been met with interventions targeted both at the individual and all of society. While the healthcare community is very aware that the global pandemic of non-communicable diseases (NCDs) has its origins in our Western ultraprocessed food diet, society has been slow to initiate any interventions other than public education, which has been ineffective, in part due to food industry interference. This article provides the rationale for such public health interventions, by compiling the evidence that added sugar, and by proxy the ultraprocessed food category, meets the four criteria set by the public health community as necessary and sufficient for regulation—abuse, toxicity, ubiquity, and externalities (How does your consumption affect me?). To their credit, some countries have recently heeded this science and have instituted sugar taxation policies to help ameliorate NCDs within their borders. This article also supplies scientific counters to food industry talking points, and sample intervention strategies, in order to guide both scientists and policy makers in instituting further appropriate public health measures to quell this pandemic.

The importance of early use of beta blockers and gastric decontamination in caffeine overdose: A case report

Caffeine is a common stimulant consumed daily worldwide and available in a wide variety of over-the-counter formulations. It is a mild central nervous system stimulant when used in recommended doses. However, it can be fatal if taken as an intentional or accidental overdose. We report a case of a 48-year-old lady with depression and post-traumatic stress disorder who consumed a significant overdose of caffeine, triggered by the stress that she had contracted coronavirus disease 19. This led to significant cardiovascular and central nervous system toxicity. The condition was identified early and managed appropriately with early β-blockers and gastric decontamination, which saved her life. There are few studies with regard to such modalities on treatment for caffeine overdose; our patient responded rapidly and favourably to the treatment. Why should an emergency physician be aware of this? Caffeine overdose is uncommon but one that clinicians should be aware of. Early identification and intervention with β-adrenergic antagonists and activated charcoal is paramount in caffeine toxicity.

Coffee in cancer chemoprevention: an updated review

INTRODUCTION

Chemoprevention of cancer refers to the use of natural or synthetic compounds to abolish or perturb a variety of steps in tumor initiation, promotion, and progression. This can be realized through different mechanisms, including activation of free radical scavenging enzymes, control of chronic inflammation, and downregulation of specific signaling pathways.

AREAS COVERED

The goal of this article is to critically review recent evidence on association between coffee and prevention of different types of cancer, with particular emphasis on the molecular mechanisms and the bioactive compounds involved in its anticancer activity.

EXPERT OPINION

Coffee is a mixture of different compounds able to decrease the risk of many types of cancer. However, its potential anticancer activity is not completely understood. Hundreds of biologically active components such as caffeine, chlorogenic acid, diterpenes are contained in coffee. Further research is needed to fully elucidate the molecular mechanisms underlying the anticancer effects of coffee and fully understand the role of different confounding factors playing a role in its reported anticancer activity.

The Influence of Recreational Substance Use in TMS Research

(1) Background: Transcranial magnetic stimulation (TMS) approaches are widely used to study cortical and corticospinal function. However, responses to TMS are subject to significant intra-and inter-individual variability. Acute and chronic exposure to recreational substances alters the excitability of the sensorimotor system and may contribute to the variability in TMS outcome measures. The increasing prevalence of recreational substance use poses a significant challenge for executing TMS studies, but there is a lack of clarity regarding the influence of these substances on sensorimotor function. (2) Methods: The literature investigating the influence of alcohol, nicotine, caffeine and cannabis on TMS outcome measures of corticospinal, intracortical and interhemispheric excitability was reviewed. (3) Results: Both acute and chronic use of recreational substances modulates TMS measures of excitability. Despite the abundance of research in this field, we identify knowledge gaps that should be addressed in future studies to better understand the influence of these substances on TMS outcomes. (4) Conclusions: This review highlights the need for TMS studies to take into consideration the history of participant substance use and to control for acute substance use prior to testing.

Occurrence, fate, persistence and remediation of caffeine: a review

Pharmaceutical and personal care products (PPCPs) have gained attention in recent years due to their continuous discharge in natural waters. Their persistence in the environment has impacted flora, fauna and human being worldwide. One of the most common PPCPs is caffeine (1, 3, 7-trimethylxanthine) which acts as a stimulant to the central nervous system in humans and is found in nature in about 60 plant species, especially in coffee, tea and cacao plants. Here we discuss the evidence with respect to caffeine occurrence, its persistence and remediation in light of increasing knowledge and the impact of caffeine on the environment. Daily intake of caffeine around the world is found to increase due to the frequent introduction of new caffeinated beverages as well as increased consumption of coffee, tea and carbonated soft drinks, which has led to increase in its concentration in water bodies including agricultural soil. The caffeine concentration in different water system, studied by various authors is also described. Diverse effects of the use of caffeine on several organisms including humans are also briefly presented. Therefore, urgent attention for the removal of caffeine and its derivatives is the need of the hour. Various methods described in literature for caffeine degradation/removal is also presented. Another widely used technique in environmental remediation is molecular imprinting (MIP); however, only few MIPs have been demonstrated for caffeine which is also discussed. Regular monitoring can be useful to control toxic effects of caffeine. Graphical abstract.

Estimates of Caffeine Use Disorder, Caffeine Withdrawal, Harm and Help-seeking in New Zealand: A cross-sectional survey

BACKGROUND

Caffeine Use Disorder (CUD) is not yet formally recognized in the DSM-5, but emerging evidence suggests CUD could impact up to one in five people. The primary aim of this study was to estimate levels of caffeine consumption and its associations with CUD and withdrawal, taking socio-demographic characteristics (age, gender, ethnicity, income) into account. Secondary aims were to measure caffeine-related harm and treatment preferences.

METHODS

We administered an online cross-sectional survey via Facebook to a convenience sample of 2379 adults in New Zealand. Caffeine consumption was assessed across six products: coffee, tea, energy drinks, cola, alcohol mixed with caffeine, and other products (e.g., caffeine pills, sports supplements).

RESULTS

20% of participants met proposed criteria for CUD, with 30% meeting DSM-5 criteria for caffeine withdrawal. Moderate (200-400 mg per day) and high consumption (>400 mg per day) was associated with a three-fold increase in the odds of CUD and a two-fold increase in the odds of withdrawal. Women and current smokers were at higher risk of CUD and withdrawal even at moderate consumption levels. Nearly 85% of respondents experienced at least one caffeine-related harm in the past 12-months. The number of harms increased with level of caffeine consumption. Nearly 50% indicated a self-help treatment for caffeine reduction would be of interest.

CONCLUSIONS

High rates of CUD and caffeine withdrawal amongst moderate caffeine users, women and smokers suggests caffeine consumption guidelines may need refinement. Caffeine-related harm that is not clinically meaningful may still be of concern to individuals and warrants further investigation.

Prevalence, Predictors, and Awareness of Coffee Consumption and Its Trend among Saudi Female Students

This study aimed to investigate the prevalence, trends, and predictors of coffee consumption among Saudi female students and its association with anthropometric and demographic variables. A survey-based study using a face-to-face interview was designed, and 930 (aged 21.5 ± 2.1 years) apparently healthy female students from different departments of King Saud University participated. The prevalence of coffee consumption was significantly higher (88.2%, p < 0.03) in the central Riyadh region. Coffee consumers had significantly higher prevalence of being overweight than non-consumers (p = 0.02). The frequency of coffee consumption was significantly higher (p < 0.02) in students who were single and belonged to families with a moderate income level. Coffee consumption was significantly higher among first-year students with a high-scale grade point average (GPA) (p < 0.001 and p = 0.03, respectively). Increased coffee consumption during exam and stress conditions was associated with unhealthy dietary habits such as using more sugar and spices. The prevalence of coffee consumption was high among Saudi females. High body mass index (BMI) and increased family income level were strong determinants for coffee consumption. Continued nutritional education and awareness about the potential positive and negative health effects of coffee consumption and the importance of food label use should be provided to younger generations in order to correct the wrong perceptions.

Real and Perceived Effects of Caffeine on Sprint Cycling in Experienced Cyclists

Anderson, DE, German, RE, Harrison, ME, Bourassa, KN, and Taylor, CE. Real and perceived effects of caffeine on sprint cycling in experienced cyclists. J Strength Cond Res 34(4): 929-933, 2020-Caffeine ingestion before an exercise bout may provide ergogenic effects on anaerobic performance, particularly in trained athletes. However, the degree of influence of caffeine may be coupled with the placebo effect. A double-blind, placebo-controlled, randomized design was used to determine the real and perceived effects of caffeine on anaerobic performance. Ten competitively trained cyclists (9 men and 1 woman) completed 3 trials of the Wingate Anaerobic Test (WAnT). Subjects were given coffee that they believed contained a high caffeine dose, a low caffeine dose, or a placebo 45 minutes before WAnT. Subjects were actually given 2 placebos (decaffeinated coffee) and one dose of caffeine (280 mg). Level of significance was p ≤ 0.05. No significant differences were found between trials for blood lactate concentration and heart rate. Seven of the subjects (70%) correctly identified the caffeine trial as the high caffeine trial. Time to peak power was significantly shorter for the trial in which subjects incorrectly guessed they had consumed caffeine when given the placebo compared with placebo trial (1.6 ± 0.1 vs. 2.3 ± 0.2 seconds). Power drop was significantly higher for the trial in which subjects incorrectly guessed they had consumed caffeine when given the placebo compared with placebo trial (524 ± 37 vs. 433 ± 35 W). There seems to be a placebo effect of caffeine on anaerobic performance. Improved performance may result from psychological advantages rather than physical advantages. Coaches may find it beneficial to use a placebo to improve anaerobic performance, especially if concerned about the side effects or cost of caffeine.

Exploring the Association between Urine Caffeine Metabolites and Urine Flow Rate: A Cross-Sectional Study

Examination of urine excretion of caffeine metabolites has been a simple but common way to determine the metabolism and effect of caffeine, but the relationship between urinary metabolites and urine flow rate is less discussed. To explore the association between urinary caffeine metabolite levels and urine flow rate, 1571 participants from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 were enrolled in this study. We examined the association between urinary caffeine metabolites and urine flow rate with linear regression models. Separate models were constructed for males and females and for participants aged <60 and ≥60 years old. A positive association was found between concentrations of several urinary caffeine metabolites and urine flow rate. Three main metabolites, namely, paraxanthine, theobromine, and caffeine, showed significance across all subgroups. The number of caffeine metabolites that revealed flow-dependency was greater in males than in females and was also greater in the young than in the elderly. Nevertheless, the general weakness of NHANES data, a cross-sectional study, is that the collection is made at one single time point rather than a long-term study. In summary, urinary concentrations of several caffeine metabolites showed a positive relationship with the urine flow rate. The trend is more noticeable in males and in young subgroups.

Quality characteristics of infusion and health consequences: a comparative study between orthodox and CTC green teas

The present study compares the effects of two green tea processing techniques, viz. orthodox and CTC (curl, tear and crush) on the quality parameters and sensory profiles under the geographical and climatic conditions of Assam, India. The results showed that CTC green tea infusions had 13.3, 7.5, 7.1, 9.8, 5.4, 17.3, 17.1 and 18.6% more total polyphenol, total catechin, (-)-epigallocatechin-3-gallate (EGCG), (-)-epicatechin-3-gallate (ECG), (-)-epigallocatechin (EGC), (-)-epicatechin (EC), water extract and theanine level, respectively than the infusions prepared from orthodox green tea. The sensory evaluation preferred the orthodox over CTC processing mode. Risk assessment with daily consumption of five cups (10 g) of green tea reveals that the EGCG level is free from the risk of hepatotoxicity and caffeine will not inflict any health hazard.

Recent Advances in Supercritical Fluid Extraction of Natural Bioactive Compounds from Natural Plant Materials

In this review, recent advances in greener technology for extracting natural bioactive components from plant origin sources are discussed. Bioactive compounds of plant origin have been defined as natural chemical compounds present in small amounts in plants. Researchers have shown interest in extracting bioactive compounds because of their human health benefits and characteristics of being eco-friendly and generally recognized as safe. Various new extraction methods and conventional extraction methods have been developed, however, until now, no unique approach has been presented as a benchmark for extracting natural bioactive compounds from plants. The selectivity and productivity of traditional and modern extraction techniques generally depend on selecting the critical input parameters, knowing the nature of plant-based samples, the structure of bioactive compounds, and good scientific skills. This work aims to discuss the recent advances in supercritical fluid extraction techniques, especially supercritical carbon dioxide, along with the fundamental principles for extracting bioactive compounds from natural plant materials such as herbs, spices, aromatic and medicinal plants.

Caffeine as a Neoadjuvant Therapy in Parathyroid Adenomas: A Narrative Review

Caffeine is the most used central nervous system stimulant drug to date. Many studies have shown the association of caffeine with bone remodeling, urinary calcium excretion, kidney stones, acid peptic disease, and the development of cancer. However, there has been very little research exploring the association between caffeine use and parathyroid gland disorders. We shed light on the possible connection between caffeine and parathyroid adenomas, as suggested in the literature.

Emerging techniques for determining the quality and safety of tea products: A review

Spectroscopic techniques, electrochemical methods, nanozymes, computer vision, and modified chromatographic techniques are the emerging techniques for determining the quality and safety parameters (e.g., physical, chemical, microbiological, and classified parameters, as well as inorganic and organic contaminants) of tea products (such as fresh tea leaves, commercial tea, tea beverage, tea powder, and tea bakery products) effectively. By simplifying the sample preparation, speeding up the detection process, reducing the interference of other substances contained in the sample, and improving the sensitivity and accuracy of the current standard techniques, the abovementioned emerging techniques achieve rapid, cost-effective, and nondestructive or slightly destructive determination of tea products, with some of them providing real-time detection results. Applying these emerging techniques in the whole industry of tea product processing, right from the picking of fresh tea leaves, fermentation of tea leaves, to the sensory evaluation of commercial tea, as well as developing portable devices for real-time and on-site determination of classified and safety parameters (e.g., the geographical origin, grade, and content of contaminants) will not only eliminate the strong dependence on professionals but also help mechanize the production of tea products, which deserves further research. Conducting a review on the application of spectroscopic techniques, electrochemical methods, nanozymes, computer vision, and modifications of chromatographic techniques for quality and safety determination of tea products may serve as guide for other types of foods and beverages, offering potential techniques for their detection and evaluation, which would promote the development of the food industry.

Energy drink intake is associated with insomnia and decreased daytime functioning in young adult females

OBJECTIVE

To investigate the association between energy drink (ED) use and sleep-related disturbances in a population-based sample of young adults from the Raine Study.

DESIGN

Analysis of cross-sectional data obtained from self-administered questionnaires to assess ED use and sleep disturbance (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire (FOSQ-10) and the Pittsburgh Sleep Symptoms Questionnaire-Insomnia (PSSQ-I)). Regression modelling was used to estimate the effect of ED use on sleep disturbances. All models adjusted for various potential confounders.

SETTING

Western Australia.

PARTICIPANTS

Males and females, aged 22 years, from Raine Study Gen2-22 year follow-up.

RESULTS

Of the 1115 participants, 66 % were never/rare users (i.e. <once/month) of ED, 17·0 % were occasional users (i.e. >once/month to <once/week) and 17 % were frequent users (≥once/week). Compared with females, a greater proportion of males used ED occasionally (19 % v. 15 %) or frequently (24 % v. 11 %). Among females, frequent ED users experienced significantly higher symptoms of daytime sleepiness (FOSQ-10: β = 0·93, 95 % CI 0·32, 1·54, P = 0·003) and were five times more likely to experience insomnia (PSSQ-I: OR = 5·10, 95 % CI 1·81, 14·35, P = 0·002) compared with never/rare users. No significant associations were observed in males for any sleep outcomes.

CONCLUSIONS

We found a positive association between ED use and sleep disturbances in young adult females. Given the importance of sleep for overall health, and ever-increasing ED use, intervention strategies are needed to curb ED use in young adults, particularly females. Further research is needed to determine causation and elucidate reasons for gender-specific findings.

The Ambiguous Role of Caffeine in Migraine Headache: From Trigger to Treatment

Migraine is a chronic disorder, and caffeine has been linked with migraine for many years, on the one hand as a trigger, and on the other hand as a cure. As most of the population, including migraineurs, consume a considerable amount of caffeine daily, a question arises as to whether it influences their headaches. Indeed, drinking coffee before a migraine attack may not be a real headache trigger, but a consequence of premonitory symptoms, including yawning, diminished energy levels, and sleepiness that may herald a headache. Here, we aim to summarize the available evidence on the relationship between caffeine and migraines. Articles concerning this topic published up to June 2020 were retrieved by searching clinical databases, and all types of studies were included. We identified 21 studies investigating the prevalence of caffeine/caffeine withdrawal as a migraine trigger and 7 studies evaluating caffeine in acute migraine treatment. Among them, in 17 studies, caffeine/caffeine withdrawal was found to be a migraine trigger in a small percentage of participants (ranging from 2% to 30%), while all treatment studies found caffeine to be safe and effective in acute migraine treatment, mostly in combination with other analgesics. Overall, based on our review of the current literature, there is insufficient evidence to recommend caffeine cessation to all migraine patients, but it should be highlighted that caffeine overuse may lead to migraine chronification, and sudden caffeine withdrawal may trigger migraine attacks. Migraine sufferers should be aware of the amount of caffeine they consume and not exceed 200 mg daily. If they wish to continue drinking caffeinated beverages, they should keep their daily intake as consistent as possible to avoid withdrawal headache.

Effects of caffeine and caffeic acid on selected biochemical parameters in L-NAME-induced hypertensive rats

Biologically active compounds such as caffeine and caffeic acid can be obtained in plants especially cocoa and coffee. Hence, the combinatory effect of caffeine and caffeic acid as well as their individual effect were assessed on the activities of arginase, angiotensin-1-converting enzyme (ACE) as well as nitric oxide (NOx), and malondialdehyde (MDA) level in the Nω-Nitro-L-arginine-methylester (L-NAME)-induced hypertensive rats. The individual and combinatory effect of caffeine and caffeic acid were investigated in L-NAME-induced rats. Animals were grouped into eleven containing six animals each. Hemodynamic parameter was determined by tail-cuff plethysmography. Furthermore, the result showed a notable rise in ACE and arginase activities of L-NAME-induced group compared with the control group. However, pretreatment with test compounds lowered ACE, arginase activities, and MDA content with rise in NOx. This study supports that caffeine and caffeic acid combinations demonstrated antihypertensive properties by lowering the systolic blood pressure in L-NAME-induced rats. PRATICAL APPLICATIONS: This duo bioactive compounds; caffeine (alkaloid) and caffeic acid (phenolic acid) are lavishly distributed in coffee. Their cardiopotective and cardiomodulatory roles have been investigated due to their biological activities. As far as we are aware, this could be foremost in-depth study on the antihypertensive and cardioprotective effect of the combinations of caffeine and caffeic acid targeting the key enzymes system relevant to hypertension. Decreased ACE and arginase activities as well as high nitric oxide (NOx) and low MDA level may be associated with its antihypertensive effect. This present study suggests that the combinations of this phenolics and alkaloid compound might proffer a therapeutic strategy in the management of hypertension.

Alcohol, nicotine, and caffeine consumption on a public U.S. university campus determined by wastewater-based epidemiology

Alcohol, nicotine, and caffeine use in at-risk populations is a public health concern that claims over 550,000 lives annually. Self-reported surveys from college students often reveal overconsumption of these substances. Unfortunately, the costs of these surveys are high, and consequently, the results from few studies are often extrapolated across the entire target population. Here we employed wastewater-based epidemiology (WBE) to directly measure the levels of these three psychotropic substances and their metabolites in sewage from a large public Southwestern U.S. university campus during the 2017-2018 academic year. Results showed per person alcohol consumption was 11.3 ± 7.5 g d^-1 person^-1 or 0.8 ± 0.5 drinks d^-1 person^-1, similar to averages of nationwide estimates from self-reporting of this subpopulation aged 18-25 years (10.1 ± 0.8 g d^-1 person^-1 or 0.7 ± 0.06 drinks d^-1 person^-1). Caffeine and nicotine consumption determined by WBE were significantly lower (p < 0.05) than nationwide estimates from self-reporting (caffeine: 114 ± 49 vs. 178 ± 19 mg d^-1 person^-1; nicotine: 627 ± 219 vs. 927 ± 243 μg d^-1 person^-1). Strong positive correlations were found for consumption of alcohol and nicotine (Spearman r_s: 0.71; p < 0.01), and nicotine and caffeine (0.59, p < 0.01), but not alcohol and caffeine (0.17). Alcohol and nicotine consumption were significantly higher on weekends compared to weekdays (p < 0.01), while caffeine consumption was higher during the week (p < 0.05). This first U.S. WBE study on alcohol, nicotine, and caffeine use among U.S. college students demonstrated the feasibility and practicality of longitudinally tracking the behavior of an entire campus population of 60,000 students directly, repeatedly, and more inexpensively (US$0.58/person) compared to conventional questionnaires (US$127/person).

Impact of psychological stress measured in three different scales on testis function: A cross-sectional study of 1362 young men

BACKGROUND

Studies have reported associations between psychological stress and semen quality, but most have been performed on selected populations using different stress measures. Thus, it is uncertain which stress scale best quantifies the effects of stress on testicular function.

OBJECTIVE

To study the association between three different measures of stress and testicular function in young men.

MATERIAL AND METHODS

In total, 1362 men (median age 19 years) delivered semen and blood samples. They also answered a questionnaire including information from three stress scales: Stress Symptoms, Stressful Life Events and Perceived Stress. Various statistical analyses for associations between stress and testicular function (semen quality and reproductive hormones) were performed.

RESULTS

Perceived Stress was negatively associated with sperm concentration, total count and motility and positively associated with serum FSH. Men with the highest scores (>30 points) had 38% (95% CI 3-84%) lower sperm concentration, 42% (95% CI 5-91%) lower total count and 22% (95% CI 2-32%) lower proportion of motile spermatozoa than men with the lowest scores (0-10 points). For the stress symptoms score, men with highest scores (>95th percentile vs. lower) had lower sperm concentration, total sperm count, motility and serum Inhibin-B/FSH-ratio. Although men with highest stress levels were characterized by an unhealthier lifestyle, adjusting for lifestyle factors did not attenuate results suggesting that the associations between stress and testicular function were not mediated by lifestyle. Stressful Life Events were not associated with testicular function.

DISCUSSION AND CONCLUSION

The linear association between Perceived Stress and semen parameters and lack of dose-response association for the other two stress scales indicated that perceived stress was the most sensitive marker of stress affecting semen quality in young men. The lack of associations between Stressful Life Events and testis function confirmed that the perception of stressful events rather than the stressful event per se matters.

Functional Needs, Emotions, and Perceptions of Coffee Consumers and Non-Consumers

Coffee is one of the most consumed beverages worldwide. Over the last decades coffee has become a specialty product. Drinking a coffee beverage entails several mixed factors, such as pleasure, experience, lifestyle, and social status. It can also provide an emotional pick-up, both mentally and physically. Only a few studies have explored the motives and emotions of coffee consumption and not consumption. There is limited understanding of consumers’ emotional approach towards coffee, and what influences a positive and negative inclination towards coffee consumption. This research fills the current research gaps by addressing three main questions: (i) What are the emotions and habits of coffee consumption? (ii) What are the motives of coffee consumption and non-consumption? and (iii) How relevant is the coffee health impact perception of consuming or not consuming coffee? The research activities include 467 face-to-face interviews with consumers. Interviews are performed in two different countries, Italy and Portugal. Data elaboration includes a principal component analysis carried out to identify latent factors on motives and emotions of consumption in both national groups, and to explore the relationship between the main emotions and consumers’ habits and socio-economic characteristics. Results support that consumers have positive emotions from coffee consumption. Perceived emotions are energy, satisfaction, and pleasure. Non-consumption is mainly driven by taste and fear of coffee’s health impacts. There are limited differences in the countries analysed. Socio-economic characteristics limitedly influence perceived emotions and consumption motives. To conclude, consumers are increasingly interested in new coffee products. Understanding the functional and emotional factors of coffee consumption contributes to supporting new coffee product development and commercialisation.

What is Needed for Evidence-Based Dietary Recommendations for Migraine: A Call to Action for Nutrition and Microbiome Research

BACKGROUND

The gastrointestinal symptoms of migraine attacks have invited numerous dietary hypotheses for migraine etiology through the centuries. Substantial efforts have been dedicated to identifying dietary interventions for migraine attack prevention, with limited success. Meanwhile, mounting evidence suggests that the reverse relationship may also exist - that the biological mechanisms of migraine may influence dietary intake. More likely, the truth involves some combination of both, where the disease influences food intake, and the foods eaten impact the manifestations of the disease. In addition, the gut's microbiota is increasingly suspected to influence the migraine brain via the gut-brain axis, though these hypotheses remain largely unsubstantiated.

OBJECTIVE

This paper presents an overview of the strength of existing evidence for food-based dietary interventions for migraine, noting that there is frequently evidence to suggest that a dietary risk factor for migraine exists but no evidence for how to best intervene; in fact, our intuitive assumptions on interventions are being challenged with new evidence. We then look to the future for promising avenues of research, notably the gut microbiome.

CONCLUSION

The evidence supports a call to action for high-quality dietary and microbiome research in migraine, both to substantiate hypothesized relationships and build the evidence base regarding nutrition's potential impact on migraine attack prevention and treatment.

Flying From Hospital to Hospital: A Case of Caffeine Intoxication

A 54-year-old woman with a history of excess weight and active smoking presented to the emergency department (ED) due to syncope after a long flight. She reported a similar episode in the previous month, which had also occurred after a long air voyage. She presented with hypotension, dehydration, and hyperlactacidemia. The clinical team ruled out acute coronary syndrome, pulmonary embolism, and cerebrovascular accident. After clinician insistence, she reported having ingested anhydrous caffeine, an over-the-counter diuretic usually used by individuals seeking to lose weight, and a diagnosis of caffeine intoxication was made. The over-the-counter sale of this apparently innocuous substances is a rising phenomenon, and physicians should be aware of the signs of its ingestion.

Relative humidity-temperature transition boundaries for anhydrous β-caffeine and caffeine hydrate crystalline forms

Caffeine is a hydrate-forming polymorphic crystalline compound that can exist in α, β, and hydrate forms. Phase transitions between hydrate and anhydrous forms of a crystalline ingredient, and related water migration, can create product quality challenges. The objective of this study was to determine the relative humidity (RH)-temperature phase boundary between anhydrous β-caffeine and caffeine hydrate. The β-caffeine→caffeine hydrate and caffeine hydrate→β-caffeine RH-temperature transition boundaries were determined from 20 to 45 °C using a combination of water activity (a_w ) controlled solution and vapor-mediated equilibration, moisture sorption, powder X-ray diffraction, and Fourier-transform infrared spectroscopy techniques. Two transition boundaries were measured: the β-caffeine→caffeine hydrate transition boundary (0.835 ± 0.027 a_w at 25 °C) was higher than the caffeine hydrate→β-caffeine transition boundary (0.625 ± 0.003 a_w at 25 °C). Moisture sorption rates for β-caffeine, even at high RHs (>84% RH), were slow. However, caffeine hydrate rapidly dehydrated at low RHs (<30% RH) into a metastable transitional anhydrous state with a similar X-ray diffraction pattern to metastable α-caffeine. Exposing this dehydrated hydrate to higher RHs (>65% RH) at lower temperatures (20 to 30 °C) resulted in full restoration to a 4/5 caffeine hydrate. This transitional anhydrous state was unstable and converted to a less hygroscopic state after annealing at 50 °C and 0% RH for 1 day. It was postulated that the caffeine hydrate→β-caffeine was the true β-caffeine↔caffeine hydrate phase boundary and that β-caffeine could be metastable above the caffeine hydrate→β-caffeine transition boundary. These caffeine RH-temperature transition boundaries could be used for selecting formulation and storage conditions to maintain the desired caffeine crystalline form. PRACTICAL APPLICATION: Caffeine can exist as either an anhydrous (without water) or hydrate (internalized water) crystalline state. The stability of each caffeine crystalline form is dictated by humidity (or water activity) and temperature, and these environmental stability boundaries for the caffeine crystalline forms are reported in this manuscript. Conversions between the two crystalline states can lead to deleterious effects; for example, the presence of caffeine hydrate crystals in a low water activity food (e.g., powder) could lead to the relocation of the water in caffeine to other ingredients in the food system, leading to unwanted water-solid interactions that could cause clumping and/or degradation.

Pharmacologic Management of Excessive Daytime Sleepiness

Excessive daytime sleepiness (EDS) is related to medical and social problems, including mental disorders, physical diseases, poor quality of life, and so forth. According to the International Classification of Sleep Disorders, Third Edition, diseases that result from EDS are narcolepsy type 1, narcolepsy type 2, idiopathic hypersomnia, hypersomnia due to a medical disorder, and others. EDS is usually treated using amphetamine-like central nervous system stimulants or modafinil and its R-enantiomer, armodafinil, wake-promoting compounds unrelated to amphetamines; a variety of new drugs are under development. The side effects of some stimulants are potent and careful selection and management are required.