Trends in caffeine intake among U.S. children and adolescents

The association of caffeine intake and prevalence of obesity among children and adolescents: A cross-sectional survey from NHANES 2011-2020 March

BACKGROUND

Many studies have demonstrated the beneficial health effects of caffeine. However, its association with obesity prevalence and caffeine intake remains controversial. Notably, the impact of caffeine on children and adolescents needs to be more adequately represented in large-scale epidemiological investigations.

OBJECTIVE

This study examines the association between caffeine intake and obesity prevalence in children and adolescents aged 2 to 19.

METHODS

This study used the database from the National Health and Nutrition Examination Survey (NHANES, 2011-2020 March) to perform a cross-sectional study. A total of 10,001 classified children and adolescents were included in this analysis. All data were survey-weighted, and corresponding logistic regression models were performed to examine the associations between caffeine intake and the prevalence of obesity.

RESULTS

In a fully adjusted model, a per-quartile increase in caffeine intake was associated with a 0.05% increased prevalence of obesity. In the subgroup analysis, the multivariate-adjusted ORs (95% CIs) of the prevalence of obesity for per-quartile 1.3497 (1.2014, 1.5163) increments in caffeine intake were 1.5961 (1.3127, 1.9406) for boys and 1.4418 (1.1861, 1.7525) for girls, 1.5807 (1.3131, 1.9027) for white race and 1.3181 (1.0613, 1.6370), 1.0500 (0.6676, 1.6515) for the age of 2-5, 1.4996 (1.1997, 1.8745) for the age of 6-12, and 1.2321 (0.9924, 1597) for the age of 13-19.

CONCLUSION

The study suggested that higher caffeine intake may have a protective effect against obesity in specific subgroups, particularly among no overweight individuals. However, the association was not significant in other groups, indicating the need for a nuanced understanding of caffeine's impact on obesity in diverse populations.

Comparing the number of outdoor sugar-sweetened beverage and caffeinated beverage advertisements near schools by school type and school-level economic advantage

INTRODUCTION

Sugar-sweetened beverage and caffeinated beverage consumption are associated with a variety of health issues among youth. Food and beverage marketing has been shown to affect youth's preferences, purchases, and consumption of marketed products. Previous research suggests that outdoor food and beverage marketing differs by community demographics, with more advertisements in lower-income communities and near schools. The purpose of this study is to examine the density of sugar-sweetened and caffeinated beverage advertisements near schools by school type (middle vs. high school) and by school-level SES.

METHODS

Data are from the Outdoor Measuring and Evaluating the Determinants and Influence of Advertising (MEDIA)study, which documented and described all outdoor food and beverage advertisements near 47 middle and high schools in 2012. Beverage advertisements were categorized as: sugar-sweetened/caffeinated, sugar-sweetened/non-caffeinated, non-sugar-sweetened/caffeinated, or non-sugar-sweetened/non-caffeinated. Schools were categorized by type (middle vs high) and by SES as determined by the percentage of students qualifying for free or reduced-price lunch. Bootstrapped non-parametric Mann-Whitney U tests compared the number of advertisements in each category by school type and school-level SES (higher vs lower).

RESULTS

Compared to schools with higher SES, schools with lower SES had significantly more advertisements for sugar-sweetened/non-caffeinated beverages (Medianlow = 28.5 (IQR 17-69), vs Medianhigh = 10.5 (IQR 4-17) (p = 0.002)., sugar-sweetened non-caffeinated (Medianlow = 46 (IQR 16-99) vs Medianhigh = 13.5 (IQR 6-25), p = 0.002), -sugar-sweetened caffeinated (Medianlow = 12 (IQR 8-19) vs Medianhigh = 6 (IQR 2-8), p = 0.000), and non-sugar-sweetened non-caffeinated (Medianlow = 30 (IQR 13-65) vs Medianhigh = 14 (IQR 4-29), p = 0.045).There were no significant differences by school type.

CONCLUSION

This study adds to the literature demonstrating pervasive marketing of unhealthy products in lower-income communities. Disproportionate exposure to sugar-sweetened and caffeinated beverage advertisements in lower-income communities may contribute to the disparities in associated health outcomes by economic status.

Coffee Consumption Among Adolescents: A Cross-Sectional Study

The purpose of this cross-sectional study is to analyze and perform a model analysis of the scope of caffeine consumption in adolescents in Turkey. The prevalence of caffeine consumption was 65.5% (321/490), with 22% of boys and 38.45% of girls consuming foodstuffs or beverages containing it. The mean daily caffeine intake was 85.8 mg. Girls consumed all types of coffee more frequently, while boys consumed black tea and energy drinks such as Red Bull and Burn more frequently than girls. Coffee was most frequently consumed to boost concentration, and tea and energy drinks out of habit. Individuals who lived in the city center, smokers, and individuals with high income levels consumed more caffeine (P = .000, P = .000, and P = .000). The level at which energy drinks were consumed by mixing with alcohol in a party setting was 11.5%, and this was more common among boys (P = .000). Greater efforts should be made to inform parents and adolescents of the potential harm resulting from misuse of caffeine.

Evolution of adolescents' dietary patterns in Northeast Brazil from 2008 to 2018

OBJECTIVE

To evaluate the evolution of the dietary patterns of adolescents in the northeast region of Brazil.

METHODS

Secondary analysis of data from the Pesquisa de Orçamentos Familiares (POF - Household Budget Surveys), collected by the Brazilian Institute of Geography and Statistics (IBGE) in the years 2008-2009 and 2017-2018. A total of 3,095 adolescents were evaluated in 2008-2009 and 3,015 in 2017-2018. Food consumption was assessed using two dietary records in 2008-2009 and two 24-hour recalls in 2017-2018, applied on non-consecutive days. Based on these data, principal components factor analysis (PCFA) was performed, followed by orthogonal rotation of the varimax type, to derive dietary patterns, stratified by sex. The results were described as means or percentage frequencies, with their respective 95% confidence intervals.

RESULTS

Three main dietary patterns were identified among adolescents from the northeast region of Brazil. Among boys, in 2008-2009, the patterns were called snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and mixed, in this order of representativeness of the group's eating habits. Among female adolescents, in 2008-2009, the patterns were snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and processed meats.

CONCLUSION

The dietary patterns identified in 2008-2009 and 2017-2018 were similar in both genders; however, the snacks pattern, which explained most of the data variability in 2008-2009, was replaced by the traditional Brazilian.

Caffeine consumption and association with sleep duration and screen time in Brazilian adolescents (ERICA Study)

OBJECTIVES

Some studies have demonstrated that caffeine consumption is a risk factor for insufficient sleep or poor sleep quality in adolescents. The aim of this study was to estimate the average daily caffeine consumption and to investigate the association between caffeine, sleep duration, and screen time in a large sample of Brazilian adolescents.

METHODS

We evaluated data from 71 533 adolescents aged 12 to 17 y, who participated in the ERICA study (Study of Cardiovascular Risk in Adolescents). Caffeine intake was extracted from 24-h dietary recalls of caffeine-containing products. The mean daily intake of caffeine/mg and caffeine/mg/kg, the prevalence of caffeine intake, and their respective 95% confidence intervals (CIs) were estimated according to the general characteristics. Associations between caffeine consumption, sleep duration, and screen time were analyzed by a multinomial logistic regression model, considering P < 0.05.

RESULTS

The overall average daily caffeine intake was 99.45 mg (95% CI, 91.43-107.47) and 1.88 mg/kg (95% CI, 1.71-2.04). Daily caffeine intake >3 mg/kg was significantly associated with screen time ≤2 h/d (odds ratio [OR], 1.16; 95% CI, 1.06-1.26) and sleep duration ≥8 h (OR, 1.31; 95% CI, 1.17-1.46), which remained significant after adjustment. The time of day of the highest caffeine consumption was in the morning (05:00-12:59). The most consumed caffeine-containing product was coffee (35%), followed by soda (27%).

CONCLUSIONS

This study demonstrated that caffeine consumption does not interfere with sleep duration or screen time. Moreover, the study provided important information about the source of caffeine most consumed by Brazilian adolescents, which could help professionals plan appropriate caffeine consumption.

Association between Beverage Consumption and Sleep Quality in Adolescents

The objective of this study was to verify if the consumption of different beverages (such as water, 100% pure fruit juice, and sugar-sweetened beverages (SSBs)) is associated with adolescents' sleep quality. French-speaking adolescents were recruited in person and online throughout the province of Québec (Canada) from the end of March to early July 2023. Beverage consumption and sleep quality were measured using French versions of validated questionnaires specifically designed for adolescents. A total of 218 adolescents (14-17 years; 55.5% female) completed the online survey. Among caffeinated SSBs, energy drink (rs = -0.16; p = 0.0197) and sugar-sweetened coffee (rs = -0.33; p < 0.0001) intake was correlated with adolescents' sleep quality. Energy drink consumption (β = -0.0048; p = 0.0005) and being male (β = 0.6033; p < 0.0001) were associated with adolescents' sleep quality. There was an interaction between sugar-sweetened coffee intake and biological sex that was associated with adolescents' sleep quality (p = 0.0053). Sugar-sweetened coffee consumption was correlated with adolescent girls' abilities to go to bed (rs = -0.21; p = 0.0203) and fall asleep (rs = -0.28; p = 0.0020), while in boys, it was only significantly correlated with their abilities to go to bed (rs = -0.27; p = 0.0069). Public health interventions aimed at adolescent boys should primarily target lowering energy drink consumption, while those aimed at girls should prioritize sugar-sweetened coffee intake to possibly improve their sleep quality.

Twin study of caffeine use, ADHD, and disrupted sleep in ABCD youth

OBJECTIVE

Evidence suggests that caffeine use disproportionately impacts sleep functioning among youth with attention-deficit/hyperactivity disorder (ADHD). The present study aimed to examine the association of caffeine use with disrupted sleep, and to test moderating effects of ADHD, by leveraging differences within twin pairs to explore potential quasi-causal (i.e., within-pair) effects.

METHOD

N = 765 complete same-sex twin pairs (mean age at baseline = 10.14 [SD = .5]; 49% girls; 73% white) from the ABCD study reported caffeine use and frequency of disrupted sleep; parents reported youth ADHD symptoms. Cotwin control analyses predicted disrupted sleep from caffeine use, ADHD, and their interaction at ages 10 and 12.

RESULTS

Neither quasi-causal within-pair effects of caffeine use on disrupted sleep, nor a moderating role of ADHD were identified. Posthoc biometric models indicated that genetic and environmental influences on these phenotypes may change over time, such that genetic influences on disrupted sleep began to emerge more robustly around early adolescence. Additionally, caffeine use and disrupted sleep, but not ADHD, displayed overlapping genetic influences (12-13% of total phenotypic variance) at age 10.

CONCLUSIONS

In a sample of preadolescent twin pairs from the ABCD Study, we did not observe evidence that caffeine use was quasi-causally associated with disrupted sleep at this early developmental stage. However, caffeine use and disrupted sleep emerged with shared etiologic influences. In sum, this study sets the stage for examining these dynamic patterns in future examinations of this critical and timely ABCD study sample, as genetic and environmental influences on behavior are known to change throughout development. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Coffee Consumption Behavior in Young Adults: Exploring Motivations, Frequencies, and Reporting Adverse Effects and Withdrawal Symptoms

Background

Coffee consumption by young people has increased dramatically over the last decades as there are substantial evidence of the physiological, cognitive, and emotional effects of coffee consumption. To reduce the risk of consuming related harm, it is necessary to understand the consumer's motivation for its use.

Objective

This study aimed to investigate coffee consumption behavior in young adults, assess the type of coffee consumption, explore motivation, document adverse effects and withdrawal symptoms of coffee intake.

Methods

A sample of 923 young adults were recruited voluntarily to complete a set of measures examining motivations, adverse effects, and withdrawal symptoms of coffee intake. Logistic regression analysis was performed to determine the association between coffee consumption and all independent variables. A p-value of 0.005 was considered as statistically significant.

Results

The results indicate that more than half of the participants consumed coffee. Coffee consumers were more like to be male, young adults, unmarried, poor sleep pattern (3-5 hours), and smokers. Main motivations of coffee intake were those related to reinforcing effects. The prevalence of dripper coffee consumption (85.59%) was observed to be highest with 20.1% participants consuming coffee in 2-3 times per day. Participants experienced restlessness, shaky, excited, difficulty in falling sleep, and fast heart beat as adverse effects of coffee consumption. Withdrawal symptoms such as headache, mood change, and tiredness were also noticed after consuming a high amount of coffee. Gender (p < 0.005), age (p < 0.003), family income (p < 0.004), BMI (p < 0.002) and sleeping pattern (p < 0.005) were found important variables associated with coffee intake.

Conclusion

The association reported in this study may allow for the implementation of appropriate strategies to address behaviors towards excessive coffee consumption and its link to an increased risk of poor health.

Association between caffeine consumption and bone mineral density in children and adolescent: Observational and Mendelian randomization study

BACKGROUND

Coffee is the most commonly consumed beverage among children and adolescences. Caffeine was demonstrated to be associated with bone metabolism. However, the relationship between caffeine intake and BMD in children and adolescents remains unclear. This study aimed to identified relationship between caffeine consumption and bone mineral density (BMD) in children and adolescents.

METHODS

Based on National Health and Nutrition Examination Survey (NHANES), we conducted an epidemiological cross-section study to measure the relationship between caffeine consumption and BMD in children and adolescents by multivariate linear regression models. Then, five methods of Mendelian randomization (MR) analyses were performed to estimate their causal relationship between coffee and caffeine intake and BMD in children and adolescents. MR-Egger and inverse-variance weighted (IVW) were used to evaluate the heterogeneity effect of instrumental variables (IVs).

RESULTS

In epidemiological studies, individuals with the highest quartile of caffeine intake do not have a significant change in femur neck BMD (β = 0.0016, 95% CI: -0.0096, 0.0129, P = 0.7747), total femur BMD (β = 0.0019, P = 0.7552), and total spine BMD (β = 0.0081, P = 0.1945) compared with the lowest quartile. In MR analysis, the IVW-random effect indicates no causal relationship between coffee consumption and TB- BMD (β = 0.0034, P = 0.0910). Other methods of MR analyses and sensitivity analysis reveals consistent findings. Similarly, the fixed-effects IVW method shows no causal association between caffeine intake and TB-BMD in children and adolescents (β = 0.0202, P = 0.7828).

CONCLUSIONS

Our study does not support a causal relationship between caffeine consumption and BMD in children and adolescents. However, more studies are needed to verify our findings, such as its underlying molecular mechanisms and the long-term impact of early caffeine exposure at a younger age.

Contextualizing drug use and pharmacological harm in the United States: a socio-historical overview

The purpose of this conceptual paper is to navigate through the socio-historical modulations in American tolerance for different psychoactive substances, and propose a theoretical synthesis formed by two vanguard philosophical doctrines, objectivism, and constructivism. Our approach is grounded on the analysis of social historical context and objective harms that have influenced drug use tolerance in the United States based on key historical events such as: heavy drinking at the dawn of nineteenth century, the establishment and repeal of prohibition, late nineteenth century opiate and cocaine tolerance followed by early twentieth century prohibition, post-prohibition drug concerns such as marijuana prohibition in the 1930s, heroin concerns and medical depressant use in the 1950s, poly-drug use in the 1960s, crack cocaine use in the 1980s, and finally modulations in tolerance for peyote use. Evidence supports the notion of drug harms reduction for the privileged, and criminalization of drug use by marginalized groups. Over long spans of history, however, more objectively harmful drugs are rejected, while drugs that can be used regularly without serous dysfunction are tolerated and normalized. We argue that a framework of social status and pharmacological harm can account for the vacillating policy responses that have emerged to different drugs at different times. Our approach informs the role of socio-cultural conflict in drug policy development and infuse the need for empirical research on the effect of socioeconomic positioning on attitudes of medicalization and legalization of marijuana and opioid policy in contemporary America.

The implications of socioeconomic factors on salivary bioscience methodological variables in a large pediatric multi-site study

Introduction

Salivary bioscience has found increased utilization within pediatric research, given the non-invasive nature of self-collecting saliva for measuring biological markers. With this growth in pediatric utility, more understanding is needed of how social-contextual factors, such as socioeconomic factors or status (SES), influence salivary bioscience in large multi-site studies. Socioeconomic factors have been shown to influence non-salivary analyte levels across childhood and adolescent development. However, less is understood about relationships between these socioeconomic factors and salivary collection methodological variables (e.g., time of saliva collection from waking, time of day of saliva collection, physical activity prior to saliva collection, and caffeine intake prior to saliva collection). Variability in salivary methodological variables between participants may impact the levels of analytes measured in a salivary sample, thus serving as a potential mechanism for non-random systematic biases in analytes.

Methods

Our objective is to examine relationships between socioeconomic factors and salivary bioscience methodological variables within the Adolescent Brain Cognitive Development Study© cohort of children aged 9-10 years old (n = 10,567 participants with saliva samples).

Results

We observed significant associations between household socioeconomic factors (poverty status, education) and salivary collection methodological variables (time since waking, time of day of sampling, physical activity, and caffeine intake). Moreover, lower levels of household poverty and education were significantly associated with more sources of potential bias in salivary collection methodological variables (e.g., longer times since waking, collections later in the day, higher odds of caffeine consumption, and lower odds of physical activity). Consistent associations were not observed with neighborhood socioeconomic factors and salivary methodological variables.

Discussion

Previous literature demonstrates associations between collection methodological variables and measurements of salivary analyte levels, particularly with analytes that are more sensitive to circadian rhythms, pH levels, or rigorous physical activity. Our novel findings suggest that unintended distortions in measured salivary analyte values, potentially resulting from the non-random systematic biases in salivary methodology, need to be intentionally incorporated into analyses and interpretation of results. This is particularly salient for future studies interested in examining underlying mechanisms of childhood socioeconomic health inequities in future analyses.

Racial/Ethnic and Sex/Gender Differences in Sleep Duration Trajectories From Adolescence to Adulthood in a US National Sample

Racial/ethnic and sex/gender disparities in sleep duration have been documented in adolescence and adulthood. Identifying racial/ethnic and sex/gender differences in sleep duration trajectories from adolescence to adulthood can inform interventions on the developmental periods individuals are most at risk for short sleep duration. We examined racial/ethnic and sex/gender differences in self-reported sleep duration trajectories from adolescence to adulthood using data from waves I, III, IV, and V of the National Longitudinal Study of Adolescent to Adult Health (1994-2018; n = 12,593). Multigroup growth mixture modeling was used to enumerate sleep duration trajectories from adolescence to adulthood. There were 3 common trajectory types across race/ethnicity and sex/gender groups: 1) consistent increasing short sleepers (i.e., increasing probability of short sleep into adulthood) (67.3%); 2) late-onset short sleepers (i.e., no probability of short sleep duration in adolescence until adulthood) (20.2%); and 3) early-onset short sleepers (i.e., declining probability of short sleep duration from adolescence into adulthood) (12.5%). The prevalence of the consistent-increasing trajectory was highest among Black male respondents, while late onset was highest among White female respondents and early onset greatest among Latinx male respondents. Findings underscore the need to intervene in early adolescence to prevent short sleep duration in adulthood.

The relationships between use of alcohol, tobacco and coffee in adolescence and mood disorders in adulthood

INTRODUCTION

Alcohol, tobacco and coffee are commonly used substances and use in adolescence has previously been linked to mood disorders. However, few large prospective studies have investigated adolescent use in relation to mental health outcomes in adulthood. The main aim of this study was to examine the prospective associations between alcohol use, cigarette smoking and coffee consumption at age 16 and subsequent mood disorders up to 33 years of age.

METHODS

Data from The Northern Finland Birth Cohort 1986 Study were used and a total of 7660 participants (49.9% male) were included. Associations between alcohol use, cigarette smoking and coffee consumption at age 16 and later diagnoses of major depression and bipolar disorder were examined using multinomial logistic regression analyses.

RESULTS

Mean number of cigarettes/day (OR, 1.23 [95% CI 1.01-1.50]) and mean volume of alcohol consumption (OR, 1.22 [95% CI 1.01-1.47]), but not frequency of excessive drinking, in adolescence were associated with increased risk for subsequent bipolar disorder after adjustment for sex, parental psychiatric disorders, family structure, illicit substance use, and emotional and behavioral problems at age 16. An association between cigarette smoking and major depression attenuated to statistically non-significant when adjusted for emotional and behavioral problems. No associations were observed between adolescent coffee consumption and subsequent mood disorders.

CONCLUSIONS

This is the first study to report an association of adolescent cigarette smoking and subsequent bipolar disorder diagnosis providing grounds for further research and pointing to a place for preventive measures among adolescents.

Association of caffeine and caffeine metabolites with obesity among children and adolescents: National Health and Nutrition Examination Survey (NHANES) 2009-2014

The effect of caffeine exposure on children's health remains poorly understood. We aimed to characterize the associations of caffeine and caffeine metabolites with adiposity outcomes among children and adolescents. We performed cross-sectional analyses of 1,447 children and adolescents aged 6-19 years from the 2009-2014 National Health and Nutrition Examination Survey. The linear regression and weighted quantile sum (WQS) regression were used to explore the associations of urinary caffeine and 14 caffeine metabolites with adiposity outcomes, including body mass index (BMI) z-score, waist circumference (WC), obesity, and overweight. In linear regression models, compared with the participants who consumed low caffeine, higher BMI z-score, WC, and risks of obesity and overweight were more likely among those who consumed high caffeine (P < 0.05). In WQS regression models, an interquartile range increase in the weighted caffeine index was significantly associated with increased BMI z-score (β = 0.10, 95% CI = 0.01, 0.17) and WC (β = 1.20, 95% CI = 0.31, 2.09), and risks of obesity (OR = 1.09, 95% CI = 1.02, 1.17). Totally, no modification effect of age or gender was observed in the linear regression model. Nonetheless, in WQS models, the positive associations of caffeine exposure with WC and risks of obesity and overweight were significant in children aged 6-11 years rather than 12-19 years. When stratified by gender, caffeine exposure was significantly associated with BMI z-score and WC in both boys and girls. These results add novel evidence that caffeine exposure might be associated with adverse adiposity outcomes among children and adolescents.

Caffeine Consumption among Various University Students in the UAE, Exploring the Frequencies, Different Sources and Reporting Adverse Effects and Withdrawal Symptoms

Background

Caffeine is widely consumed among students due to its cognitive and physical enhancing effects. However, little is known about the consumption pattern of different caffeinated products among university students in the United Arab Emirates (UAE).

Aim

To investigate the frequency of caffeine consumption among the young population of students, assess types of caffeinated products consumed, and document adverse effects and withdrawal symptoms experienced by university students.

Methods

A cross-sectional study was conducted in the UAE from December 2019 to March 2020. A random sample of 500 university students from different universities in the UAE were approached and asked to complete a self-administered online-based questionnaire. Data were analyzed using the Statistical Package for Social Science (SPSS) version 26.

Results

Of (n = 500) surveyed students, (n = 467) completed the survey 93.4%. The average level of caffeine consumption was significantly higher in females compared to male students (p < 0.005). Coffee was the highest favored source of caffeine (67.7%) followed by tea (47.3%). The average daily intake of caffeine was found to be 264 mg/day. Surprisingly, almost a third of students reported a high level of daily consumption (>400 mg/day) and more than half of them consumed less than 199 mg/day. Large proportions of students 91.1% have their caffeinated beverage after or while eating meals and 42.8% considered that this habit helped in avoiding acid reflux. Interestingly, around one third of participants have poor knowledge of caffeine-containing medical products, which seemed to affect the level of consumption in the student population (p < 0.05). The highest reported reason for caffeine intake was for studying purposes (59.4%).

Conclusion

Caffeine consumption is highly prevalent among university students in the UAE. Yet, there is insufficiency in the current knowledge of safe caffeine consumption patterns reflecting the importance of health awareness programs and nutritional lectures to decrease the long-term health issues and unintentional overdose of caffeine.

Prevalence of caffeine consumers, daily caffeine consumption, and factors associated with caffeine use among active duty United States military personnel

Background

Although representative data on caffeine intake in Americans are available, these data do not include US service members (SMs). The few previous investigations in military personnel largely involve convenience samples. This cross-sectional study examined prevalence of caffeine consumers, daily caffeine consumption, and factors associated with caffeine use among United States active duty military service members (SMs).

Methods

A stratified random sample of SMs were asked to complete an on-line questionnaire on their personal characteristics and consumption of caffeinated products (exclusive of dietary supplements). Eighteen percent (n = 26,680) of successfully contacted SMs (n = 146,365) completed the questionnaire.

Results

Overall, 87% reported consuming caffeinated products ≥1 time/week. Mean ± standard error per-capita consumption (all participants) was 218 ± 2 and 167 ± 3 mg/day for men and women, respectively. Caffeine consumers ingested 243 ± 2 mg/day (251 ± 2 mg/day men, 195 ± 3 mg/day women). On a body-weight basis, men and women consumed respectively similar caffeine amounts (2.93 vs 2.85 mg/day/kg; p = 0.12). Among individual caffeinated products, coffee had the highest use (68%), followed by sodas (42%), teas (29%), energy drinks (29%) and gums/candy/medications (4%). In multivariable logistic regression, characteristics independently associated with caffeine use (≥1 time/week) included female gender, older age, white race/ethnicity, higher body mass index, tobacco use or former use, greater alcohol intake, and higher enlisted or officer rank.

Conclusion

Compared to National Health and Nutrition Examination Survey data, daily caffeine consumption (mg/day) by SMs was higher, perhaps reflecting higher mental and physical occupational demands on SMs.

Coffee and energy drink use patterns in college freshmen: associations with adverse health behaviors and risk factors

Background

Public health concern over college students mixing caffeine-containing energy drinks (EDs) and alcohol has contributed to an array of ED-focused research studies. One review found consistent associations between ED use and heavy/problem drinking as well as other drug use and risky behaviors (Nutr Rev 72:87–97, 2014). The extent to which similar patterns exist for other sources of caffeine is not known. The present study examined associations between coffee and ED consumption and alcohol, tobacco and other drug use; alcohol use problems; and parental substance abuse and mental health problems in a sample of college freshmen.

Methods

Subjects were N = 1986 freshmen at an urban university who completed an on-line survey about demographics; caffeine; alcohol, tobacco and other drug use; and family history. The sample was 61% female and 53% White. Chi-square analyses and multivariable binary or ordinal logistic regression were used to compare substance use, problem alcohol behavior, and familial risk measures across 3 caffeine use groups: ED (with or without Coffee) (ED + Co; N = 350); Coffee but no ED (Co; N = 761); and neither coffee nor ED (NoCE; N = 875) use.

Results

After adjusting for gender and race, the 3 caffeine use groups differed on 8 of 9 symptoms for alcohol dependence. In all cases, the ED + Co group was most likely to endorse the symptom, followed by the Co group and finally the NoCE group (all p < .002). A similar pattern was found for: use 6+ times of 5 other classes of drugs (all p < .05); extent of personal and peer smoking (all p < .001); and paternal problems with alcohol, drugs and anxiety/depression as well as maternal alcohol problems and depression/anxiety (p < .04).

Conclusions

The response pattern was ubiquitous, with ED + Co most likely, Co intermediate, and NoCE least likely to endorse a broad range of substance use, problem alcohol behaviors, and familial risk factors. The finding that the Co group differed from both the ED + Co and NoCE groups on 8 measures and from the NoCE group on one additional measure underscores the importance of looking at coffee in addition to EDs when considering associations between caffeine and other risky behaviors.

Prevalence and Differences of Depression, Anxiety, and Substance Use Between Chinese College-Age Students Studying in China and America During the Coronavirus Disease 2019 Pandemic

Introduction

The coronavirus disease (COVID-19) swept the globe and harmfully influenced the mental health and behaviors of the college student population. This study aims to examine the prevalence and difference of mental health and the substance use problems of the Chinese college-age students studying in China and America (CSA) during the COVID-19 pandemic.

Methods

One thousand five hundred four students participated in this study. A total of 42.12% of students are enrolled in Chinese colleges, and 57.78% of students are enrolled in American colleges, aged 17-23 years (x ¯ ± s = 19.90 ± 1.50). Binary logistic regression and independent t-test were used in this study to find the predictor variables and association among mental health, substance use problems, and student population.

Results

The two student groups had a statistical difference in General Anxiety Disorder-7 scale, alcohol, medicines, drinks, drugs and cigarettes (p < 0.01). The students suffering depression problems from the two groups have statistical significance with drinks (odds ratio = 0.89, 95% confidence interval = 0.81-0.97, p < 0.05; odds ratio = 1.11, 95% confidence interval = 1.04-1.19, p < 0.01). CSA experiencing anxiety problem had a significant association with alcohol, drinks, cigarette, and desserts (p < 0.05).

Conclusion

This is the first cross-sectional study focusing on the comparison of the Chinese college-age students' mental health and substance use problems who are studying in China and America during the pandemic. Our study revealed severe mental health and substance use problems in both student groups, particularly in the CSA during the COVID-19 pandemic. The findings of our study also highlight the evidence to find more interventions and preventions to solve the different mental health and substance use problems for college students.

Anti-Alzheimer's disease potential of Arabian coffee versus Date palm seed extract in male rats

Coffee is among the most commonly consumed beverage all over the world. Studies have increasingly suggested caffeine and coffee as effective therapeutic interventions against Alzheimer's disease (AD). We have therefore utilized the aluminum chloride rat model for AD to compare the influence of moderately caffeinated (Arabian) and decaffeinated (Date palm seed) coffee on cognitive impairment and pathological events in AD. AD rats given Arabian or Date palm seed coffee were protected against memory impairment and had lower serum levels of the abnormal protein (amyloid-beta; Aβ1-42), the central pathogenic contributor to AD, and transforming growth factor-beta (TGF-β). Interestingly, Date palm seed (decaffeinated) coffee seems to provide more pronounced protection against AD than Arabian (moderately caffeinated) coffee as evidenced by the greater decrease in serum Aβ levels. These results suggest a surprising therapeutic potential of moderate caffeine intake in Arabian coffee to ameliorate AD through decreasing serum Aβ levels. However, Date palm seed (decaffeinated) coffee, rich in flavonoids, appears to provide a better AD-modifying ability through a direct reduction of Aβ production. PRACTICAL APPLICATIONS: Consumption of moderately caffeinated Arabian coffee attenuated AD-induced cognitive impairment via its anti-amyloidogenic potential, decreasing Aβ levels. Moreover, intake of decaffeinated Date seed extract, rich in flavonoids, exerted a superior anti-AD potential through a direct reduction of Aβ production. Both of them were also safe and maintained hepatic and renal functions in a rat model of AlCl₃ -induced AD. Further clinical studies are warranted to confirm current results and to recommend the regular drinking of Arabian coffee or Date seed extract as a protective approach to delay AD progression in vulnerable individuals or in early disease stages.

Rates of Presentation, Treatments and Serious Neurologic Disorders Among Children and Young Adults Presenting to US Emergency Departments With Headache

OBJECTIVE

To evaluate rates of presentation, neuroimaging, therapies, and serious neurologic disorders (SNDs) among children and young adults presenting to the emergency department with headache.

METHODS

We performed a cross-sectional study of a nationally representative sample survey of visits to US emergency departments between 2002 and 2017. We identified encounters of patients ≤25 years old with chief complaint of headache. We report the rates of presentation, imaging, and treatments and report proportions having concomitant diagnoses of serious neurologic disorders.

RESULTS

Among encounters ≤25 years, 2.0% had a chief complaint of headache, with no change in the yearly rates of encounters (P = .98). Overall, 20.8% had a head computed tomography (CT), with a reduction in performance between 2007 and 2016 (P < .01). One-quarter (25.2%, 95% confidence interval [CI] 22.2%-28.3%) were given narcotics and 2.5% (95% CI 1.7%-3.2%) had serious neurologic disorders.

CONCLUSION

Overall, 2.0% of emergency department encounters among patients ≤25 years were for headache, with low rates of serious neurologic disorders. CT use appeared to be declining.

The Energy to Smoke: Examining the Longitudinal Association between Beverage Consumption and Smoking and Vaping Behaviours among Youth in the COMPASS Study

This study examined the longitudinal association between changes in sugar-sweetened and/or caffeinated beverage consumption and smoking/vaping behaviour among Canadian adolescents. Using longitudinal data from the COMPASS study (2015/16 to 2017/18), four models were developed to investigate whether beverage consumption explained variability in smoking and vaping behaviour in adolescence: (1) smoking initiation, (2) vaping initiation, (3) current smoking status, and (4) current vaping status. Models were adjusted for demographic factors. Multinomial logit models were used for model 1, 2, and 3. A binary logistic regression model was used for model 4. An association between change in frequency of beverage consumption and smoking/vaping behaviour was identified in all models. A one-day increase in beverage consumption was associated with smoking initiation (OR = 1.38, 95% CI: 1.25, 1.51), vaping initiation (OR = 1.23, 95% CI: 1.14, 1.32), identifying as a current smoker (OR = 1.17, 95% CI: 1.01, 1.35), and currently vaping (OR = 1.08, 95% CI: 1.04, 1.11). Change in high-energy drink consumption was the best predictor of smoking behaviours and vaping initiation but not current vaping status. Given the health consequences of smoking and vaping and their association with high-energy drink and coffee consumption, policy initiatives to prevent smoking/vaping initiation, and to limit youth access to these beverages, warrant consideration.

The Influence of Lifestyle Factors on the Burden of Pediatric Migraine

There is a gap in patient education and coaching of lifestyle factors related to pediatric migraine, which nurses are in a unique position to fill in order to provide comprehensive care to these patients. In order to help fill this gap, we conducted a targeted review of studies examining migraine and lifestyle factors in children and adolescents. Studies older than 2010, studies examining adults above the age of 18, studies not available in the English language, and secondary sources were excluded from the review. A final sample of 42 studies was included in this review. Lifestyle factors including stress, sleep, obesity, and diet were identified as playing a significant role in increasing the frequency, severity, and duration of migraine attacks in pediatric patients. Based on these findings, a framework is discussed for practical applications of this knowledge by nursing staff working in primary and specialty care clinics.

Sleep Characteristics of Elite Youth Athletes: A Clustering Approach to Optimize Sleep Support Strategies

PURPOSE

Elite athletes experience chronic sleep insufficiency due to training and competition schedules. However, there is little research on sleep and caffeine use of elite youth athletes and a need for a more nuanced understanding of their sleep difficulties. This study aimed to (1) examine the differences in sleep characteristics of elite youth athletes by individual and team sports, (2) study the associations between behavioral risk factors associated with obstructive sleep apnea and caffeine use with sleep quality, and (3) characterize the latent sleep profiles of elite youth athletes to optimize the sleep support strategy.

METHODS

A group (N = 135) of elite national youth athletes completed a self-administered questionnaire consisting of the Pittsburgh Sleep Quality Index (PSQI) and questions pertaining to obstructive sleep apnea, napping behavior, and caffeine use. K-means clustering was used to characterize unique sleep characteristic subgroups based on PSQI components.

RESULTS

Athletes reported 7.0 (SD = 1.2) hours of sleep. Out of the total group, 45.2% of the athletes had poor quality sleep (PSQI global >5), with team-sport athletes reporting significantly poorer sleep quality than individual-sport athletes. Multiple logistic regression analysis indicated that sport type significantly correlated with poor sleep quality. The K-means clustering algorithm classified athletes' underlying sleep characteristics into 4 clusters to efficiently identify athletes with similar underlying sleep issues to enhance interventional strategies.

CONCLUSION

These findings suggest that elite youth team-sport athletes are more susceptible to poorer sleep quality than individual-sport athletes. Clustering methods can help practitioners characterize sleep-related problems and develop efficient athlete support strategies.

Caffeine intake and cognitive functions in children

RATIONALE

There is a growing concern over excessive caffeine use and development of caffeine use disorder in children.

OBJECTIVES

This study aimed to identify the association between caffeine intake and cognitive functioning in children.

METHODS

This study included 11,718 youths aged 9-10 years with cognitive and caffeine intake information that were extracted from the Adolescent Brain Cognitive Development (ABCD) study. The ABCD study is a longitudinal cohort study started in 2017 that aims to understand the relationships between substance use and neurocognition in youths living in the USA. Cognitive measures were obtained through the 7 core cognitive instruments from the NIH toolbox (vocabulary comprehension, reading decoding, inhibitory control, working memory, cognitive flexibility, processing speed, and episodic memory). Associations between caffeine intake and the seven cognitive functions were examined using multiple regression models.

RESULTS

Our study revealed that caffeine intake negatively correlated with all the seven cognitive measures. After adjustment for age, gender, sleep, and socioeconomic status (SES), caffeine intake was still found to be negatively associated with most of the cognitive functions, such as vocabulary comprehension, working memory, cognitive flexibility, processing speed, and episodic memory, except reading decoding, and inhibitory control.

CONCLUSIONS

As beverages with caffeine are consumed frequently, controlling their intake may reduce a risk for nonoptimal cognitive development in children.

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.

Non-Alcoholic Beverages, Old and Novel, and Their Potential Effects on Human Health, with a Focus on Hydration and Cardiometabolic Health

The Beverage Guidance System has established dietary recommendations for daily intake of commonly consumed beverages including water, tea, coffee, milk, non-calorically sweetened beverages, and calorically sweetened beverages. As obesity in America continues to be a growing problem, this guidance becomes of increasing importance due to many beverages' potential links to Type 2 Diabetes Mellitus (T2DM), Cardiovascular disease (CVD), and numerous other harmful health effects. However, the growing popularity of "better for you" beverages is causing a shift in the market, with consumers pushing for healthier beverage alternatives. Beverages simultaneously present advantages while posing concerns that need to be evaluated and considered. In this review, health effects of nonalcoholic beverages are discussed including various aspects of consumption and current trends of the beverage market such as the novel Soft Seltzer category as an alternative to Hard Seltzer and various mashups. A variety of advisory boards and agencies responsible for dietary guidelines in various countries suggest drinking water as the preferred practice for hydration.

Antioxidant and Neuroprotective Effects of Caffeine against Alzheimer's and Parkinson's Disease: Insight into the Role of Nrf-2 and A2AR Signaling

This paper reviews the results of studies conducted on the role of caffeine in the management of different neurological disorders, such as Parkinson's disease (PD) and Alzheimer's disease (AD). To highlight the potential role of caffeine in managing different neurodegenerative diseases, we identified studies by searching PubMed, Web of Science, and Google Scholar by scrutinizing the lists of pertinent publications. According to the collected overall findings, caffeine may reduce the elevated oxidative stress; inhibit the activation of adenosine A2A, thereby regulating the accumulation of Aβ; reduce the hyperphosphorylation of tau; and reduce the accumulation of misfolded proteins, such as α-synuclein, in Alzheimer's and Parkinson's diseases. The studies have suggested that caffeine has promising protective effects against different neurodegenerative diseases and that these effects may be used to tackle the neurological diseases and/or their consequences. Here, we review the ongoing research on the role of caffeine in the management of different neurodegenerative disorders, focusing on AD and PD. The current findings suggest that caffeine produces potent antioxidant, inflammatory, and anti-apoptotic effects against different models of neurodegenerative disease, including AD, PD, and other neurodegenerative disorders. Caffeine has shown strong antagonistic effects against the adenosine A2A receptor, which is a microglial receptor, and strong agonistic effects against nuclear-related factor-2 (Nrf-2), thereby regulating the cellular homeostasis at the brain by reducing oxidative stress, neuroinflammation, regulating the accumulation of α-synuclein in PD and tau hyperphosphorylation, amyloidogenesis, and synaptic deficits in AD, which are the cardinal features of these neurodegenerative diseases.

From Preconception Care to the First Day of School: Transforming the Health of New Families With Lifestyle Medicine

Lifestyle medicine holds great promise to transform health during the period from preconception to early childhood. Genetic, epigenetic, nutritional, and environmental factors have lifetime impact on the newborn and family. Little is known about the full potential of lifestyle medicine to improve maternal, child, and family health. Additionally, health care providers face limits in time and may have gaps in knowledge, that preclude discussion of the impact lifestyle medicine can the mother, newborn, and family. Greater understanding of the potential impact of lifestyle medicine provides opportunities to identify current deficiencies in care and areas for improvement and highlights the need for further research. This article reviews current evidence supporting the 6 pillars of lifestyle medicine: nutrition, physical activity, sleep, avoiding risky substance use, stress management and social connectedness as applied to maternal child care from preconception to early childhood, examines the current state of practice, and identifies opportunities for both practice change and further research. Rather than view each component of care in isolation, viewing care as a continuum from preconception to childhood can best establish healthy habits and optimize outcomes for the entire family.

Assessment of Phenolic Compound Intake from Plant-Derived Products in Adolescents from Ontario, Canada

Purpose: To better understand which plant-derived products contribute to the usual daily total polyphenol content (TPC) intake of Canadian adolescents. Methods: A convenience sample from 2 southwestern Ontario high schools was obtained (n = 108). Students of all gender and ethnicity were invited to participate if they were enrolled in grades 9-12 and were between the ages of 13 and 18 years. To measure the usual intake of TPC found in fruits, vegetables, fruit juices, nuts and legumes, tea, and coffee and coffee-based beverages, participants completed a food frequency questionnaire. TPC of the tea, coffee and coffee-based beverages, and fruit juices were determined spectrophotometrically, and the TPC of all other food items were calculated using the Phenol-Explorer Database. Results: Participants' median consumption of TPC was 974 mg/day (25th, 75th percentile; 559, 2161, respectively). Fruit contributed 69% to TPC intake with 24% from vegetables; 3% from juice; 2% from tea, coffee, and coffee-based beverages; and 0% from nuts and pulses. No sex differences were found. Conclusion: The results of this exploratory study suggest that fruit is the major contributor to the daily TPC intake of adolescents in Ontario, Canada; however, a larger-scale study is warranted to confirm these findings.

Comparing Methods from the National Cancer Institute vs Multiple Source Method for Estimating Usual Intake of Nutrients in the Hispanic Community Health Study/Study of Latino Youth

BACKGROUND

The Multiple Source Method (MSM) and the National Cancer Institute (NCI) method estimate usual dietary intake from short-term dietary assessment instruments, such as 24-hour recalls. Their performance varies according to sample size and nutrients distribution. A comparison of these methods among a multiethnic youth population, for which nutrient composition and dietary variability may differ from adults, is a gap in the literature.

OBJECTIVE

To compare the performance of the NCI method relative to MSM in estimating usual dietary intakes in Hispanic/Latino adolescents.

DESIGN

Data derived from the cross-sectional population-based Hispanic Community Health Study/Study of Latino Youth, an ancillary study of offspring of participants in the adult Hispanic Community Health Study/Study of Latino Youth cohort. Dietary data were obtained by two 24-hour recalls.

PARTICIPANTS/SETTING

One thousand four hundred fifty-three Hispanic/Latino youth (aged 8 to 16 years) living in four urban US communities (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA) during 2012 through 2014.

MAIN OUTCOME MEASURES

The NCI method and the MSM were applied to estimate usual intake of total energy, macronutrients, minerals and vitamins, added sugar, and caffeine.

STATISTICAL ANALYSES

Mean, standard deviation, minimum and maximum values, coefficient of variation, variance ratio, and differences between NCI and MSM methods and the 2-day mean were estimated in several percentiles of the distribution, as well as concordance correlation coefficients and Bland-Altman plot analysis.

RESULTS

The distributions of all nutrients studied were very similar between NCI and MSM. The correlation between NCI and MSM was >0.80 for all nutrients (P<0.001), except dietary cholesterol, vitamin C, and n-3 fatty acids. In individual estimations, NCI method predicted higher estimates and lower variance than the MSM. The lowest level of agreement was observed in the values at the tails of the distribution, and for nutrients with high variance ratio.

CONCLUSIONS

Overall, both MSM and NCI method provided acceptable estimates of the usual intake distribution using 24-hour recall, and they better represented the usual intake compared with 2-day mean, correcting for intraindividual variability.

Calories, Caffeine and the Onset of Obesity in Young Children

OBJECTIVE

High calorie foods and beverages, which often contain caffeine, contribute to child overweight/obesity. We evaluated the results of an educational intervention to promote healthy growth in very young children. Secondarily, we used detailed diet data to explore the association of nutrient intake with the early development of overweight and obesity.

METHODS

Mothers were obese Latina women, enrolled prenatally, and their infants. Specially trained community health workers provided breastfeeding support and nutrition education during 10 home visits, birth to 24 months. At follow-up, age 18 to 36 months, we measured growth and completed detailed diet recalls (1-7 recall days/child).

RESULTS

Of 174 infants randomized, 106 children were followed for 24 to 36 months. The educational intervention did not prevent overweight/obesity. Forty-two percent of children became overweight or obese. Fifty-eight percent of children consumed caffeine on at least 1 recall day. Mean intake was 0.48 mg/kg/day. Caffeine correlated with higher consumption of calories, and added sugar and decreased intake of protein, fiber and dairy. Compared with days without caffeine, on days when caffeine was consumed, children ingested 121 more calories and 3.8 gm less protein. Children frequently consumed less than the recommended daily intake of key nutrients such as fiber, vegetables, whole fruit, and vitamins.

CONCLUSIONS

Caffeine was a marker for increased intake of calories and decreased intake of key nutrients. When discussing dietary intake in early childhood, practitioners should screen for nutrient deficiency in young children and recommend limiting the intake of caffeinated foods and beverages.

Coffee and cigarettes: Examining the association between caffeinated beverage consumption and smoking behaviour among youth in the COMPASS study

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Caffeinated beverage consumption is associated with smoking behaviours in youth.

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High energy drink consumption is most strongly associated with smoking behaviours.

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Caffeinated beverages and smoking behaviour demonstrate a dose–response association.

In adults, coffee, sugar-sweetened beverage (SSB) and high energy drink consumption have been related to increases in risky behaviour, including smoking. However, these associations are not well understood during adolescence. The purpose of this study was to examine the association between beverage consumption and smoking behaviour among Canadian adolescents. Using data from the COMPASS study (2016–2017; n = 46,957), four models were developed to investigate whether beverage consumption explained variability in smoking behaviour in adolescence (age = 15.7 ± 1.2 yrs); 1) smoking status; 2) e-cigarette use status; 3) days smoking cigarettes per month; and 4) days using an e-cigarette per month. Models were adjusted for demographic factors. Logistic (models 1 and 2) and ordinal logistic (models 3 and 4) were used for analysis. An association between the frequency of SSBs, coffee/tea or high energy drinks consumption and smoking behaviour was identified in all models. Greater beverage consumption was associated with being a current smoker (OR = 2.46 (2.02, 2.99)), former smoker, (OR = 2.50 (1.53, 4.08)), and currently using an e-cigarette (OR = 4.66 (3.40, 6.40)). Higher beverage consumption was also associated with more days smoking/using an e-cigarette per month (OR = 2.67 (1.92, 3.70) and 3.45 (2.32, 5.12), respectively). High energy drink consumption on 4 or 5 days of the school week was the best predictor of smoking behaviour in all models. Given the health consequences of smoking and e-cigarette use and their association with SSB, high energy drinks and coffee consumption, policy initiatives to prevent smoking initiation and limit access to these beverages needs ongoing attention and implementation.

Perspective: The Role of Beverages as a Source of Nutrients and Phytonutrients

The Dietary Guidelines for Americans (DGA) provide nutrition advice for Americans >2 y of age. The 2020-2025 DGA proposes a life stage approach, focusing on birth through older adulthood. Limited recommendations for beverages exist except for milk, 100% fruit juice, and alcohol. The goal of this article is to provide a better understanding of the role of beverages in the diet using current scientific evidence. A Medline search of observational studies, randomized controlled trials, and meta-analyses was undertaken using key beverage words. We highlight the role beverages can play as a part of the DGA and considered beverages not traditionally included, such as those that are phytonutrient dense. Our primary consideration for beverage consumption targeted healthy Americans aged ≥2 y. However, with the proposed expansion to the life span for the 2020-2025 DGA, we also reviewed evidence for infants and toddlers from birth to 24 mo. Examples are provided on how minor changes in beverage choices aid in meeting recommended intakes of certain nutrients. Guidance on beverage consumption may aid in development of better consumer products to meet broader dietary advice. For example, beverage products that are nutrient/phytonutrient dense and lower in sugar could be developed as alternatives to 100% juice to help meet the fruit and vegetable guidelines. Although beverages are not meant to replace foods, e.g., it is difficult to meet the requirements for vitamin E, dietary fiber, or essential fatty acids through beverages alone, beverages are important sources of nutrients and phytonutrients, phenolic acids and flavonoids in particular. When considering the micronutrients from diet alone, mean intakes of calcium (in women), potassium, and vitamins A, C, and D are below recommendations and sodium intakes are well above. Careful beverage choices could close these gaps and be considered a part of a healthy dietary pattern.

Caffeine Consumption in Children: Innocuous or Deleterious? A Systematic Review

Caffeine is the most consumed psychostimulant worldwide. Its use among children is controversial. Although it produces an increase in brain activity, it could hamper growth and development in young consumers. Therefore, the aim of this review was to recognize changes produced by caffeine in children under 12 years of age and to identify the relevant alterations and the conditions of their occurrence. A systematic review of the literature was carried out using PRISMA. Initially, 5468 articles were found from the EBSCO, ScienceDirect, PubMed, and Clarivate Analytics databases. In this review, were retained 24 published articles that met the inclusion criteria. The results obtained showed that caffeine consumption hampers children's growth and development. In contrast, it supports the activation of the central nervous system and brain energy management.

Caffeine and Clinical Outcomes in Premature Neonates

Caffeine is the most widely used drug by both adults and children worldwide due to its ability to promote alertness and elevate moods. It is effective in the management of apnea of prematurity in premature infants. Caffeine for apnea of prematurity reduces the incidence of bronchopulmonary dysplasia in very-low-birth-weight infants and improves survival without neurodevelopmental disability at 18-21 months. Follow-up studies of the infants in the Caffeine for Apnea of Prematurity trial highlight the long-term safety of caffeine in these infants, especially relating to motor, behavioral, and intelligence skills. However, in animal models, exposure to caffeine during pregnancy and lactation adversely affects neuronal development and adult behavior of their offspring. Prenatal caffeine predisposes to intrauterine growth restriction and small growth for gestational age at birth. However, in-utero exposure to caffeine is also associated with excess growth, obesity, and cardio-metabolic changes in children. Caffeine therapy is a significant advance in newborn care, conferring immediate benefits in preterm neonates. Studies should help define the appropriate therapeutic window for caffeine treatment along with with the mechanisms relating to its beneficial effects on the brain and the lung. The long-term consequences of caffeine in adults born preterm are being studied and may depend on the ability of caffeine to modulate both the expression and the maturation of adenosine receptors in infants treated with caffeine.

Chronic caffeine exposure in adolescence promotes diurnal, biphasic mood-cycling and enhanced motivation for reward in adult mice

Adolescent's consumption of caffeine and caffeinated beverage is increasing, yet little is known about the consequences of chronic caffeine exposure during the critical development period of adolescence. In the present study, we investigated the effect of beginning chronic caffeine consumption in adolescence on locomotor, mood, sensorimotor gating, and reward seeking behaviors through adolescence and in adulthood. During the light cycle, caffeine exposed mice exhibited hypoactivity in a novel open-field box and increased anxiety-like and depressive-like behaviors, while maintaining normal home cage locomotor activity. In contrast, during the dark cycle caffeine exposed mice displayed normal locomotor activity in a novel open-field box with hyperactive home cage activity. Interestingly, we found that caffeine exposed mice also showed enhanced prepulse inhibition during the light cycle whereas they displayed a deficit of prepulse inhibition during the dark cycle. Reward seeking for sucrose was higher in caffeine exposed than control mice during the light cycle. Additionally, when granted 24 -h access to ethanol as adults, caffeine exposed mice consumed more ethanol in the absence of acute caffeine use. Altogether, mice that consumed chronic caffeine beginning in adolescence had increased reward seeking and exhibited a circadian-dependent pattern of mood fluctuations in adulthood.

Caffeinated energy drinks: adverse event reports to the US Food and Drug Administration and the National Poison Data System, 2008 to 2015

Objective:

To describe and compare caffeinated energy drink adverse event (AE) report/exposure call data from the US Food and Drug Administration Center for Food Safety and Applied Nutrition’s Adverse Event Reporting System (CAERS) and the American Association of Poison Control Centers’ National Poison Data System (NPDS).

Design:

Cross-sectional.

Setting:

Data were evaluated from US-based CAERS reports and NPDS exposure calls, including report/exposure call year, age, sex, location, single v. multiple product consumption, outcome, symptom, intentionality (NPDS only), report type, product name (CAERS only).

Participants:

The analysis defined participants (cases) by the number of caffeinated energy drink products indicated in each AE report or exposure call. Single product cases included 357 from CAERS and 12 822 from NPDS; multiple product cases included 153 from CAERS and 931 from NPDS.

Results:

CAERS v. NPDS single product cases were older and more frequently indicated serious symptoms. Multiple v. single product consumers were older in both. In CAERS, unlike NPDS, most multiple product consumers were female. CAERS single v. multiple product reports cited higher proportions of life-threatening events, but less often indicated hospitalization and serious events. NPDS multiple v. single product cases involved fewer ≤5-year-olds and were more often intentional.

Conclusions:

Despite limitations, both data sources contribute to post-market surveillance and improve understanding of public health concerns.

Trends in Energy Drink Consumption Among U.S. Adolescents and Adults, 2003-2016

INTRODUCTION

Energy drinks refer to non-alcoholic beverages that contain caffeine, amino acids, herbs, and vitamins. Although energy drinks are marketed to reduce fatigue and improve physical/mental performance, frequent consumption of these beverages has been linked to negative health consequences. The purpose of this study is to provide timely, national estimates of the percentage of energy drink consumers in the U.S. and to analyze trends in energy drink intake between 2003 and 2016.

METHODS

A total of 9,911 adolescents (aged 12-19 years); 12,103 young adults (aged 20-39 years); and 11,245 middle-aged adults (aged 40-59 years) were assessed using dietary data from the 2003-2016 National Health and Nutrition Examination Surveys. For each age group (adolescents, young adults, and middle-aged adults), logistic regression was used to estimate the proportion of energy drink consumers, and negative binomial regression was used to estimate per capita energy drink consumption, adjusting for covariates. Differences in total caffeine intake between energy drink consumers and non-consumers were examined by pooling all survey years together and using negative binomial regression. Analyses were conducted in 2018.

RESULTS

From 2003 to 2016, the prevalence of energy drink consumption increased significantly for adolescents (0.2% to 1.4%, p=0.028); young adults (0.5% to 5.5%, p<0.001); and middle-aged adults (0.0% to 1.2%, p=0.006). Per capita consumption of energy drinks increased significantly from 2003 to 2016 only for young adults (1.1 to 9.7 calories, p<0.001). Pooled across years, energy drink consumers had significantly higher total caffeine intake compared with non-consumers for adolescents (227.0 mg vs 52.1 mg, p<0.001); young adults (278.7 mg vs 135.3 mg, p<0.001); and middle-aged adults (348.8 mg vs 219.0 mg, p<0.001).

CONCLUSIONS

These findings indicate that consumption of energy drinks has grown substantially and that these drinks are a major source of caffeine among those who consume them.

Gender Differences in Any-Source Caffeine and Energy Drink Use and Associated Adverse Health Behaviors

Background: The majority of college students report caffeine use with many using caffeine daily. Energy drink (ED) use, in particular, is common among college students, and numerous studies link these heavily caffeinated drinks to a variety of adverse consequences including substance use and risky behaviors. However, little is known about correlations between any-source caffeine use and other substance use and problems. The purpose of this study was to evaluate patterns of caffeine use and examine the relationships between caffeine, in general, and EDs specifically, and adverse health behaviors in college students. Methods: We used data from a longitudinal study of alcohol use and health-related outcomes to assess caffeine, alcohol, nonprescription drug, and tobacco use and symptoms of alcohol dependence in 1958 freshmen from a mid-Atlantic university during Fall 2012. We compared adverse health behaviors between caffeine users and nonusers and ED users and nonusers. Data were evaluated separately in men and women. Results: While women reported significantly more caffeine use than men, men reported more ED use. EDs, regardless of frequency of use, were associated with all adverse health behaviors, but only in female students. Similarly, daily any-source caffeine use was significantly associated with alcohol, nonprescription drug, and tobacco use in female students, but in men, the association was less robust. Conclusions: This research shows that caffeine use is prevalent among college students, and, in female students, is associated with alcohol, nonprescription drug, and tobacco use and alcohol dependence symptoms. Interventions aimed at promoting healthy behaviors may be especially useful in this population.

Review: Trends, Safety, and Recommendations for Caffeine Use in Children and Adolescents

OBJECTIVE

Caffeine use is common in children and adolescents, but the recommendations for safe consumption are based on decades-old data collected exclusively in adults. Increased availability of caffeine-containing products and a concerted marketing effort aimed at children and adolescents, has increased interest in understanding the physiological, behavioral, and psychological effects of caffeine within this population. This manuscript provides a review of the literature concerning trends and safety of ingested caffeine in children and adolescents.

METHOD

A search of the National Library of Medicine database was conducted using the terms caffeine, children, adolescents, and safety, in addition to tailored searches on specific topics using combinations of search terms such as energy drinks, cardiovascular, mood, cognitive, mental health, sleep, and regulations.

RESULTS

The majority of the literature reviewed here suggests that typical, moderate caffeine consumption in children and adolescents is relatively safe, but that higher doses of caffeine consumption (>400 mg) can cause physiological, psychological, and behavioral harm, in particular in subgroups of children, such as those with psychiatric or cardiac conditions. More attention is being paid to the potential adverse effects of both acute and chronic caffeine use, and additional regulations surrounding the sale and marketing of highly caffeinated beverages are now being considered.

CONCLUSION

More research is needed to fill in gaps in our knowledge, including understanding the relationship between caffeine use and initiation of other substances, such as cigarettes, alcohol, or marijuana, identifying individuals at risk for caffeine toxicity, and developing harm-reduction strategies.

Risk of Energy Drink Consumption to Adolescent Health

Energy drinks are beverages marketed to quickly increase alertness and performance of the consumer that typically contain relatively high quantities of caffeine, simple carbohydrates, and a mixture of additional ingredients. The carbohydrate sources, usually glucose and sucrose, found in the beverages supply the substrates needed for physiological energy, while the high caffeine content supplies the perceived energy through enhancing feelings of alertness during fatigued states. Although mean youth caffeine consumption as a whole has decreased over the past 2 decades, adolescent energy drink consumption has significantly increased in the past 10 years. High energy drink consumption of youth is concerning due to the range of reported adverse reactions attributed to excessive caffeine consumption, ranging from mild sleep disturbances to death. Reactions are severe enough to require reporting to the National Poison Data System and may even require emergency medical treatment. Studies have also shown that adolescents who consume energy drinks are likely to also use tobacco, alcohol, and illicit drugs. There is substantial evidence to suggest that the risk energy drinks pose to health are incredibly hazardous and should not be consumed by children and adolescents.

Inverse association between caffeine intake and depressive symptoms in US adults: data from National Health and Nutrition Examination Survey (NHANES) 2005-2006

The objective of this study was to examine the association between caffeine consumption and depressive symptoms. We used data from the 2005-06 National Health and Nutritional Examination Surveys (NHANES). A total of 4737 individuals aged ≥ 18 years who answered the caffeine intake and PHQ-9 questionnaires were selected for this study. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9) with total scores between 0 and 27. Those with PHQ-9 total scores ≥ 10 were considered as having clinically relevant depression. To investigate the association of caffeine intake and PHQ-9 scores, a multiple logistic regression was used in different models. The overall weighted prevalence of depression was 5.5% (4.3% in men and 6.6% in women). After controlling for potential confounders (age, sex, family PIR, education, marital status, disease history, sleep disorders, thyroid problems, physical activity, social support, smoking, total energy, and cholesterol, retinol, vitamin A, beta-carotene, beta-criptoxanthin, vitamin B1, iron, and phosphorus levels), a significant nonlinear inverse association between caffeine consumption and PHQ-9 scores was observed. In conclusion, caffeine's psychostimulant properties appear to protect against depressive symptoms; however, additional prospective studies are required to ascertain whether or not caffeine consumption can lead to a decrease in depressive symptoms.

Health Related Nutritional Knowledge and Dietary Behavior Regarding Caffeine Intake among High School Students in Yongin Region

Objectives

We aimed to examine health-related nutritional knowledge and dietary behavior related to caffeine intake among high school students (n = 310) in the Yongin region of Korea.

Methods

Data were collected using a face-to-face survey, and analyzed using chi-square test, t- test, and logistic regression analysis.

Results

The level of caffeine intake in respondents was divided into low (< 30 mg/d; n = 208) and high caffeine intake groups (> 30 mg/d; n = 102). Total nutritional knowledge related to bone disease was higher in the low intake group (score 2.75) than the high intake group (score 2.39; p < 0.05). The high intake group had lower scores for nutritional knowledge (score 0.70; p < 0.05) related to how caffeinated beverages affect sleep and for dietary behavior (score 3.25; p < 0.001), based on “I avoid caffeinated foods before sleep,” than the low intake group (nutritional knowledge score, 0.80; dietary behavior score, 3.76).

Conclusion

In the overall analysis, the low caffeine intake group had better nutritional knowledge related to bone and sleep health, and healthier dietary behavior related to sleep health compared with the high intake group.

"Let's talk about sleep": a qualitative examination of levers for promoting healthy sleep among sleep-deprived vulnerable adolescents

OBJECTIVE

Deficient sleep is highly prevalent in disadvantaged adolescents and contributes to a range of adverse health and behavioral outcomes. We examined mediating mechanisms and strategies that adolescents adopt to improve sleep, and possible levers for promoting sleep in this population.

METHODS

We conducted three focus groups (N = 27 total, age 14-18 years) in adolescents living in low- and middle-income racially/ethnically diverse neighborhoods of Boston, Massachusetts. Participants completed a survey on their sleep and health habits prior to the moderator-led discussions. Discussions were audio-recorded, transcribed, and thematically analyzed.

RESULTS

The study population did not meet the minimum sleep recommendations, and we found a high prevalence of "social jet-lag." We also identified a disconnect between the acknowledgment of the importance of sleep and actual behavior, especially for electronic use. Phone use and screen time were the most commonly cited barriers to a good night's sleep, along with caffeine consumption, which was also high in this sample. There was also a general lack of awareness of sleep hygiene practices and recommendations. Participants reported regulating food intake and physical activity, using allopathic sleep aids, creating a comfortable sleeping environment, and a routine as some strategies to improve sleep.

CONCLUSION

Results from this study suggest facilitating the linkage between participant-generated mediating factors and strategies for better-designed interventions. These include making the negative impact of sleep on health more explicit, improving youth awareness about sleep hygiene, targeting caffeine consumption and electronic use, and introducing sleep recommendations through appropriate and effective channels.