An analysis of energy-drink toxicity in the National Poison Data System

Awake and Alert: Examining the Portrayal of Energy Drinks on TikTok

PURPOSE

Energy drinks (EDs) are not recommended for minors' consumption due to a myriad of health risks, but marketing initiatives persist. This study explored the promotion of EDs on TikTok, a platform frequented by children and adolescents.

METHODS

197 highly viewed videos from the four top ED-related hashtags on TikTok were coded for engagement variables, user information, sponsorship status, video content, and sentiment toward EDs.

RESULTS

Of the 197 videos analyzed (combined 70 + million views), 29% disclosed sponsorship and 22% featured a child/adolescent. ED consumption appeared in 46% of videos, with 15% depicting hazardous consumption. Most videos (67%) had a positive sentiment toward EDs.

DISCUSSION

ED-related TikTok videos are positively framed, have high engagement, and are not restricted for viewing by minors. As the platform's underage user-base grows, such videos may encourage heightened consumption. Given the known health risks, effective age-gated content restrictions are needed to reduce minors' exposure.

Use of Caffeine-Containing Energy Drinks by Japanese Middle School Students: A Cross-Sectional Study of Related Factors

Excessive consumption of caffeine negatively affects individuals' health. Therefore, we studied the use of energy drinks and the conditions associated with it among Japanese secondary school students. Participants were 236 students in grades 7-9 who completed anonymous questionnaires at home in July 2018. We measured the basic attributes and dietary, sleeping, and exercise habits. We used Chi-squared tests to compare differences between users and non-users of energy drinks. Logistic regression analyses were used to elucidate the complex association between the variables. The results showed that boys were more willing to consume energy drinks than girls. The reasons were 'feeling fatigued', 'needing to stay awake', 'for curiosity', and 'to quench one's thirst'. Among boys, the following were associated with the use of EDs. Buying their own snacks , not understanding nutritional labels on foods, high caffeinated beverage intake, late bed-times on weekdays, always waking up at about the same time, and weight. Health guidance is needed to prevent overconsumption and dependence on energy drinks. The cooperation of parents and teachers is needed to achieve these goals.

Caffeinated drinks, fruit juices, and epilepsy: A systematic review

The aim of this systematic review was to provide the required information regarding different aspects of the relationship between epilepsy/antiseizure medications and non-alcoholic drinks. The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were followed. MEDLINE and Scopus from the inception until 7 August 2021 were systematically searched. These key words were used: "epilepsy" OR "seizure" OR "antiepileptic" OR "antiseizure" OR "anticonvulsant" AND "coffee" OR "tea" OR "soda" OR "juice" OR "drink" OR "cola" OR "diet" (35 key word combinations). The primary search yielded 21 458 publications (PubMed, n = 4778; Scopus, n = 16 680). Only 50 studies met all the inclusion criteria and were included in the current systematic review. In total, 17 articles investigated various non-alcoholic drinks in human studies, 11 studies were case reports/series, and 22 articles were animal/in vitro studies. None of the studies provided a class 1 of evidence. There is limited evidence suggesting that certain drinks (eg, caffeinated energy drinks) might trigger seizures. Patients with epilepsy should avoid excessive consumption of certain fruit juices (eg, grapefruit, lime, pomegranate, kinnow, and star fruit) and caffeinated drinks. However, daily coffee and tea intake can be part of a healthy balanced diet, and their consumption does not need to be stopped in patients with epilepsy. Coffee/tea consumption is not harmful if consumed at levels of 200 mg (caffeine) in one sitting (about 2½ cups of coffee) or 400 mg daily (about five cups of coffee).

Effects of Caffeine and Caffeinated Beverages in Children, Adolescents and Young Adults: Short Review

The prevalence of ED consumption has increased over the past 10–15 years. Studies describing the effects of caffeine and caffeinated beverages show confusing results, so it seems important to regularly summarize the available facts, and in more detail. By a thorough analysis of more than 156 scientific papers, the authors describe the molecular background of absorption, as well as the positive and negative effects of different dosages of caffeine, just like its effects in physical activity and performance. ED and EDwA consumption is a regular habit of not only adults, but nowadays even of children and adolescents. There are no safe dosages described of caffeine or ED consumption for children. There are no positive short- or long-term effects of these compounds/products concerning developing brain functions, psycho-motor functions, or social development. Instead, there are many unpleasant side effects, and symptoms of regular or higher-dose ED consumption, especially at younger ages. This mini review describes many details of these unpleasant side effects, their severity, and motivations for consuming these compounds/products. In a quantitative research in Hungary (10–26 years, mean age: 15.6 ± 3.8 y, 1459 subjects, randomly chosen population), a survey based on a questionnaire asking people about their ED consumption habits was conducted. According to the data, 81.8% of the participants consumed EDs at least once, and 63.3% tried several products of the kind. A positive correlation was found between age and consumption (p < 0.001). The results show that a high proportion of this group often consumed EDwA, in many cases leading to harmful side-effects of caffeine overdose. In a sample of Hungarian high school and college students (17–26 years), ED consumption matched the international data, and only 19.7% of respondents did not use EDs at all (had never tasted an ED in their life).

Caffeine exposure from beverages and its association with self-reported sleep duration and quality in a large sample of Icelandic adolescents

Previous risk assessments have concluded that adolescent's caffeine exposure from energy drinks (ED) are of limited concern. Recent surveys have, however, shown substantial increase in consumption. This cross-sectional survey conducted in 2020 estimated caffeine exposure from beverages among ∼80% of all 13-15-year-old adolescents (n = 10358) relative to the European Food Safety Authority's level of no safety concern of (3.0 mg/kg bw) and level for effects on sleep (1.4 mg/kg bw). Associations with self-reported sleep duration and quality were also explored. ED consumers were more likely to exceed the limit of no safety concern (prevelance: 12-14%) compared to non-ED-consumers (1-2%). Exceeding the limit for effects on sleep was also higher among ED consumers (31-38%) than non-ED-consumers (5-8%). Across categories of low (<0.5 mg/kg bw) to high (>3.0 mg/kg bw) caffeine intake, the prevalence of participants sleeping <6 h increased from 3% to 24%, respectively. The corresponding adjusted Prevalence Ratio was 4.5 (95% CI: 3.6, 5.7) and mean decrease in duration of sleep was 0.74 h (95% CI: 0.65, 0.84). In conclusion, caffeine intake from beverages above the limit of no safety concern was largely confined to ED consumers. Consistent with effects from intervention studies in adults, caffeine intake was strongly associated with self-reported sleep duration in this representative population.

Caffeinated energy drinks in the Canadian context: health risk assessment with a focus on cardiovascular effects

In Canada, caffeinated energy drinks (CEDs) currently sold under Temporary Marketing Authorizations must meet strict eligibility criteria. These criteria, which include compositional and labelling requirements, were developed based on the outcome of a health risk assessment conducted by Health Canada (HC) in 2013. HC updated its assessment by reviewing new information with the focus on potential cardiovascular effects associated with the consumption of CEDs available for sale in Canada. Due to limited data on CED consumption among Canadians to derive accurate exposure information, the composition of a typical CED was characterized to assess the potential effects of single ingredients and synergistic interactions between ingredients on the cardiovascular system. Surveillance data on potential adverse effects related to CED consumption was also analyzed. After extensive review, HC's updated assessment confirms the current risk management approach for CEDs is health protective for Canadian consumers, including the potential for cardiovascular effects. The available evidence supports that moderate consumption (up to 500 mL per day) of a typical CED authorized for sale in Canada is safe for the general population of healthy adults and adolescents. It also re-confirms that vulnerable sub-populations (i.e., children, pregnant and/or breastfeeding women, and caffeine-sensitive individuals) should not consume CEDs. Novelty: Consumption up to 500 mL per day of a typical CED is not associated with an increased risk of cardiovascular effects. Children, pregnant and/or breastfeeding women, and caffeine-sensitive individuals should not consume CEDs.

Supersized alcopop related calls in the National Poison Data System, 2010-2019

BACKGROUND

Supersized alcopops are single-serving high-alcohol-content beverages frequently consumed by underage drinkers. However, little data exist regarding the public health burden of supersized alcopops during the last decade. The current study examined the characteristics of calls to U.S. poison control centers involving supersized alcopops. This study also compared the proportion of calls for underage consumers between calls involving consumption of supersized alcopops and calls involving other types of alcohol (e.g., liquor, beer, wine).

METHODS

Data from the National Poison Data System (NPDS) repository of calls to U.S. poison control centers were analyzed.

RESULTS

Between 2010 and 2019, poison control centers received 1719 calls for exposures to supersized alcopops. Nearly one-half of calls involving supersized alcopop consumption (46.3 %) were made for consumers who were below the legal drinking age. In all years, the proportion of calls for supersized alcopops that were for underage exposures greatly exceeded the proportion of calls that were for underage exposures for other types of alcohol. For those 0-11 years of age, 91 % of supersized alcopop exposures were unintentional; however, for each other age group, at least 84 % of exposures were intentional. Supersized alcopop exposures involved a co-ingested product in more than 80 % of cases among patients of legal drinking age and less than 50 % of cases among patient under legal drinking age.

CONCLUSIONS

Compared to other alcohol products, calls to U.S poison control centers for supersized alcopops disproportionately involved underage drinkers. To protect youth, improved regulation of supersized alcopop products is urgently needed.

The impact of acute energy drink consumption on electrical heart disease: A systematic review and meta-analysis

AIMS

Energy Drink (ED)-associated cardiovascular emergency visits have increased in recent years. Although a toxicity threshold has been established for caffeine, the safety profile of whole ED consumption has not yet been defined.

METHODS

This systematic review was conducted following the PRISMA guidelines. Three reviewers conducted two separate systematic searches on PubMed on October 24 and December 3, 2019. Out of 250 potential records, 43 prospective clinical studies assessing the effects of ED on heart rate (HR) and/or any electrocardiographic (ECG) parameters were included. A meta-analysis was conducted to estimate pooled p-values using metap command for STATA 10.0.

RESULTS

After ED consumption, resting HR increased in 71.1% of studies (pooled p-value <0.001) but was only significant in 38%; HR during and after exercise increased in 55.5% (pooled p-value <0.001) and 71.4% of studies, respectively; QRS increased in all but two protocols; evidence on PR interval was contradictory, and corrected QT interval (QTc) increased compared to baseline in all but one study, exceeding the pathological limit value in two of them. T wave changes were seen in two studies, and one study reported a ratio of 5 to 1 in the number of ectopic beats.

CONCLUSION

Acute consumption of ED can alter the ECG in certain risk populations, posing a risk whose magnitude is yet to be determined. Caution should be exercised among at-risk and underage individuals but further research in these populations is warranted before restrictions are made.

Impact of Energy Drinks on Health and Well-being

PURPOSE OF REVIEW

Energy drinks and energy shots are functional supplements with higher caffeine content marketed toward adolescents and young adults with the intention of boosting energy. Parallel to its rising popularity, there are safety concerns with the consumption of these beverages. Herein, we reviewed the impact these supplements produce on health and well-being.

RECENT FINDINGS

Most of the promoted benefits of the beverages can be attributed to caffeine. The physiologic effects, if any, of other ingredients such as vitamins and herbal extracts are unclear. The presence of a higher caffeine content as compared to soft drinks may predispose to caffeine intoxication in susceptible individuals. Also, the practice of co-ingestion of these beverages with alcohol is still prevalent and associated with serious consequences. Strict regulations (restriction of sales, clear warning labels, capping caffeine levels) and public education may help prevent the adverse outcomes from these beverages.

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.

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.

Correlates of Alcohol Mixed with Energy Drink Use Among First Year College Students: Clinical and Research Implications

Background: Alcohol mixed with energy drink (AmED) use among college students is associated with specific adverse effects (e.g., sexual assault, driving while intoxicated). This study offered the opportunity to evaluate correlates of past year AmED use in a large sample of college students. Methods: In autumn 2010, emails were sent to all first year students (n = 29,536) at 11 colleges and universities in North Carolina and Virginia, inviting them to participate in a brief web-based survey to be used to establish a cohort for the parent tobacco use study; 10,340 (35%) students responded to the web-based survey, which elicited items on demographics, past year use of AmED, and other health behaviors. Results: Past year of AmED was reported by 29.4% of students. Logistic regression analysis revealed that female gender (adjusted odds ratios [AOR] = 1.28, 95% confidence interval [CI] = 1.16-1.42); ever use of smokeless tobacco (AOR = 3.51, 95% CI = 3.00-4.10); current smoking (AOR = 4.97, 95% CI = 4.34-5.69); 2 or fewer days of physical activity per week (AOR = 1.16, 95% CI = 1.04-1.28); and 7 or 8 hours of sleep per day (AOR = 1.12, 95% CI = 1.02-1.24) predicted risk of past year use of AmED. Conclusions: Nearly a third of first year college students reported past year use of AmED. Our finding of increased past year use of AmED use among women is new and might reflect the changing epidemiology of female college alcohol use. Of additional concern, such use might also reflect targeted marketing to women by the energy drink industry. Findings can guide future research as well as substance counseling to college students.

Caffeinated energy drink use by U.S. adolescents aged 13-17: A national profile

The present study examined the national prevalence and distribution of adolescent use of caffeinated energy drinks, assessing variations in sociodemographic characteristics, personality traits, lifestyles, and patterns of alcohol and caffeine use. A cross-sectional survey was conducted in May 2014, using a nationally representative sample of 1,032 U.S. early (aged 13-15; n = 602) and middle adolescents (aged 16-17; n = 430). Nearly two thirds of teens reported ever using energy drinks; 41% had done so recently, that is, in the past 3 months. Middle adolescents reported higher prevalences of both lifetime and recent use of energy drinks than early adolescents. Common situational contexts for use (e.g., compensating for lack of sleep or playing sports) differed by both gender and age cohort. In hierarchical logistic regression analyses, gender and geographic region significantly predicted both lifetime and recent use for early adolescents only, whereas age and race were significant predictors only for middle adolescents. For both age cohorts, odds of both lifetime and recent use increased with sensation-seeking score, lifetime alcohol use, and recent caffeinated soft drink use. Among early adolescents, grade point average predicted lifetime use only, whereas coffee and caffeine pill use predicted recent use only. Among middle adolescents, impulsivity and past sports participation predicted lifetime but not recent use. Our findings show that adolescent energy drink use is widespread and varies as a function of demographic, psychosocial, lifestyle, and substance use characteristics. Future research is needed to assess whether differences between early and middle adolescent use patterns are primarily developmental or cohort effects. (PsycINFO Database Record

Perinatal exposure to energy drink induces oxidative damage in the liver, kidney and brain, and behavioral alterations in mice offspring

The worldwide consumption of energy drinks (EDs) has increased in recent years. EDs have several side effects and can be linked to liver injury, kidney damage and risk-seeking behavior. The impact of perinatal consumption of EDs on the newborns has not been previously investigated. In this study, we evaluated the effects of perinatal exposure to a caffeinated ED on the liver, kidney, brain, locomotor activity and anxiety in mice newborns. Pregnant mice received 2.5 or 5 ml ED by oral gavage from the first day of pregnancy until day 15 after birth. Perinatal exposure to the ED induced a significant increase in lipid peroxidation and declined antioxidant defenses in the liver, kidney, cerebrum, cerebellum and medulla oblongata of the newborns at days 21 and 35 after birth. ED induced several histological alterations, including vacuolations and lipid infiltration of hepatocytes, developing and degenerated glomeruli and dilated urinary spaces in the renal cortex, pyknosis and chromatolysis of the cerebral and medullary neurons, and degenerated and abnormal Purkinje cells in the cerebellum. In addition, ED increased the locomotion and induced anxiety-like behavior in mice newborns. In conclusion, perinatal exposure to EDs induces oxidative stress, tissue injury and behavioral alterations in the mice newborns. Therefore, the consumption of EDs during pregnancy and lactation has a negative impact on the newborns and should be treated as a significant health problem that warrants attention.

Adverse effects of caffeinated energy drinks among youth and young adults in Canada: a Web-based survey

BACKGROUND

Energy drink consumption has increased dramatically among young Canadians, with anecdotal evidence of adverse health effects. There is a lack of population-based studies to examine the prevalence of adverse events from energy drinks, particularly among young people. The current study sought to assess adverse events from energy drinks among a population-based sample of youth and young adults in Canada.

METHODS

An online survey was conducted in 2015 with a national sample of youth (aged 12-17 yr) and young adults (aged 18-24 yr) recruited from a consumer panel. Respondents reported prior consumption of energy drinks as well as adverse outcomes, concurrent activities associated with the outcomes and whether medical attention was sought or considered. Adverse events from coffee were also assessed for comparison. Weighted analyses are reported.

RESULTS

Of the 2055 respondents, 1516 (73.8%) reported having ever consumed an energy drink, and 1741 (84.7%) reported having ever consumed coffee (unweighted). Overall, 55.4% of respondents who had ever consumed an energy drink reported that they had experienced at least 1 adverse event, including fast heartbeat (24.7%), difficulty sleeping (24.1%), headache (18.3%), nausea/vomiting/diarrhea (5.1%), chest pain (3.6%) and seizures (0.2%); 3.1% had sought or had considered seeking medical help for an adverse event. The prevalence of reported adverse events was significantly greater among energy drink consumers than among coffee consumers (36.0%) (odds ratio [OR] 2.67 [95% confidence interval (CI) 2.01-2.56]), as was the proportion who reported seeking or considering seeking medical help for adverse events (3.1% v. 1.4%) (OR 2.18 [95% CI 1.39-3.41]).

INTERPRETATION

More than half of youth and young adults who had consumed energy drinks reported adverse outcomes, some serious enough to warrant seeking medical help. The adverse outcomes were consistent with the physiologic effects of caffeine but were significantly more prevalent than with other sources of caffeine such as coffee, consistent with data from national adverse event databases.

Taurine, caffeine, and energy drinks: Reviewing the risks to the adolescent brain

Energy drinks are emerging as a major component of the beverage market with sales projected to top $60 billion globally in the next five years. Energy drinks contain a variety of ingredients, but many of the top-selling brands include high doses of caffeine and the amino acid taurine. Energy drink consumption by children has raised concerns, due to potential caffeine toxicity. An additional risk has been noted among college-aged consumers of energy drinks who appear at higher risk of over-consumption of alcohol when the two drinks are consumed together. The differential and combinatorial effects of caffeine and taurine on the developing brain are reviewed here with an emphasis on the adolescent brain, which is still maturing. Key data from animal studies are summarized to highlight both reported benefits and adverse effects reported following acute and chronic exposures. The data suggest that age is an important factor in both caffeine and taurine toxicity. Although the aged or diseased brain might benefit from taurine or caffeine supplementation, it appears that adolescents are not likely to benefit from supplementation and may, in fact, suffer ill effects from chronic ingestion of high doses. Additional work is needed though to address gaps in our understanding of how taurine affects females, since the majority of animal studies focused exclusively on male subjects.

Informing Intervention Strategies to Reduce Energy Drink Consumption in Young People: Findings From Qualitative Research

OBJECTIVE

To determine young people's knowledge of energy drinks (EDs), factors influencing ED consumption, and intervention strategies to decrease ED consumption in young people.

DESIGN

Eight group interviews with young people (aged 12-25 years).

SETTING

Community groups and secondary schools in Perth, Western Australia.

PARTICIPANTS

Forty-one young people, 41% of whom were male and 73% of whom consumed EDs.

PHENOMENON OF INTEREST

Factors influencing ED consumption and intervention strategies informed by young people to reduce ED consumption.

ANALYSIS

Two researchers conducted a qualitative content analysis on the data using NVivo software.

RESULTS

Facilitators of ED consumption included enhanced energy, pleasant taste, low cost, peer pressure, easy availability, and ED promotions. Barriers included negative health effects, unpleasant taste, high cost, and parents' disapproval. Strategies to reduce ED consumption included ED restrictions, changing ED packaging, increasing ED prices, reducing visibility in retail outlets, and research and education.

CONCLUSION AND IMPLICATIONS

Because many countries allow the sale of EDs to people aged <18 years, identifying ways to minimize potential harm from EDs is critical. This study provided unique insights into intervention strategies suggested by young people to reduce ED consumption. In addition to more research and education, these strategies included policy changes targeting ED sales, packaging, price, and visibility. Future research might examine the feasibility of implementing such interventions.

An Increase in Dietary Supplement Exposures Reported to US Poison Control Centers

INTRODUCTION

The objective of this study was to investigate the epidemiology of dietary supplement exposures in the USA.

METHODS

A retrospective analysis was conducted of out-of-hospital dietary supplement exposures reported to the National Poison Data System from 2000 through 2012.

RESULTS

There were 274,998 dietary supplement exposures from 2000 through 2012. The annual rate of dietary supplement exposures per 100,000 population increased by 46.1% during 2000-2002, decreased 8.8% during 2002-2005, and then increased again by 49.3% from 2005 to 2012. These trends were influenced by the decrease in ma huang exposures starting in 2002. Miscellaneous dietary supplements accounted for 43.9% of all exposures, followed by botanicals (31.9%), hormonal products (15.1%), and other supplements (5.1%). The majority of dietary supplement exposures (70.0%) occurred among children younger than 6 years old and were acute (94.0%) and unintentional (82.9%). Serious medical outcomes accounted for 4.5% of exposures and most (95.0%) occurred among individuals 6 years and older. Ma huang products, yohimbe, and energy products were the categories associated with the greatest toxicity.

CONCLUSIONS

There was an overall increase in the rate of dietary supplement exposures from 2000 through 2012. Although the majority of these exposures did not require treatment at a health care facility or result in serious medical outcomes, exposures to yohimbe and energy products were associated with considerable toxicity. Our results demonstrate the success of the FDA ban on ma huang products and the need for FDA regulation of yohimbe and energy products in the USA.

Health Effects and Public Health Concerns of Energy Drink Consumption in the United States: A Mini-Review

As energy drink consumption continues to grow worldwide and within the United States, it is important to critically examine the nutritional content and effects on population health of these beverages. This mini-review summarizes the current scientific evidence on health consequences from energy drink consumption, presents relevant public health challenges, and proposes recommendations to mitigate these issues. Emerging evidence has linked energy drink consumption with a number of negative health consequences such as risk-seeking behaviors, poor mental health, adverse cardiovascular effects, and metabolic, renal, or dental conditions. Despite the consistency in evidence, most studies are of cross-sectional design or focus almost exclusively on the effect of caffeine and sugar, failing to address potentially harmful effects of other ingredients. The negative health effects associated with energy drinks (ED) are compounded by a lack of regulatory oversight and aggressive marketing by the industry toward adolescents. Moreover, the rising trend of mixing ED with alcohol presents a new challenge that researchers and public health practitioners must address further. To curb this growing public health issue, policy makers should consider creating a separate regulatory category for ED, setting an evidence-based upper limit on caffeine, restricting sales of ED, and regulating existing ED marketing strategies, especially among children and adolescents.

The Safety of Ingested Caffeine: A Comprehensive Review

Caffeine is the most widely consumed psychoactive drug in the world. Natural sources of caffeine include coffee, tea, and chocolate. Synthetic caffeine is also added to products to promote arousal, alertness, energy, and elevated mood. Over the past decade, the introduction of new caffeine-containing food products, as well as changes in consumption patterns of the more traditional sources of caffeine, has increased scrutiny by health authorities and regulatory bodies about the overall consumption of caffeine and its potential cumulative effects on behavior and physiology. Of particular concern is the rate of caffeine intake among populations potentially vulnerable to the negative effects of caffeine consumption: pregnant and lactating women, children and adolescents, young adults, and people with underlying heart or other health conditions, such as mental illness. Here, we review the research into the safety and safe doses of ingested caffeine in healthy and in vulnerable populations. We report that, for healthy adults, caffeine consumption is relatively safe, but that for some vulnerable populations, caffeine consumption could be harmful, including impairments in cardiovascular function, sleep, and substance use. We also identified several gaps in the literature on which we based recommendations for the future of caffeine research.

Effects of acute and chronic caffeine on risk-taking behavior in children and adolescents

Consumption of caffeinated beverages is associated with increased risk-taking behavior. The purpose of this study was to determine if acute caffeine administration influences risk-taking behavior in a dose-dependent manner. Participants were pre- (ages 8-9) and post-pubertal (ages 15-17) children who visited the laboratory three times and consumed a beverage containing 0, 1, or 2 mg/kg of caffeine. Thirty minutes later, participants completed the balloon analogue risk task (BART), the Iowa gambling task (IGT), and a delay discounting task. The number of balloons exploded on the BART task was significantly increased after 2 mg/kg of caffeine in moderate caffeine consumers, but was decreased after 2 mg/kg of caffeine in high caffeine consumers. There were no main effects of caffeine dose on the delay discounting task or on the IGT. Post-pubertal participants showed reduced delay discounting compared with pre-pubertal participants. Finally, average daily caffeine use was significantly, positively correlated with scores on a risk-taking questionnaire. These data suggest that caffeine dose-dependently influences decision making and risk taking. More research is needed to determine the mechanism of this difference as well as the extent to which sex and pubertal phase influence these relationships.

Energy Drink Induced Lipid Peroxidation and Oxidative Damage in Rat Liver and Brain When Used Alone or Combined with Alcohol

Energy drinks (ED) are containing large doses of metabolic stimulants and its use with ethanol has increased dramatically among young adults. In this study, we examined the effects of ED exposure either alone or in combination with ethanol on oxidative stress parameters including superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), and lipid peroxidation parameter malondialdehyde (MDA) in rat. Some histopathological findings were also evaluated. ED exposure led to a dose-dependent increase in liver MDA compared to the control indicating oxidative damage. Histopathological findings also revealed that ED alone may generate liver damage. Ethanol exposure increased MDA level and SOD, CAT, and GSH-Px activity in both the brain and the liver. The combination of ethanol and ED produced greater damage which is considered by further increases in SOD and GSH-Px activity in the brain. Similar results for MDA were observed in both the liver and brain as well. Our findings suggest that ED consumption alone or combination with ethanol may represent a significant public health concern.

Clinical Symptoms and Adverse Effects Associated With Energy Drink Consumption in Adolescents

OBJECTIVE

The aims of the study were to determine the prevalence of energy drink consumption by adolescents, to identify associated clinical symptoms and adverse effects, and to gain an understanding to the motivation behind its consumption.

METHODS

A prospective, questionnaire-based study was conducted at 2 emergency departments from June 2011 to June 2013. The questionnaire was distributed to a convenience sample of adolescents aged 12 to 18 years. Stratification was performed on the basis of frequency of consumption: frequent consumption (at least once a month) and infrequent consumption (less frequent than once a month).

RESULTS

Data analysis was performed on 612 completed questionnaires. Two hundred two responders (33%) were considered frequent energy drink consumers. Frequent consumers were more likely to be involved in high-risk behaviors and more likely to consume other caffeinated drinks. In the previous 6 months, frequent energy drink consumers were more likely to report headache (76%), anger (47%), and increased urination (24%) and were more likely to require medical evaluation for headache (41%) and difficulty breathing (22%). Frequent energy drink consumers were more likely to believe that energy drinks "help me do better in school" (12%), "help me do better in sports" (35%), "are just for fun" (46%), "help me stay up at night" (67%), and "make me concentrate/focus better" (34%).

CONCLUSIONS

Clarifying common misconceptions associated with energy drink consumption, especially in high-risk adolescents and frequent energy drink consumers, may decrease the frequency of symptoms experienced by adolescents, such as headache and difficulty breathing, requiring medical evaluation.

Consumption of energy drinks by children and young people: a rapid review examining evidence of physical effects and consumer attitudes

OBJECTIVE

To examine patterns of energy drink consumption by children and young people, attitudes towards these drinks, and any associations with health or other outcomes.

DESIGN

Rapid evidence assessment and narrative synthesis.

DATA SOURCES

9 electronic bibliographic databases, reference lists of relevant studies and searches of the internet.

RESULTS

A total of 410 studies were located, with 46 meeting the inclusion criteria. The majority employed a cross-sectional design, involved participants aged 11-18 years, and were conducted in North America or Europe. Consumption of energy drinks by children and young people was found to be patterned by gender, with boys consuming more than girls, and also by activity levels, with the highest consumption observed in the most and least sedentary individuals. Several studies identified a strong, positive association between the use of energy drinks and higher odds of health-damaging behaviours, as well as physical health symptoms such as headaches, stomach aches, hyperactivity and insomnia. There was some evidence of a dose-response effect. 2 experimental studies involving small numbers of junior athletes demonstrated a positive impact on limited aspects of sports performance. 3 themes emerged from the qualitative studies: reasons for use; influences on use; and perceived efficacy and impact. Taste and energy-seeking were identified as key drivers, and branding and marketing were highlighted as major influences on young people's consumption choices. Awareness of possible negative effects was low.

CONCLUSIONS

There is growing evidence that consumption of energy drinks is associated with a range of adverse outcomes and risk behaviours in terms of children's health and well-being. However, taste, brand loyalty and perceived positive effects combine to ensure their popularity with young consumers. More research is needed to explore the short-term and long-term impacts in all spheres, including health, behaviour and education.

TRIAL REGISTRATION NUMBER

CRD42014010192.

A Retrospective Study of Clinical Effects of Powdered Caffeine Exposures Reported to Three US Poison Control Centers

INTRODUCTION

Anhydrous caffeine, often sold on the Internet as a powdered caffeine product, is sold as "pure caffeine" to be used as an additive to beverages and has also been used as an ingredient in energy supplement products.

METHODS

This is a retrospective multiple-poison center chart review of calls regarding powdered caffeine to poison centers covering Oregon, Alaska, Guam, Washington, and Utah between January 1, 2013 and June 30, 2015.

RESULTS

There were 40 calls to three poison centers over 30 months for powdered caffeine exposure. The majority of patients were over age 19 (52.5 %; 21/40) and male (70 %; 28/40). Sixty percent (24/40) of the patients were symptomatic but only 10 % (4/40) required admission; 52.5 % (21/40) of the patient calls were for inadvertent overdose of powdered caffeine; one patient overdosed in a self-harm attempt.

DISCUSSION

Powdered caffeine calls to three poison centers during a 30-month study period were rare, and severe caffeine toxicity due to exposure was found in few patients. The majority of symptoms were reported after an inadvertent powdered caffeine overdose.

CONCLUSIONS

An analysis of calls to three poison centers for powdered caffeine found that exposures were uncommon, but did result in toxicity, and highlighted that the lack of clear dosing instructions on product packaging may place patients at risk of inadvertent overdose.

Analysis of Consumption of Energy Drinks by a Group of Adolescent Athletes

BACKGROUND

Energy drinks (EDs) have become widely popular among young adults and, even more so, among adolescents. Increasingly, they are consumed by athletes, particularly those who have just begun their sporting career. Uncontrolled and high consumption of EDs, in addition to other sources of caffeine, may pose a threat to the health of young people. Hence, our objective was to analyze the consumption of EDs among teenagers engaged in sports, including quantity consumed, identification of factors influencing consumption, and risks associated with EDs and EDs mixed with alcohol (AmEDs).

METHODS

The study involved a specially designed questionnaire, which was completed by 707 students, 14.3 years of age on average, attending secondary sports schools.

RESULTS

EDs were consumed by 69% of the young athletes, 17% of whom drank EDs quite often: every day or 1-3 times a week. Most respondents felt no effects after drinking EDs, but some reported symptoms, including insomnia, anxiety, tachycardia, nervousness and irritability. The major determinant of the choice of EDs was taste (47%), followed by price (21%). One in ten respondents admitted to consumption of AmEDs. Among the consequences reported were: abdominal pains, nausea, vomiting, amnesia, headache, and hangover.

CONCLUSIONS

EDs consumption among adolescent athletes was relatively high. Considering the habit of AmEDs and literature data, it is worth emphasizing that it may lead to health problems in the near future, alcohol- or drug-dependence, as well as other types of risk behaviour.

Desire to Drink Alcohol is Enhanced with High Caffeine Energy Drink Mixers

BACKGROUND

Consumption of alcohol mixed with energy drinks (AmED) has been associated with a variety of risks beyond that observed with alcohol alone. Consumers of AmED beverages are more likely to engage in heavy episodic (binge) drinking. This study was to investigate whether the consumption of high caffeine energy drink mixers with alcohol would increase the desire to drink alcohol compared to the same amount of alcohol alone using a double-blind, within-subjects, placebo-controlled study design.

METHODS

Participants (n = 26) of equal gender who were social drinkers attended 6 double-blind dose administration sessions that involved consumption of alcohol and energy drinks, alone and in combination. On each test day, participants received 1 of 6 possible doses: (i) 1.21 ml/kg vodka + 3.63 ml/kg decaffeinated soft drink, (ii) 1.21 ml/kg vodka + 3.63 ml/kg energy drink, (iii) 1.21 ml/kg vodka + 6.05 ml/kg energy drink, (iv) 3.63 ml/kg decaffeinated soft drink, (v) 3.63 ml/kg energy drink, and (vi) 6.05 ml/kg energy drink. Following dose administration, participants repeatedly completed self-reported ratings on the Desire-for-Drug questionnaire and provided breath alcohol readings.

RESULTS

Alcohol alone increased the subjective ratings of "desire for more alcohol" compared to placebo doses. Energy drink mixers with the alcohol increased desire for more alcohol ratings beyond that observed with alcohol alone.

CONCLUSIONS

This study provides laboratory evidence that AmED beverages lead to greater desire to drink alcohol versus the same amount of alcohol consumed alone. The findings are consistent with results from animal studies indicating that caffeine increases the rewarding and reinforcing properties of alcohol.

Adolescent energy drink consumption: An Australian perspective

Caffeinated Energy Drinks (EDs) are not recommended for consumption by children, yet there is a lack of age-specific recommendations and restrictions on the marketing and sale of EDs. EDs are increasingly popular among adolescents despite growing evidence of their negative health effects. In the current study we examined ED consumption patterns among 399 Australian adolescents aged 12-18 years. Participants completed a self-report survey of consumption patterns, physiological symptoms, and awareness of current ED consumption guidelines. Results indicated that ED consumption was common among the sample; 56% reported lifetime ED consumption, with initial consumption at mean age 10 (SD = 2.97). Twenty-eight percent of the sample consumed EDs at least monthly, 36% had exceeded the recommended two standard EDs/day, and 56% of consumers had experienced negative physiological health effects following ED consumption. The maximum number of EDs/day considered appropriate for children, adolescents, and adults varied, indicating a lack of awareness of current consumption recommendations. These findings add to the growing body of international evidence of adolescent ED consumption, and the detrimental impact of EDs to adolescent health. Enforced regulation and restriction of EDs for children's and adolescents' consumption is urgently needed in addition to greater visibility of ED consumption recommendations.

Caffeine toxicity in forensic practice: possible effects and under-appreciated sources

Caffeine is considered a very safe stimulant and is widely consumed in a variety of forms, from pure caffeine to beverages and foods. Typically, death is only seen when gram quantities of caffeine are consumed, usually in suicide attempts. Even in this scenario, death is rare. However, there are special populations that need to be considered in forensic presentations, who may be at greater risk. These include poor metabolizers, people with liver disease, and people with cardiac conditions, who can die as a result of caffeine intake at levels well below what is ordinarily considered toxic. Also, caffeine intake may be hidden. For example, herbal medicines with substantial caffeine content may not disclose these concentrations on their product label. The role of caffeine in medicolegal deaths is yet to be defined, however, herbal medicines and herbal weight loss supplements may represent an underappreciated source of caffeine in this context.

Correlates of use of alcohol mixed with energy drinks among youth across 10 US metropolitan areas

BACKGROUND

Predictors of use of alcohol mixed with energy drinks (AmED) among youth have been understudied. The current analyses investigated the prevalence of and correlates for use of AmED among alcohol users from a national study of stimulant use among youth.

METHODS

The National Monitoring of Adolescent Prescription Stimulants Study (N-MAPSS) assessed behaviors and risk factors for stimulant use from 11,048 youth, 10-18 years of age recruited from entertainment venues across 10 US cities. Of the four cross sections, two had questions on having alcohol mixed with energy drinks (AmED) in the past 30 days along with sociodemographic characteristics, current tobacco and marijuana use and current nonmedical use of prescription opioids, anxiolytics, and stimulants. Only 13 to18 year olds and those who reported alcohol use were included in the analyses.

RESULTS

Overall, 28.4% (1392 out of 4905) of the 13 to18 year olds reported past 30-day alcohol use. Among alcohol users, 27% reported having alcohol mixed with energy drinks in the past 30 days. Multivariate logistic regression indicated that use of AmED was significantly associated with tobacco and marijuana use and nonmedical use of prescription stimulants.

CONCLUSIONS

Underage drinking is common among youth and more than a quarter of these drinkers use AmED. Use of AmED is significantly associated with tobacco and marijuana use and nonmedical use of prescription stimulants. Drug and alcohol intervention programs should educate on the risks of AmED, as the same population is at high-risk for use of AmED and alcohol/drug use.

Electrocardiographic and blood pressure effects of energy drinks and Panax ginseng in healthy volunteers: A randomized clinical trial

BACKGROUND

Energy drink usage has been linked to emergency room visits and deaths. The objective of the study is to assess the electrocardiographic and blood pressure effects of energy drinks, Panax ginseng and placebo in healthy individuals.

METHODS

This was a randomized, double blinded, placebo controlled, crossover study. Young healthy volunteers with no comorbid conditions consumed 32oz of an energy drink, control drink with 800mg of Panax ginseng or matching placebo-control drink over 45min. Primary endpoints were QTc interval and systolic blood pressure. Secondary endpoints included QT interval, PR interval, QRS duration, heart rate, and diastolic blood pressure. All endpoints were assessed at baseline, 1, 2, 3.5, and 5.5h.

RESULTS

A significant increase in QTc interval 2h post energy drink consumption was evident when compared to placebo (3.37±10.7ms and -3.19±11.8ms respectively; p=0.030). Similarly, systolic blood pressure 2h post energy drink consumption increased when compared to placebo (2.00±6.37mmHg and -2.67±5.83mmHg respectively; p=0.014). The PR interval significantly reduced over a 2h period post energy drink use in a clinically non-meaningful manner. Heart rate at 2h was not significantly higher in the energy drink group when compared to others. The QT interval, QRS interval and diastolic blood pressure were not impacted at any time point.

CONCLUSIONS

Certain energy drinks consumed at a high volume significantly increase the QTc interval and systolic blood pressure by over 6ms and 4mmHg respectively. Panax ginseng does not have a significant impact on ECG or blood pressure parameters.

Prediction of plasma caffeine concentrations in young adolescents following ingestion of caffeinated energy drinks: a Monte Carlo simulation

The fast-growing consumption of caffeinated energy drinks (CEDs) is linked to increasing reports of caffeine intoxication in adolescents. There is limited data available regarding plasma caffeine concentrations in this population after CED intake and the potential implications for caffeine-related toxicity. This study was an in silico population pharmacokinetic analysis of caffeine. Population pharmacokinetic model of oral caffeine was derived from a previous study of healthy male volunteers. Maximal plasma caffeine concentration (C max) profiles following ingestion of one or two servings of popular CEDs were predicted using Monte Carlo simulation and available population body weight data of 10-15-year-old Korean adolescents. Caffeine C max values were positively correlated with the amount of caffeine ingested in CEDs and negatively correlated with body weight. The median (range) C max profiles varied from a low of 1.2 (0.5-2.6) mg/L to a concentration that is potentially associated with harmful caffeine-related effects of 25.4 (8.1-55.6) mg/L. A subgroup of female 10-11-year-old subjects exhibited the highest caffeine exposure profiles.

CONCLUSION

These data indicate that CED ingestion can increase the risk of serious caffeine intoxication in young adolescents, particularly those with low body mass.

WHAT IS KNOWN

• Excessive consumption of caffeine can lead to serious caffeine intoxication. • The risk of potential harmful caffeine intoxication after ingestion of caffeinated energy drinks (CED) has not been adequately evaluated in adolescents.

WHAT IS NEW

• Predicted maximal plasma caffeine concentration profiles of adolescents with lower body weights showed an overlap with the ingested caffeine concentrations obtained from documented fatalities. • The present simulation-based pharmacokinetic analysis demonstrates that CED ingestion could lead to potentially serious caffeine intoxication in this cohort.

Energy drinks mixed with alcohol: what are the risks?

Energy drinks are popular beverages that typically include high levels of caffeine and other ingredients such as taurine, or caffeine-containing herbs, such as guarana. While energy drinks are often consumed alone, they are also frequently used as mixers for alcoholic beverages. This review summarizes what is known about the scope of use of alcohol mixed with energy drinks, the risks associated with such mixtures, and the objective laboratory data examining how the effects of their consumption differ from consuming alcohol alone. The weight of the evidence reveals that consuming alcohol mixed with energy drinks is riskier than consuming alcohol alone and constitutes a public health concern. Consumption of these mixed beverages is frequent, especially in young and underage drinkers, and compared with alcohol alone, their use is associated with elevated rates of binge drinking, impaired driving, risky sexual behavior, and risk of alcohol dependence. Laboratory research (human and animal) has demonstrated that consuming alcohol mixed with energy drinks leads to altered subjective states including decreased perceived intoxication, enhanced stimulation, and increased desire to drink/increased drinking compared to consuming alcohol alone. Possible underlying mechanisms explaining these observations are highlighted in this review.

Influence of energy drink ingredients on mood and cognitive performance

Sales of energy products have grown enormously in recent years. Manufacturers claim that the products, in the form of drinks, shots, supplements, and gels, enhance physical and cognitive performance, while users believe the products promote concentration, alertness, and fun. Most of these products contain caffeine, a mild psychostimulant, as their foremost active ingredient. However, they also contain additional ingredients, e.g., carbohydrates, amino acids, herbal extracts, vitamins, and minerals, often in unspecified amounts and labeled as an "energy blend." It is not clear whether these additional ingredients provide any physical or cognitive enhancement beyond that provided by caffeine alone. This article reviews the available empirical data on the interactive effects of these ingredients and caffeine on sleep and cognitive performance and suggests objectives for future study.

Executive summary of NIH workshop on the Use and Biology of Energy Drinks: Current Knowledge and Critical Gaps

Sales of energy drinks in the United States reached $12.5 billion in 2012. Emergency department visits related to consumption of these products have increased sharply, and while these numbers remain small relative to product sales, they raise important questions regarding biological and behavioral effects. Although some common ingredients of energy drinks have been extensively studied (e.g., caffeine, B vitamins, sugars, inositol), data on other ingredients (e.g., taurine) are limited. Summarized here are data presented elsewhere in this issue on the prevalence and patterns of caffeine-containing energy drink use, the effects of these products on alertness, fatigue, cognitive functions, sleep, mood, homeostasis, as well as on exercise physiology and metabolism, and the biological mechanisms mediating the observed effects. There are substantial data on the effects of some energy drink ingredients, such as caffeine and sugars, on many of these outcomes; however, even for these ingredients many controversies and gaps remain, and data on other ingredients in caffeine-containing energy drinks, and on ingredient interactions, are sparse. This summary concludes with a discussion of critical gaps in the data and potential next steps.

Performance outcomes and unwanted side effects associated with energy drinks

Energy drinks are increasingly popular among athletes and others. Advertising for these products typically features images conjuring great muscle power and endurance; however, the scientific literature provides sparse evidence for an ergogenic role of energy drinks. Although the composition of energy drinks varies, most contain caffeine; carbohydrates, amino acids, herbs, and vitamins are other typical ingredients. This report analyzes the effects of energy drink ingredients on prolonged submaximal (endurance) exercise as well as on short-term strength and power (neuromuscular performance). It also analyzes the effects of energy drink ingredients on the fluid and electrolyte deficit during prolonged exercise. In several studies, energy drinks have been found to improve endurance performance, although the effects could be attributable to the caffeine and/or carbohydrate content. In contrast, fewer studies find an ergogenic effect of energy drinks on muscle strength and power. The existing data suggest that the caffeine dose given in studies of energy drinks is insufficient to enhance neuromuscular performance. Finally, it is unclear if energy drinks are the optimal vehicle to deliver caffeine when high doses are needed to improve neuromuscular performance.

Guarana provides additional stimulation over caffeine alone in the planarian model

The stimulant effect of energy drinks is primarily attributed to the caffeine they contain. Many energy drinks also contain other ingredients that might enhance the tonic effects of these caffeinated beverages. One of these additives is guarana. Guarana is a climbing plant native to the Amazon whose seeds contain approximately four times the amount of caffeine found in coffee beans. The mix of other natural chemicals contained in guarana seeds is thought to heighten the stimulant effects of guarana over caffeine alone. Yet, despite the growing use of guarana as an additive in energy drinks, and a burgeoning market for it as a nutritional supplement, the science examining guarana and how it affects other dietary ingredients is lacking. To appreciate the stimulant effects of guarana and other natural products, a straightforward model to investigate their physiological properties is needed. The planarian provides such a system. The locomotor activity and convulsive response of planarians with substance exposure has been shown to provide an excellent system to measure the effects of drug stimulation, addiction and withdrawal. To gauge the stimulant effects of guarana we studied how it altered the locomotor activity of the planarian species Dugesia tigrina. We report evidence that guarana seeds provide additional stimulation over caffeine alone, and document the changes to this stimulation in the context of both caffeine and glucose.

Combined alcohol and energy drink use: hedonistic motives, adenosine, and alcohol dependence

Consumption of alcohol mixed with energy drinks (AmED) has been associated with both short- and long-term risks beyond those observed with alcohol alone. AmED use has been associated with heavy episodic (binge) drinking, risky behaviors, and risk of alcohol dependence. Laboratory research has demonstrated that AmED beverages lead to greater motivation to drink versus the same amount of alcohol consumed alone. However, the reason consumers find AmED beverages particularly appealing has been unclear. A recent report by Droste and colleagues (Alcohol Clin Exp Res 2014; 38:2087-2095) is the first study to investigate motivations related to AmED consumption and to determine which motives predict AmED consumption patterns, experience of drinking-related harms, and risk of alcohol dependence. The findings of this study significantly enhance our understanding of why AmED consumption is related to the risk of alcohol dependence and change our understanding of why consumers choose AmED beverages. The authors report that hedonistic motives strongly predicted AmED use and the harms associated with use. While intoxication-reduction motives predicted self-reported accidents and injuries, these motives did not predict AmED consumption patterns and risk of dependence. The risk of alcohol dependence may arise from repeated experiences when drinking alcohol is more pleasurable when energy drinks are consumed with the alcohol. This commentary will focus on why energy drinks might increase the rewarding properties of alcohol in social drinkers. In addition, discussion is provided explaining why more research on the neurotransmitter, adenosine, may actually inform us about the mechanisms contributing to the development of alcohol dependence.

STEMI Associated with Overuse of Energy Drinks

Coronary artery disease (CAD) and ST-elevation myocardial infarction (STEMI) are predominantly diseases of middle-aged and older adults and when found in younger adults are usually associated with a strong family history. However, this report details the case of a nonobese 26-year-old Hispanic male who presented with an acute STEMI despite having no family history or other apparent risk factors for CAD or STEMI beyond a two pack-year smoking history and excessive energy drink consumption. The patient reported consuming between eight and ten 473 mL cans per day. Cardiac catheterization subsequently confirmed total occlusion of his left circumflex coronary artery.