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Lin Y, Huang Y, Zheng Y, Chen W, Zhang Y, Yang Y, Huang W. Taurine Inhibits Lung Metastasis in Triple-Negative Breast Cancer by Modulating Macrophage Polarization Through PTEN-PI3K/Akt/mTOR Pathway. J Immunother 2024:00002371-990000000-00097. [PMID: 38630910 DOI: 10.1097/cji.0000000000000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024]
Abstract
SUMMARY Taurine (Tau) has been found to inhibit triple-negative breast cancer (TNBC) invasion and metastasis. However, its effect on tumor-promoting macrophages and tumor suppressor macrophages in breast cancer progression remains unknown. In this study, we investigated the effects of Tau on macrophage polarization and its role in TNBC cell growth, invasion, and metastasis. We induced human THP-1 monocytes to differentiate into M2 macrophages through exogenous addition of interleukin-4. We used the TNBC cell lines MDA-MB-231 and BT-549 cultured in a conditioned medium from M2 macrophages to investigate the effect of Tau on tumor growth and invasion. We analyzed macrophage subset distribution, M1 and M2 macrophage-associated markers, and mRNA expression by quantitative polymerase chain reaction. We also detected the PTEN-PI3K/Akt/mTOR signaling pathway that mediates M1 macrophage to suppress tumor invasion using western blotting. Our results showed that Tau inhibits breast cancer metastasis to the lungs in vivo and cell invasion by altering the polarization of tumor-associated macrophage in vitro. In addition, Tau can up-regulate PTEN expression, suppress the PI3K-Akt signaling pathway, and promote the M1 polarization of macrophages, which ultimately inhibits the metastasis of TNBC cells. Our findings suggest that Tau inhibits the activation of the PI3K-Akt-mTOR signaling pathway by up-regulating PTEN, promotes the proportion of M1 macrophages in tumor-associated macrophage, and suppresses the invasion and metastasis of TNBC. This provides a potential therapeutic approach to influence cancer progression and metastasis.
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Affiliation(s)
- Yufeng Lin
- Department of Breast Care Surgery, The First Affiliated Hospital, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yongtong Huang
- Department of Breast Care Surgery, The First Affiliated Hospital, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yifan Zheng
- Department of Breast Care Surgery, The First Affiliated Hospital, Guangdong Pharmaceutical University, Guangzhou, China
| | - Wanting Chen
- School of Medical Information and Engineering, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yongcheng Zhang
- Department of Breast Care Surgery, The First Affiliated Hospital, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yongxia Yang
- School of Medical Information and Engineering, Guangdong Pharmaceutical University, Guangzhou, China
| | - Wenbin Huang
- Department of Breast Care Surgery, The First Affiliated Hospital, Guangdong Pharmaceutical University, Guangzhou, China
- Department of Hepatobiliary Surgery II, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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2
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Othman MK, Yusof Z, Mohd Rossli NI, Mohd Fauzi MH, W Isa WYH. Adverse Cardiovascular Events Associated With Kopi Jantan. Cureus 2024; 16:e52344. [PMID: 38361715 PMCID: PMC10867548 DOI: 10.7759/cureus.52344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Energy drinks (EDs) are widely accessible worldwide. In Malaysia, it is common for EDs to be premixed with sexual stimulants. ED consumption has been shown to have an association with cardiac arrest, myocardial infarction, spontaneous coronary artery dissection, and coronary vasospasm. In addition to this, EDs are associated with arrhythmias, which significantly prolong the QTc interval. Myocardial infarction with no obstructive coronary artery disease (MINOCA) is defined as a patient presenting with myocardial infarction with no obstructive coronary artery disease or ≤50% stenosis. It is a challenging and complex pathophysiology compared to obstructive coronary artery disease. MINOCA is more frequently associated with younger patients and women. Here, we report two cases related to a Malaysian local energy drink Kopi Jantan, which presented with atrial flutter and MINOCA.
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Affiliation(s)
- Mohd Khairi Othman
- Department of Internal Medicine, Universiti Sains Malaysia School of Medical Sciences, Kubang Kerian, MYS
| | - Zurkurnai Yusof
- Department of Internal Medicine, Universiti Sains Malaysia School of Medical Sciences, Kubang Kerian, MYS
| | - Nur Imani Mohd Rossli
- Department of Internal Medicine, Universiti Sains Malaysia School of Medical Sciences, Kubang Kerian, MYS
| | - Mohd Hafizazham Mohd Fauzi
- Department of Internal Medicine, Universiti Sains Malaysia School of Medical Sciences, Kubang Kerian, MYS
| | - W Yus Haniff W Isa
- Department of Internal Medicine, Universiti Sains Malaysia School of Medical Sciences, Kubang Kerian, MYS
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3
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Park SY, Karantenislis G, Rosen HT, Sun H. Effects of energy drinks on myogenic differentiation of murine C2C12 myoblasts. Sci Rep 2023; 13:8481. [PMID: 37231025 PMCID: PMC10213057 DOI: 10.1038/s41598-023-35338-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
Energy drinks, often advertised as dietary supplements that enhance physical and mental performance, have gained increasing popularity among adolescents and athletes. Several studies on individual ingredients such as caffeine or taurine have reported either adverse or favorable influences on myogenic differentiation, a key process in muscle regeneration to repair microtears after an intense workout session. However, the impact of different energy drinks with various formulas on muscle differentiation has never been reported. This study aims to examine the in vitro effects of various energy drink brands on myogenic differentiation. Murine C2C12 myoblast cells were induced to differentiate into myotubes in the presence of one of eight energy drinks at varying dilutions. A dose-dependent inhibition of myotube formation was observed for all energy drinks, supported by reduced percentage of MHC-positive nuclei and fusion index. Moreover, expression of myogenic regulatory factor MyoG and differentiation marker MCK were also decreased. Furthermore, given the variation in formulas of different energy drinks, there were remarkable differences in the differentiation and fusion of myotubes between energy drinks. This is the first study to investigate the impact of various energy drinks on myogenic differentiation and our results suggest an inhibitory effect of energy drinks in muscle regeneration.
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Affiliation(s)
- Sun Young Park
- Division of Environmental Medicine, NYU Grossman School of Medicine, 341 East 25 Street, New York, NY, 10010, USA
| | | | - Hannah T Rosen
- Division of Environmental Medicine, NYU Grossman School of Medicine, 341 East 25 Street, New York, NY, 10010, USA
| | - Hong Sun
- Division of Environmental Medicine, NYU Grossman School of Medicine, 341 East 25 Street, New York, NY, 10010, USA.
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4
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Costa R, Rocha C, Santos H. Cardiovascular and Cerebrovascular Response to RedBull® Energy Drink Intake in Young Adults. Anatol J Cardiol 2023; 27:19-25. [PMID: 36680443 PMCID: PMC9893714 DOI: 10.14744/anatoljcardiol.2022.2315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/21/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Energy drinks contain caffeine, taurine, sucrose, vitamins, and other amino acids. The dosage of these varies depending on the drink chosen. Several studies on energy drinks have been carried out, but the results obtained are still inconsistent as well as the risk associated with consumption. This study analyzed the cardio- and cerebrovascular responses after consumption of an energy drink - RedBull® - under standardized pre- and post-ingestion conditions and its impact on the cardiovascular and cerebrovascular system. METHODS A sample of 30 healthy young adult females was recruited and subjected to 3 moments of evaluation: at baseline, 30 minutes after ingesting the energy drink, and 60 minutes after ingesting it according to a non-randomized pre-post intervention study design. RESULTS It is found that over time there are significant changes in peak systolic velocity (P =.006) and endodiastolic velocity (P <.001) of common carotid artery, peak systolic velocity (P =.007), and endodiastolic velocity (P <.001) of internal carotid artery, peak systolic velocity (P =.004), end endodiastolic velocity (P =.013) of the external carotid artery, endodiastolic velocity (P =.042) of the middle cerebral artery, cardiac output (P =.004), and heart rate (P <.001). CONCLUSIONS After the consumption of Redbull®, there was a decrease in the velocities of the carotid arteries and the middle cerebral artery as well as a decrease in cardiac output accompanied by a decrease in heart rate and a slight, although not significant, increase in systolic and diastolic blood pressures. However, it is still unclear which pathophysiological mechanisms are responsible for these changes.
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Affiliation(s)
- Rita Costa
- Department of Clinical Physiology, Polytechnic Institute of Coimbra, Coimbra Health School, Coimbra, Portugal
| | - Clara Rocha
- Department of Complementary Sciences, Polytechnic Institute of Coimbra, Coimbra Health School, Coimbra, Portugal
- Department of Electrical and Computer Engineering, INESC Coimbra, University of Coimbra, Coimbra, Portugal
- Laboratory for Applied Health Research (LabinSaúde), Coimbra, Portugal
| | - Helder Santos
- Department of Clinical Physiology, Polytechnic Institute of Coimbra, Coimbra Health School, Coimbra, Portugal
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5
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Cadoni C, Peana AT. Energy drinks at adolescence: Awareness or unawareness? Front Behav Neurosci 2023; 17:1080963. [PMID: 36891321 PMCID: PMC9986288 DOI: 10.3389/fnbeh.2023.1080963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
Energy drinks (EDs) are beverages similar to soft drinks, characterized by high caffeine concentrations with additional ingredients like taurine and vitamins, marketed for boosting energy, reducing tiredness, increasing concentration, and for their ergogenic effect. The majority of consumers are children, adolescents, and young athletes. Although EDs companies claim about the ergogenic and remineralizing properties of their products, there is a serious lack of evidence at preclinical as well as clinical level to validate their benefits. The regular intake and long-term consequences of these caffeinated drinks are not well documented, especially the possible negative effects in adolescents whose brain is still developing. EDs combined with alcohol are also gaining popularity among adolescents and different publications indicate that this combined consumption might increase the risk to develop an alcohol use disorder, as well as produce serious adverse cardiovascular effects. There is an increasing need to disseminate knowledge on EDs damage on health, so that adolescents can be aware about the potential harmful outcomes of consuming these drinks.
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Affiliation(s)
- Cristina Cadoni
- Department of Biomedical Sciences, Institute of Neuroscience, National Research Council of Italy, Cagliari, Italy
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6
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Ravussin Y, Montani JP, Grasser EK. Sucrose dampens caffeine-induced blood pressure elevations - A randomized crossover pilot study in healthy, non-obese men. Front Nutr 2022; 9:896055. [PMID: 35990317 PMCID: PMC9386265 DOI: 10.3389/fnut.2022.896055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Sales for sugar-sweetened and caffeinated beverages are still rising globally and their consumption has been linked to the development of cardiovascular diseases. However, direct evidence from human interventional studies in response to such beverages is still scarce. Methods Seven young, non-obese men participated in a randomized crossover study where four test drinks [60 g sucrose + 50 mg caffeine, 60 g sucrose + caffeine-placebo, 50 mg caffeine, and caffeine-placebo] were investigated. Each drink was brought to a total volume of 500 mL with water. Continuous and beat-to-beat hemodynamic monitoring was conducted for 30 min baseline and continued for 90 min after the ingestion of each drink. Measurements included blood pressure, heart rate, stroke volume, cardiac output, total peripheral resistance, index of contractility, and double product. Results Two-factor ANOVA analysis revealed significant treatment-by-time effects for diastolic blood pressure, heart rate, stroke volume, cardiac output, total peripheral resistance, index of contractility, and double product (all p < 0.01). Diastolic blood pressure and total peripheral resistance increased significantly to caffeine-only (all p < 0.05), while sucrose + caffeine-placebo and sucrose + caffeine both decreased resistance responses (all p < 0.05). Cardiac output increased significantly to sucrose + caffeine-placebo and sucrose + caffeine (all p < 0.05), and on trend for heart rate, stroke volume, and index of contractility (all p between 0.05 and 0.09). Conclusion In young, non-obese men, a caffeinated and sucrose-sweetened beverage at concentrations similar to classical commercial Cola products exhibited distinct hemodynamic actions where the presence of sucrose dampened caffeine-induced blood pressure elevations, but at the expense of a tendency to increase cardiac work.
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Affiliation(s)
- Yann Ravussin
- Department of Endocrinology, Metabolism, and Cardiovascular System, University of Fribourg, Fribourg, Switzerland
| | - Jean-Pierre Montani
- Department of Endocrinology, Metabolism, and Cardiovascular System, University of Fribourg, Fribourg, Switzerland
| | - Erik Konrad Grasser
- Department of Endocrinology, Metabolism, and Cardiovascular System, University of Fribourg, Fribourg, Switzerland
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7
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Hammerness P, Berger A, Angelini MC, Wilens TE. Cardiovascular Considerations for Stimulant Class Medications. Child Adolesc Psychiatr Clin N Am 2022; 31:437-448. [PMID: 35697394 DOI: 10.1016/j.chc.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The cardiovascular (CV) impact of stimulants has been examined for decades, with investigations ranging from small sample targeted studies of heart rate (HR) and blood pressure (BP), to large scale epidemiologic investigations. The preponderance of evidence is reassuring, albeit generally based on healthy samples using variable methodology, excluding those at theoretic high risk (eg, comorbid cardiac illness). Screening for theoretically vulnerable patients are recommended, as well as monitoring for CV symptoms and BP/HR, with shared inquiry/further evaluation if concerned. Future investigations to support the identification of risk are needed, while attention to stimulant-associated CV risk is an opportunity for clinicians to engage in general CV risk identification and intervention.
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Affiliation(s)
- Paul Hammerness
- Psychiatry Services, Southcoast Health, 101 Page Street, New Bedford, MA, USA.
| | - Amy Berger
- Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
| | - Michael C Angelini
- Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
| | - Timothy E Wilens
- Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
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8
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Energy Drinks and Their Acute Effects on Arterial Stiffness in Healthy Children and Teenagers: A Randomized Trial. J Clin Med 2022; 11:jcm11082087. [PMID: 35456180 PMCID: PMC9025458 DOI: 10.3390/jcm11082087] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 12/04/2022] Open
Abstract
Adolescents are the main consumer group of energy drinks (ED). Studies suggest that acute ED consumption is associated with increased peripheral blood pressure. Little is known of the ED-induced effects on arterial stiffness. Therefore, this study aimed to investigate the acute effects of ED consumption on arterial stiffness in healthy children and teenagers by conducting a prospective, randomized, single-blind, placebo-controlled, crossover clinical trial. Study participants (n = 27, mean age = 14.53 years) consumed a body-weight-adjusted amount of an ED or a placebo on two consecutive days. Arterial stiffness was evaluated sonographically by two-dimensional speckle tracking of the common carotid artery (CCA) at baseline and up to four hours after beverage consumption. The ED intake led to a significantly decreased peak circumferential strain of the CCA (11.78 ± 2.70% vs. 12.29 ± 2.68%, p = 0.043) compared with the placebo. The results of this study indicate that the acute ED consumption might be associated with increased arterial stiffness in healthy children and teenagers. Minors, particularly those with increased cardiovascular morbidity, should be discouraged from ED consumption.
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9
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Tulunay Kaya C, Gerede DM, Akhundova J. Acute effects of energy drink consumption on left and right ventricular function - a 2-dimensional speckle tracking echocardiographic study. KARDIOLOGIIA 2022; 62:28-35. [PMID: 35272605 DOI: 10.18087/cardio.2022.2.n1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
Aim Energy drinks (ED) contain high levels of caffeine and taurine and are associated with several cardiovascular effects. We investigated acute effects of consuming low caffeine and taurine content ED on left ventricular (LV) and right ventricular (RV) function assessed by conventional and two-dimensional speckle tracking echocardiography.Material and methods In this crossover study, 34 healthy adults, age 19-48 yrs, drank an ED containing 53.25 milligrams of caffeine, 284 mg of taurine, or an equal volume of control drink (CD) on two separate sessions, 7-10 days apart. Standard echocardiographic and speckle tracking imaging were performed before and 60 min after consumption of the study beverages.Results Compared to CD, ED caused a significant increase in tricuspid annular plane systolic excursion (p=0.04) and RV systolic wave velocity (p=0.01) with no effect on global longitudinal strain when compared to CD. LV systolic function was not altered, but mitral early diastolic velocity by tissue Doppler imaging was significantly higher (p=0.031), and early diastolic strain rate, as measured by speckle tracking echocardiography, was significantly lower (p=0.022).Conclusion Reduced caffeine and taurine content ED does not affect LV systolic function, but increases RV longitudinal contractility and improves LV early diastolic filling.
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Affiliation(s)
| | | | - Javidan Akhundova
- Cardiology Department, Ankara University School of Medicine, Ankara, Turkey
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10
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Lau RP, Fishbein MC. Toxins and the heart. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Moussa M, Hansz K, Rasmussen M, Gillman C, Pollard C, Kwak E, Izsak E. Cardiovascular Effects of Energy Drinks in the Pediatric Population. Pediatr Emerg Care 2021; 37:578-582. [PMID: 32569249 DOI: 10.1097/pec.0000000000002165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Consumption of energy drinks in the pediatric population is correlated with more emergency department visits and causes adverse reactions, such as neurological, psychiatric, gastrointestinal, renal, and cardiovascular effects. These cardiovascular complications include increased cardiometabolic risk with high intake of sugar, short-term blood pressure increases and a decrease in cerebral blood flow due to the caffeine content, increased or decreased blood pressure from taurine, unmasked cardiac conditions, such as channelopathies, and atrial and ventral fibrillations. Cardiovascular complications can also arise when energy drinks are mixed with pharmaceutical drugs, such as amiodarone, potent CYP1A2 inhibitors, warfarin, digoxin, or corticosteroids. Combining energy drinks with alcohol also precipitates adverse cardiovascular events, posing a risk to the health of children and adolescents. This review further explores the ingredients in energy drinks and their mechanism of action in causing these cardiovascular complications.
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Affiliation(s)
- Mohamad Moussa
- From the Department of Emergency Medicine, University of Toledo College of Medicine and Life Sciences
| | - Keith Hansz
- From the Department of Emergency Medicine, University of Toledo College of Medicine and Life Sciences
| | - Michaela Rasmussen
- From the Department of Emergency Medicine, University of Toledo College of Medicine and Life Sciences
| | - Cassidy Gillman
- From the Department of Emergency Medicine, University of Toledo College of Medicine and Life Sciences
| | - Casey Pollard
- From the Department of Emergency Medicine, University of Toledo College of Medicine and Life Sciences
| | - Eunice Kwak
- From the Department of Emergency Medicine, University of Toledo College of Medicine and Life Sciences
| | - Eugene Izsak
- Department of Pediatric Emergency Medicine, Promedica Toledo Hospital, Toledo, OH
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Akhundova J, Kaya CT, Gerede Uludağ DM. Acute effects of consumption of low-caffeine energy drinks on endothelial functions in healthy volunteers. Anatol J Cardiol 2021; 25:678-683. [PMID: 34622781 DOI: 10.5152/anatoljcardiol.2021.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Energy drink consumption is increasing among the population, especially adolescents and young adults. The health effects of energy drinks are unknown. In this study, we investigate the effects of low caffeine energy drinks on endothelial functions assessed by flow-mediated dilation (FMD) of the brachial artery. METHODS Thirty healthy volunteers (15 men, 15 women) aged 19 to 46 years participated in the study. Flow-mediated dilation measurements of the brachial artery were performed and recorded per protocol. The volunteers were asked to drink 355 mL of energy drink containing 53.25 mg of caffeine after baseline measurements, and all measurements were repeated 60 minutes later. Baseline and post-energy drink values were compared. RESULTS Systolic blood pressure (p=0.592), diastolic blood pressure (p=0.714), and heart rate values (p=0.056) were similar before and after the consumption of energy drinks. Preocclusion arterial diameters (p=0.236) and blood velocities (p=0.447) did not change after energy drink consumption. FMD levels were 9.2%±4.6% and 8.1%±4.7%, respectively, before and after energy drink consumption (p=0.176). Women had a 3% increase in preocclusion arterial diameters after energy drink consumption, whereas men had a 2.6% decrease (p=0.026) Conclusion: Low caffeine energy drinks containing 53.25 mg of caffeine/355 mL can did not have any influence on blood pressure, heart rate, or endothelial functions in healthy volunteers.
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Affiliation(s)
- Javidan Akhundova
- Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey
| | - Cansın Tulunay Kaya
- Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey
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Hladun O, Papaseit E, Martín S, Barriocanal AM, Poyatos L, Farré M, Pérez-Mañá C. Interaction of Energy Drinks with Prescription Medication and Drugs of Abuse. Pharmaceutics 2021; 13:pharmaceutics13101532. [PMID: 34683828 PMCID: PMC8541613 DOI: 10.3390/pharmaceutics13101532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022] Open
Abstract
In recent years, the consumption of energy drinks (EDs) has become increasingly popular, especially among adolescents. Caffeine, a psychostimulant, is the main compound of EDs which also contain other substances with pharmacological effects. This review aims to compile current evidence concerning the potential interactions between EDs, medicines, and drugs of abuse as they are frequently consumed in combination. The substances involved are mainly substrates, inductors or inhibitors of CYP1A2, psychostimulants, alcohol and other depressant drugs. Furthermore, intoxications reported with EDs and other substances have also been screened to describe acute toxicity. The results of our review show that the consumption of both EDs alone and in combination is not as safe as previously thought. Health professionals and consumers need to be aware of the potential interactions of these drinks as well as the absence of long-term safety data.
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Affiliation(s)
- Olga Hladun
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), 08916 Badalona, Spain; (O.H.); (S.M.); (A.M.B.); (L.P.); (M.F.); (C.P.-M.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain
| | - Esther Papaseit
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), 08916 Badalona, Spain; (O.H.); (S.M.); (A.M.B.); (L.P.); (M.F.); (C.P.-M.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain
- Correspondence: ; Tel.: +34-934978843
| | - Soraya Martín
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), 08916 Badalona, Spain; (O.H.); (S.M.); (A.M.B.); (L.P.); (M.F.); (C.P.-M.)
| | - Ana Maria Barriocanal
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), 08916 Badalona, Spain; (O.H.); (S.M.); (A.M.B.); (L.P.); (M.F.); (C.P.-M.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain
| | - Lourdes Poyatos
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), 08916 Badalona, Spain; (O.H.); (S.M.); (A.M.B.); (L.P.); (M.F.); (C.P.-M.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain
| | - Magí Farré
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), 08916 Badalona, Spain; (O.H.); (S.M.); (A.M.B.); (L.P.); (M.F.); (C.P.-M.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain
| | - Clara Pérez-Mañá
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), 08916 Badalona, Spain; (O.H.); (S.M.); (A.M.B.); (L.P.); (M.F.); (C.P.-M.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain
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Chronic Red Bull Consumption during Adolescence: Effect on Mesocortical and Mesolimbic Dopamine Transmission and Cardiovascular System in Adult Rats. Pharmaceuticals (Basel) 2021; 14:ph14070609. [PMID: 34202876 PMCID: PMC8308486 DOI: 10.3390/ph14070609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022] Open
Abstract
Energy drinks are very popular nonalcoholic beverages among adolescents and young adults for their stimulant effects. Our study aimed to investigate the effect of repeated intraoral Red Bull (RB) infusion on dopamine transmission in the nucleus accumbens shell and core and in the medial prefrontal cortex and on cardiac contractility in adult rats exposed to chronic RB consumption. Rats were subjected to 4 weeks of RB voluntary consumption from adolescence to adulthood. Monitoring of in vivo dopamine was carried out by brain microdialysis. In vitro cardiac contractility was studied on biomechanical properties of isolated left-ventricular papillary muscle. The main finding of the study was that, in treated animals, RB increased shell dopamine via a nonadaptive mechanism, a pattern similar to that of drugs of abuse. No changes in isometric and isotonic mechanical parameters were associated with chronic RB consumption. However, a prolonged time to peak tension and half-time of relaxation and a slower peak rate of tension fall were observed in RB-treated rats. It is likely that RB treatment affects left-ventricular papillary muscle contraction. The neurochemical results here obtained can explain the addictive properties of RB, while the cardiovascular investigation findings suggest a hidden papillary contractility impairment.
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Alqrache A, Mostafa M, Ghabrah O, Ghabrah Z, Kamal N, Ghabrah T, Atta H. Knowledge and Patterns of Dietary Supplement Use among Students Attending King Abdulaziz University in Saudi Arabia: A Cross-Sectional Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211020882. [PMID: 34053321 PMCID: PMC8743916 DOI: 10.1177/00469580211020882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Oral dietary supplements (DSs) include vitamins, minerals, amino acids, energy drinks, and herbal products. The use of DSs is increasing and their manufacturers promote their benefits. Studies have validated some of these benefits, but have also indicated that some DSs can have adverse effects, especially if used without the appropriate supervision. Little information on DS use among Saudis is available. This study assessed the use of dietary supplements among male and female university students with the goal of educating the community about DSs and the dangers associated with their misuse. Online and paper validated questionnaires were administered to King Abdulaziz University (KAU) students between September 2019 and January 2020. The responses were collected and analyzed statistically. Of the 954 KAU students who completed the survey, one-third used DSs (42.9% women vs 25.7% men). Of these, 51.7% believed that DSs are essential for health, 41.7% classified them as both food and drugs, 67.2% were aware that DSs could not replace a healthy diet, and 25.8% were aware of their potentially harmful effects. Multivitamins and minerals were the most used DSs. DS awareness among KAU students is limited. Additional health education is necessary to assist students in their selection of the most suitable DSs.
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Affiliation(s)
| | - Mostafa Mostafa
- King Abdulaziz University, Jeddah, Saudi Arabia.,Cairo University, Cairo, Egypt
| | - Omar Ghabrah
- Maternity and Children Hospital, Al-Kharj, Saudi Arabia
| | - Ziyad Ghabrah
- Maternity and Children Hospital, Al-Kharj, Saudi Arabia
| | - Nezar Kamal
- King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Hazem Atta
- King Abdulaziz University, Jeddah, Saudi Arabia.,Cairo University, Cairo, Egypt
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Energy Drinks and Sports Performance, Cardiovascular Risk, and Genetic Associations; Future Prospects. Nutrients 2021; 13:nu13030715. [PMID: 33668219 PMCID: PMC7995988 DOI: 10.3390/nu13030715] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/05/2021] [Accepted: 02/20/2021] [Indexed: 12/29/2022] Open
Abstract
The consumption of energy drinks (e.g., containing caffeine and taurine) has increased over the last decade among adolescents and athletes to enhance their cognitive level and improve intellectual and athletic performance. Numerous studies have shown that drinking moderate doses of such drinks produces beneficial effects, as they considerably boost the sporting performance of elite athletes in various sports, including both endurance and explosive events. However, apart from their ergogenic effects, the regular consumption of energy drinks also increases blood pressure and consequently incites problems such as hypertension, tachycardia, and nervousness, all of which can lead to cardiovascular disorders. A potential positive correlation between genetics and the moderate consumption of energy drinks and athletic performance has recently been reported; notwithstanding, a better understanding of the genetic variants involved in metabolism is a key area for future research to optimize the dose of energy drink consumed and obtain the maximal ergogenic effect in elite sports. The aim of this literature review, therefore, is to present the results of recent studies, classifying them according to the differences in the associations between energy drinks and: (i) Athletic performance; (ii) cardiovascular risk factors while practicing sports; and (iii) genetic associations and future prospects between the consumption of energy drinks and performance.
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Luo YS, Chen Z, Blanchette AD, Zhou YH, Wright FA, Baker ES, Chiu WA, Rusyn I. Relationships between constituents of energy drinks and beating parameters in human induced pluripotent stem cell (iPSC)-Derived cardiomyocytes. Food Chem Toxicol 2021; 149:111979. [PMID: 33450301 DOI: 10.1016/j.fct.2021.111979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/24/2022]
Abstract
Consumption of energy drinks has been associated with adverse cardiovascular effects; however, little is known about the ingredients that may contribute to these effects. We therefore characterized the chemical profiles and in vitro effects of energy drinks and their ingredients on human induced pluripotent stem cell (iPSC)-derived cardiomyocytes, and identified the putative active ingredients using a multivariate prediction model. Energy drinks from 17 widely-available over-the-counter brands were evaluated in this study. The concentrations of six common ingredients (caffeine, taurine, riboflavin, pantothenic acid, adenine, and L-methionine) were quantified by coupling liquid chromatography with a triple quadrupole mass spectrometer for the acquisition of LC-MS/MS spectra. In addition, untargeted analyses for each beverage were performed with a platform combining LC, ion mobility spectrometry and mass spectrometry (LC-IMS-MS) measurements. Approximately 300 features were observed across samples in the untargeted studies, and of these ~100 were identified. In vitro effects of energy drinks and some of their ingredients were then tested in iPSC-derived cardiomyocytes. Data on the beat rate (positive and negative chronotropy), ion channel function (QT prolongation), and cytotoxicity were collected in a dilution series. We found that some of the energy drinks elicited adverse effects on the cardiomyocytes with the most common being an increase in the beat rate, while QT prolongation was also observed at the lowest concentrations. Finally, concentration addition modeling using quantitative data from the 6 common ingredients and multivariate prediction modeling was used to determine potential ingredients responsible for the adverse effects on the cardiomyocytes. These analyses suggested theophylline, adenine, and azelate as possibly contributing to the in vitro effects of energy drinks on QT prolongation in cardiomyocytes.
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Affiliation(s)
- Yu-Syuan Luo
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, USA
| | - Zunwei Chen
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, USA
| | - Alexander D Blanchette
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, USA
| | - Yi-Hui Zhou
- Departments of Statistics and Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Fred A Wright
- Departments of Statistics and Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Erin S Baker
- Department of Chemistry, North Carolina State University, Raleigh, NC, USA
| | - Weihsueh A Chiu
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, USA
| | - Ivan Rusyn
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, USA.
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Nagata JM, Ganson KT, Cunningham ML, Mitchison D, Lavender JM, Blashill AJ, Gooding HC, Murray SB. Associations between legal performance-enhancing substance use and future cardiovascular disease risk factors in young adults: A prospective cohort study. PLoS One 2020; 15:e0244018. [PMID: 33320903 PMCID: PMC7737961 DOI: 10.1371/journal.pone.0244018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Legal performance-enhancing substances (PES), such as creatine, are commonly used by adolescents and young adults. As PES are mostly unregulated by the US Food and Drug Administration, there has been limited empirical attention devoted to examining their long-term safety and health outcomes. Preliminary studies have demonstrated associations between PES use and severe medical events, including hospitalizations and death. PES could be linked to cardiovascular disease (CVD), the most common cause of mortality in the US, by altering the myocardium, vasculature, or metabolism. The objective of this study was to examine prospective associations between the use of legal PES in young adulthood and CVD risk factors at seven-year follow-up. MATERIALS AND METHODS Nationally representative longitudinal cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves III (2001-2002) and IV (2008), were analyzed. Regression models determined the prospective association between the use of legal PES (e.g. creatine monohydrate) and CVD risk factors (e.g. body mass index, diabetes, hypertension, hyperlipidemia), adjusting for relevant covariates. RESULTS Among the diverse sample of 11,996 male and female participants, no significant differences by PES use in body mass index, diabetes, hypertension, or hyperlipidemia were noted at Wave III. In unadjusted comparisons, legal PES users (versus non-users) were more likely to be White, be male, be college educated, drink alcohol, and engage in weightlifting, exercise, individual sports, team sports, and other strength training. There were no significant prospective associations between legal PES use at Wave III and body mass index, hemoglobin A1c, systolic and diastolic blood pressure, and cholesterol (total, HDL, LDL, triglycerides) deciles at seven-year follow-up (Wave IV), adjusting for demographics, health behaviors, and Wave III CVD risk factors. Similarly, there were no significant prospective associations between legal PES use and diabetes, hypertension, or hyperlipidemia based on objective measures or self-reported medications and diagnoses, adjusting for demographics, health behaviors, and Wave III CVD risk. CONCLUSIONS We do not find evidence for a prospective association between legal PES use and CVD risk factors in young adults over seven years of follow-up, including BMI, diabetes, hypertension, or hyperlipidemia. It should be noted that legal PES use was operationalized dichotomously and as one broad category, which did not account for frequency, amount, or duration of use. Given the lack of regulation and clinical trials data, observational studies can provide much needed data to inform the safety and long-term health associations of legal PES use and, in turn, inform clinical guidance and policy.
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Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Kyle T. Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Jason M. Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Metis Foundation, San Antonio, Texas, United States of America
| | - Aaron J. Blashill
- Department of Psychology, San Diego State University, San Diego, California, United States of America
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, California, United States of America
- San Diego Joint Doctoral Program in Clinical Psychology, University of California, San Diego, California, United States of America
| | - Holly C. Gooding
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Stuart B. Murray
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, California, United States of America
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Kamar SA, Malak HWA, Saad SA. Effect of caffeinated energy drinks on the structure of hippocampal cornu ammonis 1 and dentate gyrus of adult male albino rats. Anat Cell Biol 2020; 53:330-341. [PMID: 32993281 PMCID: PMC7527115 DOI: 10.5115/acb.20.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 02/06/2023] Open
Abstract
Energy drinks are available worldwide and frequently consumed to increase energy level and compensate lack of sleep. Energy drinks consumers aim to improve their cognitive functions. Red Bull is the most popular energy drink consumed in Egypt. However, the link between the impact of energy drinks on the structure of hippocampal cornu ammonis 1 (CA1) and dentate gyrus (DG), a highly vulnerable brain regions to various insults, has not yet documented. To study the effect of energy drinks on structure of hippocampal CA1 and DG of adult male albino rats. Twenty one adult male albino rats were divided into three groups; group I control group, groups II and III received Red Bull, with a dose of 3.75 ml/kg/day orally using gastric tube for four and eight consecutive weeks respectively. At the end of the experiment, brains were dissected and hippocampal specimens were processed for histopathological and immunohistochemical studies. Histopathological examination of hippocampal sections in group II revealed vacuoles, decrease thickness of pyramidal cell layer with irregular dark or ghost nuclei. However, changes were more severe in group III with cracks in pyramidal cell layer, massive vacuolation and signet ring cells. Moreover, star shaped astrocytes and glial fibrillary acidic protein immuno-reactivity were more abundant in group III than in group II. Caffeinated energy drinks produced neurodegenerative changes and reactive astrocytosis in hippocampal CA1 and DG of adult male albino rats. These changes were duration-dependent being more severe in longer duration of intake.
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Affiliation(s)
- Sherif A Kamar
- Department of Anatomy, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hany W Abdel Malak
- Department of Anatomy, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shereen Adel Saad
- Department of Anatomy, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Babar NF, Amin A, Asif R. Prevalence and Perceived benefits of energy drink Consumption in medical students. JOURNAL OF RAWALPINDI MEDICAL COLLEGE 2020. [DOI: 10.37939/jrmc/vol24.iss1.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: To assess the energy drink consumption patterns and perceived risks and benefits among medical students. The present study was carried out on 332 medical students from Foundation University Medical College. All the students enrolled in foundation university medical college were invited to participate. 332 students, who gave their consent were enrolled in the study. Data was collected by distributing a preformed structured questionnaire among medical students present in their classes. Data was entered and analyzed on SPSS version 17.
Results: Out of 332 students 307 (92.5%) said that they were familiar with energy drinks whereas 212 (63.9%) admitted to consuming energy drinks. sting and the red bull came out to be the most popular brands. 78 (36.7%) students said mental awareness to be the main motivator for energy drink consumption. The majority (94.3%) of the study population were aware of the untoward effects of energy drinks experienced. The most common of them was insomnia, students (49.05%) experienced it. 91 (42.92%) of the students said that their parents don’t object to their taking of these drinks.
Conclusion: Although the consumption of energy drinks was common among medical students, the knowledge of ingredients and health risks of energy drinks among them was unsatisfactory.
Keywords: Energy drink, Medical students, Caffeine, Frequency of consumption.
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Abstract
PURPOSE OF REVIEW To review latest reports of the food products which might increase blood pressure and therefore might participate in the pathogenesis of hypertension. RECENT FINDINGS Results of clinical study suggest that consumption of high-sodium food leads to transient increase in plasma sodium concentration. This is accompanied by blood pressure increase. Results of both clinical and experimental studies suggest direct vasculotoxic effects of sodium. Increased plasma sodium concentration could mediate its effects on blood pressure by changes in endothelial cell stiffness and glycocalyx integrity. Energy drinks are non-alcoholic beverages with increasing popularity. Clinical, interventional, randomized, placebo controlled, and cross-sectional studies showed that energy drinks may increase arterial blood pressure. Blood pressure increase after exposure for the energy drinks is mainly related to the caffeine content in these drinks. Many case reports were published concerning the clinically significant increase in blood pressure caused by the consumption of liquorice root or food products containing liquorice, such as candies, tea, Pontefract cookies, and chewing gum. Liquorice contains a precursor of glycyrrhetic acid. Glycyrrhetic acid reduces the activity of the 11β-hydroxysteroid dehydrogenase type 2 (11ß-HSD2) isoenzyme, which leads to activation of the mineralocorticoid receptor by cortisol in the distal convoluted tubule resulting in hypertension, hypokalemia, and metabolic alkalosis. The relationship between chronic alcohol intake and blood pressure is well established on the basis of a diverse body of evidence including animal experiments, epidemiological studies, mendelian randomization studies, and interventional studies. Results of recent studies suggested that binge drinking (i.e., episodic consumption of a very high amount of alcohol beverages) has pronounced hypertensinogenic effects. Recently, it was documented that also low doses of alcohol may increase the risk of cardiovascular complications. Therefore, the amount of alcohol consumption that is safe is zero. High-salt food products, energy drinks, food products containing liquorice, and alcoholic beverages have hypertensinogenic properties. Patients with hypertension and other cardiovascular diseases should avoid even accidental consumption of these food products.
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Nowak D, Gośliński M. Assessment of Antioxidant Properties of Classic Energy Drinks in Comparison with Fruit Energy Drinks. Foods 2020; 9:foods9010056. [PMID: 31935989 PMCID: PMC7023211 DOI: 10.3390/foods9010056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 01/22/2023] Open
Abstract
Energy drinks (EDs) contain sugar, caffeine, and other bioactive compounds. Recently, new types of EDs, enriched with fruit juices, natural pigments, and plant extracts, have been launched in the market. The objective of this study was to investigate the composition and antioxidant properties of the most popular classic and fruit EDs. The study was carried out including 24 of the most popular energy drinks (classic and fruit EDs). The composition of EDs, especially caffeine and sugar, and antioxidant properties (antioxidant capacity, total polyphenols, total anthocyanins, vitamin C) were analyzed. Energy drinks with added fruit juice or natural pigments had a significantly higher (p ≤ 0.05) antioxidant capacity compared to classic energy drinks. Fruit EDs had a higher concentration of polyphenols and vitamin C. In some fruit EDs, slight amounts of anthocyanins were found. Generally, EDs are not a rich source of polyphenols and are not distinguished by high antioxidant capacity. However, fruit energy drinks and/or ones with added natural pigments have much better antioxidant properties than classic EDs. Both classic and fruit EDs contain a large amount of caffeine and sugar, therefore, it would be advisable not to drink large amounts of EDs for possible related health issues.
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Subaiea GM, Altebainawi AF, Alshammari TM. Energy drinks and population health: consumption pattern and adverse effects among Saudi population. BMC Public Health 2019; 19:1539. [PMID: 31752795 PMCID: PMC6869250 DOI: 10.1186/s12889-019-7731-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/09/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Caffeine containing energy drinks (EDs) are heavily consumed, particularly among young adults. The number of reports of caffeine intoxication from caffeinated EDs and problems related to caffeine dependence and withdrawal is increasing. The objective was to assess the knowledge and perceived beneficial effects of EDs consumers, to assess consumption patterns and determine the adverse effects experienced by different EDs consumer groups residing in Saudi Arabia. METHODS An observational cross-sectional study with data from a randomly selected Saudi population was conducted during the period of January 15th, 2015, to April 15th, 2015, using a pre-tested 43-item questionnaire. The data were obtained and collected using interview questionnaires. Sociodemographic characteristics and data on EDs consumption patterns, the level of awareness among study subjects, and the purported benefits and reported adverse effects of EDs were collected. Frequency, percentage, and arithmetic means were calculated using Chi-square and ANOVA tests, and data with p < 0.05 were considered significant. RESULTS Of the 816 individuals invited to participate in the study, 783 participants responded and completed interviews, response rate was 96%. Consumers attributed the popularity of EDs to massive advertising media (46.7%) and their stimulating and invigorating effects (37.5%). EDs are consumed by subjects for their effects on fatigue reduction (64.6%), increased alertness and focus (75.8%), and assistance during long driving trips (75.7%). Study subjects reported suffering from adverse effects, including mainly diuresis (53.7%), palpitations (50.7%), insomnia (50.7%). Importantly, an inverse association was identified between knowledge of EDs and consumption rate, and a proportional association was identified between experienced adverse effects and consumption frequency. Lower knowledge scores were identified in daily consumers than in 1-3 times monthly consumers; higher adverse events were experienced by daily consumers than by 1-3 times monthly consumers. The majority of consumers (84.6%) recommended that authorities should regulate EDs consumption. CONCLUSIONS Excessive EDs consumption is associated with an increased risk of experiencing several adverse events, which is commensurate with published studies. Increasing knowledge about EDs and their possible risks could decrease their consumption by the general public.
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Affiliation(s)
- Gehad M. Subaiea
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Hail, Hail, Kingdom of Saudi Arabia
| | - Ali F. Altebainawi
- Medication Safety Research Chair, King Saud University, Riyadh, Kingdom of Saudi Arabia
- College of Pharmacy, University of Hail, Hail, Kingdom of Saudi Arabia
- Clinical Pharmacy Department, Pharmaceutical Care Services, King Khalid Hospital, Ministry of Health, Hail, Kingdom of Saudi Arabia
| | - Thamir M. Alshammari
- Medication Safety Research Chair, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, P.O.Box 6166, Zip code 81442 Hail City, Kingdom of Saudi Arabia
- Saudi Food and Drug Authority, Riyadh, Kingdom of Saudi Arabia
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European Cardiac Arrhythmia Society Statement on the cardiovascular events associated with the use or abuse of energy drinks. J Interv Card Electrophysiol 2019; 56:99-115. [PMID: 31482331 DOI: 10.1007/s10840-019-00610-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 08/06/2019] [Indexed: 02/06/2023]
Abstract
Energy drinks are increasingly used by young people and young athletes in order to improve their performance alone or in association of other substances, particularly alcohol. In recent years, a number of reports of reports have raised attention on the side-effects associated with the use or abuse of energy drinks particularly serious cardiovascular events. The European Cardiac Arrhythmia Society (ECAS) has undertaken a systematic and critical review of reported data on cardiovascular events including life-threatening arrhythmias with or without cardiac arrest and other cardiovascular events, and discussed in this review the possible causal effect of caffeine and other ingredients contained in energy drinks and the reported events. Twenty-two cardiovascular events were reported in association with the use or abuse of energy drinks. The European Cardiac Arrhythmia Society would like to draw attention on the possible cardiovascular complications that may occur with the consumption of these beverages and to emphasize the prevention measures to be taken particularly in the young population. Well-designed prospective studies are needed to clarify the possible role of energy drinks in inducing the cardiovascular events reported.
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Basrai M, Schweinlin A, Menzel J, Mielke H, Weikert C, Dusemund B, Putze K, Watzl B, Lampen A, Bischoff SC. Energy Drinks Induce Acute Cardiovascular and Metabolic Changes Pointing to Potential Risks for Young Adults: A Randomized Controlled Trial. J Nutr 2019; 149:441-450. [PMID: 30805607 DOI: 10.1093/jn/nxy303] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 08/31/2018] [Accepted: 11/09/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Case reports suggest a link between energy drinks (EDs) and adverse events, including deaths. OBJECTIVES We examined cardiovascular and metabolic effects of EDs and mixtures providing relevant ingredients of EDs compared to a similarly composed control product (CP) without these components. METHODS This randomized, crossover trial comprised 38 adults (19 women, mean BMI 23 kg/m2, mean age 22 y). We examined effects of a single administration of a commercial ED, the CP, and the CP supplemented with major ED-ingredients at the same concentrations as in the ED. The study products were administered at 2 volumes, 750 or 1000 mL. RESULTS Both volumes of the study products were acceptably tolerated with no dose-dependent effects on blood pressure (BP, primary outcome), heart rate, heart rate corrected duration of QT-segment in electrocardiography (QTc interval), and glucose metabolism. After ED consumption, 11% of the participants reported symptoms, in contrast to 0-3% caused by other study products. After 1 h, administration of an ED caused an increase in systolic BP (116.9 ± 10.4 to 120.7 ± 10.7 mmHg, mean ± SD, P < 0.01) and a QTc prolongation (393.3 ± 20.6 to 400.8 ± 24.1 ms, P < 0.01). Also caffeine, but not taurine or glucuronolactone, caused an increase in BP, but no QTc prolongation. The BP effects were most pronounced after 1 h and returned to normal after a few hours. All study products caused a decrease in serum glucose and an increase in insulin concentrations after 1 h compared to baseline values, corresponding to an elevation in the HOMA-IR (ED + 4.0, other products + 1.0-2.8, all P < 0.001). CONCLUSION A single high-volume intake of ED caused adverse changes in BP, QTc, and insulin sensitivity in young, healthy individuals. These effects of EDs cannot be easily attributed to the single components caffeine, taurine, or glucuronolactone. This trial was registered at clinicaltrials.gov as NCT01421979.
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Affiliation(s)
- Maryam Basrai
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
| | - Anna Schweinlin
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
| | - Juliane Menzel
- German Federal Institute for Risk Assessment, Department of Food Safety, Berlin, Germany
| | - Hans Mielke
- German Federal Institute for Risk Assessment, Department of Exposure, Berlin, Germany
| | - Cornelia Weikert
- German Federal Institute for Risk Assessment, Department of Food Safety, Berlin, Germany
| | - Birgit Dusemund
- German Federal Institute for Risk Assessment, Department of Food Safety, Berlin, Germany
| | | | - Bernhard Watzl
- Max Rubner-Institut, Department of Physiology and Biochemistry of Nutrition, Karlsruhe, Germany
| | - Alfonso Lampen
- German Federal Institute for Risk Assessment, Department of Food Safety, Berlin, Germany
| | - Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
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Kozik TM, Carey MG, Bhattacharyya M, Chien W, Charos GS, Connolly TF, Hickman MC, Schmidt S, Pelter MM. Cardiovascular responses to ENERGY drinks in a healthy population during eXercise: The C-Energy-X Study. J Electrocardiol 2018; 51:S1-S5. [DOI: 10.1016/j.jelectrocard.2018.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/19/2018] [Accepted: 07/27/2018] [Indexed: 11/28/2022]
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A case of Kounis syndrome associated with branched-chain amino acid supplementation in a 17-year-old boy. Cardiol Young 2018; 28:1165-1167. [PMID: 30047352 DOI: 10.1017/s104795111800104x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Kounis Syndrome is characterised by the concurrence of acute coronary syndrome with mast cell activation induced by inflammatory mediators released during an allergic reaction. Although several factors and diseases were reported to be associated with Kounis Syndrome, branched-chain amino acid supplements have not been previously reported as a cause of Kounis Syndrome. We present a 17-year-old boy admitted to our hospital with thoracic pain after the ingestion of a branched-chain amino acid supplement.
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Energy drink exposures reported to Texas poison centers: Analysis of adverse incidents in relation to total sales, 2010–2014. Regul Toxicol Pharmacol 2018; 97:1-14. [DOI: 10.1016/j.yrtph.2018.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/18/2017] [Accepted: 05/10/2018] [Indexed: 12/21/2022]
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Attipoe S, Delahanty L, Stephens M, Deuster PA. Energy Beverage Use Among U.S. Service Members. Mil Med 2018; 183:e554-e561. [DOI: 10.1093/milmed/usy169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 05/19/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Selasi Attipoe
- Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA
| | - Liam Delahanty
- Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA
| | - Mark Stephens
- Department of Military and Emergency Medicine, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD
| | - Patricia A Deuster
- Department of Military and Emergency Medicine, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD
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Nowak D, Gośliński M, Nowatkowska K. The Effect of Acute Consumption of Energy Drinks on Blood Pressure, Heart Rate and Blood Glucose in the Group of Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030544. [PMID: 29562659 PMCID: PMC5877089 DOI: 10.3390/ijerph15030544] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/02/2018] [Accepted: 03/14/2018] [Indexed: 02/08/2023]
Abstract
Background: Energy drinks (EDs) are very popular among young people, who consume them for various reasons. A standard ED typically contains 80 mg of caffeine, as well as glucose, taurine, vitamins and other ingredients. Excessive consumption of EDs and accumulation of the above ingredients, as well as their mutual interactions, can be hazardous to the health of young adults. The purpose of this study was to assess the effect of acute consumption of energy drinks on blood pressure, heart rate and blood glucose. Methods: The study involved 68 volunteers, healthy young adults (mean age 25 years), who were divided into two groups: the first consumed three EDs at one-hour intervals, and the second drank the same amount of water. All participants had their blood pressure (BP)—systolic and diastolic (SBP and DBP)—as well as heart rate (HR) and blood glucose (BG) measured. In addition, participants could report any health problems before and after consuming each portion of ED. Results: In the above experiment, having consumed three portions of ED (240 mg of caffeine), the participants presented a significant increase in DBP (p = 0.003), by over 8%, which coincided with a lack of any significant impact on SBP (p = 0.809). No significant changes were noted in HR (p = 0.750). Consumption of EDs caused a significant increase (p < 0.001) in BG, by ca. 21%, on average. Some participants reported various discomforts, which escalated after 2 and 3 EDs. Conclusions: Acute consumption of EDs contributed to increased diastolic blood pressure, blood glucose and level of discomfort in healthy young people. Our results reinforce the need for further studies on a larger population to provide sufficient evidence.
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Affiliation(s)
- Dariusz Nowak
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Dębowa 3, 85-626 Bydgoszcz, Poland.
| | - Michał Gośliński
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Dębowa 3, 85-626 Bydgoszcz, Poland.
| | - Kamila Nowatkowska
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Dębowa 3, 85-626 Bydgoszcz, Poland.
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Justus H. Trendy Energy Drinks and the Renal Diet. J Ren Nutr 2018. [DOI: 10.1053/j.jrn.2017.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Al-Shaar L, Vercammen K, Lu C, Richardson S, Tamez M, Mattei J. Health Effects and Public Health Concerns of Energy Drink Consumption in the United States: A Mini-Review. Front Public Health 2017; 5:225. [PMID: 28913331 PMCID: PMC5583516 DOI: 10.3389/fpubh.2017.00225] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/11/2017] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Laila Al-Shaar
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Population Health Sciences Program, Graduate School of Arts and Sciences, Harvard University, Cambridge, MA, United States
| | - Kelsey Vercammen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Chang Lu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Scott Richardson
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Population Health Sciences Program, Graduate School of Arts and Sciences, Harvard University, Cambridge, MA, United States
| | - Martha Tamez
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Water ingestion decreases cardiac workload time-dependent in healthy adults with no effect of gender. Sci Rep 2017; 7:7939. [PMID: 28801682 PMCID: PMC5554208 DOI: 10.1038/s41598-017-08446-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/12/2017] [Indexed: 12/22/2022] Open
Abstract
Ingestion of water entails a variety of cardiovascular responses. However, the precise effect remains elusive. We aimed to determine in healthy adults the effect of water on cardiac workload and to investigate potential gender differences. We pooled data from two controlled studies where blood pressure (BP) and heart rate (HR) were continuously recorded before and after the ingestion of 355 mL of tap water. Additionally, we calculated double product by multiplying systolic BP with HR and evaluated spectral parameters referring to vagal tone. All parameters were investigated for potential differences based on gender. In response to water, HR, systolic BP, and double product decreased significantly during the first 30 min. However, these effects were attenuated for HR and double product and even abolished for systolic BP over the subsequent 30 min. Over the entire post-drink period (60 min), decreases in HR and double product (all P < 0.05) were observed. Spectral markers for vagal tone increased with the on-set of the water drink and remained elevated until the end (P < 0.005). No significant gender difference in cardiac workload parameters was observed. We provide evidence that drinking water decreases, in a time-dependent fashion, cardiac workload and that these responses appear not to be influenced by gender.
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Chaban R, Kornberger A, Branski N, Buschmann K, Stumpf N, Beiras-Fernandez A, Vahl CF. In-vitro examination of the positive inotropic effect of caffeine and taurine, the two most frequent active ingredients of energy drinks. BMC Cardiovasc Disord 2017; 17:220. [PMID: 28793864 PMCID: PMC5550931 DOI: 10.1186/s12872-017-0625-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 07/12/2017] [Indexed: 01/16/2023] Open
Abstract
Background Our study aimed to evaluate changes in the contractile behavior of human myocardium after exposure to caffeine and taurine, the main active ingredients of energy drinks (EDs), and to evaluate whether taurine exhibits any inotropic effect at all in the dosages commonly used in EDs. Methods Myocardial tissue was removed from the right atrial appendages of patients undergoing cardiac surgery and prepared to obtain specimens measuring 4 mm in length. A total of 92 specimens were exposed to electrical impulses at a frequency of 75 bpm for at least 40 min to elicit their maximum contractile force before measuring the isometric contractile force (ICF) and duration of contraction (CD). Following this, each specimen was treated with either taurine (group 1, n = 29), or caffeine (group 2, n = 31) or both (group 3, n = 32). After exposure, ICF and CD measuring were repeated. Post-treatment values were compared with pre-treatments values and indicated as percentages. Results Exposure to taurine did not alter the contraction behavior of the specimens. Exposure to caffeine, in contrast, led to a significant increase in ICF (118 ± 03%, p < 0.01) und a marginal decrease in CD (95 ± 1.6%, p < 0.01). Exposure to a combination of caffeine and taurine also induced a statistically significant increase in ICF (124 ± 4%, p < 0.01) and a subtle reduction in CD (92 ± 1.4%, p < 0.01). The increase in ICF achieved by administration of caffeine was similar to that achieved by a combination of both caffeine and taurine (p = 0.2). The relative ICF levels achieved by administration of caffeine and a combination of taurine and caffeine, respectively, were both significantly higher (p < 0.01) than the ICF resulting from exposure to taurine only. Conclusion While caffeine altered the contraction behavior of the specimen significantly in our in-vitro model, taurine did not exhibit a significant effect. Adding taurine to caffeine did not significantly enhance or reduce the effect of caffeine.
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Affiliation(s)
- R Chaban
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - A Kornberger
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - N Branski
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - K Buschmann
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - N Stumpf
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - A Beiras-Fernandez
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - C F Vahl
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
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Enriquez A, Frankel DS. Arrhythmogenic effects of energy drinks. J Cardiovasc Electrophysiol 2017; 28:711-717. [PMID: 28387431 DOI: 10.1111/jce.13210] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/26/2017] [Accepted: 03/26/2017] [Indexed: 12/26/2022]
Abstract
Energy drinks (ED) are increasingly popular, especially among adolescents and young adults. They are marketed as enhancers of energy, alertness, and physical performance. ED contain high doses of caffeine and other active ingredients. Their safety has come under question due to reports temporally linking ED consumption with serious cardiovascular events, including arrhythmias and sudden cardiac death. In this article, we report 2 cases of life-threatening ventricular arrhythmias in young patients after consuming ED. We also review the ingredients of ED, the physiologic effects on the cardiovascular system, and the available evidence suggesting arrhythmogenecity.
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Affiliation(s)
- Andres Enriquez
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David S Frankel
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Selected Literature Watch. JOURNAL OF CAFFEINE RESEARCH 2017. [DOI: 10.1089/jcr.2016.29003.slw] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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