Health effects of energy drinks on children, adolescents, and young adults

Abstract

Objective: To review the effects, adverse consequences, and extent of energy drink consumption among children, adolescents, and young adults.

Methods: We searched PubMed and Google using "energy drink," "sports drink," "guarana," "caffeine," "taurine," "ADHD," "diabetes," "children," "adolescents," "insulin," "eating disorders," and "poison control center" to identify articles related to energy drinks. Manufacturer Web sites were reviewed for product information.

Results: According to self-report surveys, energy drinks are consumed by 30% to 50% of adolescents and young adults. Frequently containing high and unregulated amounts of caffeine, these drinks have been reported in association with serious adverse effects, especially in children, adolescents, and young adults with seizures, diabetes, cardiac abnormalities, or mood and behavioral disorders or those who take certain medications. Of the 5448 US caffeine overdoses reported in 2007, 46% occurred in those younger than 19 years. Several countries and states have debated or restricted energy drink sales and advertising.

Conclusions: Energy drinks have no therapeutic benefit, and many ingredients are understudied and not regulated. The known and unknown pharmacology of agents included in such drinks, combined with reports of toxicity, raises concern for potentially serious adverse effects in association with energy drink use. In the short-term, pediatricians need to be aware of the possible effects of energy drinks in vulnerable populations and screen for consumption to educate families. Long-term research should aim to understand the effects in at-risk populations. Toxicity surveillance should be improved, and regulations of energy drink sales and consumption should be based on appropriate research.

FIGURE 1

Mathematical model estimates for dietary consumption of caffeine and energy drinks in children aged 5 to 12 years (A), adolescents aged 13 to 19 years (B), and young males aged 19 to 24 years (C) using caffeine-concentration data from food and beverages combined with 24-hour diet-recall information from the 1997 New Zealand National Nutrition Survey and the 2002 New Zealand National Children's Nutrition Survey. A, Distribution of dietary baseline caffeine-exposure estimates for children (5–12 years old). P95 indicates the 95th percentile exposure and represents a high consumer. Caffeine-exposure units are mg/kg of body weight per day. B, Distribution of dietary baseline caffeine-exposure estimates for teenagers (13–19 years old). C, Distribution of dietary baseline caffeine-exposure for young males (19–24 years old). Reproduced with permission from David Crowe, manager of consumer communications for the New Zealand Food Safety Authority.

FIGURE 2

A, Estimated distribution of caffeine exposure for children (5–12 years old) after the consumption of 1 to 4 retail units of energy drinks or energy shots. B, Estimated distribution of caffeine exposure for teenagers (13–19 years old) after the consumption of 1 to 4 retail units of energy drinks or energy shots. C, Estimated distribution of caffeine exposure for young males (19–24 years old) after the consumption of 1 to 4 retail units of energy drinks or energy shots. Caffeine-exposure units are mg/kg body weight per day. An adverse effect level of 3 mg/kg body weight per day is shown as a basis for risk evaluation. The area under the curves to the right of the adverse-effect lines represents the proportion of consumers potentially at risk from adverse effects of caffeine or the probability of a random consumer exceeding the adverse-effect level. Reproduced with permission from David Crowe, manager of consumer communications for the New Zealand Food Safety Authority.

FIGURE 3

A, Cumulative probability curves of children (5–12 years old) consuming 1 to 4 retail units of energy drinks or energy shots in addition to baseline dietary exposure. B, Cumulative probability curve for teenagers (13–19 years old) consuming 1 to 4 retail units of energy drinks or energy shots in addition to baseline dietary exposure. C, Cumulative probability curve of young males (19–24 years old) consuming 1 to 4 retail units of energy drinks or energy shots in addition to baseline dietary exposure. Caffeine-exposure units are mg/kg body weight per day. An adverse-effect level of 3 mg/kg body weight per day is shown as a reference point. The portion of each curve to the right of the adverse-effect level represents the proportion of the population group potentially at risk from adverse effects of caffeine. The exposure of any percentile may be read off the x-axis by extrapolating from the intersection of the selected percentile on the y-axis with the curve of 1, 2, 3, or 4 retail units consumed; cumulative probability = 0.2 represents the 20th percentile, 0.4 = 40th percentile, etc. Reproduced with permission from David Crowe, manager of consumer communications for the New Zealand Food Safety Authority.