bNo statistically significant difference was noted between drink A and drink B for any parameter. ECGs were performed in triplicate at each time point 1minute apart and averaged. This may be a result of the way energy drinks typically are marketed. A repeatedmeasures analysis of variance, which assumes a compound symmetry covariance structure, was performed with the main effects of intervention, time, and an interaction of intervention and time (R version 3.5.2). )? The examples of energy drinks stated in the question (Red Bull, Cult and Burn) represent three of the most popular brands on the Danish market. This work was funded by the University of the Pacific. However, several studies have pointed out that mixing energy drinks with alcohol is frequent among young people.20,32 Indeed, public health and safety officials have raised concerns about the health and safety consequences of combining alcohol with energy drinks. Thank you for submitting a comment on this article. Relation between the food environment and oral healthsystematic review, Latent class trajectories of socioeconomic position over four time points and mortality: the Uppsala Birth Cohort Study, Extreme heat leads to short- and long-term food insecurity with serious consequences for health, Change in effectiveness of mammography screening with decreasing breast cancer mortality: a population-based study, Burden of cardiovascular diseases and depression attributable to psychosocial work exposures in 28 European countries, About The European Journal of Public Health, About the European Public Health Association, Receive exclusive offers and updates from Oxford Academic, Copyright 2022 European Public Health Association. Data are reported as meanSD except in figures (meanSE). Prevalence of weekly energy drink consumption in relation to different socio-demographic variables among young adults (1624 years). In Denmark, energy drinks constitute a relatively new product category in the wider soft drinks market which could be one of the reasons why young Danish adult more seldom drink energy drinks. The authors thank Kimberly Maiton, PharmD (Fellow), Ipsita Chauhan (Student volunteer) and Bhagvat Maheta (Student volunteer), at University of the Pacific for their support on the study. Please check for further notifications by email. Local Info To estimate the predictive value of health behaviour, six variables were included: smoking, high-risk alcohol consumption, alcoholic binge drinking, dietary habits, physical activity and BMI. Table3 describes the maximum change from baseline in each intervention across all end points. In 2011, 1 in 10 of these visits resulted in hospitalization. This study is based on young adults in the age of 1624 years who participated in a public health survey called How Are You?. A population-based study, European Journal of Public Health, Volume 24, Issue 5, October 2014, Pages 840844, https://doi.org/10.1093/eurpub/cku003. Website: https://pubmed.ncbi.nlm.nih.gov/. These statistically significant findings warranted further analyses of the interventions at individual time points (TableS1). Guarana, commonly included in energy drinks, contains caffeine. As mentioned, we found that the prevalence of weekly energy drink consumption was higher among people who at least once a week drank five or more alcoholic drinks at one time and among people who drank high amounts of alcohol. The results are inconsistent in other studies where energy drink volumes under 32 oz were investigated. The supplement table lists the average change from baseline for each end point across the different time points. A standard 12lead ECG (PageWriter Trim III or TC20, Phillips) was obtained with participants in the supine position. There was an 5 and 4mmHg increase in SBP and DBP, respectively after energy drink consumption relative to placebo. This study also shows that there is some kind of add on effect of energy drinks, meaning that people who also use other stimulantssuch as alcohol and cigarettesare more inclined to consume energy drinks. Methods: The study is based on a public health survey from 2010 (n = 3923). aAdjusted for gender, age, employment status, educational level and ethnic background. According to health behaviour, daily smoking, high amounts of alcohol consumption, alcoholic binge drinking and being overweight are associated with weekly energy drink consumption. Statistical analyses were performed using STATA statistical software version 12.1. Table2 describes ECG and blood pressure parameters at baseline. In 2011, 42 percent of all energy drink-related emergency department visits involved combining these beverages with alcohol or drugs (such as marijuana or over-the-counter or prescription medicines). Int J Environ Res Public Health, Wired: energy drinks, jock identity, masculine norms, and risk taking, Sport-related identities and the Toxic Jock, Energy drink use and its relationship to masculinity, jock identity, and fraternity membership among men, Caffeinated-beverage consumption and its association with socio-demographic characteristics and selfperceived academic stress in first and second year students at the University of Puerto Rico Medical Sciences Campus (UPR-MSC), The Danish National Health Survey 2010. Two participants (baseline QTcB 401 and 425ms) had a change from baseline in QTcB interval over 50ms with drink A and drink B. Also, there is a clear social gradient in the prevalence of energy drink consumption where the intake is far more common among people with low levels of education than among people with higher levels of education. aRare caffeine consumers were defined as <1 caffeine containing drink per month, occasional caffeine consumers were defined as 1 to 3 drinks per month, frequent caffeine consumers were defined as 1 to 6 caffeine containing drinks per week, daily caffeine consumers were defined as 1 caffeine containing drink per day. Dr. Shah has served as an expert witness in legal cases related to caffeinated energy drinks. use prohibited. Common ingredients contained in this study's products included a combination of caffeine, taurine, glucuronolactone, and Bvitamins. All data reported as mean (SD). The clinical study was registered on ClinicalTrials.gov (NCT03196908). The other kind, called energy shots, is sold in small containers holding 2 to 2 oz. The analysis shows that weekly energy drink intake is associated with daily smoking, binge drinking, high-risk alcohol consumption and being overweight which indicates that energy drinks more often is consumed by young people who also in other areas have an unhealthy and risky lifestyle. Blood pressure measurements were obtained in the seated position after an initial rest period of 8minutes using an automated blood pressure device (SphygmoCor XCEL PWA, AtCor Medical). Between 2007 and 2011, the number of energy drink-related visits to emergency departments doubled. The remaining authors have no relevant disclosures to report. First, the survey gives information about the frequency of energy drink consumption only, not the amount of the intake. The maximum baselinecorrected, placeboadjusted change in SBP with drink A was +6.15.5mmHg compared with +4.65.0mmHg with drink B (P=0.151). The interaction term of intervention and time was statistically significant for Bazett's corrected QT interval, Fridericia's corrected QT interval, QT, PR, QRS duration, heart rate, systolic blood pressure, diastolic blood pressure, central systolic blood pressure, and central diastolic blood pressure (all P<0.001). This could indicate that there is some kind of add on effect of energy drinks meaning that people who also use other stimulantssuch as alcohol and cigarettesare more inclined to consume energy drinks. Conclusion: Compared with other European countries the prevalence of energy drink consumption is relatively low in Denmark. The views expressed in this material are those of the authors, and do not reflect the official policy or position of the US Government, the Department of Defense, the Department of the Air Force, or University of the Pacific. Using the Danish Civil Registration System both respondents and non-respondents in the survey can be linked to central registers using the CPR numbers. QTcB indicates Bazett's corrected QT interval. For instance, gender differences were adjusted for age, employment status, educational level and ethnic background. 7272 Greenville Ave. An overnight fast (with allowance for water only) was required preceding every study day, and no food was allowed during the study monitoring period. dStatistically significant difference between drink B and placebo. A small but growing number of researchers have examined the physiological and psychological impacts of these beverages. The Author 2014. People who combine caffeinated drinks with alcohol may not be able to tell how intoxicated they are; they may feel less intoxicated than they would if they had not consumed caffeine, but their motor coordination and reaction time may be just as impaired. Further investigation is warranted on whether an individual ingredient or a unique combination leads to the observed electrophysiological and hemodynamic changes. A systematic review, Sociodemographic correlates of energy drink consumption with and without alcohol: results of a community survey, Clinically significant pharmacokinetic interactions between dietary caffeine and medications, Safety issues associated with commercially available energy drinks, New-onset seizures in adults: possible association with consumption of popular energy drinks, Detrimental effects of energy drink consumption on platelet and endothelial function, Drinking patterns and risk behaviors associated with combined alcohol and energy drink consumption in college drinkers, A survey of energy drink consumption patterns among college students, Alcohol mixed with energy drinks: consumption patterns and motivations for use in U.S, college students. U.S. Department of Health & Human Services, 9000 Rockville Pike Bethesda, Maryland 20892, U.S. Department of Health and Human Services. A large body of epidemiologic data shows that diet quality follows a socio-economic gradient.30 However, only a few studies have addressed the matter of social inequality in consumption of energy drinks due to the fact that most studies are based on socially homogeneous groups such as college students.5,1921,31,32. All end points were measured at baseline and at 30, 60, 90, 120, 150, 180, 210, and 240minutes on each study day. The analysis indicates that after adjustment for other socio-demographic factors men have higher odds of weekly energy drink consumption than women (adjusted OR 3.9). To assess binge drinking respondents were asked how often they consume five alcoholic drinks or more at one time. However, 3 patients did have a QTc increase >50ms when compared with baseline.23 One parallel designed study assessed the impact of consuming 460mL of 3 different types of caffeinated energy drinks on ECG parameters with no clinically significant changes.32. Study design and respondent characteristics, Characteristics associated with consumption of sports and energy drinks among US adults: National Health Interview Survey, 2010, Constructions of masculinity and their influence on men's well-being: a theory of gender and health, Mixing an energy drink with an alcoholic beverage increases motivation for more alcohol in college students, Consumption of energy drinks among physical education students, Red Bull Gives You Wings for better or worse: a double-edged impact of brand exposure on consumer performance, Energy drinks, race, and problem behaviors among college students, Energy drink co-administration is associated with increased reported alcohol ingestion, Increased alcohol consumption, nonmedical prescription drug use, and illicit drug use are associated with energy drink consumption among college students, Energy drink consumption and increased risk for alcohol dependence, Caffeinated cocktails: energy drink consumption, high-risk drinking, and alcohol-related consequences among college students. Under the new Danish regulation, beverages with a high caffeine content must be labelled: High caffeine content. When assessing the intervention effect alone, a statistically significant difference was noted in cSBP, cDBP, SBP, and DBP (all P<0.001) while a trend towards significance was observed for QTcB and QTcF (P=0.082 and 0.064 for ANOVA, respectively). Dallas, TX 75231 Thirtyfour participants were included (age 22.13.0years). Individuals with acquired or congenital long QT syndrome and those with hypertension should be more vigilant and limit their energy drink intake. The outcome measure, frequency of energy drink consumption, was based on responses to this single item question: How often do you drink energy drinks (Red Bull, Cult, Burn, etc. There is a clear social gradient in the prevalence of energy drink consumption where the intake is far more common among people with low levels of education than among people with higher levels of education. Table 1 shows the results from the multivariate logistic regression analysis on weekly energy drink consumption in relation to gender, age, employment status, educational level and ethnic background. There appears to be a mild PR shortening effect and is currently thought to be clinically nonsignificant. Respondents were categorized into two groups every day/weekly vs. seldom/never. There was no statisticallysignificant difference between interventions in PR, QRSd, QT, and HR. The machine reported HR, PR interval, QRSd, QT interval, and QTc interval (Bazett's formula [QTcB]) end points were used for analysis. Figure 2. It is not intended to substitute for the medical expertise and advice of your health care provider(s). Figure 1 shows that, in total, 4.3% of the young adults drink energy drinks 34 times per week or more frequent, 11.5% consume energy drinks 12 times per week and 84.3% rarely or never drink the beverage. Energy drinks may enhance alertness and improve reaction time, but they may also reduce steadiness of the hands. Every person living in Denmark has a unique identification 10-digit central personal registry number (CPR number). In a survey of 2040 respondents, 16% reported having once consumed >2 energy drinks in a day.43 We assessed the effects of acute consumption of an energy drink <4hours, which does not lend insight to longterm effects nor the effects of chronic consumption. Next to multivitamins, energy drinks are the most popular dietary supplement consumed by American teens and young adults. A single 16-oz. smoking, drinking, physical activity and dietary habits) because understanding this relationship is important for the design of public health interventions. cStatistically significant difference between drink A and placebo. The authors verified that this assumption was a reasonable one for their data. Mixing energy drinks with alcohol may be hazardous given the stimulant nature of energy drinks and depressant characteristics of alcohol. Small Business Research Grant Program (SBIR), About Research Training and Career Development, Training Grant Application, Review, and Award Process, Integrative Medicine Research Lecture Series, Division of Extramural Research Sponsored by NCCIH, Division of Intramural Research Conducted at NCCIH, How To Find Information About Complementary Health Approaches on PubMed. A strength of this study is that the study population is based on a population-based sample. Duplication is encouraged. SBP indicates systolic blood pressure. The American Heart Association is qualified 501(c)(3) tax-exempt The maximum changes from baseline in SBP for drink A, drink B, and placebo were +15.95.0, +14.44.8, and +9.84.8mmHg, respectively (P<0.001 for ANOVA) (Table3). (For comparison, a 12-oz. The study also shows that young age, being employed and having a low educational level are associated with weekly energy drink consumption. An intentiontotreat analysis was performed using the lastobservationcarriedforward methodology to account for missing data. Guidance and guidelines | NICE, Review of published cases of adverse cardiovascular events after ingestion of energy drinks, Consumption of caffeinated energy drinks among youth and young adults in Canada, The use of caffeinated alcoholic beverages among underage drinkers: results of a national survey, Evaluation of 10 QT prediction formulas in 881 middleaged men from the seven countries study: emphasis on the cubic root Fridericia's equation. Energy drinks are beverages that are characterized by the addition of various energy-enhancing ingredients and are marketed to boost energy, decrease feelings of tiredness and enhance mental alertness and concentration.1 The most common active substance in energy drinks is caffeine, which is often combined with taurine, d-glucurono--lactone, guaran, maltodextrin, ginseng, carnitine, creatine and gingko biloba. The second table shows the association between weekly energy drink consumption and health behaviour [smoking status, alcoholic binge drinking, high-risk alcohol consumption, leisure time physical activity, dietary habits and body mass index (BMI)]. Significant prolongation in the QT interval was also evident within the first hour after energy drink consumption but these are thought to be HR related changes. Those who were taking any chronic prescription or overthecounter medications were excluded except those who had been taking oral contraceptives for over 1month. All participants were provided written informed consent consistent with university requirements for clinical studies involving human subjects. However, it is important to note that QTc prolongation does not necessitate onset of torsades de pointes and is simply a risk factor. The impact of longterm energy drinks consumption remains unknown. Consuming energy drinks raises important safety concerns. National Center
The finding that men are much more likely than women to consume energy drinks is consistent with findings from other studies.18,28 An American study has concluded that energy drink use is strongly associated with a traditional masculinity ideology and risk taking.24 Another study among college undergraduates has also concluded that frequent consumption of energy drinks can be recognized as a potential predictor of a toxic jock identity defined as a sport-related identity predicated on risk taking and hypermasculinity.22 It is well known that young men in general have unhealthier lifestyles than women also in relation to dietary habits.29 Further, the marketing strategies of energy drinks are to a high extent associated with extreme sports such as snowboarding, rock-climbing, parasailing and motorsports, which means that the imagery of energy drinks revolves around the nexus of masculinity and risk taking.22 The fact that about one-quarter of the Danish young men consumes energy drinks on a weekly basis suggests that the marketing strategy has been successful among this segment of consumers.