To review the effects, adverse consequences, and extent of energy drink consumption among children, adolescents, and young adults.
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.
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.
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.
When facts become fiction - a tale of energy drinks and Chinese whispers.
We read with interest the recent article by Seifert et al. entitled "Health effects of energy drinks on children, adolescents, and young adults". We were surprised at the data attributed to the Irish National Poisons Information Centre (NPIC). Seifert et al. stated that "Ireland's poison centre reported 17 energy drink adverse events including confusion, tachycardia and seizures, and 2 deaths between 1999 and 2005," and cited a report from the Federal Institute for Risk Assessment from 2008. This report pointed out that "according to information from the National Poisons Information Centre in Ireland (NPIC) 17 cases had been reported between 1999 and 2005 involving two fatalities in conjunction with the consumption of energy drinks" and furthermore that "BfR contacted the Irish Centre and asked for information". The BfR in turn referenced an article by Lehtihet et al., in a Swedish language journal, in 2006, that reported on the safety of energy drinks.
The original paper by Lehtihet et al. included data provided by the NPIC, requested via a personal communication [M. Lehtihet, personal communications 9th November 2005, 14th November 2005]. The NPIC data on energy drink enquiries were retrospectively collated and comprised 22 enquiries over a 7-year period; 18 enquiries concerned the medical management of 18 patients, and there were 4 requests for information only. 17/18 patients were symptomatic following the ingestion of an energy drink, however in at least 50% of these cases, other co-ingestants were reported including alcohol (n=8), recreational drugs of abuse (n=4), and one patient also co-ingested 150 mg of Flurazepam with cocaine, ecstasy, and alcohol. The average number of caffeine-containing energy drinks consumed by 12 patients (where the ingested quantities were recorded), was 9 cans with each can containing approximately 80mg of caffeine per 250mL. Two of the information enquiries originated from healthcare professionals seeking information on the ingredients of the energy drink, in relation to two post-mortem cases. A summary of each enquiry was forwarded electronically to Lehtihet et al. but there was no causality established, or inferred by the NPIC between the consumption of the energy drink and the two fatalities. Unfortunately, our data appear to have been misinterpreted and the wrong conclusions were drawn.
As the primary source of the data, we believe that it is our responsibility to address the inaccuracies that have recently come to our attention. We would like to take this opportunity to place the facts in context, lest the errors should become established fiction in the medical literature, or indeed in the wider lay media. If data misrepresentations are not clarified and halted, there is potential for negative social consequences. This unfortunate situation has led us to consider the consequences of sharing our data with another party for collaborative research and highlights the potential risks associated with the communication of scientific information.
Conflict of interests: None.
References 1. Seifert SM, Schaechter JL, Hershorin ER and Lipshultz SE. Health effects of energy drinks on children, adolescents, and young adults. Paediatrics 2011;127(3);511-528. 2. Federal Institute for Risk Assessment. New human data on the assessment of energy drinks. Available at www.bfr.bund.de/cm/245/new_human_data_on_the_assesment_of_energy_drinks.pdf. Accessed January 17,2011. 3. Lehtihet M, Beckman S, Andersson DH. 2006, Energidryck - farlig elle inte? Lakartidningen, 103/38:2738-2741 4. Gonon F,Bezard E, Boraud T. Misrepresentation of neuroscience data might give rise to misleading conclusions in the media: The case of Attention Deficit Hyperactivity Disorder. Plos One 2011;6(1):e14618 doi ;10.1371/journal.pone.0014618
Conflict of Interest: