Prevalence of fatigue and consumption of energy drinks consumption among nursing students studying part-time

Background: Professional nurses who study part-time are faced with demanding tasks, demanding routine, having to cope with their studies and family commitments. Some nurses try different tactics to cope with their demanding tasks, such as the consumption of energy drinks, to alleviate tiredness and fatigue. Although these energy drinks can alleviate fatigue and boost their energy levels, they have adverse effects to their health such as migraines, insomnia, seizures, arrhythmias and other cardiovascular complications. Aim: To determine the health effects of energy drinks among nurses studying part-time. Setting: Selected university in the Gauteng province, South Africa. Methods: Descriptive, quantitative method that was contextual in nature was used. Self-administered questionnaire was used to collect data from a conveniently sampled population to determine the health effects of the use of energy drinks. Data analysis were done by means of descriptive statistics using the Statistical package for Social Sciences version 26. Results: Findings indicated that nurses studying part-time experience fatigue (n = 86; 49%). To alleviate fatigue (n = 91; 52%), they use energy drinks. Conclusion: Use of energy drinks is prevalent among the nurses because of fatigue caused by studying while working. To reduce the use of energy drinks, the participants need study leave and to be supported by their families and employers. Contribution: The study encourages reduction or prevent the use of energy drinks by nurses who work and study part-time. Participants must use time management as a coping mechanism.

Rabdomiólisis inducida por consumo crónico de bebidas energizantes asociado a ejercicio físico de baja intensidad: reporte de caso / Rhabdomyolysis induced by long-term consumption of energy drinks associated with low intensity physical exercise: case report

RESUMEN Introducción: Un riesgo potencialmente mortal es el hábito de consumo de bebidas energizantes, porque puede producir un síndrome caracterizado por la necrosis muscular que promueve la liberación de enzimas y mioglobina proveniente del interior del miocito hacia la circulación, creando una peroxidación lipídica llegando a generar lesión renal aguda e hyperkalemia; conocido como rabdomiólisis. La rabdomiólisis la esperaríamos encontrar entre 24 y 48 h después de actividades extenuantes, aún más con un índice de Borg modificado mayor o igual a 5 puntos; sin embargo, las bebidas energizantes por su alto contenido de cafeína y otros componentes pueden generar este evento adverso poco conocido. Caso clínico: Paciente de 37 arios, obeso, que ingresó al servicio de urgencias por cuadro clínico de mialgia y orina oscura que apareció 24h después de 4 días de ejercicio muscular de baja intensidad, asociado a consumo diario de bebida energizante por 2 años. El diagnóstico de rabdomiólisis se confirmó por hiperCKemia e hipertrasaminemia; no fue posible medir los niveles de mioglobina. El paciente fue tratado con fluidoterapia agresiva. Nunca presentó complicaciones renales ni hidroelectrolíticas. Conclusión: Nuestro caso destaca la aparición de rabdomiólisis aguda en pacientes sometidos a ejercicios de baja intensidad no descartando como causa principal el consumo crónico de bebidas energizantes. Son pocos casos actualmente reportados en la literatura. Gracias al tratamiento oportuno se evitó la progresión a lesión renal aguda.

ABSTRACT Introduction: The habit of consuming energy drinks is a life-threatening risk, because it can produce a syndrome characterised by a muscle necrosis. This promotes the release of enzy mes and myoglobin from inside the myocyte into the circulation, creating lipid peroxidation and leading to acute kidney injury, and hyperCKemia, together producing rhabdomyolysis. Rhabdomyolysis can be expected to be found within 24 to 48 h after strenuous activities, even more so with a modified Borg index greater than or equal to 5 points. However, energy drinks, due to their high content of caffeine and other components, can generate this little known adverse event. Clinical case: A 37-year-old patient admitted to the emergency department due to clinical symptoms of myalgia, and dark urine that appeared 24 h after four days of low-intensity muscular exercises, and was associated with daily consumption of an energizing drink for 2 years. The diagnosis of rhabdomyolysis was confirmed by increased creatine kinase and transaminases. It was not possible to measure myoglobin levels. The patient was treated with aggressive fluid therapy. He never presented with any renal or electrolyte complica tions. Conclusion: This case highlights the appearance of acute rhabdomyolysis in patients taking low intensity exercises, and not ruling out long-term consumption of energy drinks as the main cause. There are few cases currently reported in the literature. Owing to the timely treatment, progression to acute kidney injury was avoided.

Survey of University Students’ Self-medication Interest and Energy Drink Use Trend: A Pilot Study / 社会薬学

In recent years, one of Japan’s policies for controlling increased medical expenses is promoting self-medication. Owing to their influence on the health of young people, energy drinks (a caffeine-containing beverage) have attracted attention. However, only a few surveys have evaluated their use in Japan. Therefore, we conducted a questionnaire survey on university students on self-medication interest and energy drink use trend, involving 180 students aged 18-26 years. The results showed 28.3% of the students were interested in self-medication and 4.4% were knowledgeable on the self-medication tax system. Additionally, 73.9% of them used over-the-counter (OTC) drugs, especially common cold medicines (65.0%). Further, 77.2% of them consumed energy drinks, mainly to stay awake (61.9%), and most frequently from evening to midnight (54.7%). Furthermore, 26.6% of the students had experienced discomfort or poor health when taking energy drinks, with the most common symptoms being “tachycardia” (n＝13) and “sleep disorders” (n＝12). Pharmacy and drugstore pharmacists could contribute to caffeine overdose prevention by educating the public on the caffeine content of common cold medications and various foods and drinks such as energy drinks. It is desirable for future studies to investigate in depth the usage of caffeine-containing beverages, including energy drinks.

Beverage consumption among Korean adolescents: data from 2016 Korea Youth Risk Behavior Survey

BACKGROUND/OBJECTIVES: Association between the consumption of sugar-sweetened beverages (SSBs) and obesity is universally a controversial issue. This study was undertaken to examine the beverage consumption pattern of Korean adolescents. SUBJECTS/METHODS: Data was collected from the 2016 Korea Youth Risk Behavior Survey involving 65,528 adolescent respondents. A list of the most frequently consumed beverages was analyzed, and the consumption frequency of carbonated beverages, SSBs, and energy drinks during the past seven-days was assessed. The main reasons for the adolescents to consume the beverages were also determined. RESULTS: The beverage preference of adolescents were carbonated beverages (31.0%), ‘fruit and vegetable beverages (17.7%)’, ‘milk (13.6%)’, and ‘coffee (12.7%)’. Carbonated beverages and SSBs were consumed more than three times a week by 27.1% and 41.1% of the respondents, respectively. About 86.2% of adolescents did not take of any energy drinks during the last seven-days. Taste was the most common reason that adolescents considered when choosing a drink. Carbonated beverages consumed more frequently by boys than girls, and high school students drank coffee more frequently than middle school students. CONCLUSIONS: Boys had a higher preference for unhealthy beverages than girls, whereas consumption of high-caffeine drinks was greater amongst high-school students than middle school students.

Risk Assessment of "Other Substances" – Caffeine

The Norwegian Scientific Committee for Food Safety (Vitenskapskomiteen for mattrygghet, VKM) has, at the request of the Norwegian Food Safety Authority (Mattilsynet, NFSA), assessed the risk of "other substances" in food supplements and energy drinks sold in Norway. VKM has assessed the risk of doses given by NFSA. These risk assessments will provide NFSA with the scientific basis while regulating the addition of “other substances” to food supplements and other foods. "Other substances" are described in the food supplement directive 2002/46/EC as substances other than vitamins or minerals that have a nutritional or physiological effect. It is added mainly to food supplements, but also to energy drinks and other foods. In this series of risk assessments of "other substances", VKM has not evaluated any claimed beneficial effects from these substances, only possible adverse effects. The present risk assessment of caffeine is based on previous risk assessments and articles retrieved from a literature search. According to information from NFSA, caffeine is an ingredient in food supplements and energy drinks sold in Norway. NFSA has requested a risk assessment of 100 and 300 mg/day of caffeine in food supplements, and of 32 mg/100 ml of caffeine in energy drinks. Drinking patterns reflecting a high acute intake, a mean chronic intake and a high chronic intake were assessed. The total exposure to caffeine from other sources than energy drinks, such as foods and cosmetic products, is not included in the risk assessment. The main sources of caffeine in the diet include coffee, tea, caffeinated soft drinks (including energy drinks) and chocolate. The means and 95th percentiles of daily caffeine intake from all sources for adults (from 16 EU Member States) calculated by the European Food Safety Authority (EFSA) ranged from 37 to 319 mg and from 109 to 742 mg, respectively. The median daily caffeine intake from different sources among pregnant Norwegian women, selfreported at gestational weeks 17 and 30, was 126 mg/day pre-pregnancy, 44 mg/day at gestational week 17, and 62 mg/day at gestational week 30. Caffeine is rapidly and completely absorbed after oral intake, and the peak plasma concentration can be reached within 30-120 minutes. Caffeine crosses the blood–brain barrier, the placental barrier and the blood–testicular barrier, and is excreted in breast milk. Several studies and assessments addressing safety or risk of caffeine have been performed. With regard to caffeine intake and adverse birth weight-related outcomes, these outcomes were observed at all levels of caffeine intake, with no threshold below which this relationship was not observed (EFSA, 2015). In the risk characterization, VKM has applied the intake levels considered unlikely to cause adverse health effects in the new and comprehensive risk assessment by EFSA (EFSA, 2015), also taking into account previous risk assessments and newer literature. The intake levels of caffeine for different population groups (children, adolescents, pregnant women and fetus, lactating women and the breastfed infant and adults) unlikely to cause adverse effects have been identified. For the general adult population (not including pregnant women), these levels are: • Single intake of caffeine up to 200 mg (about 3 mg/kg bw for a 70-kg adult) do not give rise to safety concerns. • Intakes up to 400 mg per day (about 5.7 mg/kg bw per day for a 70-kg adult) consumed throughout the day, do not give rise to safety concerns for adults in the general population, except for pregnant women (see below). • Caffeine intake of about 1.4 mg/kg bw may increase sleep latency and reduce sleep duration in adults. For children and adolescents, these levels are: • A daily intake of 3 mg/kg bw per day do not give rise to safety concerns. • Caffeine doses of about 1.4 mg/kg bw may increase sleep latency and reduce sleep duration in some children and adolescents. For pregnant women and the fetus, these levels are: • 200 mg per day (about 3 mg/kg bw for a 70-kg adult) consumed throughout the day do not give rise to safety concerns. • With regard to caffeine intake and adverse birth weight-related outcomes, it was concluded that these outcomes were observed at all levels of caffeine intake, with no threshold below which this relationship was not observed. It was considered that the risk becomes clinically relevant at total daily doses of about 200 mg of caffeine from all sources. Sengpiel et al. (2013) reported that caffeine intake from different sources was associated with lower birth weight, and that caffeine intake of 200 to 300 mg/day increased the odds for the baby being small for gestational age compared to 0 to 50 mg/day. For lactating women and the breastfed infant, these levels are: • Single doses of caffeine up to 200 mg (about 3 mg/kg bw) and habitual caffeine consumption at doses of 200 mg per day do not give rise to safety concerns. Food supplements: From a daily dose of 100 mg caffeine, the calculated intake levels are 2.3, 1.6 and 1.4 mg/kg bw per day for children (10 to <14 years), adolescents (14 to <18 years) and adults (≥18 years), respectively. From a daily dose of 300 mg caffeine, the calculated intake levels are 6.9, 4.9 and 4.3 mg/kg bw per day for the same age groups, respectively. VKM concludes that it is unlikely that a dose of 100 mg of caffeine per day from food supplements causes adverse health effects in children (10 years and above), adolescents (14 to <18 years), pregnant women and the fetus, lactating women and the breastfed infant and adults (≥18 years). However, for children and adolescents, a dose of 100 mg per day is above the intake that may increase sleep latency and reduce sleep duration. For adults, a dose of 100 mg per day is equal to the intake that may increase sleep latency and reduce sleep duration. VKM concludes that a dose of 300 mg of caffeine per day from food supplements may represent a risk of adverse health effects in children (10 years and above), adolescents (14 to <18 years), pregnant women and the fetus and lactating women and the breastfed infant. Consumed as a single dose, 300 mg of caffeine from food supplement may represent a risk of adverse health effects in adults (≥18 years). Consumed throughout the day, it is unlikely that a dose of 300 mg of caffeine per day from food supplements causes adverse health effects in adults. A dose of 300 mg per day is above the intake that may increase sleep latency and reduce sleep duration. Energy drinks: The estimated exposure to caffeine from a drinking pattern reflecting a high acute intake of caffeine from energy drinks (containing 32 mg caffeine/100 ml) is 13.9 mg/kg bw per day for children (3 to <10 years), 11.1 mg/kg bw per day for children (10 to <14 years), 10.4 mg/kg bw per day for adolescents (14 to <18 years) and 9.1 mg/kg bw per day for adults (≥18 years). VKM concludes that a drinking pattern reflecting a high acute intake of caffeine from energy drinks (containing 32 mg caffeine/100 ml) may represent a risk of adverse health effects in children (3 years and above), adolescents (14 to <18 years), pregnant women and the fetus, lactating women and the breastfed infant and adults (≥18 years). In addition, the intake is above the intake that may increase sleep latency and reduce sleep duration. The estimated exposure to caffeine from a drinking pattern reflecting a mean chronic intake of caffeine from energy drinks (containing 32 mg caffeine/100 ml) is 0.8 mg/kg bw per day for children (3 to <10 years), 0.5 mg/kg bw per day for children (10 to <14 years), 0.3 mg/kg bw per day for adolescents (14 to <18 years) and 0.3 mg/kg bw per day for adults (≥18 years). VKM concludes that it is unlikely that a drinking pattern reflecting a mean chronic intake of caffeine from energy drinks (containing 32 mg caffeine/100 ml) causes adverse health effects in children (3 years and above), adolescents (14 to <18 years), pregnant women and the fetus, lactating women and the breastfed infant and adults (≥18 years). In addition, the intake is below the intake that may increase sleep latency and reduce sleep duration. The estimated exposure to caffeine from a drinking pattern reflecting a high chronic intake of caffeine from energy drinks (containing 32 mg caffeine/100 ml) is 2.3 mg/kg bw per day for children (3 to <10 years), 1.3 mg/kg bw per day for children (10 to <14 years), 1.1 mg/kg bw per day for adolescents (14 to <18 years) and 1.5 mg/kg bw per day for adults (≥18 years). VKM concludes that it is unlikely that a drinking pattern reflecting a high chronic intake of caffeine from energy drinks (containing 32 mg caffeine/100 ml) causes adverse health effects in children (3 years and above), adolescents (14 to <18 years), pregnant women and the fetus, lactating women and the breastfed infant and adults (≥18 years). For children (3 to <10 years) and adults (≥18 years), the intake is above the intake that may increase sleep latency and reduce sleep duration. For children (10 to <14 years) and adolescents (14 to <18 years), the intake is below the intake that may increase sleep latency and reduce sleep duration.

Risk Assessment of "Other Substances" – Inositol

The Norwegian Scientific Committee for Food Safety (Vitenskapskomiteen for mattrygghet, VKM) has, at the request of the Norwegian Food Safety Authority (Mattilsynet; NFSA), assessed the risk of "other substances" in food supplements and energy drinks sold in Norway. VKM has assessed the risk of doses given by NFSA. These risk assessments will provide NFSA with the scientific basis while regulating the addition of “other substances” to food supplements and other foods. "Other substances" are described in the food supplement directive 2002/46/EC as substances other than vitamins or minerals that have a nutritional and/ or physiological effect. It is added mainly to food supplements, but also to energy drinks and other foods. In this series of risk assessments of "other substances", VKM has not evaluated any potential beneficial effects from these substances, only possible adverse effects. The present risk assessment is based on previous risk assessments of inositol and articles retrieved from a literature search. According to information from NFSA, inositol is an ingredient in energy drinks sold in Norway. NFSA has requested a risk assessment of 10 mg/100 ml inositol in energy drinks. Drinking patterns reflecting a high acute intake, a mean chronic intake and a high chronic intake were assessed. Inositol (CAS no. 6917-35-7) is a sugar alcohol. Among the nine possible stereoisomers, myo inositol (CAS no. 87-89-8) is the most abundant. The name inositol is frequently used as a synonym for myo -inositol. Inositol occurs naturally in all organisms including humans, and is an important component in all human cells. Inositol-containing lipids and phosphates are required for various structural and functional processes, including membrane formation, signalling, membrane trafficking and osmoregulation. Endogenous production of inositol in humans amounts to about 4 g/day (about 57 mg/kg bw per day in a 70 kg adult) (EFSA, 2014). The total dietary intake of inositol in adults is estimated to range between 500 to 1000 mg/day (about 7-14 mg/kg bw per day). Inositol added to energy drinks in Norway denotes the compound myo -inositol, according to information from NFSA. M yo -inositol is a water-soluble compound naturally occurring in the cells of all living organisms including humans, animals, plants and microorganisms. Certain plant (fruits and vegetables) and foods from animals contain inositol, and seeds of cereals and legumes show high levels of the inositol storage form, phytic acid (inositol hexaphosphate). With regard to hazard identification and characterisation of inositol, most of the adverse effects observed in several human studies were related to gastrointestinal symptoms such as nausea, flatulence, loose stools and diarrhoea. Drinking patterns reflecting a high acute intake, a mean chronic intake and a high chronic intake were assessed for energy drinks containing 10 mg inositol per 100 ml, for the age groups children (3 to <10 years and 10 to <14 years), adolescents (14 to <18 years) and adults (≥18 years). For the high acute drinking pattern, the intake was estimated to be 1000, 1500, 2000 and 2000 ml/day for children (3 to <10 years), children (10 to <14 years), adolescents (14 to <18 years) and adults (>18 years), respectively. For the mean chronic drinking pattern, the intake was estimated to be 58, 65, 64 and 71 ml/day for children (3 to <10 years), children (10 to <14 years), adolescents (14 to <18 years) and adults (≥18 years), respectively. For the high chronic drinking pattern, the intake was estimated to be 163, 180, 210 and 320 ml/day for children (3 to <10 years), children (10 to <14 years), adolescents (14 to <18 years) and adults (≥18 years), respectively. The data on toxicity of inositol was very limited. The human study with the longest exposure at highest doses (3 months treatment at maximum tolerated dose) that was available for risk assessment was a clinical study of 40-74 year old smokers with bronchial dysplasia, from which a NOAEL of 18 g/day of myo -inositol was established (Lam et al. 2006). VKM estimated the margins of exposure (MOE) based on the NOAEL established in this study. The MOE is the ratio of the NOAEL value to the exposure. An acceptable MOE value for a NOAEL-based assessment of inositol based on a human study is ≥10, taking into account a factor 10 for the interindividual variation between humans in toxicokinetics and toxicodynamics. Due to the uncertainty regarding the relevance of the study by Lam et al. (2006) for the general healthy population, an additional safety factor of 3 was used. Therefore, an acceptable MOE value was 30. For all age groups, the MOE values were in the range of 857 to 2570 for mean chronic intake and in the range of 367 to 857 for high chronic intake of energy drinks, respectively, i.e. far above the acceptable MOE value of 30. Since neither the sub-optimal human study by Lam et al. (2006) or the animal studies in rodent models of chronic diseases available were on healthy subjects, as a supplement to the MOE values calculated from the human study, comparisons with endogenous production and amounts in food of inositol were also performed. No studies specifically on children (3 to <10 years and 10 to <14 years) and adolescents (14 to <18 years) were identified. Based on the included literature there was no evidence indicating that age affects tolerance or endogenous production of inositol. Therefore, in this risk characterisation a tolerance and an endogenous production of inositol as for adults, based on body weight, was assumed for these age groups. For the high acute drinking pattern, and for the mean chronic and the high chronic drinking patterns all estimated intakes of inositol from energy drinks containing 10 mg/100 ml were far below the endogenous production (57 mg/kg bw per day), and also below the dietary intake (7-14 mg/kg bw per day). VKM concludes that it is unlikely that the exposure to inositol from the high acute, the mean chronic or the high chronic drinking patterns causes adverse health effects in children (3 to <10 years and 10 to <14 years), adolescents (14 to <18 years) and adults (≥18 years).

Risk Assessment of "Other Substances" – Taurine

The Norwegian Scientific Committee for Food Safety (Vitenskapskomiteen for mattrygghet, VKM) has, at the request of the Norwegian Food Safety Authority (Mattilsynet; NFSA), assessed the risk of "other substances" in food supplements and energy drinks sold in Norway. VKM has assessed the risk of doses in food supplements and concentrations in energy drinks given by NFSA. These risk assessments will provide NFSA with the scientific basis while regulating the addition of “other substances” to food supplements and other foods. "Other substances" are described in the food supplement directive 2002/46/EC as s ubstances other than vitamins or minerals that have a nutritional and/or physiological effect . It is added mainly to food supplements, but also to energy drinks and other foods. VKM has not in this series of risk assessments of "other substances" evaluated any claimed beneficial effects from these substances, only possible adverse effects. The present report is a risk assessment of taurine, and it is based on previous risk assessments and articles retrieved from a literature search. According to information from NFSA, taurine is an ingredient in food supplements and energy drinks sold in Norway. NFSA has requested a risk assessment of 750, 800, 900, 1000 and 2000 mg/day of taurine in food supplements, and of 300, 350 and 400 mg/100 ml of taurine in energy drinks. Drinking patterns reflecting a high acute intake, a mean chronic intake and a high chronic intake were assessed. For food supplements, the intake of taurine was estimated for the age groups children (10 to <14 years), adolescents (14 to <18 years) and adults (>18 years), whereas for energy drinks the age group children (3 to <10 years) was also included. Other sources of taurine, such as foods and cosmetics, have not been included in the present risk assessment. Taurine (CAS No. 107-35-7) is synthesised endogenously (average 50-125 mg per day), and participates in the formation of bile salts and is involved in a number of crucial physiological processes, including modulation of calcium flux and neuronal excitability, osmoregulation and membrane stabilisation. Taurine occurs naturally in food, especially in meat and seafood. The mean daily intake of taurine from the diet has been estimated to vary between 40 and 400 mg/day. There are indications that taurine may have cardiovascular and neurological effects in humans. However, based on the human studies, an intake of approximately 21 mg/kg bw per day is considered unlikely to cause adverse health effects. Based on a 13-week neurotoxicity study in rats, a no observed adverse effect level (NOAEL) of 1000 mg/kg bw per day for pathological changes was set in 2009 by the European Food Safety Authority (EFSA). In the present risk assessment, VKM has used this NOAEL of 1000 mg/kg bw per day from rats. The human studies available were not of sufficient quality (due to low number of participants, non-healthy populations, short duration) to be used as the sole basis for the risk characterisation. The risk characterisation is based on the margin of exposure (MOE) approach; the ratio of the NOAEL to the exposure. An acceptable MOE value for a NOAELbased assessment of taurine based on an animal study is ≥100, which includes a factor 10 for extrapolation from animals to humans and a factor 10 for interindividual human variation. However, since the NOAEL set by EFSA was based on the highest tested dose and there is a possibility that the actual NOAEL is higher than 1000 mg/kg bw per day, the intake that was considered unlikely to cause adverse health effects based on human studies (21 mg/kg bw per day) was also taken into consideration in the risk characterisation. Food supplements: For children (10 to <14 years), the estimated daily intakes of taurine were 17.3, 18.4, 20.7, 23.0 and 46.1 mg/kg bw per day from daily doses of 750, 800, 900, 1000 and 2000 mg taurine, respectively, from food supplements. The margin of exposure (MOE) values was in the range of 22-58 for the various taurine doses, i.e. all below 100. However, from a daily intake of 750, 800 or 900 mg taurine from food supplements, the estimated intakes were below 21 mg/kg bw per day (the intake considered unlikely to cause adverse health effects based on human studies). VKM therefore concludes that it is unlikely that a daily intake of 750, 800 or 900 mg taurine from food supplements causes adverse health effects in children (10 to <14 years). The estimated exposure from a daily intake of 1000 or 2000 mg taurine was above 21 mg/kg bw per day. Thus, VKM concludes that a daily intake of 1000 or 2000 mg taurine from food supplements may represent a health risk in children (10 to <14 years). For adolescents (14 to <18 years), the estimated daily intakes were 12.2, 13.1, 14.7, 16.3 and 32.6 mg/kg bw per day from daily doses of 750, 800, 900, 1000 and 2000 mg taurine, respectively, from food supplements. For adults (≥18 years), the estimated intakes were 10.7, 11.4, 12.9, 14.3 and 28.6 mg/kg bw per day from a daily intake of 750, 800, 900, 1000 and 2000 mg taurine, respectively, from food supplements. For adolescents (14 to <18 years) and adults (≥18 years), the MOE values were in the range of 31-82 and 35-93, respectively, i.e. all below 100. However, from a daily intake of 750, 800, 900 or 1000 mg taurine from food supplements the estimated intakes were below 21 mg/kg bw per day (the intake considered unlikely to cause adverse health effects based on human studies) for both age groups. Thus, VKM concludes that it is unlikely that a daily intake of 750, 800, 900 or 1000 mg of taurine causes adverse health effects in adolescents (14 to <18 years) and adults (≥18 years). For adolescents (14 to <18 years) and adults (≥18 years) the estimated MOE values were 31 and 35, respectively, i.e. below 100, after a daily intake of 2000 mg taurine from food supplements. In addition, the estimated intakes were above the intake level of 21 mg/kg bw per day (the intake considered unlikely to cause adverse health effects based on human studies) for both age groups. Thus, VKM concludes that a daily intake of 2000 mg of taurine may represent a risk of adverse health effects in adolescents (14 to <18 years) and adults (≥18 years). Energy drinks: High acute drinking pattern, all age groups: For the high acute drinking pattern, the estimated consumption of energy drinks was 1000, 1500, 2000 and 2000 ml/day for children (3 to <10 years), children (10 to <14 years), adolescents (14 to <18 years) and adults (≥18 years), respectively. For the concentrations of 300, 350 and 400 mg taurine/100 ml energy drink, the intake levels of taurine after a high acute consumption of energy drinks (in mg/kg bw per day) were 130, 152 and 173; 104, 121 and 138; 97.9, 114 and 131; and 85.7, 100 and 114, for children (3 to <10 years), children (10 to <14 years), adolescents (14 to <18 years) and adults (≥18 years), respectively. Due to lack of an acute reference dose or other data for acute toxicity of taurine, it was not possible to characterise the risk related to an acute intake of taurine for any of the age groups. Mean chronic drinking pattern, all age groups: For the mean chronic drinking pattern, the estimated consumption of energy drinks was 58, 65, 64 and 71 ml/day for children (3 to <10 years), children (10 to <14 years), adolescents (14 to <18 years) and adults (≥18 years), respectively. For the concentrations of 300, 350 and 400 mg taurine/100 ml energy drink, the intake levels of taurine after a mean chronic drinking pattern (in mg/kg bw per day) were 7.5, 8.8 and 10.0; 4.5, 5.2 and 6.0; 3.1, 3.7 and 4.2; and 3.0, 3.6 and 4.1, for children (3 to <10 years), children (10 to <14 years), adolescents (14 to <18 years) and adults (≥18 years), respectively. In all age groups, the estimated MOE values were 100-333, i.e. 100 or above, for all three taurine concentrations. In addition, the estimated intakes were all below 21 mg/kg bw per day (the intake considered unlikely to cause adverse health effects based on human studies) for all age groups. Thus, VKM concludes that it is unlikely that the mean chronic intake of all three concentrations of taurine causes adverse health effects in children (3 to <10 years), children (10 to <14 years), adolescents (14 to <18 years) and adults (≥18 years). High chronic drinking pattern, all age groups: For the high chronic drinking pattern, the estimated consumption of energy drinks was 163, 180, 211 and 320 ml/day for children (3 to <10 years), children (10 to <14 years), adolescents (14 to <18 years) and adults (≥18 years), respectively. For the concentrations of 300, 350 and 400 mg taurine/100 ml energy drink, the intake levels of taurine after a high chronic drinking pattern (in mg/kg bw per day) were 21.2, 24.7 and 28.2; 12.4, 14.5 and 16.6; 10.3, 12.0 and 13.8; and 13.7, 16.0 and 18.3 mg/kg bw per day for children (3 to <10 years), children (10 to <14 years), adolescents (14 to <18 years) and adults (≥18 years), respectively. For children (3 to <10 years), the estimated MOE values were 47, 40 and 35, for the three taurine concentrations of 300, 350 and 400 mg/ml, respectively, i.e. all below 100. In addition, the estimated intakes were all above 21 mg/kg bw per day (the intake considered unlikely to cause adverse health effects based on human studies) for all three taurine concentrations. Thus, VKM concludes that a high chronic intake of all three concentrations of taurine from energy drinks may represent a health risk in children (3 to <10 years). For children (10 to <14 years), adolescents (14 to <18 years) and adults (≥18 years), the estimated MOE values were in the range of 55-97, i.e. all below 100 for all three taurine concentrations. However, the estimated intakes were all below the intake level of 21 mg/kg bw

Risk Assessment of "Other Substances" – D-Glucurono-γ-lactone

The Norwegian Scientific Committee for Food Safety (Vitenskapskomiteen for mattrygghet, VKM) has, at the request of the Norwegian Food Safety Authority (Mattilsynet; NFSA), assessed the risk of "other substances" in food supplements and energy drinks sold in Norway. VKM has assessed the risk of doses given by NFSA. These risk assessments will provide NFSA with the scientific basis while regulating the addition of “other substances” to food supplements and other foods. "Other substances" are described in the food supplement directive 2002/46/EC as substances other than vitamins or minerals that have a nutritional and/or physiological effect. It is added mainly to food supplements, but also to energy drinks and other foods. VKM has not in this series of risk assessments of "other substances" evaluated any claimed beneficial effects from these substances, only possible adverse effects. The present report is a risk assessment of D-glucurono-γ-lactone, and it is based on previous risk assessments. A literature search was performed, however, no articles fulfilled the inclusion criteria. According to information from NFSA, D-glucurono-γ-lactone is an ingredient in energy drinks sold in Norway. NFSA has requested a risk assessment of 24 mg/100 ml of D-glucurono-γ-lactone in energy drinks. Drinking patterns reflecting a high acute intake, a mean chronic intake and a high chronic intake were assessed. D-glucurono-γ-lactone (CAS no. 32449-92-6; EINECS no. 251-053-3) and its hydrolysis product glucuronic acid are endogenous metabolites in humans and other mammals, they occur naturally in several dietary sources and are readily metabolized to innocuous products and excreted. The estimated exposure to D-glucurono-γ-lactone from naturally occurring sources in the diet is 1-2 mg/day. No human toxicity data on D-glucurono-γ-lactone was available in the included literature. A no observed adverse effect level (NOAEL) of 1000 mg/kg bw per day, the highest dose tested, was set in 2009 by the European Food Safety Authority ( EFSA) (EFSA, 2009) based on a 13 week rat study of daily oral administration of D-glucurono-γ-lactone performed under good laboratory practice. VKM has used the NOAEL of 1000 mg/kg bw per day for the risk characterisation in the present risk assessment. The risk characterisation is based on the margin of exposure (MOE) approach; the ratio of the NOAEL to the exposure. An acceptable MOE value for a NOAEL-based assessment of D-glucurono-γ-lactone is ≥100, which includes a factor 10 for extrapolation from animals to humans, and a factor 10 for interindividual human variation. Due to lack of an acute reference dose or other data on acute toxicity for D-glucurono-γ-lactone, it is not possible to characterise the risk related to a high acute drinking pattern for any of the age groups. For the mean chronic drinking pattern, the intake was estimated to be 58, 65, 64 and 71 ml/day for 3 to <10 year old children, 10 to <14 year old children, 14 to <18 year old adolescents and adults, respectively. With regard to the mean chronic drinking pattern, the MOE values are 1667 for the age group 3 to <10 years, 2500 for the age group 10 to <14 years, 3333 for the age group 14 to <18 and 5000 for adults ≥18 years. VKM concludes that it is unlikely that a daily mean chronic intake of D-glucurono-γ-lactone from energy drinks (containing 24 mg/100 ml) causes adverse health effects to children (3 years and above), adolescents or adults. For the high chronic drinking pattern, the intake was estimated to be 163, 180, 211 and 320 ml/day for 3 to <10 year old children, 10 to <14 year old children, 14 to <18 year old adolescents and adults, respectively. With regard to the high chronic drinking pattern, the MOE values are 588 for the age group 3 to <10 years, 1000 for the age group 10 to <14 years, 1250 for the age group 14 to <18 and 909 for adults (≥18 years). VKM concludes that it is unlikely that a daily high chronic intake of D-glucurono-γ-lactone in energy drinks (containing 24 mg/100 ml) causes adverse health effects to children (3 years and above), adolescents or adults.

Effects of energy drinks on biochemical and sperm parameters in Wistar rats

BACKGROUND: The present study evaluates the effects of energy drinks on the reproductive and biochemical parameters of adult male rats. METHODS: A total of 40 male rats (Wistar) were exposed to an energy drink mixed with the drinking water for a period of 120 days. The animals were divided into four groups and exposed to increasing therapeutic doses (DT) of an energy drink, based on allometric extrapolation, resulting in values (mL/day) per animal of 250 g: DT1 2.36 mL, DT3 7.47 mL, and DT6 14.16 mL. The control group (CTRL) consumed water only. During the treatment, the rats were assessed for signs of toxicity. After treatment, the animals were sacrificed and their organs were weighed. Sperm parameters (motility, concentration, and morphology) were evaluated. The biochemical markers alanine eamino transferase, aspartate amino transferase, alkaline phosphatase, lactic dehydrogenase, urea, creatinine, creatine phosphokinase, and creatine kinase MB fraction were measured, in addition to total cholesterol and testosterone. RESULTS: There was a significant decrease (p< 0.05) in the concentration of sperm in the treated groups (DT18.5 ± 0.7; DT3 7.2 ± 0.9; DT6 8.4 ± 0.9) compared to the control group (12.3 ± 1.2). No difference was observed with respect to relative weights of the animals'organs, water consumption, signs of toxicity, behavioral changes, biochemical markers, and sperm motility and morphology. CONCLUSION: The long-term consumption of energy drinks interferes negatively with sperm concentration, without affecting sperm motility and morphology or altering the hepatic, cardiac, or renal functions

A ingestão aguda de bebida energética aumenta o desempenho em exercícios resistidos / The acute energy drink intake improve performance in resistance exercises

O objetivo do presente estudo foi verificar a influência aguda da ingestão da bebida energética que contem cafeína (BE) sobre o desempenho na execução de exercícios resistidos para membros superiores e inferiores. A frequência cardíaca (FC) foi analisada como variável complementar. Participaram do estudo 15 indivíduos (9 homens e 6 mulheres: 21,6 ± 0,5 anos; 171,1 ± 2,3 cm e 66,1 ± 2,6 kg), saudáveis e treinados. Em um delineamento duplo-cego, cruzado e aleatorizado, os indivíduos realizaram duas sessões experimentais (com intervalo mínimo de 48h) nos exercícios de extensão de joelhos e supino articulado (75% 1RM até a exaustão, 3 séries, 90 s de intervalo entre as séries, 3 min de intervalo entre os exercícios). Em um dia a amostra ingeriu BE (2,5 mg de cafeína por kg de peso corporal) ou placebo 60 min antes do treinamento. As bebidas foram equalizadas pela quantidade calórica. A FC foi medida em repouso, 60 min após a ingestão e ao fim de cada série de cada exercício. Os resultados mostraram que a ingestão de BE proporcionou maior quantidade total de repetições em relação ao placebo no supino (27,3±2,8 vs 23,9±3,0; P=0,03) e na extensão de joelhos (36,0±2,2 vs 33,8±2,1; P=0,02). A FC ficou mais elevada após a ingestão de BE (P<0,05), tanto antes dos exercícios quanto ao final de cada uma das séries realizadas. Em conclusão, a ingestão de BE melhora o desempenho de exercícios até a exaustão de membros superiores e inferiores, acompanhado de um aumento significativo na FC...(AU)

The purpose of this study was verify the acute influence of caffeine-containing energy drinks (ED) on resistance exercises performance. Heart rate (HR) was include as additional variable. In a double-blind cross-over randomized design, fifteen healthy and trained subjects (9 males; 6 females: 21.6 ± 0.5 yrs; 171.1 ± 2.3 cm; 66.1 ± 2.6 kg) performed two experimental sessions (48h of minimum interval) in knee extension and chest-press (75% 1RM until fatigue, 3 sets, 90 s of rest interval between sets, 3 min of rest interval between exercises). In one day, the subjects intake ED (2.5 mg of caffeine per body mass kg) or placebo 60 min before the exercises. The beverages were equalized by calories amount. The HR was measured during the rest, 60 min after the beverages intake and at the end of each exercise sets. The results showed that ED intake improved the amount of repetitions in relation to placebo in chest-press (27.3±2.8 vs 23.9±3.0; P=0.03) and knee extension (36.0±2.2 vs 33.8±2.1; P=0.02). The HR was higher after ED intake than placebo (P<0,05) before and after each exercise sets. In conclusion, ED intake improve the resistance exercises performance until exhaustion with increase in HR....(AU)

Intake-related factors and educational needs regarding energy drinks in female high school students in the Incheon area / 한국영양학회지

PURPOSE: The purpose of this cross-sectional study was to investigate intake-related factors of energy drinks and educational needs regarding energy drinks in female high school students. METHODS: Subjects were 340 female high school students in Incheon, and data were collected using self-administered questionnaires. Statistical analysis was performed using the SPSS 20.0 program. RESULTS: Subjects who had drunk energy drinks were 74.3% (249 subjects) of all subjects. The first time they drank an energy drink was significantly associated with grade (p < 0.05). In 75.1% of 249 subjects who had drunk energy drinks, the places for buying energy drinks were supermarkets and convenience stores near their homes. For the effects of energy drink intake, sleeplessness (44.6%) and no effect (41.7%) were cited, and 24.5% experienced side effects such as palpitation, tremors, etc. The scores for self-diagnosis of caffeine addiction were significantly higher in the low weight group compared to the overweight group (p < 0.05). The degree of caffeine addiction was significantly associated with effects of energy drink intake (p < 0.001) and type of side effects (p < 0.001). Willingness to stop consuming energy drinks (p < 0.001) and necessity of nutrition education about energy drinks (p < 0.05) were significantly lower in the caffeine addiction group compared to the general group. About 75.0% of subjects wanted to be educated about the side effects of energy drinks and caffeine. CONCLUSION: This study shows that female high school students need proper education about the effects of intake of energy drinks. Therefore, guidelines and a nutrition education program right intake of energy drinks should be provided as well as campaigns concerning the side effects of energy drinks and caffeine in female high school students.

Bebidas energizantes: efectos benéficos y perjudiciales para la salud / Energy drinks: beneficial and harmful effects on health

Antecedentes: las bebidas energizantes se promueven como curas milagrosas contra el cansancio, lo cual ha logrado que su consumo se incremente progresivamente. Objetivo: revisar el estado actual del conocimiento respecto a las bebidas energizantes y sus componentes, particularmente sus efectos benéficos y adversos. Materiales y métodos: se realizó una búsqueda bibliográfica abierta en las bases de datos Science Direct, Scielo, Medline y Pubmed utilizando diferentes combinaciones de los siguientes descriptores: energy drinks, marketing, caffeine, taurine, glucose, guarana, xantine, vitamins, pharmacology, heart rate, cognition, natural product, decision-making. Resultados: aunque no se conocen con claridad todos los componentes y sus concentraciones en las bebidas energizantes comercializadas, algunos de los componentes más comunes, tales como la cafeína y la taurina, tienen efectos adversos demostrados. Conclusión: no existen estudios concluyentes que demuestren los efectos benéficos de las bebidas energizantes, pero si existe suficiente evidencia de los efectos adversos de algunos de sus componentes más comunes. Son necesarios más estudios para determinar con certeza la seguridad de las bebidas energizantes, las cuales poseen un potencial tóxico considerable, que no es informado debidamente al consumidor.

Background: Energy drinks are promoted as solutions to prevent tiredness, which has caused that their consumption increased progressively. Objective: To review the current state of knowledge regarding energy drinks and their components, particularly the beneficial and adverse effects. Materials and methods: A broad search was performed in Science Direct, SciELO, Medline and Pubmed databases, employing different combinations of the following descriptors: energy drinks, marketing, caffeine, taurine, glucose, guarana, xantine, vitamins, pharmacology, heart rate, cognition, natural product, decision-making. Results: Although the commercial energy drink components and their concentrations are not clearly determined, there is not enough evidence to support the adverse effects of some of their most common components as caffeine and taurine. Conclusion: There are no conclusive studies to support beneficial effects of energy drinks, but instead there is enough evidence about the adverse effects of some of the most common components of these beverages. Many more studies are needed to determine the safety of energy drinks, which have a considerable toxic potential not adequately informed to the consumer.

The Application of Magnetic Resonance Spectroscopy to Investigate the Effect of a Commercial Energy Drink.

Aims: Proton magnetic resonance spectroscopy (MRS) is an imaging technique that provides noninvasive, in-vivo measurement of brain biochemistry. The objective of this study was to explore the effects of a commercial energy drink (ED) on brain metabolites in adult males using MRS. Methods: Ten males (18 to 30 years), of mean body mass index 23.8±2.2 kg/m2 [range 21.4-27.8 kg/m2] were recruited and randomized to either the intervention group (n=5) or control group (n=5). The intervention group were asked to consume two 250ml cans of Red Bull and the control group consumed no drink. One dimensional MRS on a 1.5T Achieva MRI scanner was obtained of bioccipital gray matter. Subjects were placed in the scanner and a spectrum acquired every 5.75 minutes for 60 minutes. Linear mixed models were generated to determine the main effects due to differences between groups and times and the interaction. Results: There was a significant group by time effect for N-acetylaspartate (NAA) (P= .02, d= 0.7) and a statistical trend for macromolecule 20 (MM20) (P= .06 d= 0.1) with the control group having higher concentrations than that of the intervention. Mean differences from baseline to 45 minutes for NAA in the intervention group were -0.8 mM (-12%) compared with 0.15 mM (<1%) for control and for MM20 -0.12 mM (<1%) in the intervention group compared with 0.03 mM (<1%) for control. Conclusions: Consumption of two cans of ED was found to produce few changes in brain metabolites with moderate effect sizes. Changes detected in this study demonstrate the sensitivity of the MRS method to explore nutrition related variables with 1.5T clinical MRI unit. The study provides some insight into an understudied, topical area of research.

The Effect of Caffeinated Energy Drink Consumption on Intraocular Pressure in Young Adults

PURPOSE: Several energy drinks containing a high content of caffeine are widely consumed among young adults. We examined the effects of caffeinated energy drinks on intraocular pressure (IOP) and blood pressure (BP) in healthy young subjects. METHODS: In this prospective randomized, case-controlled cross over study conducted, from August to September of 2014, 40 healthy young volunteers (80 eyes) in their 20's and 30's drank 2 types of beverage each consumed after a 3-month washout period. The study participants were randomly given the caffeinated energy drink (group I, n = 20) or caffeine-free drink (group II, n = 20), IOP and BP were measured at 0, 30, 60, 90, and 120 minutes and 12 and 24 hours after beverage consumption. RESULTS: In group I, the mean +/- standard deviation (SD) of IOP at baseline was 13.2 +/- 1.56 mm Hg and the IOP increased until 24 hours after drink consumption. IOPs at 30, 60, 90, and 120 minutes and 12 and 24 hours after drinking caffeinated energy drink were 14.45 +/- 2.12, 14.93 +/- 2.02, 14.85 +/- 1.55, 14.2 +/- 1.34, 14.25 +/- 1.74, and 13.35 +/- 1.61, respectively and statistically significant at 30, 60, 90, 120 minutes and 12 hours (p < 0.05). A corresponding increase in BP after drinking the caffeinated energy drink was observed but without statistical significance. Drinking the caffeine-free beverage did not affect IOP or BP significantly. CONCLUSIONS: IOP increases after consuming the caffeinated energy drink were statistically significant at 30, 60, 90, and 120 minutes and 12 hours. Therefore, caffeinated energy drinks may not be recommended for glaucoma patients or glaucoma suspects.

The Effect of Caffeinated Energy Drink Consumption on Intraocular Pressure in Young Adults

PURPOSE: Several energy drinks containing a high content of caffeine are widely consumed among young adults. We examined the effects of caffeinated energy drinks on intraocular pressure (IOP) and blood pressure (BP) in healthy young subjects. METHODS: In this prospective randomized, case-controlled cross over study conducted, from August to September of 2014, 40 healthy young volunteers (80 eyes) in their 20's and 30's drank 2 types of beverage each consumed after a 3-month washout period. The study participants were randomly given the caffeinated energy drink (group I, n = 20) or caffeine-free drink (group II, n = 20), IOP and BP were measured at 0, 30, 60, 90, and 120 minutes and 12 and 24 hours after beverage consumption. RESULTS: In group I, the mean +/- standard deviation (SD) of IOP at baseline was 13.2 +/- 1.56 mm Hg and the IOP increased until 24 hours after drink consumption. IOPs at 30, 60, 90, and 120 minutes and 12 and 24 hours after drinking caffeinated energy drink were 14.45 +/- 2.12, 14.93 +/- 2.02, 14.85 +/- 1.55, 14.2 +/- 1.34, 14.25 +/- 1.74, and 13.35 +/- 1.61, respectively and statistically significant at 30, 60, 90, 120 minutes and 12 hours (p < 0.05). A corresponding increase in BP after drinking the caffeinated energy drink was observed but without statistical significance. Drinking the caffeine-free beverage did not affect IOP or BP significantly. CONCLUSIONS: IOP increases after consuming the caffeinated energy drink were statistically significant at 30, 60, 90, and 120 minutes and 12 hours. Therefore, caffeinated energy drinks may not be recommended for glaucoma patients or glaucoma suspects.

Condições higiênico-sanitárias da bebida guaraná da Amazônia comercializada por vendedores ambulantes na cidade de São Luís, MA / Sanitary conditions of the Amazonian guarana drink sold by street vendors in the city of São Luís, MA

O objetivo deste estudo foi avaliar as condições higiênico-sanitárias da bebida guaraná da Amazônia comercializada por vendedores ambulantes na cidade de São Luís, Maranhão. Trinta amostras, provenientes de 10 pontos de venda, foram submetidas às seguintes análises microbiológicas: pesquisa de Salmonella spp., quantificação do número mais provável de coliformes a 35°C e a 45°C, enumeração de bactérias aeróbias mesófilas, fungos e estafilococoscoagulase positivos. Em cada ponto de venda avaliado foi aplicado um questionário tipo check-list para verificar as condições higiênicas do local e de preparo do guaraná da Amazônia. Verificaram-se nas amostras os micro-organismos pesquisados, com exceção de Salmonella spp. Foram encontradas contagens elevadas de coliformes a 35ºC (n= 24; 80%) e a 45ºC (n=18; 60%), indicando condições higiênico-sanitárias insatisfatórias das amostras analisadas. Também foram verificadas várias inadequações nos pontos de venda, indicando deficiências higiênicas no preparo da bebida guaraná da Amazônia. Os resultados reforçam a importância de investimentos em programas de qualidade, conscientização e treinamento para os vendedores ambulantes da bebida guaraná da Amazônia na cidade de São Luís, Maranhão.(AU)

The objective of this study was to evaluate the hygienic-sanitary conditions of the Amazonian guarana drink sold by street vendors in the city of Sao Luís, Maranhão, Brazil. Thirty samples from 10 outlets were subjected to the following microbiological analysis: Salmonella spp., quantification of the most probable number of coliforms at 35°C and 45°C, enumeration of mesophilic aerobic bacteria, fungi and Staphylococcus coagulase-positive. A check-list questionnaire was administered at each point of sale assessed to check the hygienic conditions of the site and preparation of the drink. Except for Salmonella spp., all microorganisms studied were found in the samples. We found high counts of coliforms at 35ºC (n=24; 80%) and 45°C (n=18; 60%), indicating inadequate sanitary conditions of the samples. Also, there were numerous gaps in retail outlets, indicating impairment in the preparation of the Amazonian guarana drink. The results reinforce the importance of investing in quality programs, awareness and training for street vendors in the city of Sao Luís, Maranhão.(AU)

Comparison of a Web-Based Frequency Questionnaire for Assessment of Beverage Intake with a Validated 7-Day Web-Diary from Danish Teenagers.

Aims: To compare beverage intake measured using a web-based quantitative beverage frequency questionnaire (BFQ) with a 7-day estimated beverage diary (WebDAS), and to evaluate the BFQ’s feasibility. Study Design: Cross-sectional comparison of the BFQ, which contained 37 beverage types including energy drinks and caffeinated beverages, with the WebDAS. Place and Duration of Study: Sample: Three 9th grade local authority school classes totalling 73 14-16-year-old students from a suburban area in Copenhagen were recruited. The study was carried out between September 2013 and November 2013. Methodology: First respondents completed the WebDAS at home, and after 2 weeks they completed the BFQ at school. McNemar’s test, the Wilcoxon signed rank test, Spearman’s rank correlation coefficients, a Bland-Altman plot, weighted Kappa statistics and percentages of exact agreement were used to compare the results of the two methods. Results: 49 (29 boys; 20 girls) had acceptable data from both the WebDAS, and the BFQ. The mean total beverage intake measured by the two methods differed significantly (BFQ: 1566 vs. WebDAS: 1231g/day, P<.01). The Spearman rank correlations were positive (r=.41-75) for all beverages including energy drinks, and significant for most beverages. Significant agreement for the numbers of consumers was observed between methods, except for soft drinks and chocolate. The mean (SD) difference was 335 (769)g/day, primarily due to an intake of water measured with BFQ almost twice as high as that measured with WebDAS. This was reflected in the Bland-Altman plot and in the percentages of exact agreement, which were lower for water than for other beverages (29% vs. 39-46%). Conclusion: The BFQ gave results comparable to a 7-day beverage diary (WebDAS) in 14-16-year-olds. With a few adjustments, especially with regard to portion sizes and entries for water, we believe the BFQ will be useful in large population-based studies for assessment of beverage intake.

Pattern of Energy Drink Consumption and Associated Adverse Symptoms among University Students.

Aims: This study estimated the prevalence of energy drink consumption among students at the University of the West Indies (UWI), and describes the frequency of consumption and associated adverse symptoms. Study Design: A cross-sectional survey was conducted using a sex-stratified random sample of students residing in the halls of residence at the UWI, in Jamaica. Place and Duration of Study: The study was conducted at the Mona campus of UWI, between October 2011 and January 2012. Methodology: A self-administered questionnaire was used to obtain demographic data, use of energy drinks, frequency of use, symptoms associated with use and perception of benefits. Results: There were 607 participants, consisting of 336 (55.4%) females and 271 (44.6 %) males. The mean age was 20.7 years. Jamaicans constituted 80% of responders. Energy drinks were used by 450 participants (74.1%), with 288 (64%) being once weekly users, consisting of 160 males (74.8%) and 128 females (54.2%). There were 20 students (4.4%) who used energy drinks 2-3 times/week, 11 (2.4%) 4-6 times weekly, 3 (0.7%) were daily users. Adverse symptoms experienced were: palpitation in 133 (29.6%), headache in 64 (14.2%), and nervousness in 58 (12.9%). Insomnia occurred in 236 (52.4%) with 129 (54.7%) females and 107 (50%) males. Chest pain was reported by 27 (6.0%) and fainting occurred in 2 respondents. Perceptions reported about the use of energy drinks included, enhanced sport performance, 38.9%, improved academic performance, 60%, and improved sexual performance, 21.8% and improvement in daily activities (both mental and physical), 22.3%. Conclusion: Energy drink use is common among students on the halls of residence at UWI in Jamaica. Insomnia, palpitation and headache were the most common adverse symptoms, but students perceived benefits in their academic and daily activities.

Hypercobalaminemia Induced by an Energy Drink after Total Gastrectomy: A Case Report / Journal of Rural Medicine

We encountered a case of hypercobalaminemia induced by oral intake of an energy drink after total gastrectomy. The patient was referred to our hospital due to findings suspicious for gastric cancer on screening. A 20 mm type 0-IIc lesion was detected in the gastric subcardia on esophagogastroduodenoscopy. Total gastrectomy followed by Roux-en-Y reconstruction was performed. He was discharged without complications. His basal serum vitamin B₁₂ level was initially maintained with monthly intramuscular injections of vitamin B₁₂. After 9 months, his serum vitamin B₁₂ level suddenly increased up to 36-fold higher than the normal range and persisted there for one year without vitamin B₁₂ injections. The patient ultimately reported consuming half a bottle of an energy drink each day during this time period. This case demonstrates the risk of unexpected hypervitaminemia resulting from self-administration of nutritional supplements.

ST elevation myocardial infarction in a young patient after ingestion of caffeinated energy drink and ecstasy / 世界急诊医学杂志（英文）

BACKGROUND: Caffeinated energy drinks are widely used worldwide. They are associated with a variety of adverse effects and are of concern to health authorities, yet there is still scarce information about their adverse effects and inadequate awareness among medical personnel. METHODS: Case description and discussion of a patient presenting to the emergency room after overdose of energy drinks in combination with 3,4-methylenedioxymethamphetamine (MDMA). RESULTS: Despite best medical efforts, the patient died of fatal cardiac arrhythmias. There is a paucity of information about adverse effects of energy drinks. CONCLUSION: Although energy drinks are widely used, there is a lack of awareness in the population and medical staff about their hazards.