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Energy Drink Consumption in Children and Adolescents: What’s Happening?

Posted: 2024-02-12
Energy Drink Consumption in Children and Adolescents: What’s Happening?

What’s happening?

A recently published systematic review (1) builds on a previous review examining the evidence of the physical effects of energy drink consumption on children and adolescents (2). Evidence continues to grow linking energy drink consumption with detrimental health effects and health-related behaviours in children and adolescents, with an estimated 12-35% of children and adolescents consuming energy drinks at least once per week (1). This new research has prompted the British Dietetic Association (BDA) to support the call for restricting the sale and marketing of energy drinks to children and adolescents (3). 
 
Energy drinks are non-alcoholic beverages that contain high amounts of caffeine (≥150 mg/L) and sugar (9-13 mg/100 mL), along with other stimulants, vitamins, electrolytes and nutritive and non-nutritive sweeteners (1,4). They are advertised to increase energy and alertness (5). Energy drinks have been regulated in many countries, including Lithuania, Latvia, Turkey and Sweden, with sales banned to children under 18 years old (under 15 years in Sweden) (1). The Canadian Pediatric Society identifies the health risks associated with energy drink consumption among children and adolescents and recommends that health providers assess energy drink consumption in this population (4). In late 2023, the International Society of Sports Nutrition (ISSN) published a position statement on energy drinks, which included a statement that does not recommend energy drinks for children aged two to 12 years (5).
 

What does this mean for children’s health?

The detrimental health, educational and social effects associated with the frequent consumption of energy drinks in children and adolescents include:
  • lower academic performance, short sleep duration and poor quality sleep, and an increased likelihood to consume energy-dense, nutrient-limited foods, including other sugar-sweetened beverages (SSBs) (1,2)
  • health-related behaviours like smoking, alcohol use, binge drinking, substance abuse and the intention to initiate these behaviours (1,2)
  • mental and physical health effects, like increased anxiety, the risk of suicidality, stress and depressive and panic symptoms (1). These specific findings are identified in the most recent review of the evidence, suggesting that additional factors that impact children's and adolescents' health are emerging with the consumption of energy drinks.
     
The health and behavioural effects of energy drinks are attributed to caffeine, sugar and other ingredients and stimulants (1). The evidence suggests a dose-response effect, raising concern about the overall health impact on children and adolescents; however, dose was not reported. While the caffeine content of energy drinks can vary, energy drinks are also high in sugar, which is associated with other health-related considerations in this population, including weight gain, type 2 diabetes and dental erosion. The evidence reviewed indicates that boys are more likely to consume energy drinks, based on targeted branding and marketing as key influencing factors related to sports performance. Social/peer influence, price and ease of access are also growing factors influencing use.
 

Review analysis

The findings of the systematic review were based on 57 studies that met the study selection criteria (1). The review article reported on the effects of energy drink consumption on children and adolescents up to the age of 21 years, with the exposure assessed as energy drink consumption (including lifetime, occasional and regular intake); the control was the absence of energy drink consumption. The frequency of energy drink consumption differed across the studies, ranging from four to seven or more drinks per week. Cross-sectional, experimental and longitudinal studies were included, as well as one retrospective and one qualitative study. The overall sample size was over 1.2 million children and adolescents in more than 21 countries, indicating that a breadth of data was used to support the authors' analysis.
 
The authors concluded there is a need to restrict the consumption of energy drinks among children and young people and noted the potential of policy-makers to adopt the precautionary principle to prevent harm to children and adolescents (1). They commented that most studies included in the review were cross-sectional, limiting the ability to determine causation (1). Furthermore, the recommendations were based on a narrative synthesis, minimizing the ability to account for bias in the analysis and producing less reliable findings to inform decision-making. More long-term studies with experimental designs are warranted.

What now?

With the systematic review findings indicating that the consumption of energy drinks among children and adolescents is of major public health importance (1), dietitians may consider:
  • Educating families and their children ≤18 years of age about how to limit the consumption of SSBs, including energy drinks, as the consumption of these beverages may result in a higher daily calorie intake and displacement of nutrients obtained from other sources, including milk and milk alternatives (4,7). 
  • Promoting environmental interventions likely to reduce SSB intake, including labelling interventions (e.g. health warnings), price increases and promoting healthier items in grocery stores (8).
 
The PEN Team continues to monitor the evidence related to energy drinks and their impact on children and adolescents as part of the Child and Youth Nutrition Knowledge Pathway.
 
Raising Our Healthy Kids Caffeinated Beverages (Video)

References

  1. Ajibo C, Van Griethuysen A, Visram S, Lake AA. Consumption of energy drinks by children and young people: a systematic review examining evidence of physical effects and consumer attitudes. Public Health. 2023 Oct 30:S0033-3506(23)00318-9. doi: 10.1016/j.puhe.2023.08.024. Epub ahead of print. PMID: 38228408. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/38228408/ 
  2. Visram S, Cheetham M, Riby DM, Crossley SJ, Lake AA. Consumption of energy drinks by children and young people: a rapid review examining evidence of physical effects and consumer attitudes. BMJ Open. 2016 Oct 8;6(10):e010380. doi: 10.1136/bmjopen-2015-010380. PMID: 27855083; PMCID: PMC5073652. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/27855083/ 
  3. British Dietetic Association. BDA supports call for restricting the sale and marketing of energy drinks to children and young people. 2024 Jan 23. Available from: https://www.bda.uk.com/resource/bda-supports-call-for-restricting-the-sale-and-marketing-of-energy-drinks-to-children-and-young-people.html 
  4. Pound CM, Blair B; Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario. Energy and sports drinks in children and adolescents. Paediatr Child Health. 2017 Oct;22(7):406-410. doi: 10.1093/pch/pxx132. Epub 2017 Oct 6. PMID: 29491725; PMCID: PMC5823002. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/29491725/
  5. Jagim AR, Harty PS, Tinsley GM, Kerksick CM, Gonzalez AM, Kreider RB, Arent SM, Jager R, Smith-Ryan AE, Stout JR, Campbell BI, VanDusseldorp T, Antonio J. International society of sports nutrition position stand: energy drinks and energy shots. J Int Soc Sports Nutr. 2023 Dec;20(1):2171314. doi: 10.1080/15502783.2023.2171314. PMID: 36862943; PMCID: PMC9987737. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/36862943/
  6. Dietitians of Canada. What are the short- and long-term physical and mental health effects of high added sugar consumption in children and adolescents (≤18 years old)? In Practice-based Evidence in Nutrition® [PEN]. Available from: https://www.pennutrition.com/KnowledgePathway.aspx?kpid=18724&pqcatid=145&pqid=23864 2019-06-26. Access only by subscription. Click Sign Up on the PEN login page.
  7. Dietitians of Canada. What interventions can help reduce children’s energy consumption from sugar-sweetened beverages (SSBs)? In Practice-based Evidence in Nutrition® [PEN]. Available from: https://www.pennutrition.com/KnowledgePathway.aspx?kpid=18724&pqcatid=146&pqid=23868 2023-05-25. Access only by subscription. Click Sign Up on the PEN login page.
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