Up to half of children worldwide and up to a third of children in the UK consume energy drinks every week, with a tally on five or more days of the week associated with certain health and behavioral problems, according to research published in open access journal BMJ open.
But while this secondary analysis of the available data helps fill the evidence gap, most of the data is derived from surveys, making it impossible to distinguish between cause and effect, the researchers warn.
Energy drinks are marketed to reduce fatigue and improve concentration as well as to increase energy. An average 250ml energy drink contains a similar amount of caffeine as a 60ml espresso.
Many of these drinks also contain other active ingredients, such as guarana and taurine (stimulants) and sugar, although sugar-free options are also available.
In 2018 the UK government carried out a consultation on banning the sale of these drinks to children, but as only two UK studies were identified from the available evidence, additional UK data was sought and a secondary analysis of the data was carried out to ensure relevance for UK policy.
To do this, the researchers wanted to know what type and how many energy drinks British teenagers drank. And they wanted to explore the potential impact on the physical and mental health and behavior of young people.
In July 2021, the researchers updated their original trawl of relevant research from 9 databases made in May 2018.
Two more systematic reviews have been added to the original 13, covering a total of 74 studies, published in English since 2013: 6 of these 15 reviews reported on prevalence and 14 reported on associations between drinking and health or behavior.
The additional analysis included data representative of the UK or one of the devolved countries, including information on levels and patterns of energy drink consumption among children and potential effects on cardiovascular health, health mental, neurological disorders, academic achievement, substance abuse or sleep.
Data from the systematic review found that, globally, between 13% and 67% of children had consumed energy drinks in the past year.
Analysis of additional UK data indicated that between 3% and 32% of children in the UK consumed energy drinks on at least one day of the week, with no difference by ethnicity.
Frequent consumption, defined as consuming an energy drink 5 or more days per week, was associated with poorer mental and physical health and poor overall well-being compared to those who did not consume energy drinks.
Evidence from the reviews indicated consistent associations between energy drinks and self-harm, suicide, hyperactivity, academic performance and school attendance.
Evidence from reviews and data from the UK suggests that boys drank more than girls, with consumption increasing with age; and that drinking was associated with more headaches, sleep problems, alcohol consumption, smoking, irritability and school exclusion.
But application of a quality grading system (GRADE) suggests the evidence is weak. Indeed, most of the review data came from cross-sectional surveys, while none of the supplemental data included long-term information.
And it was impossible to pool the survey data from the reviews due to reported differences in design and measurements.
“These data support the idea that there is a link between alcohol consumption [caffeinated energy drinks] and poor health and behavior in children, although the cause is unclear,” the researchers write.
They conclude: “Based on a comprehensive overview of available systematic reviews, we conclude that up to half of children, worldwide, drink [caffeinated energy drinks] weekly or monthly, and based on analysis of the datasets, up to a third of UK children do.
They add: ‘There is weak but consistent evidence, from UK reviews and datasets, that the health and wellbeing of children who drink is worse. [caffeinated energy drinks]. In the absence of [randomised controlled trials]which are unlikely to be ethical, longitudinal studies may provide stronger evidence.
The title of the article
Consumption and effects of caffeinated energy drinks among young people: overview of systematic reviews and secondary analysis of UK data to inform policy
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