ViewpointEnergy Drink Overconsumption in Adolescents: Implications for Arrhythmias and Other Cardiovascular Events
Section snippets
Heart Diseases Predisposing to Arrhythmia in Adolescents
Although most cases of sudden cardiac death (∼ 80%) are attributed to underlying coronary artery disease, a non-negligible 5%-10% of all cases occur in young apparently healthy individuals. The most frequent underlying conditions of tachyarrhythmia and sudden arrhythmic death syndrome (SADS) in children, adolescents, and young adults are structural heart diseases (ie, cardiomyopathies) and primary electrical disorders, the so-called channelopathies (ie, cardiac ion channel diseases). Ion
Assessing the Evidence
Cardiac manifestations such as atrial or ventricular arrhythmias, QT prolongation, or ST-segment elevation, have been reported after high ingestion of EDs.21, 22 Frost and Vestergaard described the association of caffeine overconsumption with the incidence of atrial fibrillation (AF) or flutter in almost 48,000 participants in the Danish Diet, Cancer, and Health Study.23 Supraventricular tachyarrhythmias such as AF are less dangerous than ventricular tachyarrhythmias, but they can trigger
Conclusions
As ED consumption continues to grow, physicians are advised to ask adolescent patients whether they consume EDs, to be aware of the symptoms of ED overconsumption, and to discuss the dangers of EDs alone and mixed with alcohol. Although the use of EDs with alcohol was mentioned as a risk, and there is a well-established biochemical interaction between ED contents and alcohol, the fact that EDs enable the drinker to stay alert would further increase the risk of assuming larger amount of
Recommendations
On the basis of the aforementioned evidence, we offer tentative advice, which is presented in Table 3. In summary, 1 can (250 mL) of an ED per day is safe for most healthy adolescents. ED consumption before or during sports practice should be avoided. Adolescents with clinically relevant underlying medical conditions should consult cardiologists before drinking EDs. Excessive consumption of EDs together with alcohol or other drugs, or both, may lead to adverse effects, including death. Parents
Disclosures
The authors have no conflicts of interest to disclose.
References (33)
- et al.
Energy drink consumption and the risk of alcohol use disorder among a national sample of adolescents and young adults
J Pediatr
(2014) - et al.
Energy drinks: the new eye-opener for adolescents
Clin Ped Emerg Med
(2008) - et al.
Energy beverages: content and safety
Mayo Clin Proc
(2010) - et al.
Pharmacological activity of Guarana (Paullinia cupana Mart.) in laboratory animals
J Ethnopharmacol
(1997) - et al.
Ginseng pharmacology: multiple constituents and multiple actions
Biochem Pharmacol
(1999) - et al.
Atrial fibrillation after ingestion of a high energy drink
An Pediatr (Barc)
(2012) - et al.
Cardiovascular and cerebrovascular effects in response to Red Bull consumption combined with mental stress
Am J Cardiol
(2015) - et al.
Ventricular arrhythmias in the absence of structural heart disease
J Am Coll Cardiol
(2012) - et al.
Sudden cardiac death in young athletes: practical challenges and diagnostic dilemmas
J Am Coll Cardiol
(2013) - et al.
Review of published cases of adverse cardiovascular events after ingestion of energy drinks
Am J Cardiol
(2014)
Death of a young man after overuse of energy drink
Am J Emerg Med
Caffeine and risk of atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study
Am J Clin Nutr
Caffeine and arrhythmia
Am J Clin Nutr
Energy drink-induced near-fatal ventricular arrhythmia prevented by an intracardiac defibrillator decades after operative “repair” of tetralogy of Fallot
Am J Cardiol
Detrimental effects of energy drink consumption on platelet and endothelial function
Am J Med
Health effects of energy drinks on children, adolescents, and young adults
Pediatrics
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Dietary assessment methods in surveillance systems targeted to adolescents: A review of the literature
2019, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :In more than half of the systems, foods specifically consumed by adolescents, such as ‘fast’ food or sweet snacks or savoury snacks that are high in fat, sugar and/or salt, are not assessed, although they may be a major part of their diet [27]. Similarly, knowing that the consumption of energy drinks among adolescents has become a popular behaviour, which has implications for different cardiovascular events, their inclusion in the FFQ would be worthwhile to consider [28]. It is noteworthy that assessment of food/beverage items often differs between countries due to local habits, as well as definitions and terms used or the incorporation of some items within a wider food group (e.g. dried fruit often included in the fruit item; legumes included in the vegetables item; energy drinks and sports drinks sometime overlapping).
Effects of coffee, energy drinks and their components on hemostasis: The hypothetical mechanisms of their action
2019, Food and Chemical ToxicologyCitation Excerpt :Similarly, the wide variety of study designs (human, in vivo and in vitro studies etc.) have resulted in them being ascribed both protective and harmful effects. Nevertheless, some reports have found particularly large intakes of energy drinks to be associated with the occurrence of cardiovascular disorders, including acute cardiovascular adverse events (Sanchis-Gomar et al., 2015, 2016), and others report that energy drinks may elevate the risk of cerebrovascular accidents and myocardial infarctions by various mechanisms, such as by increasing blood platelet aggregation and decreasing endothelial functions (Arboix, 2015). The changes occurring in platelet function depend on the bioactive components of energy drinks, for example caffeine increases the formation of blood platelet microparticles (McEwen, 2014).
Intake of caffeine from all sources and reasons for use by college students
2019, Clinical NutritionEnergy drink exposures reported to Texas poison centers: Analysis of adverse incidents in relation to total sales, 2010–2014
2018, Regulatory Toxicology and PharmacologyCitation Excerpt :This is in stark contrast to several publications citing regular use of energy drinks by adolescents on the order of 30–50%. Sanchis-Gomar and colleagues (Sanchis-Gomar et al., 2015), in a paper that summarizes arrhythmias and cardiovascular events in adolescents, state that 30–50% of adolescents and young adults consume energy drinks. They cite Seifert et al. for this figure (Seifert et al., 2011).
Energy Drinks and atrial fibrillation in young adults
2018, Clinical NutritionCitation Excerpt :Cocaine effects on cardiovascular system are well known and we want to exclude this trigger for arrhythmias [3]. A direct pathogenetic link between abuse of EDs and acute onset of high-rate AF is supported by the absence of recurrence of this complication after a complete abstinence from this beverage [4–7]. We consider EDs toxicity as quantity-related, first to their total caffeine content, but also to other components, not completely known.
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