The effects of caffeinated products on sleep and functioning in the military population: A focused review.

Military personnel rely on caffeinated products such as coffee or energy drinks (ED) to maintain a maximal level of vigilance and performance under sleep-deprived and combat situations. While chronic caffeine intake is associated with decreased sleep duration and non-restful sleep in the general population, these relationships are relatively unclear in the military personnel. We conducted a focused review of the effects of caffeinated products on sleep and the functioning of military personnel. We used a pre-specified search algorithm and identified 28 peer-reviewed articles published between January 1967 and July 2019 involving military personnel. We classified the findings from these studies into three categories. These categories included descriptive studies of caffeine use, studies evaluating the association between caffeinated products and sleep or functioning measures, and clinical trials assessing the effects of caffeinated products on functioning in sleep-deprived conditions. Most of the studies showed that military personnel used at least one caffeine-containing product per day during active duty and coffee was their primary source of caffeine. Their mean caffeine consumption varied from 212 to 285 mg/day, depending on the type of personnel and their deployment status. Those who were younger than 30 years of age preferred ED use. Caffeine use in increasing amounts was associated with decreased sleep duration and increased psychiatric symptoms. The consumption of caffeinated products during sleep deprivation improved their cognitive and behavioral outcomes and physical performance. Caffeine and energy drink consumption may maintain some aspects of performance stemming from insufficient sleep in deployed personnel, but excessive use may have adverse consequences.

Use of Sports Supplements in Competitive Handball Players: Sex and Competitive Level Differences.

Sports supplements are commonly used by elite athletes with the main goal of enhancing sport performance. Supplements use might be substantially different depending on the sport discipline, sex, and competitive level. To date, data about prevalence and the most-commonly used supplements in handball are scarce. Thus, the aim of this investigation was to determine the patterns of supplements use by handball players of both sexes and with different competitive levels: One hundred and eighty-seven handball players (112 men and 75 women) of different competitive levels (106 professional and 81 amateur) completed a validated self-administered questionnaire about supplements use. Supplements were classified according to the categorization of the Australian Institute of Sport (AIS). Overall, 59.9% of the handball players (n = 112) declared the use of at least one supplement and there were no significant differences between men and women (58.9% vs. 61.3%, p = 0.762) nor between professional vs. amateur handball players (67.1% vs. 53.8%, p = 0.074). The most prevalent supplements were sports drinks (42.2%), followed by energy bars (35.3%) and caffeine-containing products (31.6%). However, a greater consumption of group A supplements (those with strong scientific evidence; p = 0.029) and group B supplements (those with emerging scientific support, p = 0.012) was observed in male compared to female handball players. Supplements categorized as medical supplements were more commonly consumed in professional vs. amateur players (0.48 ± 0.80 vs. 0.21 ± 0.44, supplements p < 0.006). Additionally, a higher consumption of group B supplements was observed in professional compared to amateur players (0.58 ± 0.88 vs. 0.33 ± 0.72 supplements, p = 0.015). Handball players revealed a moderate use of supplements while sex and competitive level slighted changed the pattern of supplements use. A high portion of handball players use supplements as fuel during exercise and reported the use of caffeine-containing supplements to enhance performance.

Are students at Krakow universities turning to energy-boosting dietary supplements?

INTRODUCTION: Recent studies have revealed an increase in the consumption of dietary supplements including frequency of use of caffeine, which is addictive and potentially harmful in higher doses. Energy drinks include high doses of caffeine and are particularly targeted at young people. OBJECTIVE: The aim of the study was to investigate the frequency of use of caffeine-containing energy products, associated factors and understanding the associated side- effects in university students. MATERIAL AND METHODS: A cross-sectional questionnaire-based survey was conducted among students of the 5 largest Universities in Krakow. Statistical significance was set at the 0.05 level. RESULTS: Around 35% of respondents reported the use of different supplements including high doses of caffeine. Frequency of caffeine-containing products consumption was significantly higher in female students compering to males. Also, those respondents who originated from big cities were more likely to use caffeine-containing products. The study revealed that these substances were also more popular among those participants who study economics. Most students use these substances in order to reduce feeling tired and the duration of sleep, others mainly to increase concentration prior to examinations. Almost one fourth of the group who used these substances admitted to having experienced some sideeffects in the past. They suffered mainly from insomnia, but also from excessive stimulation and muscle trembling. Almost half of the substances users did not know of any potential side-effects. CONCLUSIONS: Attempts should be made to increase public awareness of the side-effects of these substances, particularly among the student population. These campaigns should be targeted especially at female students who come from bigger cities. This study is a step towards drawing attention to this issue.

Micronutrient fortification of caffeinated energy drinks and supplemented foods marketed in Canada.

To examine the micronutrient content of discretionarily fortified products marketed under Canada's current regulations, we conducted an in-store and online search for products granted Temporary Marketing Authorizations in 2018. We located 129 caffeinated energy drinks and 98 other beverage products. Most were fortified at levels well below permitted maximums, but 82.2% of energy drinks and 35.7% of other beverage products contained nutrients above 100% of Daily Values, suggesting that current fortification practices are largely gratuitous. Novelty The micronutrients in a sample of discretionarily fortified products marketed under Canada's current regulations were generally below permitted maximum levels, but many greatly exceeded nutrient requirements.

Relationships between use of dietary supplements, caffeine and sensation seeking among college students.

Objective: Caffeine and dietary supplement (DS) use by college students is not well-documented. Given reported associations between energy drink consumption and sensation seeking, we used the Sensation Seeking Scale Form V (SSS-V) to assess relationships between sensation-seeking, caffeine, and DS use. Participants: Data from 1,248 college students from five US institutions were collected from 2009 to 2011. Methods: Linear regression was used to examine relationships between scores on the SSS-V and caffeine and DS use, demographic, and lifestyle characteristics. Results: Male sex, nonHispanic race-ethnicity, higher family income, tobacco use, consuming caffeinated beverages, more than 400 mg caffeine per day, and energy drinks with alcohol at least 50% of the time, were significantly associated with higher total SSS-V scores (P < 0.001). Those using protein DSs had higher total, disinhibition, and boredom susceptibility SSS-V scores (Ps < 0.001). Conclusions: Results demonstrate a positive correlation between sensation-seeking attitudes and habitual caffeine, energy drink, and DS consumption.

Investigating associations between caffeinated beverage consumption and later alcohol consumption among early adolescents.

Previous research has demonstrated that caffeinated beverage consumption predicts alcohol consumption among early adolescents. This study aimed to investigate this association in two ways: (1) by examining if this association remained significant once other established risk factors for alcohol were adjusted for statistically; and (2) by considering three possible moderators of this association: gender, sensation-seeking, and parental monitoring. Data from the Camden Youth Development Study, a longitudinal, community-based study of middle-school students, were used. Youth were initially assessed in 6th and 7th grade and followed-up 16 months later. Self-reports of frequency of energy drink, coffee, and alcohol consumption, as well as sensation-seeking, perceived peer and best friend alcohol use, alcohol expectancies, and parental monitoring, were used. Results indicated that both energy drink and coffee consumption predicted later alcohol consumption, even after adjusting for other risk factors for alcohol consumption. Parental monitoring was a significant moderator of this link, such that youth who consumed energy drinks and reported low parental monitoring were particularly at risk for later alcohol consumption. These findings indicate that the link between earlier caffeine consumption and later alcohol consumption is not simply due to the co-occurrence of caffeine consumption with other risk factors for alcohol use. In addition, risk associated with early energy drink consumption appears to be particularly pronounced for youth in families characterized by low parental monitoring.

Non-medical prescription stimulant use to improve academic performance among Australian university students: prevalence and correlates of use.

BACKGROUND: Some university students consume pharmaceutical stimulants without a medical prescription with the goal of improving their academic performance. The prevalence of this practice has been well documented in the US, but less so in other countries. The potential harms of using prescription stimulants require a better understanding of the prevalence of this practice within Australian universities. METHODS: An internet survey of 1136 Australian students was conducted in 2015 in three large Australian universities. Students were asked about their personal use of prescription stimulants, attitudes and experiences with prescription stimulants. They were also asked about their use of caffeine, energy drinks and illicit drugs to enhance their academic performance. RESULTS: Lifetime self-reported use of stimulant medication to improve academic performance was 6.5, and 4.4% in the past year. Students were far more likely to report using coffee and energy drinks (41.4 and 23.6% respectively, lifetime use) than prescription stimulants to help them study and complete university assessments. Non-medical use of prescription stimulants was strongly associated with a history of illicit drug use. CONCLUSION: The prevalence of nonmedical prescription stimulant use to improve academic performance is low among university students in Australia, especially when compared with their use of coffee and energy drinks.

Caffeinated energy drink use by U.S. adolescents aged 13-17: A national profile.

The present study examined the national prevalence and distribution of adolescent use of caffeinated energy drinks, assessing variations in sociodemographic characteristics, personality traits, lifestyles, and patterns of alcohol and caffeine use. A cross-sectional survey was conducted in May 2014, using a nationally representative sample of 1,032 U.S. early (aged 13-15; n = 602) and middle adolescents (aged 16-17; n = 430). Nearly two thirds of teens reported ever using energy drinks; 41% had done so recently, that is, in the past 3 months. Middle adolescents reported higher prevalences of both lifetime and recent use of energy drinks than early adolescents. Common situational contexts for use (e.g., compensating for lack of sleep or playing sports) differed by both gender and age cohort. In hierarchical logistic regression analyses, gender and geographic region significantly predicted both lifetime and recent use for early adolescents only, whereas age and race were significant predictors only for middle adolescents. For both age cohorts, odds of both lifetime and recent use increased with sensation-seeking score, lifetime alcohol use, and recent caffeinated soft drink use. Among early adolescents, grade point average predicted lifetime use only, whereas coffee and caffeine pill use predicted recent use only. Among middle adolescents, impulsivity and past sports participation predicted lifetime but not recent use. Our findings show that adolescent energy drink use is widespread and varies as a function of demographic, psychosocial, lifestyle, and substance use characteristics. Future research is needed to assess whether differences between early and middle adolescent use patterns are primarily developmental or cohort effects. (PsycINFO Database Record

Energy Drink and Nutritional Supplement Beliefs Among Naval Aviation Candidates.

INTRODUCTION: The National Academy of Medicine called for increased research on nutritional supplement use among military members. Current research has suggested potential health risks posed by energy drink consumption. The purpose of this study was to examine the relationship of energy drink consumption and beliefs about nutritional supplements in a U.S. military population. METHODS: Data were collected by means of an anonymous 44-item survey that was administered to and completed by 302 naval aviation candidates (100% response rate) enrolled in aviation preflight indoctrination (API) at Naval Air Station Pensacola, FL. RESULTS: Bivariate correlations indicated a statistically significant relationship between beliefs regarding the safety of energy drinks, energy drink consumption frequency, and personal beliefs regarding supplements [r(202) = -0.23]. The negative correlational coefficient indicated an inverse relationship between favorable perceptions on supplements and energy drink consumption. DISCUSSION: This study assessed beliefs about the safety of nutritional supplements among API candidates and to examine if a relationship between nutritional supplement beliefs and energy drink consumption exists. Results indicated a significant inverse relationship between API candidates' beliefs regarding consumption frequency and safety of energy drinks as well as beliefs regarding supplement use. Results also suggested that the more positively an API candidate perceived nutritional supplements, the less frequently energy drinks were consumed. The findings of this study indicated a weak inverse relationship between the beliefs/use of energy drinks and beliefs regarding the effectiveness of nutritional supplement use among naval aviation candidates.Sather TE, Woolsey CL, Delorey DR, Williams RD Jr. Energy drink and nutritional supplement beliefs among naval aviation candidates. Aerosp Med Hum Perform. 2018; 89(8):731-736.

Energy Beverage Use Among U.S. Service Members.

INTRODUCTION: The use of energy drinks (ED) or shots (ES) is becoming increasingly popular in U.S. beverage market. In addition, young, physically active males, such as active-duty enlistees represent a prime target for the advertising of ED/ES; however, the exact mechanisms and safety of these products have come under scrutiny. This cross-sectional, exploratory, web-based survey among U.S. service members describes the prevalence of ED/ES use as well as common side effects and safety of these products among self-reported users. MATERIALS AND METHODS: A convenience sample of U.S. military members (n = 1,706; response rate = 7%) was used to conduct a cross-sectional, exploratory, web-based survey of ED/ES usage among U.S. military members. Main outcome measures included: (1) prevalence of ED/ES use, (2) perceived effects associated with use, and (3) differences among subgroups. RESULTS: Among all respondents, 50% reported consuming ED and 16% reported consuming ES at least once a month. Young, male, enlisted and members of operational military units were significantly more likely to indicate use of ED/ES at least once within the past 30 days than other groups, and were more likely to co-ingest ED and alcohol. Self-reported reasons for using ED included needing an energy boost (77%) and increasing mental alertness (52%). Perceived increases in mental alertness, heart rate, and mental endurance were the most commonly reported effects of ED/ES consumption. About a third (36%) perceived energy beverages and dietary supplements to be safe; while more than half (53%) reported not discussing ED, ES, vitamins/minerals, DS, caffeine, or alcohol use with their healthcare provider(s). CONCLUSION: Military Service members fit the targeted age and gender demographic of many marketing campaigns for ED/ES products, and many perceive these beverages as safe to use. The possible problems associated with overuse/reliance on ED/ES products, particularly relating to operational force readiness, merit further investigation.

Energy drink and ginseng consumption by Italian university students: a cross-sectional study.

INTRODUCTION: The consumption of energy drinks (ED) and ginseng by young people to enhance their mental and physical performance has become widespread. Reported side-effects of ED have raised doubts regarding their safety. This cross-sectional study investigates the phenomenon. METHODS: An anonymous questionnaire was administered to a representative sample of Verona university students. The resulting data were analyzed with Excel 2013, STATA 13 software. RESULTS: ED and ginseng consumption was reported by 38.6% and 37.4% of the students, respectively. More than 70% of ED and ginseng users were 18 to 22 years old. Excluding non-responders, ED consumers were mostly males (51.8% vs 33.0%), contrary to ginseng consumers (females 40.4% vs 30.9%). Being a working student was significantly positively associated both to EDs (OR 1.5) and ginseng use (OR 1.4). The most frequently reported academic and other reasons for ED use were: "to study longer" (47.5%), and "to socialize" (29.1%). The most often used combinations were ED containing alcohol (65.6%) and ginseng-coffee beverages (71.8%). CONCLUSIONS: The diffusion of ED and ginseng consumption warrants prevention and monitoring measures, and deserves further analysis.

Cálculo de ingesta de cafeína en estudiantes de etapa escolar y de educación superior de San Salvador de Jujuy, Argentina / Calculation of caffeine intake in students of school and higher education in San Salvador de Jujuy, Argentina

La cafeína es una de las sustancias psicoactivas más consumidas en todo el mundo; se encuentra presente en chocolates, bebidas colas, bebidas energéticas, café e infusiones, actúa sobre el sistema nervioso central. Su consumo elevado puede provocar irritabilidad, palpitaciones, temblores y convulsiones. El objetivo del trabajo ha sido determinar y comparar las ID de cafeína de niños de etapa escolar y estudiantes de educación superior de San Salvador de Jujuy, para establecer el nivel de exposición, a partir de la cuantificación de cafeína en los alimentos más consumidos en ambos grupos. Se realizaron 240 encuestas en 6 escuelas primarias y 4 instituciones de nivel superior, para conocer la ingesta de cafeína y las principales fuentes de cafeína. Se realizó la determinación de cafeína en bebidas de cola, de chocolate, e infusiones (té, mate, mate cebado y café) de las marcas más consumidas y disponibles en los supermercados, la extracción se realizó con cloroformo y la determinación analítica mediante espectrofotométrica U.V - visible." Las ingestas diarias se calcularon, considerando los volúmenes de bebidas e infusiones consumidas, los pesos corporales de cada niño y joven-adulto encuestado y la concentración de cafeína aportados por los alimentos. Las bebidas colas presentaron concentraciones de cafeína entre 0,03 y 0,19 mg/L; las infusiones de 0,15-0,67 "mg/L"; las chocolatadas 0,03-0,06"mg/L"; el mate cebado 0,67"mg/L"; bebidas energéticas 0,35"mg/L". Las IDEt promedio en mg/día en las niñas fueron de 321,71"mg/L"; en los niños de 314,7"mg/L"; en jóvenes adultas de 420 "mg/L" y jóvenes adultos de 379,8"mg/L". El promedio de IDEt (mg/Kg pc/día) para niños fue de 7,07 "mg/L" y para adultos de 6,4"mg/L". Se concluye que la población infantil presenta una ID de cafeína mayor a los adultos y los posiciona como consumidores moderados a altos de cafeína. El té fue el principal contribuyente de cafeína en ambas poblaciones

Caffeine is one of the most consumed psychoactive substances in the world; It is present in chocolates, cola drinks, energy drinks, coffee and infusions, acts on the central nervous system. Its high consumption can cause irritability, palpitations, tremors and convulsions. The aim of this study was to determine and compare the caffeine ID of school children and higher education students of San Salvador de Jujuy, to establish the level of exposure, from the quantification of caffeine in the foods most consumed in both groups. 240 surveys were conducted in 6 primary schools and 4 institutions of higher level, to know the intake of caffeine and the main sources of caffeine. The determination of caffeine in cola beverages, chocolate, and infusions (tea, mate, mate cebado and coffee) of the brands most consumed and available in supermarkets, the extraction was made with chloroform and the analytical determination by UV spectrophotometry - visible. ".The daily intakes were calculated, taking into account the volumes of beverages and infusions consumed, the body weights of each child and young adult surveyed and the concentration of caffeine provided by the food. The cola drinks presented caffeine concentrations between 0.03 and 0.19 mg / L; the infusions of 0.15-0.67 "mg / L"; chocolate bars 0.03-0.06 "mg / L"; the primed mate 0.67 "mg / L"; energy drinks 0.35 "mg / L". The mean IDEt in mg / day in girls was 321.71 "mg / L"; in children 314.7 "mg / L"; in young adults of 420 "mg / L" and young adults of 379.8 "mg / L". The average IDEt (mg / Kg pc / day) for children was 7.07 "mg / L" and for adults 6.4 "mg / L". It is concluded that the infant population has a higher caffeine ID than adults and positions them as moderate to high caffeine consumers. Tea was the main contributor of caffeine in both populations

Nutritional supplement practices of professional Ugandan athletes: a cross-sectional study.

BACKGROUND: The use of nutritional supplements (NS) places athletes at great risk for inadvertent doping. Due to the paucity of data on supplement use, this study aimed to determine the proportion of Ugandan athletes using nutritional supplements and to investigate the athletes' motivation to use these supplements. METHODS: A cross-sectional study was conducted in which an interviewer-administered questionnaire was used to collect data from 359 professional athletes participating in individual (boxing, cycling, athletics) and team (basketball, rugby, football, netball, and volleyball) sports. The data were categorized, and a Chi-square test was used for statistical analysis. RESULTS: Of the 359 athletes, 48 (13.4%) used nutritional supplements. Carbohydrate supplements, energy drinks, vitamin and mineral supplements, fish oils, and protein supplements were the most common supplements used by athletes. NS use was significantly more common among athletes who played rugby and basketball (X2 = 61.101, p < 0.0001), athletes who had played the sport for 5-10 years (X2 = 7.460, p = 0.024), and athletes who had attained a tertiary education (X2 = 33.377, p < 0.0001). The athletes' occupation had no bearing on whether they used supplements. Nutritionists/dieticians, retail stores and pharmacies were the most common sources of NS products, whereas health practitioners, online media and teammates were the most common sources of information regarding NS. Most athletes used NS to improve their physical performance and health. CONCLUSIONS: Compared to NS use by athletes elsewhere, NS use among Ugandan athletes was low. However, determinants of athlete NS use in the current study (category of sport and duration of time spent playing the sport) are similar to those reported elsewhere.

Influence of knowledge and beliefs on consumption of performance enhancing agents in north-western Saudi Arabia.

BACKGROUND: Consumption of performance enhancing agents (PEAs) has a wide range of negative health consequences, but knowledge of these consequences among gym users of PEAs in Saudi Arabia is not well understood. OBJECTIVES: Identify the knowledge, awareness, beliefs and attitudes of gym users about negative health consequences of using PEAs, and the relationship between these factors and use of these agents. DESIGN: Cross-sectional study. SETTING: Five gyms in Madinah city, Saudi Arabia. SUBJECTS AND METHODS: Convenience sampling was used to recruit gym users. An electronic self-administered questionnaire was used to collect data. MAIN OUTCOME MEASURE(S): Level of knowledge about the negative health consequences of PEAs among gym users. RESULTS: About 70% of 316 participants had used one or more of PEAs over the last six months. Of those, about 68.4% used protein powder supplements and 48.1% used energy drinks. Participants who believed that protein powder supplements (c2=52.3, P < .01) and energy drinks (c2=35.2, P < .01) had health hazards used these agents less often than others during the six months preceding data collection. Participants who had less knowledge about the negative health consequences were more likely to use protein powder supplement (t=2.38, P=.018). On the other hand, those who were more knowledgeable about the negative health consequences of insulin, were more likely to use insulin (t=2.45, P=.015). CONCLUSION: Misuse of PEAs is widespread among gym users in Saudi Arabia. Improving the level of knowledge and awareness of possible serious health consequences would hopefully lead to reduced PEA consumption. LIMITATIONS: The temporal sequence of cause and effect could not be determined in a cross sectional study. Convenience sampling in a single city limited the generalizability of the findings to all regions of Saudi Arabia.

Demographic, Lifestyle Factors, and Reasons for Use of Dietary Supplements by Air Force Personnel.

BACKGROUND: Dietary supplement (DS) use is common among U.S. Army personnel to purportedly improve health, provide energy, and increase strength. However, a comprehensive analysis of DS use among U.S. Air Force (USAF) personnel has not been conducted using the same survey instrument, which would permit direct comparisons to DS use by Army personnel. METHODS: A standardized questionnaire was used to assess DS use, demographic factors, and reasons for use of DS by USAF personnel (N = 1750). Logistic regression models adjusted for age, sex, and rank were used to determine relationships among categories of DS (multivitamin and multimineral, individual vitamins and minerals, protein/amino acid supplements, combination products, herbal supplements, purported steroid analogs, and other) and demographic factors. Findings were compared to reports from other military services and civilian populations. RESULTS: DS were used by 68% of USAF personnel: 35% used 1-2 DS ≥ 1 time/wk, 13% 3-4 DS ≥ 1 time/wk, and 20% ≥ 5 DS ≥ 1 time/wk. There were 45% of personnel who used a multivitamin and mineral, 33% protein supplements, 22% individual vitamins/minerals, 22% combination products, and 7% herbals. Logistic regression demonstrated aerobic exercise duration and strength training were associated with increased DS use. Individuals who previously deployed were more likely to use DS. CONCLUSIONS: Like Army personnel, college students and athletes, USAF personnel use more DS than the general population and are more likely to use purported performance enhancing DS, such as protein supplements, and concurrently consume multiple DS. Austin KG, Price LL, McGraw SM, Leahy G, Lieberman HR. Demographic, lifestyle factors, and reasons for use of dietary supplements by Air Force personnel. Aerosp Med Hum Perform. 2016; 87(7):628-637.

Sources of Caffeine in Diets of US Children and Adults: Trends by Beverage Type and Purchase Location.

New sources of caffeine, besides coffee and tea, have been introduced into the US food supply. Data on caffeine consumption age and purchase location can help guide public health policy. National Health and Nutrition Examination Surveys (NHANES) were used to estimate population-level caffeine intakes, using data from 24-h dietary recall. First, caffeine intakes by age-group and beverage type were estimated using the most recent 2011-2012 data (n = 7456). Second, fourteen years trends in caffeine consumption, overall and by beverage type, were evaluated for adults and children. Trend analyses were conducted by age groups. Last, trends in caffeine intakes by purchase location and beverage type were estimated. In 2011-2012, children aged four to eight years consumed the least caffeine (15 mg/day), and adults aged 51-70 years consumed the most (213 mg/day). The population mean (age ≥ four years) was 135 mg/day, driven largely by coffee (90 mg/day), tea (25 mg/day), and soda (21 mg/day). For the 14-19 years and 20-34 years age-groups, energy drinks contributed 6 mg/day (9.9%) and 5 mg/day (4.5%), respectively. The bulk of caffeine came from store-bought coffee and tea. Among both children and adults combined, caffeine intakes declined from 175 mg/day (1999-2000) to 142 mg/day (2011-2012), largely driven by a drop in caffeine from soda (41 mg/day to 21 mg/day). Store-bought coffee and tea remain principal drivers of caffeine intake in the US. Sodas and energy drinks make minor contributions to overall caffeine intakes.

Associations between smoking and caffeine consumption in two European cohorts.

AIMS: To estimate associations between smoking initiation, smoking persistence and smoking heaviness and caffeine consumption in two population-based samples from the Netherlands and the United Kingdom. DESIGN: Observational study employing data on self-reported smoking behaviour and caffeine consumption. SETTING: Adults from the general population in the Netherlands and the United Kingdom. PARTICIPANTS: Participants from the Netherlands Twin Register [NTR: n = 21 939, mean age 40.8, standard deviation (SD) = 16.9, 62.6% female] and the Avon Longitudinal Study of Parents and Children (ALSPAC: n = 9086, mean age 33.2, SD = 4.7, 100% female). MEASUREMENTS: Smoking initiation (ever versus never smoking), smoking persistence (current versus former smoking), smoking heaviness (number of cigarettes smoked) and caffeine consumption in mg per day through coffee, tea, cola and energy drinks. FINDINGS: After correction for age, gender (NTR), education and social class (ALSPAC), smoking initiation was associated with consuming on average 52.8 [95% confidence interval (CI) = 45.6-60.0; NTR] and 59.5 (95% CI = 51.8-67.2; ALSPAC) mg more caffeine per day. Smoking persistence was also associated with consuming more caffeine [+57.9 (95% CI = 45.2-70.5) and +83.2 (95% CI = 70.2-96.3) mg, respectively]. Each additional cigarette smoked per day was associated with 3.7 (95% CI = 1.9-5.5; NTR) and 8.4 (95% CI = 6.9-10.0; ALSPAC) mg higher daily caffeine consumption in current smokers. Smoking was associated positively with coffee consumption and less strongly with cola and energy drinks. For tea, associations were positive in ALSPAC and negative in NTR. CONCLUSIONS: There appears to be a positive association between smoking and caffeine consumption in the Netherlands and the United Kingdom.

An examination of the nutrient content and on-package marketing of novel beverages.

Changing regulatory approaches to fortification in Canada have enabled the expansion of the novel beverage market, but the nutritional implications of these new products are poorly understood. This study assessed the micronutrient composition of energy drinks, vitamin waters, and novel juices sold in Canadian supermarkets, and critically examined their on-package marketing at 2 time points: 2010-2011, when they were regulated as Natural Health Products, and 2014, when they fell under food regulations. We examined changes in micronutrient composition and on-package marketing among a sample of novel beverages (n = 46) over time, compared micronutrient content with Dietary Reference Intakes and the results of the 2004 Canadian Community Health Survey to assess potential benefits, and conducted a content analysis of product labels. The median number of nutrients per product was 4.5, with vitamins B6, B12, C, and niacin most commonly added. Almost every beverage provided at least 1 nutrient in excess of requirements, and most contained 3 or more nutrients at such levels. With the exception of vitamin C, there was no discernible prevalence of inadequacy among young Canadian adults for the nutrients. Product labels promoted performance and emotional benefits related to nutrient formulations that go beyond conventional nutritional science. Label graphics continued to communicate these attributes even after reformatting to comply with food regulations. In contrast with the on-package marketing of novel beverages, there is little evidence that consumers stand to benefit from the micronutrients most commonly found in these products.

Estimating caffeine intake from energy drinks and dietary supplements in the United States.

No consistent definition exists for energy products in the United States. These products have been marketed and sold as beverages (conventional foods), energy shots (dietary supplements), and in pill or tablet form. Recently, the number of available products has surged, and formulations have changed to include caffeine. To help characterize the use of caffeine-containing energy products in the United States, three sources of data were analyzed: sales data, data from federal sources, and reports from the Drug Abuse Warning Network. These data indicate that sales of caffeine-containing energy products and emergency room visits involving their consumption appear to be increasing over time. Data from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 indicate that 2.7% [standard error (SE) 0.2%] of the US population ≥1 year of age used a caffeine-containing energy product, providing approximately 150-200 mg/day of caffeine per day in addition to caffeine from traditional sources like coffee, tea, and colas. The highest usage of these products was among males between the ages of 19 and 30 years (7.6%, SE 1.0). Although the prevalence of caffeine-containing energy product use remains low overall in the US population, certain subgroups appear to be using these products in larger amounts. Several challenges remain in determining the level of caffeine exposure from and accurate usage patterns of caffeine-containing energy products.

Energy drink and energy shot use in the military.

Use of energy drinks and energy shots among military personnel is controversial. High amounts of caffeine (the primary active ingredient in these products) may impact performance of military duties. The impact of caffeine overconsumption and potential subsequent side effects that might be experienced by service members with unique roles and responsibilities is a concern. Reported here are the prevalence of use, reasons for use, and side effects associated with consumption of energy drinks and energy shots among several populations of active duty personnel in the US military. A snowball survey was sent to over 10,000 active duty personnel. A total of 586 (∼6% response rate) individuals completed a 30-item electronic survey. Over half of respondents (53%) reported consuming an energy drink at least once in the past 30 days. One in five (19%) reported energy shot consumption in the prior 30 days. One in five (19%) also reported consuming an energy drink in combination with an alcoholic beverage. Age and gender were significantly associated with energy drink consumption. Young male respondents (18-29 years) reported the highest use of both energy drinks and energy shots. Among those reporting energy drink and energy shot use, the most common reasons for consumption were to improve mental alertness (61%) and to improve mental (29%) and physical (20%) endurance. Nearly two-thirds (65%) of users self-reported at least one side effect. The most commonly reported side effects included increased pulse rate/palpitations, restlessness, and difficulty sleeping. Use of energy products among military personnel is common and has the potential to impact warrior health and military readiness.