Consumption of caffeinated energy drinks rises in the United States

A new study in the American Journal of Preventive Medicine examines the growing trend and recommends actions to minimize its risks


Ann Arbor, April 29, 2019

According to a new study appearing in the American Journal of Preventive Medicine, published by Elsevier, energy drink consumption in the United States has increased substantially over the past decade among adolescents, young adults, and middle-aged adults. Energy drink consumers had significantly higher total caffeine intake compared with non-consumers and the beverages represented a majority of their total daily caffeine. While the findings indicate that daily intake among adolescents and middle-aged adults may be leveling off and overall use across all groups is relatively limited, use by young adults continues to steadily rise.

“The increasing use of energy drinks, especially among young adults, is cause for concern and warrants continued study and surveillance,” explained senior author Sara N. Bleich, PhD, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA. “Although the beverages are marketed to reduce fatigue and improve physical and mental performance, frequent consumption of these highly caffeinated and sugary beverages has been linked to negative health consequences.”

Energy drinks are non-alcoholic beverages that contain caffeine, other plant-based stimulants (e.g., guarana), amino acids (e.g., taurine), herbs (e.g., ginkgo biloba), and vitamins. Introduced to US markets in 1997, their caffeine content ranges from 50 mg to 500 mg per serving, compared to 95 mg for an eight-ounce cup of coffee. Although moderate caffeine intake (up to 400 mg/day for adults and 100 mg/day for teens) is considered safe, higher volumes may increase the possibility that individuals will engage in risk-seeking behaviors, experience mental health strains like increased depression, and/or adverse cardiovascular effects like increased blood pressure. Added sugar in many of the energy drinks may also increase risk for obesity, type 2 diabetes, and dental caries. Mixing energy drinks with alcohol, which is growing in popularity among young adults, can lead to overconsumption of alcohol and incidence of alcohol-related events (e.g., car accidents).

Although US Food and Drug Administration (FDA) regulations require that energy drink labels indicate if the product contains caffeine, the FDA does not impose a caffeine limit or require reporting of the actual level of caffeine. While some energy drink companies are taking part in voluntary labeling initiatives, Dr. Bleich noted, “Our findings point to the need for an evidence-based upper caffeine limit and consistent labeling on these beverages to reduce the potential negative health impact on consumers.”

The study’s objective was to provide national estimates of the percentage of energy drink consumers in the US by age group (adolescents, young adults, and middle-aged adults), as well as analyze trends in energy drink consumption between 2003 and 2016. The investigators also examined the differences in the prevalence of energy drink consumption by demographic characteristics (age category, sex, race/ethnicity, and educational attainment), and compared total caffeine intake between energy drink consumers and non-consumers.

The analysis used data from the National Health and Nutrition Examination Survey (NHANES), a repeated cross-sectional study that is representative of the American non-institutionalized population. The study sample included data for 2003–2016 from 9,911 adolescents, 12,103 young adults, and 11,245 middle-aged adults. Because it was necessary to pool data across the seven survey cycles to ensure a sufficient analytic sample, it was only possible to examine differences in the prevalence of energy drink consumption by sex, race/ethnicity, and educational attainment category for all years combined.

From 2003 to 2016, the prevalence of energy drink consumption on a typical day increased significantly for adolescents (0.2 percent to 1.4 percent); young adults (0.5 percent to 5.5 percent); and middle-aged adults (0.0 percent to 1.2 percent). Per capita consumption of energy drinks increased significantly from 2003 to 2016 only for young adults (1.1 to 9.7 calories). Pooled across years, energy drink consumers had significantly higher total caffeine intake compared with non-consumers for adolescents (227.0 mg vs 52.1 mg); young adults (278.7 mg vs 135.3 mg); and middle-aged adults (348.8 mg vs 219.0 mg).
Line graph showing the prevalence of engergy drink consumption for adolescents (solid black line); young adults (dotted line); and middle-aged adults (dash line).
Prevalence of energy drink consumption for adolescents, young adults, and middle-aged adults, 2003–2016. Note: Prevalence includes consumption of both full-calorie and diet energy drinks. The following covariates were included in all age-stratified models: sex (male, female); race/ethnicity (non-Hispanic white, non-Hispanic black, Mexican American, other Hispanic, other race/ethnicity); and education status (less than high school, high school graduate or GED, more than high school graduate). For adolescents, education status refers to the education of the primary household respondent.

Notably, middle-aged Mexican Americans and young adults with low educational attainment were found to have the highest prevalence of energy drink consumption. “This important finding signals the need for targeted policy and programmatic efforts among these groups,” added Dr. Bleich.

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Notes for editors
The article is “Trends in Energy Drink Consumption Among U.S. Adolescents and Adults, 2003–2016,” by Kelsey A. Vercammen, MSc, J. Wyatt Koma, BS, and Sara N. Bleich, PhD (https://doi.org/10.1016/j.amepre.2018.12.007). It appears in advance of the American Journal of Preventive Medicine, volume 56, issue 6 (June 2019) published by Elsevier.

Full text of this article is available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or ajpmmedia@elsevier.com. Journalists who wish to interview the authors should contact Sara N. Bleich at sbleich@hsph.harvard.edu.

About the American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

Media contact
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