Use of energy drinks among children and adolescents – a cause for concern?

The use of EDs is widespread among adolescents and contributes with caffeine amounts associated with adverse health effects. Regulatory measures to limit the ED sale to adolescents are needed.

Background
Energy drinks (EDs) are non-alcoholic beverages with high caffeine content (320 mg per litre). Caffeine is a stimulant not suitable for children and adolescents in high doses because they tolerate less caffeine than adults, mainly due to lower body weight. Also, they are in a critical phase for physical, mental and brain development. ED consumption in children and adolescents is associated with sleep disturbance, higher level of stress, anxiety, and depression. The increasing sale and popularity of EDs in recent years and their potential health risks due to high caffeine content and low pH causing dental erosion, highlight the need for surveillance. The aim of this study was to assess the prevalence of current ED consumption and changes in ED use in recent years, in Norwegian children and adolescents aged 10-18 years.
Methods
We used data from two nationally representative surveys. In Ungdata, a total of 301,992 pupils in lower (~13-15 years) and upper secondary schools (~16-18 years) had answered the question “how often do you drink energy drinks?” in years 2017 to 2022. Additionally, FHI conducted a survey including 1,748 participants aged 10-18 years in June 2023 asking about use of EDs, high intakes, attitudes, influencing factors and perceived health effects.
Results
There was a significant increase in the proportion of ED consumers and frequency of intake among consumers from 2017 to 2022. In 2022, the prevalence of any ED use was 58% (95%CI: 57-59%) in 13-15-years-old adolescents and 36% (95%CI: 35-37%) reported weekly ED intake. These proportions were significantly higher in 16-18-year-olds. Among ED consumers, the average intake frequency was 2.4 times/week in 13-15-year-olds and 3.1 times/week in 16-18-year-olds. The ED survey in 2023 showed lower prevalence of ED consumption in 10-12-year-olds compared to older groups (16% reported any use and 2% reported weekly use). Among 10-18-year-old ED-consumers, the preferred can size was 500 mL in all age groups, and 33% responded that they had at least once consumed three or more cans within 24 hours. One in three had experienced adverse effects after ED intake, while 24% reported having experienced discomfort or other symptoms of dependency when not drinking EDs.
Conclusion
The use of EDs among adolescents in Norway is a cause for concern as both the proportion of users and the frequency of ED consumption are high and increasing. A significant number of adolescents have reported consuming high quantities of ED within a 24-hour period. The caffeine content in a single 500 mL can exceeds the tolerance level for sleep disturbances in persons younger than 18 years and will also surpass the tolerance level for general negative health effects in individuals weighing 53 kg or less.