Energy Drinks and Their Adverse Health Effects: A Systematic Review and Meta-analysis

Abstract

Context: Energy drinks are the fastest growing product in the beverage industry. However, there is concern regarding potential for adverse effects with use.

Objective: To evaluate the reported adverse effects of energy drink consumption.

Data sources: The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies from inception to November 2019, and pertinent data were abstracted.

Study selection: Only clinical studies reporting adverse events after energy drink consumption were included.

Study design: Systematic review.

Level of evidence: Level 4.

Data extraction: Data regarding sample size characteristics, energy drink characteristics, comparators, and all adverse events were extracted in duplicate and recorded.

Results: A total of 32 studies and 96,549 individuals were included. Frequently reported adverse events in the pediatric population were insomnia (35.4%), stress (35.4%), and depressive mood (23.1%). Frequently reported adverse events in the adult population were insomnia (24.7%), jitteriness/restlessness/shaking hands (29.8%), and gastrointestinal upset (21.6%). Alcohol mixed with energy drinks significantly reduced the likelihood of sedation effects but increased the likelihood of stimulatory effects. Energy drink consumption significantly increased the odds of insomnia (OR, 5.02; 95% CI, 1.72-14.63) and jitteriness/activeness (OR, 3.52; 95% CI, 1.28-9.67) compared with the control group.

Conclusion: The authors recommend that individuals avoid frequent energy drink consumption (5-7 energy drinks/week) and avoid co-consumption with alcohol; increased regulatory standards should be placed in the sale of energy drinks, particularly with regard to the pediatric population.

Keywords: adverse events; caffeine; energy drink; safety.

Figure 1.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) scheme of retrieved literature.

Figure 2.

Frequencies of energy drink consumption (n = 92,006). ED, energy drinks.

Figure 3.

Co-ingestants reported with consumption of energy drinks (n = 6796). AmED, alcohol mixed with energy drinks.

Figure 4.

Rates of the most frequently reported adverse event per organ system in the pediatric, adult, and total populations. GI, gastrointestinal; MSK, musculoskeletal.

Figure 5.

Meta-analysis forest plots evaluating the odds of (a) headaches, (b) insomnia, (c) jitteriness/activeness, (d) tachycardia/palpitations, (e) muscular pain, (f) anxiety/nervousness, and (g) abdominal pain with energy drink consumption compared with control. M-H, Mantel-Haenszel test.