An assessment of potential adverse health effects as a result of the consumption of energy drinks by children and adolescents
Report no: 2019:01
Children and adolescents who drink large portions of energy drinks containing caffeine, especially if consumed within a short period of time, can have problems sleeping and can experience anxiety and cardiovascular effects. Occasional consumption by young people of small amounts of caffeinated energy drinks, however, is not associated with negative health effects.
These are some of the conclusions of the risk assessment of energy drinks and caffeine that the Norwegian Scientific Committee for Food and the Environment (VKM) has done for the Norwegian Food Safety Authority.
Consumption of caffeine above 1.4 milligrams (mg) per kilogram of body weight per day may pose a risk of sleep disturbance. If the intake is above 3 mg per kilogram of body weight per day, there is a risk of general adverse health effects such as effects on the cardiovascular and central nervous system.
How much caffeine is there in energy drinks, and how much can a child or adolescent safely drink?
Different energy drinks may contain different amounts of caffeine. Several energy drinks contain 32 mg caffeine per deciliter (1 dl = 100 ml). This is equivalent to 160 mg caffeine in a half-liter can and 80 mg caffeine in a 250 ml can. This means that for children weighing around 30 kg, half a 250 ml can per day is all they can safely drink. A youth weighing about 60 kg can drink the entire can without it being likely to affect the quality of their sleep.
About the risk assessment
The Royal Norwegian Ministry of Health and Care Services asked the Norwegian Food Safety Authority (NFSA) to investigate and recommend measures to protect children and adolescents from adverse health effects caused by a high consumption of energy drinks. The NFSA requested the Norwegian Scientific Committee for Food and Environment (VKM) to assess potential adverse health effects of energy drinks and caffeine in children and adolescents.
The population groups included in the current assessment are children and adolescents aged 8 to 18 years old. Possible effects of energy drinks with caffeine on pregnant and lactating women, foetuses, and children aged 0 to 7 years are not assessed.
Data from the following studies and surveys were used to estimate energy drink consumption for different drinking patterns: The Ungkost 3 study, the Norwegian Consumer Council study, the follow-up study to the Norwegian Mother and Child Cohort Study, and the Ungdata survey. Median chronic (regular) consumption of energy drinks was estimated to be in the range of less than 1 to 81 ml per day, and high chronic intake (high regular; 95-percentile) varied from 114 to 418 ml per day. The highest acute (24-hour, short-term) intake ranged from 400 ml among children aged 8-9 in the Ungkost 3 study, to 10 liters consumed by one participant (16-18-year age group) in the Norwegian Consumer Council study.
Data from the Ungkost 3 study and the Norwegian Consumer Council study were also used to estimate caffeine exposure from other food and beverages containing caffeine.
The hazard assessment was based on risk assessments, reports, and randomised, controlled trials (RCTs) published in the period 2013 to 2018. Literature searches were performed by an expert librarian and the publication selection was based on predefined criteria. Risk of bias and the confidence in the evidence of the RCTs were evaluated.
The regular* daily intake of energy drinks was from 1 to 81 ml, whereas a high regular, ** daily intake was 114 to 418 ml for the 8- to 18-year-olds. The highest acute intake, that is the highest reported acute intake within a 24-hour period reported in each study and age group, was 400 ml in the age group 8-9 and 10 liters in the age group 16-18. These amounts form the basis of the conclusions below.
The highest acute intake of energy drinks containing 32 mg caffeine per dl, consumed within a short time, e.g. during a 24-hour period, may pose a risk of sleep disturbances and other general adverse health effects in 8- to 18-year-olds. A regular intake poses little or no risk in this age group. A high regular intake poses low or no risk for 8- to 12-year-olds, while for 13- to 18-year-olds it may pose a risk of sleep disturbances.
Children and adolescents who consume energy drinks tend to have a higher caffeine intake than youths who do not consume energy drinks. That is, children and young people who consume energy drinks also seem to consume more of other foods and drinks containing caffeine than do youths who don’t consume energy drinks. This conclusion is based on the average daily caffeine intake for the population studied.
A regular intake of caffeine from food and drinks, except for from soft drinks (Ungkost 3 study), represented little or no risk to 8- to 18-year-olds. A high regular intake of caffeine from beverages other than from energy drinks (Norwegian Consumer Council investigation) may pose a risk for sleep disturbance to 16- to 18-year-olds. The same goes for 13- to 15-year-olds, but only for those who drink energy drinks. For 10- to 12-year-olds, a high regular intake may pose a risk to both sleep disturbance and other general adverse health effects, but again this applies only to the group that drinks energy drinks. Note that in this study, the participants in the age group 10-12 are too few for us to conclude with certainty about how high intake of energy drinks may affect them.
* Regular intake is the middle value, also called the median
** High regular intake is the 95 percentile
The panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food, and Cosmetics is responsible for the assessment published on 1 February 2019.