DOI: 10.1515/cipms-2016-0040
Curr. Issues Pharm. Med. Sci., Vol. 29, No. 4, Pages 190-194
Current Issues in Pharmacy and Medical Sciences
Formerly ANNALES UNIVERSITATIS MARIAE CURIE-SKLODOWSKA, SECTIO DDD, PHARMACIA
journal homepage: http://www.curipms.umlub.pl/
Energy drinks – consumption and awareness among students
of Medical University of Lublin
Piotr Cencek, Ewelina Wawryk-Gawda*, Patryk Samborski, Barbara Jodlowska-Jedrych
Chair and Department of Histology and Embryology with Experimental Cytology Unit, Medical University of Lublin, Radziwiłłowska 11,
20-080 Lublin, Poland
ARTICLE INFO
Received 05 July 2016
Accepted 20 October 2016
Keywords:
energy drink,
students,
caffeine,
taurine.
ABSTRACT
Energy drinks (ED), containing caffeine, taurine and another substances, are one of
the more frequently used legal stimulants. Still, because these can endanger consumers'
health, it is thought that their marketing should be legally controlled.
In our study, we analyzed the frequency of energy drink consumption, as well as the
knowledge held about these drinks among medicine and dentistry students of the Medical
University of Lublin. In the study, 131 students participated, and the study was done in
the form of a survey. The results of this indicate that 81 students (61.83%) declared a daily
consumption, and most respondents (78.48%) stated at least a one time consumption of
250 to 749 ml of energy drink. What is more, 26.25% of respondents combined ED with
other substances, most frequently with coffee and alcohol. Regarding knowledge of ED
effects, contents and side effects, more males than females actively sought and held this
information. Furthermore, more than half of all respondents believed that the availability
of EDs in Poland should be limited.
Our study showed that the awareness of the effects and mechanisms of action of EDs,
among the questioned students is relatively high. Nevertheless, they frequently consume
EDs and combine these with other stimulants.
INTRODUCTION
Energy drink (ED) products are carbonated, stimulantladen beverages. They most frequently contain taurine,
arginine, caffeine, acidity regulators, various B vitamins,
vitamin C, herbal extracts, and sugar, as well as other sweetening substances. Many authors observe that the caffeine
content of EDs is usually higher than that of a cup of coffee
[2,21]. In Poland, energy drinks contain an average 32 mg
of caffeine in 100 ml of drink, but additional amounts of
caffeine can be found in the other ingredients of EDs, among
these, kola nuts, guarana or yerba mate [17]. Regardless of
the analyzed caffeine contents, EDs are usually consumed
in larger quantities than coffee or other stimulating drinks.
Moreover, the typical consumer of EDs are young people
or even children. The caffeine and taurine contents of EDs
purportedly assist in focusing attention, enhance the general
mental functional capacity, and reduce the feeling of fatigue.
This is why EDs are popular among people involved in hard
physical labour, or those who wish to stay alert for longer
periods of time, e.g. drivers, and students while studying.
* Corresponding author
e-mail: ewelina.wawryk@wp.pl
190
EDs are also popular at parties. These are frequently mixed
with alcohol in order to enhance their effect. This action
can result in an overdose, impaired cognitive functions
and weaker symptoms of alcoholic intoxication [17,18].
Still, frequent consumption of EDs in large quantities may
be dangerous for the health or life of the consumer. The
observed side effects of ED over-consumption include: headaches, heart palpitations and arrhythmia, digestive system
disorders, breathing problems and liver or kidney disorders [6,8,15,16,20]. Consumption by children may induce
osseous mass effects, insomnia, cardiovascular diseases
and mood and behavioral disorders [6,17,20]. According
to current literature, the risk of negative consequences is
higher in certain populations, including children, pregnant
women (risk of late miscarriages, impaired fetal growth)
and people with underlying cardiac conditions or diabetes
mellitus. Despite the possibility of serious consequences,
EDs in Poland are sold in most grocery stores or general
shops, and likened as being a kind of soft drink. The annual
market share of EDs in the USA has reached 20 billion USD
[9] and in Poland, in 2013, this figure was 765 million PLN
and has increased since [7]. The phenomenal popularity of
© 2016 Medical University of Lublin. This is an open access article distributed under the Creative Commons
Attribution-NonComercial-No Derivs licence (http://creativecommons.org/licenses/by-nc-nd/3.0/)
Piotr Cencek, Ewelina Wawryk-Gawda, Patryk Samborski, Barbara Jodlowska-Jedrych
MATERIAL AND METHODS
The ED consumption survey was conducted among 96
students of Medicine and 35 students of Dentistry at the
Medical University of Lublin. It included 20 questions
referring to their personal data (age, weight, height, sex
and origin), the amount of EDs they had consumed, their
consumption style (including whether or not they mixed EDs
with alcohol or another substances), the occurrence of side
effects, and the results of their consumption. The statistical
analysis of the results was performed using Statistica 10
PL software, with the following nonparametric tests: the
chi-square test, the Mann-Whitney U test, and the Fisher
test. Statistical significance level of p ≤ 0.05 was applied
for all calculations.
(chi-square test, p=0.295261), although we observed that
the percentage of male consumers (67.31% of all men)
was higher than of women (58.23% of all women). ED
consumers presented a varied consumption pattern, that
is they consumed different quantities of EDs at different
rates. Figures 1 and 2 present the consumption frequency
and quantity. The difference between the ED consumption
frequency in the group of men and women was not statistically significant, (p>0.05 in the Mann-Whitney U test for
each interval). The consumed quantity varied from person
to person, from 200 to 2000 ml, average 454.43±282.48 ml.
The majority (78.48%) confirmed a consumption of more
than 250 to 749 ml of EDs at one time, 8.86% of all users
declared consumption under 250 ml, and more than 749
ml of asks ED consumers drank 12.66%. The difference
between one-time ED consumption quantity by the men
and women was not statistically significant (p > 0.05 in the
Mann-Whitney U test).
40%
35%
percentage of ED consumers
EDs has attracted the attention of many consumer researchers throughout the world. Those involved in such have
analyzed preferences, consumption style, reasons of consumption, as well as their impact on the general health and
mental condition. In Poland, such studies have been conducted among students of medical faculty of universities in
Lodz, Bydgoszcz and Cracow and in the University of Life
Sciences in Lublin. In our study, we assessed consumption
and the awareness concerning EDs among the 1st and 2nd
year students of Faculty of Medicine and Dentistry of the
Medical University of Lublin.
30%
25%
20%
women
15%
men
10%
5%
RESULTS
0%
every day
Vol. 29, No. 4, Pages 190-194
ED consumption frequency
Figure 1. The ED consumption frequency in the group of men and
women. The most of answered drank the ED few times per month.
The difference between the ED consumption frequency in the group
of men and women was not statistically significant
80%
70%
percentage of ED consumers
In the study, 131 students were surveyed, including 79
women and 52 men. Of these, 93 were in their 1st year,
and 38 were in their 2nd year of university. The majority
of the subjects (75.19%) were born in cities, and only
24.81% of subjects were from rural areas. The age median
was 20 (19-25 years old). Basing on the submitted weight
and height, BMI (body mass index) was calculated for
the subjects according to the formula BMI = weight [kg]/
(height [m])2. The resulting mean BMI in the subjects was
21.63±2.70 kg/m2 and ranged from 16.65 to 32.83 kg/m2.
Moreover, the majority of the subjects (77.10%) had normal
BMI (18.5-24.99 kg/m2), and included in this figure were
both women (77.22% of all women) and men (76.92% of
all men). Of note: 13.92% of all women had BMI lower
than normal (3 women were severely underweight with
the BMI of 16.0-16.99 kg/m2) [4]. As to overweight (BMI
25.0-29.99 kg/m2), we observed such in 19.23% of all men
and in 1.27% of all women. What is more, the BMI of one
man indicated obesity (BMI 32.83). Seven students did not
respond to this question.
Among the all surveyed subjects, 81 (61.83%) declared
an ED consumption. The average BMI in ED consumers
was 21.75 ± 3.04 kg/m2, and in the ED non-consumers was
21.46 ± 2.08 kg/m2. The difference was not statistically significant (Mann-Whitney test, p=0.865571). Of the urban
subjects, 65.98% confirmed ED consumption. Among the
subjects from rural areas, 50% of all people declared ED
consumption. The difference was not statistically significant
(chi-square test, p=0.106311). The correlation between consumption and sex also was also not statistically significant
few
1 time/week
few
1 time/month
few
times/week
times/month
times/year
60%
50%
40%
women
men
30%
20%
10%
0%
< 250 ml
250-749 ml
quantity of one-time ED consumption
> 750
Figure 2. The quantity of one-time ED consumption in the group
of women and the group of men
The survey also included questions concerning ED
mixing with other substances. Most of respondents declared
that they consumed EDs mixed with a few other substances.
The number of subjects declaring such are presented in
Table 1.
191
Energy drinks - consumption and awareness among students of Medical University of Lublin
Table 1. The percentage of ED consumers which mix energy
drinks with other substances
The percentage of ED consumers
Substance
p in chi-square
test
all ED
consumers
women
men
alcohol
13.75%
13.33%
14.29%
cigarettes
11.25%
11.11%
11.43%
0.964443
3.75%
0%
8.57%
0.045300
17.50%
13.33%
22.86%
0.266077
3.75%
2.22%
5.71%
0.414746
designer drugs
coffee
medication
0.902338
The data suggest a relatively infrequent mixing of EDs
with other substances. A consumption of any of the listed
substances, together with Eds, was declared by 26.25% of
those surveyed who declared an ED consumption (22.22% of
all women and 31.43% of all male consumers, p = 0.35398
in the Chi-square test). Coffee and alcohol were stated as
being consumed most frequently together with EDs.
The following questions concerned the impact of EDs on
their consumers’ health, such consumers’ knowledge about
EDs and the opinion about their accessibility (Table 2).
Almost half of all respondents believed that the availability
of ED in Poland is right, the others hold that it should be
limited.
Table 2. The experience with consumption of ED and knowledge
about these beverages in the group of men and women
Question
„Have you ever
experienced any
side effects of
EDs?”
„Have the
experienced side
effects discouraged
you from further
consumption of
EDs?”
„Do you know
the ingredients of
EDs?”
„Do you know the
effects of energy
drinks?”
“Do you know the
side effects of EDs”
„Do you think that
ED availability in
Poland is right?”
The percentage of respondents who p in chi-square
answered „YES”
test
(difference between
all
women
men
men and women)
respondents
43.21%
50.00%
34.00%
0.157278
25.71%
21.74%
33.33%
0.456308
78.63%
70.89%
90.38%
0.007733
86.26%
81.01%
94.23%
0.031553
61.83%
51.90%
76.92%
0.003919
41.75%
37.97%
50.00%
0.173450
Further questions concerned their knowledge of contraindications. The results are presented in Table 3 (this was a
multiple choice question).
Table 3. The knowledge of contraindications to energy drinks
consumption in the group of men and women
The percentage of respondents who p in chi-square
Answers for
answered „YES”
question: “For who
test
energy drinks are
(difference between
all
women
men
men and women)
contraindicated?” respondents
children under 18
65.65%
68.35%
61.54%
0.421539
years old
pregnant women
people with gastric
or duodenal
disorders
people with
hypertension
people drinking
coffee
people with
diabetes mellitus
other
192
93.89%
94.94%
92.31%
0.538675
72.52%
73.42%
71.15%
0.776424
79.23%
76.92%
82.69%
0.426964
45.80%
49.37%
40.38%
0.312695
64.89%
65.82%
63.46%
0.781768
5.8%
3.8%
5.8%
0.485735
The final part of the survey concerned the consumption preferences of the subjects. This part of the survey
included questions about the reasons for ED consumption
and the location of the purchase of EDs. For the answer to
the question about the reasons for ED consumption, the
subjects either selected from the options provided in the
survey or were allowed to give other reasons. The numbers
representing ED consumption for specific reasons are presented in Table 4.
Table 4. The reasons for ED consumption in the group of men
and women
Percentage of ED consumers which use p in chi-square
its in follows reasons
test
(difference between
all
women
men
men and women)
respondents
Reasons
improvement of
physical activity
improvement of
mental agility
overcome
sleepiness
increased
concentration span
while studying
improvement
physical ability
during sporting
events
other
reasons
8.75%
4.44%
14.29%
0.122262
46.25%
51.11%
40.00%
0.322762
75.00%
77.78%
71.43%
0.515305
30.00%
28.89%
31.43%
0.805757
2.5%
0%
5.71%
0.104377
8.75%
6.67%
11.43%
0.482259
DISCUSSION
Actual ED marketing began in Austria, in 1987, and in the
United States, in 1997, when Red Bull was introduced [6,
13]. Presently, EDs are becoming a popular consumer good
all over the world. In Poland, EDs were introduced in the
1990s, and their market share is still increasing. Their popularity (especially among young people), and their contents:
caffeine, taurine, sweetening substances, and patented herbal
extracts (of unknown effect), have made them the focus of
attention of numerous researchers. The main research tool
applied is the survey [4,11,19].
The aim of the present survey was the evaluation of the
consumption and awareness of EDs among medicine and
dentistry students in Lublin. The survey was carried out
among 131 students of the Faculty of Medicine and Dentistry of Medical University of Lublin. The data analysis
revealed that EDs are popular among the subjects, and
61.83% of the surveyed confirmed their consumption.
The acquired values are similar to those concerning other
universities and presented by other authors. Kopacz et al.
states that among the students of Warsaw University of
Life Sciences, 67% of all students surveyed consume EDs
[11]. Among the students of the Collegium Medicum of
Bydgoszcz, 73% of all students consumed ED, and, among
the students of the Medical University of Lodz, 76% take
in EDs, as shown the study of Garus-Pakowska et al. [7].
Regarding Polish adolescents of junior high schools and
senior high school attendance, 67% of all students have
declared ED consumption [17]. As to the United States of
America, the values referring to ED consumers fluctuate
from 24% (O’Brien 2008) to 70% [19], while the results of
a survey conducted among the students of the Marmara University Medical School in Istanbul, Turkey gave the result of
32 % of the survey population declaring Eds consumption.
In addition, ED consumption among medical students in
Current Issues in Pharmacy and Medical Sciences
Piotr Cencek, Ewelina Wawryk-Gawda, Patryk Samborski, Barbara Jodlowska-Jedrych
South Africa is at the level of 36% of all the student body
[12], and in Ghana [5], e ED consumption was declared by
62.2% of all students surveyed. Regarding Ed consumption,
the record-breaking results were achieved in the United Arab
Emirate, where 92% of all surveyed students declared ED
consumption [10].
The present study indicated lack of a clear correlation between the ED consumption and the sex, origin or
body weight expressed by the BMI. On the contrary, the
research conducted by Marcinkowska et al. (2014) revealed
the presence of a significant positive correlation between
the consumption of sweetened fizzy drinks and the BMI
(p=0.017) [14].
The most frequently declared reason for ED consumption among the surveyed subjects was the need to overcome
sleepiness. This reason was put forward by 75.0% of the
surveyed subjects. Thus, the need for the improvement of
mental agility was specified by 46.25% of all ED drinkers,
physical activity by 8.75% of them, and an increased concentration span while studying by 30% of all consumers. Our
observation is consistent with the survey results obtained
by other authors. Kopacz et al. reported that the need to
overcome sleepiness and to improve mental performance
were the most frequently declared reasons for ED consumption among students, especially during the examination
period [11]. Similar results were obtained by other Polish
authors. In the study of Chuda et al., 47% of all participants
consumed energy drinks in order to improve mental performance while studying and 47% did so to increase general
levels of physical and mental energy [6]. In the study of
Semeniuk, 54.7% of all students consumed ED to eliminate sleepiness, 48% of all students declared consumption
of energy drinks to improve mental performance, 32.7%
of all surveyed did so to increase the physical capacity of
the organism and 16% of the total surveyed population
consumed such for mood improvement [22]. In the study
of Garus-Pakowska et al., the participating students took in
EDs when they felt tired (35%) and during greater mental
(32%) or physical (9%) effort) [22].
Numerous studies put forward that ED consumption frequently accompanies alcohol consumption, the smoking of
cigarettes, the taking of medication, as well as other stimulating substances [3]. In the study of Nowak et al., nearly
10% of of the surveyed (teenagers) had energy drinks at
parties, and 24% admitted to mixing EDs with alcohol [17].
Of note: Gunja and Brown claim that such a situation may
be relevant for more than 1/3 of all ED consumers [8]. Allied
with the aforementioned, Garus-Pakowska indicated that
47% of the asked students drank ED together with alcohol
[7], while in the study of Chuda et al., 10% of all surveyed
students mixed EDs with alcohol [6]. In our study, 26% of
the surveyed declared a joined consumption of ED and other
stimulating substances. The latter include alcohol (13.75%),
cigarettes (11.25%), designer drugs (3.75%), coffee (17.5%)
and certain medicaments (3.75%).
The majority of all studies of energy drink consumption also dealt with an assessment of the knowledge of the
surveyed about energy drinks. This level appears to be high.
However, high knowledge about the harmfulness and about
the side effects of ED consumption does not decrease usage
Vol. 29, No. 4, Pages 190-194
of these beverages by young people. In our study, 86.26%
of all the surveyed students knew about the effects of ED
usage, 78.63% knew the ingredients of EDs, and 61.83%
knew about their side effects when consumed, while 43.21%
of all the surveyed had actual experience of some of these
side effects. Still, just 25.71% of the surveyed declared that
the experienced side effects had discouraged them from
further ED consumption.
In the study of Chuda et al., almost half (48%) of the
consumers had observed the diverse side effects of ED
consumption [6]. The most common symptoms were heart
palpitations (observed by 48% of all students surveyed) and
significant stimulation and tremors/trembling of their hands
(20%), less often, the surveyed consumers had experienced
headaches (9%), disorders of the gastrointestinal tract
and breathing problems (5%) [6]. A similar breakdown of
symptoms was seen in the study of Semeniuk. In this study,
50.7% of the respondents had observed an acceleration of
their heart rates. Moreover, 35.3% of all students surveyed
had observed excessive mental stimulation and heightened
aggression, and 34.7% had experienced sleeplessness
[22]. Observation of these worrisome symptoms tend
to expand the research regarding the increased risk of
aggressive behaviors, including unprotected sex, substance
abuse and violence within ED consumers [6]. In the
study of O’Brien et al., students who reported common
consumption of EDs had significantly higher prevalence
of alcohol-related consequences, including being taken
advantage of sexually, taking advantage of another sexually,
riding with an intoxicated driver, being physically hurt or
injured, and requiring medical treatment [18]. Publication
of the aforementioned results should be the basis for the
introduction of a limit in the ED market among some groups
of population. In the our study, we evaluated the awareness
of students concerning ED contraindications. The conviction
that EDs should not be consumed by pregnant women was
the one most frequently stated (93.89%), while hypertension
(79.23%), gastric and duodenal disorders (72.52%), and
being of an age below 18 (65.65%) or being afflicted with
diabetes mellitus (64.89%) were also enumerated as the
contraindicating factors for ED consumption. Moreover,
58.25 % of respondents think that ED marketing should be
limited.
The survey showed that the phenomenon of ED consumption is known to the students of the Medical University of Lublin. What is important, a relatively large number
of students have an awareness of the effects and possible
consequences of ED consumption, nevertheless, they have
an inclination for risky behaviors such as mixing EDs
with other stimulating substances or consuming them in
large quantities. The fact that only one half of the surveyed
subjects noticed the need for limiting access to EDs in case
of children, may be the result of an inadequate knowledge
concerning the level of ED consumption among youth, and
the impact they have on the growing and developing body.
That is why it is important to share that knowledge concerning EDs among young parents or parents-to-be. Additionally, present students of all medical faculties should demonstrate profound knowledge concerning the avoidance of
high consumption of EDs and set out other health-promoting
193
Energy drinks - consumption and awareness among students of Medical University of Lublin
behaviours amongst their peers and those whom they will
encounter in their professional lives.
We declare the non-existence of any relationships
(conflict of interests) that could affect the objectivity and
credibility of the work.
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Current Issues in Pharmacy and Medical Sciences