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Study Title and Description

Energy drink consumption is associated with anxiety in Australian young adult males.



Key Questions Addressed
1 For [population], is caffeine intake above [exposure dose], compared to intakes [exposure dose] or less, associated with adverse effects on behavior*?
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Primary Publication Information
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TitleData
Title Energy drink consumption is associated with anxiety in Australian young adult males.
Author GS Trapp,K Allen,TA O'Sullivan,M Robinson,P Jacoby,WH Oddy,
Country
Year 2014
Numbers

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Extraction Form: Behavior - Design Details - INCLUDED Studies
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Design Details
Question... Follow Up Answer Follow-up Answer
Refid 24019267
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What outcome is being evaluated in this paper? Behavior
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What is the objective of the study (as reported by the authors)? The purpose of this study was to investigate the association between energy drink consumption and mental health problems in a population-based sample of young adults participating in the Western Australian Pregnancy Cohort (Raine) Study.
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Provide a general description of the methods as reported by the authors. Information should be extracted based on relevance to the SR (i.e., caffeine related methods) PARTICIPANTS Participants were drawn from the Western Australian Pregnancy Cohort (Raine) Study, a prospective cohort study that has followed participants from gestation to early adulthood. Detailed methods regarding the Raine Study have been published previously. These children and their families have been followed at regular intervals. The 20-year follow-up was the first to assess energy drink intake. LOSS TO FOLLOW-UP Full details of cohort attrition have been documented previously. ENERGY DRINK CONSUMPTION (MILLILITER PER DAY) Participants reported their frequency of energy drink consumption in a confidential self-report questionnaire. Response options were: never, <1/month, 1 day/month, 2 days/month, 3 days/month, 1 day/week, 2 days/week, 3 days/week, 4 days/week, 5 days/week, 6 days/week, and every day. In addition, participants were asked to report the usual amount (total number of cans) they would drink per day on a day that they consumed an energy drink. Frequency and amount data were then used to create a milliliter per day consumption variable. We based these assumptions on one can containing 250 mL of energy drink given the volume capacity of a regular-sized Red Bull R _x0003_ can as Red Bull R _x0003_ is the most popular energy drink by market share.[1] This was a conservative estimate given that some energy drinks are available in larger can sizes. The energy drink consumption variable (mL/day) was also grouped into the following categories: 0 mL/day, <250 mL/day, and ≥250 mL/day). MENTAL HEALTH Mental health was assessed using the short form of the depression, anxiety, and stress scales (DASS-21).[28] The longer DASS-42 and short-form DASS-21 were developed using Australian data and have been validated in both clinical and nonclinical samples. The DASS-21 is a self-report measure comprised of 21 items that assess symptoms of depression (seven items), anxiety (seven items), and stress (seven items). It yields separate depression, anxiety, and stress subscale score. The depression scale assesses hopelessness, self-deprecation, devaluation of life, lack of interest/involvement, dysphoria, anhedonia, and inertia; the anxiety scale assesses autonomic arousal, skeletal muscle effects, subjective experience of anxious affect and situational anxiety; and the stress scale assesses nervous arousal, difficulty relaxing, being easily upset/agitated, irritable/over-reactive, and impatient.[28] CONTROL VARIABLES We adjusted for factors that have a known relationship with energy drink consumption and/or mental health in young adults. - Sociodemographic variables. - Physical activity and body mass index. - Total energy intake and alcohol consumption. - Illicit drug use.
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How many outcome-specific endpoints are evaluated? 3
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What is the (or one of the) endpoint(s) evaluated? (Each endpoint listed separately) depression
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List additional health endpoints (separately).
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List additional health endpoints (separately)
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Notes
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Clinical Clinical
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Physiological
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Other
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What is the study design? Cross-sectional
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Randomized or Non-Randomized?
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What were the diagnostics or methods used to measure the outcome? Subjective
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Optional: Name of Method or short description Mental health was assessed using the short form of the depression, anxiety, and stress scales (DASS-21).[28] The longer DASS-42 and short-form DASS-21 were developed using Australian data and have been validated in both clinical and nonclinical samples. The DASS-21 is a self-report measure comprised of 21 items that assess symptoms of depression (seven items), anxiety (seven items), and stress (seven items). It yields separate depression, anxiety, and stress subscale score. The depression scale assesses hopelessness, self-deprecation, devaluation of life, lack of interest/involvement, dysphoria, anhedonia, and inertia; the anxiety scale assesses autonomic arousal, skeletal muscle effects, subjective experience of anxious affect and situational anxiety; and the stress scale assesses nervous arousal, difficulty relaxing, being easily upset/agitated, irritable/over-reactive, and impatient.[28]
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Caffeine (general)
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Coffee
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Chocolate
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Energy drinks Energy drinks
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Gum
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Medicine/Supplement
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Soda
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Tea
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Measured
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Self-report Self-report
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Children
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Adolescents
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Adults Adults
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Pregnant Women
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What was the reference, comparison, or control group(s)? (e.g. high vs low consumption, number of cups, etc.) multivariate linear regression categories: 0 mL/day, < 250 mL/day; > 250 mL/day
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What were the listed confounders or modifying factors as stated by the authors? (e.g. multi-variable components of models.  Copy from methods) sex, maternal education, family income,completion of secondary school, alcohol and kilojoule intake, physical activity, BMI, and illicit drug use
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Provide a general description of results (as reported by the authors). In univariate analyses (i.e., Model 1 in Tables 3 through 5), energy drink consumption (100 mL/day) was significantly associated with depression (total sample and males but not females; Table 3), anxiety (total sample and both males and females; Table 4), and stress (total sample and both males and females; Table 5) scores (all P < .05). After adjusting for sex, maternal education, family income, completion of secondary school, alcohol and kilojoule intake, physical activity, BMI, and illicit drug use (i.e., Model 2 in Tables 3 through 5), energy drink consumption was significantly associated with depression, anxiety, and stress for the total sample and males (P <.05) but not for females. After further adjustment (i.e., Models 3–5), only the association between energy drink consumption and anxiety in males remained significant (β = 0.32; 95% CI = 0.05, 0.58). Associations between DASS scores and categories of energy drink consumption are presented in Table 6. After adjusting for sex, maternal education, family income, completion of secondary school, alcohol and kilojoule intake, physical activity, BMI, and illicit drug use, participants who consumed ≥250 mL/day of energy drink (compared to 0 mL/day) had higher anxiety and stress scores and this was true for the total sample and males (all P <.05) but not for females (P >.05). No significant associations were found between these categories of energy drink consumption and depression, for either the whole sample or by gender. LOGISTIC REGRESSION MODELS Table 7 presents the logistic regression results of being in the highest quartile (vs. lowest quartile) of DASS scores. For the total sample, energy drink consumption (100 mL/day) was associated with an increase in the odds of being in the highest quartile (vs. lowest quartile) of depression (OR = 1.15; 95% CI = 1.01, 1.31) and anxiety (OR = 1.17; 95% CI = 1033, 1.30) but not stress scores (P >.05). In males, energy drink consumption was associated with an increase in the odds of being in the highest quartile (vs. lowest quartile) of anxiety (OR = 1.23; 95% CI = 1.03, 1.48) and stress (OR = 1.21; 95% CI = 1.01, 1.45) but not depression scores (P >.05). No significant associations were found between being in the highest quartile (vs. lowest quartile) of DASS depression, anxiety or stress scores, and energy drink consumption (per 100 mL/day) in females.
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Did the authors perform a dose-response analysis (or trend/related analysis)? No
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What were the authors's observations re: trend analysis?
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What were the author's conclusions? Our results suggest a positive association between anxiety and energy drink consumption in young adult males. This relationship remained after adjusting for covariates and the presence of other mental health difficulties.
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What were the sources of funding? We would also like to acknowledge the Lions Eye Institute, CIHR (Lye et al.) and the NHMRC grants that funded the 20- year follow-up (ID 63445, ID 634509, ID 634457, and ID 1003424).
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What conflicts of interest were reported? All authors declare no conflict of interest
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Does the exposure (dose) need to be standardized to the SR? Yes
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Provide calculations/conversions for the exposure based on the decision tree in the guide (for all endpoints/exposure levels of interest). energy drink = 10 mg/oz caffeine = 10 mg/30 mL * 250 mL = 83 mg caffeine 10 mg/30 mL * 100 mL = 33.3mg caffeine
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List all the endpoint(s) followed by the dose (mg) which will be used in comparison to Nawrot.  Characterize value as LOAEL/NOAEL, etc. if possible.  From multivariate linear regression: depression - NOAEL = 83 mg/day anxiety - LOAEL = 83 mg/day stress - LOAEL = 83 mg/day
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Notes regarding selection/listing of endpoints and exposures/doses to be compared to Nawrot. effects seen below Nawrot levels and were apparent in the whole group and males specifically, but not in females. Logistic regression showed that 100 mL/day (33.3 mg caffeine) was associated with increased chances of being in the highest vs lowest quartile for depression (OR = 1.15; 95% CI = 1.01, 1.31) and anxiety (OR = 1.17; 95% CI = 1.033, 1.30) but not stress scores. When considering sex, no significant effects were seen in females alone but in males, energy drink consumption was associated with an increase in the odds of being in the highest quartile (vs. lowest quartile) of anxiety (OR = 1.23; 95% CI = 1.03, 1.48) and stress (OR = 1.21; 95% CI = 1.01, 1.45) but not depression scores (P >.05).
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What is the importance of the study with respect to the adverseness of the outcome? Important
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