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Study Title and Description

Caffeinated sugar-sweetened beverages and common physical complaints in Icelandic children aged 10-12 years.



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 Caffeinated sugar-sweetened beverages and common physical complaints in Icelandic children aged 10-12 years.
Author AL Kristjansson,ID Sigfusdottir,MJ Mann,JE James,
Country
Year 2014
Numbers

Secondary Publication Information
There are currently no secondary publications defined for this study.


Extraction Form: Behavior - Design Details - INCLUDED Studies
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Design Details
Question... Follow Up Answer Follow-up Answer
Refid 24494227
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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 objective of this study was to assess the prevalence of caffeinated sugar-sweetened beverages (CSSBs) in children aged 10–12 years and examine the relationship between CSSBs and common physical complaints.
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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) Sample The present study utilized population-wide cross-sectional data from the 2013 Youth in Iceland study, which is a population-based survey that monitors trends in a wide range of demographic and health-related variables in children aged 10–12 years in all primary schools in Iceland (Kristjansson et al., 2013b; Sigfusdottir et al., 2009). Participants reported in this study were 5th, 6th and 7th grade students who were 10, 11 and 12years of age. Under ICSRA oversight, teachers at each school supervised questionnaire completion on-site. Measures CSSBs The consumption of CSSBs was assessed with two questions headed, "how many cans/bottles/or glasses of the following beverages do you typically consume each day": and the following items: "Cola drinks (e.g., Coca Cola, Pepsi Cola)" and "Energy drinks (e.g., Red Bull, Magic, Burn, Monster, XL)". Response categories were 1 = "None", 2="Less than one", 3="One", 4="Two to three", 5="Four to five", and 6="Six or more". For the purpose of this analysis the responses were combined to form three groups with 0="none", 1="less than one per day", and 2="one or more per day". Common physical complaints Physical complaints were measured with four questions pertaining to the frequency of symptoms during the past 7 days headed, "how often, if ever, have you experienced the following symptoms during the last 7 days": and the following items: "Headaches", "Stomachaches", "Low appetite", and "Sleeping problems", and the following response categories: 1="never", 2= "almost never", 3="seldom", 4="sometimes", and 5="often". For the purpose of the present analysis the responses were collapsed to form a dichotomous measure with 0="never–almost never–seldom", and 1="sometimes– often". Family structure Participants were asked which of the following live in their home: father, step- or foster father, mother, step- or foster mother, siblings (if any), grandfather, grandmother, and other relatives. For the purpose of this analysis these variables serve as statistical controls in all predictive models. Statistical analysis First we report frequencies and percentages of grade, frequency of physical complaints, and prevalence of CSSB consumption. Second, we use logistic regression with adjusted odds ratios (OR) and 95% confidence intervals (CI) in our predictive analyses. All models were run separately for boys and girls with the reference category set to "none" on both respective beverage categories. To overcome statistical contamination in effects we adjust for the covariance of cola drinks when analyzing the relationship between energy drinks and physical complaints and vice versa. Third, to explore possible gender differences in the relationship between caffeine consumption and the outcome, we also ran all models by including the gender variable and caffeine ∗ gender interaction term. The software IBM SPSS Statistics, version 20.0, was used to analyze the data.
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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) sleep
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List additional health endpoints (separately).
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List additional health endpoints (separately)
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Notes sleep was defined as sleeping problems; appetite as low appetite
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Clinical Clinical
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Physiological 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 questionnaire
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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 Soda
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Tea
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Measured
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Self-report Self-report
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Children Children
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Adolescents Adolescents
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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.) none (no caffeine), less than one can (soda or energy drink) per day, one or more can (soda or energy drink) per 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) gender, family structure
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Provide a general description of results (as reported by the authors). For both genders, the prevalence of physical complaints generally increased with greater frequency of cola drink consumption. The adjusted odds ratios show a dose–response relationship between cola drink consumption and physical complaints for both boys and girls on 13 out of 16 occasions. The exceptions are in the models for headaches and stomachaches for boys who drink cola drinks less than once per day, and sleeping problems for girls who consume cola drinks less than once per day. Table 3 shows the cross-tabulations and odds ratios for the relationship between energy drink consumption and physical complaints among boys and girls. For boys and girls the prevalence of physical complaints generally increased with greater energy drink use. The adjusted odds ratio models show a dose–response relationship between energy drink consumption and physical complaints on 12 out of 16 occasions for both sexes, with the exception of low appetite for boys who drink energy drinks less than once per day and headaches, sleeping problems and low appetite for girls who consume energy drinks less than once per day.
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Did the authors perform a dose-response analysis (or trend/related analysis)? Yes
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What were the authors's observations re: trend analysis? Increase in consumption of both cola drinks and energy drinks was, for the most part, linearly associated with the prevalence of physical complaints. This finding also holds for those boys and girls who consume cola and energy drinks less than every day. Additionally, the adjusted odds ratio models indicate a dose–response relationship between cola drink consumption and physical complaints while statistically controlling for the consumption of energy drinks, and vice versa.
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What were the author's conclusions? We observed a dose–response relationship between the frequency of consumption of both cola drinks and energy drinks with physical complaints in the form of headaches, stomachaches, sleeping problems and low appetite in a population sample of boys and girls aged 10–12 years. The adjusted odds ratio models indicate a stronger relationship between energy drinks and physical complaints than for cola drinks. This finding, which was consistent across both sexes, supports our concern that due to their higher levels and concentration of caffeine, energy drinks may pose a relatively greater risk to young people than other sources of caffeine.
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What were the sources of funding? None listed.
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What conflicts of interest were reported? The authors declare that there are no conflicts 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). can of cola = 36 mg caffeine (assuming 12 oz) = 0.6 mg/kg can of energy drink = 80 mg caffeine (assuming 8 oz) = 1.4 mg/kg Note: average body weight for children 11 to under 16 = 56.8 kg (used this number as most protective for the 10-12 age group in this study; >2/3 of which fall into this age range)
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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.  Headache - NOAEL = >0 to <0.6 mg/kg caffeine/day (boys); LOAEL = >0 to <0.6 mg/kg caffeine/day (girls); LOAEL = >0.6 mg/kg to < 1.4 mg/kg caffeine/day (boys) Sleep - NOAEL = NOAEL = >0 to <0.6 mg/kg caffeine/day (girls); LOAEL = >0 to <0.6 mg/kg (boys); LOAEL = >0.6 mg/kg to < 1.4 mg/kg caffeine/day (girls) Appetite - LOAEL = >0 to <0.6 mg/kg caffeine/day (boys and girls)
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Notes regarding selection/listing of endpoints and exposures/doses to be compared to Nawrot. Effects seen at or below levels in Nawrot.
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What is the importance of the study with respect to the adverseness of the outcome? Important
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