Energy Drinks; Impact of Use in Patients with Diabetes, Obesity, and/or other Cardiometabolic Spectrum Conditions.

Energy drinks (EDs) are a brand of non-alcoholic beverages that are typically distinguished from regular sweetened caloric beverages (SCBs) by their augmented carbohydrate and purine alkaloids/methylxanthines (usually either caffeine; 1,3,7 trimethylxanthine and/or theobromine; 3,7 dimethylxanthine) content touted as being able to boost energy levels. At initial inception they were dominantly consumed by young adults (with an initial strong male preponderance) but in the last few decades as their variety, main-stream acceptance and widespread marketing has increased their appeal and consumption has become widespread and virtually universal to the general population including virtually all age, gender and ethno-racial demographics. With increased widespread consumption concerns regarding their safety and potential impact on long term health have started being raised. This is particularly pertinent as their regulatory oversight and monitoring is often presently minimal. Diabetes and Obesity represent two dominant halves of the global diabesity epidemic that afflicts over 650 million adults worldwide with over 40% of the adult population in the United States affected. The well documented cardiometabolic spectrum (CMS) of diseases that are associated comorbidities of diabesity are well documented and it is inevitable that the increasing consumption of EDs would involve these group of persons in adult, geriatric, adolescent and even pediatric populations. This review summarizes and synthesizes the limited published data on the described and potential health impact of EDs use particularly in persons with and/or at risk for diabetes, obesity and other CMS diseases to make the case for need of more careful study, monitoring and scrutiny of the use of these beverages in these group of persons. After providing an overview of the history, epidemiology and major components of EDs we detail the major potential and reported systemic complications of their long-term intake especially in at risk populations discussing the modulating effects of genetics, present comorbidities and alcohol co-intake. The prominent roles of caffeine and carbohydrates in the potential poly-systemic effects of EDs and their reported toxidromes is also highlighted while acknowledging the limitations in the present body of published data in this area.