Regulatory Efforts and Health Implications of Energy Drink Consumption by Minors in Poland

Introduction

THE MARKET AND CONSUMPTION OF EDS:

Before 1 January 2024, EDs were widely available to all consumers, including children and adolescents. However, starting 1 January 2024, Poland introduced a legal ban on the sale of EDs containing caffeine (CAF) and taurine (TA) to individuals under age 18 years. This regulatory move reflects growing global concerns about the increasing consumption of these beverages and their potential health risks, particularly among young people. In recent years, EDs have become a popular beverage choice among adolescents and young adults, raising significant public health challenges. Given that childhood and adolescence are critical stages of development during which the body and brain are still maturing, young individuals are particularly vulnerable to the harmful effects of EDs, including the high levels of CAF and sugar that can disrupt both their physical and cognitive growth. The market and consumption of EDs have been increasing each year since their introduction [1,2]. In 2020, the international EDs market was valued at 45.80 billion USD, with projections suggesting it will reach 108.40 billion USD by 2031 [3].

The increasing consumption of EDs and related health risks have become a public health challenge, as excessive intake, especially when combined with alcohol, drugs, or chronic illnesses, raises the risk of serious cardiovascular problems [4]. EDs negatively impact health by affecting a broad range of organ systems. Consumption of these drinks can result in anxiety, gastrointestinal disturbances, dehydration, nervousness, and tachycardia. Excessive consumption can lead to more serious health outcomes, including rhabdomyolysis, acute kidney injury, ventricular fibrillation, seizures, acute mania, and stroke. It has also been demonstrated that ED consumption can lead to death [5].

The primary consumers of EDs are young people. EDs are available in over 140 countries, with half of the consumers aged 14–24 years [6]. A 2013 study of 37 500 children and adolescents from 16 European countries revealed that 18% of children (aged 3–10 years) and 68% of adolescents (aged 10–18 years) had consumed EDs in the preceding year [7]. Research indicates that children as young as 10 consume EDs, with up to 70.5% having at least 1 experience of consumption [8]. The Nomisma-Areté Consortium, on behalf of the European Food Safety Authority (EFSA), found that the highest frequency of energy drink consumption occurs among adolescents (68%), followed by adults (30%) and children (18%). Among underage consumers, long-term high consumption was reported in 12% of adolescents and 16% of children, while single instances of high-dose EDs consumption were observed in 12% of both groups [4,7].

According to the Food and Drug Administration’s definition, EDs are “a class of liquid products that typically contain CAF, with or without other added ingredients.” They often contain high amounts of CAF, sugars, other additives, and legal stimulants such as guarana, TA, and L-carnitine, intended to increase energy and improve concentration. These ingredients also raise blood pressure and heart rate. EDs are primarily marketed as products to enhance mental and physical performance [2,9].

Consumption of EDs by people under age 18 poses significant health risks, including metabolic disorders, mental health issues, and the detrimental impact of CAF on the developing body. For these reasons, public health experts advocate for strict regulatory measures to limit youth access to these products. Implementing such regulations is crucial for protecting the health and well-being of young people and preventing the long-term consequences of excessive consumption [10]. The urgency for legal regulations on energy drink sales is heightened by the fact that young people are the largest consumer group.

Countries like Lithuania, Latvia, Turkey, and Sweden have implemented bans on the sale of EDs to people under age 18 [11–13]. The Spanish Agency for Food Safety and Nutrition (AESAN) has recommended that individuals under age 18, pregnant women, and breastfeeding mothers avoid EDs [14]. Although there are no formal age restrictions in the United States, numerous organizations raise significant concerns regarding ED consumption among children, adolescents, and young adults, emphasizing potential health risks associated with their use [15]. This article aims to review the background of the reasons for the ban of sale of energy drinks to young people in Poland from January 2024.

The literature for this publication was collected by searching databases such as PubMed, Google Scholar, and Science Direct, as well as reviewing national and international scientific journals. Keywords used in the searches included: Energy Drinks, Caffeine, Taurine, Adolescent Health, Public Health. The analysis included guidelines and reports from Polish public health institutions, including the National Institute of Public Health (NIPH). National regulations on the sale of EDs to people under age 18 were also examined.

Description of the State of Knowledge

HISTORICAL CONTEXT:

The first energy drink products emerged in the 1960s. Red Bull, the first widely recognized ED, was introduced to the European market in 1987 and to the American market in 1997 [16,17]. In Poland, EDs appeared in the mid-1990s, with Red Bull debuting around 1995 as one of the earliest and most heavily promoted brands. The popularity of these products in Poland has grown over time as part of a global trend [18,19]. By 2006, approximately 500 new ED brands had entered the global market [20]. EDs are now the fastest-growing product in the beverage industry, second only to bottled water [2]. The rapid growth in consumption of these non-alcoholic beverages is one of the most notable trends in the beverage market across many countries. Increasing consumption of EDs is associated with higher exposure to CAF, TA, and D-glucuronolactone. These beverages are especially popular among young people, to whom manufacturers often target their products with claims of improved concentration and enhanced physical performance [21].

HEALTH IMPLICATIONS OF EDS:

The rise in popularity of CAF-containing EDs has been linked to numerous adverse health effects, particularly among youth. Over half of young consumers have reported adverse effects from EDs, including increased heart rate, sleep disturbances, headaches, nausea/vomiting/diarrhea, chest pain, and even seizures [22,23]. Among the most severe adverse effects is the risk of CAF intoxication, which can cause a range of symptoms affecting both physiological and psychological functions. Typical symptoms of CAF intoxication include heightened anxiety, nervousness, hyperactivity, insomnia, diuresis, gastrointestinal disturbances, and muscle tremors. Other possible effects include chaotic, accelerated thoughts and speech, arrhythmias, and psychomotor agitation [13,24,25].

ENERGY DRINK CONSUMPTION PATTERNS:

The EFSA commissioned the Nomisma-Areté Consortium to conduct a study on ED consumption among adults, adolescents, and children across 16 European Union countries. The study aimed to determine the exposure levels of these groups to active ingredients in EDs, such as CAF, TA, and D-glucuronolactone. Additionally, it analyzed total daily CAF intake and specific consumption patterns, including energy drink use in combination with alcohol and during intense physical activity among adolescents and adults [7].

Among adults aged 30–49, 30% of respondents (n=14 557) reported consuming EDs. The highest consumption rates were observed in Austria (50%), the Czech Republic (46%), and Poland (45%), whereas the lowest rates were recorded in Cyprus (14%), Belgium (15%), and the Netherlands (21%). Males reported energy drink consumption more frequently than females, with 37% of men and 26% of women reporting use in the past year [7].

In the adolescent group (n=31 070), with a mean age of 16 years, 68% of respondents reported consuming EDs in the past year, and 28% had consumed them within 3 days of the survey. Consumption among adolescents was notably higher than among adults, with the highest consumption rates in the Czech Republic (82%), Hungary (78%), and Poland (73%). The lowest rates were observed in Greece (48%), Cyprus (53%), and Italy (62%). Overall, one-quarter of European consumers reported drinking EDs once or twice per month, 21% weekly, and 33% at least twice per week. Adolescents aged 15–18 exhibited higher consumption rates (73%) than those aged 10–14 (55%), and male respondents consumed EDs more frequently (74%) than females (63%) [7].

Among children aged 3–10 years (n=4960), 18% reported ED consumption in the past year. In children aged 3–5, 2% consumed EDs, while in those aged 6–10, 18% did. The highest consumption was recorded in the Czech Republic (40%), Spain (26%), and the United Kingdom (24%), while the lowest rates were seen in Hungary (6%), Belgium (8%), and Austria (9%). Boys showed a higher consumption rate (22%) than girls (14%) [7].

EDs are primarily consumed by adolescents, who often seek a readily available source of energy, particularly during periods of intense physical activity or study [26]. These products are frequently consumed by youth, with the first consumption typically occurring before the age of 12 [27]. Studies have shown that compared to girls, boys are more likely to consume EDs during adolescence. Energy drink consumption is a common habit among adolescents, with consumption patterns varying based on sociodemographic factors, notably gender. Adolescents who consume more than 1 energy drink weekly often also have daily soda consumption, weekly alcohol use, extended screen time, and short sleep hours [21,28]. Early adolescent energy drink consumption may serve as a predictor for later use of other psychoactive substances. Consumption at age 14 correlates with an increased likelihood of legal and illegal substance use by age 16 [29,30]. A study among Spanish youth indicated that nearly half of students aged 13–18 reported consuming EDs, primarily during leisure time and social events, with 49% of consumers combining them with alcohol during events or sports activities [31].

Health Risks Among Various Age Groups

Research highlights an increasing body of evidence that energy drink consumption among children and adolescents is associated with various adverse health effects and risky behaviors, which may impact their health and well-being. Despite these risks, EDs remain popular among young consumers due to their appealing taste and perceived effects [32].

Energy drink consumption carries a range of adverse health effects, particularly among adolescents. The high CAF and stimulant content, including TA and guarana, increases the risk of cardiovascular issues such as arrhythmias, hypertension, and tachycardia [33,34]. EDs negatively affect the hemodynamic system, with the severity and nature of these adverse effects largely determined by the CAF and sugar content of each product [35].

The lack of adequate regulatory oversight has led to aggressive marketing of EDs primarily targeting young people, which heightens the risk of excessive consumption among people under age 18. Studies indicate that around half of college students consume EDs at least once a month to counteract sleep deprivation, boost energy, or mix with alcohol at social events. This trend is potentially even more hazardous in younger people, who are more susceptible to CAF-related adverse effects [18,19]. As a response, several countries have introduced regulations regarding the labeling, distribution, and sale of EDs, particularly those with high CAF content, to protect young consumers’ health. These measures include restrictions on sales to minors and mandatory warning labels. However, these regulations vary among countries, underscoring the need for uniform protective standards, especially regarding youth access to EDs [11–15].

Legal Definition and Consumption Trends of EDs in Poland

According to Article 12l of the Public Health Act of September 11, 2015 (t.j. Dz. U. z 2022 r. poz. 1608 z późn. zm.), an energy drink is defined as a beverage product with added CAF or TA, classified as a food item under the Polish Classification of Goods and Services in class 10.89 or division 11. To meet this definition, a product must contain CAF levels exceeding 150 mg/L or include TA, excluding cases where these substances are naturally present in the beverage [36].

This provision, as part of Chapter 3b of the Public Health Act, focuses on products with synthetic CAF and TA additives that may affect consumer health, particularly among minors. It provides the legal basis for prohibiting the sale of EDs to individuals under 18 years old and in schools. Article 12n of the Public Health Act mandates that EDs containing CAF or TA be properly labeled. Manufacturers or importers must display clear, durable, and non-removable labels on packaging, indicating the nature of the product, with the wording “Energy Drink” or “Energizing Drink” to ensure consumers are fully aware of the presence of stimulants. The legislator’s intent specifies that the minimum label content should include either “energy drink” or “energizing drink” as acceptable product designations [36].

This labeling requirement aims to increase consumer awareness, particularly among youth, who may not be aware of the effects of these ingredients. Such labeling seeks to reduce the risk of accidental consumption by individuals for whom high CAF or TA content may be detrimental to health [37].

According to NielsenIQ data, Polish consumers allocate the most expenditure to carbonated beverages, with annual sales reaching 7.8 billion PLN, followed by water at 7.1 billion PLN and juices, drinks, and nectars at 4.9 billion PLN. Energy and isotonic drinks rank fourth in this list, generating annual sales of 4.2 billion PLN [38]. The substantial market share of energy and isotonic drinks indicates their high popularity, especially among younger consumer groups.

Poland is among the countries with high levels of energy drink consumption, particularly among youth [7]. A national study by the NIPH on the dietary habits and nutritional status of the Polish population revealed that a significant proportion of youth aged 10–17 regularly consume sugar-sweetened carbonated beverages. Daily consumption was reported by 9.7% of boys and 6.3% of girls, with 34% and 29.6%, respectively, consuming them several times a week. Although energy drink consumption is lower, 35.7% of boys and 27.4% of girls reported drinking them. Isotonic drinks are also present in the diets of 37.6% of boys and 27.9% of girls, typically consumed a few times a month or less frequently. Worryingly, 2.1% of children aged 3–9 consume EDs, which poses particular health risks due to CAF’s adverse effects on the developing body [39].

A study conducted in the Pomeranian Voivodeship found that 66.29% of respondents (n=709) reported consuming EDs, typically in 250-ml portions, 1–3 times a month, while 5.36% of youth consumed them multiple times per day [40]. Another study among secondary school students in Łódź [n=218] indicated that 36.7% of respondents did not consume EDs. About 30% reported consumption less than once per week, 17% weekly, and 6% multiple times per week, while 10% consumed EDs daily [41]. In the Kuyavian-Pomeranian Voivodeship [n=2,629], 67% of students aged 12–20 consumed EDs, with over 16% indicating frequent consumption. Other studies corroborate the high frequency of energy drink consumption among youth, with over half of consumers being children (<12 years), adolescents (12–18 years), and young adults (19–25 years). Between 28% and 31% of adolescents aged 12–17 and 34% of those aged 18–24 report regular energy drink consumption. Additionally, 10% of young individuals consume EDs frequently, and 46–51% report occasional use [42].

EDs are a significant source of CAF in the diets of Polish adolescents, particularly teenagers, among whom the popularity of these drinks is steadily growing. Average CAF intake in this group was 98.54 mg per day, with EDs contributing around 13% of this intake. Among Polish teenagers, 73% reported consuming EDs, with an average daily CAF content of 171.44 mg [43]. Adolescents are primarily motivated to consume EDs for taste, a desire for increased energy, and improved concentration, which are especially important in the context of schoolwork and sports activities. Additionally, EDs are viewed as a symbol of youth lifestyle, particularly during social gatherings and entertainment events [44]. An increase in the consumption of both carbonated and non-carbonated sweetened beverages, as well as functional drinks such as isotonic and energy drinks, has been observed, particularly among youth [45].

Consumption of sweetened carbonated, energy, and isotonic drinks is significantly higher among younger age groups, especially males. Young people tend to consume these products more frequently, while older individuals show a lower propensity for such consumption or avoid it altogether.

The increase in EDs consumption among Polish youth, currently the largest consumer group, has raised concerns among public health specialists and policymakers. Studies show that over half of adolescents regularly consume EDs, often viewing them as a source of additional energy, improved concentration, and a lifestyle element. Consequently, legislative measures were deemed necessary to introduce a ban on the sale of EDs to people under age 18.

Recent Regulatory Changes

In response to the growing consumption of EDs among youth, as of January 1, 2024, under Article 12m of the Public Health Act, Poland has implemented a ban on the sale of beverages containing CAF or TA to individuals under 18 years old. This ban also includes sales in educational institutions, in line with the Education Act, and vending machines. In cases where a buyer’s age is uncertain, sellers have the right to request identification to confirm age [36].

Since the enactment of this ban, significant changes have been observed in the Polish EDs market. A comparison of sales data from January 2023 to January 2024 shows a 14% decline in sales volume. Consequently, the number of units sold has decreased by about 10%, reflecting the regulatory impact on reducing underage consumer access to these products. Some manufacturers have responded by adapting their product strategies, introducing caffeinated soft drinks with CAF content below 150 mg/L, which are legally exempt from the new regulations and can continue to be sold without age restrictions [46].

Impact of Energy Drinks on Youth Health and the Need for Health Education

EDs pose a growing threat to public health, with youth consumption increasing globally [47,47]. Unlike most beverage categories, EDs and other high-CAF products continue to see sales growth, with marketing often targeting individuals under 18 [10]. Effective regulation, including limiting sales to those under 18, enforcing clear labeling requirements, setting CAF content limits, and expanding health education, is essential to mitigate the health risks associated with youth consumption of these products [47]. Given the significant health risks EDs pose to those under 18, further strict regulatory measures are necessary [49].

Physicians have long raised concerns about the adverse effects of EDs consumption among young people, citing evidence of conditions such as insomnia, dehydration, and even depression. The popularity of EDs among adolescents, due to their high content of CAF, TA, and sugar, necessitated regulatory actions aimed at limiting their widespread availability and unregulated consumption.

Medical professionals have observed an increase in pediatric cases linked to ED consumption, highlighting the urgent need to address this issue. Mental health experts point to addiction to energy drinks among children and adolescents, emphasizing the complex, long-term effects of physiological overstimulation during developmental periods. These include potential links to risk-taking behaviors, poor mental health, and challenges in personality development [50].

The low level of awareness among adolescents regarding the long-term health effects associated with the consumption of EDs poses a significant challenge for public health. Research indicates that teenagers often overlook potential consequences, such as the development of type 2 diabetes or cardiovascular diseases, focusing instead on immediate aesthetic effects, such as acne or weight gain. Public health experts emphasize the need to develop educational programs tailored to the needs of young people, effectively addressing these issues to enhance their engagement and awareness of the health risks associated with EDs consumption. Experts emphasize that the ban could raise awareness among parents and healthcare professionals about the risks associated with EDs. Such regulations often encourage parents to take greater control over their children’s dietary habits, fostering a better understanding of the health impacts of EDs consumption [50].

Conclusions

EDs have gained significant popularity among young consumers, becoming a frequent choice, particularly during periods of intense physical or mental exertion, such as studying or sports activities. Over half of teenagers consume EDs regularly, making them the largest consumer group for these products. With high levels of CAF, TA, and sugar, EDs pose serious health risks. The introduction of regulations, including the 2024 ban on the sale of EDs to individuals under 18, addresses critical concerns surrounding their high consumption rates among youth.

However, legal restrictions alone are insufficient to mitigate the health risks associated with EDs consumption. Systematic health education that highlights the potential health impacts of EDs and promotes natural alternatives is essential. Poland currently lacks comprehensive and systematic studies on EDs consumption, particularly among young people, who are the primary consumers. Regular monitoring of these factors would enable the development of more effective health and educational policies to protect public health.

The 2024 ban on EDs sales to minors is a pivotal step in addressing this growing public health challenge. A combined approach, including legal restrictions, targeted education programs, and heightened awareness among key stakeholders, is crucial for reducing the health risks associated with EDs consumption among Polish youth. By adopting this multifaceted strategy, policymakers can create a safer environment for young people and better safeguard their health and well-being.