+91 9063922599
+91 9063922599
submission@jccpractice.com
|
FAQs
IntroductionCoffee is one of the most consumed beverages in the world because of its energizing effects. Medical students are often under great stress and in need of energy, which is why they frequently consume coffee. Methods We conducted a prospective study using an online questionnaire among medical students to assess the reasons, frequency and amount of coffee consumption and adverse events experienced. Results A total of 119 students responded to the questionnaire. The majority consumed coffee (84.9%, n=101), but also caffeinated drinks (68.1%, n=81). The main reasons for drinking coffee were the need to improve productivity (75.2%, n=76) and the need to combat sleep deprivation (64.4%, n=65). A total of 84.2% (n=85) experienced at least one adverse event, including agitation (78.8%, n=67/85), tachycardia (72.9%, n=62/85) and tremor (63.5%, n=54/85). Smoking was encountered in only 21.8% (n=26) of students. Conclusions Although the beneficial effects of balanced coffee consumption are well known, a large proportion of medical students use it to combat fatigue, sleepiness and to increase productivity.
Coffee is one of the most popular and widely consumed beverages in the world and is the main source of caffeine in humans.1 But there are other beverages that contain caffeine, such as tea, carbonated drinks and energy drinks.2 The reasons for drinking coffee are varied. It is often consumed for its energizing effect, improved alertness and mood, as well as for its pleasant taste and aroma, antioxidant effect, and for socializing.3However, adverse events have also been described as a result of increased coffee consumption, and thus increased caffeine intake,4 but the consumption of up to 1-4 cups of coffee per day appears to be safe.5
Europe represents the largest share of the world's coffee market (about 33%), with an average consumption of more than 5 kg of coffee/person, with the highest consumption in Scandinavian countries.6
Medical students are a population group subject to stress induced by the sheer volume of information they have to assimilate. Therefore, among medical students there are high rates of sleep deprivation, low sleep quality and excessive daytime sleepiness, which have a negative impact on academic performance. Medical students' coffee consumption is thus supported by the need to compensate for fatigue, sleep deprivation, to be alert and productive in the learning process, and to improve their cognitive performance.7
In this context, we set out to examine the frequency of coffee consumption among 5th year medical students. We also sought to identify the reasons and adverse events experienced as a result of coffee consumption.
We conducted a cross-sectional, analytical, descriptive and comparative study by applying an online questionnaire among 5th year medical students between 1-5 May 2022.
The questionnaire consisted of 15 questions through which we assessed the reasons, frequency and amount of coffee consumed, adverse events experienced, as well as the association with consumption of sweets, juices, and smoking. Validation of the questionnaire was done by distributing it to 15 students who checked the consistency and validity of the questions. Their responses were not included in the final analysis. The questionnaire was distributed in Romanian by electronic means of communication among medical students on 1 May 2022 and was kept open for a period of 5 days.
There were 119 valid responses. In this case, given that there are about 880 students enrolled in year 5, there is a 95% chance that the real value is within ±8.36% of the measured value (margin of error).
Statistical analysis was performed with IBM SPSS Statistics for Windows, version 25 (IBM Corp., USA). The level of statistical significance was set at p<0.05. For continuous parametric variables we present mean values and standard deviation. For categorical variables we present numbers and percentages, and in the analysis of relationships between them we used the Chi-square test with calculation of risk by odds ratio (OR) and 95% confidence interval (95% CI).
A total of 119 students responded to the questionnaire. The majority were female (80.7%, n=96), consumed coffee (84.9%, n=101), caffeinated drinks (68.1%, n=81), other juices (63.9%, n=76) and sweets (97.5%, n=116), while only 21.8% (n=26) were smokers. The mean age of the respondents was 23.5±1.0 years. Women (88.5%) drank coffee more frequently as opposed to men (69.6%, p=0.023) (Table 1) and consumed sweets on a daily basis (52.1% vs. 27.3%, p=0.035, Figure 1A). There were no significant differences in consumption of other caffeinated or non-caffeinated drinks or smoking (Table 1, Figures 1B, 1C).
Coffee consumption
Of the 101 students who drank coffee, 82.2% (n=83) drank daily and 8.9% (n=9) drank weekly or occasionally. Those who drank coffee daily consumed on average 1.9 coffees per day (29 respondents – 1 coffee/day, 38 – 2 coffees/day, 12 – 3 coffees/day, 4 – 4 coffees/day). The majority consumed coffee throughout the day (47.5%, n=48) or in the morning (46.5%, n=47) and only 5.9% (n=6) at lunchtime. Approximately half (48.5%, n=49) of the respondents had started drinking coffee after starting college, with the rest having done so since high school.
The main reasons medical students consumed coffee were the perceived need to improve productivity (75.2%, n=76) and the need to combat sleep deprivation (64.4%, n=65) (Figure 2).
A total of 84.2% (n=85) experienced at least once an adverse effect of coffee consumption among which agitation (78.8%, n=67/85), tachycardia (72.9%, n=62/85) and tremor (63.5%, n=54/85) were the most common (Figure 3).
Figure 3. Adverse events reported by medical students as a result of coffee consumption
A quarter of the students (25.7%, n=26) would like to stop drinking coffee, but 53.5% (n=54) of respondents said they experienced withdrawal symptoms when they temporarily stopped drinking coffee.
A large proportion of coffee drinkers habitually consumed caffeinated drinks (69.3%, n=70), sweetened beverages (64.4%, n=65) and sweets (97.0%, n=98). With the exception of one student, all smokers consumed coffee daily (96.2%, n=25/26, p=0.082).
In our study we identified a high consumption of coffee among Romanian medical students in their 5th year of university. It was associated with increased consumption of soft drinks (caffeinated and non-caffeinated) and sweets, but not with smoking. We showed higher coffee consumption among female students. This could have a bias component as a result of the fact that the majority of the respondents were female. It should be kept in mind that overall female students predominate at the medical school. The same tendency appears in other similar studies, with the same explanation.1 On the other hand, among men, a higher consumption of caffeine-based drinks (energy drinks) was found compared to coffee intake.8
Unlike other studies where more than two-thirds of daily coffee intake was recorded in the morning,9 in our study we identified that students consumed equal proportions of coffee both in the morning and at lunchtime, and some throughout the day. This showed the increased need for medical students to be productive for as much of the day as possible.
From the literature data, the main reason for coffee consumption is mental stimulation through its energizing effect, improving alertness and work capacity.10 Increased productivity was the main reason for coffee consumption among our respondents as well. In addition, they showed that coffee helped them combat sleep deprivation. In addition, a number of consumers justify their daily caffeine intake as habit-forming, routine maintenance, but also as an opportunity to socialize, creating an environment conducive to social interaction.
Among the adverse events of coffee consumption, agitation, tachycardia and tremor have been reported, due to anxiety-inducing effects reported in other studies.11 Insomnia has also been reported in more than 40% of cases. Previous studies have reported an increased prevalence of insomnia and fatigue among those with high caffeine intake, leading to a subsequent increase in coffee consumption.12
More than half of the students reported withdrawal symptoms when they stopped drinking coffee. Symptoms such as headache, dizziness, dysphoria, brain fog or lack of alertness can be described within this syndrome.11 Initial studies reported symptoms at high caffeine intake exceeding 600 mg/day but these could also be found at moderate doses of 100 mg/day.11
Pharmacologically, caffeine is an adenosine receptor antagonist, thus exerting its effects on neural systems associated with sleep, alertness, and concentration. Given these pharmacological characteristics, it is easy to understand the recurrent and strategic consumption of coffee to improve daytime performance with an impact that can be predicted and modulated.12,13 Studies in the literature have shown a variety of positive effects on physical and cognitive performance associated with coffee consumption, as well as negative effects, both of which are statistically and clinically relevant. Studies are limited, however, by the ubiquitous presence of caffeine in the modern diet, but also by the high inter-individual variability in response to coffee consumption.12 On the other hand, the dose of caffeine administered must be taken into account. Increased performance was recorded from low caffeine doses of 32 mg;14250 mg of caffeine improved visual search ability, selective spatial attention, and perceptual sensitivity.15,16 On the other hand, increased doses of caffeine were found to decrease cognitive performance, especially on tasks involving confounding or ambiguous stimuli.17
In relation to cognitive function, numerous epidemiological reports have correlated chronic coffee consumption with a lower risk of developing neurodegenerative diseases such as Alzheimer`s disease by preventing the production and accumulation of β-amyloid and thus associated memory deficits. In experimental models of Parkinson`s disease, coffee also appears to play a role in preventing the onset of motor manifestations by preventing the destruction of dopaminergic neurons.11 Anxiogenic effects are also documented both in humans and in experimental animal models and are dose-dependent: at lower concentrations, caffeine mainly stimulates psychomotor activity, while at higher concentrations, anxiogenic effects dominate.11 As for peripheral effects, at moderate doses, cardiovascular effects are not shown to be harmful.13 Immediate undesirable effects have also been reported, such as increased blood glucose by decreased insulin sensitivity and impaired glucose tolerance.18
Studies show a correlation between coffee consumption and smoking, with smokers consuming 56 mg more caffeine than non-smokers. Nicotine increases the rate of caffeine metabolism by up to 50%, with smokers having to consume more caffeine than non-smokers to have similar effects. Stress could have similar effects on coffee and nicotine intake, resulting in increased consumption among both.6 However in our study we showed that medical students smoke at a much lower rate compared to coffee consumption. This may be explained by their concern for health and high knowledge about the negative effects of smoking.
Throughout life, individuals may consume large amounts of caffeine. Some people continue to use or abuse caffeine to improve their memory, their concentration or their physical performance, which in certain instances can lead to an addiction syndrome. "Abuse” is when there is uncontrolled desire to consume caffeine, even when this is harmful to health. This becomes "addiction” when tolerance and withdrawal patterns emerge on top of chronic consumption habits that further promote the detrimental effects of caffeine. In caffeine addiction, people start consuming extremely high doses, often combining two or more sources of caffeine (e.g., coffee and energy drinks) even if it has been shown not to have the desired additional effects, ignoring all possible harmful effects.11,13
Medical students report moderate coffee consumption as their main source of caffeine. Stress associated with academic pressure has been shown to have negative effects including on personal life and well-being. At the same time, educational success improves perceived self-esteem, efficacy, and feelings of resilience, which support medical students` need for academic success, which is most likely why coffee is a commonly consumed beverage among medical students.19
Our study has several limitations including assessment of coffee consumption only among 5th year students, online application of the questionnaire and a relatively small number of respondents. However, it provides an overview of the aspects of coffee consumption among medical students in Romania.
We identified a high proportion of coffee consumption among medical students in Romania. Although the beneficial effects of coffee are known, it should not be routinely used to combat fatigue, the need for sleep, and to increase productivity, as medical students appear to do. What is needed is the stimulation of a balanced learning environment along with relaxing activities through which students` academic levels are raised and stress levels lowered.
1. Mahoney CR, Giles GE, Marriott BP, et al. Intake of caffeine from all sources and reasons for use by college students. Clin Nutr. 2019;38:668-75.
https://doi.org/10.1016/j.clnu.2018.04.004
2. Verster JC, Koenig J. Caffeine intake and its sources: a review of national representative studies. Crit Rev Food Sci Nutr. 2018;58:1250-59.
https://doi.org/10.1080/10408398.2016.1247252
3. Agoston C, Urban R, Kiraly O, Griffiths MD, Rogers PJ, Demetrovics Z. Why do you drink caffeine? The development of the motives for caffeine consumption questionnaire (MCCQ) and its relationship with gender, age and the types of caffeinated beverages. Int J Ment Health Addict. 2018;16:981-99.
https://doi.org/10.1007/s11469-017-9822-3
4. Yang A, Palmer AA, de Wit H. Genetics of caffeine consumption and responses to caffeine. Psychopharmacology (Berl). 2010;211:245-57.
https://doi.org/10.1007/s00213-010-1900-1
5. Barrea L, Pugliese G, Frias-Toral E, et al. Coffee consumption, health benefits and side effects: a narrative review and update for dietitians and nutritionists. Crit Rev Food Sci Nutr. 2021:1-24.
https://doi.org/10.1080/10408398.2021.1963207
6. Czarniecka-Skubina E, Pielak M, Salek P, Korzeniowska-Ginter R, Owczarek T. Consumer choices and habits related to coffee consumption by poles. Int J Environ Res Public Health. 2021;18:3948.
https://doi.org/10.3390/ijerph18083948
7. Sawah MA, Ruffin N, Rimawi M, et al. Perceived stress and coffee and energy drink consumption predict poor sleep quality in podiatric medical students a cross-sectional study. J Am Podiatr Med Assoc. 2015;105:429-434.https://doi.org/10.7547/14-082
8. Riera-Sampol A, Rodas L, Martinez S, Moir HJ, Tauler P. Caffeine intake among undergraduate students: sex differences, sources, motivations, and associations with smoking status and self-reported sleep quality. Nutrients. 2022;14:1661.
https://doi.org/10.3390/nu14081661
9. Lieberman HR, Agarwal S, Fulgoni VL, 3rd. Daily patterns of caffeine intake and the association of intake with multiple sociodemographic and lifestyle factors in US adults based on the NHANES 2007-2012 surveys. J Acad Nutr Diet. 2019;119:106-14. https://doi.org/10.1016/j.jand.2018.08.152
10. Samoggia A, Riedel B. Coffee consumption and purchasing behavior review: Insights for further research. Appetite. 2018;129:70-81.
https://doi.org/10.1016/j.appet.2018.07.002
11. Cappelletti S, Piacentino D, Sani G, Aromatario M. Caffeine: cognitive and physical performance enhancer or psychoactive drug? Curr Neuropharmacol. 2015;13:71-88. https://doi.org/10.2174/1570159X13666141210215655
12. O'Callaghan F, Muurlink O, Reid N. Effects of caffeine on sleep quality and daytime functioning. Risk management and healthcare policy. 2018;11:263-71. https://doi.org/10.2147/RMHP.S156404
13. Nehlig A, Armspach JP, Namer IJ. SPECT assessment of brain activation induced by caffeine: no effect on areas involved in dependence. Dialogues Clin Neurosci. 2010;12:255-63. https://doi.org/10.31887/DCNS.2010.12.2/anehlig
14. Lieberman HR, Wurtman RJ, Emde GG, Roberts C, Coviella IL. The effects of low doses of caffeine on human performance and mood. Psychopharmacology (Berl). 1987;92:308-12. https://doi.org/10.1007/BF00210835
15. Ruijter J, De Ruiter MB, Snel J. The effects of caffeine on visual selective attention to color: an ERP study. Psychophysiology. 2000;37:427-39.
https://doi.org/10.1111/1469-8986.3740427
16. Ruijter J, de Ruiter MB, Snel J, Lorist MM. The influence of caffeine on spatial-selective attention: an event-related potential study. Clin Neurophysiol. 2000;111:2223-33.
https://doi.org/10.1016/S1388-2457(00)00462-4
17. Foreman N, Barraclough S, Moore C, Mehta A, Madon M. High doses of caffeine impair performance of a numerical version of the Stroop task in men. Pharmacol Biochem Behav. 1989;32:399-403.
https://doi.org/10.1016/0091-3057(89)90169-X
18. Graham TE, Sathasivam P, Rowland M, Marko N, Greer F, Battram D. Caffeine ingestion elevates plasma insulin response in humans during an oral glucose tolerance test. Can J Physiol Pharmacol. 2001;79:559-65. https://doi.org/10.1139/y01-026
19. Bergmann C, Muth T, Loerbroks A. Medical students' perceptions of stress due to academic studies and its interrelationships with other domains of life: a qualitative study. Med Educ Online. 2019;24:1603526. https://doi.org/10.1080/10872981.2019.1603526
Download
Download
Download
Download
Download XML
