A new research review adds to a growing body of evidence demonstrating the harmful health effects of energy drink consumption, particularly among people 21 and under.

After a systematic review of 57 previous studies covering 1.2 million children in 21 countries, researchers from Newcastle University in the United Kingdom reported that energy drink consumption among young people is linked to poor sleep quality, short sleep duration and lower academic performance.

Energy drink consumption was also associated with increased risk of attention deficit hyperactivity disorder (ADHD) symptoms, psychological distress, depression, anxiety, insulin resistance, and dental issues.

This study also affirmed the previous study’s findings of a strong positive correlation between drinking energy drinks and smoking, alcohol use, binge drinking, and other substance use.