Prevalence of, and factors associated with health supplement use in Dubai, United Arab Emirates: a population-based cross-sectional study

Longitudinal changes in adverse effects reporting in multiple dietary supplement classifications: The US military dietary supplement use study

Over 70% of United States military service members (SMs) regularly use dietary supplements (DSs) and about 18% have reported adverse effects (AEs) associated with use. This investigation examined longitudinal changes in AEs reporting among DS users. On two separate occasions 1.3 ± 0.2 years apart (mean ± standard deviation), 5778 SMs completed identical questionnaires on DS use and associated AEs. Among SMs reporting DS use ≥1 time/week, ≥1 AE was reported by 19% and 15% in the baseline and follow-up phases, respectively. The risk of reporting DS use at follow-up was similar among those reporting and not reporting AEs at baseline for most DS categories including prohormones, proteins/amino acids, individual vitamins and minerals, multivitamin/multiminerals, herbals, fish oils, joint health products, and other DSs. An exception was combination products where those reporting AEs at baseline had an increased risk of use at follow-up (risk ratio = 1.13, 95% confidence interval = 1.06-1.09). Those reporting AEs at baseline and continuing DS use in the follow-up were more likely to report AEs at follow-up compared to those not reporting baseline AEs. In conclusion, AEs reported at baseline did not deter many participants from using DSs in the follow-up period, and many SMs reporting AEs at baseline continued reporting them at follow-up.

Impact of an educational flyer and sensitization on performance-enhancement attitudes of bodybuilders in United Arab Emirates

Background

A high proportion of bodybuilders use supplements to improve performance, with some turning to prohibited substances and methods. The attitudes of bodybuilders towards performance enhancement may be gauged through surveys such as the Performance Enhancement Attitude Scales (PEAS). Educational interventions are recommended as part of anti-doping measures. The objective of this project was to assess the impact of a pharmacy-led intervention using an antidoping educational flyer and the performance enhancement attitude scale to measure the attitude of bodybuilders in the United Arab Emirates (UAE).

Methods

The PEAS eight-item short form questionnaire was administered to male bodybuilders in the UAE. The PEAS was conducted before and after administration of an educational flyer concerning the problems associated with supplement use among bodybuilders. The Wilcoxon Signed-Rank and Kruskal Wallis tests were used for data analysis.

Results

A total of 218 bodybuilders, who reported taking dietary supplements, filled out the survey both pre and post viewing the antidoping educational flyer. A difference was observed between the full-time professional bodybuilders, students, and part-time bodybuilders with other primary occupations (p-value <0.05). In addition, PEAS score decreased among the study population for all eight PEAS items (p-value <0.05).

Conclusions

The pharmacy-led intervention using an antidoping educational flyer and sensitization by PEAS achieved more favorable scores, suggesting a significant shift of opinion toward avoiding use of performance enhancing substances among the bodybuilder study population. More research is required on sustaining the attitude and demonstrating the impact on doping behavior.

Dietary Supplement Use and Associated Factors Among Adults Working in Urban Settings in Tanzania: A Cross-Sectional Study

Dietary supplements are products consumed to provide nutrients or other substances that the user may not consume in sufficient amounts through normal diets. Despite their increased global popularity, there is still scant information regarding the use of dietary supplements and associated factors among adult populations in Tanzania. This study aimed to assess the extent of dietary supplement use and factors associated with use among adults working in urban settings. This was a cross-sectional study involving 419 adults working in public and private institutions within the Ilala District of Dar es Salaam who were selected using stratified and simple random sampling techniques. The study's data was collected using quantitative methods through a self-administered questionnaire. Data analysis was done through descriptive statistics for frequencies, means, standard deviations, and proportions; cross-tabulations with chi-square tests for comparing observed differences in supplement use; and multivariable logistic regression for identifying factors associated with supplement use. A P-value of <.05 was considered statistically significant in the analysis. The prevalence of dietary supplement use among working adults was 46.5%, where 36.9% reported regular and 63.1% occasional supplement use, respectively. Seven types of dietary supplements were identified to be consumed, of which 45.1% of the respondents consumed more than one type of dietary supplement. Multivitamins (64.1%) were the most frequently reported type of supplement consumed, followed by Mineral (34.9%) and Herbal/Botanical (26.7%) supplements. The most commonly reported reason for dietary supplement use among working adults was to improve overall health (67.1%). A third of the users (35.9%) admitted to self-prescribing dietary supplements without seeking professional medical advice. The use of dietary supplements was significantly associated with being female (AOR = 2.243, 95% CI 1.415-3.555, P = .001) and knowledgeable of supplements (AOR = 6.756, 95% CI 4.092-11.154, P < .001). Overall, the use of dietary supplements is popular among adults working within urban settings, but its use is exacerbated by perceived knowledge and self-prescription instead of health professional advice. Therefore, there is a need for further studies to explain better the underlying drivers for perceived knowledge on decision-making. There is also a strong need for extensive health education to prevent inappropriate or excessive use of supplements which might lead to potential adverse events.

Lifestyle, Eating Habits, and Health Behaviors Among Dietary Supplement Users in Three European Countries

Dietary supplements (DS) are used by about 30-50% of adults in developed countries. However, only a few studies have compared the characteristics of DS users in different nations. This study aimed to identify and compare selected health-related behaviors of DS users from three European countries. A total of 3,588 adults (32.08 ± 8.04 years) from Poland (1,030 females, 287 males), Germany (994 females, 190 males), and the United Kingdom (911 females, 176 males) were included in the analysis. The study was based on a self-administered survey consisting of 70 questions regarding baseline characteristics, lifestyle, eating, and health habits. The associations of the obtained results were compared using the Kruskal-Wallis test, Pearson Chi-Square test, and Cramer's V value. The highest percentage of DS users (56.98%, n = 2,044) had a correct body weight, while higher body weight values were observed in 39.19% (n = 1,406). In terms of lifestyle, statistically significant differences (p < 0.05) were noted for alcohol consumption and the level of physical activity. Fruit and vegetables were most often consumed a few times a weeks (34.67%, n = 1,244). A similar result was observed for the consumption of whole grain (37.76%, n = 1,355), dairy (39.99%, n = 1,435), eggs (49.67%, n = 1,782), and meat (51.45%, n = 1,846). Most DS users did not have a chronic disease (66.72%, n = 2,394). Among the other conditions, a frequent occurrence (a few times a weeks) of gastrointestinal problems (28.29%, n = 1,015) and concentration disorders (29.15%, n = 1,046) was noted. Cramer's V values (<0.3) indicated a weak (but significant p < 0.05) relationship between the country of residence and most of the analyzed variables. In conclusion, DS users were characterized by a healthy lifestyle with appropriate behaviors but not healthy eating habits.

Prevalence of and Factors Associated With Nutritional Supplement Use Among Older Chinese Adults: A Nationwide Cross-Sectional Study in China

Objective

This study identified the prevalence of nutritional supplement (NS) use among older Chinese adults and explored the factors associated with NS use in this population.

Methods

We used data from 11,089 Chinese men and women aged ≥ 65 years from the 2018 Chinese Longitudinal Healthy Longevity Survey. The chi-square test was used to examine the differences in demographics, health status and lifestyles at different levels. Multivariate logistic regression was used to assess the association between NS use and demographic and lifestyle characteristics.

Results

Twelve percent of Chinese adults aged 65 years and above used NS. In terms of the type of supplement used, the most commonly used was calcium (8.49%), followed by protein (2.73%) and multivitamins (2.40%). In terms of demographic characteristics, women, older people, urban residents with other marital status, higher educational level, better living conditions and better lifestyle habits showed a greater use of some kinds of NS to varying degrees. Factors associated with the use of any NS included female gender [OR = 1.71, 95% confidence intervals (95% CI): 1.09-1.44], age 85-94 (OR = 1.30, 95% CI: 1.08-1.58), urban household registration (hukou) (OR = 1.25, 95% CI:1.46-2.00), higher education (primary school and middle school: OR = 1.32, 95% CI:1.14-1.52; high school and above: OR = 1.56, 95% CI:1.25-1.94), average and poor living standard (average: OR = 0.64, 95% CI:0.56-0.73; poor: OR = 0.42, 95% CI:0.32-0.55), poor health status (OR = 1.36, 95% CI:1.13-1.63), former smoking (OR = 1.33, 95% CI:1.11-1.60), and having exercise habits (former exercise: OR = 2.24, 95% CI:1.83-2.74; current exercise: OR = 2.28, 95% CI:2.00-2.61). Women reported taking 2-3 kinds of NSs, and more than 50% of NS users reported taking supplements often.

Conclusion

This study provides information on the current prevalence of NS use among older Chinese adults, and it clarifies the association of NS use with demographic, lifestyle and other factors. Providing scientifically based health guidance on NS use for older people is crucial to promoting their health.

Knowledge, use and practices of licensed dietitians related to dietary supplements in Lebanon

OBJECTIVE

To evaluate Lebanese licensed dietitians' knowledge, prevalence of use and recommendation of dietary supplements (DS), and their associated factors.

DESIGN

Cross-sectional survey.

SETTING

Dietitians across Lebanon were contacted through the telephone and were asked to participate in the study. An online self-administered questionnaire was designed and sent to dietitians either by email or by WhatsApp, between 4 March and 4 May 2020.

PARTICIPANTS

This study included 319 dietitians randomly selected from the dietitians' list that was provided by the Lebanese Ministry of Public Health.

RESULTS

Around 75 % of dietitians had a knowledge score above 50 %. Overall, 73·7 % of them have used DS and 46·1 % have recommended them. Higher knowledge score was associated with less years of experience, using scientific articles as source of information on DS, and participating in research. Resorting to pharmacists was significantly associated with both nutrient supplements (NS) and herbal supplements (HS) use, whereas referring to health food stores was associated with HS use only. NS recommendation to patients was associated with personal NS use (OR = 3·38, P < 0·001), considering pharmacists as a source of information on DS (OR = 2·29, P = 0·01) and discussing DS with patients (OR = 3·82, P = 0·01). Having personally used HS (OR = 12·23, P < 0·001) and having discussed DS with patients (OR = 8·51, P = 0·01) increased the likelihood of recommending HS.

CONCLUSIONS

A proper DS education, the elaboration of national scientific guidelines and the implementation of concise laws regarding the regulations of DS would play a crucial role in supporting dietitians' practices and improving the quality of patient care with respect to DS.

Dietary Supplement Use among Primary Health Care Attendants in Abha City, Southwestern Saudi Arabia

Dietary supplements are commercially available manufactured products used as an addition to the normal diet and involve vitamins, minerals, herbs (botanicals), amino acids, and various other products. With the use of a cross-sectional survey, the present paper intended to analyze dietary supplement usage and its health and sociodemographic determinants among attendants of primary health care centers in Abha City, southwestern Saudi Arabia. The sample was selected randomly using the two-stage cluster sampling technique. The study included 438 participants (115 males and 323 females). Their ages ranged from 18 to 59 years, with an average of 36.2 ± 11.7 years. The study showed that 330 people used dietary supplementation, giving a prevalence of 75.3% (95% CI: 71.1-79.2%). The most commonly used supplements were multivitamins (215, 65.2%), specific vitamins (60, 18.2%), and mineral pills (38, 11.5%). Advice from health care workers was the most frequent reason for using dietary supplements (49.4%). The majority (71.2%) reported feeling a better quality of life after using dietary supplements. The most frequent disadvantages of using dietary supplements were constipation and headache (30%) and the most frequent advantage was increasing appetite (59.8%). The people who most frequently recommended the use of supplements were health care workers (190, 57.6%), followed by friends or family members (62, 18.8%), and people on social media (43, 13%). Females had a significantly higher probability of using dietary supplements than males did (Cor = 2.0, 95% CI = 1.21-3.27), and those with a chronic disease had a considerably higher likelihood of using dietary supplements (cOR = 3.48, 95% CI = 2.04-6.06). Age, educational level, and marital status were not significantly related with dietary supplement usage. In conclusion, health care workers should focus on females and persons with chronic diseases in their practice. They should provide them with evidence-based advice regarding the use of dietary supplements. Continued medical education training programs tailored to the needs of health care staff addressing this issue should be provided. New guidelines should be developed to help health professionals to provide their patients with comprehensive care at the primary health care level.

Prevalence and Determinants of Sex-Specific Dietary Supplement Use in a Greek Cohort

We describe the profile of dietary supplement use and its correlates in the Epirus Health Study cohort, which consists of 1237 adults (60.5% women) residing in urban north-west Greece. The association between dietary supplement use and demographic characteristics, lifestyle behaviors, personal medical history and clinical measurements was assessed using logistic regression models, separately for women and men. The overall prevalence of dietary supplement use was 31.4%, and it was higher in women (37.3%) compared to men (22.4%; p-value = 4.2-08). Based on multivariable logistic regression models, dietary supplement use in women was associated with age (positively until middle-age and slightly negatively afterwards), the presence of a chronic health condition (OR = 1.71; 95% CI, 1.18-2.46), lost/removed teeth (OR = 0.52; 95% CI, 0.35-0.78) and diastolic blood pressure (OR per 5 mmHg increase =0.84; 95% CI, 0.73-0.96); body mass index and worse general health status were borderline inversely associated. In men, dietary supplement use was positively associated with being employed (OR = 2.53; 95% CI, 1.21-5.29). A considerable proportion of our sample used dietary supplements, and the associated factors differed between women and men.

Fish oil supplements, oxidative status, and compliance behaviour: Regulatory challenges and opportunities

BACKGROUND

Fish oil supplements that are rich in omega-3 long-chain polyunsaturated fatty acids (n-3 PUFAs). PUFAs are among the most widely-used dietary supplements globally, and millions of people consume them regularly. There have always been public concerns that these products should be guaranteed to be safe and of good quality, especially as these types of fish oil supplements are extremely susceptible to oxidative degradation.

OBJECTIVES

The aim of the current study is to investigate and examine the oxidation status of dietary supplements containing fish oils and to identify important factors related to the oxidation status of such supplements available in the United Arab Emirates (UAE).

METHODS

A total of 44 fish oil supplements were analysed in this study. For each product, the oxidative parameters peroxide value (PV), anisidine value (AV), and total oxidation (TOTOX) were calculated, and comparisons were made with the guidelines supplied by the Global Organization for EPA and DHA Omega-3s (GOED). Median values for each of the above oxidative parameters were tested using the Kruskal-Wallis and Mann-Whitney U tests. P values < 0.05 were chosen as the statistically significant boundary.

RESULTS

The estimate for the average PV value was 6.4 with a 95% confidence interval (CI) [4.2-8.7] compared to the maximum allowable limit of 5 meq/kg. The estimate for the average P-AV was 11 with a 95% CI [7.8-14.2] compared to the maximum allowable limit of 20. The estimate for the average TOTOX value was 23.8 meq/kg with a 95% CI [17.4-30.3] compared to the maximum allowable limit of 26 according to the GOED standards.

CONCLUSION

This research shows that most, although not all, of the fish oil supplements tested are compliant with the GOED oxidative quality standards. Nevertheless, it is clear that there should be a high level of inspection and control regarding authenticity, purity, quality, and safety in the processes of production and supply of dietary supplements containing fish oils.