Self-Reported Use and Reasons among the General Population for Using Sports Nutrition Products and Dietary Supplements

Prevalence of energy drink consumption world-wide: A systematic review and meta-analysis

BACKGROUND AND AIMS

The increasing market for energy drinks (EDs) in recent years, as well as the health risks caused by their consumption, prompt calls to estimate the prevalence of ED use among different countries. This systematic review and meta-analysis aimed to synthesize the prevalence of ED use in different continents and age groups.

METHOD

We searched two databases (i.e. PubMed and PsycInfo) on 31 March 2023 to identify studies reporting the prevalence of ED use. A total of 192 studies (196 distinct samples; n = 1 120 613; 53.37% males) from the United States, Europe, Asia, Oceania and Africa were included in the analysis. A random-effects model was applied to estimate the overall pooled prevalence at several time-periods. Subgroup analyses were performed to provide prevalence based on continent and age group. The quality of articles was assessed using Joana Brigg's Institute (JBI) critical appraisal checklist. Measurements included prevalence of ED use (i.e. life-time, past 12 months, past 30 days, past 7 days and daily use), continent and age group (i.e. children, adolescents, young adults and adults).

RESULTS

The life-time ED use world-wide-pooled prevalence was estimated to be 54.7% [95% confidence interval (CI) = 48.8-60.6; I2  = 99.80], 43.4% (95% CI = 36.1-50.6; I2  = 99.92) in the past 12 months, 32.3% (95% CI = 28.8-35.8; I2  = 99.82) in the past 30 days, 21.6% (95% CI = 18.7-24.5; I2  = 99.95) in the past 7 days and 8.82% (95% CI = 6.3-11.4; I2  = 99.95) daily ED use. Subgroups analyses showed significant differences in ED life-time use within age groups (P = 0.002) and continents (P = 0.035).

CONCLUSIONS

The world-wide prevalence of energy drink use appears to be high, particularly among adolescents and young adults.

Efficacy and utility of a tool for both measurement of vitamin B6, B12, D, folate and iron status and assessment of diet quality in athletes

NutriProfiel® is a tool to measure micronutrient status and to assess diet quality. It consists of measurement of micronutrient status in blood and a short food frequency questionnaire (FFQ) ('Eetscore-FFQ'). Based on the results, individuals receive a dietary advice. In this study, we evaluated the application of NutriProfiel in athletes ('NutriProfiel-Sport') by assessing the coverage of nutrient intake of the Eetscore-FFQ (part 1) and by evaluating athlete's dietary behaviour after using NutriProfiel-Sport and their satisfaction with this tool (part 2). For part 1, data of 419 athletes were used. We evaluated the coverage of nutrient intake of the Eetscore-FFQ using first and second MOMents (MOM1 and MOM2) sum scores of food items in the questionnaire. Forty-eight athletes were involved in part 2. They gave blood samples for micronutrient status measurement and were asked to complete the Eetscore-FFQ at baseline and after 3 months, as well as a questionnaire on their satisfaction with NutriProfiel-Sport. Results showed that for most nutrients, MOM1 and MOM2 scores were above 80 %, meaning that nutrient intake was sufficiently covered by the Eetscore-FFQ. No difference in diet quality was observed between baseline and after 3 months. Nevertheless, a majority of athletes reported the NutriProfiel-Sport results and advice as useful. On a scale from 0 to 10, NutriProfiel-Sport was graded with a mean (±sd) score of 7⋅6 (±0⋅8). In conclusion, NutriProfiel-Sport is a potential valuable and appreciated tool for athletes and the Eetscore-FFQ as part of this tool sufficiently covers nutrient intake in athletes.

Prevalence, Determinants, and Consumer Stance towards Dietary Supplements According to Sex in a Large Greek Sample: A Cross-Sectional Study

A stratified random sampling technique was used in order to explore the prevalence of and the factors influencing dietary supplement (DS) use and the consumer stance towards DS by Greeks (n = 28,491, ≥15 years) according to sex. Additionally, we performed a Pearson’s chi-square to test within DS users for the dependence between sex and the examined factors, and binary logistic regression to create predictive DS user profiles. A history of DS use accounted for 55.5% and was more prevalent in women (58.4% vs. 52.3%, p < 0.001); multivitamins were the most popular DS used. The significant predictors for DS use for both sexes were age, education, employment status, exercise, and following a special diet, while BMI and monthly income were significant for women and men, respectively. The women and men DS users had mostly illness-health and fitness-related goals, respectively. Substantial proportions of the respondents had false beliefs about DS. A noticeable percentage of DS users displayed imprudent behavior regarding DS use, e.g., one out of five did not know the definition or did not take into consideration the recommended daily allowance. While several factors seemed to impact DS use, with certain differences between the sexes, the considerable lack of knowledgeable and responsible use of DS, with few differences between the sexes, observed can point state authorities and health professionals towards appropriate countermeasures.

Use of Drugs and Dietary Supplements in University Students of Sports Science: Results of a Survey-Based Cross-Sectional Study

Dietary supplements are used to implement and balance common dietary habits. The general belief is that natural substances reduce the risk of chronic diseases and amplify sports performance with no harmful side effects. Since sports science students will become professionals of sport activities and may also have a role in suggesting the use of dietary supplements to athletes, the aim of this study was to evaluate if physical activity influences the use of drugs and dietary supplements. A modified version of the International Physical Activity Questionnaire—Short Form (IPAQSF) was administered to perform these evaluations. A total of 1452 students from the University of Messina, Italy, enrolled in sports science courses completed the survey; of these, 1075 (704 male and 371 female students) were physically active in moderate- or high-intensity training. Of those physically active students, 709 (440 male and 269 female) were competitive athletes, identified on the basis of their answer to a specific question also indicating the type of sport they practice. The results suggest that 5.6% of all respondents were regular consumers of pharmaceutical products, compared to just 1.0% of the cohort of competing athletes. In contrast, the consumption of natural supplements was similar (14% vs. 15%) between groups. The most frequently used supplements were vitamins, including vitamin C, vitamin B complex, and multivitamin complex, followed by minerals and amino acids or protein complex. The probability of using dietary supplements was mostly related to the male gender (OR 1.64; 95% CI: 1.17–2.30), having a job (OR 1.45; 95% CI: 1.07–1.96), and, most of all, performing physical activity (OR 3.53; 95% CI: 2.18–5.71). The only factor related to a higher use of drugs was female gender (OR 2.40; 95% CI: 1.52–3.79), and the most used class was antihistaminic, followed by FANS. These results suggest that among the specific population of sports science students, those performing physical activity are less prone to using pharmaceutical products and have healthier habits.

Dietary practices and supplement use among CrossFit® participants

Background

CrossFit® is a popular high-intensity functional training program. CrossFit® participants may practice popular diets or consume dietary and sports supplements to support their health or physical pursuits, but the specific dietary and supplement practices of CrossFit® participants remain unknown.

Methods

An electronic questionnaire was developed to collect data on practice of popular diets (i.e. Paleo and The Zone Diet®), dietary and sports supplement use, reasons for practicing a diet or using supplements, sources of information on diets and supplements, and various beliefs associated with nutrition among CrossFit® participants.

Results

Of the 2,576 complete responses (female 51.9%, male 48.1%, age 39.4 ± 11.1 years, body mass index 26.1 ± 3.9 kg/m²), 695 (27%) reported being a CrossFit® trainer or coach and 1,392 (54%) reported competing, or planning to compete, in CrossFit® or other fitness competitions. The average years of CrossFit® experience were 5.3 ± 3.1 years, and the average frequency of CrossFit® participation was 4.5 ± 1.1 days/week. Most participants (60.1%) reported practicing a particular diet. Macro Counting (18.6%), Intermittent Fasting (7.7%), and Paleo (6.1%) were the most frequently reported diets. The top reasons for practicing a diet were to improve overall health (45.6%), decrease body fat (29.2%), and improve CrossFit® performance (25.2%). The top sources of dietary information were the Internet (47.5%), coach/trainer (28.7%), and nutritionist/dietitian (26.2%). Most participants (67.3%) reported “Urine Color” as the best method to assess hydration. Additionally, most participants (82.2%) consumed at least one supplement, with protein (51.2%), creatine (22.9%), and pre-workout/energy (20.7%) being most popular. The top reasons for consuming supplements were to improve recovery (52.6%), improve overall health (51.4%), and increase muscle mass/strength (41.7%). The top sources of information on supplements were the Internet (53.1%), coach/trainer (27.0%), and peer-reviewed research (23.0%).

Conclusions

A large proportion of CrossFit® participants may practice popular diets or consume supplements with the intention of improving health or performance. These findings may support future research on the effects of various dietary patterns and supplements on CrossFit® performance.

Physically inactive adults are the main users of sports dietary supplements in the capital of Brazil

Purpose

This cross-sectional study aimed to provide estimates of dietary supplements (DS) use and to examine the relationship between sports dietary supplements (SDS) use and sociodemographic and lifestyle characteristic, body mass index and total daily physical activity (PA) in the adult population of Brasília, Brazil.

Methods

DS use was collected from 506 adults via a Food Frequency Questionnaire. DS were divided into multivitamin-minerals, electrolyte drinks, energy, protein, partial meal replacements, creatine, caffeine, and others. Electrolyte drinks, energy, and protein supplements were considered as SDS. PA was estimated from a 24-h PA recall, and total MET (metabolic equivalents)/day and MET-h/day were calculated. Participants were categorized as physically inactive or active according to MET-h/day.

Results

DS were used by 68% of adults; multivitamin-minerals (38%) and protein supplements (29%) were the most commonly used products. SDS use was associated with the highest socioeconomic level, younger age, and male gender, but not with PA. Also, most SDS users were physically inactive.

Conclusion

These findings indicate that SDS may be used unnecessarily by adults in Brasília. Specific recommendations and control procedures for the use of SDS are warranted.

Social Media, Body Image and Resistance Training: Creating the Perfect 'Me' with Dietary Supplements, Anabolic Steroids and SARM's

BACKGROUND

Few studies have assessed the use of dietary supplements, anabolic androgenic steroids (AAS) and selective androgen receptor modulators (SARM) in male gym users. The comparison of physical appearance with others on social media and the exposure to fitness-related content on social media (i.e., image-centric social media use) may have a profound role in using these compounds due to its role in creating negative body images in male gym users.

OBJECTIVE

Provide contemporary data on the use of dietary supplements, AAS and SARM among young male gym users, and test the hypothesis that social media is associated with the use of dietary supplements, AAS and SARM, as a result of a negative body image.

METHODS

In this cross-sectional study, conducted in the Netherlands, male gym users (N = 2269; 24 ± 6 years) completed an online questionnaire including self-reported measures regarding resistance training participation, image-centric social media use, dietary supplement intake, and body image. The prevalence of AAS and SARM use was assessed with randomized response, a technique to ask sensitive questions indirectly.

RESULTS

Of all participants, 83% used ergogenic dietary supplements (mainly protein and creatine), and an estimated 9 versus 2.7% had ever used AAS versus SARM. Image-centric social media use was positively associated with the use of dietary supplements (r = .26; p < 0.01) and AAS (p < 0.05), but not SARM. Image-centric social media use was associated with a more dissatisfied body image (r = .34; p < 0.01). Body image did not mediate the relationship between image-centric social media use and the use of doping compounds.

CONCLUSIONS

The use of dietary supplements in young male gym users is exorbitant, with the use of AAS and SARM being substantial. Image-centric social media use is positively associated with the use of dietary supplements and AAS.

Knowledge and Prevalence of Supplements Used by Brazilian Resistance Training Practitioners Before Coronavirus Outbreak

Introduction

The use of dietary supplements and ergogenic aids (DSEA) is popular among physical activity enthusiasts. Particularly, resistance training (RT) practitioners represent important DSEA consumers due to its easy access and the appeal of claims related to muscle hypertrophy, aesthetics, and physical performance improvements.

Methods

Our aim was to study knowledge, prevalence, and profile of DSEA used by Brazilian recreational RT practitioners. For this, RT practitioners of both sexes (n=129, female=58 and male=71) answered a paper-based questionnaire. The questionnaire was specifically created for the studied population to assess different aspects of the DSEA used and sociodemographic variables.

Results

Seventy-seven percent of the participants (n=99) declared that they had already used DSEA. The majority (53%) searched the internet to obtain information about DSEA. Whey protein (66%) was the most used followed by branched chain amino acids (48%).

Conclusion

The use of DSEA, before coronavirus outbreak, was popular among RT practitioners; protein and amino acids were the most used DSEA. Most users used internet to obtain information about DSEA. The results suggest the need for appropriate attitude and guidance by health professionals who deal with this population, especially dietitians, nutritionists, and physical training professionals in order to promote best and security practices.

Undeclared Doping Substances are Highly Prevalent in Commercial Sports Nutrition Supplements

Sports nutrition supplements have previously been reported to contain undeclared doping substances. The use of such supplements can lead to general health risks and may give rise to unintentional doping violations in elite sports. To assess the prevalence of doping substances in a range of high-risk sports nutrition supplements available from Dutch web shops. A total of 66 sports nutrition supplements - identified as potentially high-risk products claiming to modulate hormone regulation, stimulate muscle mass gain, increase fat loss, and/or boost energy - were selected from 21 different brands and purchased from 17 web shops. All products were analyzed for doping substances by the UK life sciences testing company LGC, formerly known as the Laboratory of the Government Chemist, using an extended version of their ISO17025 accredited nutritional supplement screen. A total of 25 out of the 66 products (38%) contained undeclared doping substances, which included high levels of the stimulants oxilofrine, β-methylphenethylamine (BMPEA) and N,β-dimethylphenethylamine (NBDMPEA), the stimulant 4-methylhexan-2-amine (methylhexaneamine, 1,3-dimethylamylamine, DMAA), the anabolic steroids boldione (1,4-androstadiene-3,17-dione) and 5-androstene-3β,17α-diol (17α-AED), the beta-2 agonist higenamine and the beta-blocker bisoprolol. Based upon the recommended dose and the potential variability of analyte concentration, the ingestion of some products identified within this study could pose a significant risk of unintentional doping violations. In addition to inadvertent doping risks, the prescribed use of 3 products (4.5%) could likely impose general health risks.

Sport Dietary Supplements and Physical Activity in Biomedical Students

Biomedical students should have suitable knowledge about sport dietary supplements (SDS) usage as they are future medical professionals who will have SDS users in their care. The aim of this study was to assess the habits, opinions, and knowledge about SDS usage, along with the level of physical activity, in 386 biomedical students at the University of Split School of Medicine. A specialized questionnaire was developed by a group of experts for the assessment of habits, opinions, and knowledge about SDS and the International Physical Activity Questionnaire—Short Form (IPAQ-SF) was used to evaluate the level of physical activity. The results showed that 49.2% of students used SDS and there was a significant positive correlation between the knowledge questionnaire score and the level of physical activity (r = 0.744, p < 0.001). Moreover, SDS users had a higher knowledge questionnaire score (p < 0.001) and a higher level of physical activity (p < 0.001) compared to non-users. These results suggest that more physically active students are better informed about SDS, but these results also imply that SDS should be implemented in the study program of future medical professionals to ensure that they are informed for their own personal consumption and will be confident in giving advice about SDS usage to their future patients.

Dutch Olympic and Non-Olympic Athletes Differ in Knowledge of and Attitudes Toward Third-party Supplement Testing

Knowledge of third-party testing is important for elite athletes using nutritional supplements to reduce the chances of a positive doping incident. Therefore, we compared the self-reported knowledge and attitudes of N = 601 Dutch Olympic status and non-Olympic status athletes toward an independent Dutch third-party tested system (NZVT) for purchasing nutritional supplements (NSs). Most of the athletes believed that contaminated NSs could lead to a positive doping test (68.0%), and found it unacceptable to use a contaminated NS as a result of incomplete labeling (87.8%). More Olympic status athletes were familiar with the NZVT system (71.1%) than non-Olympic status athletes (24.5%, p < 0.001). Of the athletes knowing about NZVT, Olympic status athletes reported more frequently using the NZVT than non-Olympic athletes (81.7% vs. 50.0%, p < 0.001). Apart from status, more females were familiar with and used the NZVT system for purchasing NSs than males, p < 0.01. In conclusion, many athletes were not familiar with nor used the preferred third-party testing supplement system in the Netherlands when purchasing NSs. While doping warnings and regulations have been in place, considering the risk of unintentional doping use for over two decades, the knowledge of Olympic status and non-Olympic status high-level athletes could still be improved, as many are not reporting the use of third-party testing systems.

Third-Party Testing Nutritional Supplement Knowledge, Attitudes, and Use Among an NCAA I Collegiate Student-Athlete Population

Dietary supplements, sports foods, and ergogenic supplements are consumed to increase performance, recovery, and health, but risk contamination with illegal substances. Third-party testing programs may assist in regulating the purity and safety of supplements, yet athletes' attitudes and use of such programs are not widely reported. This study examined nutritional supplement knowledge, attitudes, and use, as well as the purchase of third-party tested supplements among university student-athletes (N = 138). Knowledge of nutritional supplements yielded a median and (IQR) score of 25% (17 to 42%). Sixteen percent of student-athletes said they were knowledgeable about supplements and their effects, p < 0.001. All athletes stated they used a dietary supplement or sports food at least once within the last 12 months, and 77% consumed at least one “claimed to be” ergogenic supplement. Sixty-six percent of student-athletes purchased nutritional supplements not provided by the athletic department. Females athletes were more likely to consume a combination of vitamins and single minerals, a larger variety of sports foods, exotic berries, herbs, maca root powder, ribose, ephedra, colostrum, and hydroxy-methyl-buterate (HMB) than males. Over 90% believed it was essential to know if a supplement was third-party tested. However, only 57% stated the supplements bought were third-party tested. No sex differences were found for nutritional supplement knowledge, attitudes, and use of third-party testing programs. Our results indicate a need to improve student-athletes' attitudes toward and knowledge of nutritional supplements, and the initiation of programs to assist in the choosing and consuming of third-party tested supplements.

An Investigation of Habitual Dietary Supplement Use Among 557 NCAA Division I Athletes

Background: Supplements may expose athletes to dangerous ingredients, banned substances, toxins or contaminants; however, few investigations assess use among collegiate athletes in the U.S.Objective: This cross-sectional study evaluated habitual dietary supplement intake, defined use ≥2 days/week over the past year, in NCAA Division I athletes.Methods: Male and female members of a NCAA Division I team, at two universities in southern California completed a 13-item survey. Among 705 eligible participants, 596 submitted surveys (84.5% response rate), 557 surveys included complete data. Chi-square (χ²) analyses evaluated differences among athletes based on sex, weight status, year in college, and sport-type. Independent t-test or ANOVA evaluated mean differences for continuous variables.Results: A total of 45.2% athletes (n = 252) reported taking supplements (≥2 days/week over the past year). Vitamin/minerals (25.5%, n = 142), protein/amino acids (24.6%, n = 137) were used most frequently. Male, vs female athletes, took more supplements overall (1.2 ± 0.1 vs 0.8 ± 0.1, p = 0.004) and indicated higher use of protein/amino acid products (34.2% vs 13.5%, p < 0.005), whereas, females reported higher use of vitamin/minerals (30.5% vs 21.1%, p < 0.05). Higher supplement use was also reported by athletes with BMI ≥ 30.0 kg/m² (vs <30 kg/m², 1.9 ± 0.3 vs 1.0 ± 0.1, p = 0.02), and athletes in ≥ third college year (vs first or second year, 1.2 ± 0.1 vs 0.9 ± 0.1, p = 0.03).Conclusions: Nearly half of NCAA athletes reported habitual supplements use, with significant variation in patterns based on sex, sport-type, year in college, and weight status.

Predicting and Testing Bioavailability of Magnesium Supplements

Despite the presumption of the beneficial effects of magnesium supplementation, little is known about the pharmacokinetics of different magnesium formulations. We aimed to investigate the value of two in vitro approaches to predict bioavailability of magnesium and to validate this in subsequent in vivo testing. In vitro assessment of 15 commercially available magnesium formulations was performed by means of a Simulator of the Human Intestinal Microbial Ecosystem (SHIME^®) and by dissolution tests. Two magnesium formulations with contrasting bioavailability prediction from both in vitro tests (best vs. worst) were selected for in vivo testing in 30 subjects. In vivo bioavailability was compared following one acute ingestion by monitoring blood magnesium concentrations up to 6 h following intake. The in vitro tests showed a very wide variation in absorption and dissolution of the 15 magnesium products. In the in vivo testing, a significant different serum magnesium absorption profile was found up to 4 h following supplement ingestion for the two supplements with opposing in vitro test results. Moreover, maximal serum magnesium increase and total area under the curve were significantly different for both supplements (+6.2% vs. +4.6% and 6.87 vs. 0.31 mM.min, respectively). Collectively, poor bioaccessibility and bioavailability in the SHIME model clearly translated into poor dissolution and poor bioavailability in vivo. This provides a valid methodology for the prediction of in vivo bioavailability and effectiveness of micronutrients by specific in vitro approaches.

Multi-ingredient pre-workout supplements, safety implications, and performance outcomes: a brief review

In recent years, a new class of dietary supplements called multi-ingredient pre-workout supplements (MIPS) has increased in popularity. These supplements are intended to be taken prior to exercise and typically contain a blend of ingredients such as caffeine, creatine, beta-alanine, amino acids, and nitric oxide agents, the combination of which may elicit a synergistic effect on acute exercise performance and subsequent training adaptations compared to single ingredients alone. Therefore, the purpose of this article was to review the theoretical rationale and available scientific evidence assessing the potential ergogenic value of acute and chronic ingestion of MIPS, to address potential safety concerns surrounding MIPS supplementation, and to highlight potential areas for future research. Though direct comparisons between formulations of MIPS or between a MIPS and a single ingredient are challenging and often impossible due to the widespread use of "proprietary blends" that do not disclose specific amounts of ingredients in a given formulation, a substantial body of evidence suggests that the acute pre-exercise consumption of MIPS may positively influence muscular endurance and subjective mood, though mixed results have been reported regarding the acute effect of MIPS on force and power production. The chronic consumption of MIPS in conjunction with a periodized resistance training program appears to augment beneficial changes in body composition through increased lean mass accretion. However, the impact of long-term MIPS supplementation on force production, muscular endurance, aerobic performance, and subjective measures is less clear. MIPS ingestion appears to be relatively safe, though most studies that have assessed the safety of MIPS are relatively short (less than eight weeks) and thus more information is needed regarding the safety of long-term supplementation. As with any dietary supplement, the use of MIPS carries implications for the athlete, as many formulations may intentionally contain banned substances as ingredients or unintentionally as contaminants. We suggest that athletes thoroughly investigate the ingredients present in a given MIPS prior to consumption. In conclusion, it appears that multi-ingredient pre-workout supplements have promise as an ergogenic aid for active individuals, though further information is required regarding long-term efficacy and safety in a wider variety of populations.