Knowledge, Attitudes, and Practices Related to Dietary Supplementation, before and during the COVID-19 Pandemic: Findings from a Cross-Sectional Survey in the Lebanese Population

Prevalence and predictors of vitamin D deficiency in Lebanon: 2016-2022, before and during the COVID-19 outbreak

BACKGROUND

Vitamin D deficiency is very common worldwide, particularly in Middle-Eastern countries. Recent Lebanese studies demonstrated an improvement in vitamin D status over time. However, the comparison between the years before and during the COVID-19 outbreak has never been analyzed in the Middle-East area. This study aimed to determine the prevalence and the predictors of 25-hydroxyvitamin D (25(OH)D) levels during the last 7 years.

METHODS

Serum 25(OH)D levels from a large laboratory database were retrospectively collected from Hôtel-Dieu de France Hospital between January 2016 and June 2022 (N = 66,127). Data related to age, gender, season and year of sampling were also retrieved.

RESULTS

Mean age of the population was 50.6 ± 19 years, 62.7% were women, 5.3% were children and adolescents, 67.6% adults and 27% elderly. Mean serum 25(OH)D level was 25.7 ± 11.9 ng/mL. The overall population with vitamin D sufficiency (>30 ng/mL) was 31.9%. The increase in mean serum 25(OH)D observed between 2016 and 2022 was 6.36 ng/mL (p < 0.0001). The prevalence of 25(OH)D deficiency (<30 ng/mL) decreased from 76.2% in 2016 to 56.5% in 2022 (p < 0.0001) with a significant difference between the period before and during the COVID-19 outbreak (72.3% vs.42.5%, p < 0.0001). In a multivariate logistic regression, older age, female sex, summer season, years of the COVID-19 outbreak and outpatient samples were protective factors against the risk of hypovitaminosis D (p < 0.0001 for all variables).

CONCLUSION

Our study showed a continuous positive change in vitamin D status time, most notably after the COVID-19 outbreak. Further studies are needed to assess the clinical impact of the pandemic on vitamin D status in our population.

Perception, knowledge, and consumption pattern of dietary supplement used during COVID-19 pandemic among black Africans: Perspective of Nigerians

The awareness of the health implication of Covid-19 pandemic marked an increase consumption of various dietary and herbal supplements (DHS) for the deterrence and/or prophylaxis against the novel emerging and infectious disease. However, there is little indication of the usefulness or otherwise of their use in alleviating symptoms of COVID-19.

Objectives

To investigate the pattern and determinants of DHS use among the Nigerian population for the prevention and treatment of COVID-19.

Design

Cross-sectional questionnaire survey. Setting: Older adolescents and adults residing in Nigeria.

Participants

Participants (n = 645) residing in the Nigeria were recruited from different geo-political zones and various ethnic groups.

Primary and secondary outcomes

Prevalence and determinants for the use of different DHS for the prevention and treatment of COVID-19 in Nigeria, and sources of information for DHS use.

Results

Most participants (425, 65.9%) believed that dietary supplements are necessary during infectious disease outbreak, but a fewer proportion believed that supplements can be used in conjunction with other drugs to treat Covid-19. Vitamin C was the most known (70.0%) and Vitamin A. The least known (0.3%) dietary supplement Approximately half (50.2%) of the study subjects, more than a third (37.8%) and less than a quarter (22.7%) were aware that Folic acid, vitamin D and vitamin E are DS. Herbal dietary supplements mentioned as known by the study participants included Garlic (46.5%), Ginger (44.7%), Tumeric (36.3%), Moringa (40.0%) and Ginseng (26.3%). Citrus fruit as a DS was recognized by fewer (6.5%) study participants and only 1.6% referred to herbal tea as DHS. In all, 571 (88.5%) of the study participants took DHS during the Covid-19 pandemic with males 1.5 times more likely to take DHS than females (χ2 = 3.09, P-value = 0.08, OR = 1.54, 95% CI = 0.95, 2.47) during the pandemic. Participants reported lesser consumption of Selenium (27, 4.2%), Iron (20,3.1%), Zinc (61, 9.5%) and calcium (101, 15.7%) to prevent/treat Covid-19. Majority (271, 42.0%) of the study participants mentioned "health worker" as source of information on DHS while 13% mentioned "Social media". The sociodemographic determinants of DHS practices used to prevent/treat COVID-19 during the pandemic included older age group of 61-70 years, widows, secondary level of education and not employed.

Conclusions

The findings showed widespread use of DHS for the prevention and treatment of COVID-19. The use of DHS in this study was mainly guided by health workers with a marginal role of social media and Mass media. These findings call for a more robust consolidative tactic towards DHS to ensure its proper and safe use.

The impact of vitamin D, vitamin C, and zinc supplements on immune status among Jordanian adults during COVID-19: cross-sectional study findings

BACKGROUND AND AIMS

Nutritional status is essential for the maintenance of the immune system, with malnutrition suppressing immunity. The aims of the current study were to assess the immune status of a group of Jordanian adults and to evaluate the association between vitamin C, vitamin D, and zinc consumption and the Immune Status during the COVID-19 pandemic.

METHODS

A total of 615 adults Jordanian participants were enrolled in this study, an online- based cross sectional survey was used as a tool for this study. Data was collected by distributing the questionnaire form link through social media platforms. The association between ISQ score and the supplement intake pattern (daily, weekly, monthly and rarely) was assessed using multinomial logistic regression analysis, described as Odds ratio and 95% CI.

RESULTS

Data have indicated that the majority of the participants did not take Vitamin D supplements during the pandemic (46.3%). Also, there was a significant association between the frequency of Vitamin D supplement intake and ISQ (r = 12.777; P < 0.05). Data showed that the majority of participants used vitamin C supplementation (49.4%). Also, there was a significant association between the frequency of Vitamin C supplement intake and ISQ (r = 12.797; P < 0.05). Data also have indicated that the majority of the participants did not increase their consumption of Zinc during the COVID-19 pandemic (55.6%).

CONCLUSIONS

The findings of this study suggest a significant association between the frequency of Vitamin D, and vitamin C supplement intake and ISQ. Nutritional status is essential for the maintenance of the immune system, with malnutrition suppressing immunity.

Intention to purchase halal health supplement online: Lessons learned from the health crisis

Consuming health supplements is essential to strengthen the immune systems and protect against illness, especially during health crises such as the COVID-19 pandemic. Considering the increasing number of Muslim populations worldwide and the necessity of online applications during health crises, this research aims to study the consumer's purchase intention of halal health supplement products online by examining variables influencing consumer's purchase intention. The Theory of Planned Behaviour has been applied as an underlying theory for this study, including religiosity and COVID-19 as an extension to the theory. 214 respondents participated in this study by completing the survey questionnaire via an online platform. Analysis was performed using SmartPLS4. The findings illustrate that perceived benefit is the most important indicator for Indonesian respondents, while attitude, subjective norms, and the COVID-19 pandemic are the factors that contribute to purchase intention among Malaysian respondents. The study enhances current literature, specifically in the context of halal health supplement products. Additionally, investigating the COVID-19 pandemic in the context of halal health supplements with a unique set of variables leads to a new path of study. Examining consumer behavior such as perceived benefit, attitude, subjective norms, and the COVID-19 pandemic that influence online purchase intention will provide consumer insights to marketers involved in halal health supplement products. The perspective on consumer beliefs gives directions for strategy development to businesses.

Effect of educational intervention on knowledge and attitude about the role of vitamins, minerals and nutraceuticals in COVID-19 and other disorders among medical and nursing undergraduates of a tertiary care teaching hospital

PURPOSE

There must be a perfect balance between Food and Dietary supplements (DS) to ensure optimal well-being. The purpose of this study was to evaluate the impact of a webinar on the change in knowledge and attitude about the role of vitamins, minerals and DS among medical and nursing undergraduates so that they could bring about a positive change in popular practices, as well-informed Health Care Professionals (HCPs).

MATERIALS AND METHODS

The study was a cross-sectional analytical study comprising 12 knowledge and 11 attitude questions administered to medical and nursing undergraduates with the help of semi-structured and pre-validated google form both before and after a webinar explaining the role of key nutrients and also the evidence and recommendations surrounding DS. Data were analyzed using STATA.12 to assess the impact of the webinar.

RESULTS

There were 415 participants, with 265 medical and 150 nursing students. There was a significant improvement both in the knowledge (4.95 (±1.45), 7.76 (±1.69) and attitude scores (pre-webinar mean score 31.8 (±5.57) post-webinar mean score 27.7 (±4.90))of the participants after the webinar. An overall positive correlation before the webinar changed to a more significant negative correlation, indicating a positive impact of the webinar (0.0054-0.0701).

CONCLUSION

The study suggests that continuing education informing various HCPs and undergraduate students about the absolute necessity of a diet rich in nutrients, vitamins, minerals, and probiotics is the need of the hour. Additionally, the efficacy and safety concerns, appropriate indications and dosages of various DS should be adequately stressed so that informed decisions can be made. Such training programs might have a far-reaching impact on the nutrition choices of the population at large.

A Global Overview of Dietary Supplements: Regulation, Market Trends, Usage during the COVID-19 Pandemic, and Health Effects

Over the last 20 years, the use of dietary supplements (DS) has continued to grow in many countries. Due to the public health crisis brought on by the COVID-19 pandemic and amidst fears regarding COVID-19 vaccines and their low supply in many regions of the world, there has been a marked interest in the use of DS as alternative means of protecting against and treating this emerging disease, as well as boosting the immune system and minimizing the risk of inflammation. Despite a lack of evidence to suggest their efficacy, a surge in the sales of DS has been reported in many parts of the world. Questions have also been raised about the health effects associated with DS due to their increased use during the health crisis. Numerous scientific studies have demonstrated their beneficial properties as well as some adverse and even toxic effects. In addition, given the current global interest in this issue, a review is needed to establish the status of dietary supplements before and during the health crisis. The aim of this review is to summarize the current evidence on the impact of dietary supplements on the incidence of the COVID-19 pandemic, as well as their regulation and associated market trends. First, we provide an overview of DS, including a comprehensive review of the legislative and regulatory aspects of DS in the USA, China, the EU, and Algeria. Second, we describe the prevalence of the most commonly consumed DS and their efficacy as a prophylactic modality in the era of COVID-19. Additionally, we examine the structure and size of the DS market in the countries that predominantly produce and import them, its global market trend, and the impact of the COVID-19 pandemic on market growth. Finally, in this review, we also discuss the profile of DS users.

Knowledge and attitudes towards herbal and dietary products use during the COVID-19 pandemic

Background and aim

The outbreak of coronavirus (COVID-19) has made a global public health disaster. Little information is known about how to combat this infection. Therefore, preventive health measures that can reduce the severity and progression of this disease are needed. Some dietary supplements and herbal products have antiviral and anti-inflammatory effects. Thus, it may be used to enhance immunity and reduce the risk of COVID-19 infection. In this study, we reviewed selected supplements that may play a key role in the prevention and management of COVID-19 (e.g. vitamin D, vitamin C, and zinc), and that was to determine the level of knowledge and attitudes toward them by the adult population in Jordan.

Methodology

This is a cross-sectional study design, in which an online questionnaire was conducted and distributed on different social media websites. People who are above 18 years old were included in this study. Demographic, Attitudes, and knowledge data were collected and then analyzed using the Statistical Package for Social Sciences (SPSS 23).

Results

In this study, (62.8%) of participants became more concerned with their health during the COVID-19 pandemic, and (49.2%) of them used dietary and herbal supplements to protect themselves from the coronavirus. In addition, (18.5%) of participants reported that they had used these supplements for a while and then stopped.

Conclusion

The findings of our study provided evidence that the general population in Jordan has a reasonable level of knowledge and acceptance of dietary and herbal supplements used during the COVID-19 pandemic.

Evaluation of dietary supplementation and/or herbal food consumption habits and common beliefs on their effectiveness during the COVID-19 pandemic

Since 2020, COVID-19 has affected the entire world. Various dietary supplements/herbal foods are recommended to protect against and/or treat COVID-19 through social media and conventional media platforms, although their effects are unproven. Hence, this study aimed to investigate dietary supplementation and/or herbal food consumption habits intended to protect against and/or treat COVID-19, as well as common thoughts and beliefs about these products during the COVID-19 pandemic. This cross-sectional study was conducted as an online survey via the "SurveyMonkey" platform between June and December 2021. Participants were invited to participate in the study via social media (Instagram, Twitter, Facebook, WhatsApp) and the questionnaire was administered online. A total of 1767 participants were confirmed to be eligible. Overall, 35.3% used dietary supplements/herbal foods for protection against COVID-19 and 67.1% used them for treatment. Most believed that certain dietary supplements/herbal foods have an effect on the prevention and treatment of COVID-19. According to the COVID-19 infection status, participants differed in their opinions regarding the protective effects of vitamin D supplementation against COVID-19 (P = .02). It is important to raise public awareness of this issue and to avoid the unnecessary use of dietary supplements before sufficient evidence has been presented.

Practice and knowledge of dietary supplement consumption among Indonesian adults post-delta wave of the COVID-19 pandemic

Background: Increasing dietary supplement (DS) consumption was observed during the COVID-19 pandemic, including during the post-Delta wave period. This study aimed to measure the practice of DS consumption and respondents' knowledge of DS. Methods: An internet-based survey was distributed from October-December 2021 and obtained 541 valid and completed responses. Descriptive analysis was performed to present the practice of DS consumption, including frequency, duration, aim, preferable dosage form etc. Level of knowledge on DS principles, side effects and regulation were also measured. Inferential analyses were conducted to determine the predictors of the respondents' DS practice and level of knowledge. Results: Data from 541 valid responses showed that 77.63% of respondents consumed DS in the last 3 months, with only 59.52% reporting also consuming DS before the COVID-19 pandemic. One half of the respondents had good knowledge about DS; however, some knowledge regarding side effects and possible drug-supplement interaction needed improvement. Their DS consumption practice was affected by their economic status and history of contracting COVID-19. Nevertheless, the level of knowledge was not affected by the sociodemographic factors and DS supplement experience. Conclusions: Taken together, the practice of self-consumption of DS in Indonesia is increasing; hence, knowledge of DS is necessary to avoid detrimental effects that might occur in the future. Increasing access to information on better labelling and educating consumers about DS are important actions to consider.

The prevalence of trimester-specific dietary supplements and associated factors during pregnancy: An observational study

Objectives: This study aimed to assess the prevalence of trimester-specific dietary supplements (DS)s use and their possible correlates during pregnancy.

Method: Pregnant women were convenience sampled and recruited from a comprehensive obstetric care center in Shanghai, China. Data relating to the use of DS during pregnancy, social support and other social-demographic and obstetric data were collected. Trimester-specific DS use and factors related DS were explored.

Results: Of the 2803 women participating in this study, 94.8%, 96.2%, 93.8%, and 94.4% reported the use of at least one DS during pregnancy (all trimesters) and in the first, second, and third trimesters of pregnancy, respectively. Significant differences were noted in the use of DS containing folic acid, calcium, iron, vitamins, and docosahexaenoic acid (DHA), during the three trimesters of pregnancy. A higher proportion of DS use was negatively associated with certain categories of pregnant woman, including unemployed/housewife, low education level, obese, and low social support. A positive association was identified with gestational age.

Conclusion for practice: Considering the high prevalence of DS use during pregnancy, future studies are needed to evaluate the accuracy and suitability of DS usage during pregnancy.

Supplementation use and diet changes during COVID-19 pandemic according to anxiety level and Mediterranean diet adherence

Aim; This study was planned and conducted to examine the change in food consumption and nutritional supplement use during the COVID-19 pandemic according to individuals' status of anxiety and Mediterranean diet adherence. Methods; This prospective, cross-sectional research was completed online with the participation of 949 people (66.4% women). The Mediterranean Diet Adherence Screener Scale (MEDAS) and Coronavirus Anxiety Scale (CAS) were applied. After this section of the questionnaire was completed, the participants were tasked with answering questions regarding changes in food consumption and use of nutritional supplements during the pandemic. Results; While 50.8% of the participants had low adherence to the Mediterranean diet, 18.2% were considered to have a high adherence. It was observed that legume (p = 0.001), milk and dairy (p = 0.01), and fruit (p < 0.001) consumption of participants with high adherence to the Mediterranean diet increased during the pandemic, and packaged food (p < 0.001) consumption decreased. The increase in the consumption of fruit (p < 0.001) and vegetables (p = 0.018) were significantly higher in the group with anxiety. Age, sex, educational status, positive COVID-19 test, place of residence, CAS score and MEDAS score affect the use of dietary supplements according to binary logistic regression (R² = 0.106 p < 0.001). The three most commonly used supplements were identified as vitamins C, D and B₁₂. Conclusions: These results can shed light on how to prepare for possible future pandemics when it comes to dealing with anxiety through diet.

Attitudes and beliefs regarding the use of herbs and supplementary medications with COVID-19: A systematic review

BACKGROUND AND AIM

There is growing interest in using herbs and supplementary medications to treat and/or prevent COVID-19, evidenced by multiple reports exploring their effectiveness and safety. From a health psychology perspective, the desire to use herbs and supplementary medications to prevent and/or treat COVID-19 is a health behavior which is attributed to attitudes and beliefs. This systematic review critically appraised and synthesized the data from studies investigating these attitudes and beliefs.

METHODS

EMBASE, PubMed, ScienceDirect, Scopus, Cochrane (library), and WebOfScience were searched from inception to December 13, 2021 for studies investigating attitudes and beliefs on the use of herbs and supplementary medications to treat and/or prevent COVID-19.

RESULTS

A total of 17 articles were identified for inclusion. All except one were of cross-sectional design. Participants across most studies had a positive attitude towards using herbs and supplementary medications. They believed that herbs and supplementary medications were effective and were confident in their value in preventing and/or treating COVID-19 symptoms. The majority of included studies had significant flaws in study design and reporting, including inconsistent definitions of herbs and supplementary medications, a lack of theoretical models and conceptual frameworks underpinning the study of beliefs and attitudes, in addition to methodological issues of robustness affecting the validity and reliability of data.

CONCLUSION

The use of herbs and supplementary medicines to prevent and/or treat COVID-19 could well be driven by a positive attitude stemming from beliefs of effectiveness and safety. There is a need for well-designed studies on attitudes and beliefs that are driven by health behavior theories to permit generalizability of findings and establish more conclusive relationships between beliefs, attitudes and the decision to use herbs and supplementary medications to treat and/or prevent COVID-19.

Covid-19 related factors to food security and dietary diversity among urban households in western Oromia, Ethiopia

Background

This study aims to assess factors associated with food security and dietary diversity among poor urban households of western Oromia, Ethiopia, after the outbreak of the Covid-19 pandemic.

Method

A cross-sectional, community-based study was conducted in May to June 2021 with 361 poor urban households in the Horo Guduru Wollega zone, western Oromia, Ethiopia. A pre-tested structured questionnaire was used to collect primary data. Twenty-four hour reminder points were used to assess household dietary diversity, and household food security was assessed using the Household Food Insecurity Access Scale tool. Data were evaluated using the statistical software SPSS version 25.0.

Results

This study showed a prevalence of food insecurity in households of 59.6%. The mean and standard deviation of household dietary diversity values were 4.19 ± 1.844. Family size (AOR = 8.5; 95% CI:3.295-21.92), monthly income (AOR = 3.52; 95% CI; 1.771-6.986), dietary diversity (AOR = 8.5; 95% CI; 3.92-18.59), knowledge (AOR = 3.0, 95% CI = 1.08-)8.347), attitude (AOR = 8.35, 95% CI:3.112-22.39) and practices against Covid-19 (AOR = 2.12; 95% CI:1.299-11.4) were factors significantly associated with food insecurity. Variables like educational status (AOR = 3.46; 95% CI:1.44-8.312), increased family size after the Covid-19 pandemic (AOR = 2.26; 95% CI:1.02-5.04), food security (AOR = 6.7; 95% CI:4.01-19.01), knowledge (AOR = 3.96; 95% CI:1.57-10.0), attitude (AOR = 3.9; 95% CI:1.75-8.82) and practices toward coronavirus (AOR = 2.23; 95% CI:2.18-23.95) were predictors significantly associated with dietary diversity.

Conclusion

This study concluded that family size, monthly income, and dietary diversity were factors contributed to household food security. On the other hand, variables such as educational status, family size, and food security were highly relevant factors for dietary diversity after the outbreak of the Covid-19 pandemic. Knowledge, attitudes, and practices were also variables related to both household food security and dietary diversity. Therefore, immediate interventions such as nutrition-specific interventions can be suggested to address food insecurity and problems of inadequate food intake in poor urban households. In addition, governmental and non-governmental organizations should raise awareness and policies to support those at higher risk by developing affordable, sustainable and targeted social protection systems that ensure food security and adequate dietary intake at the household level.

Global Dietary and Herbal Supplement Use during COVID-19-A Scoping Review

During the first year of the COVID-19 pandemic, the lack of cure and the intensity of the global spread raised a common awareness of health. The aim of this scoping review is to summarize dietary supplement use globally during first two years of the COVID-19 pandemic. A systematic search was conducted in December 2021 following PRISMA guidelines. PubMed, ERIC, and Scopus databases were searched, and 956 results were screened for eligibility. Fourteen cross-sectional studies from 11 countries and 3 continents were examined. All studies were large population surveys investigating healthy eating and supplement use during COVID-19. Vitamin C, vitamin D, zinc and multivitamins were the most widely reported, as well as natural/herbal products such as ginger and honey. The most common reason cited for supplements use was to strengthen immune system and to prevent infection of COVID-19. These studies reported that populations are relying on healthcare providers, family, friends, and social media to learn about supplement use. Future studies on the treatment of COVID-19 should include more evidence for supplement use.

Aspects Regarding the Consumption of Dietary Supplements among the Active Population in Romania

Food supplements contain a variety of combinations of vitamins, minerals, plant extracts, and other substances. Any physical effort requires energy from balanced and healthy nutrition. This research aimed to identify the categories of dietary supplements used by active and very active participants who attend the sports and leisure centers from Targu Mures city. The survey was developed in paper and online forms using the Internet and supported multimedia and self-administration. The sample consists of 517 subjects chosen randomly from the research population and divided into the active and highly active PAI subgroups based on age, education, and gender. IBM SPSS Statistics Version 20.0 was used to process the collected data. All data were analysed descriptively. Differences between independent groups were assessed using an Independent sample t-test and a Chi-square test. Statistical significance was accepted when p < 0.05. Additionally, a Pearson correlation was done. The most representative age category was between 18 and 22 years old (42.7%), the ones using dietary supplements most frequently. There were significant differences by group of age regarding the consumption of food supplements (p < 0.05) and also by gender (p < 0.05).

Knowledge, attitudes, and practices regarding immunity boosting dietary behavior of mass population amid COVID-19

During the increasing spread of COVID-19 occurrences in Chattogram Metropolitan Area (CMA) of Bangladesh, a series of measures were taken to control the transmission. These measures greatly influenced the knowledge, attitudes, and practices (KAP) of the population on their dietary behavior. However, there are no current studies demonstrating the KAP of the CMA citizens regarding their dietary habit that can boost the immunity. In this study, we appraised KAP in regard to immunity boosting dietary behavior from April 26, 2021 to November 17, 2021 during implementation of lockdown measures by the government of Bangladesh. Apart from the basic knowledge and attitudes toward immunity boosting dietary behavior, we have also aimed to assess the practices of the population by whether the nutrients, especially vitamin A, B6, B9, B12, C, D, E, and trace minerals such as zinc, selenium, and iron were included in their diet and in what frequency. This study is a cross-sectional study, and the participants were recruited using both online platforms during the lockdown and through in-person interviews after the withdrawal of lockdown. After obtaining the proper consent from the participants, their sociodemographic variables, and KAP towards immunity boosting dietary behavior were assessed. Total 400 participants were included in this study and a non-probability sampling technique named purposive sampling has been followed for participants recruitment. Among the 400 participants, the majority of them (64.3%) were male, most of them (62.7%) were students, unmarried (69.5%), aged between 18-35 years (82.5%), had a bachelor's degree (50.0%), and had a monthly family income between 10000-30000 BDT (35.5%). This study indicated that 82.8% of the populations had the correct knowledge, 71.3% had favorable attitudes, and 44% had good practices regarding immunity boosting diet during COVID-19. The majority (79.3%) of the participants had an idea about nutrition, most of them (78.5%) knew the nutrients needed to strengthen their immune system, almost all (98.5%) washed fruits and vegetables purchased from the market before eating them, 78% did not often purchase food online, and 53% often ate junk food. In a binary logistic regression, correct knowledge was significantly associated with the females, having HSC or bachelor's degree, being in the occupation of business, laborer or others, and having a monthly family income between 50000-100000 or >100000. The favorable attitudes were significantly associated with having a master's degree or above, and for government job holders. However, the good practices did not show any significant association with the sociodemographic factors in binary logistic regression. Moreover, the study found the presence of bad or unhealthy practices among the populations despite having correct knowledge and favorable attitudes. Thus, this study could identify the variables, such as gender differences, education, monthly family income, and occupation on which emphasis should be given during public health campaigns or training programs to improve the KAP regarding immunity boosting diet.

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.

Nutritional status, nutrient imbalances, food-related behaviors and dietary supplements use among patients with celiac disease on a gluten free diet in Lebanon: a national cross-sectional study

Background: Celiac disease is an autoimmune disorder triggered by gluten, that occurs in susceptible individuals and is associated with dietary restriction and subsequent nutritional deficiencies. This study investigated the diet quality, nutrition imbalances and nutrition status among young children,adolescents and adults with CD who followed a gluten free diet an who were referred to several hospitals in Lebanon. Methods: A cross-sectional study in 50 individuals (31.74 ± 15.64 years) with CD was conducted, using biochemical parameters, anthropometric measurements, dietary and physical activity assessments. Results: Of the 50 participants, 38% and 16% were presenting low serum levels of iron and vitamin B12, respectively. The majority of participants were physically inactive and around 40% of them had low muscle mass. A weight loss of 10% to 30% indicating mild to moderate malnutrition was shown in 14% of individuals. The assessment of food-related behaviors shows that 80% of participants were reading nutrition labels and 96% of them were following gluten-free diets. Some barriers including family ignorance (6%), language of the nutrition labels (20%) and expensive GF products (78%) were limiting the adherence to GFD. The inadequacy of the daily energy intake along with insufficient intakes of calcium and vitamin D were remarked among individuals with CD. However, protein and iron intake were exceeding the recommendations among all age groups, except in males aged 4-8 years and 19-30 years. Half the study participants were using dietary supplements where 38%, 10%, 46%, 18%, 16% and 4% used vitamin D, vitamin B12, iron, calcium, folate and probiotics, respectively. Conclusion: GFD is the key treatment for CD. However, it is not without inadequacies and may cause certain deficiencies such as calcium and vitamin D leading to reduced bone density. This underlines the critical role of dietitians in education and maintenance of healthy GFD among individuals with CD.

A Snapshot of the Experience of Dietitians during the COVID-19 Crisis in Five Arab Countries: Findings from a Regional Cross-Sectional Study

COVID-19's intimidating spread has challenged the resilience of the global health systems, causing shifts in the practices of healthcare workers, including dietitians. The current study aimed to assess the change in dietitians' practices and duties in hospitals/clinics after the commencement of COVID-19 pandemic. This cross-sectional study was conducted in five Arab countries between November 2020 and January 2021. A convenient sample of 903 dietitians filled an online self-administered questionnaire to meet the study aims. Nearly 40.0% of the dietitians experienced a change in their workload and caseload during the pandemic. Besides, 18.7% of the dietitians had been assigned additional tasks in their facilities. Nearly half the dietitians (46.9%) had started giving remote nutrition consultations, associated with a 21% drop in the number of dietitians offering in-person consultations (p = 0.001). Approximately 58.9% of the dietitians provided nutrition care to COVID-19 patients, with 48.4% having access to personal protective equipment. Moreover, 17.0% of dietitians supported COVID-19 patients with enteral and parenteral nutrition. In addition, 45.0% of dietitians reported that managing COVID-19 was challenging given that it was a newly discovered condition.

Prevalence and factors associated with dietary supplement use among Bangladeshi public university students: A cross-sectional study

INTRODUCTION

The usage of dietary supplement (DS) such as vitamins, minerals, and fish oil has expanded, but there is limited data on their use by sub-populations such as university students. The study was aimed to investigate the prevalence of DS use among Bangladeshi university students and its associated factors.

METHODS

A cross-sectional survey of 390 students was conducted from two public universities from Barishal Division in Bangladesh using a structured questionnaire with 72 questions divided into five sections: sociodemographic, knowledge, opinions, and attitudes, types of DS, reasons and sources for using DS, and adverse reactions after taking DS. Descriptive statistics and logistic regression were utilized to estimate the results.

RESULTS

Among all the students, 15.6% students were using DS where only 7.7% of them used DS according to physicians' recommendation. Additionally, students used DS for general health and well-being, weight gaining and as a source of energy for physical and sporting activities, etc. The use of DS was significantly associated with female sex (AOR = 5.44, 95% CI: 2.18-13.52), ≥25 years age (AOR = 0.08, 95% CI: 0.01-0.67), underweight (AOR = 5.86, 95% CI: 1.95-17.62), having major illness (AOR = 6.99, 95% CI: 1.98-24.70) and good knowledge of DS (AOR = 2.64, 95% CI: 1.23-5.64).

CONCLUSION

This study provides new findings on DS use and its correlates in Bangladeshi students which may be used by the policymakers to improve DS usage among students. Adaptation of an appropriate program is recommended to educate students on proper and safer ways of using DS.

Perceptions of COVID-19 symptoms, prevention, and treatment strategies among people in seven Arab countries: A cross-sectional study

BACKGROUP

the widespread COVID-19 infection worldwide has resulted in the inability of healthcare facilities to receive all infected patients; therefore, most are treated at home. In addition, factors such as high mortality, types and severity of symptoms, and the prevalence of unreliable information have prompted patients to resort to self-treatment.

OBJECTIVES

To assess prevention, treatment, degree of symptoms, and sources of information among patients with COVID-19 in Arab countries METHOD: A cross-sectional study was conducted in seven Arab countries: Algeria, Egypt, Iraq, Lebanon, Libya, Tunisia, and the United Arab of Emirates. People who have recovered from COVID-19 completed the study questionnaire. Score of symptoms during and after COVID-19 infection has been calculated by giving the participants a list of 13 symptoms.

RESULTS

A total of 3519 participants completed the survey. Mostly females (68.3%), and aged between 18 and 40 years old (59.4%). Prophylaxis treatments, including vaccines and antibiotics, have been used in around 40% of the participants. The total average score of symptoms during the infection period was found 7.31 ± 3.66 out of 13. However, the symptoms score upon recovery was low (0.48 ± 1.11 score). The significant associations with increased incidence of symptoms during infection were reported with older people, married, divorced or widowed, people with chronic diseases, and obese. Moreover, significant associations with decreased symptoms were reported with those who worked in the health sector, non- or ex-smokers, and vaccinated people.

CONCLUSION

The use of medication and other treatments to prevent infection with COVID-19 was common among the participants in the seven countries. Taking the vaccine was the only effect on the number of symptoms experienced by patients. Although nearly two years have passed since the onset of the disease, there is still a need to raise treatment awareness among patients at home.

Prevalence of Essential Nutrient Supplement Use and Assessment of the Knowledge and Attitudes of Lebanese Mothers towards Dietary Supplement Practices in Maternal, Infancy and Preschool Ages: Findings of a National Representative Cross-Sectional Study

Mothers are understandably concerned about protecting the well-being of their offspring in every way possible, including providing oral dietary supplements (DSs). Up to now, there has been limited data on maternal knowledge and attitudes toward concomitant maternal–child DSs practices in Lebanon. This study evaluated the maternal knowledge and attitudes toward DSs and documented the DS-related practices in mothers and their under-5 children with their correlates. This cross-sectional study involved a representative stratified cluster random sample of 511 mother–child dyads (mothers: mean age ± SD = 30.25 ± 4.98 years; children: mean age ± SD = 18.7 ± 15.5 months, girls: 55.0%). A self-administered questionnaire was used to meet study aims. Most mothers lack awareness and hold unfavorable attitudes regarding DS use. Among all mothers, 47% were DS users, with the majority using vitamin D (82%). Almost 64% of mothers provide DSs for their children, with a predominant use of multivitamin drops (61.0%). “To keep the child healthy” was the reported reason by 60.0% of mothers to provide DSs for their children. Physicians were the primary information source about DSs for most mothers (64.0%). The usage of DSs among mothers was influenced by their pregnancy status, child’s age, number of children per household, and their awareness and attitudes towards DSs. DS usage among children was correlated with maternal DS use and their mothers’ attitudes towards DSs. DS usage among Lebanese mother–child dyads is common. Mothers should be the focus of education sessions regarding DS use.

Perceptions and Patterns of Dietary Supplements' Use during COVID-19 among Undergraduate Female Students in Saudi Arabia

(1) Background: During the COVID-19 pandemic, the use of Dietary Supplements (DSs) has increased for health promotion purposes. Few data records were found on the safe use of DSs among university students in Saudi Arabia, during COVID-19. This study aimed to assess the perceptions and patterns of DSs during COVID-19 among students at a selected female university. (2) Methods: A descriptive cross-section design was used. A convenient sample of undergraduate students (n = 651) were recruited via email, to fill in an online validated questionnaire: The nutrition and intake of DSs during COVID-19. Data were analyzed using descriptive and inferential statistics. (3) Results: Among the 509 students who did not have chronic diseases, 85% of them had taken DSs. About 35.5% of the students had not changed their dietary habits since the beginning of COVID-19, but 78.6% thought that they needed to improve their immunity by taking DSs. Half of the students 51.2% believed that healthy habits may reduce the chance of being infected with COVID-19. The most used DSs were vitamin C (84.3%), followed by honey (65.3%), and vitamin D (47.7%). At the top of students’ references for DSs was personal judgment or previous knowledge of the benefits (27.3%). (4) Conclusion: The usage and patterns of DSs were impacted by the COVID-19 pandemic. Taking DSs without a doctor’s prescription may lead to several complications. DSs users should be educated effectively about the proper use of DSs as an external supplementation.

Vitamin D prescribing practices among clinical practitioners during the COVID‐19 pandemic

Background and Aims

COVID‐19 has caused devastation globally. Low vitamin D status, particularly during the winter months, remains commonplace around the world, and it is thought to be one of the contributing factors toward causation and severity of COVID‐19. Many guidelines do not recommend vitamin D for the treatment or prevention of the disease. Hence, we set out to conduct a global survey to understand the use and prescribing habits of vitamin D among clinicians for COVID‐19.

Methods

An online anonymous questionnaire was sent to clinicians enquiring about their prescribing habits of vitamin D and personal use of vitamin D. Data of the survey were collected between January 15, 2021, and February 13, 2021.

Results

Four thousand four hundred forty practicing clinicians were included in the analysis, with the majority of those responding from Asia, followed by Europe. 82.9% prescribed vitamin D before COVID‐19, more commonly among general practitioners (GPs) in comparison with medical specialists, and Asian clinicians were more likely to prescribe vitamin D in comparison with Caucasian physicians (p < 0.01). GPs were also more likely to prescribe vitamin D prophylactically to prevent COVID‐19 in comparison with medical specialists (OR 1.47, p < 0.01). Most GPs (72.8%) would also prescribe vitamin D to treat COVID‐19 in comparison with medical specialists (OR 1.81, p < 0.01), as well as more Asian in comparison with Caucasian physicians (OR 4.57, p < 0.01). 80.4% of respondents were taking vitamin D, more so in the 45–54 and 65–74 age groups in comparison with the 18–24 years category (OR 2.15 and 2.40, respectively, both p < 0.05), many of whom did so before COVID‐19 (72.1%).

Conclusion

This survey has shown that many clinicians would prescribe vitamin D for the prevention and treatment of COVID‐19. The majority would also recommend measuring vitamin D levels, but not so in patients with COVID‐19.

Nutritional status, nutrient imbalances, food-related behaviors and dietary supplements use among patients with celiac disease in Lebanon: a national cross-sectional study

Background: Celiac disease (CD) is an autoimmune disorder triggered by gluten, that occurs in susceptible individuals and is associated with dietary restriction and subsequent nutritional deficiencies. This study investigated the diet quality, nutrition imbalances and nutrition status among young children, adolescents and adults with CD who were referred to several hospitals in Lebanon. Methods: A cross-sectional study in 50 individuals (31.74 ± 15.64 years) with CD was conducted, using biochemical parameters, anthropometric measurements, dietary and physical activity assessments. Results: Of the 50 participants, 38% and 16% were presenting low serum levels of iron and vitamin B12, respectively. The majority of participants were physically inactive and around 40% of them had low muscle mass. A weight loss of 10% to 30% indicating mild to moderate malnutrition was shown in 14% of individuals. The assessment of food-related behaviors shows that 80% of participants were reading nutrition labels and 96% of them were following gluten-free diets (GFD). Some barriers including family ignorance (6%), language of the nutrition labels (20%) and expensive GF products (78%) were limiting the adherence to GFD. The inadequacy of the daily energy intake along with insufficient intakes of calcium and vitamin D were remarked among individuals with CD. However, protein and iron intake were exceeding the recommendations among all age groups, except in males aged 4-8 years and 19-30 years. Half the study participants were using dietary supplements where 38%, 10%, 46%, 18%, 16% and 4% used vitamin D, vitamin B12, iron, calcium, folate and probiotics, respectively. Conclusion: GFD is the key treatment for CD. However, it is not without inadequacies and may cause certain deficiencies such as calcium and vitamin D leading to reduced bone density. This underlines the critical role of dietitians in education and maintenance of healthy GFD among individuals with CD.

Dietary Supplements Use among Athletes in Lebanon: Knowledge, Attitudes, Practices, and Correlates

Athletes are under the utmost pressure to reach excellence in their performance and achieve the desired outcomes in competitions, prompting them to use dietary supplements. Given the threats to both health and eligibility, it is crucial to observe the prevalence, sources of information, knowledge, attitudes, and practices (KAPs) among Lebanese athletes practicing their sports for at least two years. In the present paper, a cross-sectional study is performed using the snowball sampling method, in which a self-administered KAP questionnaire is used to collect data from 455 athletes (mean age: 27.4 ± 7.9 years; men: 73.1%) participating in four sports categories (ball games, combat sports, endurance sports, and weightlifting). Among the Lebanese athletes, the prevalence of dietary supplement (DS) use was 74%, where half of them had predominately used sports supplements. Athletes in Lebanon heavily rely on coaches (74%) and online sources, including webpages and social media (64%), as key information sources for DSs. The findings suggest that significant proportions of athletes show knowledge deficits and unsatisfactory attitudes towards multiple aspects related to supplementation. Moreover, education and sports type modulate the use of DSs among athletes. Furthermore, 34% reported using supplements without a recommendation from specialists, and 69% admitted to not reading the supplement's nutrition facts. This study urges the need for the regulation of concerned authorities and education programs to help overcome the existing challenges.

Use of Traditional, Complementary and Integrative Medicine During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Background

Traditional, Complementary and Integrative Medicine (TCIM) has been reported to use for symptom management of coronavirus disease 2019 (COVID-19). The objective of this review was to identify the overall usage prevalence of TCIM interventions for COVID-19.

Methods

Surveys on the general population and observational studies on the COVID-19 patient chart review were located in the search of PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases in September 2021. Observational studies, such as cross-sectional studies, surveys, cohort studies and hospital-based patient case reviews, published in any language, reporting the usage of TCIM in the patients with COVID-19 or the general population during the COVID-19 pandemic were included in this review. Data screening and extraction were performed independently by two reviewers. The reporting quality of the included studies was assessed with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement. To conduct a meta-analysis of the usage prevalence of various TCIM interventions, the effect size of the proportion for each intervention was calculated with the inverse variance method. The main outcome was usage prevalence of TCIM interventions among patients with COVID-19 or the general population during the COVID-19 pandemic.

Results

A total of 62 studies were included in this review. The overall TCIM usage prevalence was estimated to be 0.64 (95% CI 0.54–0.73). The overall prevalence did not differ between the population-based survey (0.65, 95% CI 0.48–0.81) and the hospital-based patient case review (0.63, 95% CI 0.52–0.73). Statistical heterogeneity and comparatively low quality in reporting were observed, which should be cautiously considered when interpreting the results.

Conclusion

Various TCIM interventions were reported to be used with comparatively high frequency. Future international collaborative research might overcome the main limitation of this study, i.e., the heterogeneity of the included data.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=278452, identifier: CRD42021278452.

Knowledge of COVID-19 and Its Relationship with Preventive Behaviors and Vaccination among Adults in Northern Thailand's Community

(1) Background: the 2019 coronavirus disease outbreak (COVID-19) has posed a major threat to public health and had a significant impact on all areas of people’s lives. Vaccines against COVID-19 have been developed to control the disease, and an array of personal hygiene measures has been introduced. As a result, information that will support and promote vaccination among populations as well as other health measures against COVID-19 are urgently needed. The goal of this research was to look into the knowledge about COVID-19 and how it relates to preventive behaviors and vaccination among people living in rural areas of northern Thailand. (2) Methods: a cross-sectional study was performed in four upper northern provinces of Thailand. A total of 1524 participants were recruited using the probability sampling technique. Questionnaires were distributed to collect data on general health information, as well as knowledge and preventive behaviors regarding COVID-19. (3) Results: more than half (55.9%) of the participants were female and had not received the COVID-19 vaccine (67.2%). Their mean age was 44.13 years. The majority had moderate COVID-19 knowledge and engaged in preventive behaviors (65.5% and 42.0%, respectively). A linear regression model showed that the COVID-19 knowledge score was related to the COVID-19 preventive behaviors score, with a standardized coefficient of 0.510, after adjusting for age, underlying disease, and body mass index (B = 2.64; 95%CI = 2.42, 2.87). Binary logistic regression revealed that after controlling for age, education, occupation, financial status, and current disease (AOR = 1.87; 95%CI = 1.64–2.13), the score of COVID-19 knowledge was significantly associated with having the COVID-19 vaccine. (4) Discussion: knowledge of COVID-19 is very important for people in rural regions to engage in COVID-19 prevention behaviors and vaccination. Relevant government agencies and health network partners should support proactive education campaigns emphasizing the risk of contracting the disease and its severity in order to promote vaccination against COVID-19 among unvaccinated groups. These campaigns can highlight COVID-19’s positive benefit-risk balance in the short and long term and ensure public safety measures against COVID-19.

Nutritional status, nutrient imbalances, food-related behaviors and dietary supplements use among patients with celiac disease on a gluten free diet in Lebanon: a national cross-sectional study

Background: Celiac disease is an autoimmune disorder triggered by gluten, that occurs in susceptible individuals and is associated with dietary restriction and subsequent nutritional deficiencies. This study investigated the diet quality, nutrition imbalances and nutrition status among young children,adolescents and adults with CD who were referred to several hospitals in Lebanon. Methods: A cross-sectional study in 50 individuals (31.74 ± 15.64 years) with CD who follow a gluten free diet was conducted, using biochemical parameters, anthropometric measurements, dietary and physical activity assessments. Results: Of the 50 participants, 38% and 16% were presenting low serum levels of iron and vitamin B12, respectively. The majority of participants were physically inactive and around 40% of them had low muscle mass. A weight loss of 10% to 30% indicating mild to moderate malnutrition was shown in 14% of individuals. The assessment of food-related behaviors shows that 80% of participants were reading nutrition labels and 96% of them were following gluten-free diets (GFD). Some barriers including family ignorance (6%), language of the nutrition labels (20%) and expensive GF products (78%) were limiting the adherence to GFD. The inadequacy of the daily energy intake along with insufficient intakes of calcium and vitamin D were remarked among individuals with CD. However, protein and iron intake were exceeding the recommendations among all age groups, except in males aged 4-8 years and 19-30 years. Half the study participants were using dietary supplements where 38%, 10%, 46%, 18%, 16% and 4% used vitamin D, vitamin B12, iron, calcium, folate and probiotics, respectively. Conclusion: GFD is the key treatment for CD. However, it is not without inadequacies and may cause certain deficiencies such as calcium and vitamin D leading to reduced bone density. This underlines the critical role of dietitians in education and maintenance of healthy GFD among individuals with CD.

Consumption of Food Supplements during the Three COVID-19 Waves in Poland-Focus on Zinc and Vitamin D

Food supplements (FS) are a concentrated source of vitamins, minerals, or other ingredients with nutritional or other physiological effects. Due to their easy availability, widespread advertising, and sometimes low price, increased consumption of this group of preparations has been observed. Therefore, the aim of the study was to assess the knowledge and intake of FS during the COVID-19 pandemic in Poland, with particular reference to FS containing zinc and vitamin D. It was noted that both of the above ingredients were used significantly more often by people with higher education (59.0%), with a medical background or related working in the medical field (54.5%), and/or exercising at home (60.1%). Preparations containing vitamin D were used by 22.8% of the respondents in the first wave, 37.6% in the second wave, and 32.9% in the third wave. To sum up, we showed the highest consumption of vitamin and mineral supplements, and preparations containing zinc and vitamin D were taken significantly more often by people with higher medical and related education. This indicates a high awareness of health aspects and the need for preventive measures in these groups.