|Ahead of print publication
Nutritional supplements: A craze among youngsters
Ajeet Saoji1, Prachi Ajeet Saoji2, Shilpa Hajare1, Pranita Dharmadhikari1
1 Department of Community Medicine, NKP Salve Institute of Medical Sciences and Research Center and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
2 Department of Mathematics, Shri Ramdeobaba College of Engineering and Management, Nagpur, Maharashtra, India
|Date of Submission||15-Mar-2021|
|Date of Decision||24-Apr-2021|
|Date of Acceptance||15-May-2021|
Resident Doctor, Department of Community Medicine, NKP Salve Institute of Medical Sciences and Research Center, Nagpur, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: The haphazard use of supplements without proper consultation from a health expert can lead to side effects, especially in youngsters. These supplements have very few regulations nationwide, and practically, no effort has been taken to make the public aware of its ill effects, besides warnings issued by the manufacturing companies on the products. Methodology: A cross-sectional study among 2nd -3rd MBBS students studying in a medical college was carried out to study the prevalence of use of supplementary nutrition, its type, source of information, and preferred type of supplements. Results: The overall proportion of dietary supplement use among medical college students participated in this study was 29.4%. Multivitamins, protein powders, and energy drinks were the most preferred type and the reasons mentioned for intake were for general well-being to avoid future illness and muscle-building purpose. Conclusion: More awareness among frequent and haphazard users who are on supplementary nutrition without any medical opinion should be incorporated to avoid side effects created by unregulated nutritional supplements available in market.
Keywords: Intake of protein powders, nutritional supplements, unregulated market of supplements
| Introduction|| |
The urban India has become more health conscious than ever. Changes in lifestyle, online connect, and increased awareness contributed by the media and the surroundings have played a key role in making sure that fitness is not just a hobby but also a priority.
Downside to this has resulted in overtly conscious young generation who are influenced by various sources to take up dietary nutritional supplements in addition to their diet or worse as a substitution for their diet.
As the Indian population largely idolizes Bollywood persons and sportspersons, the desire to imitate their physique blindly can lead to unguided and often unnecessary use of dietary supplements (DSs), which include proteins, vitamins, minerals, slimming products, weight gainers, and herbal products, to name a few. The haphazard use of supplements without proper consultation from a health expert can lead to side effects such as allergies, gastric upset, abnormal weight gain, and liver and kidney diseases among others., The growing number of gyms has only strengthened this notion. Besides this, gym can create an atmosphere wherein the above-mentioned stereotypes are encouraged.
The Indian gyms, as well as online websites, provide a large market for these supplements with a low level of concern, regarding misinformation and limited studies of the Indian market on this issue. These supplements have very few regulations nationwide, and practically, no effort has been taken to make the public aware of its ill effects, besides warnings issued by the manufacturing companies on the products.
In a large-scale study in the Danish population involving over 4000 participants, it was observed that more than half of the study participants were users of these micronutrient DSs with the intention to eat healthy. In a study done in Saudi Arabia among pharmacy students, a total of 46.8% of the students used DSs, while only half of them were using it with doctor's consultation. Another multicenter study conducted in Ludhiana city showed that overall prevalence of use of DSs was 70%.
The Indian DS market grew at a Compound Annual Growth Rate (CAGR) of 15% during 2014–2019 and reached a value of US$ 3.5 Billion in 2019. Moreover, the Drug Marketing and Manufacturing Association has stated that 60%–70% of DSs sold across India are fake and extremely difficult to identify. Furthermore, because DSs are subject to little oversight by the Food and Drug Administration, the safety and efficacy of supplements are not rigorously established.
DSs are food products containing dietary ingredients intended to add more nutritional value to a normal diet. However, the high prevalence of DSs among college students is a growing concern. This may be since young adults are more likely to be open and experiment with health alternatives, during this period of life. Since generally health habits develops in adolescent age group, persist throughout life also, at this young age they can get attracted to use even those products of which health benefits have not been proven. A potential problem related with the use of DSs is that users might see them as a substitute, rather than a supplement, to the intake of fruits and vegetables.
In view of relatively high use and misuse of dietary supplements worldwide, current study has been undertaken with the aim to study the prevalence of nutritional supplements among medical students as well as finding the most common nutritional supplement use, the knowledge they hold about any possible side effects and to explore the major lifestyle factors responsible for the usage of nutritional supplements.
| Methodology|| |
It is a cross-sectional study among 3rd–4th-year MBBS students studying in a medical college from Nagpur city.
- MBBS students from 2nd to 3rd year
- Those willing to give consent.
After taking permission and obtaining approval certificate from the Institutional Ethics Committee (ref no.-IEC/6/2018), data were collected by interview method with the help of a semi-structured questionnaire. Informed written consent was obtained from the participants after explaining the purpose of the study.
Development of questionnaire
A semi-structured questionnaire was developed and modified to suit the study population. The questionnaire comprised two parts.
This obtained the sociodemographic characteristics of the participants.
This was designed to obtain the prevalence and pattern of nutritional supplement usage among participants. It consisted of questions to evaluate the reasons for consumption and the source of information regarding the same. Further questions were asked to evaluate the knowledge of participants regarding side effects associated with consumption of nutritional supplements and if they have experienced any.
Descriptive statistics of prevalence and pattern of nutritional supplements was reported with frequency tables and graphical representations. Statistical analysis was performed using Microsoft Excel sheet and Open-Epi software version 3.01.
In addition, respondents were counseled about the ill effects of consuming nutritional supplements haphazardly and the importance of seeking out the opinion of a health expert before consuming them in large quantities.
| Results|| |
Of total 260 students who were approached, 258 students responded to the survey giving a response rate of 99.2%. The study included students from 2nd to 3rd year of MBBS curriculum.
[Figure 1] shows age- and gender-wise distribution of the participants (n = 258). The mean age of students was found to be 20.4 years. Around equal number of male (51%) and female (49%) participated in this study. Majority of 258 students were from higher socioeconomic class (83%).
[Figure 2] shows that 29.4% is the overall proportion of DSs use among medical college students participated in this study. When gender-wise distribution was seen among DS users, proportion of female users (59%) was more as compared to male users (41%).
Duration and frequency of consuming the DS by users has been shown in [Table 1]. When questioned about which type of DS do you use? Multiple responses were noted from the users. The preferred types of DSs use are shown in [Figure 3]. Multivitamins were the most popular products among other supplements. Furthermore, energy drinks followed by protein powder intake were also the prominent supplements. Other supplements reported were weight gainers, liquid medications, and creatinine.
From [Figure 4], it is clear that the most common reason for taking supplements is for general health and well-being so that to reduce the frequency of future illnesses followed by to combat nutritional deficiencies. Other reasons elicited by participants were for body shaping and weight gaining muscle-building purpose.
|Figure 4: Reasons for supplementary nutrition consumption (multiple responses)|
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From [Figure 5], it shows that more than half of the participants primarily purchase supplements from online, i.e., from social media sites. Pharmacies and gyms were the 2nd–3rd most preferred place of purchase resp.
|Figure 5: Sources of information of supplementary nutrition (multiple responses)|
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The information sources of DSs are shown in [Figure 6]. The most popular way of obtaining information about DSs was via gym trainers. Another second largest proportion of participants took supplements on the advice of doctors or dietitian. This was followed by friends, social media through Internet, and relatives.
Results of whether students were aware and whether they have ever experienced any side effects after taking supplementary nutrition are illustrated in [Table 2].
Other factors assessed in this study were proportion of students doing physical exercise, as shown in [Figure 6].
While it was seen from [Figure 7] that only 24% of participants were going to gym, whereas rest 76 were not.
The average monthly cost attributed to DS use by responders was reported as 1200 INR per month. However, minimum and maximum cost incurred per month was around 500 INR by 42% of users and around 4000 INR by 4% of users, respectively.
| Discussion|| |
Almost two-third (29.4%) of college students responded to the survey consume DSs. Similar results found in one study conducted in Australia stated that 20.1% of adolescents were using supplementary nutrition. Furthermore, the prevalence of DS use, among university students, was 30.5%.
In this study, according to age- and gender-wise distribution of respondents, around equal number of male (51%) and female (49%) participated. When gender-wise distribution was seen among DS users, proportion of female users (59%) were more as compared to male users (41%).
When questioned about which type of DS do you use? Multiple responses were noted from the users. The preferred type of DSs reported were multivitamins among other supplements. Furthermore, energy drinks followed by protein powder intake were also the prominent supplements. Other supplements reported were weight gainers, liquid medications, and creatinine. Likewise, another study conducted by O'Brien et al. reported that the most commonly used supplements were multivitamins and/or multi-minerals. Similarly, multivitamins/ multi-minerals, followed by vitamin C, proteins and calcium use was reported by Harris R. Lieberman et al, who studied patterns of dietary supplement use among college students.
From this survey, it is clear that the most common reason for taking supplements is for general health and well-being so that to reduce the frequency of future illnesses followed by to combat nutritional deficiencies. Other reasons elicited by the participants were for body-shaping and weight-gaining muscle-building purpose. While another study also reported similar reasons by students to use supplements to promote general health (73%), provide more energy (29%), increase muscle strength (20%), and enhance performance (19%). This study found that every male, especially the young boys, wants to attain the muscular body and attractive looks. For this, they use muscle-building supplements. Most of the people, particularly young adolescents, use muscle-building supplements as they think those supplements will improve their athletic skills and enhance their physical appearance. Ajitha Sharma et al. also found that the most common reasons for consuming supplements were to maintain good health (40.1%) and ensure adequate nutrition (36.9%).
Article drew attention to the source of purchasing priority of DSs which showed that more than half of the participants primarily purchase supplements from online, i.e., from social media sites. Pharmacies and gym were the 2nd–3rd most preferred place of purchase, respectively.
The most popular way of obtaining information about DSs was through the gym trainers. Another second largest proportion of participants took supplements on the advice of doctors or dietitian. This was followed by friends, social media through Internet, and relatives. Although most students obtained information about DSs through the Internet, they typically purchased the supplements from drug stores.
Social determinants in this study are showing that majority students were from higher socioeconomic class. This might be the reason for high monthly cost incurred per month and attributed to DS use by respondents.
In this study, awareness regarding side effects of using supplementary nutrition was good. Another study by Bandyopadhyay et al., when asked about beneficial and adverse effects, reported that protein supplements may have many beneficial effects such as lowering of blood pressure, antioxidant defense mechanisms, lowered incidence of breast cancers, and reduced severity of menopausal symptoms specifically for women, but they also have a few negative effects on bone health and metabolism and hepatic and renal function if not taken in the correct dose or frequency. Few respondents (14.5%) from this study also experienced side effects because of supplements haphazard use. Likewise, the students surveyed in Tokyo (7.5%) experienced adverse effects.
Thus, an appropriate, accurate and scientifically sound information regarding the benefits and side effects of nutritional supplements should be disseminated. Thereby helping them to choose the correct supplements for consumption and aware them about the long lasting effects of them unhealthy supplements.
| Conclusion|| |
This study highlights the inclination of young generation toward newer approaches for fitness and well-being. In conclusion, the prevalence of consumption of nutritional supplements was higher among students. Multivitamins were most commonly used supplements found among targeted population in this study. Large chunk of students were purchasing supplements from online market and for majority of them the source of information was Doctors followed by friends. These findings were in line with previously reported literatures.
This research is one of the first, to be conducted in a two-tier city of India. Though study was conducted in single setup which covered students coming from different geographical with different socio-demographic background. Inclusion of various age groups would have helped for more comparison. Thus promotes, conduction of long term studies on impact of such supplements upon individual's health.
Hence, there is a need for counseling about the importance regarding seeking out the opinion of a health experts rather than using it haphazardly.
It is imperative to create more awareness among frequent users of nutritional supplements so that complete knowledge of the pros and cons of consuming nutritional supplements is attained.
We would like to thank all the participants who consented to participate in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2]