Prevalence, knowledge, awareness, and attitudes towards dietary supplements among Bahraini adults: a cross-sectional study

Allehdan et al. Food Production, Processing and Nutrition (2023) 5:54 https://doi.org/10.1186/s43014-023-00168-7 Food Production, Processing and Nutrition Open Access RESEARCH Prevalence, knowledge, awareness, and attitudes towards dietary supplements among Bahraini adults: a cross‑sectional study Sabika Allehdan1*†, Mariam Hasan1†, Simone Perna1, Mariam Al‑Mannai2, Tariq Alalwan1, Duha Mohammed1, Mohamed Almosawi1, Maha Hoteit3,4,5 and Reema Tayyem6*    Abstract The usage of dietary supplements (DS) is a global trend that is likely influenced by sociodemographic variables and body weight status. Some individuals utilize supplements in the hopes that they may enhance their health and prevent illness. Main objective of this study is to assess knowledge and awareness about using DS among Bahraini adults. This cross-sectional study was conducted using snowball sampling method, in which an electronic self-admin‑ istrative questionnaire was used to collect information from 582 eligible participants. Data about socio-demographic characteristics, anthropometric measurements, knowledge, awareness, and attitudes toward using DS was collected from each participant. Prevalence of DS use was high (59.3%) and most of users were females. Most DS users (87.5%) thought that DS are safe (P < 0.001). The DS users were significantly more likely than non-users to believe that DS can prevent and treat chronic and communicable diseases, as well as the DS having side effects (P < 0.05). The most frequently consumed DS were vitamin D (29.5%) and vitamin C (26.4%). The main purpose of using DS among the DS users was to treat nutrient deficiency and around 60% of them used DS based on physician’s prescription. In conclu‑ sion, the using of DS was highly prevalent among younger adult females with normal body weight. The findings of this study emphasize the need for implementing public educational programs about safe and proper use of DS. Keywords Dietary supplements, Prevalence, Knowledge, Awareness, Attitudes, Bahrain † Sabika Allehdan and Mariam Hasan contributed equally to this work. *Correspondence: Sabika Allehdan Reema Tayyem Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Allehdan et al. Food Production, Processing and Nutrition (2023) 5:54 Page 2 of 12 Introduction A nutritious and well-balanced diet must contain all the essential nutrients that maintain the general health of individuals. However, dietary supplements (DS) have complementary roles, intended to help individuals in reaching their daily recommended dietary intakes (Alowais & Selim 2019; Valavanidis 2016). The Food and Drug Administration (FDA) defines DS as one or a combination of dietary substances such as vitamins, minerals, amino acids, and botanical herbs used by individuals to increase the total dietary intake for general health purposes. These DS are produced in specific dosages and multiple forms including capsules, tablets, powders, and liquids (FDA 2021). Since DS represent an important source of essential nutrients, they have vital roles in cellular processes including energy metabolism (i.e., as enzymes cofactors or structural components), as well as roles in cell growth and development (Huskisson et al. 2007a). Regular diet should contain all the necessary nutrients, but there are individuals with specific nutritional needs that require DS intake such as those who have nutritional deficiencies, disorders of absorption, pregnant and lactating women as well as elderly people (Alowais & Selim 2019; Huskisson et al. 2007a; Huskisson et al. 2007b). It is well established that dietary supplements can treat existing conditions of nutrient-deficiency diseases like scurvy, rickets, and pellagra require constant supplementation of vitamin C, vitamin D, and Vitamin B-3, respectively (Harsha et al. 2019; Holick 2006; Khalife et al. 2019). Dietary supplements are not considered as drugs nor intended for use to prevent or treat diseases, with inconsistent evidence on their efficiency (Sirico et al. 2018). For an example, no significant effects were found upon regular consumption of vitamin C, vitamin E, and betacarotene for the primary prevention of type 2 diabetes (Pathak et al. 2019). Also, the long-term intake of multivitamin supplementation was insufficient in reducing major cardiovascular events, myocardial infarction (MI), stroke, and cardiovascular disease (CVD) mortality (Sesso et al. 2012). Recently, DS became one of the most increasing trends in the healthcare industry, playing a significant role in the global economy (Marcus 2016). One of the reasons for gaining more popularity is through advertising and marketing DS products in social media platforms, claiming for their safety and effectiveness. Another reason is the Graphical Abstract Allehdan et al. Food Production, Processing and Nutrition (2023) 5:54 Page 3 of 12 increasing availability of DS in the markets, while it is not mandatory for sellers to conduct any research to prove the safety of these products (Bjelica et al. 2020). Thus, significant associations were found between relatively healthy and active individuals and the increased tendency to use DS (Sirico et al. 2018). For instance, studies conducted in Japan and Saudi Arabia have found increased prevalence of using DS among college students for health improvement purposes. These students have common beliefs that DS can improve general health, give physical strength, promote weight loss, and ensure adequate nutrition (Alowais & Selim 2019; Kobayashi et al. 2017). DS users have limited knowledge about the adverse effects caused by DS (Alfawaz et al. 2017; Tangkiatkumjai et al. 2014). Many DS products may contain toxic or illegal ingredients such as 1,3-dimethylamylamine (DMAA). All products that contain DMAA are prohibited by FDA regulations (FDA 2022). Excessive intake of DS can also be harmful and cause severe complications (Genaro & Martini 2004). A toxicity report was made about pyridoxine overdose due to daily use of multivitamin supplements in two men aged 60 and 65 years (de Kruijk & Notermans 20 (...truncated)