|Year : 2019 | Volume
| Issue : 10 | Page : 3147-3154
General public knowledge and use of dietary supplements in Riyadh, Saudi Arabia
Hamad A Algaeed1, Mohammed I AlJaber1, Abdullah I Alwehaibi1, Lubna I AlJaber2, Abdulrahman M Arafah1, Mohammed A Aloyayri1, Omar A Binsebayel1, Sultan A Alotaiq1, Musaab A Alfozan1, Ibrahim Bin Ahmed3
1 College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
2 Clinical Dietitian/Home Health Care Department, King Fahad Medical City, Riyadh, Saudi Arabia
3 College of Medicine, Family Medicine Department, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
|Date of Submission||29-Jun-2019|
|Date of Decision||22-Aug-2019|
|Date of Acceptance||11-Sep-2019|
|Date of Web Publication||31-Oct-2019|
Dr. Hamad A Algaeed
P.O Box 340873, Zip Code 11333, Riyadh
Source of Support: None, Conflict of Interest: None
Context: Dietary supplements is a growing industry, pharmaceuticals are having several types of similar supplements and multivitamins as over-the-counter products, a complete diet is necessary for a healthy body which leads to the usage of supplements or multivitamins complementing diets as needed, therefore leading to its encouraged usage among the population worldwide. Aims: The study was aimed to determine the public's knowledge and their use of dietary supplements. Settings and Design: A cross-sectional study was conducted among the general public of Riyadh, Saudi Arabia. Methods and Materials: The sample consisted of 679 participants including 41% males and 59% females. The ethnicity of the participants is 100% Arabs. Statistical Analysis Used: SPSS. Results: The sociodemographic data showed there were more female participants than males (59.1% vs. 40.9%), most of our participants had at least bachelor degree (64.4%), most of our participants had normal BMI (62.3%). 88.5% had knowledge on supplements and only 11.5% stated they were not aware at all. Conclusions: Dietary supplements and multivitamins consumption is prevalent among Saudi Arabian population. Our study suggests the majority of consumers understand the supportive role of dietary supplements and are aware of risks and side effects.
Keywords: Dietary supplements, general public, multiminerals, multivitamins, nutrition, Saudi Arabia
|How to cite this article:|
Algaeed HA, AlJaber MI, Alwehaibi AI, AlJaber LI, Arafah AM, Aloyayri MA, Binsebayel OA, Alotaiq SA, Alfozan MA, Ahmed IB. General public knowledge and use of dietary supplements in Riyadh, Saudi Arabia. J Family Med Prim Care 2019;8:3147-54
|How to cite this URL:|
Algaeed HA, AlJaber MI, Alwehaibi AI, AlJaber LI, Arafah AM, Aloyayri MA, Binsebayel OA, Alotaiq SA, Alfozan MA, Ahmed IB. General public knowledge and use of dietary supplements in Riyadh, Saudi Arabia. J Family Med Prim Care [serial online] 2019 [cited 2020 Nov 29];8:3147-54. Available from: https://www.jfmpc.com/text.asp?2019/8/10/3147/269973
| Introduction|| |
A dietary supplement is defined by the Food and Drug Administration (FDA) as a product intended for ingestion that contains a “dietary ingredient” intended to add further nutritional value to (supplement) the diet. Dietary supplements are used by millions in many forms such as multivitamins and it is commonly used as a result of self-diagnosed conditions and/or promote health,, and the usage of supplements such as multivitamins has increased considerably in the past several years, as it plays a key role in maintaining good health as a diet delivers essential nutrients while supplements complement said diet as it allows consumption of any deficiencies the diet lacks. With increased health awareness, education and availability for dietary supplements would lead to overall wide usage. It is often used to supplement diet, prevent illness, treat infection and remedy diseases. The average 20--30% of the populace in developed countries use dietary supplements such as multivitamins. And according to a study by AlRuthia et al., 44.5% of participants were supplement users. In an attempt to improve overall health, nonetheless, consumers tend to not have enough knowledge about said supplements and its usage or if there is an interaction with other food substances, consumers tend to use them without consulting healthcare professionals., In 2008, in a study by Kennedy et al., most Americans in tandem of conventional medical treatment use vitamin supplements, but only about a third discuss their consumption with a physician. The most commonly consumed dietary supplements are mulltivitamins/multiminerals, vitamin C, and vitamin D. And the most consumed non-multivitamin/multiminerals supplements are fish oil, omega-3/DHA, glucosamine, echinacea, flaxseed oil, chondroitin, and ginseng. Dietary supplements are important source of nutrients which helps fix any deficiencies., Manufacturers are not required to establish the safety and efficacy of herbal supplements to the FDA, which leads to industries involved in the creation of said multivitamins and are reported to be the world's fastest expanding industry. A balanced diet is necessary for the population to be overall healthy and to keep at bay chronic diseases and is a key component to proper dentofacial development.,, Dietary supplements such as multivitamins has benefits as there is a potential adverse effect due to overuse or higher than necessary intake. In earlier studies, they found that most dietary supplements in the market held more nutrients than the recommended daily need., Granting them have certain benefits such as folic acid intake which is established that prevents neural tube defects. Other examples including inadequate and irregular nutrition, sedentary lifestyle, stress, and cigarette smoking are risk factors for coronary heart disease, type 2 diabetes, osteoporosis, and cancers. Malnutrition is one of the leading causes of ill health in the developing world due to micronutrient deficiencies, as supplements have been a boon to those treating these deficiencies. It has been reported in literature that there is an interaction between vitamin E and aspirin causing an antithrombotic effect. There are some large scale randomized trials showing that multivitamins supplements are ineffective for the majority of the populace. In one of the randomized trial, 14,641 participants in USE showed that daily multivitamin supplement did not reduce cardiovascular events, such as myocardial infarction or stroke in men. Another trial for selenium and vitamin E cancer prevention trial showed that Vitamin E may increase risk of prostate cancer in healthy men., In a recent study in Saudi Arabia, almost half of the volunteers were consuming dietary supplements, the samples used in the research were health science students and the general public as participants. In a study that combined data from three separate studies showed that family physicians were prescribed dietary supplements the most. As it is trending worldwide, we wanted to assess the general public's knowledge and awareness on dietary supplements, due to the fact that it is used mostly as a trend and was not recommended by a proper physician or a dietician, which could lead to either deficits not being filled due to lack of knowledge or improper usage due to being influenced by others.
| Subjects and Methods|| |
This cross-sectional study was conducted among the general public of Riyadh, Saudi Arabia. The sample consisted of 679 participants including 41% males and 59% females. The ethnicity of the participants is 100% Arabs.
Inclusion and exclusion criteria
The participants must be Saudis and aged from 18 years old and above.
The survey was divided into three parts. First part contained the gender, age, marital status, level of education, and weight. In the second part of the questionnaire, we asked about whether the participants' knowledge about dietary supplements and multivitamins are up-to-date or not, we also asked if they use or have ever used it or if they knew someone who uses it. The third part consisted of nine questions that addresses the attitude, perception, and behavior regarding the dietary supplements and multivitamins. In the last part of this questionnaire, we used an open question that tackles the participants' point of view whether the dietary supplements and multivitamins are necessary or just an obsession.
Data collection and analysis
This self-administered survey was distributed manually during an awareness campaign set in a mall on a span of 3 days. A verbal consent was obtained from participants. Data statistical analysis was done by SPSS software.
The study was ethically approved by the Institutional Review Board (IRB) of Imam Muhammad ibn Saud Islamic University, Riyadh, Saudi Arabia (Project Number.35-2019) 02/04/2019AD.
| Results|| |
Our study included 679 Saudi Arabian participants. In order to reveal awareness and attitude toward dietary supplements and multivitamins among our participants we provided all of them with sample material. The main sociodemographic data obtained from our survey is presented in [Table 1]. There were more female participants than males (59.1% vs. 40.9%). As the participants included in our study were 18 years old and above, the distribution by ages was as follows: 18 to 25-51.3%, 26 to 33-20.3%, 34 to 41-17.4%, 42 and above - 11%. Most of the participants were single (53.8%), whereas married and divorced participants were distributed, respectively, 44% and 2.2%. Study participants were classified into five categories according to their education level, with the following distribution: elementary school - 0.9%, high school - 23.4%, bachelor degree - 64.4%, higher education - 9%. What applies to BMI, our results showed that 62.3% of the participants had normal BMI, whereas 28.1% and 9.6% participants had respectively BMI above and below average values.
A statistically significant difference was obtained for BMI distribution below average with predominance in females (female to male 10% vs. 9%, respectively). While 55.4% males had normal BMI, females had a larger quantity in this group (67.1%). Finally, males were found to have BMI above average in higher rates than females (35.6% vs. 22.9%) [Figure 1].
It seems that you are more likely to consume a dietary supplement if you are single compared to one that is married as shown in [Table 1], 52.7% vs 45.7 respectively. As well as no statistically significant relationship was observed between levels of education and age compared with the consumption of dietary supplements and multivitamins (P > 0.05). However, statistically significant relationship was observed for weight and gender variables (P < 0.01) [see [Table 1].
We tried to figure out how much money do our participants spend on purchasing this kind of nutritional products. We divided the results obtained from our survey into three groups and received the following distribution: less than 200 riyals (50 USD) – 60.4%, 200 to 500 riyals – 33%, more than 500 riyals – 6.6%.
As the aim of our study was to evaluate how educated our participants were about dietary supplements and multivitamins, we provided this article with the answers given by our study participants in [Table 2].
The results showed 50.7% of study participants had some knowledge about dietary supplements and multivitamins, 37.8% indicated that they are up to date, and only 11.5% stated they were not aware at all. According to obtained answers, 63.2% of participants either consumed dietary supplements and multivitamins at the moment of filling in the survey or had ever consumed them in the past, while 36.8% did not ever taken in this kind of products. 48% participants marked not consuming any kind of dietary supplements and multivitamins, yet they knew a family member who did, 30.8% were aware that a friend used them, and 21.1% could not recall in memory anyone consuming. Finally, statistically significant relationship was found for the knowledge of our participants depending on the answer if it was up to date, and consumption of dietary supplements and multivitamins (P < 0.01) [Table 3].
We also tried to reveal what kind of supplements were the most popular and widely used ones among our study participants, so we received this kind of pattern: vitamins and multivitamins 32.1%, fatty acids 25.9%, minerals 24.3%, amino acids and proteins 17.7%.
Attitude of our study participants toward dietary supplements and multivitamins usage is illustrated in [Table 4]. Most of the participants (61.6%) expressed that dietary supplements and multivitamins could be a supportive option in treatment, however, the minority (15%) did not agree with that statement.
A large group (75%) of the participants considered supplements to cover any deficit in the diet and stated them to be harmful in case of excessive usage. Our results showed the majority of participants (55%) stated they consume dietary supplements and agree with the idea of multivitamins to be prescribed by a doctor or dietician, while 22.8% stated supplement consumption on their own, 11.9% were using based on advice given by coach, 10.3% consumed them relying on a friends' recommendation. Most of the participants advised to use dietary supplements and multivitamins with a medical prescription (79%), while 17.4% believed diet can cover all the nutrients needed, and only 4% warned against supplement usage. Most of the participants were sure that purchase of dietary supplements and multivitamins should be through a pharmacy (88%), while only 6.5% and 5.6% stated that internet and other means such as specialized shops, friends, gym, hospital, etc., are the main source of their dietary supplements purchase.
What applies to the leaflet reading that comes with the dietary supplements and multivitamins, 56% of the participants usually do read instructions, 30% read them sometimes, whereas 14% do not read them at all.
| Discussion|| |
There has been a great rise in demand for dietary supplements and multivitamins, so that the usage has spread to the point where this kind of products are bought off over-the-counter without any doctor prescription or dietician advice. Besides benefits, there are adverse effects.
For example, it is known that vitamins A and D are lipophilic therefore in case of overdosing excessive cumulation may cause side effects which can even be a treat for health.
The problem is most of the supplement consumers (55.8%) are unaware of any adverse effects and interactions as it was shown in Saini et al. study.
The quantity of our study participants and the mean distribution by genders was similar to the characteristics of general population in Saudi Arabia, therefore our study results show the real image of the discussed issue. As dietary supplements are not recommended for children, the selected age distribution of our study participants was chosen correctly. The interesting finding was dietary supplements were more widely used among people of young age (18—25 years).
In terms of demographics, in our study, most of the consumers were female (59.1%), which coincides with several articles such as Sharma et al. (2014) with a majority of female consumers in their study. According to Alowais et al. (2019), 85.9% female participants were included in the study. In a study by Braun et al. (2008), 62.5% of participants were female, while Shahwan et al. (2018) showed their results with a prevalence of male participants - 56.1% compared with 43.9% females.
The relationship between consumption and education was apparent in our study---those having bachelor's degree were the largest group consuming supplements (64.6%). This statement agrees with Alowais et al. (2019) finding applying to usage of supplements being higher in those having higher education (84.5%). In Braun et al. 2008 study, 67.9% study participants had a history of tertiary education and supplement consumption.
Our participants were quite knowledgeable on the topics of multivitamins and dietary supplements-----up to 88.5% had knowledge on dietary supplements and its benefits. According to Al Tamimi et al., 89.9% of study participants were knowledgeable. The awareness level was also high (91.6%) in Žeželj et al. study, and an awareness level of 98% was obtained by Qidwai et al.
About half of our participants were aware about what dietary supplements are and why they should be used, but 37.8% out of the other half were up to date with information, which was an indicator of high awareness level in Saudi Arabian population. 93.65% of Chandika et al. study participants had good knowledge about supplements.
It is good to note that 63.2% of our participants showed that they consumed dietary supplements, and this result had a similar percentage to a study performed by Saini et al. (2019) which was 62%. About a half of those who did not were aware of a familiar person consuming any kind of dietary supplements and multivitamins. 84.8% of Qidwai et al. and 64.2% of Saini et al. study participants were taking dietary supplements, yet only 30.5% of student participants were taking them according to Žeželj et al., Alowais et al. study showed the total participants consuming dietary supplements were 49% and 53.6% of medical sciences students reported supplementary nutrition consuming.
A large group of our study participants (75%) were aware of dietary supplements usage limitations and aware of the side effects. 42% of Qidwai et al. study participants noted they were aware of harmful effects of dietary supplements and multivitamins. Saini et al. received 55.8% unawareness response regarding the harmful effects of vitamin supplements.
Alfawaz et al. in their study revealed that the majority (57%) of participants were taking supplements based on a doctor advice, whereas internet, friends, and other sources were chosen in descending order. These results confirm the ones obtained by our study, as our participants relied more to the doctor advice, even more, most of them was “for” selling supplements by prescription. The same study concluded that most commonly used supplements were proteins (29%) and multivitamins (21%), whereas our results show the following distribution: vitamins and multivitamins 32.1%, fatty acids 25.9%, minerals 24.3%, amino acids and proteins 17.7%. In Dickinson et al. study, 82% of participants declared people considering taking a high dose, single nutrient supplement should talk with their doctor first. Yet 79.6% participants of Croatian study stated they do not seek professional medical help in what applies to supplement consumption. According to Qidwai et al., 66% of their study participants received recommendation of vitamin supplements by their doctors. The same result was obtained by Sekhri et al.---69.5% participants were advised to take in supplementary nutrients by their doctors. Chandika et al. received 71.43% positive answers to the question about supplements being advised by doctor. But in Rosalia et al. study only 27.6% stated being prescribed a dietary supplement by doctor.
A large group of our study participants was sure supplements may cover any deficit in diet. That is why they were asked if they ever had a long period of no eating vegetables and fruits, which are the main sources for vitamins and minerals. Most of them recalled a period shorter than a week, however the percentage for longer periods was high too. 55.8% students of health sciences in Alowais et al. study stated that diet only is enough to maintain good health, whereas only 37.1% of other specialty participants were thinking that way. Dickinson et al. study stated that 81% participants considered dietary supplements to be only a part of healthy diet and 80% stated they should not replace healthy lifestyle habits. 89% of Rosalia et al. study participants believed that intake of a balanced diet was best choice to maintain a healthy lifestyle.
It was already shown by Alowais et al. that students tend to consume more dietary supplements, mostly by health sciences students. The interesting fact is, multivitamins were the most popular among students, which represents the same pattern obtained by our study. Students with normal BMI (61.5%) and the most physically active students (37.7%) took significantly more dietary supplements according to Žeželj et al. In the same study, medical students were compared to non-medical students, the latest showed lower rate of supplements intake, yet they were more knowledgeable about safety.
Supplementary nutritional products are often associated with great expenses, unworthy money spending, and economic burdening. In Saudi Arabia, this problem is not investigated well yet, but there may be a need to estimate annual costs. The major problem is multivitamins consumption by people of younger age, while there is no need as food provides enough nutrients to be healthy.
| Conclusion|| |
Dietary supplements and multivitamins consumption is prevalent among Saudi Arabian population. Our study suggests the majority of consumers understand the supportive role of dietary supplements and are aware of risks and side effects.
Supplements consumption is more prevalent in people of a younger age, which is either a sign of being anxious about own health or the real need of accessory support.
As the majority of participants were well educated in what applies to dietary supplements and multivitamins consumption, their main statements were to perform supplementary products' sales through pharmacies through a doctor prescription as the supplementary products may be a good assistance in treatment, which shows that primary care and family physicians participation in the communities health and awareness, but an excessive use of this kind of products can be tricky for health.
Consuming dietary supplements was not associated with high economic costs for the country: the mean spending was less than 200 riyals per month.
Some special groups need to be investigated on the subject of supplementary nutrients intake. We also recommend for special programs and campaigns on the topic of proper usage to the public.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bailey RL, Gahche JJ, Lentino CV, Dwyer JT, Engel JS, Thomas PR, et al.
Dietary supplement use in the United States, 2003-2006. S J Nutr 2011;141:261-6.
Owens C, Toone T, Steed-Ivie M. A survey of dietary supplement knowledge, attitudes, and use in a rural population. J Nutr Food Sci 2014;4:304.
Maughan RJ, Burke LM, Dvorak J, Larson-Meyer DE, Peeling P, Phillips SM, et al.
IOC consensus statement: Dietary supplements and the high-performance athlete. Br J Sports Med 2018;52:439-55.
Perlitz H, Mensink G, Lage Barbosa C, Richter A, Brettschneider AK, Lehmann F, et al.
Use of vitamin and mineral supplements among adolescents living in Germany-Results from EsKiMo II. Nutrients 2019;11:1208.
Sirico F, Miressi S, Castaldo C, Spera R, Montagnani S, Di Meglio F, et al.
Habits and beliefs related to food supplements: Results of a survey among Italian students of different education fields and levels. PLoS One 2018;13:e0191424.
Mileva-Peceva R, Zafirova-Ivanovska B, Milev M, Bogdanovska A, Pawlak RM. Socio-demographic predictors and reasons for vitamin and/or mineral food supplement use in a group of outpatients in Skopje. Prilozi 2011;32:127-39.
McDowall JA. Supplement use by Young Athletes. J Sports Sci Med 2007;6:337-42.
Sekhri K, Kaur K. Public knowledge, use and attitude toward multivitamin supplementation: A cross-sectional study among general public. Int J Appl Basic Med Res 2014;4:77-80.
AlRuthia Y, Balkhi B, Alrasheed M, Altuwaijri A, Alarifi M, Alzahrani H, et al.
Use of dietary and performance-enhancing supplements among male fitness center members in Riyadh: A cross-sectional study. PLoS One 2018;13:e0199289.
Kaushansky K, Kipps TJ. Hematopoietic agents: Growth factors, minerals and vitamins. In: Brunton LL, editor. Gooodman and Gilman's The Pharmacological Basis of Therapeutics. 12th
ed. New York: McGraw Hill, Medical Publishing Division; 2011. p. 1067-99.
Sood A, Sood R, Brinker FJ, Mann R, Loehrer LL, Wahner-Roedler DL. Potential for interactions between dietary supplements and prescription medications. Am J Med 2008;121:207-11.
Tsai HH, Lin HW, Pickard AS, Tsai HY, Mahady GB. Evaluation of documented drug interactions and contraindications associated with herbs and dietary supplements: A systematic literature review. Int J Clin Pract 2012;66:1056-78.
Kennedy J, Wang C-C, Wu C-H. Patient disclosure about herb and supplement use among adults in the US. Evid Based Complement Alternat Med 2008;5:451-6.
Radimer K, Bindewald B, Hughes J, Ervin B, Swanson C, Picciano MF. Dietary supplement use by US adults: Data from the National Health and Nutrition Examination Survey, 1999-2000. Am J Epidemiol 2004;160:339-49.
Wu CH, Wang CC, Kennedy J. Changes in herb and dietary supplement use in the US adult population: A comparison of the 2002 and 2007 National Health Interview Surveys. Clin Ther 2011;33:1749-58.
Shao A, Drewnowski A, Willcox DC, Krämer L, Lausted C, Eggersdorfer M, et al.
Optimal nutrition and the ever-changing dietary landscape: A conference report. Eur J Nutr 2017;56(Suppl 1):1-21.
National Institues of Health. Office of Dietary Supplements. Dietary Supplement Health and Education Act of 1994. Public Low 103-417. 108 Stat 4325. Available from: https://ods.od.nih.gov/About/DSHEA_Wording.aspx
. [Last accessed on 2018 Jan 18].
US Food and Drug Administration. FDA 101: Dietary supplements. FDA Consumer Health Information. 2008.
Bruins MJ, Bird JK, Aebischer CP, Eggersdorfer M. Considerations for secondary prevention of nutritional deficiencies in high-risk groups in high-income countries. Nutrients 2018;10:47.
Lim S. Eating a balanced diet: A healthy life through a balanced diet in the age of longevity. J Obes Metab Syndr 2018;27:39-45.
Tyszkowski M. There a relationship between nutrition, facial development, and crowding of the teeth? Int J Orthod Milwaukee 2016;27:15-7.
Ronis M, Pedersen KB, Watt J. Adverse effects of nutraceuticals and dietary supplements. Annu Rev Pharmacol Toxicol 2018;58:583-601.
Chugh PK, Lhamo Y. An assessment of vitamin supplements in the Indian market. Indian J Pharm Sci 2012;74:469-473.
] [Full text]
Dwyer JT, Coates PM, Smith MJ. Dietary supplements: Regulatory challenges and research resources. Nutrients 2018;10:41.
van der Horst K, Siegrist M. Vitamin and mineral supplement users. Do they have healthy or unhealthy dietary behaviours? Appetite 2011;57:758-64.
Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol 2012;2:1143-211.
Woodside JV, McCall D, McGartland C, Young IS. Micronutrients: Dietary intake v. supplement use. Proc Nutr Soc 2005;64:543-53.
Wang CZ, Moss J, Yuan CS. Commonly used dietary supplements on coagulation function during surgery. Medicines (Basel) 2015;2:157-85.
Kamangar F, Emadi A. Vitamin and mineral supplements: Do we really need them? Int J Prev Med 2012;3:221-6.
Sesso HD, Christen WG, Bubes V, Smith JP, MacFadyen J, Schvartz M, et al.
Multivitamins in the prevention of cardiovascular disease in men: The Physicians' Health Study II randomized controlled trial. JAMA 2012;308:1751-60.
Lippman SM, Klein EA, Goodman PJ, Lucia MS, Thompson IM, Ford LG, et al.
Effect of selenium and vitamin E on risk of prostate cancer and other cancers: The Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 2009;301:39-51.
Klein EA, Thompson IM Jr, Tangen CM, Crowley JJ, Lucia MS, Goodman PJ, et al.
Vitamin E and the risk of prostate cancer: The Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 2011;306:1549-56.
Alowais MA, Selim MA. Knowledge, attitude, and practices regarding dietary supplements in Saudi Arabia. J Family Med Prim Care 2019;8:365-72.
] [Full text]
Tarn DM, Paterniti DA, Good JS, Coulter ID, Galliher JM, Kravitz RL, et al.
Physician-patient communication about dietary supplements. Patient Educ Couns 2013;91:287-94.
Hamishehkar H, Ranjdoost F, Asgharian P, Mahmoodpoor A, Sanaie S. Vitamins, Are They Safe?. Advanced pharmaceutical bulletin 2016;6:467–77.
Saini S, Hasan N. A survey of multivitamin supplement knowledge, attitude, and use in the urban community of Bikaner, Rajasthan. CHRISMED J Health Res 2015;2:329-32. [Full text]
Sharma A, Shalini A, Ashok M. Knowledge, attitude and practices related to dietary supplements and micronutrients in health sciences students. J Clin Diagn Res 2014;8:10–3.
Braun M, Venter I. Use of dietary supplements, and awareness and knowledge of the recommended fruit and vegetable intakes and consumption of health food store customers in the Cape Town city bowl. South African Journal of Clinical Nutrition 2008;21:323-30. DOI: 10.1080/16070658.2008.11734174.
Shahwan M, Zain-AlAbdin SM. Knowledge and practice of dietary supplement and micronutrients among medical students at Ajman University. J Pharm Sci Res 2018;10:85-90
AlTamimi JZ. Awareness of the consumption of dietary supplements among students in a University in Saudi Arabia. J Nutr Metab 2019;2019. doi: 10.1155/2019/4641768.
Žeželj SP, Tomljanović A, Jovanović GK, Krešić G, Peloza OC, Dragaš-Zubalj N, et al.
Prevalence, Knowledge and Attitudes Concerning Dietary Supplements among a Student Population in Croatia. Int J Environ Res Public Health 2018;15. pii: E1058. doi: 10.3390/ijerph 15061058.
Qidwai W, Samani ZA, Azam I, Lalani S. Knowledge, attitude and practice of vitamin supplementation among patients visiting out-patient physicians in a teaching hospital in Karachi. Oman Med J 2012;27:116-20.
Chandika RM, Uthakalla VK, Hussein EA, Abdullah SM, Afifi SF. Knowledge attitude and practices about nutritional supplements of the students of applied medical sciences, Jazan University, Jazan, Saudi Arabia. Indian J Nutr 2017;4:157.
Alfawaz A, Krishnaswamy S, Al-Faifi L, Atta H, Al-Shayaa M, Alghanim S, et al.
Awareness and attitude towards use of dietary supplements and the perceived outcomes among Saudi adult male members of fitness centers in Saudi Arabia. Int J Sport Nutr Exerc Metab 2018;28:509-14.
Dickinson A, MacKay D, Wong A. Consumer attitudes about the role of multivitamins and other dietary supplements: Report of a survey. Nutr J 2015;14:66.
Rosalia R, Panjwani S, Ali AA, Al-Hayali MM, Alahmad AM, Shirwaikar A, et al.
Across sectional survey on the knowledge and attitude towards the use of multivitamin products among the students of a Medical University in the U.A.E. J App Pharm Sci 2017;7:201-8.
Guallar E, Stranges S, Mulrow C, Appel LJ, Miller ER. Enough is enough. Stop wasting money on vitamin and mineral supplements. Ann Intern Med 2013;159:850-1.
[Table 1], [Table 2], [Table 3], [Table 4]