Supplement Users Research Articles

The Prevalence of Dietary Supplement Use for the Purpose of COVID-19 Prevention in Japan.

COVID-19 is still the biggest issue worldwide. Many dietary supplements on the market claim to have anti-COVID-19 effects without scientific evidence. To elucidate the prevalence of dietary supplement usage for the prevention of COVID-19, we conducted an online cross-sectional questionnaire survey among Japanese adults in January 2022. The prevalence of dietary supplement use for the prevention of COVID-19 was 8.3%, and there was no gender difference. We also conducted additional research on these dietary supplement users (1000 males and 1000 females). The most popular ingredient used was vitamin C (61.0%), with vitamin D (34.9%) and probiotics (33.4%) following. Half of these participants reported using supplements for more than one year. The information sources that reportedly led them to start using dietary supplements for the prevention of COVID-19 were the Internet (44.0%), television and radio (29.9%), and family or friends (26.0%), and these information sources differed among generations. In conclusion, some of the population used vitamin/mineral supplements for the prevention of COVID-19 that might be beneficial for their health, but some used ingredients with no scientifically proven effects against the virus at this time. Therefore, information-based scientific evidence is important to prevent the inappropriate use of dietary supplements by consumers.

Profile of Folate in Breast Milk from Chinese Women over 1-400 Days Postpartum.

Folate is an essential nutrient for growth in early life. This study aimed to determine the levels and compositions of folate in Chinese breast milk samples. This study was part of the Maternal Nutrition and Infant Investigation (MUAI) study. A total of 205 healthy mothers were randomly recruited in Chengdu over 1–400 days postpartum. Five different species of folate, including tetrahydrofolate (THF), 5-methyl-THF, 5,10-methenyl-THF,5-formyl-THF and unmetabolized folic acid (UMFA), were measured for liquid chromatography–tandem mass spectrometry (LC-MS). The median levels of total folate ranged from 12.86 to 56.77 ng/mL in the breast milk of mothers at 1–400 days postpartum, gradually increasing throughout the lactating periods. The median levels of 5-methyl-THF, minor reduced folate (the sum of THF, 5,10-methenyl-THF and 5-formyl-THF) and UMFA were in the ranges of 8.52–40.65 ng/mL, 3.48–16.15 ng/mL and 0.00–1.24 ng/mL during 1–400 days postpartum, respectively. 5-Methyl-THF accounted for more than 65% of the total folate in all breast milk samples. The levels of UMFA in mature breast milk samples were higher in supplement users than nonusers, but not for colostrum and transitional milk samples (p < 0.05). In conclusion, the level of total folate in the breast milk changed along with the prolonged lactating periods, but 5-methyl-THF remains the dominant species of folate in the breast milk of Chinese populations across all entire lactating periods.

‘Between foods and medicines’: A qualitative interview study of patient experiences of the meaning and usage of oral nutritional supplements

The aim of this study was to deepen the understanding of what oral nutritional supplements mean to patients and how this meaning connects to supplement usage, by exploring patient experiences of such supplements. Qualitative interviews were conducted in June 2019–March 2020 with ten patients with malnutrition or at nutritional risk, prescribed oral nutritional supplements by dietitians. Data were thematically analysed using systematic text condensation. Two final categories were identified: ‘Oral nutritional supplements are a one-dimensional remedy’ and ‘Everyday oral nutritional supplement usage is regulated autonomously’. The patients described the meaning of oral nutritional supplements as nutrition. While the supplements could compensate for nutrients not eaten or be part of a helpful compensation strategy, they could not lessen the burden of altered eating. Supplement usage was described as dependent on the acceptance of taste and the priority given to nutrition in everyday life. Usage was greater when nutrients were perceived as needed, such as when striving for higher bodyweight or disease recovery. Usage was lower when a patient's own goals were not increased nutrient intake or bodyweight or when other activities were perceived as more important. Patient experiences indicated that oral nutritional supplements could serve as a remedy for malnutrition, but not for a situation of altered eating. Supplement usage was described as being regulated autonomously based on patient views on the importance of nutrition. Those views were diverse, highlighting the importance of supplement prescribers discussing treatment goals with each patient. A deeper understanding of the meaning of oral nutritional supplements and reasons for their usage from a patient perspective is crucial in order for healthcare to provide appropriate, effective nutrition therapy for malnutrition.

Food Supplement Use Differs from the Recommendations in Pregnant Women: A Multinational Survey.

The aim was to investigate, among pregnant women, (1) the use of food supplements and (2) the awareness of food supplement recommendations and beliefs about food supplement use in four European countries: Finland, Italy, Poland, and the United Kingdom. The participants (n = 1804) completed an online questionnaire with predefined statements. Daily intakes of vitamins and minerals were calculated using uploaded pictures or weblinks of the supplement packages. Country differences were assessed. Most participants (91%) used at least one food supplement during pregnancy. A prenatal multivitamin was the most commonly used supplement type (84% of the users), and 75% of the participants thought consumption of multivitamin is recommended. Of the participants, 81% knew that folic acid is recommended during pregnancy while 58% knew the recommendation for vitamin D. In 19% of the supplement users, the daily safe upper intake limit of at least one nutrient was exceeded. Nevertheless, most participants agreed that they knew which supplements (91%) and doses of supplements (87%) needed to be used during pregnancy. To conclude, the majority of the participants used food supplements, but lower proportions knew and adhered to the recommended intakes. Between-country differences were observed in the use and knowledge of and beliefs regarding supplements. The results suggest a need for assessment and monitoring of supplement use in antenatal care to ensure appropriate use.

Who is taking dietary supplements in Peru? Results of a non-probability crosssectional survey

Objective: To identify the profile and perception of dietary supplement users in the population of Lima, Arequipa and Trujillo, Peru. Materials and methods: An analytical cross-sectional study conducted with subjects over 18 years of age residing in the cities of Lima, Arequipa and Trujillo, Peru. The study was performed in two steps. In the first step, personal interviews were held using structured and standardized surveys. In the second step, a structured survey was designed with open and closed questions related to the purchasing and consumption habits of dietary supplements. Results: Eight hundred ninety (890) people were interviewed, out of which 42 % reported to be dietary supplement users, being vitamins and minerals the most commonly used products. It was observed that these users had been taking daily doses of dietary supplements for 3 to 12 months. Additionally, it was found that family and friends served as a source of information on dietary supplements similar to the one provided by doctors and nutritionists. Conclusions: The results of this study conducted with a representative sample from Lima, Arequipa and Trujillo showed that a high percentage of the population was satisfied with using dietary supplements regularly. It is important to point out that there were no significant differences between the percentage of the surveyed population that used dietary supplements recommended by nutritionists and the one which used them on family and friends’ recommendation. This suggests that it is necessary to improve nutritional habits with educational strategies on eating habits and adapt the use of dietary supplements to a balanced diet. These results could allow the population to use dietary supplements more effectively as a tool to reduce nutritional deficiencies.

Use of Dietary Supplements among Japanese Female Nursing Professionals.

The use of dietary supplements has become a common way to maintain good health. This study evaluated the status of supplement use and supplement user characteristics among participants from the Japan Nurses' Health Study, which comprised a cohort of Japanese female nursing professionals. A questionnaire survey covering the use of vitamins and supplements was conducted. Supplements were classified according to their constituents and formulations. Logistic regression analyses were performed to determine the characteristics of supplement users. Results were as follows. There were 4,017 supplement users (34.4% of 11,665 valid answers). The supplement types used were: vitamins (n=2,655), minerals (n=1,121), amino acids and proteins (n=139), botanical products (n=714), animal by-products (n=849), herbal medicines (n=152), nutritional drinks (n=19), others (n=117), and unclassified supplements (n=320). Logistic regression analyses showed that supplement use was significantly associated with age and body mass index, and there were significantly higher proportions of supplement users among pregnant women, black tea drinkers, soy milk consumers, and lactobacillus beverage drinkers. In conclusion, the overall percentage of supplement users was 34.4%. A high prevalence of supplement use was observed among older, non-obese, and pregnant participants, and those who paid more attention to their health. The prevalence of supplement users was significantly higher among those who habitually drank black tea, soy milk, and lactobacillus beverages, suggesting participants used supplements to maintain their health or prevent diseases based on high health consciousness.

Evaluating perceptions and usage of natural remedies, herbal medicine, and dietary supplements for kidney stones among a diverse, international, urban patient population.

Our goal was to assess the use and perceptions of complementary and alternative medicine (CAM) for kidney stones among a diverse, urban population. This was a cross-sectional study of patients treated for kidney stones in the Bronx, NY. We assessed demographic information, personal history of kidney stones, as well as knowledge and use of CAM for kidney stones. Patient demographics and responses were analyzed using chi-squared, t tests, and binomial logistic regression. 113 patients were surveyed. 90% identified as non-white, of whom 58% indicated Hispanic, 46% Latinx, and 23% Black. 56% of patients were born outside the United States. 56% of patients had heard of CAM for kidney stones and 44% had used CAM for kidney stones. The most common CAM were fruits (N = 42, 84%). Recurrent stone formers were more likely than first-time stone formers to have heard of CAM (68 vs 44% p = 0.013) and to have used CAM (56 vs 30%, p = 0.008). Those identifying as Hispanic were more likely to have both heard of and tried CAM for kidney stones (p = 0.036 and 0.022, respectively) compared to non-Hispanic patients. CAM are commonly used among our diverse, urban patient population. While some remedies are high in citrate and alkali (i.e., lemon, cranberry), others are high in oxalate (i.e., beets) and could potentially contribute to stone formation. These findings underpin the importance that medical providers educate themselves on the CAM used in their specific patient populations and discussing use with patients. Providers should aim to identify and reconcile therapeutics that oppose goals of treatment.

Sport supplement use among high school rugby players in South Africa: A scoping review.

The use of sport supplements has increased for all types and levels of sport, with an estimated increase of 5.8% annually. Sport supplement usage and doping among high school athletes has increased over the years to meet the demands of the sports. This scoping review identifies the trends and gaps in current literature regarding sport supplement use among high school rugby players in South Africa. A search was conducted using six electronic databases, namely Oxford Academic, Emerald Publishing, ResearchGate, SABINET, PubMed and Google Scholar. The eligibility of the articles was determined by means of a PRISMA flow diagram with the following inclusion criteria: (1) research concerning supplement use among rugby players, (2) research concerning supplement use among high school rugby players. Five articles all comprising of cross-sectional study designs were included in this scoping review. The prevalence of sport supplement use among adolescent rugby players ranged from 30% to 45%. Protein supplements (31% - 79%) were the most commonly identified supplement used among adolescent rugby players with the aim to improve sport performance as the most common reason for use. The internet (74%) and magazines (72%), followed by coaches comments (28% to 30%), were given as the most common sources of information. The use of sport supplements is increasing among high school athletes due to the belief that these substances will provide sporting performance benefits or enhance the competitive 'edge' of these athletes. Additional education regarding the safety of supplements is necessary to lower the incidences of doping among young athletes and avoid the adverse health effects that uncontrolled supplement use can cause.

Influence of the Emotion of Fear on Patterns of Consumer Behavior toward Dietary Supplements during the COVID-19 Pandemic

The focus of this paper is placed on the role of emotions in consumer behavior, specifically in the process of purchasing dietary supplements during the COVID-19 pandemic. The theoretical part is based on current knowledge from relevant Croatian and foreign scientific and professional literature on dietary supplements, the COVID-19 pandemic, consumer behavior, decision-making and the impact of emotions on it, while the empirical research portion of this paper details the attitudes of consumers who buy food supplements, the role and importance of different emotions that have a greater or a lesser impact on the purchase of food supplements, with special reference to the timing of the COVID-19 pandemic, and the factors that make consumers decide to purchase food supplements. This research was conducted in the form of a survey that included 257 respondents who were actual users of dietary supplements. It showed that the main drive for buying dietary supplements during the COVID-19 pandemic is the emotion of fear, as the consumers perceived this new disease as a threat to their health and life.

Dietary Supplement Perception and Usage Pattern Among the Chinese Older Population: A Pilot Study

ObjectivesThe usage of dietary supplements (DS) is increasingly prevalent in China. The purpose of this pilot study was to examine DS use and the factors that influence the buying and usage.MethodsData is from an anonymous, self-developed, online questionnaire administered to Chinese adults ≥60 years. Statistical analyses were conducted using chi-square, independent t-tests, and single-factor ANOVA to test differences in DS usage among characteristic-based stratified groups.Results75 participants were anonymously recruited (66.7% female). The most popular DS was calcium (74.7%). Participants’ children were the most prevalent source for hearing about and obtaining DS (59%). Participants who completed senior high or higher used more DS than those who completed junior high or lower, P = 0.011. Participants living in the North and Northeast Hukou regions took fewer DS than those in other regions, P = 0.007. No significant differences were found in the prevalence of DS use in relation to chronic disease diagnoses.ConclusionsThe results show the lack of awareness and knowledge of DS use. Appropriate guidance and scientific education about DS, such as the benefits and risks of different types of DS and the effectiveness of DS related to chronic diseases, should be provided to Chinese older people by public health departments, healthcare providers, and even DS companies in the future. Older Chinese adults with higher education and living in the North and Northeast Hukou regions are more likely to use DS.Funding SourcesNone.

Polypharmacy and premature aromatase inhibitor (AI) discontinuation in older women with breast cancer.

6568 Background: Treatment with AI therapy for at least five years is recommended to reduce risk of cancer recurrence in postmenopausal women with hormone-positive breast cancer, but up to 50% prematurely discontinue their AI. Prior studies have demonstrated higher rates of nonadherence in older patients. Higher rates of comorbidities are also present in older patients, many of which require treatment with prescription medications. However, in prior studies, the impact of polypharmacy on AI persistence in older women has been variable. We evaluated the relationship between use of prescription and over-the-counter (OTC) medications and AI discontinuation in older women in a randomized controlled trial of AI therapy. Methods: In the Exemestane and Letrozole Pharmacogenetics (ELPh) trial, postmenopausal women with stage 0-III hormone-positive breast cancer were randomized to receive exemestane or letrozole and followed for two years. Prescription medication and OTC supplement usage was prospectively collected. Only enrolled participants at least 65 years of age were included in this analysis. Univariate and multivariable Cox proportional hazards models evaluated the association between baseline prescription medications, OTC medications, initial assigned AI medication, and time to discontinuation of initial AI. Results: 131 women at least 65 years old with baseline medication and OTC supplement information were identified. The average age was 70.4 (SD 5). 58 participants (44%) were randomized to exemestane and 73 (56%) to letrozole. 21% had previously received tamoxifen and 18% received taxane-based chemotherapy. The average number of prescription medications at AI initiation was 4.95, and 127 patients reported taking at least one. The average number of OTC medications was 3.23, and 107 patients reported taking at least one. There was no difference in number of prescription medications or OTC medications by study arm. As previously reported, exemestane was associated with premature discontinuation (HR 1.92 [95%CI 1.06-3.50], p = 0.032). Controlling for AI, the risk of discontinuation decreased by 12% for every additional prescription medication (HR 0.88 [95%CI 0.78-0.99], p = 0.038). OTC medication use was not significantly associated with AI duration. Conclusions: Increased prescription medication usage at AI initiation was associated with decreased risk of premature discontinuation of AI. Further research is needed to evaluate this interaction and identify characteristics that impact AI persistence in older women with breast cancer. Clinical trial information: NCT00228956.

Supplement Intake Among Older Cancer Survivors: Socio-Demographic Associations, Supplement Types, Reasons for Use, and Cost

ObjectivesTo evaluate associations between supplement intake and socio-demographic factors among older cancer survivors and to identify type of supplements, reasons for use, and cost.MethodsThis secondary analysis was performed on baseline data from 368 older cancer survivors enrolled in the Harvest for Health vegetable gardening intervention trial. Survivors self-identifying as supplement users reported data on prescribed, over-the counter, and dietary supplements. Chi-square tests were performed to identify associations among supplement use, cancer type, and socio-demographic variables. Descriptive analyses were used to identify common types, reasons of supplement intake, and total daily cost of supplements.ResultsMore than half (59%) of the sample reported taking supplements. Female (OR 2.12, 95% CI 1.35–3.32), Non-Hispanic White (OR 1.78, 95% CI 1.06–3.01), and breast and gynecological cancer survivors (OR 1.58, 1.04–2.40) were significantly more likely to take a supplement compared to males, minorities, and other cancer-types (p-value < 0.05). Survivors reported a mean intake of three supplements, with vitamins (38%), multivitamins (22%), and minerals (12%) as the most prevalent. Commonly-reported reasons for supplement intake were to improve general health (47%), medical conditions (39%), and cancer-related symptoms (12%). Bone health was the most prevalent reason cited under medical conditions, and hair loss, fatigue, and sleep were most commonly reported under cancer-related symptoms. The daily cost of supplements ranged from $0.02–$19.81, with the mean, median and mode being $1.29/day, $0.78/day, and $0.34/day, respectively.ConclusionsNutritional supplement use is prevalent among older cancer survivors with overall health identified as the most common reason for supplement intake. Moreover, out-of-pocket recurrent costs can be substantial. These data emphasize the need to encourage a diet rich in nutrients to minimize daily cost of supplements among older survivors who may live on fixed incomes. Survivors should discuss proper use of supplements with their healthcare providers.Funding SourcesThis work was supported by the National Cancer Institute and the American Cancer Society.

Lifestyle, Eating Habits, and Health Behaviors Among Dietary Supplement Users in Three European Countries.

Dietary supplements (DS) are used by about 30–50% of adults in developed countries. However, only a few studies have compared the characteristics of DS users in different nations. This study aimed to identify and compare selected health-related behaviors of DS users from three European countries. A total of 3,588 adults (32.08 ± 8.04 years) from Poland (1,030 females, 287 males), Germany (994 females, 190 males), and the United Kingdom (911 females, 176 males) were included in the analysis. The study was based on a self-administered survey consisting of 70 questions regarding baseline characteristics, lifestyle, eating, and health habits. The associations of the obtained results were compared using the Kruskal–Wallis test, Pearson Chi-Square test, and Cramer's V value. The highest percentage of DS users (56.98%, n = 2,044) had a correct body weight, while higher body weight values were observed in 39.19% (n = 1,406). In terms of lifestyle, statistically significant differences (p < 0.05) were noted for alcohol consumption and the level of physical activity. Fruit and vegetables were most often consumed a few times a weeks (34.67%, n = 1,244). A similar result was observed for the consumption of whole grain (37.76%, n = 1,355), dairy (39.99%, n = 1,435), eggs (49.67%, n = 1,782), and meat (51.45%, n = 1,846). Most DS users did not have a chronic disease (66.72%, n = 2,394). Among the other conditions, a frequent occurrence (a few times a weeks) of gastrointestinal problems (28.29%, n = 1,015) and concentration disorders (29.15%, n = 1,046) was noted. Cramer's V values (<0.3) indicated a weak (but significant p < 0.05) relationship between the country of residence and most of the analyzed variables. In conclusion, DS users were characterized by a healthy lifestyle with appropriate behaviors but not healthy eating habits.

The actual status of users of supplements and health foods

The actual status of users of supplements and health foods

Employing an “aging paradox” to uncover effective measures for advancing productive longevity

Data gathered from healthy and non-diabetic volunteers who previously had participated in assorted clinical research trials, reveal that many medical risk factors primarily related to insulin resistance (IR) and the metabolic syndrome (MS) gradually intensify between ages 25 and 70 years. This phase here labeled “Continuum of risks” (CR) is a period whereby the metabolic changes that correlate with health situations adjust unfavorably but never exceed nor fall outside ranges that would diagnose established pathological diseases. The strengths of some of these risk factors unexpectedly reverted in an opposite and beneficial direction. This occurred somewhere beyond age 70 years. This phenomenon is defined as “Aging paradox” (AP). Because comparing data from the CR and AP periods did not reveal any significant differences in the glucose-insulin relationships with other components of MS, the beneficial happenings in AP were attributed to “Survivor bias.” The meaning behind this is that those volunteers possessing the more promising profile of risk factors can contribute to clinical studies, while participants with poorer profiles cannot take part as volunteers in later life due to medical debilities or even death. Health-wise, the average values of the following markers changed in a favorable direction when evaluated in the later AP period: Body weight, fat mass, fat free mass, levels of fasting blood glucose (FBG), triglycerides, HDL-cholesterol, and alanine aminotransferase enzyme. The lowering of FBG levels signifies the lessening of IR, the well accepted driving force behind MS. In contrast, total, LDL-, and non-HDL-cholesterol levels as well as systolic blood pressure essentially did not transform favorably over time. Health parameters associated with active survival should be at the center of attention in any developing schema to extend meaningful longevity. Thus, natural regimens involving nutrition, exercise, and dietary supplement usage exist to carry out necessary therapeutic measures to mitigate IR and its disabling components – thus potentially contributing to a longer healthier lifespan.

Dietary supplement use and its associated factors among gym users in Southern Brazil

ABSTRACT Objective Dietary supplement use is popular among gym users. However, there is a lack of understanding about their use. This study investigated the relationship between dietary supplement use and associated factors among gym users from Southern Brazil. Methods This is a cross-sectional study including gym users (n = 543; 18–59 years old). Subjects answered an online questionnaire concerning demographic, lifestyle and sports practice questions, and dietary supplement use. Pearson chi-square test was used with a significance level of p < .05. Results The prevalence of dietary supplement use was 36.5%. Supplement users were mostly men (54.5%; p < .001), exercised 3–5 times a week (73.2%; p < .001) and had trained for longer than one year (55.4%, p < .05). Men reported more frequently self-prescribed dietary supplement use (42.6%), while women reported supplements use prescribed by nutritionists (35.6%; p < .01). The use to gain mass (p < .05), to improve performance (p < .01), and to improve body aesthetics (p < .05) were associated with sex. Supplements categorized as sport foods (84.3%; p < .05) were the most frequently consumed supplements by both sexes. Conclusion Supplement users were more likely to be men, to use sport foods, and to have as a goal to increase muscle mass. Moreover, men are more likely to self-prescribe dietary supplements, while women tend to obtain information from nutritionists.

The Prevalence of Dietary Supplement Usage in Military Aviators.

Background: The prevalence of dietary supplement (DS) and energy drink (ED) usage in military personnel differs from branch to branch and is between 55% and 76% (higher values in special operations forces). Aviators with highly demanding tasks might be especially interested in using dietary supplements. To date, there are only limited data available for this special profession inside the military. Methods: An internet-based survey was conducted on the prevalence of DS and ED usage, the reasons for their usage and the place of purchase for all wings of the German Armed Forces. Results: Of the 181 pilots who participated in the survey, 34% used DSs and 16% EDs. Usage was linked to sports activities but not to the type of aircraft. DSs were purchased on the internet by 50% of the respondents; mostly protein supplements, magnesium and omega-3fatty acids. Only 42% said they would feel an effect from taking DSs. Conclusions: Although the present study showed that the prevalence of usage was comparable to that of the civilian population, the sources of supply and the range of the substances taken give cause for concern. This calls for education and information campaigns to make the pilots aware of the possible risks to their health.

Usage of nutritional supplements to improve immunity during the COVID-19 pandemic: An online survey

Background and aimsProper nutrition to optimise immune function is mandatory as at present there is no specific medicine to cure COVID-19. Our study aimed to investigate the use of nutritional supplements and their key immunity enhancing components among Sri Lankans.MethodsThis current study was an online survey conducted during the period from 27th May to 2nd June 2021 disseminated via various social media platforms. Details were collected on highlighting the frequency and composition of nutritional supplements consumed.ResultsIn a total of 3707 responders, a proportion of 25.5% (944) of the participants took supplements regularly, and 32.6% (1210), 14.5% (538), 27.4% (1015) intake were occasionally, rarely and never respectively. Older participants (>40 years of age) had a significantly higher intake of supplements than the younger counterpart of 31–35 years age group (OR: 0.604; 95% CI, 0.451–0.809; p < 0.001). Almost half (46.0%) took vitamin C supplements and females tend to take more (OR: 1.325; 95% CI, 1.120–1.567; p < 0.001) of vitamin C when compared to males. Comparatively to the other groups regarding monthly income, the participants with the highest income category are more likely to take vitamin D (OR:1.899; 95% CI, 1.034–3.490; p = 0.039) and multivitamin (OR: 3.222; 95% CI, 1.737–5.977; p < 0.001). The most commonly used main ingredient in home-made remedy was coriander in Sri Lanka.ConclusionThe use of nutritional supplements and natural products to improve immunity during the pandemic were frequent among Sri Lankan adults. In general, older, female gender and high income was significantly associated with increased intake of the nutrient supplements.

Compliance and Patients' Perspectives Towards Nutritional Supplementation Following Bariatric Surgery.

Nutritional supplementation is recommended as a prophylactic strategy for nutritional deficiencies after bariatric surgery. Little is known regarding compliance and patients' perspectives. The purpose of the study was to explore supplement intake, compliance, and patients' perspectives (including barriers, facilitators, and beliefs) and to examine whether compliance to nutritional supplementation can be predicted after bariatric surgery. MATERIAL ANDMETHODS: A questionnaire was developed to explore supplement intake and patients' perspectives. The Probabilistic Medication Compliance Scale (ProMAS) was included and modified to measure behaviors related to supplementation compliance. Content validity was assessed with an expert and patient panel. Consequently, a cross-sectional survey was conducted among patients that underwent bariatric surgery, who were invited using social media. Descriptive statistics and Spearman correlations were applied. Multiple linear regression analysis was performed to predict compliance. A 58-item questionnaire was developed and content validated, resulting in a scale-content validity index of 0.93. The questionnaire was completed by 402 subjects. Sixty-nine subjects reported not consuming any nutritional supplement (n = 69; 17.2%). For the supplement users (n = 333; 82.8%), a median ProMAS sum score of 11.0 (7.0-15.0) was observed. Increasing age and medicine intake were positive predictors of compliance (age: B = 0.058, p = 0.01; medicine intake: B = 0.39, p < 0.001), while experiencing barriers was identified as a negative predictor of compliance (B = - 4.637, p < 0.001). Top three barriers for supplement use were forgetfulness (n = 118; 29.4%), too expensive (n = 91; 22.6%), and experiencing side effects (n = 61; 15.2%). Lifelong nutritional supplementation is essential after bariatric surgery, but compliance can be affected by the presence of barriers.

Moral values and moral identity moderate the indirect relationship between sport supplement use and doping use via sport supplement beliefs

ABSTRACT The Incremental Model of Doping Behaviour suggests doping grows out of the habitual use of performance-enhancing methods (e.g., sport supplements) and belief that they are necessary for performance. Importantly, in this model, doping is viewed as functional rather than moral choice. In two studies, we examined whether sport supplement use was indirectly related to doping use via sport supplement beliefs, and whether personal morality moderated this relationship. Competitive athletes (Study 1, N = 366; Study 2, N = 200) completed measures of supplement use, beliefs, and doping use. They also completed measures of moral values (Study 1) and moral identity (Study 2). In both studies, supplement use was indirectly related to doping use via beliefs. Moreover, this indirect relationship was moderated by moral values (Study 1) and moral identity (Study 2). That is, the relationship between supplement use and doping use via beliefs was negated when moral values and moral identity were high but not when they were low or moderate. Taken together, our findings suggest that sport supplement users, who believe they are necessary, are more likely to dope if they have low moral values and believe that being a moral person is unimportant to their self-image.