Fish oil (FO) dietary supplements (DS) have gained popularity over the past few decades and emerged as one of the most popular DS in both Europe and the USA. However, in Greece, no study has been carried out to determine the prevalence and characteristics of FO consumers.
The aim of this study was to describe the stance (i.e., beliefs, knowledge and habits) and practices of FO users in Greece towards DS.
A cross-sectional study, using in-person questionnaires and a stratified random sampling technique, was conducted throughout 2018–2019. A total of 28491 Greek citizens over 15 years old were interviewed in 74 regional units corresponding to the 13 administrative regions of Greece. Having used DS at least once, deemed one as: DS+FO, if FO were among them; DS-FO, if FO were never used or DS non-user, if DS were never used. Pearson's chi-square test was used to determine independence between relevant outcome variables and FO use and multinomial logistic regression was performed to create models predictive of FO use.
The sample consisted of 3.5% DS+FO, 51.3% DS-FO and 43.8% DS non-users, while 1.4% could not remember whether they had used DS. Significant predictors for being a DS+FO were identified. DS+FO were more likely to judge a DS-less diet as insufficient, support DS use and comprehend DS's labels. Also, DS+FO had used additional DS, considered more parameters when buying DS and were receivers of DS recommendations from more sources compared to DS-FO. 90% of DS users seek at least one approval source of their DS and 50% support DS recommendation by doctors.
Favorableness towards DS is more prevalent among DS+FO. Most respondents lack knowledge about the legislative background of DS and many would agree to professional guidance.
Citation: Panagiotis-David Soukiasian, Zacharenia Kyrana, Konstantina Gerothanasi, Efstratios Kiranas, Lambros E. Kokokiris. Fish oil users of Greece: Predictors, knowledge and habits regarding dietary supplement use[J]. AIMS Public Health, 2023, 10(4): 896-917. doi: 10.3934/publichealth.2023058
Fish oil (FO) dietary supplements (DS) have gained popularity over the past few decades and emerged as one of the most popular DS in both Europe and the USA. However, in Greece, no study has been carried out to determine the prevalence and characteristics of FO consumers.
The aim of this study was to describe the stance (i.e., beliefs, knowledge and habits) and practices of FO users in Greece towards DS.
A cross-sectional study, using in-person questionnaires and a stratified random sampling technique, was conducted throughout 2018–2019. A total of 28491 Greek citizens over 15 years old were interviewed in 74 regional units corresponding to the 13 administrative regions of Greece. Having used DS at least once, deemed one as: DS+FO, if FO were among them; DS-FO, if FO were never used or DS non-user, if DS were never used. Pearson's chi-square test was used to determine independence between relevant outcome variables and FO use and multinomial logistic regression was performed to create models predictive of FO use.
The sample consisted of 3.5% DS+FO, 51.3% DS-FO and 43.8% DS non-users, while 1.4% could not remember whether they had used DS. Significant predictors for being a DS+FO were identified. DS+FO were more likely to judge a DS-less diet as insufficient, support DS use and comprehend DS's labels. Also, DS+FO had used additional DS, considered more parameters when buying DS and were receivers of DS recommendations from more sources compared to DS-FO. 90% of DS users seek at least one approval source of their DS and 50% support DS recommendation by doctors.
Favorableness towards DS is more prevalent among DS+FO. Most respondents lack knowledge about the legislative background of DS and many would agree to professional guidance.
[1] | Mishra S, Stierman B, Gahche JJ, et al. (2021) Dietary supplement use among adults: United States, 2017–2018. NCHS Data Brief 399: 1-8. |
[2] | O'Brien SK, Malacova E, Sherriff JL, et al. (2017) The prevalence and predictors of dietary supplement use in the Australian population. Nutrients 9: 1154. https://doi.org/10.3390/nu9101154 |
[3] | Mengelberg A, Leathem J, Podd J (2018) Fish oil supplement use in New Zealand: A cross-sectional survey. Complement Ther Clin 33: 118-123. https://doi.org/10.1016/j.ctcp.2018.09.005 |
[4] | Brustad M, Braaten T, Lund E (2004) Predictors for cod-liver oil supplement use--the Norwegian women and cancer study. Eur J Clin Nutr 58: 128-136. https://doi.org/10.1038/sj.ejcn.1601759 |
[5] | Leung SY, Lum CM (2011) Use of nutritional health supplements and associated factors among parents with children at kindergartens in Hong Kong. Hong Kong Med J 17: 365-371. |
[6] | Food supplements consumer research Food Standards Agency. Available from: https://www.food.gov.uk/research/behaviour-and-perception/food-supplements-consumer-research |
[7] | Algaeed HA, AlJaber MI, Alwehaibi AI, et al. (2019) General public knowledge and use of dietary supplements in Riyadh, Saudi Arabia. J Family Med Prim Care 8: 3147-3154. https://doi.org/10.4103/jfmpc.jfmpc_511_19 |
[8] | Skeie G, Braaten T, Hjartåker A, et al. (2009) Use of dietary supplements in the European Prospective Investigation into Cancer and Nutrition calibration study. Eur J Clin Nutr 63: S226-S238. https://doi.org/10.1038/ejcn.2009.83 |
[9] | Soukiasian PD, Kyrana Z, Gerothanasi K, et al. (2022) Prevalence, determinants, and consumer stance towards dietary supplements according to sex in a large Greek sample: A cross-sectional study. Nutrients 14: 5131. https://doi.org/10.3390/nu14235131 |
[10] | Lentjes MAH, Welch AA, Mulligan AA, et al. (2014) Cod liver oil supplement consumption and health: Cross-sectional results from the EPIC-Norfolk Cohort study. Nutrients 6: 4320-4337. https://doi.org/10.3390/nu6104320 |
[11] | Bailey RL, Gahche JJ, Miller PE, et al. (2013) Why US Adults Use Dietary Supplements. JAMA Intern Med 173: 355-361. https://doi.org/10.1001/jamainternmed.2013.2299 |
[12] | Kanellou A, Papatesta EM, Martimianaki G, et al. (2022) Dietary supplement use in Greece: methodology and findings from the National Health and Nutrition Survey–HYDRIA (2013–2014). Brit J Nutr 1–8. https://doi.org/10.1017/S000711452200321X |
[13] | Kantor ED, Rehm CD, Du M, et al. (2016) Trends in Dietary Supplement Use Among US Adults From 1999-2012. JAMA 316: 1464-1474. https://doi.org/10.1001/jama.2016.14403 |
[14] | Clarke TC, Black LI, Stussman BJ, et al. (2015) Trends in the Use of Complementary Health Approaches Among Adults: United States, 2002–2012. Natl Health Stat Report : 1-16. |
[15] | Guy Ra.The history of cod liver oil as a remedy. Am J Diseases of Children (1923) 26: 112-116. https://doi.org/10.1001/archpedi.1923.04120140011002 |
[16] | Hernigou P, Auregan JC, Dubory A (2019) Vitamin D: part II; cod liver oil, ultraviolet radiation, and eradication of rickets. Int Orthop 43: 735-749. https://doi.org/10.1007/s00264-019-04288-z |
[17] | Secretary of the Nordic Council of Ministers, Nordic Council of MinistersNordic Nutrition Recommendations 2012 (2014). Available from: https://www.norden.org/en/publication/nordic-nutrition-recommendations-2012 |
[18] | National Institutes of Health, Office of Dietary SupplementsOmega-3 Fatty Acids (2004). Available from: https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/ |
[19] | Calder PC (2010) Omega-3 Fatty Acids and Inflammatory Processes. Nutrients 2: 355-374. https://doi.org/10.3390/nu2030355 |
[20] | Rizza S, Tesauro M, Cardillo C, et al. (2009) Fish oil supplementation improves endothelial function in normoglycemic offspring of patients with type 2 diabetes. Atherosclerosis 206: 569-574. https://doi.org/10.1016/j.atherosclerosis.2009.03.006 |
[21] | European CommissionEU register of health claims. Available from: https://food.ec.europa.eu/safety/labelling-and-nutrition/nutrition-and-health-claims/eu-register-health-claims_en |
[22] | Rontogianni MO, Kanellopoulou A, Markozannes G, et al. (2021) Prevalence and Determinants of Sex-Specific Dietary Supplement Use in a Greek Cohort. Nutrients 13: 2857. https://doi.org/10.3390/nu13082857 |
[23] | Rovira MA, Grau M, Castañer O, et al. (2013) Dietary supplement use and health-related behaviors in a Mediterranean population. J Nutr Educ Behav 45: 386-391. https://doi.org/10.1016/j.jneb.2012.03.007 |
[24] | Frey A, Hoffmann I, Heuer T (2017) Characterisation of vitamin and mineral supplement users differentiated according to their motives for using supplements: Results of the German National Nutrition Monitoring (NEMONIT). Public Health Nutr 20: 2173-2182. https://doi.org/10.1017/S1368980017001021 |
[25] | Pouchieu C, Andreeva VA, Péneau S, et al. (2013) Sociodemographic, lifestyle and dietary correlates of dietary supplement use in a large sample of French adults: results from the NutriNet-Santé cohort study. Brit J Nutr 110: 1480-1491. https://doi.org/10.1017/S0007114513000615 |
[26] | Pajor EM, Eggers SM, Curfs KCJ, et al. (2017) Why do Dutch people use dietary supplements? Exploring the role of socio-cognitive and psychosocial determinants. Appetite 114: 161-168. https://doi.org/10.1016/j.appet.2017.03.036 |
[27] | Hill C, Gill TK, Appleton S, et al. (2009) The use of fish oil in the community: results of a population-based study. Rheumatol 48: 441-442. https://doi.org/10.1093/rheumatology/ken498 |
[28] | Directive 2002/46/EC of the European Parliament and of the Council of 10 June 2002 on the approximation of the laws of the Member States relating to food supplements (Text with EEA relevance). Available from: http://data.europa.eu/eli/dir/2002/46/oj/eng |
[29] | Agresti A (2013) Categorical data analysis. Hoboken, NJ: John Wiley & Sons 75-80. |
[30] | Field A Discovering statistics using IBM SPSS statistics, Los Angeles London New Delhi Singapore Washington DC Melbourne, SAGE (2018) 308-335. |
[31] | Liu M, Ye Z, Yang S, et al. (2022) Habitual fish oil supplementation and incident chronic kidney disease in the UK biobank. Nutrients 15: 22. https://doi.org/10.3390/nu15010022 |
[32] | Parmenter BH, Bumrungpert A, Thouas GA (2021) Socio-demographic factors, beliefs and health perceptions associated with use of a commercially available Ω-3 fatty acid supplement: A cross-sectional study in Asian countries. Pharma Nutrition 15: 100237. https://doi.org/10.1016/j.phanu.2020.100237 |
[33] | Parmenter BH, Bumrungpert A, Thouas GA (2022) Sociodemographic factors and parental views associated with use of an omega-3 supplement for their children. Pharma Nutrition 20: 100289. https://doi.org/10.1016/j.phanu.2022.100289 |
[34] | Dickinson A, MacKay D (2014) Health habits and other characteristics of dietary supplement users: a review. Nutr J 13: 14. https://doi.org/10.1186/1475-2891-13-14 |
[35] | Simpson L, McConville C, McCormack J (2015) Predictors of fish oil supplement use in Northern Irish adults. Eur Health Psychologist 2015: 839. |
[36] | Teoh SL, Ngorsuraches S, Lai NM, et al. (2019) Factors affecting consumers' decisions on the use of nutraceuticals: a systematic review. Int J Food Sci Nutr 70: 491-512. https://doi.org/10.1080/09637486.2018.1538326 |
[37] | El Khoury G, Ramadan W, Zeeni N (2016) Herbal products and dietary supplements: A cross-sectional survey of use, attitudes, and knowledge among the Lebanese population. J Community Health 41: 566-573. https://doi.org/10.1007/s10900-015-0131-0 |
[38] | Samojlik I, Mijatović V, Gavarić N, et al. (2013) Consumers' attitude towards the use and safety of herbal medicines and herbal dietary supplements in Serbia. Int J Clin Pharm 35: 835-840. https://doi.org/10.1007/s11096-013-9819-3 |
[39] | Hilleman DE, Teply R, Packard KA (2020) Knowledge, perceptions, and patterns of fish oil use in cardiac patients. J Pharm Pract 33: 580-585. https://doi.org/10.1177/0897190018824485 |
[40] | National Organization for MedicinesLaws/Bulletins for other products (2009). Available from: https://www.eof.gr/web/guest/lawother?p_p_id=62_INSTANCE_n9UN&p_p_state=maximized&_62_INSTANCE_n9UN_struts_action=%2Fjournal_articles%2Fview&_62_INSTANCE_n9UN_groupId=12225&_62_INSTANCE_n9UN_articleId=18165&_62_INSTANCE_n9UN_version=1.0. |
publichealth-10-04-058-s001.pdf |