The relationship between dietary supplement usage habits and healthy eating attitudes among 1^st and 5^th year students of the faculty of pharmacy: The case of Trakya University

INTRODUCTION

According to the U.S. Food and Drug Administration, dietary supplements (DS) are products distinct from conventional foods and are intended to supplement or complete the diet.^[1] The Turkish Food Codex defines ‘nutritional supplements’ or ‘DS’ as products designed to complement normal nutrition, containing concentrated or extracted nutrients such as vitamins, minerals, proteins, carbohydrates, fibre, fatty acids, amino acids or other plant, herbal and animal-derived substances with nutritional or physiological effects as well as bioactive substances. These are formulated as capsules, tablets, lozenges, single-use powder packets, liquid ampoules, dropper bottles and other similar liquid or powder forms, with a specified daily intake dose.^[2]

A balanced and adequate intake from the fundamental food groups is crucial for growth, development, maintaining good health, protecting and promoting wellness and reducing the risk of chronic diseases.^[3] While some publications argue that DS is unnecessary with a sufficient and balanced diet, modern factors such as population growth, increased work demands and similar pressures can disrupt individuals’ dietary patterns, thereby creating a need for DS.^[4]

AIMS AND OBJECTIVES

The aim of this study is to examine the relationship between DS usage and attitudes towards healthy eating among 1st and 5th year students at the Faculty of Pharmacy, Trakya University.

MATERIAL AND METHODS

The population of this cross-sectional study consists of 1^st- and 5^th-year students at the Faculty of Pharmacy, Trakya University, during the 2024–2025 academic year. With a study population of 243, a power of 85% and α = 0.05, the sample size was calculated to be 146. Considering potential data loss, a 10% increase was added, resulting in a final sample size of 160. Based on the distribution of students, it was planned to include 91^st-year and 75^th-year participants. The study was conducted between 15 February 2024 and 15 May 2024.

RESULTS

The study included 120 female students (75.0%) and 40 male students (25%), with a mean age of 21.23 ± 2.85 years. Thirteen participants (8.1%) reported having a chronic illness. Seventeen students (10.6%) indicated they had a food or drug allergy. Among the participants, 34 (21.25%) were smokers, and 79 (49.3%) reported alcohol use. Smokers consumed an average of 15.23 ± 8.89 cigarettes per day. A total of 39 participants (24.3%) indicated that they exercise regularly. No statistically significant differences were found between 1^st- and 5^th-year pharmacy students regarding the presence of food or drug allergies, chronic illness status, smoking or alcohol use, amount of alcohol consumed, income level, dietary habits, regular exercise habits, self-assessed health status and average body mass index (BMI) (P > 0.05). The distribution of participants by year is presented in Table 1.

A total of 147 participants (91.8%) reported having previously heard of the term DS, and 131 students (81.8%) indicated that they had used DS at least once in their lives. Statistically significant differences were found regarding DS education, DS usage and perceptions of DS prices as expensive (P < 0.005). Participant characteristics are presented in Table 2.

The most common source of information on DS was reported to be university lectures (28.8%), and the product for which participants most desired; further, education was vitamins/multivitamins (18.9%). Among those who had used DS, 18.9% reported using vitamin/multivitamin preparations. Participants’ education, views and experiences related to DS are presented in Figure 1.

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Figure 1:

Participants’ education, experience and opinions on dietary supplements. *Participants provided multiple responses to the questions.

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In our study, the Cronbach’s alpha coefficient for the ASHN was found to be 0.822.

The mean scale scores were significantly higher among 5^th-year students, those who primarily consumed home-prepared meals, those who exercised regularly, those who conducted more than four health-related searches in the past month and those who rated their own health as very good/good (P < 0.005). The associations between independent variables and scale scores are presented in Table 3.

No correlation was found between participants’ average BMI and their scores on the ASHN (P > 0.005).

DISCUSSION

This study presents the DS usage habits and attitudes towards healthy eating among 1^st- and 5^th-year students at the Trakya University Faculty of Pharmacy.

Approximately 90% of participants, including all 5^th-year students, reported having heard the term ‘DS’ previously. Despite the absence of DS-related courses in the 1^st-year pharmacy curriculum, participants’ familiarity with this term may stem from its popularity in society.

Among 5^th-year students, 92.9% reported using DS, while 71.1% of 1^st-year students reported the same. In a similar study among nursing students, 55.6% were found to use DS.^[6] Consistent with previous studies, vitamins and multivitamin preparations were the most commonly used DS in our study.^[6,7] Participants indicated that the products they most wished to receive training on were vitamins/multivitamins. This finding, consistent with both our study and results from other studies, may be associated with the higher prevalence of vitamin use as a common supplement.^[8]

In a study involving athletes, the most frequently cited reason for supplement use was fat burning and fitness maintenance.^[9] In contrast, in our study, students primarily reported using DS to boost energy.

In a study with university student-athletes, it was found that participants most commonly used DS on the recommendation of their coaches.^[10] Similarly, in a study conducted among the general consumer group, participants reported obtaining DS from pharmacies, mostly based on physician recommendations.^[7] In alignment with this finding, participants in our study who used DS also reported that they most often obtained their supplements from pharmacies following physician advice.

Fifth-year pharmacy students assessed the prices of DS as ‘expensive’ compared to 1^st-year students. This perspective may be due to their higher usage of DS or their involvement in the sale of these products during internship periods.

In our study, no statistically significant difference was observed in ASHN scores between genders. This finding aligns with a study conducted among university students.^[11] In a study involving medical faculty students, a statistically significant positive correlation was found between ASHN total scores and academic year.^[12] Similarly, the higher scores of 5^th-year students may be associated with health education included in the faculty curriculum. Notably, despite the World Health Organization’s explicit warnings about the harmful effects of smoking, there was no significant difference in ASHN scores between smokers and non-smokers – a remarkable finding. Those who primarily consumed homemade foods, engaged in regular physical activity, perceived their health status as very good/good and conducted health-related research more than 4 times per month scored significantly higher on the ASHN.

Although DS are used to complement nutrition, there are opinions suggesting that such supplements are unnecessary with adequate and balanced nutrition.^[4] In our study, no statistically significant relationship was found between DS use, knowledge level, educational level, price perceptions and ASHN scores.

CONCLUSION

DS is widely used among participants. However, no difference was found in the mean scale scores between pharmacy students who used DS and those who did not. The DS that participants most wished to receive information on, as well as the most commonly used DS, was multivitamins. Enhancing the awareness of future pharmacists who will work in primary healthcare regarding DS is crucial for the appropriate management of these increasingly popular products.