Self-reported side-effects associated with use of dietary supplements in an armed forces population

Individual Beliefs and Experiences With Brain Health Dietary Supplements in the United States

BACKGROUND

Although the use of brain health dietary supplements (brain DS) has increased, there is limited research on safety and risk of these products. Brain DS may be beneficial for improving memory, concentration, and focus but may also carry risks.

OBJECTIVES

To assess brain DS users' utilization experiences and identify factors associated with likelihood of brain DS use among nonusers.

DESIGN

An internet-based cross-sectional survey study was conducted using a sample of middle-aged US adults. Respondents' sociodemographic characteristics and health beliefs regarding brain DS were collected. Brain DS users' utilization experiences such as negative side effects and spending were also collected.

PARTICIPANTS AND SETTING

Purposive sampling was utilized for users and nonusers sample recruitment.

MAIN OUTCOME MEASURES

Brain DS users' utilization experience and future likelihood of brain DS use among nonusers.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics on brain DS users' utilization experiences were reported. Ordinal logistic regression with sociodemographic and belief characteristics as predictors was employed to identify factors associated with the likelihood of brain DS among nonusers.

RESULTS

Five hundred twenty-five respondents (mean age = 43.8 ± 9.2 years) completed the survey. Among 260 users, primary reasons for use were enhancing memory (n = 136) and helping concentration and focus (n = 108). During the past year, 40% spent $50 to $200 (range = $0 to >$1,000) and 37% reported experiencing negative side effects. Among 265 nonusers, being female (odds ratio 2.04, 95% CI 1.21 to 3.45), perceived susceptibility to brain problems (odds ratio 1.90, 95% CI 1.28 to 2.83), recommendation from others (odds ratio 1.55, 95% CI 1.03 to 2.35) and perceived benefits of brain DS (odds ratio 2.82, 95% CI 1.60 to 4.96) were significantly associated with increased likelihood of future brain DS use.

CONCLUSIONS

Individual spending on brain DS varies and about 40% of users reported experiencing negative side effects. As individuals primarily rely on healthcare providers for recommendations, health care providers should be prepared to engage in discussions about brain DS with patients.

Longitudinal changes in adverse effects reporting in multiple dietary supplement classifications: The US military dietary supplement use study

Over 70% of United States military service members (SMs) regularly use dietary supplements (DSs) and about 18% have reported adverse effects (AEs) associated with use. This investigation examined longitudinal changes in AEs reporting among DS users. On two separate occasions 1.3 ± 0.2 years apart (mean ± standard deviation), 5778 SMs completed identical questionnaires on DS use and associated AEs. Among SMs reporting DS use ≥1 time/week, ≥1 AE was reported by 19% and 15% in the baseline and follow-up phases, respectively. The risk of reporting DS use at follow-up was similar among those reporting and not reporting AEs at baseline for most DS categories including prohormones, proteins/amino acids, individual vitamins and minerals, multivitamin/multiminerals, herbals, fish oils, joint health products, and other DSs. An exception was combination products where those reporting AEs at baseline had an increased risk of use at follow-up (risk ratio = 1.13, 95% confidence interval = 1.06-1.09). Those reporting AEs at baseline and continuing DS use in the follow-up were more likely to report AEs at follow-up compared to those not reporting baseline AEs. In conclusion, AEs reported at baseline did not deter many participants from using DSs in the follow-up period, and many SMs reporting AEs at baseline continued reporting them at follow-up.

Prevalence and adverse effects of sport-related nutritional supplements (sport drinks, bars, and gels) in the military before and during the COVID-19 pandemic: the US Military Dietary Supplement Use Study

BACKGROUND

Sport-related nutritional supplements (SRNS) include sport drinks, sport bars, and sport gels. This investigation examined temporal patterns in SRNS use and adverse effects (AEs) reported by a single cohort of United States active-duty service members (SMs) surveyed before and during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A stratified random sample (n = 22,858) of SMs (Air Force, Army, Navy, and Marine Corps) who completed a questionnaire on their SRNS use and AE experiences and were still on active duty were asked to complete the identical questionnaire on a second occasion. Twenty-five percent of successfully contacted SMs completed both questionnaires (n = 5,778) and were included in this investigation. The average ± standard deviation time between questionnaires was 1.3 ± 0.2 years.

RESULTS

Prevalence of reported SRNS use ≥1 time/week in the baseline (BL) and follow-up (FU) phases were as follows: any SRNS: BL = 46%, FU = 41%; sport drinks: BL = 31%, FU = 28%; sport bars: BL = 30%, FU = 24%; sport gels: BL = 4%, FU = 4%. Reported weekly aerobic and resistance training durations were reduced in the FU period (8% and 26%, respectively). The proportion of SMs reporting SRNS use in both study phases was as follows: any SRNS = 62%, sport drinks = 54%, sport bars = 50%, sport gels = 35%. Prevalence of reported AEs in the BL and FU phases were as follows: any SRNS: BL = 1.9%, FU = 1.9%; sport drinks: BL = 1.0%, FU = 1.3%; sport bars: BL = 1.7%, FU = 1.4%; sport gels: BL = 3.3%, FU = 2.5%. The proportion of SMs reporting AEs in both phases was as follows: any SRNS = 14%, sport drinks = 11%, sport bars = 17%, sport gels = 0%.

CONCLUSIONS

Overall SRNS use prevalence decreased slightly in the FU period, possibly because of reduced physical training related to military restrictions imposed during the emergence of COVID-19 between surveys. A large proportion of SMs reported changing their use patterns in the FU with some discontinuing use and others initiating use. The AE incidence was similarly low in the BL and FU phases, and few SMs reported AEs in both phases suggesting AEs were transitory. AE reporting for SRNSs was much lower than previously found for dietary supplements, possibly because of greater government regulatory control over SRNSs.

Relative safety and quality of various dietary supplement products U.S. Service Members ask about

CONTEXT

The purpose of this project was to determine types of dietary supplement products U.S. Service Members frequently ask about and identify risks associated with select products that consumers should be aware of when considering their use.

METHODS

Forty-one dietary supplement products frequently asked about through the Operation Supplement Safety's (OPSS.org) Ask-the-Expert portal were selected. Product analysis was performed to verify whether select products were accurately labeled and to identify any risky ingredients contained in these products. Operation Supplement Safety Risk Assessment Scorecard criteria were additionally used as a screening tool to assess a product's relative safety potential.

RESULTS

Among the select dietary supplements, 12 (29.3%) were marketed as pre-workout products; 14 (34.1%) for weight loss; four (9.8%) for male enhancement/testosterone boosters; and 11 (26.8%) as body building supplements. Eleven (26.8%) products had accurate labels; only eight of these had accurate labels plus no risky ingredients listed on the labels. Twenty-six (63.4%) products were misbranded; 10 (24.4%) were adulterated, and six (14.6%) were both misbranded and adulterated. Risky ingredients appeared on 23 (56%) of all product labels. Eight of these 23 products also had additional risky ingredients not listed on the labels but detected through analysis. According to the Scorecard based on label claims, 35 (85.4%) received a rating of "no-go/risky".

CONCLUSIONS

U.S. Service Members and the public at large should be aware that dietary supplements may contain risky ingredients and know how to identify ingredients on the label to evaluate potential risk.

Prevalence of and Factors Associated with Dietary Supplement Use in a Stratified, Random Sample of US Military Personnel: The US Military Dietary Supplement Use Study

BACKGROUND

About 50% of Americans and 70% of US military service members use dietary supplements (DSs).

OBJECTIVES

This cross-sectional survey examined current prevalence of and factors associated with DS use in service members.

METHODS

A stratified random sample of 200,000 service members from the Air Force, Army, Marine Corps, and Navy was obtained from military manpower records, and these service members were asked to complete a questionnaire on their DS use and personal characteristics. Chi-square statistics and multivariable logistic regression examined differences across various strata of demographic, lifestyle, and military characteristics.

RESULTS

About 18% of successfully contacted service members (n = 26,681) completed the questionnaire between December 2018 and August 2019 (mean ± SD age: 33 ± 8 y, 86% male). Overall, 74% reported using ≥1 DS/wk. Multivitamins/multiminerals were the most commonly used DSs (45%), followed by combination products (44%), proteins/amino acids (42%), individual vitamins/minerals (31%), herbals (20%), joint health products (9%), and purported prohormones (5%). In multivariable analysis, factors independently associated with DS use included female gender [OR (female/male): 1.91; 95% CI: 1.73, 2.11], older age [OR (≥40/18-24 y): 1.25; 95% CI: 1.08, 1.44], higher education level [OR (college degree/high school or less): 1.35; 95% CI: 1.19, 1.53], higher BMI [OR (≥30/<25 kg/m2): 1.37; 95% CI: 1.25, 1.52], more weekly resistance training [OR (>300/≤45 min/wk): 5.05; 95% CI: 4.55, 5.61], smokeless tobacco use [OR (user/nonuser): 1.30; 95% CI: 1.17, 1.44], higher alcohol intake [OR (≥72/0 mL/wk): 1.41; 95% CI: 1.29, 1.54], and higher military rank [OR (senior officer/junior enlisted): 1.26; 95% CI: 1.06, 1.51].

CONCLUSIONS

Compared with civilian data from the NHANES, service members were much more likely to use DSs and used different types of DSs, especially combination products and proteins/amino acids often used to purportedly enhance physical performance. Comparisons with previous military data suggest DS use has increased over time.

Prevalence, factors associated with use, and adverse effects of sport-related nutritional supplements (sport drinks, sport bars, sport gels): the US military dietary supplement use study

Background

Sport-related nutritional supplements (SRNSs) include sport drinks, sport bars, and sport gels. Previous studies indicate that 25–35 % of athletes and 25–50 % of military personnel report using these supplements. This study examined prevalence, factors associated with use, and adverse effects (AEs) of SRNSs among United States military service members (SMs).

Methods

A stratified random sample of 200,000 SMs was obtained from military workforce records, and asked to complete a survey on demographics, SRNS use, and AEs experienced. About 18 % (n = 26,681) of contacted SMs (n = 146,365) completed the survey between December 2018 and August 2019.

Results

Overall, 45 % of SMs used ≥ 1 SRNS at least once per week in the past 6 months. Prevalence of use (± standard error) for sport drinks, bars, and gels were 32 ± 0.3, 27 ± 0.3, and 3 ± 0.1 %, respectively. Use of 1, 2, or 3 SRNSs was 28.9 ± 0.5, 13.6 ± 0.6, and 2.2 ± 0.6 %, respectively. Multivariable logistic regression indicated greater use of any SRNS was independently associated with male gender, younger age, single marital status, more weekly aerobic or resistance training, tobacco use, higher alcohol intake, officer status, combat arms occupations, and service in the Marine Corps or Navy (compared to the Air Force). Overall, the proportion of users reporting ≥ 1 AE was 2.0 ± 0.1 %, with 1.3 ± 0.1 % for sport drinks, 1.6 ± 0.2 % for sport bars, and 2.8 ± 0.6 % for sport gels.

Conclusions

This large study of a stratified random sample of SMs found that nearly half of SMs consumed SRNSs weekly, and self-reported AEs were comparatively low. The AE incidence for SRNSs was much lower than typically found for dietary supplements, possibly because of more rigorous regulatory oversight for SRNSs.

Prevalence of and Factors Associated with Dietary Supplement Use in a Stratified, Random Sample of US Military Personnel: The US Military Dietary Supplement Use Study

BACKGROUND

About 50% of Americans and 70% of US military service members use dietary supplements (DSs).

OBJECTIVES

This cross-sectional survey examined current prevalence of and factors associated with DS use in service members.

METHODS

A stratified random sample of 200,000 service members from the Air Force, Army, Marine Corps, and Navy was obtained from military manpower records, and these service members were asked to complete a questionnaire on their DS use and personal characteristics. Chi-square statistics and multivariable logistic regression examined differences across various strata of demographic, lifestyle, and military characteristics.

RESULTS

About 18% of successfully contacted service members (n = 26,681) completed the questionnaire between December 2018 and August 2019 (mean ± SD age: 33 ± 8 y, 86% male). Overall, 74% reported using ≥1 DS/wk. Multivitamins/multiminerals were the most commonly used DSs (45%), followed by combination products (44%), proteins/amino acids (42%), individual vitamins/minerals (31%), herbals (20%), joint health products (9%), and purported prohormones (5%). In multivariable analysis, factors independently associated with DS use included female gender [OR (female/male): 1.91; 95% CI: 1.73, 2.11], older age [OR (≥40/18-24 y): 1.25; 95% CI: 1.08, 1.44], higher education level [OR (college degree/high school or less): 1.35; 95% CI: 1.19, 1.53], higher BMI [OR (≥30/<25 kg/m2): 1.37; 95% CI: 1.25, 1.52], more weekly resistance training [OR (>300/≤45 min/wk): 5.05; 95% CI: 4.55, 5.61], smokeless tobacco use [OR (user/nonuser): 1.30; 95% CI: 1.17, 1.44], higher alcohol intake [OR (≥72/0 mL/wk): 1.41; 95% CI: 1.29, 1.54], and higher military rank [OR (senior officer/junior enlisted): 1.26; 95% CI: 1.06, 1.51].

CONCLUSIONS

Compared with civilian data from the NHANES, service members were much more likely to use DSs and used different types of DSs, especially combination products and proteins/amino acids often used to purportedly enhance physical performance. Comparisons with previous military data suggest DS use has increased over time.

Healthy lifestyles among military active duty service members, and associations with body-building and weight-loss supplement use

PURPOSE

The purpose of this study was to characterize health behavior profiles among active duty service members and associate these profiles with body-building and weight-loss dietary supplement (DS) use.

METHODS

Based on U.S. active duty service members who completed the 2011 Health-Related Behavior Survey (n = 39,877), we used latent class analysis to place respondents into latent classes (using healthy/unhealthy food consumption, aerobic activity, strength training, and sleep) and examined associations between latent class and DS use.

RESULTS

We identified seven health behavior classes that could be classified by physical activity and diet. Three classes with high activity were further characterized by healthy diet (24%); few unhealthy foods (18%); and unrestricted diet (9%). Three classes with low activity were further characterized by restricted diet (15%), healthy diet (15%), and unhealthy diet (6%). The last class (13%) reported moderate levels of all behaviors. The classes did not vary by sleep. Participant characteristics across most classes were relatively homogenous along demographics and military branch. The active classes had relatively higher usage of body-building and weight-loss DSs.

CONCLUSIONS

Latent classes from health behavior indicators might be considered "market segments", which can be targeted with distinct messaging. Service members appear to consume DSs as part of an otherwise healthy lifestyle.

Personality Traits and Occupational Demands Are Linked to Dietary Supplement Use in Soldiers: A Cross-sectional Study of Sensation Seeking Behaviors

INTRODUCTION

Military personnel use dietary supplements (DS) more frequently and in a higher quantity than the general population. Patterns of DS used and the motivation for use among the military population are different than those of the civilian population. Soldiers are much more likely to use potentially dangerous DS purported to enhance physical performance and/or promote weight loss in spite of limited evidence regarding the safety and efficacy of these products. Sensation seeking (SS) behaviors can be associated with risky lifestyle behaviors and may be associated with use of DS by Soldiers. This study assessed Soldiers' SS behaviors in relation to DS use and various demographic factors.

MATERIALS AND METHODS

Demographic and behavioral questionnaires were administered to 289 Soldiers (mean ± SD, 28 ± 6 years, 27 ± 3 kg/m2 BMI, 83% male) at three U.S. military installations. The Brief SS Scale (four 10-point subscales) and Arnett Inventory of SS (two 40-point subscales) were used to assess SS behaviors. Independent sample t-tests determined the significant differences between SS subscale scores of DS users and non-users for each type of DS (i.e., protein, multivitamin, etc.). One-way analysis of variances and Tukey's post hoc comparisons assessed differences in SS scores across demographic categories. Tukey's post hoc analyses assessed SS scores between users and non-users within the DS categories.

RESULTS

Overall, 75% of Soldiers used DS ≥1 time/week. The most frequently used DS were protein/amino acids (52%), multivitamins/multiminerals (47%), "other" supplements (43%), and combination products (35%). Overall, DS users scored higher in experience seeking (8.0 ± 1.7 vs 7.5 ± 2.0; p < 0.05) and novelty (28.4 ± 3.7 vs 26.8 ± 4.7; p < 0.05) than non-users. Protein/amino acid users scored higher than non-users for all six SS traits: experience seeking (p < 0.001), boredom susceptibility (p < 0.001), thrill seeking (p < 0.001), disinhibition (p < 0.01), novelty (p < 0.001), and intensity (p < 0.001). Users of bodybuilding DS scored higher than non-users in four of the six SS traits: boredom susceptibility (p < 0.05), thrill seeking (p < 0.001), disinhibition (p < 0.01), and intensity (p < 0.001).

CONCLUSIONS

Soldiers who use DS that are frequently associated with health risks scored higher for sensation-seeking characteristics which are predictors of risky behaviors. Protein/AA and combination product DS users scored higher in sensation-seeking traits and this may be due to underestimation of risk, anticipation of positive outcomes, and/or high levels of confidence in these types of DS by high sensation seekers. Additional investigation into the association of sensation-seeking behaviors as predictors of harmful DS use is warranted.

A Systematic Review of the Effect of Dietary Supplements on Cognitive Performance in Healthy Young Adults and Military Personnel

Intake of dietary supplements has increased, despite evidence that some of these have adverse side effects and uncertainty about their effectiveness. This systematic review examined the evidence for the cognitive benefits of a wide range of dietary supplements in healthy young adult samples; the aim was to identify if any might be useful for optimising cognitive performance during deployment in military personnel. Searches were conducted in 9 databases and 13 grey literature repositories for relevant studies published between January 2000 and June 2017. Eligible studies recruited healthy young adults (18-35 years), administered a legal dietary supplement, included a comparison control group, and assessed cognitive outcome(s). Thirty-seven of 394 identified studies met inclusion criteria and were included for synthesis. Most research was deemed of low quality (72.97%; SIGN50 guidelines), highlighting the need for sound empirical research in this area. Nonetheless, we suggest that tyrosine or caffeine could be used in healthy young adults in a military context to enhance cognitive performance when personnel are sleep-deprived. Caffeine also has the potential benefit of improving vigilance and attention during sustained operations offering little opportunity for sleep. Inconsistent findings and methodological limitations preclude firm recommendations about the use of other specific dietary supplements.

Current regulatory guidelines and resources to support research of dietary supplements in the United States

The U.S. Dietary Supplement Health and Education Act (DSHEA) established the regulatory framework for dietary supplements as foods through the Food and Drug Administration (FDA). DSHEA outlined the legal definition, labeling requirements, and process for adverse event reporting for dietary supplements. FDA also issued formal guidance on current Good Manufacturing Practice to ensure that processes for preparation, packaging, labeling, and storage of supplements and ingredients are documented and meet specifications to ensure purity, composition, and strength. However, efficacy of dietary supplements is not required under U.S. law. Despite regulations to improve the marketplace, many challenges remain; as a result, the quality and safety of products available can be highly variable, especially for botanical and herbal products. The ability of regulators to successfully carry out their mission is hampered by the sheer number of products and manufacturing facilities and a lack of analytical methods for all ingredients and products in the marketplace, this is especially difficult for herbal and botanical dietary supplements. Safety issues continue to exist such as adulteration and contamination, especially with specific product types (i.e. body building, sexual enhancement). Thus, a need remains for continued efforts and improved techniques to assess the quality of dietary supplements, especially with regard to purity, bioavailability, and safety. This review will highlight the existing American regulatory framework for dietary supplements and will describe the remaining regulatory barriers to ensuring that safe and high-quality dietary supplements are offered in the marketplace.

Identification of the anabolic steroid 6β-chlorotestosterone in a dietary supplement

Capsules that were labeled to be performance-enhancing dietary supplements obtained during an investigation were found to contain an unrecognized steroid-like substance. This compound was isolated by liquid chromatography (LC) fraction collection and characterized using several qualitative analytical techniques, including ultraviolet (UV) spectroscopy, gas chromatography-mass spectrometry (GC-MS), liquid chromatography-high resolution accurate mass-mass spectrometry (LC-HRAM-MS), as well as ¹ H, ¹³ C, and two-dimensional nuclear magnetic resonance (NMR) spectrometry. This multi-technique analytical approach was used to identify the designer steroid as 6β-chloro-4-androsten-17β-ol-3-one (6β-chlorotestosterone), an analog of testosterone about which little has been published.

A Survey Instrument to Assess Intake of Dietary Supplements, Related Products, and Caffeine in High-Use Populations

Substantial data on the use of dietary supplements by the general adult population are available, but many population subgroups have not been extensively studied. Because military service members and young people consume large amounts of dietary supplements, including for enhancement of physical performance, weight control, and bodybuilding, which can be dangerous, we developed a comprehensive questionnaire to characterize patterns of supplement use in these and other populations. The questionnaire has been used to study >7000 military service members and 1000 college students. This supplement article presents a detailed description of the questionnaire, which contains comprehensive questions on demographic characteristics, exercise habits, attitudes with regard to dietary supplements, and amount of money spent on supplements. Intakes of specific dietary supplements and caffeine, frequency of use, and reasons for use are assessed. The questionnaire was designed for studying dietary supplement and caffeine intake patterns with the use of paper-and-pencil administration to military populations and was modified for use with college students and for computer and Web administration. It is available online at https://go.usa.gov/xn9FP and in the Supplemental File for this publication. It can be used to study other populations if minor modifications are made. The online version of the questionnairewill be updated periodically as newversions become available. In conclusion, a validated, detailed, noncopyrighted questionnaire designed to assess the use of dietary supplements, energy drinks (and related products), and caffeine is available for use in diverse populations. The format of the questionnaire is adaptable to computer administration and scoring, and it can be customized for specific subpopulations, locations, and product categories including updates that reflect changes in the availability of supplements or availability of new products.

Surveillance of the armed forces as a sentinel system for detecting adverse effects of dietary supplements in the general population

Objective

Half the US population takes dietary supplements, but surveillance systems available to regulatory and public health authorities to determine whether specific dietary supplements present a risk are inadequate and numerous severe injuries and deaths have occurred from their consumption. Uniformed military personnel regularly use dietary supplements and are more likely to use potentially dangerous supplements than civilians. Recently, the supplement 1,3-dimethylamylamine (DMAA) was marketed for physical performance-enhancement and weight loss. However, after over 100 reports of illness attributed to DMAA, including six deaths, the Food and Drug Administration issued a warning to cease its sale.

Design

When DMAA was legal (2010–2011), we conducted, using convenience samples, supplement surveys of service members and determined prevalence of use and self-reported symptoms of DMAA use.

Subjects

We surveyed 4374 armed forces personnel using a standardized dietary supplement survey administered by local health-care professionals.

Results

Overall, 11 % of survey respondents used dietary supplements labelled as containing DMAA at least once/week. Regular users were over two times more likely to report tachycardia (P<0·0001), tremors (P<0·0001) and dizziness (P=0·0004), and over three times more likely to report numbness/tingling (P<0·0001) than non-users.

Conclusions

Military services could readily monitor adverse events associated with dietary supplements using electronic surveys and medical records. Since armed forces personnel are much more likely than civilians to use potentially dangerous dietary supplements like DMAA, near real-time surveillance of them using electronic surveys and medical records would provide early warning to regulatory agencies and the medical and public health communities when high-risk dietary supplements are introduced.

Current dietary supplement use of Australian military veterans of Middle East operations

Objective

To assess patterns and levels of dietary supplement use among Australian Defence Forces, previously deployed to the Middle East Area of Operations.

Design

A cross-sectional study. Participants of a large survey self-completed questions about dietary supplement use, health status, personal and job-related characteristics, and lifestyle factors. Frequency of current use of supplements was assessed in three categories (bodybuilding, energy and weight loss).

Setting

Middle East Area of Operations post-deployment health survey.

Subjects

Current and ex-serving Australian Defence Force personnel (n 14 032) who deployed to the Middle East between 2001 and 2009.

Results

Bodybuilding supplements were used by 17·5 % of participants, energy supplements by 24·5 % and weight-loss supplements by 7·6 %. Overall, 32·3 % of participants used any of these supplements. Bodybuilding and energy supplements were more often used by men, younger persons and those in the Army, while weight-loss supplements were more commonly used by women and Navy personnel. Supplements in all three categories were more commonly used by persons in lower ranks, active service and combat roles. Users of bodybuilding supplements had healthier lifestyles and better health status, while users of energy and weight-loss supplements had less healthy lifestyles and poorer mental and physical health status. Overall, 11·7 % of participants used supplements containing caffeine and 3·6 % used a creatine-containing product.

Conclusions

Use of dietary supplements among Australian Defence Force personnel is common, and patterned by lifestyle factors and health status.

Longitudinal trends in use of dietary supplements by U.S. Army personnel differ from those of civilians

Prevalence and patterns of dietary supplement (DS) use by U.S. Army soldiers differ from the civilian population. Longitudinal trends in use of DSs by civilians have been examined, but are unavailable in subpopulations such as military service members. The present study examined longitudinal changes in DS use by soldiers. A standardized questionnaire on DS use was administered in 2006–2007 (N = 989) and 2010–2011 (N = 1196) to convenience samples of active duty soldiers. Data were weighted for total population demographics of age, sex, and rank. Regular use of DSs by soldiers increased significantly (56% ± 1.6% vs. 64% ± 1.7%; p ≤ 0.001) over the 4 years primarily because of an increase of DS use among the youngest 18- to 24-year-old soldiers (43.0% ± 2.5% vs 62.3% ± 2.4%; p ≤ 0.01). Protein (22% ± 1.4% vs. 26% ± 1.5%; p ≤ 0.001) and combination (10.0% ± 1.0% vs. 24% ± 1.4%; p ≤ 0.001) product consumption also increased over the 4 years. Individual vitamin and mineral use — including iron, magnesium, selenium, and vitamins A, B6, B12, and D — significantly increased as well (p ≤ 0.05). In addition, expenditures on DSs by soldiers increased over time (p < 0.01). Reasons reported by soldiers for DS use suggest use increased to meet the occupational demands of military service. Educational interventions to minimize inappropriate use of DSs by soldiers are necessary to reduce adverse events resulting from unnecessary use of DSs and the financial burden associated with their use.

Self-reported side-effects associated with use of dietary supplements in an armed forces population

Approximately 60–70% of Armed Forces personnel consume a dietary supplement (DS) at least once a week and there have been numerous reports of severe adverse events among DS users. This study assessed patterns of DS use and self‐reported side‐effects among 4400 Armed Forces personnel using a paper‐and‐pencil survey. Multivariable logistic regression was used to examine associations between patterns of DS use and self‐reported side‐effects. Sixty‐nine percent of personnel surveyed reported using a DS. Seven percent of DS users reported experiencing abnormal heart beats, 6% tremors, 5% stomach pain, 3% dizziness, and 3% numbness/tingling and they believed these symptoms were associated with the use of DS. After adjustment for use of other DS classes, total supplement use, and demographic characteristics, protein supplement users were more likely than non‐users to report numbness/tingling; combination product users were more likely to report experiencing abnormal heart beats, stomach pain, dizziness, tremors, and numbness/tingling; and users of purported steroid analogues were more likely to report dizziness. Use of more than one DS per week was associated with an increased likelihood of reporting side‐effects. Respondents with a higher body mass index were more likely to report side‐effects. Further research is necessary to determine whether self‐reported side‐effects associated with multiple DS use and some DS classes impact the long‐term health or performance of service members. Surveillance of military populations using surveys like this one may provide a method for detecting adverse health events of DS before they are apparent in the civilian population. © 2015 The Authors. Drug Testing and Analysis published by John Wiley & Sons, Ltd.