KNOWLEDGE AND PATTERNS OF DIETARY SUPPLEMENT USE AMONGS STUDENTS IN TERTIARY INSTITUTIONS IN NSUKKA LGA ENUGU STATE

ABSTRACT

The dietary supplements market is growing at an alarming rate despite dietary source being acknowledged as the primary and priority source of nutrients. Nigeria’s dietary supplements market has experienced a steady growth since 2009 owing to increasingly busy lifestyles, growing health consciousness and disposable income among the general population. Little has been documented about use of dietary supplements in Nigeria despite their increase in popularity. The purpose of this study was to determine the prevalence of dietary supplements use and dietary practices among students in tertiary institutions in Nsukka LGA, Enugu State. Students were chosen to represent the general population because it’s a homogeneous group, with average Nigerian income, evenly distributed across the country and hence opinion shapers in the community. The study adopted cross-sectional analytical study design with qualitative and quantitative methods in data collection, analysis and presentation. Researcher administered questionnaire and key informant interview guides were used to elicit information from the participants. Simple random sampling was used to select a sample of 178 students from tertiary institutions located in Nsukka LGA, Enugu State while purposive sampling was used to select a sample of the key informants. Data was analyzed using SPSS version 22. Data from the 24 hour dietary recall was analyzed using Nutri-survey to obtain specific nutrients consumed. A P-value of <0.05 was considered statistically significant. The mean age of the students was 38.53 ± 9.75 years with most being between the ages of 41-50 years. Majority of the participants were females (60.7%), married (65.7%) had an undergraduate university degree (67.4%), and earned an average household income of >N 50,000 (53.9%). Out of the possible 14 food groups, the mean DDS was 7.42 ± 1.40. The mean intakes for vitamin A, B6, iron and zinc (2300±4432, 1.43 ± 0.69; 28.39 ± 24.7; 14.40 ± 5.30 respectively) were found adequate as opposed to those of vitamin C, D and E as well as calcium (55.30 ± 27.09; 6.906 ± 4.59; 10.12 ± 5.697 and 703.04 ± 420.87 respectively) that fell below the RNIs. Consumption patterns showed high intake of starchy staples with rice and ugali having the highest intakes. There was moderate intake of proteins with high consumption of animal source foods while consumption of fruits and vegetables was low and moderate respectively. The prevalence of dietary supplements use was 28.7% with the most commonly consumed supplements being omega 3 and 6 (60.8%), calcium (56.9%) and multivitamins (19.6%). The main reasons for supplements use were medical reasons (59.6%), prevent deficiencies (29.8%) and to promote good health (25.5%). Key informants were used to give an insight on DS use. The main sources of information on dietary supplements use were health workers (68.6%) and internet (62.7%). Dietary supplements use was significantly associated with age (P<0.001), gender (P<0.000), marital status (P<0.006) and household income (P<0.049), with those above 40 years of age being 3.25 times more likely to use DS (AOR:3.2;C.I;1811-8.956; P value=0.023). Chi square test further showed that DDS was significantly associated with DS use (P<0.045). Furthermore, there was significant relationship (p<0.05) between nutrient intake (vitamin A, C, iron and calcium) and dietary supplements use. Due to the increased number of people (28.7% prevalence) using dietary supplements among the general population, there is need for a solid foundation of regulatory framework to forestall consumer exploitation and promote their safety as well as prevent abuse of the products by consumers.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

The Global market for dietary supplements appear to be growing at an alarming rate (Valavanidis, 2016). Over the last decade, sales of dietary supplements have soared due to swelling demand and many new companies have now invested in the dietary supplements (DS) industry. More people appear to be appreciating the value of good health (Euro monitor International, 2017). It is reported that upsurge in lifestyle diseases, healthcare costs and the ever growing aging population are some of the factors driving the growth in the DS industry in different places across the world (Aryeetey & Tamakloe, 2015; Fransen et al., 2016; Ministry of Health, 2017).

Universally, the sales of dietary supplements are estimated to be $50 billion, with an annual forecast growth of up to 4% by the year 2018 with Singapore, Hong Kong and Norway leading in their usage and spending in household consumption and use (Euro monitor International, 2014). In the United States, The Council Responsible for Nutrition reports that 68% of US adults are taking supplements with multivitamins being the most commonly used (taken by 52% of DS users) followed by vitamin D (20%), omega 3 fish oil (19%), calcium (18%) and vitamin C (17%) (CRN, 2013). In South Africa, the dietary supplements market is estimated to be worth R7 billion, with main categories being fish oils, vitamins, minerals, herbs, fiber and probiotics (Euro monitor, 2014). Those who buy into the country’s health and fitness trends and those with large disposable income are the major consumers of healthcare products and dietary supplements (Gabriels et al., 2011).

In Nigeria, according to Euro monitor Nigeria, (2014), the consumption of various brands of dietary supplements in the country has increased since 2009 as individuals become more mindful of their health, coupled with rising disposable incomes. Besides, people seem to increasingly adopt busier lifestyles that militate against good dietary practices (Kearney, 2010; Berkum, Linderhoff, & Achterbosch, 2017).

For promotion of good health, it is important to ensure adequate intake of essential nutrients by having a variety of foods and increasing the number of food groups consumed (Ministry of Health, 2017). Dietary intake is correlated with a series of positive health outcomes of public health concerns. A diet that meets

recommendations for both food groups (Melina et al., 2016) and nutrients (Institute of Medicine Food and Nutrition Board, 2000), and which is associated with disease prevention and promotion of optimal health, is considered a high-quality diet (Kranz, 2006). Further, nutrient dense diets have been linked to lower risk of obesity in children (Kranz, 2008; Tulchinsky, 2010) and other chronic diseases (Daaboul & Siverstein, 2004).

Access to good quality diet that is adequate in terms of nutrients is essential for human health, productivity and employment output (WHO, 2015). A non-diversified, low quality diet can impact negatively on an individual’s health and wellbeing since it may not meet his/her micronutrient requirements (FANTA, 2011; Habte & Krawinkel, 2016; Nithya & Bhavani, 2018). Dietary supplements can help bridge the gap between dietary intakes and the recommended nutrient intakes (RNIs) for various micronutrients in situations where the latter may not be easily attainable through normal diet (Shao et al., 2017). The use of dietary supplements, however, should not make up for poor food choices and inadequate diets (Burke et al., 2012). A wellchosen diet will promote an adequate intake of all nutrients.

1.2 Problem Statement

Increasing awareness about the functions of micronutrients in promotion of good health has resulted in a huge growth in the production, marketing and consumption of dietary supplements globally (Miller & Welch, 2013; Dickson & Mackay, 2014). In Nigeria, the last few years have witnessed a tremendous growth in the dietary supplements’ market (Euro monitor, 2013). Large multinational companies have engaged or contracted various local marketing and distribution agents who in turn have set up ‘health shops’ at strategic locations in major urban centers as well as using multilevel marketing to augment sales.

An uptake of 43.5% among Nigerian gym users (Wachira, 2011) and 15.5% among Nigeria league rugby players (Kimiywe and Simiyu, 2008), has been reported but it is uncertain whether the use of dietary supplements has increased due to selfmedication, aggressive marketing by producers, expensive health care or simply owing to inadequate diets. With the market unregulated and too many brands of the same product and unknown ingredients, there is a likelihood of business malpractice as well as consumer abuse of products through overuse (Euro monitor, 2013).

Although many studies have described the prevalence, trends and the dynamics in the use of dietary supplements in various populations (Archer and Boyle, 2008; Pouchieu et al., 2013; Kantor et al., 2016; Alfawaz et al,. 2017), they are mostly restricted to profiled groups or to medically challenged subjects who often use dietary supplements alongside drug prescriptions. There is limited information on the factors and outcomes surrounding their use in the general population. In Nigeria, there exist minimal empirical evidence regarding dietary supplements usage among the general adult population and its linkage to dietary practices. This study, therefore intends to fill in a gap in the literature on prevalence of supplements use on a general population.

1.3 Purpose of the Study

The purpose of this study was to determine the prevalence of dietary supplements use and dietary practices among students in public secondary school in Nsukka LGA, Enugu State.

1.4 Objectives of the Study

The objectives of this study were to:

1. Establish the demographic and socio economic characteristics of the students in tertiary institutions in Nsukka LGA, Enugu State.

2. Determine dietary practices among students in tertiary institutions in Nsukka LGA, Enugu State.

3. Determine the prevalence of dietary supplements use among students in public secondary school in Nsukka LGA, Enugu State.

4. Establish the relationship between demographic and socio-economic characteristics and use of dietary supplements among students in tertiary institutions in Nsukka LGA, Enugu State.

5. Establish the relationship between dietary practices and use of dietary supplements among students in tertiary institutions in Nsukka LGA, Enugu State.

1.5 Hypotheses of the Study

H₀₁ There is no relationship between demographic and socio-economic characteristics of the students and use of dietary supplements among students in Nsukka LGA, Enugu State. H₀₂ There is no relationship between dietary diversity and use of dietary supplements among students in Nsukka LGA, Enugu State.

H₀₃ There is no relationship between nutrient intake and use of dietary supplements among students in Nsukka LGA, Enugu State.

1.6 Significance of the Study

The findings of this study may be used by the Ministry of Health to inform policy initiatives regarding use of dietary supplements as an emerging trend in the dietary lifestyle of Nigerians. The findings will also provide evidence that can inform nutrition counseling interventions among specific sub-populations including students. The study may also avail information to the individual students and the general population so as to make informed choices on dietary practices and dietary supplements usage.

1.7 Limitation of the Study

The study focused only on commercial dietary supplements which included vitamins, minerals and essential oils and not traditional supplements that are not on the commercial market that are used for management and treatment of health conditions.

1.8 Delimitation of the Study

The study included only students in Nsukka LGA, Enugu State and hence the results can only be generalized to schools with same attributes.

1.9 Conceptual Framework

The conceptual framework used in this study was modified from Frank et al, (2002) Foote et al., (2003), Randimer et al., (2004) on factors associated with prevalence of dietary supplements use (Figure 1.1).

Figure 1.1 : Conceptual framework on factors associated with dietary supplements use

Demographic and Socio-economic characteristics of an individual as well as the types and sources of dietary information that one receives may influences ones dietary practices with regard to intakes, diversity and consumption patterns, which eventually has a bearing on the diet adequacy of the individual. Holding other factors constant, the adequacy or gaps (perceived or real) in the diet will determine the individual’s decision regarding the use of dietary supplements. Socio-economic factors as well as demographic characteristics of an individual may also directly influence ones use of dietary supplements. For instance, the cost implications may be a barrier to use of dietary supplements despite an individual’s own awareness of the shortfall in his diet. The nature and sources of information have a varied influence on different groups: Beauty (complexion) hype about certain supplements may sell well with females and younger audience and motivate their use of the supplements. As well, perceived credibility of an information source may catalyse a potential DS user’s decision to initiate use of dietary supplements.