|Year : 2021 | Volume
| Issue : 1 | Page : 32
Prevalence of supplement consumption in Iranian athletes: A systematic review and meta-analysis
Farzin Halabchi1, Sakineh Shab-Bidar2, Maryam Selk-Ghaffari3
1 Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
3 Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
|Date of Submission||14-Apr-2020|
|Date of Acceptance||04-Aug-2020|
|Date of Web Publication||29-Mar-2021|
Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
Background: Due to widespread use of supplement among athletes, determining the prevalence and pattern of dietary supplement consumption and its moderators will be a road map for developing a strategic planning in the national level to achieve healthy lifestyle and avoid harmful nutritional approaches. Methods: A systematic search of the electronic resources including Medline, PubMed, Scopus, Google Scholar and National Persian Databases including Magiran, SID, IranDoc and CIVILICA (between 1979 and November 2019 in Persian and English language) was accomplished. Inclusion criteria were (a) studies containing the prevalence rate of dietary supplement consumption, specifically (b) studies were conducted in athletes. Finally, 32 articles were included. Results: The prevalence rate of supplement use in overall Iranian athletic population was 64.8% (95% CI, 55.8%-73.8%) with significant heterogeneity (I2 = 99.7%, P < 0.001). The prevalence rate was reported to be higher in male athletes, athletes aged 25 and older and elite athletes (P < 0.05). The most prevalent source of information about supplement use among athletes were trainers, followed by physicians, friends-teammates and dietitians. Conclusions: According to the high prevalence of supplement consumption among Iranian athletes, policy making for educational programs is mandated. Trainers are the most popular source to provide information about supplements and educational programs should be conducted for this target population.
Keywords: Athletes, dietary supplements, prevalence, public health
|How to cite this article:|
Halabchi F, Shab-Bidar S, Selk-Ghaffari M. Prevalence of supplement consumption in Iranian athletes: A systematic review and meta-analysis. Int J Prev Med 2021;12:32
|How to cite this URL:|
Halabchi F, Shab-Bidar S, Selk-Ghaffari M. Prevalence of supplement consumption in Iranian athletes: A systematic review and meta-analysis. Int J Prev Med [serial online] 2021 [cited 2021 Nov 30];12:32. Available from: https://www.ijpvmjournal.net/text.asp?2021/12/1/32/312521
| Introduction|| |
Nutrition is proposed as a crucial health-related determinant, conventionally. Optimal nutrition is a critical requirement in athletic performance and is considered as a basic principle in enhancing physical fitness and performance. Regular structured training is mandated at the elite level, while promotions in supplementation and nutrition strategies has an effective role in success achievement, recovery and maintenance of optimal level of competitive performance. Dietary Supplement Health and Education Act (DSHEA) of 1994, has defined dietary supplements as a commercially available product intended to supplement the diet. Dietary supplements contain vitamins, herbs (botanicals), enzymes, minerals, metabolites and a variety of other products.
Athletes at different levels of performance and sport disciplines may use various dietary supplements with different purposes. The rational of supplements consumption by athletes has a wide spectrum including boosting physical and mental performance, maintaining wellbeing and improving recovery process.,, The consumption of dietary supplements among athletic populations is a crucial health related issue, which mandates professional medical supervision.
The use of sports supplements has rapidly increased over the last decade and the wide variety of products on the market and limited supervision on the production process makes it difficult to conduct appropriate scientifically-based studies about their safety, quality and effectiveness. With the raising consumption of sports supplements, there is also a need for more extensive education about these products. Unfortunately, many athletes have not proper knowledge and attitude toward sport supplements and the safety and efficacy issues., Also, they infrequently get information from educated sources such as registered dietitians or team physicians. Furthermore, continuous educational programs on this subject are not accessible in many countries, especially in the developing ones. This may result in athletes' susceptibility to misinformation which may lead to health hazards and poor athletic performance. It is demonstrated that the use of dietary supplements is also a risk factor for illicit drug misuse, and may cause so-called inadvertent doping due to the contamination of their ingredients. However, according to the rule of the athlete's strict liability by anti-doping authorities, the athletes are fully responsible for any prohibited substance, which is found in their sample, regardless of intention or its source.
Determining the prevalence and pattern of dietary supplement consumption and its moderators will be a road map for developing a strategic planning in the national level to achieve healthy lifestyle and avoid harmful nutritional approaches. Sporadic cross-sectional studies have explored the prevalence of dietary supplement use among Iranian athletes, meanwhile according to the heterogeneous nature of the studies, documents in this domain has a diverse spectrum in different provinces and athletic levels.
To our knowledge, no quantitative meta-analysis has been accomplished in this domain in Iran. Moderators of the prevalence rate will be identified via conducting a meta-analysis in this domain and this will be an applicable guide for future planning and policy-making to achieve a healthy nutritional strategy. Therefore, the aim of this study was to determine the prevalence rate of dietary supplement use in the Iranian elite and recreational athletes via applying available prevalence studies between 1979 and November 2019. The second purpose of this meta-analysis study was to determine prevalence rates of dietary supplement according to different genders, age ranges, sport disciplines, professional levels and regions.
| Methods|| |
A systematic review and meta-analysis was conducted based on the Preferred Reporting
Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The project was registered in PROSPERO (code: 170637).
Information sources and search
A systematic search of the electronic resources including Medline, PubMed, Scopus, Google Scholar and National Persian Databases including Magiran, SID, IranDoc and CIVILICA (between 1979 and November 2019 in Persian and English language) was accomplished. Simultaneously, citations in the selected studies were evaluated. The following keywords: “Sport supplement” OR “nutritional supplement” were used in combination with “athlete” and Iran for the search. Theses and conference records were recognized by investigating over reference lists of selected studies.
Eligibility criteria and study selection
Inclusion criteria were (a) studies containing the prevalence rate of dietary supplement consumption, specifically. (b) studies were conducted in athletes. Prevalence studies consisting of cross-sectional and longitudinal studies that included data of supplement consumption in Iranian athletes were assessed. Studies in English and Persian language were assessed. The studies were not excluded based on the method they measured prevalence rate of supplement consumption.
Assessment of methodological quality
Quality, methodology and risk of bias of the studies were evaluated via the Joanna Briggs Institute (JBI) critical appraisal checklist for studies reporting prevalence data.
The questions of the tool are illustated in [Table 1]. All studies meeting the inclusion criteria were reviewed by two critical appraisers independently. The results were assessed and if any disagreement existed, 2 reviewers discussed the subject and if no consensus was achieved, a third review assessed the study.
Data extraction was accomplished via two reviewers (F.H. & M.S.), individually. A standardized data extraction form was applied. Characteristics of the study participants including first author's name, year of publication, number of participants, gender (male, female and both), age, type of sport disciplines (body-building, all sports or not registered), professional level (recreational, elite, both or not registered), study location (province or national teams' camp), assessment tool, study design and sampling method, and stated prevalence rate of dietary supplements consumption (lifetime prevalence) and response rate were documented. Disagreements between two reviewers were deliberated and further assessment of the studies were accomplished until settlement in results were attained.
With the aim of estimating the lifetime prevalence rate of dietary supplement consumption in Iranian athletes, a random-effects model was used to calculate the prevalence rates of dietary supplement consumption and 95% CIs. The Q-statistic and the I-squared index was applied to measure the heterogeneity. Variables including gender, age range, professional level, type of sport disciplines and locations where the study was accomplished, were applied to conduct subgroup analyses. The meta-analysis was accomplished using STATA, Version 12.
| Results|| |
A systematic search was accomplished according to the available studies through PubMed, Scopus and Google Scholar. Eighty-nine articles in PubMed, 25 articles in Scopus and 51 studies in Google Scholar were identified. Additional search of national English and Persian sources resulted in 72 studies, including SID (n = 26), Magiran (n = 19), and CIVILICA (n = 41). Thus, a total of 124 articles after removing duplicates were recognized following the search strategy conducted. Two reviewer (F.H. & M.S.) assessed the titles and abstracts of 124 studies in next step, individually. Included articles were screened in primary stage for eligibility (considering language, country and reporting dietary supplement consumption) and 65 articles were excluded (Not related to sport supplements: 44, Not in Iran: 21) and 59 remained for further evaluation. Complete manuscript of eligible studies was assessed by two reviewers (F.H. & M.S.), individually and following this procedure, final decision on eligibility was completed. Finally, 32 articles met inclusion criteria: (a) studies with the precise prevalence rate of supplement consumption, (b) participants were athletes [Figure 1]. Any dissimilarity for selection of studies were evaluated via third reviewer (S. S).
|Figure 1: Flow diagram of systematic literature search on lifetime prevalence of supplement consumption among Iranian athletes|
Click here to view
Risk of bias assessment
The results of quality assessment of the studies via the Joanna Briggs Institute (JBI) critical appraisal checklist for studies reporting prevalence data are illustrated in [Table 2].
|Table 2: Critical appraisal of studies on the supplement consumption prevalence among Iranian athletes|
Click here to view
Overall, 32 articles were recognized that studied prevalence of supplement consumption among 11,017 Iranian athletes. Studies were conducted in Tehran province (7 studies),,,,,,, Alborz province (3 studies),,, East Azerbaijan province (2 studies),, Isfahan province (2 studies),, Hamadan province (2 studies),, National level (2 study),, 2 non- registered study,, Semnan province (1 study), Khorasan Razavi province (1 study), North Khorasan province (1 study), Fars province (1 study), Kordestan province (1 study), Kerman province (1 study), Kermanshah province (1 study), Lorestan province (1 study), Ardabil province (1 study), Olympic level (1 study), National Olympiad level (1 study) and National teams (1 study). The study characteristics are presented in [Table 3]. Assessment method in all studies were via questionnaire.
|Table 3: Characteristics of studies on the supplement consumption prevalence among Iranian athletes|
Click here to view
Prevalence rate of supplement use
[Table 4] presents the prevalence rate of supplement use among the overall Iranian athletic population including female and male athletes. The prevalence rate of supplement use in overall Iranian athletic population was 64.8% (95% CI, 55.8%-73.8%) with significant heterogeneity (I2 = 99.7%, P < 0.001) [Figure 2].
|Table 4: Prevalence rates of supplement consumption and heterogeneity statistics among the overall Iranian athletic population, male athletes, and female athletes|
Click here to view
|Figure 2: Forest plot of prevalence rates of supplement consumption in overall athletic population. The lower diamond in the graph represents the global cumulative estimate. ES: Prevalence|
Click here to view
Subgroup analysis of prevalence rate of supplement
Subgroup analysis by gender showed that heterogeneity in the prevalance rate of supplement consumption in overall athletic population was not related to gender [Table 4]. The prevalence rate of supplement consumption in male athletes (68.8%) was higher than female athletes (47%) (P < 0.001).
Furthermore, sport disciplines, professional level and age was not the potenial source of heterogenisity reported in prevalance rate of supplement intake in the Iranian athletic population. Prevalance rate of supplement consumption in athletes aged 25 and older (68.7%) was higher compared to athletes younger than 25 years old (49.1%) (P < 0.001). Prevalance rate of supplement consumption among soccer players (100%) and body building athletes (71.8%) were higher compared to rowing (61.9%), wrestling (25%) and other athletes (53.8%) (P < 0.001). The prevalance rate of supplement consumption among elite athletes (73.9%) was higher compared to recreational athletes (61.5%) (P < 0.001) [Table 5].
|Table 5: Prevalence rates of supplements consumption and heterogeneity statistics among Iranian athletic population according to age range, type of sport disciplines, professional level|
Click here to view
Source of information about supplement use
The most prevalent source of information about supplement use among Iranian athletes were trainers, followed by physicians, friends-teammates and dietitians. The most prevalent supplements used among Iranian athletes were multivitamins followed by performance enhancing supplements and macronutrients.
| Discussion|| |
The overall prevalence rate of supplement consumption in the Iranian athletic population was reported 64.8%. The prevalence rate was reported to be higher in male athletes, athletes aged 25 and older and elite athletes. Prevalance rate of supplement consumption among soccer players and body building athletes was reported higher compared to other athletes.
Many studies exist which have evaluated the prevalence rate of supplement consumption among general population. However, limited studies have evaluated the prevalence rate among Iranian athletes.
In our study, prevalance rate of supplements consumption among elite athletes was reported 73.9% which was significantly higher compared to recreational athletes (61.5%). Our findings was sismilar to a systematic review by Knapik et al. in which global prevalence rate of supplement consumption among elite athletes was higher compared to recreational athletes and the global prevalence rate of dietary supplement consumption among elite and recreational athletes was reported about 60%. In a study by Baltazar-Martins et al. prevalence rate of dietary supplements consumption among elite Spanish athletes was reported sixty-four percent and in a study by Sousa et al. showed the prevalence rate of supplement consumption in 64% of Portuguese national team athletes, which were consistent by our results. However, in a study by Al-Jaloud et al. in Saudi Arabia prevalence rate of supplement consumption among professional athletes was reported 93.3%, in a study by Silva et al. prevalence rate of dietary supplement intake among national-level athletes was reported 94% in Sri Lanka, and a study by Nabuco et al. prevalence rate of supplement consumption among Brazilian competitive athletes was reported 47.3%, which were inconsistent with our findings. According to the high prevalence of supplement consumption among Iranian athletes, developing documents and programs to manage this domain is mandated.
The most prevalent supplements used among Iranian athletes were multivitamins followed by performance enhancing supplements and macronutrients. The findings of our research were consistent with the findings of a global systematic review by Knapik et al., a study by Silva et al. in Sri Lanka and a study by Sousa et al. among Portuguese national team athletes in which the most prevalent supplements among elite and recreational athletes were multivitamins. Our findings were inconsistent with the findings of a study by Nabuco et al. in which the most prevalent supplement consumed among Brazilian competitive athletes was Whey protein, a study by Baltazar-Martins et al., in which the most prevalent supplement consumed among elite Spanish athletes were macronutrients including proteins and a study by Al-Jaloud et al. in which the most prevalent dietary supplement consumed among professional athletes in Saudi Arabia were sports drinks.
In our study the most popular source of information for athletes were trainers followed by physicians, friends- teammates and dietitians. Our findings were consistent with the findings of a study by Denham, according to the studies conducted in United States and international studies and the findings of a study by Nabuco et al. among Brazilian competitive athletes, in which the most prevalence source of information was reported trainers. Our findings were inconsistent with the results of a study by Al-Jaloud et al. in Saudi Arabia and the results of a study by Silva et al., in Sri Lanka, in which the most popular source of information related to supplements among athletes was from physicians and the results of a study by Baltazar-Martins et al., in which high proportions of the elite Spanish athletes obtained information about the supplements themselves and did not seek professional consults.
Considering the fact that most popular source of information for athletes about dietary supplements are coaches, developing educational guidelines and conducting workshops for coaches is mandated and policy making in this domain should consider the significant role of coaches in acquiring healthy life-style among athletes. Physicians and dietitians also have a prominent role in consultation about dietary supplements. Considering the fact that dietary supplements are related to mental health which is effective in success of athletic performance, Updating and retraining educational programs for physicians and dietitians should be also considered.
There were several limitation according to this study. First some of the studies assessing the prevalence of supplement consumption in Iranian athletes were limited to a single sport discipline. Second, lack of a unified Assessment tool and questionnaire for sports supplement consumption in studies was another existing limitation. Other existing limitations in this study are lack of a unified definition of sports supplements, heterogeneity of the studies (definition of athlete and level of their exercise), disparities in source of reports of supplements consumption (self-report, physician and nutritionist), limitation in keywords in search strategy and the possibility of non-inclusion of a number of Persian articles due to the non-comprehensive Persian databases
| Conclusions|| |
The overall prevalence rate of supplement consumption in the Iranian athletic population was reported 64.8% and the most popular source of information for athletes were trainers. According to the high prevalence of supplement consumption among Iranian athletes, policy making for educational programs is mandated. And educational programs should be conducted for trainers.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Zeinalian M, Eshaghi M, Hadian M, Naji H, Asgary S. Personalized nutrition: An ancient concept in Iranian traditional medicine. Int J Prev Med 2019;10:94.
] [Full text]
Sousa M, Fernandes MJ, Carvalho P, Soares J, Moreira P, Teixeira VH. Nutritional supplements use in high-performance athletes is related with lower nutritional inadequacy from food. J Sport Health Sci 2016;5:368-74.
Thomas DT, Erdman KA, Burke LM. Position of the academy of nutrition and dietetics, dietitians of Canada, and the American college of sports medicine: Nutrition and athletic performance. J Acad Nutr Diet 2016;116:501-28.
Knapik JJ, Steelman RA, Hoedebecke SS, Austin KG, Farina EK, Lieberman HR. Prevalence of dietary supplement use by athletes: Systematic review and meta-analysis. Sports Med 2016;46:103-23.
De Silva A, Samarasinghe Y, Senanayake D, Lanerolle P. Dietary supplement intake in national-level Sri Lankan athletes. Int J Sport Nutr Exerc Metab 2010;20:15-20.
Baltazar-Martins G, de Souza DB, Aguilar-Navarro M, Muñoz-Guerra J, del Mar Plata M, Del Coso J. Prevalence and patterns of dietary supplement use in elite Spanish athletes. J Int Soc Sports Nutr 2019;16:30.
Dascombe B, Karunaratna M, Cartoon J, Fergie B, Goodman C. Nutritional supplementation habits and perceptions of elite athletes within a state-based sporting institute. J Sci Med Sport 2010;13:274-80.
McDowall JA. Supplement use by young athletes. J Sports Sci Med 2007;6:337-42.
Seif-Barghi T, Halabchi F, Dvorak J, Hosseinnejad H. How the Iranian football coaches and players know about doping? Asian J Sports Med 2015;6:e24392.
Halabchi F, Esteghamati A, Razzaghi A, Noori A. How the Iranian free-style wrestlers know and think about doping?–A knowledge and attitude study. World Acad Sci Eng Technol 2011;59:209-14.
Jovanov P, Đorđić V, Obradović B, Barak O, Pezo L, Marić A, et al
. Prevalence, knowledge and attitudes towards using sports supplements among young athletes. J Int Soc Sports Nutr 2019;16:27.
Froiland K, Koszewski W, Hingst J, Kopecky L. Nutritional supplement use among college athletes and their sources of information. Int J Sport Nutr Exerc Metab 2004;14:104-20.
Angoorani H, Halabchi F. The misuse of anabolic-androgenic steroids among Iranian recreational male body-builders and their related psycho-socio-demographic factors. Iran J Public Health 2015;44:1662-9.
Angoorani H, Jalali M, Halabchi F. Anabolic-androgenic steroids and prohibited substances misuse among Iranian recreational female bodybuilders and its associated psycho-socio-demographic factors. Addict Health 2018;10:216-22.
Sundgot-Borgen J, Berglund B, Torstveit MK. Nutritional supplements in Norwegian elite athletes—impact of international ranking and advisors. Scand J Med Sci Sports 2003;13:138-44.
Halabchi F. Doping in athletes. Hakim Res J 2007;10:1-12.
Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and incidence data. Int J Evid Based Healthc 2015;13:147-53.
Alidoust Ghahfarrokhi E, Mokhlesi S, Shariati J. An investigation of consumption and awareness of side effects of doping and weight loss drugs in non-professional athletes in Tehran fitness clubs. Sport Physiol Manag Investig 2017;9:113-26. [Persian].
Aghili M, Gholami M. Prevalence of ergogenic substance misuse and awareness toward the side effects of doping agents in male bodybuilders of Tehran 2011: 6th scientific-students congress on physical education and sport sciences; Sport Sciences Research Institute of Iran. 2011. [Persian]. https://www.civilica.com/Paper-SSTU06-SSTU06_174.html
Fakhari-Rad F, Gholami M. The prevalence of the use of ergogenic aids and awareness of their side effects among Iranian body builders. Int J Sport Stud 2014;4:830-5.
Kordi R, Ziaee V, Rostami M, Wallace WA. Patterns of weight loss and supplement consumption of male wrestlers in Tehran. Sports Med Arthrosc Rehabil Ther Technol 2011;3:4.
Minasian V, Sarlak M. Prevalence, attitude and knowledge of side effects of ergogenic substances in elite athletes of national teams and professional clubs of Tehran province. Sport Manag Stud 2010, 4:119-30. [Persian].
Saeedi P, Mohd Nasir MT, Hazizi AS, Vafa MR, Rahimi Foroushani A. Nutritional supplement use among fitness club participants in Tehran, Iran. Appetite 2013;60:20-6.
Shojaee Mahallati A. Frequency of Nutrition Supplements and energy enhancing drugs in bodybuilding athletes in Tehran. [M.D. Thesis], Islamic Azad University of Tehran; 1999. [Persian].
Hozoori M, Safaei-Motlagh A, Marzban A. The epidemiology of dietary supplements consumption in the athletes of Karaj Iran. Int J Epidemiol Res 2016;3:222-31.
Mahdavi M, Shooshtarizadeh ASF, Sadri B, Bigdeli O, Miraftabi S, Ehsanifar S. Study of prevalence of consumption and consumer awareness of doping substances and supplements side effects among male bodybuilders in Karaj. Res Pharm Sci 2012;7:65-72.
Shoshtarizadeh F, Bahramian F, Safari A, Pourghaderi M, Barati H. Investigation of prevalence of energizer drugs and supplements consumption and effective factors among bodybuilder men in Karaj (2011). Alborz Univ Med J 2013;2:175-82.
Hozoori M, Ehteshami M, Haghravan S, Azarpira A. Prevalance, reasons of consumption and information sources about dietary and sports supplements in different disciplines athletes in Tabriz. Sports Biosciences 2012;12:77-91. [Persian]
Khabiri A. Evaluation of Knowledge and Prevalence of Using Supplements and Stimulating Drugs in Elite Athletes in the Province of East Azarbaijan. Tabriz University of Medical Sciences, Faculty of Pharmacy; 2019.
Darvishi L, Askari G, Hariri M, Bahreynian M, Ghiasvand R, Ehsani S, et al
. The use of nutritional supplements among male collegiate athletes. Int J Prev Med 2013;4(Suppl 1):S68-72.
Karimian J, Esfahani PS. Supplement consumption in body builder athletes. J Res Med Sci 2011;16:1347-53.
Allahverdipour H, Jalilian F, Shaghaghi A. Vulnerability and the intention to anabolic steroids use among Iranian gym users: An application of the theory of planned behavior. Subst Use Misuse 2012;47:309-17.
Khorramabady Y. The Effect of Muscle Dysmorphia and Social Physique Anxiety on the Use of Supplements and Drugs. Zahedan Journal of Research in Medical Sciences 2017;19:1-6.
Golshanraz A, Hakemi L, Pourkazemi L. Prevalance of dietary supplement use among elite Iranian athleetes (male & female national level athletes). Br J Sports Med 2014;48:599-600.
Seif-Barghi T, Yosaee S, Halabchi F, Mazaheri R, Djafarian K. Type and frequency of dietary supplement use by Iranian soccer players. J Nutr Sci Diet 2015;1:93-7.
Golshanraz A, Hakemi L, Pourkazemi L, Dadgostar E, Moradzandi F, Tabatabaee R, et al. Patterns of sports supplement use among Iranian female athletes. International Journal of Sport and Health Sciences 2012;6:2480-3.
Hoseini Kakhak AR. The amount and frequency of use of performance-enhancing adjuvants (drugs and supplements, protein and vitamins) in elite fitness clubs in the cities of Tehran and Mashhad. [Thesis], Tarbiat Moallem university; 2001. [Persian].
Malek M, Ghanaei M, Ghorbani R. Survey of the frequency percentage of doping drugs among the male body building athletes and rate of knowledge to side effects. KOOMESH 2005;6:123-30. [Persian].
Rashid Lamir A, Dehbashi M, Taghizadeh V. Study the prevalence of legal and illegal supplements between athlete's men in Bodybuilders and powerlifting field. Shomal J Manag Physiol Sport 2014;2:1-11. [Persian].
Aminpour M. The prevalence of ergogenic substance use, attitude and tendency toward their use among Bojnord's body builders [M.S. Thesis]. Sabzevar Tarbiat Moallem University, Faculty of physical education and sport science, Iran, 2011[Persian].
Ekramzadeh M, Taherinasab S. The prevalence of sport dietary supplements consumption among male athlete students in Shiraz University of Medical Sciences, Shiraz, Iran. J Nutr Sci 2017;2:218-23.
Aliabadi S, Hesami S. The Relation between Awareness, Attitude and the Amount of Doping Substances and Illegal Supplements in Body Builders of Sanandaj, Iran. Arabian Journal of Business and Management Review (Oman Chapter) 2014;4:73-76.
Nakhaee M, Pakravan M. Prevalence and reasons for nutritional supplement use among athletes in body building gyms, Kerman 2012. J Rafsanjan Univ Med Sci 2014;12:873-80.
Bahari-Rad N, Komasi S, Khatooni A, Moradi F, Soroush A. Frequency and causes of consuming sports supplements and understanding their side effects among bodybuilders in fitness gyms of Kermanshah City. Curr Nutr Food Sci 2019;15:735-44.
Kargarfard M, Kashi A, Sarlak Z. Prevalance of ergogenic substances use and athletes'knowledge of effects and side effects of them in Lorestan province, western part of Iran. J Fundam Ment Health 2009;11:123-34.
Nakhostin-Roohi B, Asadi M. The prevalence, level of knowledge and methods of providing nutritional supplements among females participating in private sports clubs in the City of Ardabil, Iran. Int J Nutr Sci 2018;3:18-24.
Amirsasan R. Study the amount and kind of dietary supplements consumption in Iranian athletes participating in the London 2012 Olympic Games based on a theory of planned behavior. Sport Physiol 2014;6:43-60.
Arazi H, Saeedi T, Sadeghi MM, Nastaran M, Mohammadi M. Prevalence of supplements use and knowledge regard to doping and its side effects in Iranian athlete university students participated in sports Olympiad at summer 2012. Acta Kinesiologica 2014;8:76-82.
Azizi M, Mali AD, Tabari E. Study of prevalence of supplement use and knowledge of men national team rowers about doping and side effects. World Appl Sci J 2012;17:724-8.
Aljaloud SO, Ibrahim SA. Use of dietary supplements among professional athletes in Saudi Arabia. J Nutr Metab 2013;2013:245349. doi: 10.1155/2013/245349.
Nabuco HCG, Rodrigues VB, BARROS WMd, Ravagnani FCDP, Espinosa MM, Ravagnani CDFC. Use of dietary supplements among Brazilian athletes. Rev Nutr 2017;30:163-173.
Denham BE. Athlete information sources about dietary supplements: A review of extant research. Int J Sport Nutr Exerc Metab 2017;27:325-34.
Garthe I, Maughan RJ. Athletes and supplements: Prevalence and perspectives. Int J Sport Nutr Exerc Metab 2018;28:126-38.
Khanna P, Chattu VK, Aeri BT. Nutritional aspects of depression in adolescents-A systematic review. Int J Prev Med 2019;10:42.
] [Full text]
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]