Use of Dietary Supplements by Military Personnel (2008) / Chapter Skim
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2 Recent Survey Findings and Implications for Future Surveys of Dietary Supplement Use
2 Recent Survey Findings and Implications for Future Surveys of Dietary Supplement Use
Pages 36-71
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From page 36... ...
Given the large number and wide variety of supplements readily available, as well as a lack of scientific evidence addressing health benefits or safety, it is important to monitor the use of supplements by military personnel. One effective approach to this is the use of surveys with comprehensive data collection (e.g., well-designed questions on patterns of use)
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From page 37... ...
A low response rate can lead to a biased sample that does not represent the supplement use of the targeted military population. The benefits of survey use include having data on the extent of the use of dietary supplement products, changes in patterns of use, and insights on specific health behaviors (e.g., reasons for use, degree of consultation with physician, views on dietary supplements)
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From page 38... ...
For practical purposes, however, it is justifiable to include them in the surveys as dietary supplements. In this report, the committee's deliberations about dietary supplements also included products that meet the legal definition as well as food products that are commonly perceived as nutritionally enhanced with dietary ingredients, botanicals, or vitamins and minerals (e.g., sports drinks, sports bars)
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serving in the supplement users military, National Guard, or Reserve") 2005 Jaghab Army physicians Physicians, Survey of Army health care providers on Electronic survey on Army Medical and ancillary n=573 dietary supplement usage, supplement Department Knowledge Management care providers Ancillary, n=614 types, usage concerns, educational website.
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From page 40... ...
Females, 28.8 ±8.2 y Rangers Males, n=768 Same as above for general Army Response rate not known. 1999 Average age=23.6 ± 4.3 y Special Forces Males, n=152 Same as above The surveys were administered in a 2000 Average classroom setting by U.S.
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From page 41... ...
3,356; Air Force: DoD Survey of Health Related Behaviors officers at each installation coordinated the 2005 4,627) Among Active Duty Military Personnel survey, a 50-minute questionnaire either completed in group sessions or returned by mail.
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From page 42... ...
2000 n=367 associated factors Bovill et al., U.S. Army Special Forces Average age=31 y Use of supplements and Response rate not known.
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From page 43... ...
Army enlisted active duty Average age=24.9 y Use of supplements and The 15-question survey on dietary n=874 (750 males, 124 females)
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From page 44... ...
. PREVALENCE OF USE OF DIETARY SUPPLEMENTS BY MILITARY PERSONNEL Overall Use and Behavioral Patterns This section summarizes the results from surveys (published and unpublished)
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From page 45... ...
show that 85 percent of those entering Special Forces and Ranger training reported current or previous use of dietary supplements, and 64 percent reported current usage. The patterns of dietary supplement use among athletes might be expected to be similar to those of military populations.
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From page 46... ...
Various smaller surveys suggest a similar level of usage among active duty military personnel. In the ongoing Army-wide survey, 30 percent of male respondents reported using MV/MM supplements (Lieberman et al., 2007)
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From page 47... ...
Army War College reported using "health-promoting" dietary supplements, and among Rangers, 30 percent used performance-enhancing supplements. Analysis of data from NHANES 1999–2002 shows that dietary supplements other than vitamins and minerals are used by 7 percent of the U.S.
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From page 48... ...
. When categorized by perceived effect, the 2005 DoD Survey of Health Related Behaviors indicated that among active duty military users of dietary supplements other than vitamins and minerals, 21 percent used "bodybuilding" supplements, 18 percent used "weight-loss products," 9 percent used "joint health" products, 8 percent used "performance-enhancing" products, and 9 percent reported using other types of supplements (Marriott, 2007)
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From page 49... ...
reported that 43 percent of active duty Army personnel assigned to Europe between 2003 and 2005 reported using sports drinks. The only military subpopulation reporting a relatively low usage of sports drinks was officers attending the Army War College, of whom only 10 percent reported routinely using sports drinks (Lieberman et al., 2007)
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From page 50... ...
Similarly, the 2005 DoD Survey of Health Related Behaviors indicates that dietary supplement usage is highest among the oldest survey respondents; however, bodybuilding supplements are most likely to be used by service members less than 43 years old, and weight-loss products and performance-enhancing supplements are used most frequently by service members less than 34 years old. Military members over 44 years of age are more likely to be taking multivitamins and single-ingredient dietary supplements for health enhancement, such as individual vitamins and minerals, antioxidants, and products to improve joint health (see Marriott et al.
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From page 51... ...
This information is particularly valuable when obtained from the special military subpopulations facing higher risks because of demanding mental or physical tasks, and more likely to use dietary supplements. These types of survey questions are not meant to be used to draw causal inferences about dietary supplements and adverse events.
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From page 52... ...
Weight loss Strength Increase lean muscle mass Stamina Fatigue reduction Cognition/alertness Memory Other DoD Survey of Health Related Behaviors Supplement diet Among Active Duty Military Personnel Improve health (Marriott, 2007) Improve mental health Improve cognitive function Improve physical performance Increase muscle mass Lose weight Specific health problems Army health care personnel Performance enhancement (Jaghab, 2007)
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From page 53... ...
The committee inquired about additional information on potential associations between specific dietary supplements and adverse events and received one such analysis. The frequency of adverse effects across each category of dietary supplement (vitamins, performance enhancers, and herbal)
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Except for heart attacks, fewer than 50 percent of the perceived side effects from dietary supplements were reported to the health care provider (Thomasos, 2007)
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From page 55... ...
with questions related to adverse events and beneficial outcomes as well as the use of specific dietary supplements that might be of concern. Given the specific needs and challenges of military personnel, particularly of some military subpopulations, supplement use among military personnel is a special concern for the DoD.
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From page 56... ...
would be more likely to use dietary supplements and face higher or unknown risks due to greater mission demands and harsher environments (e.g., high altitude, extreme temperature) than most military personnel.
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From page 57... ...
Contract requirements could also specify that suppliers of dietary supplements notify an appropriate health care professional when new dietary supplements in categories of interest are being introduced for sale on base. Nevertheless, electronic health records are unlikely to contain accurate information on dietary supplement use because of low report rates, while sales data do not reflect actual consumption.
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From page 58... ...
Longitudinal data would provide the opportunity to discern trends in dietary supplement use and patterns of behavior that are affected by changes in supplement policies, as well as examine relationships between dietary supplement use and health outcomes. Health- or performance-related outcomes of interest to the military would include those that are suspected of being affected by dietary supplements, such as weight loss, cardiovascular disease, palpitations, headaches, diminished alertness, or gastrointestinal disturbances.
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From page 59... ...
Planning Stage: Recommendations for Better Survey Designs This committee believes that making a few adjustments to the surveys could remarkably improve the quality and value of the information collected. Important information gaps identified in surveys include the inability to accurately characterize respondents as users or nonusers of supplements, since frequency of use is not well characterized; and the incomplete assessment of total dose/exposure, especially of potentially important types of supplements (e.g., caffeine)
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Important to include specific questions about dietary supplements of concern. Assess dose/ How much creatine Please retrieve the container for your dietary Important to have respondent retrieve the amount of dietary do you consume supplement before answering these questions.
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Determine whether Current surveys do During the time that you were using (insert supplement Response options may be composed of supplement users not ask for this name here) , did you experience any of the following symptoms that are reported in civilian experience adverse information.
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From page 62... ...
other: __________ Why do you take dietary supplements?
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From page 63... ...
This might be the case for vitamins and minerals, for example, as well as other bioactive substances such as caffeine, for which the dietary intake from several sources must be included in order to determine potential impact on military personnel. Given the broad range in caffeine content in products in the market, this is a challenging task, as shown by a recent publication that analyzed products sold in various delivery forms and found that taking the amount of product recommended on the label resulted in intake of amounts of caffeine ranging from 1 to 820 mg/day (Andrews et al., 2007)
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From page 64... ...
In summary, acquiring data on prevalence of use is a first step in determining the extent of dietary supplement use by military personnel; however, total dose/exposure data (e.g., from dietary supplements, food, and medication sources) is necessary to determine whether military personnel are exposed to hazardous levels of a particular dietary supplement.
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From page 65... ...
as well as from pills or powders. This was also supported by the IOM Committee on Mineral Requirements for Military Personnel (IOM, 2006)
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From page 66... ...
With the amount of active substance in products varying substantially, it is critical that survey respondents note the amount from the product label (though it should be noted that product labels can also be inaccurate [Andrews et al., 2007]
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From page 67... ...
adverse effects perceived to be attributable to dietary supplements. In-depth probing about adverse events or outcomes (heart palpitations, headaches, etc.)
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From page 68... ...
Questions on effectiveness of communication The committee recommends that questions about sources of information on dietary supplements that military personnel consult be added to questionnaires as these would help determine the most effective methods to disseminate accurate information. Once strategies to disseminate information are implemented, survey questions to measure the level of outreach and effectiveness of the information strategy will also be needed.
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From page 69... ...
Selfreported surveys present the following limitations: (1) lower response rates; (2)
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From page 70... ...
2007. Dietary supplements questionnaire.
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From page 71... ...
2006. Dietary supplements in a national survey: Prevalence of use and reports of adverse events.
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