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 Table of Contents  
Year : 2019  |  Volume : 21  |  Issue : 1  |  Page : 19-23

Knowledge and practices about protein supplement use amongst students of a medical college

1 Officer Commanding, 48 Field Health Organization, Bhatinda, Punjab, India
2 Department of Community Medicine, INHS Asvini, Mumbai, Maharashtra, India
3 Instructor, AMC College and Centre, Lucknow, Uttar Pradesh, India
4 Department of Lab Sciences, Army Hospital (Research & Referral), New Delhi, India
5 Research Associate, UPMC Pinnacle, Harrisburg, Pennsylvania, USA

Date of Submission14-Oct-2018
Date of Acceptance10-Mar-2019
Date of Web Publication19-Jun-2019

Correspondence Address:
Maj Gurpreet Singh Bhalla
Department of Lab Sciences, Army Hospital (R and R), New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmms.jmms_65_18

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Background: Nutrition and sports go hand in hand. With the availability of a wide range of protein supplements in the market and a risk taking mindset of the young generation to achieve fast and presentable results to their appearance or performance, a thorough knowledge and the selection of the right product becomes important. Materials and Methods: A descriptive cross-sectional study was conducted in a medical college in an urban locality over a period of 06 months. Participants were selected from a medical college by simple random sampling method and a total of 385 selected participants were distributed pre-tested questionnaires. Data was collected and the results were tabulated using appropriate statistics. Results: Amongst 385 participants (276 male & 109 females), 80 (20.8%) participants used supplements regularly. The mean age and BMI of protein supplement consumers was found to be 20.8 ± 1.4 years & 21.61 ± 1.9 Kg/m2. The association of use of supplements was found to be highly significant amongst those playing more than one sport (p<0.001), playing daily (p<0.001) and working out in gym (p<0.001). While the most common reason participants cited for consumption of supplements was to augment their diet and build muscles (46.3%), the commonest source of their information was found to be internet (65.8%). Conclusion: There still exists a huge gap in the knowledge and practices on the use of supplements amongst the college students which needs to be bridged and thus, by highlighting gaps in nutritional knowledge, sport nutrition professionals may begin to address these gaps by educating sportsperson with a view toward minimizing injury and enhancing sport performance.

Keywords: Medical students, nutritional knowledge, practices, protein supplements

How to cite this article:
Bandyopadhyay K, Ray S, Vashisht S, Bhalla GS, Sarao MS. Knowledge and practices about protein supplement use amongst students of a medical college. J Mar Med Soc 2019;21:19-23

How to cite this URL:
Bandyopadhyay K, Ray S, Vashisht S, Bhalla GS, Sarao MS. Knowledge and practices about protein supplement use amongst students of a medical college. J Mar Med Soc [serial online] 2019 [cited 2023 Feb 6];21:19-23. Available from: https://www.marinemedicalsociety.in/text.asp?2019/21/1/19/260670

  Introduction Top

Protein supplements are consumed by young, college going, and recreationally active students to maximize physical performance and achieve increase in muscle mass. The stress is mainly on increased protein consumption and not on a balanced nutrition.[1] All types of sports including team games such as football and cricket; individual sports such as body building and wrestling; and mind games such as chess and video games require appropriate nutritional constitution. The recommended dietary allowance is the average daily dietary intake (of that nutrient), sufficient for the maintenance of health in nearly all (covers nearly 97.5% of the population) healthy individuals in a particular life stage and gender group and is dependent on the physical activity.[2] Understanding the requirement of the specific type of nutrient in an individual's diet is considered important.

As per the present day, food research, proteins (whey proteins, alanine, and tyrosine), carbohydrates (high glycemic), fats (omega 3), minerals, and vitamins are essential components to improve endurance, muscle strength, mental ability, and bulk in sportsperson, which may or may not be met with routine diet.[3],[4] The theory behind the use of supplementation is that sportsmen, by virtue of their unique training methods and end goals, require higher than average quantities of nutrients (especially proteins) to support maximal muscle growth and to optimize health and fitness or sports performance.[5]

While protein supplements may have many beneficial effects such as lowering of blood pressure, antioxidant defense mechanisms, lowered incidence of breast cancers, and reduced severity of menopausal symptoms specifically for women,[6],[7] they also have a few negative effects on bone health, metabolism, hepatic, and renal function if not taken in the correct dose or frequency. Individuals with existing renal or hepatic comorbidities are also at risk of aggravating their disease. However, studies have shown that the risk of the development of metabolic ketosis on consumption of high protein diet appears only for the initial period of 3–6 months and gradually reduces thereafter. The association of high protein diet with increased calcium excretion and bone loss is also found to be ambiguous with conflicting results from various studies suggesting the likely role of other confounding factors and thus rendering the effect of protein on bone health still unclear.[8],[9]

With the availability of a wide range of protein supplements in the market and a riskier, shortcut mindset of the young generation to achieve fast and presentable results to their appearance or performance, a thorough knowledge and the selection of the right product become imperative.[10] The present study was conducted among medical college students to study the knowledge and practices regarding the quantity and frequency of intake of the protein supplements and to study the various factors guiding the use of these supplements and their source of knowledge.

  Materials and Methods Top

A cross-sectional study was conducted in a medical college in an urban locality over a period of 6 months. Taking the anticipated percentage of knowledge and practices of taking protein supplements to be 50%, with level of confidence interval to be 95%, power of the study assumed to be 80%, and an absolute error of 5%, the sample size was calculated to be 385.

Medical students from the medical college were selected by simple random sampling method from a list of students who regularly undertook at least one form of sports (requiring physical activity). Sports requiring physical activity included cricket, football, volleyball, basketball, hockey, gymnasium workout, running, cycling, tennis, swimming, badminton, and squash.

The purpose of the study was explained and a written and informed consent was obtained from all the participants. Data were collected by distributing a pilot-tested questionnaire to all the participants. The data collected were compiled and entered into Excel and analyzed using SPSS software Version 20.0 (IBM Corp., Armonk, NY, USA).

  Results Top

The study showed that of 385 participants (276 males and 109 females), 80 (20.8%) participants used supplements regularly, of which 66 (82.5%) were male and 14 (17.5%) were female (P = 0.015, Odds ratio = 2.13 [1.14–3.90]). Males had twice the odds of consuming protein supplements than females. While the mean weight of the participants was found to be higher among those who did not consume any supplement as compared to those who consumed (P < 0.05), there was no significant difference in them in terms of body mass index [Table 1].
Table 1: Mean difference of variables in study participants

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Of all the participants, who consumed supplements, majority of them were active in the gym followed by playing basketball and running [Figure 1]. Among these sportspersons, 8.7% of those who played only one sport and 28.4% of those who played >1 sport consumed protein supplements (P = 0.0001, odds ratio = 4.14 [2.19–7.83]). About 30.9% of those who played daily and 10.1% of those who played ≤ thrice a week used supplements (P = 0.0001, odds ratio = 3.98 [2.27–7.00]). Of the participants using the gym, 64.1% used supplements compared to 7.2% of those who played other sports (P = 0.0001, odds ratio = 23.15 [12.51–42.84]). The association of use of supplements was found to be highly significant among those playing more than one sport (P < 0.001), playing daily (P < 0.001), and working out in gym (P < 0.001) [Table 2].
Figure 1: Distribution of consumption of protein supplements as per the sports played

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Table 2: Frequency distribution of variables with protein supplement consumption

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The knowledge component of the study showed a mixed response among the participants. While 89% of the participants could correctly define what a protein supplement was, only 45% of the participants were aware of the constituents of a protein supplement. The overall awareness about various forms of supplements available was fairly satisfactory among the users [Figure 2], but the awareness about the side effects of using supplements was quite low [Figure 3]. Similarly, when asked whether protein supplement is a type of nutritional supplement, overall 69.1% of all participants were aware (96.2% among users vs. 61.9% among nonusers), but the overall knowledge about the beneficial effects of using protein supplements was found to be less satisfactory with only 54% of participants being aware and the rest either partially or totally unaware.
Figure 2: Awareness of various forms of protein supplements available

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Figure 3: Awareness about the side effects of protein supplements

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The most common reason the participants cited for consumption of supplements was to augment their diet and build muscles (46.3%), followed by building stamina (45%), for weight loss (7.5%), and as a fashion statement (1.2%). It was found that majority of them (87.5%) started using supplements before joining college while the rest (12.5%) started using it only after joining the college. Among, those who consumed supplements, 42.5% used it daily, whereas the rest were found to be using it only twice or thrice a week. The pattern of consumption of supplements was found to be once a day for the majority (90%) compared to only 10% who consumed it more than once a day. While the most important deciding factors for selecting a particular supplement were its cost and taste (47.94%), recommendation by experts and peers (33.21%), and brand name and availability of supplement (18.85%), the most important source of information about the supplements was internet (65.8%), followed by friends and colleagues (25.7%) and others such as magazines or television (8.5%).

  Discussion Top

Apart from the print and social media, health-care professionals play a very important role in molding the public opinions and beliefs regarding health-related issues. Thus, with the dramatic surge in the supplement usage among the present health conscious generation, especially the students, it is vital to assess the actual knowledge gap that exists among them. The distribution of participants in the study as per their gender revealed that majority 276 (71.7%) were male and rest 109 (28.3%) were female with mean age of participants being 20.8 ± 1.4 years which is similar to many studies such as Supriya and Ramaswami[11] and Azizi et al.[12] with mean age being 18.0 ± 3.2 years and 21.5 ± 2.4 years, but is low as compared to a study done by Golshanraz et. al.[13] with mean age being 27.08 years, and the reason being the participants were selected from a medical college.

This study showed that very few participants (80, 20.8%) used supplements regularly, out of which 82.5% were male and 17.5% were female which is similar to studies done by Jonnalagadda et al.[5] and Scofield and Unruh[14] which found it to be 23% and 22.3%, respectively, while other studies such as Sharma and Adiga[15] Block et al.[16] and Teng et al.[17] found it to be as high as 49.5%, 50%, and 71.9%, respectively. The reason behind the low consumption percentage in the present study could be attributed to financial dependence on parents with the products available being expensive and difficult to afford on a regular basis.

The present study showed that those who consumed supplements were playing at least one form of sports, majority of them were active in the gym 59 (73.8%) followed by basketball (10%) and running (6.6%). The association of use of supplements was found to be highly significant among those playing more than one sport (P < 0.001), playing daily (P < 0.001) and working out in gym (P < 0.001) which is comparable to studies done by Froiland et al.[18] and Nazni and Vimala[1] who also had similar results.

Many studies have found the sports nutrition knowledge of the participants to be inadequate.[19] While a study by Golshanraz et al.[13] found it to be adequate in only 30.7%, another study by Azizi et al.[20] found it to be moderate at 57.3%. However, the present study found a mixed result with the overall knowledge being found to be around 70% on various aspects of the subject among the supplement users compared to only 40% in the nonusers. This finding is similar to studies such as Nazni and Vimala[1] and Jazayeri and Amani[10] with similar results.

While in the present study, the most common reason cited by participants for using protein supplements was to augment their diet and build muscles (46.3%) which is similar to the findings of studies done by Froiland et al.[18] and Jonnalagadda et al.[5] The studies done by Sharma and Adiga[15] and Al-Naggar and Chen[9] found the most common reason to be maintenance of an overall good health with 40%–80% response, respectively, from the participants.

The present study observed the most important source of information about the supplements among the participants to be from the internet (65.8%), followed by from friends or colleagues (25.7%) and magazines or television (8.5%). Other studies such as Froiland et al.[18] and Erdman et al.[21] found the source of information to be from nutritionists and fellow athletes. In similar studies conducted by Malinauskas et al.[22] and Scofield and Unruh[14] 71% and 38% of athletes, respectively, considered their coaches to be the best consultants. In the present study, about 90% of the participants did not experience any form of side effects on prolonged use of these supplements which is comparable to studies done by Golshanraz et al.[13]

The study was conducted on medical students who might have an inherent knowledge of nutrition and thus considered to be a limiting factor for generalizability of the study. However, as an undergraduate medical student, such knowledge is considered to be limited as was found in the study, where the source of knowledge was mainly from internet search. Furthermore, in our study, apart from the association of gender with supplement use, the high variance of the data set for number of sports played, frequency of use, and the kind of sports played indicates scattered data in the study. Further research with increased power may provide better precision for the results of these associations.

  Conclusion Top

Our study found the most common reason for use of dietary supplements among college going students was to supplement the perceived inadequacy of proteins in the regular diet and to build muscles. But with the wide variety of supplements present in the market and the irrational use of it owing to the inadequate knowledge, advertisements, social trend, or peer pressure, it is of utmost importance that the individuals consuming these supplements have good knowledge and safe practices regarding their use. This study has highlighted the major gaps in nutrition knowledge related to sports nutrition, and is needed to be addressed by nutritional professionals. It is recommended that there should be a government regulation on proper labeling practices in the use of protein supplements so that adverse effects and use under supervision are mentioned clearly on it.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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Park K. Nutrition and health. Park's Textbook of Preventive and Social Medicine. 24th ed. Jabalpur: Banarasidas Bhanot Publishers; 2017. p. 670.  Back to cited text no. 2
Webster I, Huisamen B, Du Toit EF. Creatine and exercise – Strong evidence for stronger muscles? J Exerc Physiol Online 2011;14:85-108.  Back to cited text no. 3
Thomas C, Perrey S, Ben Saad H, Delage M, Dupuy AM, Cristol JP, et al. Effects of a supplementation during exercise and recovery. Int J Sports Med 2007;28:703-12.  Back to cited text no. 4
Jonnalagadda SS, Rosenbloom CA, Skinner R. Dietary practices, attitudes, and physiological status of collegiate freshman football players. J Strength Cond Res 2001;15:507-13.  Back to cited text no. 5
Pal S, Ellis V. The chronic effects of whey proteins on blood pressure, vascular function, and inflammatory markers in overweight individuals. Obesity (Silver Spring) 2010;18:1354-9.  Back to cited text no. 6
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Al-Naggar RA, Chen R. Prevalence of vitamin-mineral supplements use and associated factors among young Malaysians. Asian Pac J Cancer Prev 2011;12:1023-9.  Back to cited text no. 9
Jazayeri S, Amani R. Nutritional knowledge, attitudes and practices of bodybuilding trainers in Ahwaz, Iran. Pak J Nutr 2004;3:228-31.  Back to cited text no. 10
Supriya V, Ramaswami L. Knowledge, attitude and dietary practices of track and field athletic men and women aged 18-22 years. Int J Innov Res Dev 2013;2:399-404.  Back to cited text no. 11
Azizi M, Aghaee N, Ebrahimi M, Ranjbar K. Nutrition knowledge, the attitude and practices of college students. FU Phys Ed Sport 2011;9:349-57.  Back to cited text no. 12
Golshanraz A, Hakemi L, Pourkazemi L, Dadgostar E, Moradzandi F, Tabatabaee R, et al. Patterns of sports supplement use among Iranian female athletes. Prevent 2012;9:25.  Back to cited text no. 13
Scofield DE, Unruh S. Dietary supplement use among adolescent athletes in central Nebraska and their sources of information. J Strength Cond Res 2006;20:452-5.  Back to cited text no. 14
Sharma A, Adiga S. Knowledge, attitude and practices related to dietary supplements and micronutrients in health sciences students. J Clin Diagn Res 2014;8:HC10-3.  Back to cited text no. 15
Block G, Jensen CD, Norkus EP, Dalvi TB, Wong LG, McManus JF, et al. Usage patterns, health, and nutritional status of long-term multiple dietary supplement users: A cross-sectional study. Nutr J 2007;6:30.  Back to cited text no. 16
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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.  Back to cited text no. 18
Jessri M, Jessri M, RashidKhani B, Zinn C. Evaluation of iranian college athletes' sport nutrition knowledge. Int J Sport Nutr Exerc Metab 2010;20:257-63.  Back to cited text no. 19
Azizi M, Rahmani-Nia F, Malaee M, Malaee M, Khosravi N. A study of nutritional knowledge and attitudes of elite college athletes in Iran. Braz J Biomotricity 2010;4:105-12.  Back to cited text no. 20
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Malinauskas BM, Overton RF, Carraway VG, Cash BC. Supplements of interest for sport-related injury and sources of supplement information among college athletes. Adv Med Sci 2007;52:50-4.  Back to cited text no. 22


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2]


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