Dietary supplements consumption and its association with socioeconomic factors, obesity and main non-communicable chronic diseases in the north of Iran: the PERSIAN Guilan Cohort Study (PGCS)
BMC Nutrition volume 7, Article number: 84 (2021)
Dietary supplements (DSs) use have become a growing trend worldwide, and it may be affected by demographic and sociocultural factors. Some people use supplements with the thought that they can improve their health, reduce symptoms and prevent disease. The aim of the present study was to define the frequency of DS use and its association with socioeconomic factors among participants with selected main non-communicable chronic diseases (NCDs) (diabetes, cardiovascular disease (CVD), hypertension (HTN), cancers, and obesity in the north of Iran.
This large cross-sectional study was conducted as a part of the PERSIAN Guilan cohort study. Supplement use during last year and its type, demographic factors, socioeconomic status, lifestyle habits were asked by face-to-face interview. The history of chronic disease was defined by a trained team. Data were analyzed using SPSS. The chance of supplement use according to demographic, socioeconomic, and lifestyle variables and history of chronic disease was analyzed by logistic regression.
10,520 men and women aged 35–70 years in Some’e Sara County (including urban regions and 39 villages) were studied. About 25% of participants consumed DSs. The highest consumption of DS was calcium/vitamin D (11.1%), ferrous sulfate (8.8%), and vitamin D pearl or ampoule (7.7%). The highest percent of the history of chronic disease was central obesity (62.7%), HTN (43.2%), and general obesity (32.7), respectively. After adjustment for confounders, those with female gender, the highest age ranges (55–65 and > 65 years), high academic education, living in urban regions, and good economic status were more likely to be DSs consumers; however, married and smoker subjects were more likely to consume DS. Participants who had a history of diabetes, HTN, CVD, Obesity, and Central Obesity were more likely to intake DS in comparison with healthy subjects.
This study showed that a quarter of the participants were DS users. Female sex, older age groups, and higher educated participants, and among chronic disease, patients with HTN, CVD, and diabetes were more likely to be users of any DS.
Following the epidemiological transition, non-communicable diseases (NCDs) are a major part of the community’s health problems . According to the definition of the World Health Organization (WHO), the main types of NCDs are cardiovascular diseases (CVD), cancers, chronic respiratory diseases, and diabetes which are collectively responsible for almost 70% of all deaths worldwide . This organization also predicts that NCDs will be responsible for three-quarters of all deaths in the world by 2030 . In Iran, the first rank of death is attributed to cardiovascular disease, and the third is cancer [4,5,6,7]. Many factors may contribute to the development of chronic diseases, including genetics and environmental factors [8,9,10]. The rising trend of obesity has also made it one of the main leading causes of NCDs in the world [11,12,13], which makes it the important risk factor of other chronic diseases such as cardiovascular diseases and cancers .
Previous studies showed that adults with cancer or other chronic diseases tend to use supplements more than healthy subjects [15, 16], and according to NHANES data, dietary supplements use has been rising since the 1970s . Based on the Food and Drug Administration description, a dietary supplement is a product that contains nutrients to increase the nutritional value of one’s diet. Using dietary supplements such as vitamins, antioxidants, fiber, trace elements, amino acids has become an important health trend worldwide . Nowadays, various types of dietary supplements are widely sold through pharmacies [19, 20]. It is estimated that more than 50% of adults in the UK use at least one dietary supplement daily . Some studies have suggested the role of supplements in preventing or progression of chronic diseases [22, 23]; however other studies have not found a positive association between supplementation and chronic diseases [24,25,26]. Also, some health experts are concerned about the interactions of these supplements with the drugs used by people with chronic diseases, especially those with cancer . Nevertheless, most people use supplements with the thought that supplements are natural and safe compounds that can improve their health, reduce symptoms and prevent disease .
The use of dietary supplements has become a growing trend worldwide, and it may be affected by demographic and sociocultural factors. Still, studies about the use of dietary supplements in Iran are limited, and there is not enough information about dietary supplement consumption status in the north of Iran. To the best of our knowledge, this is the first study to investigate the consumption of commonly available dietary supplements and their association with socioeconomic factors in participants with selected main NCDs (diabetes, CVD, hypertension (HTN), cancers, obesity, and central adiposity) in the north of Iran.
Materials and methods
The present cross-sectional study was conducted within the framework of the PGCS; a study performed on 10,520 men and women between 35 and 70 years old in Some’e Sara County (including urban regions and 39 villages) that is located in northern Iran, from October 8, 2014 to January 20, 2017 as part of the Prospective Epidemiological Research Studies in Iran (PERSIAN) [28, 29].
Men and women in the age range of 35–70 residing in urban and rural areas of Some’e Sara county located in North of Iran who used dietary supplementations were included in the present study. Participants were excluded if they were unable to attend the clinic for interview and physical examination, if they had mental retardation, or if they were unwilling to participate.
Data were obtained by a questionnaire by a face-to-face interview with trained interviewers. Regarding supplement use, people were asked if they were regularly using even one of the dietary supplements (DS) (Mineral Multivitamin, Multivitamin, Calcium-D, Calcium, Vitamin D, Folic acid, ferrous sulfate, zinc sulfate, and omega-3) during last year and its type. Participant characteristics, including demographic (age, gender, family number) characteristics, socioeconomic status (educational status, occupation, household economic status), lifestyle habits (smoking and alcohol consumption habit), employment status, and anthropometric indices including weight (kg), height, etc. were measured by trained health care providers. Body mass index (BMI) was calculated as weight (in kg) divided by height squared (in m2). Obesity and central obesity were defined as BMI ≥30 kg/m2 and waist ≥95 cm [based on national cut-off] , respectively. History of chronic illnesses including diabetes, HTN, CVD, and cancers was assessed by sophisticated physicians of the team. Diabetes was defined as fasting blood glucose equal to or higher than 126 mmol/L, or was on medication for raised blood glucose, or had a history with the diagnosis of diabetes . HTN was defined as systolic blood pressure (SBP) ≥130 mmHg, and /or a diastolic blood pressure (DBP) ≥80 mmHg according to the ACC/AHA guideline, a prior diagnosis of hypertension by a health professional indicating that one had high BP or used antihypertensive drugs . CVD includes the history of myocardial infarction or/and stroke or/and cardiac ischemia. Alcohol consumption and smoking habits were asked by yes or no question.
Data were analyzed using the statistical software package SPSS Version 16.0. Participants’ age was divided into four age groups: 35 to < 45 years, 45 to < 55 years, 55 to < 65 years, and 65 years and over. Household economic status was defined by scoring owning house status and its room number and infrastructure per capita and household assets, based on their economic value according to a previous study , and computing the total score. The total score was categorized into tertiles (T), and T1, T2, and T3 were labeled as low, middle, and high SES, respectively.
To compare the general characteristics of participants between two living regions (urban and rural), χ2 tests were used. The chance (95% confidence interval [95%CI]) of supplement use according to demographic, socioeconomic, and lifestyle variables and history of chronic disease was analyzed by logistic regression simultaneously adjusted for all assessed variables (demographic, socioeconomic, lifestyle factors). In the regression models, the supplement use status was considered as a dependent binary variable. P < 0·05 was considered as significant.
Table 1 represents the sociodemographic characteristics, history of NCDs, and the supplement use status of the participants (n = 10,520), of which 56.2% (n = 5907) and 43.8% (n = 4613) lived in rural and urban regions, respectively. Most of them were 45 ≤ or < 55 years old (36.6%). Among total participants, the majority of the respondents aged < 55 years (66.5%), married (90.6%). Half of them were illiterate or had under 6 years of education (48%). A quarter of individuals consumed DS and 14% of them had alcohol consumption habits. The highest consumption of DS reported by participants was calcium/vitamin D (11.2%), ferrous sulfate (8.8%), and vitamin D pearl or ampoule (7.7%). The highest percent of the history of chronic disease was central obesity (62.7%), HTN (43.2%), and obesity (32.7%), respectively. Demographic, socioeconomic, and lifestyle characteristics of participants based on regions of living varied significantly. Based on the regions, individuals who lived in rural areas had higher consumption of DSs than those residing in urban regions. Furthermore, the frequency of diabetes and hypertension were significantly higher in urban areas.
Table 2 represents the characteristics and history of NCDs in dietary supplement consuming participants across living regions. In total participants, a higher percentage of DS users were women, married, in the age range of 45 ≤ age < 55 years, had higher educational years, not having alcohol consumption habits. Among DS consumers, a higher percentage of those with a history of HTN lived in urban regions.
The odds ratio (95% Confidence Interval) of dietary supplement use according to socioeconomic characteristics and history of chronic disease of participants was shown in Tables 3 and 4. After adjustment for all variables in the model, female in comparison to male, those at the highest age ranges (55 ≤ age < 65, and ≥ 65 years) in comparison with those at the lowest age range (35-45 years), Post Graduates in comparison with individuals with 0–11 years education, those living in urban regions in comparison with rural areas, participants with medium and high economic status in comparison with those with Low economic status were more likely to consume DS. In contrast, married and smoker subjects were less likely to use DS (Table 3). Participants with diabetes, HTN, CVD, Obesity, and Central Obesity appeared to be more likely to consume DS in comparison with healthy subjects. After adjustment for confounders (demographic, socioeconomic, and lifestyle), the significance remained for diabetes, HTN, and CVD (Table 4).
This large cross-sectional study assessed the status of DSs use in participants with selected main NCDs (diabetes, CVD, HTN, cancers) and obesity and central adiposity as well as the sociodemographic characteristics of supplement users in the north of Iran.
Findings showed a quarter of our population consumed DS and the highest reported DS was calcium/vitamin D. Data from the United States national Health and Nutrition Examination Survey in 2017–2018 showed that 57% of adults have taken dietary supplements in the last 30 days and Supplements that were common in all age groups were multivitamins, followed by vitamins D and omega-3. These data also show an increasing trend in supplement consumption over the past decade . Evidence about DS use in the world shows that, in 2015, 71% of the Danish population were dietary supplement users . Reportedly, in 2017–2018 more than 50% of adults residing in the United States use DS on a regular basis for a variety of health reasons [39, 40]. Also, based on an Australian health survey during 2011–2012, less than one-third of Australians used a dietary supplement . In Iran, a study in 2010 found that 41.9% of health centers visitors in west Tehran had used at least one type of dietary supplement . In our population, DS use was associated with sex, age, educational level, urban living region, and economic status, while married participants were more likely to consume DS. These results are consistent with the findings from other studies. In a study  on 1633 students and staff members of a university in Australia, age, sex, and income factors were associated with the use of dietary supplements during illness. In a narrative review, Felicity et al.  showed that applying complementary and alternative medicine was related to the demographic characteristics of users. Some studies have also shown that supplement users are more likely to be female, old, and have a higher educational level [41, 43,44,45,46,47].
In our study, there was a significant difference between men and women in consuming DS. These differences may partly reflect marketing strategies targeting females. Alternatively, men and women may have different perceptions of health behaviors as well as nutrition and lifestyle, and women have a higher tendency to use supplements in order to prevent disease . Although some studies have identified marital status associated with DS use [45, 49], in our population, it did not seem to be a significant predictor.
Based on our results, the most DSs use was observed among those with academic education. Previous studies have shown that people with higher literacy have been reported to be more likely to intake DSs [44, 45], probably due to strong awareness of eating needs.
In the present study, non-smokers and those who did not drink alcohol were more likely to use DS, which was consistent with findings of previous studies [38, 50]. A cross-sectional study on 54,948 Danish people, aged 50 ≤ and < 64 years, showed that people with healthy lifestyles and more health-related awareness were more likely to be a DS users .
There is not sufficient evidence for reasons of higher consumption of DS in NCD patients of the studied population. It is assumed that patients may incline to change their life-style and to adopt some healthier and more protective habits such as healthy dietary habits and DS consumption following their doctors advice for controlling their disease .
Participants with CVD and those suffering from hypertension were more likely to consume DS in our study. In a meta-analysis, Bin et al. reviewed 20 studies that investigated the prevalence of DS use in cardiac patients in Australia. The result of the study revealed that overall, 36% of cardiac patients use DS . Another study by Karny-Rahkovich et al. in 2015 evaluated DS consumption in patients with cardiac disease; this study showed that DS use is common in cardiac patients, and 45% of them consumed DS . Gohar et al., in a Cross-sectional questionnaire survey in 2008 on hypertensive patients in the UK, showed that the prevalence of complementary and alternative medicine use was higher in hypertensive patients than in the UK population, and the most commonly used CAM (complementary and alternative medicine) were vitamins . CAM often was chosen by consumers instead of or in addition to antihypertensive medications . Data of Epirus Health cohort study showed that women with chronic diseases are more likely to receive supplements, and also in this data DS use showed an inverse association with diastolic blood pressure in women .
Our results showed that nearly 30% of diabetic participants consumed DS. This result was approximately one-third of the frequency of consumption reported by Ewers et al. in 2018 in the Danish population which reported almost all (99%) of people with diabetes were taking dietary supplements . On the other hand, a recent study found that DS use was lower in people with a diagnosis of diabetes .
In our population, obese participants and those with central obesity were more likely to consume DS in comparison with healthy subjects. This result is inconsistent with previous studies. Some studies have found that overweight/obese individuals are less likely to use supplements [38, 59, 60]. Barnes et al. showed that DS use is higher in people with BMI less than 24.9 kg/m2 . Also, findings of Burnett et al. on Australian adults from the 2011–2012 National Nutrition and Physical Activity Survey did not find a relationship between BMI and supplement use .
Previous studies showed that DS use is common among cancer survivors [61,62,63]. Friedman et al. found that participants with cancer were more likely to use DS than those whithout cancer, which after adjusting for age, race and gender, the difference between groups was no longer significant . In our population, only about 1% of cancer-diagnosed patients consumed DS. This may be because studies exploring the effect of DS on cancer outcomes are mixed, with some studies reporting benefits and others finding significant adverse outcomes . Also, the prevalence of cancer was very low in our study population; hence, data was limited to draw any conclusion. There is also a concern that DS might interfere with cancer treatments. For this reason, oncologists often recommend that patients avoid dietary supplements until their cancer treatment is over and encouraged to obtain micronutrients and phytonutrients associated with a reduced risk of cancer by consuming a diet rich in fruits, vegetables, legumes, and nuts .
There are some strengths and limitations to consider when interpreting the results of this study. A large sample size and considering geographic distribution from both rural and urban residents increases the accuracy and generalizability of results to the whole population. Some limitations of this study include a cross-sectional design that did not let us investigate any causal relationships. Also, self-report of DSs use may mask the actual intake report.
In conclusion, this study showed that a quarter of the participants were users of dietary supplements. Females, older age groups, and higher educated participants, and regarding NCDs, patients with HTN, CVD, and diabetes appeared to be more likely to consume dietary supplements.
Availability of data and materials
The study protocol and the datasets analyzed are available from the corresponding author upon request.
Non-communicable chronic diseases
World Health Organization
Body mass index
Systolic Blood Pressure
Diastolic Blood Pressure
Complementary and alternative medicine
Karimi S, Javadi M, Jafarzadeh F. Economic burden and costs of chronic diseases in Iran and the world. Health Inf Manag. 2012;8(7):984–96.
Organisation WH. Available from: https://www.who.int/health-topics/noncommunicable-diseases#tab=tab_1.
Mathers C. The global burden of disease: 2004 update: World Health Organization; 2008.
Hatmi Z, Tahvildari S, Motlag AG, Kashani AS. Prevalence of coronary artery disease risk factors in Iran: a population based survey. BMC Cardiovasc Disord. 2007;7(1):32.
Naghavi M. Death report from 10 provinces in Iran. Tehran: Ministry of health; 2000.
Hassanipour S, Fathalipour M, Salehiniya H. The incidence of prostate cancer in Iran: a systematic review and meta-analysis. Prostate Int. 2018;6(2):41–5.
Hassanipour S, Namvar G, Fathalipour M, Salehiniya H. The incidence of kidney cancer in Iran: a systematic review and meta-analysis. Biomedicine. 2018;8(2):9.
Khajebishak Y, Payahoo L, Homayouni Rad A, Shokrvash B. The role of intestinal microbiota in the health and a short review on the probiotic and prebiotic supplements in obesity prevention. Arak Med Univ J. 2014;17(90):18–26.
Organization WH. Chronic diseases and their common risk factors. Geneva: WHO; 2005.
Strong K, Mathers C, Leeder S, Beaglehole R. Preventing chronic diseases: how many lives can we save? Lancet. 2005;366(9496):1578–82.
Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9· 1 million participants. Lancet. 2011;377(9765):557–67.
Mansour-Ghanaei F, Joukar F, Mobaraki SN, Mavaddati S, Hassanipour S, Sepehrimanesh M. Prevalence of non-alcoholic fatty liver disease in patients with diabetes mellitus, hyperlipidemia, obesity and polycystic ovary syndrome: a cross-sectional study in north of Iran. Diabetes Metab Syndr. 2019;13(2):1591–6.
Mirahmadizadeh A, Fathalipour M, Mokhtari AM, Zeighami S, Hassanipour S, Heiran A. The prevalence of undiagnosed type 2 diabetes and prediabetes in eastern Mediterranean region (EMRO): a systematic review and meta-analysis. Diabetes Res Clin Pract. 2020;160:107931.
Malnick SD, Knobler H. The medical complications of obesity. J Assoc Physicians. 2006;99(9):565–79.
Briefel RR, Johnson CL. Secular trends in dietary intake in the United States. Annu Rev Nutr. 2004;24:401–31.
Miller MF, Bellizzi KM, Sufian M, Ambs AH, Goldstein MS, Ballard-Barbash R. Dietary supplement use in individuals living with cancer and other chronic conditions: a population-based study. J Am Diet Assoc. 2008;108(3):483–94.
Bailey RL, Gahche JJ, Lentino CV, Dwyer JT, Engel JS, Thomas PR, et al. Dietary supplement use in the United States, 2003–2006. J Nutr. 2011;141(2):261–6.
Stickel F, Kessebohm K, Weimann R, Seitz HK. Review of liver injury associated with dietary supplements. Liver Int. 2011;31(5):595–605.
Canter PH, Ernst E. Herbal supplement use by persons aged over 50 years in Britain. Drugs Aging. 2004;21(9):597–605.
Radimer K, Bindewald B, Hughes J, Ervin B, Swanson C, Picciano MF. Dietary supplement use by US adults: data from the National Health and nutrition examination survey, 1999–2000. Am J Epidemiol. 2004;160(4):339–49.
Henderson L, Gregory J, Swan G. Vitamin and mineral intake and urinary analytes. In: The National Diet and nutrition survey: adults aged 19 to 64 years; 2003. p. 3.
Guallar E, Stranges S, Mulrow C, Appel LJ, Miller ER III. Enough is enough: stop wasting money on vitamin and mineral supplements. Ann Intern Med. 2013;159(12):850–1.
Joukar F, Naghipour M, Hassanipour S, Fakhrieh Asl S, Pourshams A, Mansour-Ghanaei F. Vitamin D deficiency associated with reproductive factors in northern Iranian women: the PERSIAN Guilan cohort study (PGCS). Clin Nutr ESPEN. 2020;38:271–6.
Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP. Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: an updated systematic evidence review for the US preventive services task force. Ann Intern Med. 2013;159(12):824–34.
Grodstein F, O’Brien J, Kang JH, Dushkes R, Cook NR, Okereke O, et al. Long-term multivitamin supplementation and cognitive function in men: a randomized trial. Ann Intern Med. 2013;159(12):806–14.
Lin J, O’Connor E, Rossom RC, Perdue LA, Eckstrom E. Screening for cognitive impairment in older adults: a systematic review for the US Preventive Services Task Force. Ann Intern Med. 2013;159:601–12.
Akilen R, Tsiami A, Robinson N. Individuals at risk of metabolic syndrome are more likely to use a variety of dietary supplements. Adv Integr Med. 2014;1(3):131–7.
Mansour-Ghanaei F, Joukar F, Naghipour MR, Sepanlou SG, Poustchi H, Mojtahedi K, et al. The PERSIAN Guilan cohort study (PGCS). Arch Iran Med. 2019;22(1):39–45.
Poustchi H, Eghtesad S, Kamangar F, Etemadi A, Keshtkar A-A, Hekmatdoost A, et al. Prospective epidemiological research studies in Iran (the PERSIAN cohort study): rationale, objectives, and design. Am J Epidemiol. 2018;187(4):647–55.
Heshmat R, Khashayar P, Meybodi H, Homami MR, Larijani B. The appropriate waist circumference cut-off for Iranian population. Acta Med Indones. 2010;42(4):209–15.
Schneider H, Shaw J, Zimmet P. Guidelines for the detection of diabetes mellitus-diagnostic criteria and rationale for screening. Clin Biochem Rev. 2003;24(3):77.
Mirzaei M, Mirzaei M, Mirzaei M, Bagheri B. Changes in the prevalence of measures associated with hypertension among Iranian adults according to classification by ACC/AHA guideline 2017. BMC Cardiovasc Disord. 2020;20(1):1–9.
Joukar F, Naghipour M, Hassanipour S, Salari A, Alizadeh A, Saeidi-Saedi H, et al. Association of Serum Levels of vitamin D with blood pressure status in northern Iranian population: the PERSIAN Guilan cohort study (PGCS). Int J Gen Med. 2020;13:99–104.
Joukar F, Naghipour MR, Yeganeh S, Sepehrimanesh M, Keshtkar A, Ashoobi MT, et al. Validity and inter-observers reliability of blood pressure measurements using mercury sphygmomanometer in the PERSIAN Guilan cohort study. Blood Press Monit. 2020;25(2):100–4.
Joukar F, Yeganeh S, Naghipour M, Hassanipour S, Nikbakht HA, Mansour-Ghanaei F. Validation of Omron HBP-1100-E Professional Blood Pressure Measuring Device According to the American Association for the Advancement of Medical Instrumentation Protocol: the PERSIAN Guilan Cohort Study (PGCS), vol. 13. Auckland: Medical devices; 2020. p. 231–6.
Mahdavi-Roshan M, Rezazadeh A, Joukar F, Naghipour M, Hassanipour S, Mansour-Ghanaei F. Comparison of anthropometric indices as predictors of the risk factors for cardiovascular disease in Iran: the PERSIAN Guilan cohort study. Anatol J Cardiol. 2021;25(2):120–8.
Mishra S, Stierman B, Gahche JJ, Potischman N. Dietary supplement use among adults: United States, 2017–2018; 2021.
Kofoed CL, Christensen J, Dragsted LO, Tjønneland A, Roswall N. Determinants of dietary supplement use–healthy individuals use dietary supplements. Br J Nutr. 2015;113(12):1993–2000.
Marian MJ. Dietary supplements commonly used by cancer survivors: are there any benefits? Nutr Clin Pract. 2017;32(5):607–27.
Zhao L, Tyson N, Liu J, Hébert J, Steck S. Trends in Dietary Supplement Use Among US Adults Between 2009 and 2018. Curr Dev Nutr. 2021;5(Supplement_2):701.
Burnett AJ, Livingstone KM, Woods JL, McNaughton SA. Dietary supplement use among Australian adults: findings from the 2011–2012 national nutrition and physical activity survey. Nutrients. 2017;9(11):1248.
Najmabadi S, Nojomi M. Nutritional supplement use among adults in different areas of west Tehran. Iran J Endocrinol Metab. 2010;12(4):365–75.
Barnes K, Ball L, Desbrow B, Alsharairi N, Ahmed F. Consumption and reasons for use of dietary supplements in an Australian university population. Nutrition. 2016;32(5):524–30.
Islam M, Hasan MT, Al-Fuad MS, Al Mamun MA, Biswas BK, Razon AH, et al. Dietary supplements use and associated determinants among adult population in southern Bangladesh. Am J Food Sci Nutr Res. 2018;5(3):64–70.
Lee YJ, Kang M, Paik HY, Song Y. Use of dietary supplements and determinants of taking dietary supplements by gender in the Korean population: using the 4 th Korean National Health and nutrition examination survey (2007-2009). Korean J Commun Nutr. 2017;22(4):347–55.
Masumoto S, Sato M, Maeno T, Ichinohe Y, Maeno T. Factors associated with the use of dietary supplements and over-the-counter medications in Japanese elderly patients. BMC Fam Pract. 2018;19(1):20.
Sotoudeh G, Kabiri S, Yeganeh HS, Koohdani F, Khajehnasiri F, Khosravi S. Predictors of dietary supplement usage among medical interns of Tehran university of medical sciences. J Health Popul Nutr. 2015;33(1):68.
Conner M, Kirk SF, Cade JE, Barrett JH. Why do women use dietary supplements? The use of the theory of planned behaviour to explore beliefs about their use. Soc Sci Med. 2001;52(4):621–33.
Kato I, Nomura A, Stemmermann GN, Chyou P-H. Vitamin supplement use and its correlates among elderly Japanese men residing on Oahu, HI. Public Health Rep. 1992;107(6):712.
Peklar J, Henman MC, Richardson K, Kos M, Kenny RA. Food supplement use in the community dwelling population aged 50 and over in the Republic of Ireland. Complement Ther Med. 2013;21(4):333–41.
Rezazadeh A, Rashidkhani B. The association of general and central obesity with major dietary patterns of adult women living in Tehran, Iran. J Nutr Sci Vitaminol. 2010;56(2):132–8.
Bin YS, Kiat H. Prevalence of dietary supplement use in patients with proven or suspected cardiovascular disease. Evid Based Complement Alternat Med. 2010;2011.
Karny-Rahkovich O, Blatt A, Elbaz-Greener GA, Ziv-Baran T, Golik A, Berkovitch M. Dietary supplement consumption among cardiac patients admitted to internal medicine and cardiac wards. Cardiol J. 2015;22(5):510–8.
Gohar F, Greenfield SM, Beevers DG, Lip GY, Jolly K. Self-care and adherence to medication: a survey in the hypertension outpatient clinic. BMC Complement Altern Med. 2008;8(1):4.
Rasmussen CB, Glisson JK, Minor DS. Dietary supplements and hypertension: potential benefits and precautions. J Clin Hypertens. 2012;14(7):467–71.
Rontogianni MO, Kanellopoulou A, Markozannes G, Bouras E, Derdemezis C, Doumas MT, et al. Prevalence and determinants of sex-specific dietary supplement use in a Greek cohort. Nutrients. 2021;13(8):2857.
Ewers B, Trolle E, Jacobsen SS, Vististen D, Almdal TP, Vilsbøll T, et al. Data on the use of dietary supplements in Danish patients with type 1 and type 2 diabetes. Data Brief. 2019;22:241–4.
Friedman J, Birstler J, Love G, Kiefer D. Diagnoses associated with dietary supplement use in a national dataset. Complement Ther Med. 2019;43:277–82.
Gunther S, Patterson RE, Kristal AR, Stratton KL, White E. Demographic and health-related correlates of herbal and specialty supplement use. J Am Diet Assoc. 2004;104(1):27–34.
Pouchieu C, Andreeva VA, Péneau S, Kesse-Guyot E, Lassale C, Hercberg S, et al. Sociodemographic, lifestyle and dietary correlates of dietary supplement use in a large sample of French adults: results from the NutriNet-Sante cohort study. Br J Nutr. 2013;110(8):1480–91.
Ferrucci LM, McCorkle R, Smith T, Stein KD, Cartmel B. Factors related to the use of dietary supplements by cancer survivors. J Altern Complement Med. 2009;15(6):673–80.
Miller PE, Vasey JJ, Short PF, Hartman TJ. Description of dietary supplement use in adult cancer survivors. InOncology nursing forum 2009 Jan (Vol. 36, No. 1, p. 61). NIH Public Access.
Velicer CM, Ulrich CM. Vitamin and mineral supplement use among US adults after cancer diagnosis: a systematic review. J Clin Oncol. 2008;26(4):665–73.
Authors wish to thank all staff of Guilan center of Prospective Epidemiological Research Studies of the Iranian Adults (PERSIAN) cohort study for their kindly help in data collection.
A substantial part of this study was supported by the Research Council of Guilan University of Medical Sciences (Grant number: 1399.370).
Ethics approval and consent to participate
Written informed consent was taken after informing the purpose and importance of the study to each participant. To ensure confidentiality of participant’s information, codes were used whereby the name of the participant and any identifier of participants was not written on the questionnaire. The study protocol was in accordance with the guidelines of the 2013 version of the Helsinki Declaration and was confirmed by the Ethics Committee of Guilan University of Medical Sciences (Ethics code: IR.GUMS.REC.1399.370).
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Mahdavi-Roshan, M., Rezazadeh, A., Joukar, F. et al. Dietary supplements consumption and its association with socioeconomic factors, obesity and main non-communicable chronic diseases in the north of Iran: the PERSIAN Guilan Cohort Study (PGCS). BMC Nutr 7, 84 (2021). https://doi.org/10.1186/s40795-021-00488-2