You are on page 1of 10

Journal of Dietary Supplements

ISSN: 1939-0211 (Print) 1939-022X (Online) Journal homepage: http://www.tandfonline.com/loi/ijds20

Profiling the Use of Dietary Supplements by


Brazilian Physical Education Professionals

Ricardo Borges Viana, Maria Sebastiana Silva, Wellington Fernando da Silva,


Mário Hebling Campos, Marília dos Santos Andrade, Rodrigo Luiz Vancini &
Claudio Andre Barbosa de Lira

To cite this article: Ricardo Borges Viana, Maria Sebastiana Silva, Wellington Fernando da
Silva, Mário Hebling Campos, Marília dos Santos Andrade, Rodrigo Luiz Vancini & Claudio Andre
Barbosa de Lira (2017): Profiling the Use of Dietary Supplements by Brazilian Physical Education
Professionals, Journal of Dietary Supplements, DOI: 10.1080/19390211.2017.1406424

To link to this article: https://doi.org/10.1080/19390211.2017.1406424

Published online: 27 Dec 2017.

Submit your article to this journal

Article views: 3

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at


http://www.tandfonline.com/action/journalInformation?journalCode=ijds20

Download by: [Australian National University] Date: 29 December 2017, At: 06:11
JOURNAL OF DIETARY SUPPLEMENTS
https://doi.org/./..

RESEARCH ARTICLE

Profiling the Use of Dietary Supplements by Brazilian Physical


Education Professionals
Ricardo Borges Viana, MSca , Maria Sebastiana Silva, PhDa , Wellington Fernando da Silva,
BSca , Mário Hebling Campos, PhDa , Marília dos Santos Andrade, PhDb ,
Rodrigo Luiz Vancini, PhDc , and Claudio Andre Barbosa de Lira, PhDa
a
Setor de Fisiologia Humana e do Exercício, Faculdade de Educação Física e Dança, Universidade Federal de
Goiás, Goiânia, Brazil; b Departmento de Fisiologia, Universidade Federal de São Paulo, São Paulo, Brazil;
Downloaded by [Australian National University] at 06:11 29 December 2017

c
Centro de Educação Física e Desporto, Universidade Federal do Espírito Santo, Vitória, Brazil

ABSTRACT KEYWORDS
A survey was designed to examine the use of dietary supplements dietary supplements;
by Brazilian physical education professionals. The study included 131 physical education; training;
Brazilian physical education professionals (83 men and 48 women). whey protein
A descriptive statistical analysis was performed (mean, standard
deviation, and absolute and relative frequencies). A chi-square test
was applied to evaluate differences in use of dietary supplements
according to particular variables of interest (p < .05). Forty-nine percent
of respondents used dietary supplements. Approximately 59% of
dietary supplement users took two or more kinds of supplements.
Among users of supplements, men professionals (73%) consumed more
dietary supplements than women (27%). The most-consumed dietary
supplement was whey protein (80%). The results showed a higher use
of dietary supplements by men. The most-consumed supplements
were rich in protein. The consumption of dietary supplements by
almost half of the participants in this study suggests that participants
did not consider their dietary needs to be met by normal diet alone.

Introduction
Several national health agencies publish food and nutrient intake guidelines to provide the
general public and health practitioners with evidence-based recommendations on nutrient
and dietary intakes associated with a low risk of nutrient deficiencies and diet-related chronic
diseases (Thompson and Veneman, 2005; Rodriguez et al., 2009). Indeed, there is consen-
sus that a balanced diet is sufficient to meet an individual’s energy and nutrient demands
(Rodriguez et al., 2009). Despite these public health recommendations, the number of dietary
supplement users has increased dramatically (Goston, 2008). This increase can be explained
by the demands of modern life; people whose hectic daily routine leaves little time for feeding
and food preparation make use of supplements because of their convenience. People also use
dietary supplements with the purpose of improving physical fitness and performance (Rigon
and Rossi, 2012). However, the use of dietary supplements is often accompanied by a lack
of knowledge about proper nutrition; on many occasions the use of dietary supplements is
unnecessary (Rigon and Rossi, 2012).

CONTACT Claudio A. B. de Lira, PhD andre.claudio@gmail.com Faculdade de Educação Física e Dança, Universidade
Federal de Goiás, Avenida Esperança s/n, Campus Samambaia- CEP: .–. Goiânia, Goiás, Brazil.
©  Taylor & Francis Group, LLC
2 R. B. VIANA ET AL.

On the other hand, dietary supplementation is beneficial when there is a shortage of nutri-
ents obtained through food (ADA, 2005). In this context, dietary supplements can be recom-
mended to those at risk of nutritional deficiencies such as children, elderly people, and athletes
(Meirelles et al., 2001; Fletcher and Fairfield, 2002). For those undertaking regular physical
activity, practitioners, and/or people whose professional activities depend on physical fitness,
good nutrition attenuates the physical exhaustion resulting from training sessions and/or
competitions (especially those activities characterized by high intensity and long duration)
(Hasson and Barnes, 1989), reduces muscle fatigue and the incidence of injury (Brouns et al.,
1986), optimizes energy deposits (Kang et al., 2016), improves the status of micronutrients
(Sherman and Costill, 1984), increases muscle mass (Clarkson and Rawson, 1999), improves
athletic performance (Sherman and Costill, 1984; Tokmakidis and Karamanolis, 2008), and
contributes to the overall health of the individual (Nieman, 2011; Mitchell et al., 2013).
In Brazil, physical education professionals are health professionals responsible for organiz-
Downloaded by [Australian National University] at 06:11 29 December 2017

ing, following up, and monitoring physical activity programs. Physical education profession-
als who work in gyms are challenged to teach and direct exercise programs for clients, and
this, coupled with their own individual training sessions, makes the professional’s daily rou-
tine physically exhausting; this can lead to health problems. For example, Cunha et al. (2014)
studied 46 physical education professionals who worked between 31 and 40 hours per week
and found that they had health problems with their voices due to their work since the voice
is used to influence student discipline, raise the level of awareness, and explain the perfor-
mance of the activities proposed, besides being important to encourage and motivate them to
continue the execution of the exercise. Goossens et al. (2016) studied 103 physical education
professionals and 58 non–physical education professionals and found that physical education
professionals had a more extensive injury history.
Understanding the demographic characteristics of those who use supplements and the
nature of the supplements used can help to develop effective public health interventions
to reduce the consumption of unnecessary dietary supplements (Rodriguez et al., 2009).
Since studies detailing dietary supplement use for physical education professionals are, to our
knowledge, relatively scarce, we conducted a survey to examine the extent to which physi-
cal education professionals use dietary supplements. This study tested the hypothesis that the
prevalence of supplement use among physical education professionals is high and that this
prevalence is higher among professionals who have a greater amount of weekly exercise.

Methods

Participants
The study included 131 (83 men and 48 women) Brazilian physical education profession-
als (age 27.1 ± 6.0 years, height 175.5 ± 9.1 cm, weight 73.7 ± 13.9 kg, and body mass index
[BMI] 24.7 ± 3.8 kg/m2 ). Participants were recruited from the largest gyms and physical activ-
ity centers located in Goiânia (Goiás, Brazil). Inclusion criterion was to be a physical education
professional hired by the gym. Table 1 shows the general characteristics of the participants.
Height, weight, and body mass index were significantly higher in men than in women (all
p < .001).
Participants were informed of the potential risks and benefits of the study and signed
an informed consent form to take part. All experimental procedures were approved by the
University Human Research Ethics Committee and conformed to the principles outlined in
the Declaration of Helsinki.
JOURNAL OF DIETARY SUPPLEMENTS 3

Table . Age, height, WEIGHT, and BMI of participants according to sex.


Men (n = ) Women (n = ) p Total (N = )

Age (years) . ± . . ± . . . ± .


Height (cm) . ± .∗ . ± . < . . ± .
Weight (kg) . ± .∗ . ± . < . . ± .
BMI (kg/m ) . ± .∗ . ± . < . . ± .

Values are presented as mean ± standard deviation. BMI = body mass index.
∗ Statistically different from women; p resulted from Mann-Whitney test.

Survey
A self-administered survey was designed to investigate the use of dietary supplements. The
survey contained eight items with simple and closed-end type response scales. Questions con-
cerned: (a) professional experience (two questions), (b) physical training regimen (four ques-
Downloaded by [Australian National University] at 06:11 29 December 2017

tions), and (c) use of dietary supplements (two questions). The following questions assess the
physical training regimen: (1) How many days a week do you practice physical activity? (2)
How many hours a day do you practice physical exercise? (3) What kind of physical exer-
cise do you practice? and (4) How long (months) do you maintain this routine of physical
exercise? The questions used to assess the use of dietary supplements were as follows: (1) Do
you often consume dietary supplements aimed at improving your performance (yes or no)?
and (2) Which ones? (creatine and/or branch chain amino acids [BCAA]; amino acids and/or
whey protein and/or carbohydrates and/or others – please specify). For the purposes of this
study, the “often” term was defined as consumption of dietary supplements at least three times
per week. Participants were asked to answer the question according to this definition.

Statistical analysis
A descriptive statistical analysis was performed (mean, standard deviation, and absolute
and relative frequencies). Weight presented normal distribution according to Kolmogorov-
Smirnov test; for this reason, an unpaired Student’s t test was used to compare variables
obtained between sexes. Age, height, and body mass index did not present normal distribu-
tion according to Kolmogorov-Smirnov test; for this reason, a Mann-Whitney test was used
to compare variables obtained between sexes. A chi-square test was applied to evaluate possi-
ble differences in use of dietary supplements, physical training frequencies, session volumes,
work areas, types of training performed, main objectives of training, and number of dietary
supplements consumed between men and women. A significance level of .05 was adopted for
all statistical tests.

Results
The participants had 5.4 ± 5.2 years of professional experience, and 77.1% (n = 101) worked
at least with resistance training, while the remaining 22.9% (n = 30) were distributed on
the modalities of fighting, gymnastics/cycling, running, swimming, hydrogymnastics, and/or
others. Regarding the training regimen, 30.5% (n = 40) of participants trained four times
per week, 42.7% (n = 56) of participants trained five times per week, 17.6% (n = 23) of par-
ticipants trained six times per week, and 9.2% (n = 12) of participants trained seven times
per week. Of the participants, 91.6% (n = 120) trained for 1–2 hours/session, 3.8% (n = 5)
trained for 3–4 hours/session, 3.8% (n = 5) trained for 5–6 hours/session, and 0.8% (n = 1)
trained for 7 or more hours/session. With regard to the main objective of physical training,
4 R. B. VIANA ET AL.

Table . Training regimen and main objective of physical training of participants according to sex.
Men (n = ) Women (n = ) Total (N = )

Type of traininga
Resistance training .% (n = ) .% (n = ) .% (n = )
Fighting .% (n = ) .% (n = ) .% (n = )
Gymnastics/cycling .% (n = ) .% (n = ) .% (n = )
Running .% (n = ) .% (n = ) .% (n = )
Sports .% (n = ) .% (n = ) .% (n = )
Other .% (n = ) .% (n = ) .% (n = )
Weekly training
x/week .% (n = ) .% (n = ) .% (n = )
x/week .% (n = ) .% (n = ) .% (n = )
x/week .% (n = ) .% (n = ) .% (n = )
x/week .% (n = ) .% (n = ) .% (n = )
Hours/session
– .% (n = ) .% (n = ) .% (n = )
Downloaded by [Australian National University] at 06:11 29 December 2017

– .% (n = ) .% (n = ) .% (n = )


– .% (n = ) .% (n = ) .% (n = )
ࣙ % (n = ) .% (n = ) .% (n = )
Main objective of physical training
Health .% (n = ) .% (n = ) .% (n = )
Body aesthetics .% (n = ) .% (n = ) .% (n = )
Physical fitness .% (n = ) .% (n = ) .% (n = )
Physical performance .% (n = ) .% (n = ) .%% (n = )
Quality of life .% (n = ) .% (n = ) .% (n = )
Professional work capacity .% (n = ) % (n = ) .% (n = )
Leisure .% (n = ) .% (n = ) .% (n = )
a The sum of men and women does not result in the total number of men and women since there were participants who per-
formed more than one type of training.

30.5% (n = 40) undertook regular physical exercise to improve their health, 22.9% (n = 30)
to improve body aesthetics, 13.0% (n = 17) to improve physical fitness, 12.2% (n = 16) to
improve physical performance, 10.7% (n = 14) to improve quality of life, 7.6% (n = 10) to
improve professional work capacity, and 3.1% (n = 4) for leisure purposes. All these data are
shown in Table 2 according to gender.
Forty-nine percent of the physical education professionals surveyed (n = 64) stated that
they used dietary supplements to improve their performance, of which 73% (n = 47) were
men and 27% (n = 17) were women. A chi-square test revealed that men professionals con-
sumed significantly more dietary supplements than women (p < .05). Among the dietary
supplements analyzed, whey protein was the most commonly used (80%, n = 51), followed
by BCAA (53%, n = 34), carbohydrates (27%, n = 17), creatine (25%, n = 16), and others
(albumin, thermogenic, glutamine, and/or vitamin C [17%, n = 11]). Table 3 presents the
descriptive data about dietary supplement consumption by gender.
Figure 1 shows that among the participants who consumed dietary supplements, most
reported taking one or two types of supplements. In addition, there was no significant dif-
ference in the quantity of dietary supplements consumed between genders (p = .285).

Table . Dietary supplements used by physical education professionals.


Men (n = )a∗ Women (n = )a Total (n = )a

Creatine % (n = ) % (n = ) % (n = )


BCAA/amino acids % (n = ) % (n = ) % (n = )
Whey protein % (n = ) % (n = ) % (n = )
Carbohydrates % (n = ) % (n = ) % (n = )
Others % (n = ) % (n = ) % (n = )
a The sum of users of respective supplements does not result in the total number of men and women since there were partici-
pants who took more than one kind of supplement (Figure ); BCAA = branch chain amino acids; n = number of participants.
JOURNAL OF DIETARY SUPPLEMENTS 5
Downloaded by [Australian National University] at 06:11 29 December 2017

Figure . The number of supplements taken by physical education professional supplement users surveyed.

The chi-square test revealed that those professionals that trained more times per week
consumed significantly more dietary supplements (p < .01) and that there were no significant
differences in consumption in regard to daily training volume (p = .690), work area (p = .107),
types of training performed (p = .255), or the main objectives of training (p = .681) (Table 4).

Discussion
The main objective of this study was to describe and analyze the use of dietary supplements by
Brazilian physical education professionals. To the best of our knowledge, this is the first study
profiling the use of dietary supplements in this population. Our results from this convenience
sample of physical education professionals indicate that dietary supplement use is common;

Table . Association of consumption of dietary supplements with training regimen and main objective of
physical training.
Consumption of dietary supplements
Yes (n = ) No (n = ) Total (N = ) p

Type of training .


 Modality .% (n = ) .% (n = ) .% (n = )
 Modalities .% (n = ) .% (n = ) .% (n = )
 Modalities .% (n = ) .% (n = ) .% (n = )
Weekly training <.
x/week .% (n = ) .% (n = ) .% (n = )
x/week .% (n = ) .% (n = ) .% (n = )
x/week .% (n = ) .% (n = ) .% (n = )
x/week .% (n = ) .% (n = ) .% (n = )
Hours/session .
– .% (n = ) .% (n = ) .% (n = )
– .% (n = ) .% (n = ) .% (n = )
– .% (n = ) .% (n = ) .% (n = )
ࣙ .% (n = ) .% (n = ) .% (n = )
Main objective of physical training .
Health .% (n = ) .% (n = ) .% (n = )
Body aesthetics .% (n = ) .% (n = ) .% (n = )
Physical fitness .% (n = ) .% (n = ) .% (n = )
Physical performance .% (n = ) .% (n = ) .% (n = )
Quality of life .% (n = ) .% (n = ) .% (n = )
Professional work capacity .% (n = ) .% (n = ) .% (n = )
Leisure .% (n = ) .% (n = ) .% (n = )

Data are shown as relative frequency (absolute frequency); p value refers to chi-square test.
6 R. B. VIANA ET AL.

49% of the participants reported using some type of dietary supplement. In addition, we found
that the prevalence of supplement use among physical education professionals was higher
among professionals who have a greater amount of weekly exercise (those professionals who
trained more times per week).
Previous studies have also shown a high prevalence in the use of dietary supplements
among athletes and physical activity practitioners. Tian et al. (2009) investigated the intake
of dietary supplements in 82 college athletes and found a prevalence of approximately 77%.
Aljaloud and Ibrahim (2013) reported that among 105 professional soccer players in Saudi
Arabia, 98.3% used dietary supplements. The most-consumed dietary supplements were
sports drinks (88.7%), vitamin C (82.6%), and a multivitamin complex (52%). Athletes jus-
tified this high intake of dietary supplements as an attempt to improve health and athletic
performance.
Kristiansen et al. (2005) conducted a study with varsity athletes at a Canadian university
Downloaded by [Australian National University] at 06:11 29 December 2017

and reported a prevalence in the use of dietary supplements of approximately 99%. Among
the dietary supplements used, athletes cited sports drinks, gel carbohydrate, protein powder,
and creatine. In our study, the most widely used supplements were amino acids and proteins.
We believe that this result is because 77.1% of the volunteers practiced resistance training.
Bearing in mind that the main objective of resistance training is muscle hypertrophy, it is
expected that the most-used supplement would be an amino acid and protein based. Indeed,
Nieman (2011) reported that several individuals who exercise, especially resistance training,
believe that consuming food with high protein content and protein supplements is necessary
for developing muscle mass. Bianco et al. (2011) analyzed 207 volunteers (127 men and 80
women) who attended a fitness center in Palermo (Italy) and found that volunteers cited
protein supplements to be the way to gain muscle mass and strength. El Khoury and Antoine-
Jonville (2012) reported a prevalence of 36.3% in the use of dietary supplements among
512 individuals who undertook regular physical activity in the gyms of Beirut (Lebanon).
The most widely used supplements were protein powders (39.8%), amino acids in pill form
(34.9%), and whey protein (32.2%). The most common reasons reported for the use of food
supplements was for muscle mass or weight gain (47.3%). Oliver et al. (2011) evaluated the
intake of protein powder supplements in 415 gym attendees in the city of Seville (Spain) and
found that 28% of the total sample used this type of supplement. These results are similar
to those found by Goston and Correia (2010), who analyzed the dietary supplement intake
of 1,102 people who attended 50 gyms in the city of Belo Horizonte (Brazil) and found that
approximately 37% of volunteers used dietary supplements, and of those, 58% consumed
amino acids and protein supplements. Bianco et al. (2011) found that 30.1% of people who
undertook physical activity in the fitness center in Palermo (Italy) used protein supplements.
In addition, Bianco et al. (2014) reported that individuals consuming protein supplements
also had high-protein food diets. It is noteworthy that the consumption of 0.8 grams of
protein per kilogram of body weight is recommended by the American Dietetic Association,
Dietitians of Canada, and American College of Sports Medicine for those with a typically
sedentary lifestyle, whereas for very active individuals one ingestion of 50% to 125% of this
value is recommended (Rodriguez et al., 2009). Furthermore, excessive intake of protein and
amino acids may be potentially harmful to health since they can cause disorders of bone and
calcium homeostasis, disorders of renal function, increased cancer risk, and disorders of liver
function and can precipitate progression of coronary artery disease (Delimaris, 2013).
In our study, the prevalence of consumption of dietary supplements and protein supple-
ments is higher than that found in previous studies (49% and 80%, respectively). However,
these findings are in line with a study conducted by Dickinson et al. (2012). These authors
JOURNAL OF DIETARY SUPPLEMENTS 7

verified the use of dietary supplements among dieticians and investigated whether dieticians
recommend dietary supplements to their patients or clients. The authors found that 74% of the
dieticians surveyed said they were regular users of dietary supplements. When asked whether
they “ever recommend dietary supplements to clients,” 97% of the respondents said they did.
Other studies have also shown regular dietary supplement use was reported in over 70% of
dieticians and nurse practitioners; around 60% of pharmacists, nurses and dermatologists;
about 50% of family care physicians, obstetrician/gynecologist physicians, and orthopedists;
and 37% of cardiologists (Dickinson et al., 2009, 2011). Altogether, these data suggest that
health professionals use and promote dietary supplement consumption. Bearing in mind that
the physical education professionals investigated in this study are also health professionals in
the fitness and wellness sphere, this can be considered a possible explanation for our findings.
Another explanation for the higher prevalence of dietary supplement consumption in our
findings is associated with educational status. National Health and Nutrition Examination
Downloaded by [Australian National University] at 06:11 29 December 2017

Surveys (Radimer et al., 2004; Bailey et al., 2011) showed that use of dietary supplements
increases in line with level of education. Since physical health professionals are likely to hold
college degrees, this could be another explanation for the high consumption found in this
group.
Another interesting finding of the present study is that consumption of dietary supple-
ments by men (73%) is higher than that by women (27%). Bianco et al. (2014), Kristiansen
et al. (2005), Oliver et al. (2011), El Khoury and Antoine-Jonville (2012), Lacerda et al. (2015),
and Goston and Correia (2010) studied dietary supplement use and also found that consump-
tion was higher in men than in women. In this respect, our results are in accordance with the
literature. Conceivably, this greater consumption of dietary supplements by men is due to a
greater interest in increasing muscle strength and hypertrophy as previously reported.

Limitations of study
The major limitation of this study is the sampling method (convenience sample), since it
is difficult to generalize the results. In addition, some people may benefit from supplement
use, such as those with a nutrient deficiency and individuals consuming diets that exclude
(or contain fewer) food groups who may be at an increased risk of inadequate dietary intake
(Meirelles et al., 2001; Fletcher and Fairfield, 2002). However, in the current study, it was not
possible to identify participants who may have benefited from dietary supplement use since
these data were not collected. Neither did we assess objectively the quantity and frequency
of dietary supplements consumed, which means that we are unable to determine whether
participants’ supplement consumption accords with current recommendations. Last, the par-
ticipants’ reasons for taking dietary supplements were not investigated.

Conclusion
Despite nutrition authorities consistently advocating a “food first” approach to achieving
nutritional adequacy, we found a high consumption of dietary supplements by a convenience
sample of physical education professionals, especially supplements constituted by protein. In
addition, we found a higher use of dietary supplements among men and in those professionals
who trained longer per week. The consumption of dietary supplements by almost half of the
participants in this study suggests that participants did not consider that their dietary needs
could be met by a normal diet alone or that excessive intake of protein could harm their health.
Thus, additional research is needed to better understand the need for dietary supplements in
8 R. B. VIANA ET AL.

this population. Although a convenience sampling method (limitation of current study) was
used, we believe that these limitations do not negate the conclusions of the study.

Acknowledgments
The authors thank all the participants who volunteered their time to participate in this study.

Declaration of interest
The authors report no conflicts of interest. The authors are responsible for the content and writing of
the article.
Downloaded by [Australian National University] at 06:11 29 December 2017

About the authors


Ricardo Borges Viana, MSc, is a PhD candidate in the Faculty of Medicine at Federal University of
Goiás, Goiânia, Brazil.
Maria Sebastiana Silva, PhD, is an associate professor in the Faculty of Physical Education and Dance
at Federal University of Goiás, Goiânia, Brazil.
Wellington Fernando da Silva, BSc, is a MSc candidate in the Faculty of Medicine at Federal University
of Goiás, Goiânia, Brazil.
Mário Hebling Campos, PhD, is an adjunct professor in the Faculty of Physical Education and Dance
at Federal University of Goiás, Goiânia, Brazil.
Marília dos Santos Andrade, PhD, is an adjunct professor in the Department of Physiology at Federal
University of São Paulo, São Paulo, Brazil.
Rodrigo Luiz Vancini, PhD, is an adjunct professor in the Center for Physical Education and Sports at
Federal University of Espírito Santo, Vitória, Brazil.
Claudio Andre Barbosa de Lira, PhD, is an associate professor in the Faculty of Physical Education and
Dance at Federal University of Goiás, Goiânia, Brazil.

References
ADA. 2005. Practice Paper of the Dietary Reference Intakes. American Dietetic Association: Dietary
Supplements. J. Am. 105(3):461–470.
Aljaloud SO, Ibrahim SA. 2013. Use of Dietary Supplements among Professional Athletes in Saudi
Arabia. J. Nutr. Metab. 2013:1–7.
Bailey RL, Gahche JJ, Lentino CV, Dwyer JT, Engel JS, Thomas PR, Betz JM, Sempos CT, Picciano MF.
2011. Dietary Supplement Use in the United States, 2003–2006. J Nutr 141(2):261–266.
Bianco A, Mammina C, Paoli A, Bellafiore M, Battaglia G, Caramazza G, Palma A, Jemni M. 2011.
Protein Supplementation in Strength and Conditioning Adepts: Knowledge, Dietary Behavior and
Practice in Palermo, Italy. J Int Soc Sport. Nutr 8(1):25.
Bianco A, Mammina C, Thomas E, Bellafiore M, Battaglia G, Moro T, Paoli A, Palma A. 2014. Protein
Supplementation and Dietary Behaviours of Resistance Trained Men and Women Attending Com-
mercial Gyms: A Comparative Study between the City Centre and the Suburbs of Palermo, Italy. J
Int Soc Sport. Nutr 11:30.
Brouns F, Saris W, Hoor FT. 1986. Nutrition as a Factor I the Prevention of Injuries in Recreational and
Competitive Downhill Skiing. J. Sport. Med. Balt. 9(4):1121–1129.
Clarkson PM, Rawson ES. 1999. Nutritional Supplements to Increase Muscle Mass. Crit Rev Food Sci
Nutr 39(4):317–328.
JOURNAL OF DIETARY SUPPLEMENTS 9

Cunha DS, De Abreu LC, Frizzo AC, Cardoso MA, Valenti VE. 2014. Vocal Complaint in Physical
Education Teachers and Its Association with the Cardiovascular System. Int Arch Med 7(1):7.
Delimaris, I. 2013. Adverse Effects Associated with Protein Intake above the Recommended Dietary
Allowance for Adults. ISRN Nutr. 2013:126929.
Dickinson A, Boyon N, Shao A. 2009. Physicians and Nurses Use and Recommend Dietary Supple-
ments: Report of a Survey. Nutr J. 8:29.
Dickinson A, Shao A, Boyon N, Franco JC. 2011. Use of Dietary Supplements by Cardiologists, Derma-
tologists and Orthopedists: Report of a Survey. Nutr. J. 11:20.
Dickinson A, Bonci L, Boyon N, Franco JC. 2012. Dietitians Use and Recommend Dietary Supplements:
Report of a Survey. Nutr J 11:14.
Fletcher RH, Fairfield KM. 2002. Vitamins for Chronic Disease Prevention in Adults: Clinical Applica-
tions. JAMA. 287(23):3127–3129.
Goossens L, Vercruysse S, Cardon G, Haerens L, Witvrouw E, De Clercq D. 2016. Musculoskeletal
Injuries in Physical Education versus Non-Physical Education Teachers: A Prospective Study. J
Sport. Sci. 34(12):1107–1115.
Downloaded by [Australian National University] at 06:11 29 December 2017

Goston JL. 2008. Prevalência Do Uso de Suplementos Nutricionais Entre Praticantes de Atividade Física
Em Academias de Belo Horizonte: Fatores Associados. Belo Horizonte (Brazil): Universidade Fed-
eral de Minas Gerais Vol. 2008, Pós-Gradua.
Goston JL, Correia MI. 2010. Intake of Nutritional Supplements among People Exercising in Gyms and
Influencing Factors. Nutrition. 26(6):604–611.
Hasson S, Barnes WS. 1989. Effects of Carbohydrate Ingestion on Exercise of Varying Intensity and
Duration. Sport. Med. Auckl. 4(2):110–201.
Kang M, Kim DW, Lee H, Lee YJ, Jung HJ, Paik HY, Song YJ. 2016. The Nutrition Contribution
of Dietary Supplements on Total Nutrient Intake in Children and Adolescents. Eur J Clin Nutr
70(2):257–261.
El Khoury D, Antoine-Jonville S. 2012. Intake of Nutritional Supplements among People Exercising in
Gyms in Beirut City. J Nutr Metab. 2012:703490.
Kristiansen M, Levy-Milne R, Barr S, Flint A. 2005. Dietary Supplement Use by Varsity Athletes at a
Canadian University. Int J Sport Nutr Exerc Metab 15(2):195–210.
Lacerda FM, Carvalho WR, Hortegal EV, Cabral NA, Veloso HJ. 2015. Factors Associated with Dietary
Supplement Use by People Who Exercise at Gyms. Rev Saude Publica. 49:63.
Meirelles CD, Da Veiga GV, Soares ED. 2001. Nutritional Status of Vegetarian and Omnivorous Ado-
lescent Girls. Nutr. Res. 21:689–702.
Mitchell NM, Potteiger JA, Bernardoni B, Claytor RP. 2013. Effects of Carbohydrate Ingestion during
Exercise on Substrate Oxidation in Physically Active Women with Different Body Compositions.
Appl Physiol Nutr Metab 38(3):314–319.
Nieman DC. 2011. Exercise Testing and Prescription – A Health-Related Approach, 6th ed. McGraw-
Hill Companies.
Oliver AJS, Leon MTM, Hernandez EG. 2011. Prevalence of Protein Supplement Use at Gyms. Nutr
Hosp 26(5):1168–1174.
Radimer K, Bindewald B, Hughes J, Ervin B, Swanson C, Picciano MF. 2004. Dietary Supplement Use
by US Adults: Data from the National Health and Nutrition Examination Survey, 1999–2000. Am J
Epidemiol 160(4):339–349.
Rigon TV, Rossi RGT. 2012. Quem E Porque Utilizam Suplementos Alimentares? Rev. Bras. Nutr.
Esportiva 6 (36):420–426.
Rodriguez NR, DiMarco NM, Langley S. 2009. Position of the American Dietetic Association, Dietitians
of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance. J Am
Diet Assoc 109(3):509–527.
Sherman WM, Costill DL. 1984. The Marathon: Dietary Manipulation to Optimize Performance. Am.
J. Sport. Med. Columbus 24(5):200–2015.
Thompson TG, Veneman AM. Dietary Guidelines for Americans. 2005. http://www.health.gov/
dietaryguidelines/dga2005/report/HTML/D3_Disccalories.htm.
Tian HH, Ong WS, Tan CL. 2009. Nutritional Supplement Use among University Athletes in Singapore.
Singapore Med J 50(2):165–172.
Tokmakidis SP, Karamanolis IA. 2008. Effects of Carbohydrate Ingestion 15 Min before Exercise on
Endurance Running Capacity. Appl Physiol Nutr Metab 33(3):441–449.