Explanations for Dietary and Muscle Enhancement Supplement Use Among College Students: A National Cross-Sectional Study | BMC Nutrition

Summary of Findings

This study aimed to explore the frequency and reasons for the use of DS, as well as the frequency and explanatory factors for the use of MEDS particularly among male and female university students.

Among Norwegian university students, a similar frequency of men (42.3%) and women (39.5%) reported using the DS. Most students reported being in good health, improving physical or mental performance, and increasing muscle mass, as reasons for using the DS in general. Up to 1 in 4 men and 1 in 10 women used MEDS, with a significant gender difference. Among men, being a member of a gym, exercising to improve muscle mass, and a higher level of physical activity positively explained MEDS use, while exercise to increase endurance and being an exercise science student negatively explained the use of MEDS. In women, internalization of the athletic body ideal and exercise to improve muscle mass positively explained the use of MEDS.

Frequency of use of dietary supplements and muscle building supplements

The frequency of DS and MEDS use in our sample is lower than previously reported [2, 5, 7,8,9]. Differences in BMI do not appear to explain these differences, as BMI in the current sample is comparable to previous student samples [2, 5, 13, 35]. Differences in the use of DS in general, and MEDS in particular, compared to other studies, may have been influenced by how “use” was defined, in which our study asked about ” current use”, while previous studies asked about “use”. last six months » [2, 7, 8] or “last 12 months” [9]. Our results indicate a low frequency of illegal DS use (0.3% in both sexes), which is lower than previous results in Norwegian men (2.9%) and women (1.0%) trying to undergo basic military training. [38].

The lack of a gender difference in DS use in general echoes what most studies from other countries have found. [5, 6, 11, 13, 14]. However, our study is among the few that have investigated gender differences for specific supplements, such as MEDS, and supports the hypothesis that men are more likely to use MEDS than women. [5, 8, 11]. This gender difference may reflect a gap in advertising targeting men and women [39]. It could also reflect a longer period of idealization of the muscular body in the history of masculinity, resulting in a more established focus on using supplements to achieve this body ideal in men compared to women. [40].

Reasons for using dietary supplements

The most frequently reported reasons for DS use among our college students, where ‘to maintain or improve health’, ‘enhance mental or physical performance’ and ‘increase muscle mass’, similar to what others student samples reported [2, 5, 9,10,11]. Unlike previous studies, we also looked at gender differences and found that significantly more men than women reported using DS to improve performance and muscle mass, and to increase weight for looks. This gender difference may underscore the pressure on under-communicated body appearance among male students [21]and their use of body modification methods.

Explanatory factors for the use of muscle-enhancing dietary supplements

Among men, being a member of a fitness center explained most of the variance in MEDS use, indicated by the fact that they were four times more likely to use MEDS than not be members. This result is consistent with the findings of Norwegian secondary school students [24] but brings new in-depth information regarding adults [31, 32]. Additionally, consistent with results in high school students, although higher level of physical activity slightly increases the odds of MEDS use in men, our results are not consistent between MEDS use and participation in organized sports. [24]. Possible explanations could be the culture within fitness centers, where the sale and use of these products is encouraged [31]and where the emphasis is on appearance and body shape, as opposed to performance, enjoyment, health and social orientation, more promoted in organized sports [29, 30, 41].

Among men, reporting exercise “to increase muscle mass” nearly doubled the odds of using MEDS, consistent with previous findings among US male fitness club members [32]. This is to be expected, as those aiming to improve muscle strength might be more receptive to advertising claiming to give you a quick fix to improve muscle strength. In contrast, reporting exercise “to increase endurance” reduced the odds of using MEDS, which makes sense given less intensive reports related to the products’ effects on endurance and less need for building muscle when aiming to improve endurance.

Finally, among men, we also found that being an exercise science student, relative to other students, reduced the odds (OR: 0.47) of using the MEDS. Our finding adds to current knowledge about differences in MEDS use between groups of students. First, because previous studies of curriculum differences have investigated differences in DS use in general, not MEDS specifically. Second, previous studies included nursing, medical, and pharmacy students as health-related students who, unlike exercise science students, do not have a background in sports nutrition and in exercise physiology, and represent a very different group of students. . Educating students in exercise science provides them with knowledge about sports nutrition and exercise that may have equipped them with lifestyle-related media literacy. This argument is based solely on the authors’ knowledge of the exercise science students’ curriculum, as we did not measure supplement knowledge in our sample. However, one study supports our suggested explanation, finding that students with higher media literacy were less likely to be DS users. [14]. Additionally, exercise science students are exposed to a social environment that does not emphasize the need for supplements and specialty products in addition to or at the expense of real food.

Among female students, internalization of the athletic body ideal and exercise to increase muscle mass, being two highly coincidental elements, partially explained the variance in MEDS use, after adjusting for all other variables in the model. of regression. New in adults is the finding that women who internalized the athletic body ideal and exercised to increase muscle mass were almost twice as likely to use MEDS. However, this supports earlier findings in Norwegian adolescent girls [24]and further point out that dealing with improving physical appearance towards the muscular body ideal, helps to explain the use of MEDS.

Based on our findings that explanatory factors vary between genders, one could speculate whether men’s habits related to MEDS use are more affected by the environment in which they engage (exercise context and curriculum), while women’s habits are more strongly influenced by their own perceived demands and needs to meet ideals (internalisation). Importantly, in discussing the explanatory factors for MEDS use in men and women, it is necessary to emphasize that the regression models for both genders only partially explained MEDS use, leaving room for further investigation into other explanatory factors that were not measured in this study. For example, we were unable to assess energy and nutrient intake in the current study, and we only assessed current supplement use without asking about duration and amount. of use by supplement. The inclusion of these aspects of use could be particularly important in future studies aimed at investigating and reflecting on the potential long-term health consequences of such use. Additionally, given the design of our study, we were unable to explore causality. Therefore, we cannot be sure whether students who are introduced to, say, an exercise science program or a fitness center develop specific behaviors in terms of use or non-use. of MEDS, or whether individuals with specific characteristics are more likely to engage in such environments, and at the same time use these supplements. Longitudinal studies to better investigate the direction of associations are needed in future research.

Importantly, our sample is comparable to previous student samples with respect to age, BMI, and gender distribution within the sample. However, our sample differs in that it represents both exercise science students and non-health, non-exercise science students. Moreover, unlike most studies, our sample included several universities, representing students from all parts of Norway.

Strengths and limitations

Our study included a large sample size, compared male and female college students, and included understudied explanatory factors for MEDS use. Despite the large sample size, a low response rate can impede generalization, and well-known biases relate to self-reporting of physical activity and exercise. Finally, based on our cross-sectional study design, the causal relationship cannot be discussed.


Since higher education is believed to lead to increased competence in practicing source criticism and making evidence-based lifestyle choices, the high frequency of DS and MEDS use among Norwegian university students is surprising. Although we found less frequent use of DS and MEDS compared to previous studies, the frequency, reasons for, and explanatory factors for use, such as appearance, are of concern due to potential negative effects on physical and mental health. Variables related to body idealization reduce well-being and mental health. Therefore, the use of MEDS may be linked to a less favorable mental health status. Since the study of exercise science seemed to lead to a decrease in the frequency of MEDS use in our study, increased knowledge of health, exercise and nutrition may be important in preventing the non-critical use of such supplements. Changes are also needed within the fitness center industry, as this exercise context is known to promote the idealization of specific body types in addition to promoting and selling MEDS.

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