Food Supplements Use and Pandemic
An optimal diet can help improve overall health, reduce the risk of disease, and reduce the rate of morbidity associated with COVID-19 [18]. It has been shown that the use of FS has increased in different countries during the COVID-19 pandemic [8, 19–22]. FS use before and during the pandemic were 29.5% and 71.9% in Asia, 21.3% and 75.7% in USA, 30.8% and 68.7% in Europe, and 21.3% and 62.2% in Turkey, respectively, [23], In the United Arab Emirates 56.5% of adults used FS during the COVID-19 pandemic period; 53.8% of them started to use FS with the beginning of COVID-19 pandemic [24]. In Saudi Arabia FS use was 62.4% during COVID-19 and FS use increased in 24.6% of adults during the COVID-19 pandemic in Lithuania [25]. Norton et al. [24] found that FS use during COVID-19 was 29.9% in USA, Puścion-Jakubik et al. [26], showed that FS use in the first, second and third waves of the COVID-19 pandemic was 57.2%, 80.3% and 76.1%, respectively in Poland. Mukattash et al. [27], found that FS use in the second wave of the COVID-19 pandemic was 47% in Jordan, Lebanon, Palestine, Saudi Arabia and the United Arab Emirates. Özdemir et al. [28], showed that FS use increased during the pandemic compared to the pre-pandemic period in Turkey. In another study conducted in Turkey, it was found that FS use in adults was 31.5% and 55.6% before and during the pandemic respectively [29]. In present study, FS use was observed 27.0% before the pandemic and 37.1% during the COVID-19 pandemic (Table 1). It was found that the likelihood of food supplement use increased during the pandemic compared to the pre-pandemic period (Table 2) (p < 0.05). The fact that individuals who used FS before the pademic also used FS during the pandemic and it is consistent with previous studies. The high rate of FS use during the pandemic process has revealed that adults act with the instinct to protect themselves against the disease.
Reasons for FS use during the COVID-19 pandemic varies. In the United Arab Emirates, FS use to protect against was themselves COVID-19 pandemic or to support treatment was 56.6% [4]. Hamulka et al. [30], found that FS use to strengthen the immune system during the pandemic was 60% in adults. In the USA, Europe and Turkey it was found that FS use to strengthen the immune system was 53.0% [25]. In this study, it was found that 52.7% of the participants used FS to boost the immune system (Fig. 1). Since the study was conducted during the COVID-19 pandemic, it is an expected result that strengthening the immune system ranked first among the reasons for using FS in accordnce with previous studies. All these studies show that adults are aware of the immune-strenghten effects of FS.
The most commonly used FS are vitamins, minerals, plants and herbs, botanical compounds, amino acids and probiotics [31]. Studies have shown that vitamin C, vitamin D and multivitamins supplements are the most commonly used FS during COVID-19 [5, 9, 23, 32, 33]. Hamulka et al. [34], in worldwide and Poland showed that use of vitamin C, vitamin D and zinc increased the most during the pandemic. In Malaysia, vitamin C was found to be the the most commonly used (81.3%) FS and followed by multivitamins/multimineral supplements with 17.7%, B complex vitamins with 17.7%, omega-3 with 10.3% and probiotics with 9.9%. during COVID-19 [6]. In the United Arab Emirates multivitamins (77.8%) were found to be the most commonly used FS during the COVID-19 pandemic [35]. In another study nerede?, it was determined that the most frequently used FS during the pandemic were vitamin C (87.6%), vitamin D (76.9%) and multivitamins (69.7%) [19]. Francis et al. [36] found that 46.0% of adults used vitamin C, 10.8% used multivitamins and 8.6% used vitamin D supplements during the pandemic. Araluskas et al. [25], found that in Linhuania the most commonly used FS during the pandemic period were vitamin C, vitamin D, omega-3 fatty acids and magnesium. In a study in USA, it was found that 33.2% of adults used vitamin C, 23.6% used multivitamins and 9.6% used vitamin D during COVID-19 [24]. Mohseni et al. [37], found vitamin D was to be the most commonly used FS in individuals both infected and not infected with COVID-19. In our study, the most commonly used FS during COVID-19 were vitamin D and vitamin C (Fig. 2). This result is in parallel with previous results The fact that the frequency of vitamin D and C use is higher than other FS is also consistent with the use of FS to strengthen the immune system. In this study, it was observed that vitamin D, vitamin C and multivitamins were the most commonly used FS before and during the COVID-19 pandemic. There was an increase in the use of vitamin D, vitamin C, multivitamins, omega-3, propolis and zinc supplements (Fig. 2). The fact that the use of nutrients known to support the immune system increased during the pandemic once again reveals that adults use FS to boost the immune system.
Food Supplement Use and Gender
It has been shown that FS usage may vary by gender [4]. Another study in Malaysia [6] showed that 57.2% of female and 42.5% of male and anoher study conducted in Lebanon [38] found that 60.3% of female and 39.7% of male used FS during the COVID-19 pandemic. In this study, the use of FS during the COVID-19 pandemic period was found to be 40.4% in female and 26.2% in male (Table 1). It was also observed that the likelihood of food supplement use was higher in female (Table 2) (p < 0.05). In accordance with previous studies from different countries, in present study, the prevalence of food supplement use during COVID-19 was higher in female than in male and also found that female were more likely to use FS than male. This may be due to the fact that female are more vulnerable to nutrient deficiencies and are more intested in health and nutrition. [28]. Gender may also affect the type of food supplement. Another study found that 40.6% of male and 49.1% of female who used FS during the COVID-19 pandemic used vitamin C supplements [36]. Alfawaz et al. [3], was found that male who had COVID-19 predominantly used multivitamins and zinc, while female who had COVID-19 predominantly used vitamin D and vitamin C supplements. In this study, it was observed that female were more likely to use vitamin C, vitamin D and omega-3 supplements than male (Table 3) (p < 0.05). Likelihood of usage of other FS were found irrespective of gender (Table 3) (Table 4) (p > 0.05). Research shows that female are more focused on micronutrient supplements that have an immune-boosting effect.
Food Supplements Use and Exposed to COVID-19
Having a family member at risk for COVID-19 and having COVID-19 may affect the use of FS Özdemir et al. [28] found that 72.7% of adults with a family member who exposed COVID-19 use FS in Turkey. Widiasih et al. [39] found that adults use FS to protect family members from COVID risk in Indonesia. In present study it was found that 44.1% of the participants who had a family member at risk for COVID-19 used FS (Table 1) (p < 0.05). It was observed that the presence of a family member at risk for COVID-19 increased the likelihood of food supplement use (Table 2). It was also found that having a family member at risk for COVID-19 increased the likelihood of vitamin C, multivitamins and probiotic use (Table 3) (p < 0.05). It has been revealed that adults with family members at risk for COVID-19 are more likely to use FS to protect themselves and their family members.
It has been shown that COVID-19 infection can have an impact on FS usage [32, 37]. Mohseni et al. in Iran (36), and Alfawaz et al. in Saudi Arabia [3] found that FS usage was respectively 55% and 44% in individuals infected with COVID-19 and 57% and 55.6% of individuals who had not infected. Bagheri et al. [32] found that FS usage was 44% in COVID-19 infected outpatientsand 32% in COVID- infected hospitalized patients in Iran. [32]. Aldwihi et al. [40] found that FS usage increased in hospitalized patients due to COVID-19 in Saudi Arabia. In present study, FS usage was 52.0% in individuals infected with COVID-19 and 61.1% in individuals hospitalized due to COVID-19 infecton (Table 1) (p < 0.05). In the present study, similar to previous studies, FS usage was high among hospitalized participants than outpatients (p < 0.05). Kyprianidou et al. [41] showed that FS usage was 59.2% in adults during the COVID-19 lockdown. In present study FS usage was 44,3% in adults during COVID-19 lockdown. (Table 1). It was also observed that FS usage was more frequent in COVID-19 infected and, hospitalized individuals during lockdown and our findings are in accordance with previous studies. Adults infected with COVID-19 and hospitalized for COVID-19 may have switched to FS to avoid becoming infected with COVID-19 again.
It has been shown that vitamin C, vitamin D, multivitamins and omega-3 supplementation may have positive effects against COVID-19 infection [42–46]. In present study, infected with COVID-19 increased the likelihood of use of vitamin C, vitamin D, multivitamins, zinc, propolis and curcumin/turmeric (Table 3) (Table 4), being hospitalized due to COVID-19 infection increased the likelihood of use of multivitamins and omega-3 supplement use and lockdown increased the likelihood of use of vitamin C, vitamin D and multivitamins supplemens. (Table 3). Our findings suggest that hospitalization and quarantine, and being infected with COVID-19 increased the use of FS, which are known to strengthen the immune system.
Food Supplement Use and Being Interested in Nutrition
According to our knowledge this is the first study examining the interest in nutrition and health, on FS usage before and during the pandemic. In the present study, 63.3% of the adults were found to be interested in nutrition and health before COVID-19, 85.6% of adults were found to be interested in nutrition and health during the pandemic. Where FS usage was 43.3% in adults before COVID-19 pandemic it increased to 81.0% in adults who interested in nutrition and health (Table 1). t was observed that the increase of the interest in nutrition and health before and during the COVID-19 pandemic, increased the the likelihood of FS usage (Table 2) (p < 0.05). It was determined that the likelihood of vitamin C, vitamin D, omega-3, B group vitamins and zinc supplement usage increased during the pandemic among individuals who were interested in nutrition and health before the COVID-19 lockdown (Table 3). It was shown that being interested in nutrition and health during the pandemic increased the likelihood of usage of vitamin C, vitamin D, multivitamins, omega-3, B group vitamins, zinc, propolis and probiotic supplements (Table 3) (Table 4) (p < 0.05). It has been determined that having a family member at risk for COVID-19, being infected with COVID-19, and being interested in nutrition and health during the pandemic can lead adults to the use of FS that have an immune system boosting effect. It has been observed that interest in nutrition and health before and during the pandemic leads adults to use FS and can increase awareness of the positive effects of FS use, especially on boosting the immune system.
Food Supplements Use and Anxiety
It has been demonstrated that anxiety prevalance increased in different populations during the COVID-19 pandemic [2, 47]. A meta-analysis by Salari et al.[48] found that the anxiety prevalence in adults during COVID-19 was 31.9%. A meta-analysis by Daly and Robinson [49] showed that anxiety disorder cases increased 25.6% in the COVID-19 pandemic. In a study conducted in Nepal, by Sigdel et al. [50] showed that 31.2% of adults were found to have anxiety. In a study conducted in Brazil by Negrão et al. [51], 47.9% of adults were found to have anxiety during the pandemic. In a study conducted in Turkey by Macit [52], 63.6% of adults were found to have anxiety during COVID-19 pandemic. Concerns about to be infected with COVID-19, unexistence of a certain treatment of infection, and, uncertainty about when the pandemic will be ended are main reasons for COVID-19 related anxiety [12]. In a study conducted in Canada by Stephenson et al. [2], it was shown that need of anxiety and depression treatment during the COVID-19 pandemic increased. In a study conducted in Greece by Marakis et al. [9], 33.8% of elderly were found to have COVID-19-related anxiety. In a study in Spain by Fullana et al. [53], 65% of adults were found to have symptoms of anxiety and depression during COVID-19. In a study conducted by Choi et al. in China [54], 14.0% of the adults had anxiety and 19% had depression during COVID-19. In a study conducted by Tang et al. [55] in China, depression was found 26.5% and anxiety in 70.8% in quaratinated adults due to COVID-19. In a study conducted in UK by Shevlin et al. [56] 23.4% of adult female and 31.7% of male were found to have anxiety/depression indicators during COVID-19. A study in the Republic of Ireland by Hyland et al. found that 22.1% of adult male and 32.8% of female had anxiety or depression [13]. In a study conducted by Mazza et al. [57] in Italy found that 42% of adults who had COVID-19 had anxiety and 31% had depression. In present study, it was determined that all participants had various degrees of anxiety. It was determined that 60.2% of the adults had severe and extremely severe anxiety (Table 1). Our results shows anxiety is closely related to COVID-19 and supports the results of previous studies from different countries. All these results reveal the negative impact of COVID-19 on people's mental state.
Even the number of studies about anxiety level and FS usage is limited, anxiety has been shown to be strongly associated with FS usage [58]. Merwid-Lad et al. demonstarted that 33.0% of adults used FS for anxiety, depression or sleep disorders in Poland [59]. Marakis et al showed that COVID-19 related anxiety was shown to increase FS usage in elderly [9]. In this study, it was observed that FS usage increased with anxiety level (Table 1) (p < 0.05). It was found that the likelihood of FS usage is lower in adults with mild and moderate anxiety compared to adults with extremely severe anxiety (Table 2) (p < 0.05). In this study, it was found that adults with anxiety commonly used FS to boost the immune system regardless of anxiety level (Fig. 3). It was also determined that the type of preferred FS can be affected by anxiety level. In our study, it was found that individuals with mild and moderate anxiety were less likely to use vitamin C, vitamin D, multivitamins and B group vitamin supplements (Table 3) (p < 0.05). The fact that individuals with severe anxiety are more likely to use vitamin C, vitamin D, multivitamins and B group vitamin supplements for boosting immunity. This result once again demonstrates that adults are worried about the disease during the COVID-19 pandemic and use FS, which has an immune system-boosting effect, to protect themselves.
As a conclusion, The COVID-19 pandemic has led to dramatic changes in the lifestyle of adults around the World. It has been also demonstrated that FS usage has become widespread during the pandemic. This study showed that FS usage dramatically increased in Turkish adults during the COVID-19 pandemic and FS usage was higher in female than male. The reasons for FS usage were determined respectively as boosting immunity, being healthy, preventing nutrient deficiencies, and for well being.
We found that vitamin C, D and multivitamins have been used both before and during the pandemic while likelihood of usage of omega 3, propolis and zinc has increased in Turkish adults with COVID-19 pandemic. Adults whith family member at risk of COVID-19 were found to be more likely to use Vitamin C, multivitamins and probiotics. FS usage was found higher when exposed to COVID-19 and hospitalization due to COVID-19. Adults exposed to COVID-19 were found to be more likely to use zinc, propolis, curcumin/turmeric and hospitalized adults were fouund to be more likely to use omega 3.
Adults who were interested in nutrition and health were more likely to use propolis and probiotic in addition their vitamin C, D and multivitamins, omega-3, B group vitamins and Zinc usage before and during the pandemic. We found that, regardless of anxiety level, it was observed that individuals used FS to boost the immune system and likelihood of vitamin C, vitamin D, multivitamins and B group vitamin usage increased with anxiety level. As a result our finding suggest that, FS usage increased in Turkish adults with COVID − 19 pandemic. Having family member at risk for COVID-19, being exposed to COVID-19, hospitalization due to COVID-19 and anxiety level was found to increase the FS usage and also found to effect the type of used FS.