the use of dietary supplements , including multivitamins has increased substantially in the past few decades . on an average 20 - 30% of the population in developed countries use such vitamin supplements .
industries involved in their manufacture are reported to be one of the world 's fastest growing industries .
although , the use of multivitamin supplementation may provide benefits in terms of increased nutrient intake , there are potential adverse effects also due to high intake .
although certain benefits , like that of folic acid supplementation and protection against neural tube defects in specific populations is well - established , but results of some large scale randomized trials have shown that for the majority of the population multivitamin supplements are ineffective .
sesso et al . in a randomized controlled trial conducted in 14,641 participants in usa revealed that daily multivitamin supplement did not reduce cardiovascular events , myocardial infarction or stroke in men . in today 's scenario with
more literate and health conscious patients who are capable of making their own decisions regarding their health care coupled with wide availability of such supplements , present study was conducted to explore pattern of use , public knowledge and attitude toward consumption of these multivitamin supplements .
a descriptive cross - sectional population based study was conducted from january to june 2013 among the general public .
subjects included were patients and other hospital attendees like patients ' family members / relatives or friends , of either sex aged 18 years or older while they were waiting in the outpatient department .
study participants were assured of confidentiality and anonymity of the information and written informed consent was obtained from them .
a total of 120 participants were interviewed and information was collected in a structured questionnaire .
the questionnaire was based on previous studies undertaken among adults about their attitude toward multivitamin supplementation and it was suitably modified for the present setting .
the survey questions in addition to questions covering demographic , education level ( primary , secondary or above ) , alcohol drinking status , contained questions regarding awareness of multivitamin supplements , its consumption ( frequency , duration of usage ) , reasons for usage ( self - medication , physician advice ) and its effect . at the end of the study
pearson chi - square test was applied to see the association between genders and educational status with the use of multivitamins .
of the 120 study participants , 66 were males ( 55% ) and 54 were females ( 45% ) .
mean age of the males was 43.85  15.44 years and of females was 38.75  12.87 years .
no association was found between gender and use of multivitamins ( p = 0.969 ) . regarding educational status , approximately ( 58 )
48% were graduates , ( 13 ) 11% postgraduates , ( 36 ) 30% had completed secondary education and ( 7 ) 6% had covered only primary education while ( 6 ) 5% were illiterate .
educational status of the participants did not show any association with the use of multivitamins ( p = 0.583 ) .
source of awareness of vitamin supplement use was a family doctor , relatives or friends and media , e.g. newspaper / internet [ table 1 ] .
percentage of participants with different sources of information regarding multivitamins about 68.33% ( 82 ) of the participants were either current or former users of multivitamin supplements while 31.66% ( 38 ) claimed that they had never taken multivitamins .
out of these users , 18.2% ( 15 ) admitted taking multivitamins of their own , 69.5% ( 57 ) consumed on the advice of their physicians while 12.1% ( 10 ) relied on the advice of family or friends . among the users , 70.73% ( 58 ) considered multivitamin supplements to be helpful .
study respondents when queried as to whether they had experienced any health problem due to the use of such supplements , only one reported diarrhea which he believed to be related to multivitamin supplement use .
majority of the participants were unaware of the harmful effects of multivitamin supplements or their possible interactions with other drugs .
nearly 12% ( 14 ) of study participants were alcoholics and all of them were multivitamin supplement users . out of these , only three said that there is a benefit of taking these supplements along with alcohol while seven considered no benefit in consuming supplements along with alcohol .
reasons quoted for the self - medication use of multivitamins are depicted in figure 1 .
physician prescribed reasons were multiple , like in mouth ulcers , with concurrent antibiotic prescription , arthritis , hypotension , weakness , leg pain etc .
reasons for the use of multivitamin supplements among self - medicated users there was a variable response regarding frequency of vitamin supplementation . out of the self - medication group ,
approximately 10 consumed multivitamin on a daily basis while 3 consumed 2 times a day .
some of them reported consuming them 4 times weekly or some even mentioned taking for 4 weeks after every 6 months [ table 2 ] .
frequency of usage of multivitamins by self - prescribed users majority of the participants were unaware regarding the correct indications for the multivitamin supplementation .
study participants who were aware of the multivitamin use when asked about the opinion whether these drugs can be self - medicated , 60% ( 50 ) responded affirmatively . regarding knowledge about the natural sources of these vitamins , as many as 76% ( 64 ) showed ignorance .
in the present scenario of high prevalence of nutrient supplementation use world - wide , present study was conducted to examine multivitamin consumption in the general adult population .
our study depicted multivitamin use by 68.33% of the participants . similarly , national health and nutrition examination survey 2003 - 2006 reported use of dietary supplements by 53% of the respondents and out of which most frequently used supplement was multivitamin . a survey conducted in columbia on the estimate of use of dietary supplements revealed 73% users , out of which
85% reported using multivitamin supplements . likewise , a study conducted in 11,929 men in germany reported use of vitamin or mineral supplements by 40% of population .
moreover , internet sites and television are flooded with advertisements depicting increased energy with the use of such supplements .
health conscious people now - a - days feel happy to consume such supplements thinking they are actively taking care of their health .
most common source of information regarding vitamin supplement use , in our study was doctors , 69.1% users consumed multivitamins on the advice of doctors .
these results are in concordance with the study conducted in karachi , which revealed recommendation of vitamin supplement by doctors to be 66.2% .
number of self - prescribed multivitamin users consuming multivitamins on a daily basis was high which is consistent with results from other studies where dietary supplement was consumed on a daily basis by more than 50% of multiple dietary supplement users .
this is an area of concern as it has been seen in some other studies as well .
a study conducted in america among five ethnic groups found that the median daily nutrient intake from multivitamin / minerals among users were above the recommended daily allowance for some vitamins such as a , b-6 , b-12 and e , thiamin , riboflavin , niacin , pantothenic acid and folate .
this is more so a problem in the country like ours where there is the wide availability of supplements without physician prescription , which can clearly lead to excessive use of vitamins and hence possible adverse effects or interactions .
furthermore , nutrient composition of multivitamins is extremely variable which in some cases can lead to excessive use . in india , chughchugh and lhamo
have shown that the majority of the supplements available in the market contained nutrient amounts higher than the recommended dietary intakes .
various studies such as alpha - tocopherol , beta - carotene cancer prevention study reported increased risk of hemorrhagic stroke by 50% with the use of alpha tocopherol for 6 years and selenium and vitamin e cancer prevention trial revealed that vitamin e supplements could increase the risk of prostate cancer among healthy men .
reasons quoted for using vitamin supplements by self - prescribers were similar to study conducted by dickinson et al . where maintaining wellness was the top reason for personal use .
similar reasons were seen in studies by neuhouser and eldridge and sheenan though there is no conclusive evidence that vitamin supplementation is beneficial in persons with adequate dietary intake .
results of the meta - analysis have revealed that for the majority of the population multivitamin supplements are not effective .
notable ones are meta - analysis of five randomized control trials which found no significant beneficial effect of such supplementation and data from eight prospective studies did not support the hypothesis that use of folate , vitamin a , c , e and multivitamins reduce the risk of lung cancer .
ignorance of the participants regarding potential deleterious effects of over supplementation reflected their false belief that these medications are safe .
hence , physicians should ask direct questions to their patients regarding use of self - prescribed multivitamins and educate them toward harmful effects and potential interactions with prescription medication . interaction between vitamin e and aspirin leading to additive antithrombotic effect and between vitamin e and warfarin leading to increased risk of bleeding are available in the literature .
similarly , large doses of antioxidants such as vitamin e and alpha lipoic acid can decrease the effectiveness of radiation or chemotherapy for cancer .
there are certain limitation of this study , which needs to be acknowledged like its cross - sectional design and its conductance at the single hospital .
furthermore , association between different variables can not be established as it is a descriptive cross - sectional study .
findings from this study suggest that multivitamin use is highly prevalent and the majority of the participants were ignorant of any possible harm or drug interactions . in light of this , there is a need to adopt certain educational interventions to minimize self - directed supplement use . at the same time health care professionals should take extra care to know about their patients multivitamin use and hence should counsel them about the correct use .
 background and objective : the use of supplements has increased substantially in the past few decades . 
 the present study is an effort to explore pattern of use , knowledge and attitude toward consumption of multivitamin supplements among the general public.materials and methods : a descriptive cross - sectional study on 120 adult participants from the general public was conducted . 
 the participants were interviewed and information was collected in a predesigned structured questionnaire . 
 the data was analyzed and expressed as counts and percentages.results:of the 120 study participants , 66 were males and 54 were females . 
 results revealed that 68.33% ( 82 ) of the participants were users of multivitamin supplements . 
 out of the users , 69.5% ( 57 ) participants consumed on the advice of doctors , 18.2% ( 15 ) were self - prescribers while 12.1% ( 10 ) relied on advice of family or friends . among the users , 70.96% considered such supplements to be helpful . 
 reasons quoted for self - medication use of multivitamins were multiple such as maintenance of general health ( 55% ) , to allay weakness or fatigue ( 20% ) , to improve appetite ( 15% ) etc . majority of the participants were unaware regarding the correct indications for multivitamin supplementation . 
 regarding knowledge about the natural sources of these vitamins , as many as 76% showed ignorance.conclusion:finding from this study suggests that multivitamin use is highly prevalent and the majority of the participants were ignorant of any possible harm or drug interactions . in light of this , there is a need to adopt certain educational interventions to minimize self - directed supplement use and increase awareness regarding their correct usage . 
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