Though dietary supplement use increasing worldwide, especially among children, few studies have examined the details of their use among children in China.
Researchers at China’s Central South University therefore conducted a cross-sectional study to assess the prevalence of dietary supplement consumption and its related factors in primary school students in four primary schools in Hunan.
Supplements for students
They enrolled a total of 706 Chinese parents and caregivers of schoolchildren between the ages of six and 12, using self-administrated questionnaires to collect information about their children’s dietary supplement intake, as well as their socio-demographic details.
Subsequently, they reported that 20.4% of the students regularly consumed dietary supplements. Among these, the most commonly consumed were calcium (16.7%), vitamin C (9.2%) and vitamin D (8.5%).
The popularity of calcium and vitamin D could be attributed to the widespread deficiency in both among Chinese children, whose average dietary calcium intake is extremely low. Between 19.6% and 34.3% of children suffer from calcium deficiency.
While calcium intake can support bone health, vitamin D can promote the absorption of calcium. In China, vitamin D deficiency is common even in southern China, where it tends to be sunnier than other regions in the country.
An estimated 10.8% to 39% of children up to the age of 12 have been reported as suffering from vitamin D insufficiency or deficiency in southern China.
The parents and caregivers said their key reasons for buying dietary supplements for their children were immunity enhancement (43.6%) and growth promotion (36.5%).
However, 26.4% admitted to having purchased these supplements online, including from dubious or unknown merchants.
More worryingly, 37.5% of the caregivers had not received any formal guidance on dietary supplementation, even if they bought the supplements via formal channels, such as hospitals, speciality stores, supermarkets, pharmacies and recognised e-commerce platforms.
While about 33% of parents and caregivers believe primary school students need dietary supplements, most of them lack sufficient knowledge on the function of dietary supplements, and only 49.1% of the supplement use was based on professional recommendations from medical staff.
Even among college-educated parents who were more likely to purchase dietary supplements for their children, 32.3% bought them through online shopping, the daigou platform, direct-selling, or other informal channels.
The study reported that online shoppers preferred to focus on the shopping experience when selecting products, rather than whether or not they were actually suitable for their needs.
While the government has recently begun to crack down on daigou and direct sellers, many of the products that have already been purchased through these channels had not been inspected by the national customs and quality inspection department.
The researchers wrote: “There are real questions regarding the safety of these products, particularly for those using dietary supplements regularly.”
Perceptions and purchases
They also acknowledged that the study population was insufficient to reflect the dietary supplement use of all Chinese children, and that they did not assess if the overall nutrient intake among the children was appropriate.
However, they also noted that the study results could provide a rough picture of dietary supplement intake among schoolchildren in China, and therefore help to improve parents’ and caregivers’ perceptions and purchase behaviours when it came to dietary supplements for their children.
In conclusion, they wrote: “In this study, we found that 20.4% of primary school students used dietary supplements. The educational background and the occupation of caregivers were both related to the use of dietary supplements for children.
“The most popular dietary supplements are calcium, vitamin C, vitamin D, iron, and vitamin E. Dietary supplements can be used when children are not getting adequate calcium, vitamin C, vitamin D, iron and vitamin E from their diet, and appropriate guidance should be provided for caregivers or children regarding the effective use of supplements.
“Guidelines and counselling regarding dietary supplements for children may be helpful in public health work.”
Source: International Journal of Environmental Research and Public Health
“Dietary Supplement Use Among Chinese Primary School Students: A Cross-Sectional Study in Hunan Province”
Authors: Hanmei Liu, et al.