Document Type: Original Articles


1 Research Center for Health Sciences, Department of Clinical Nutrition, Faculty of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran;

2 Student Research Committee, Faculty of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran;

3 Department of Statistics and Epidemiology, Faculty of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran


Background: Due to the increasing global use of nutritional supplements, dietitians play a key role in raising consumer awareness and reducing supplementary side effects. Hence, determination of the states of knowledge, attitudes and practices of this group as to common dietary supplements is important. Methods: A list of all the dietitians employed in the health centers, nutrition clinics and private offices of Shiraz city was prepared; then, all the 36 qualified dietitians were referred to and the information of 25 dietitians was collected. To gather the data, we employed a 4-part questionnaire including demographic data and questions related to their knowledge, attitudes, and practices about prescribed dietary supplements. The knowledge scores of less than 50%, 50-75%, and over 75% were considered as low, medium, and good knowledge, respectively. And the classification of attitudes was determined based on quartile ranking. The data were statistically analyzed through SPSS, version19, using Chi-square and t-test statistical methods. Results: Most of the dietitians had moderate (80%) and low (20%) level of knowledge, while 100% of them had a positive attitude (3rd quartile) about the role of dietary supplements in health, side effects, and food interactions. The most common supplements recommended were those for anemia and growth of children. In this study, the dietitians who had higher level of knowledge significantly used nutritional journals to increase their awareness. Conclusion: Considering the key roles of dietitians and their knowledge, attitudes, and practices in the field of supplements and the results of the study, it appears that necessary measures should be taken to enhance the dietitians’ knowledge.


  1. References
  2. Debas HT, Laxminarayan R, Straus SE. Complementary and alternative medicine. 2006.
  3. Hetherwick C, Morris MN, Silliman K. Perceived knowledge, attitudes, and practices of California registered dietitians regarding dietary supplements. Journal of the American Dietetic Association. 2006;106(3):438-42.
  4. Lederman VG, Huffman FG, Enrione EB. Knowledge of Florida nurses and dietitians regarding dietary supplements. Complementary therapies in clinical practice. 2009;15(1):38-43 %@ 1744-3881.
  5. Maddah M, Shoyooie R, Akbarian Z, RostamNejad M, Soleymani M. Dietary supplement use among Iranian adults: a study in northern Iran. Mediterranean Journal of Nutrition and Metabolism. 2013;6(1):69-72.
  6. Lee Y-K, Georgiou C, Raab C. The knowledge, attitudes, and practices of dietitians licensed in Oregon regarding functional foods, nutrient supplements, and herbs as complementary medicine. Journal of the American Dietetic Association. 2000;100(5):543-8.
  7. Timbo BB, Ross MP, McCarthy PV, Lin C-TJ. Dietary supplements in a national survey: prevalence of use and reports of adverse events. Journal of the American Dietetic Association. 2006;106(12):1966-74 %@ 0002-8223.
  8. Palmer ME, Haller C, McKinney PE, Klein-Schwartz W, Tschirgi A, Smolinske SC, et al. Adverse events associated with dietary supplements: an observational study. The Lancet. 2003;361(9352):101-6 %@ 0140-6736.
  9. American Dietetic A. Position of the American Dietetic Association: fortification and nutritional supplements. Journal of the American Dietetic Association. 2005;105(8):1300 %@ 0002-8223.
  10. Marra MV, Boyar AP. Position of the American Dietetic Association: nutrient supplementation. Journal of the American Dietetic Association. 2009;109(12):2073-85 %@ 0002-8223.
  11. Wildish DE. An evidence-based approach for dietitian prescription of multiple vitamins with minerals. Journal of the American Dietetic Association. 2004;104(5):779- 86 %@ 0002-8223.
  12. Gardiner P, Woods C, Kemper KJ. Dietary supplement use among health care professionals enrolled in an online curriculum on herbs and dietary supplements. BMC complementary and alternative medicine. 2006;6(1):1.
  13. Stuber K, Bruno P, Kristmanson K, Ali Z. Dietary supplement recommendations by Saskatchewan chiropractors: results of an online survey. Chiropractic & manual therapies. 2013;21(1):1.
  14. Mahan LK, Escott-Stump S, Raymond JL. Krause’s food & the nutrition care process: Elsevier Health Sciences; 2012.
  15. Tulchinsky TH. Micronutrient deficiency conditions: global health issues. Public Health Reviews. 2010;32(1):243.
  16. Lankarani S, Musaiger AO. The state of nutrition in Fars, Iran: a review. Nutrition and health. 1991;7(3):135-42.
  17. Karimi M, Yarmohammadi H, Kadivar R. Assessment of the prevalence of iron deficiency anemia, by serum ferritin, in pregnant women of Southern Iran. Medical Science Monitor. 2002;8(7):CR488-CR92.
  18. Keikhaei B, Zandian K, Ghasemi A, Tabibi R. Irondeficiency anemia among children in southwest Iran. Food and nutrition bulletin. 2007;28(4):406-11.
  19. Kadivar MR, Yarmohammadi H, Mirahmadizadeh AR, Vakili M, Karimi M. Prevalence of iron deficiency anemia in 6 months to 5 years old children in Fars, Southern Iran. Medical Science Monitor. 2003;9(2):CR100-CR4.
  20. Maleki M. Food consumption and nutritional status of 13 year old village and city schoolboys in Fars province, Iran†‡. Ecology of Food and Nutrition. 1973;2(1):39-42 %@ 0367-244.
  21. Dickinson A, Bonci L, Boyon N, Franco JC. Dietitians use and recommend dietary supplements: report of a survey. Nutrition journal. 2012;11(1):1.
  22. Cashman LS, Burns JT, Otieno IM, Fung T. Massachusetts registered dietitians’ knowledge, attitudes, opinions, personal use, and recommendations to clients about herbal supplements. The Journal of Alternative & Complementary Medicine. 2003;9(5):735-46.