Jovanov et al.

Journal of the International Society of Sports Nutrition (2019) 16:27

https://doi.org/10.1186/s12970-019-0294-7

RESEARCH ARTICLE Open Access

Prevalence, knowledge and attitudes

towards using sports supplements among
young athletes
Pavle Jovanov1* , Višnja Đorđić2, Borislav Obradović2, Otto Barak3, Lato Pezo4, Aleksandar Marić1
and Marijana Sakač1

Abstract
Background: The aim of this international study was to investigate the prevalence of the use of sports
supplements among young athletes, as well as their knowledge and attitudes towards sports supplementation.
Methods: Organized survey study testing the level of knowledge, attitudes, beliefs and practices concerning the
use of sports supplements was administered to 348 athletes, 15–18 year olds from 4 countries competing in 18
sports at the international level.
Results: The prevalence rate of the intake of sports supplements was 82.2%, with the protein supplements being
predominant (54.5%). Coaches were identified as the primary source of information regarding supplementation
(41.4%). The enhancement of athletic performance (35.4%) was the major motivation for the supplements intake.
The majority of athletes (72.1%) were aware of associated health risks. The young athletes possess varying levels of
knowledge regarding their own supplementation. The obtained data about the level of knowledge were statistically
analyzed using the correspondence analysis. Less than 40% of athletes had the knowledge about the proper and
intended use of protein, creatine, amino acids, beta alanine and glutamine, while they had greater understanding
about vitamins and minerals, sports drinks and caffeine. The athletes in developed countries had greater access and
utilization of professional resources such as dieticians. Young athletes are still unfamiliar with WADA regulations
(55.5%), and the misuse of sports supplements represents an ethical dilemma for some.
Conclusion: These findings indicate the necessity of a comprehensive education of all team members about sports
supplements and careful supervision of the athletic development of young athletes.
Keywords: Survey analysis, Correspondence analysis, Test of knowledge, Ethics in sports

Background athletes seek for some ergogenic aid, an external influence,

Due to the development of novel training methodologies which may just be the key impetus for victory. Dietary
and media representation of professional sports, athletes supplements are considered nutritional ergogenic aids,
from an early stage of adolescence have been raising the and the ones intended for the improvement of an athletic
scale of competitive edge by employing different strat- performance and faster recovery are known as sports sup-
egies. Sports nutrition represents the integration and plements [1, 2].
application of scientifically-based nutrition and exercise Increased energy requirements are not regularly met
physiology principles that support and enhance physical in young athletes, especially during competition season;
activity, athletic performance and recovery. Besides the therefore, most of them are unable to make adequate
implementation of sports nutrition and training strategies, nutritional choices for growth and development as well
as for optimized athletic performance and rely on
* Correspondence: [email protected]
additional nutritional intake taken from sports supple-
1
Institute of Food Technology in Novi Sad, University of Novi Sad, Bulevar ments [1, 3–5].
cara Lazara 1, Novi Sad 21000, Serbia
Full list of author information is available at the end of the article

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Jovanov et al. Journal of the International Society of Sports Nutrition (2019) 16:27 Page 2 of 9

The prevalence of sports supplements has rapidly in- competitions. Coaches, teachers or parents of potential
creased over the last decade and the rate of new prod- participants were contacted and introduced to the study
ucts availability on the market cannot be followed by the in order to recruit athletes for the survey. The inclusion
appropriate scientifically-based studies about their safety, criteria were: the age between 15 and 18 and inter-
quality and effectiveness [6–8]. Moreover, the increasing national competition level.
social acceptance of consumption of sports supplements Three hundred and forty-eight athletes met the criteria
may give some explanation of this phenomenon [8]. and were surveyed, among which male and female partici-
With the raising consumption of sports supplements pants were equally distributed. Also, the age distribution
there is also a need for more extensive education about was balanced with half of the athletes of 15–16 years of
these products [9]. Unfortunately, athletes rarely seek in- age and the other half of 17–18 years of age. This inter-
formation from educated sources such as registered die- national study included participation of young athletes
titians. Also, continuous educational programs on this from 4 countries: Serbia (39.4%), Germany (23.0%), Japan
subject are not available in every country, especially in (20.1%) and Croatia (17.5%), all representing their countries
the developing ones. This leaves athletes susceptible to at international competitions in 18 sports: kayak (27.9%),
misinformation which may lead to health problems and rowing (12.6%), canoeing (11.5%), basketball (8.6%), volley-
poor athletic performance [10]. The use of dietary sup- ball (8.6%), swimming (8.0%), athletics (4.0%), boxing
plements is also a risk factor for illicit substance use and (2.3%), soccer (2.3%), tennis (2.0%), karate (2.0%), handball
may cause so-called inadvertent doping due to the (2.0%), water polo (1.4%), dance (1.4%), golf (1.4%), weight-
contamination of their ingredients [11]. Another aspect lifting (1.4%), archery (1.4%), and fencing (1.2%).
worth considering is their effectiveness which is contro- The survey consisted of 20 questions, divided into four
versial [11, 12]. main parts. The first part collected demographic and
There are only a few studies published each year tar- personal information on the study participants: age, sex,
geting the dietary supplementation in adolescents lead- country, and the type of sport they are competing in.
ing to insufficient resources and subsequent The second part obtained information regarding the
misjudgment of emerging trends in this field. Consider- usage, importance, source of information, safety and
ing the participation of young athletes in the major procurement of sports supplements. The third part
sports events, it is important to know the patterns of tested the athlete’s knowledge about the proper use (tim-
sports supplements use among them in order to develop ing, dosage and reason for use) of sports supplements.
education programs towards avoiding unnecessary and The last part investigated athletes’ beliefs and attitudes
indiscriminate supplements use [12]. towards the use of sport supplements and possible Anti-
Although many studies investigated the athletes self- Doping rules violations.
reported level of knowledge about sports supplementa- Athletes voluntarily completed the written survey on
tion, in this study a different approach was used, i.e. test- different occasions and places such as: international
ing of young athletes’ knowledge about the use and competitions, high schools or on individual basis at dif-
purpose of sports supplements according to the prevail- ferent sport clubs. The survey was previously reviewed
ing facts about sports supplementation [13]. by various certified coaches in different sports, physi-
Hence, the objectives of this study were: (a) to deter- cians, university professors and researches specialized in
mine the prevalence of sports supplements, (b) to deter- food science and sport psychology.
mine source of information regarding supplementation, The reliability analysis of the survey items revealed that
(c) to assess beliefs and attitudes towards the use of all variables measured were reliable with reliability values
sports supplements, (d) to estimate the level of know- of all the latent variables extracted above 0.7 (for
ledge with specifically defined survey questions and the Cronbach’s Alpha). The Composite Reliability (CR), which
reasons for taking supplements, (e) to identify trends or represents the overall reliability of a multi-dimensional
differences between categories of supplement users, and construct reached values above 0.9, which is attributed as
(f ) to obtain an insight into young athletes’ ethical di- particularly significant. Data were normally distributed
lemma about the misuse of sports supplements. and negatively skewed with relatively flat peak. Average
Variance Extracted (AVE) was estimated, and the signifi-
Methods cant values above 0.5 were obtained, meaning that the
Survey development and statistical analysis latent variables were bringing significant variation in the
This study was conducted in a period between March face of random measurement error.
and November 2018. In this perspective study a design All three conditions of convergent validity were satis-
survey was used (provided as Additional file 1). Before factorily met, i.e. regression weights/factor loadings were
each data collection, the study was announced a few equal to or greater than 0.5, whereas squared multiple
days earlier in schools, sports clubs or international correlations (SMC) were equal to or greater than 0.7,
Jovanov et al. Journal of the International Society of Sports Nutrition (2019) 16:27 Page 3 of 9

while AVE values were equal to or greater than 0.5. All proper use of sports supplements among different demo-
aforementioned conditions confirmed the convergent graphics were analyzed using the correspondence analysis.
validity of the constructs. In order to test whether This analysis is a useful statistical technique for analyzing
two constructs differ from each other, discriminant data collected in sport surveys by simple graphical presen-
validity of the constructs was also checked and con- tation with a set of points with respect to two coordinate
firmed by showing that AVE was greater than SMC axes [14]. Symmetric normalization model [15–17] was
for each variable. suitable for exploring relationships between items of two
All surveyed athletes were previously informed about nominal variables.
the study objectives and had a chance to clarify any pos-
sible misunderstanding of the survey questions with the
team conducting the study. While filling out the survey Results
a representative of the team conducting the study was Prevalence of the use of sports supplements
present at the site. The survey showed that 82.2% of athletes were using
This study was approved by the Ethics Committee of sports supplements among which 60.6% were male ath-
the Faculty of Medicine, University of Novi Sad, and all letes. The analysis revealed that 47.7% of athletes were
procedures were conducted in accordance with the 15–16 year olds (p = 0.038) and 52.3% were 17–18 year
Declaration of Helsinki. olds (p = 0.032). Furthermore, male athletes were more
Data were processed using Microsoft Excel (Microsoft prone to the use of sports supplements in both age
Corporation, Redmond, Washington, USA) and analyzed categories (56.8 and 64.0% in 15-16Y, (p = 0.029) and
using the statistical software Statistica 12 (Dell Software, 17-18Y, (p = 0.021), respectively).
Round Rock, Texas, USA). Descriptive data were calcu- The study revealed that 82.2% of athletes used 1–2
lated as frequencies. Data were evaluated by sex and age different supplements at the same time, 62.1% 2–3, and
using chi-square (χ2) analyses. Significance was determined 35.9% 3–4, while 14.7% of athletes used 4 and more.
at p < 0.05. For the statistical analysis, two age categories Biplot in Fig. 1 shows the projection of the correspond-
were used: athletes 15–16 year olds (15-16Y) and athletes ence analysis (total inertia of 0.6955, χ2 of 64.682,
17–18 year olds (17-18Y). The collected data about the p = 0.007) of number of supplements taken by different

Fig. 1 Correspondence analysis – the first dimension distinguishes between different sports, while the second dimension presents the differences
in a number of consumed sports supplements among different sports
Jovanov et al. Journal of the International Society of Sports Nutrition (2019) 16:27 Page 4 of 9

sports, among which kayak, swimming and karate were Supplement safety information were gathered from the
identified as the one with the highest number. coach (38.2%), dietician or medical professional (33.3%)
Figure 2 shows that whey protein usage by 54.5% of ath- or the declaration on the product (20.1%). The athletes
letes can be observed, together with the prevalence of ten rely less on their own research about the health impact
other sports supplements. The males use more (p = 0.030) of the sports supplements (8.3%).
whey protein, creatine, amino acids, caffeine and NO The majority of athletes, mostly males and 15-16Y re-
reactor compared to females who take more vitamins and ported that they obtained information regarding sports
mineral complexes, while there is an almost equal use of supplements from their coach (41.4%); likewise 17-18Y
energy drinks, glutamine and carbohydrates between athletes rely on the Internet as shown in Fig. 3c.
sexes. Between the age categories the use of protein sup- Athletes mostly procure sports supplements in special-
plements and consumption of energy drinks were equally ized retail stores (59.1%) as shown in Fig. 3d. There was
distributed; younger athletes tend to use more carbohy- no significant statistical difference (p > 0.05) between age
drates, beta alanine, glutamine, vitamins and mineral com- categories concerning the answers to the question where
plexes versus 17-18Y athletes who take more creatine, they buy sports supplements. However, male athletes
caffeine, NO reactor and amino acids. tended to use more online shopping in acquiring sports
supplements than females.

Reasons for the use, attitudes, supplement source and Knowledge about proper and intended use of the sports
source of information regarding sports supplements supplements
When asked how important good nutrition and proper One of the main goals of this international study was to as-
supplementation is for enhancement of athletic perform- sess the young athletes’ understanding of the proper and
ance 30.2% of athletes thought that it is very important, intended use of the sports supplements. The level of know-
while 18.4% though it is unimportant (Fig. 3a). ledge was assessed by conducting an enquiry about the
The main reasons the athletes gave for taking supple- proper timing (before, during or after training), right serv-
ments are presented in Fig. 3b with the improvement of ing amounts and the main reason for their use. Graphical
their athletic performance (35.3%) being the predomin- presentation of correspondence analysis is presented in
ant one. Female athletes were significantly (p = 0.047) Fig. 4. A significant correspondence (p = 0.008) was found
more likely to take supplements “for their health” while between the considered categories, representing the total
males use it for boosting of athletic performance. inertia of 0.141 and χ2 value of 214.88. The first two di-
The attitudes of the athletes who do not take supple- mensions account for 74.5% of the total inertia. Substantial
ments were expressed through the following statements: differentiation between the proper use and sources of in-
I don’t need them (48.4%); I don’t know enough about formation among different demographics can be observed.
them (21.0%); they are unhealthy (14.5%); they are Unfortunately, young athletes lacked proper knowledge
expensive (8.1%); using supplements is like cheating about the use of creatine (11.1% of athletes responded cor-
(4.8%); they are not allowed (1.6%), I fear of a positive rectly), beta alanine (20.0%), amino acids (20.0%), NO re-
doping test (1.6%). actor (22.2%), glutamine (37.5%), protein (38.5%), and
Considering the “unclear picture” regarding the health carbohydrates (48.3%). Yet they seem to have more know-
safety and quality of sports supplements and their im- ledge about sports drinks (50%), caffeine (61.8%) and vita-
pact on athlete’s health, 72.1% of athletes were aware of mins and mineral complexes (71.0%). Previous attendance
a certain health risk, 14.9% thought they are risky and at educational seminars influenced the right answers
12.9% of athletes consider them safe. about the use of creatine (75% of athletes previously

Fig. 2 Prevalence of sports supplements – percentage of athletes using a specific sports supplement marked as total bars. The age and sex
distribution within specific supplement is represented by corresponding bars marked as male/female (100%) and 15-16Y/17-18Y (100%)
Jovanov et al. Journal of the International Society of Sports Nutrition (2019) 16:27 Page 5 of 9

Fig. 3 a Attitudes, b beliefs, c impact on supplementation and d procurement of sports supplements

attended seminars), amino acids (66.7%), carbohydrates Croatia (r = 0.979; p < 0.001). Younger athletes (15-16Y)
(57.1%), proteins (55.0%), vitamins and minerals (52.6%), had better understanding of the proper use of creatine
caffeine (50.0), NO reactor (50%), glutamine (46.7%), (87.5%), carbohydrates (67.9%), sports drinks (66.7%),
sports drinks (44.4%) and beta alanine (33.3%). beta alanine (66.7%), and caffeine (55.9%), while the
Athletes 17-18Y showed better knowledge than 15-16Y older athletes (17-18Y) gave the right answers when it
(r = 0.968; p < 0.001), as well as female athletes compared comes to the proper use of glutamine (60.0%), vitamins
to males (r = 0.953; p < 0.001). Athletes from all 4 coun- and minerals (60.5%), proteins (70.0%) and amino acids
tries were among the ones who knew the proper use of (86.7%). Male athletes were better informed on the right
supplements: Serbia (r = 0.9013, p = 0.003), Germany use of NO reactor (100.0%), creatine (75.0%), amino
(r = 0.9302, p < 0.001), Japan (r = 0.954; p < 0.001) and acids (66.7%), protein (60.0%) and glutamine (53.3%),
Jovanov et al. Journal of the International Society of Sports Nutrition (2019) 16:27 Page 6 of 9

Fig. 4 Correspondence analysis – the first dimension explains differentiation among proper use of sports supplements regarding the sources of
impact while the second dimensions explains the differences in demographics data of athletes regarding different sports supplements

while the female participants were more educated in the supplements using the Internet (r = 0.951; p < 0.001) and
proper use of caffeine supplements (73.5%), carbohy- attending seminars (r = 0.961; p < 0.001), while female
drates (71.4%), beta alanine (66.7%), vitamins and min- athletes were mostly advised by their coaches (r = 0.892;
erals (56.6%) and sports drinks (55.6%). p = 0.007). Also, athletes from Serbia used the Internet
The coach was the only source of information regard- as a source of information more than athletes from
ing the proper use of creatine. The coach was also the other countries, who knew the proper way of using
sole source of information for 83.1% of athletes about sports supplements (r = 0.971; p < 0.001).
proper carbohydrates use, amino acids (73.3%), caffeine Only 27.9% of all surveyed athletes had the opportun-
(73.3%), sports drinks (72.2%), glutamine (53.3%), NO ity to work with dieticians in their sports clubs, but only
reactor (50.0%), protein (40.0%), beta alanine (33.3%), 20.0% of those who answered correctly about the proper
and vitamins and mineral complexes (32.9%). The use of sports drinks and proteins and 3.6% about carbohy-
15-16Y athletes took supplements properly according to drates used that opportunity. Mostly, athletes from
the coach’s advice (r = 0.912; p = 0.003). The older athletes Germany had a dietician in their clubs (r = 0.778; p = 0.006).
(17-18Y) gathered information from the Internet (r = 0.942; Athletes in Germany and Japan who answered correctly
p < 0.001) and have attended the seminars about that topic about the use of supplements attended more seminars
(r = 0.963; p < 0.001). Athletes in Serbia had a better un- (r = 0.927; p = 0.004 and r = 0.923; p = 0.004, respectively)
derstanding of the proper use of proteins (50.0% of right and utilized more advice from dieticians, rather than
answers), while athletes in Japan were better educated on athletes from other countries (r = 0.824; p = 0.003 and
the use of vitamins and minerals (32.9%). Furthermore, r = 0.882; p = 0.003, respectively).
athletes from Germany had a better understanding of car-
bohydrates (35.7%) and creatine (50.0%). Croatian athletes
showed good recognition of sports drinks (50.0%). Risks of doping and ethical dilemma
The physician was the source of information for 36.8% Awareness and caution about possible risks of doping is
of athletes about vitamins and mineral complexes, while the key for proper supplement use, following regulations
others used the Internet. Athletes who used sports sup- of the World Anti-Doping Agency (WADA). This study
plements properly attended more seminars about sports revealed that only 55.5% of athletes had the access and are
supplementation than others (r = 0.967; p < 0.001). Male familiar with these regulations. When asked if they would
athletes gathered the information on how to use sports be willing to use prohibited substance to enhance their
Jovanov et al. Journal of the International Society of Sports Nutrition (2019) 16:27 Page 7 of 9

athletic performance if they knew that they would not be meals [1]. Creatine is one of the most popular sports
tested by WADA, 11.8% of athletes gave a positive answer. supplement these days and it is consumed by 25–40% of
young athletes [7, 10, 12, 19]. A broad range of creatine
Discussion use can be attributed to its greater representation in sports
This study dealt with the prevalence, tested level of where strength and speed are imperious [24]. The use of
knowledge and ethical dilemmas about the consumption vitamins and mineral complexes was reported by 37.4% of
of sports supplement among young elite athletes com- athletes, which is similar to 45.0% of Australian athletes
peting at the international level in 18 different sports [8] and 45–47% of UK athletes [7, 21]. These results differ
from 4 countries. from the prevalence higher than 80% found in other
studies [19]. The possible mismatch of the total share can
Prevalence and beliefs be attributed to the inclining use of other sports supple-
The percentage of athletes using sport supplements in this ments compared to seemingly same amounts of vitamins
study (82.2%) is in an agreement with the studies who and mineral complexes used over last decade.
pointed out high supplement consumption among young The majority of young athletes (57.2%) believe that sup-
athletes [5, 10, 18, 19]. Furthermore, similar prevalence plementation is important for sport success which is op-
can be observed in 87.5% of Australian athletes [8], 77.0% posite to 78.4% athletes in study of Petróczi et al. [7] who
of Singaporean athletes [13], and 71.2% of USA adoles- did not attribute the importance of supplementation. How-
cents [20], while more than half of the British athletes ever, the change of the attitude can be attributed to increas-
(62.0%) and 45.0% of Iranian athletes [6] take some type ing media influence on the sports supplements market.
of a sports supplement [21]. On the contrary, Nabuco et One of the main reasons behind the use of supple-
al. [12] reported that only 47.3% of Brazilian athletes use ments is enhancement of athletic performance. Results
sport supplements. Scofield and Unruh [22] reported that found in this study corroborate the results of other stud-
only 22.3% of young USA athletes consume supplements. ies which elaborated the same reasoning [4, 6, 8, 12].
The overall prevalence rate of sports supplements differs Health concern is also a strong motivation, but only
between studies, and a possible explanation can be found 27.5% of athletes think so, which is in agreement with
in variable sample size, age category and different level of the study of Nieper [21], and in contrast to high percent-
competition among athletes. The results in this study age of athletes in other studies [5, 18, 19] who found
clearly show that the prevalence of sports supplements in- that health concern was the main reason behind taking
creases with age and that supplementation is more prefer- sports supplements. Although young German athletes
able choice of male athletes. were surveyed in the study of the Braun et al. [19] and
High percentage of athletes consuming more than four in this study, the ones in this study were more focused
supplements (14.7%), which was found in this study, can on boosting their athletic performance.
be compared with 15.1% reported by Nabuco et al. [12], There is a high percentage of athletes who are not
raising the awareness about possible health implications supplement users and the most frequent reason they
among youth. Dascombe et al. [8] found that kayakers and stated was that they had no need for supplementation.
swimmers use considerably higher number of supple- Similar reasoning was found in other studies [4, 12, 21].
ments compared to other investigated sports, which is in Lack of knowledge was another strong reason for avoid-
agreement with this study exploring the possibility that ing supplements, and this study confirms that the
athletes in individual sports rely more on supplementation greater the knowledge about supplementation is, there is
than athletes in team sports. The necessity of using differ- more willingness in an athlete to use supplements [21].
ent energy systems during sporting events can result in an Young athletes agree on one thing; some sports sup-
increased number of sports supplements in these sports. plements carry certain health risks. 72.1% of athletes in
Prevalence of whey protein in this study deviates from this study shared that belief with 83% of UK young ath-
the one of 21.7% reported by Froiland et al. [10]. How- letes [21], and the decision on whether the supplement
ever, the consumption of whey protein increased over is safe is based mostly on the advice from the coach. In
the last two decades [23], first to 30% in 2006 [19] than line with other studies [4, 7, 11, 12, 19, 21, 22, 25–28]
53.5% in 2014 [12] and finally 54.5% in this study. In the coach is a primary source of information about the
reaching new world records, current intensive training supplements, which is somehow expected since the
regimes demand higher protein intake for greater meta- athletes in early stages of their semi-professional or
bolic adaptation, better remodelling and faster tissue re- professional sport career are very emotionally attached
pair. Balanced meal plans do not usually meet these to their coaches and spend a lot of time with them.
requirements, while the additional protein intake satis- However, these findings emphasize the need for the
fies these needs and provides a comfortable choice for enforcement of education programs for coaches about
young athletes who do not spend time preparing their sports supplements.
Jovanov et al. Journal of the International Society of Sports Nutrition (2019) 16:27 Page 8 of 9

Knowledge about the proper use of supplements use banned substances for the advancement in sports. Many
Based on the correct responses on proper and intended reasons could be found behind that rationale, but the im-
use of sports supplements, the study participants exhib- portance of ongoing education about possible health impli-
ited a relatively low level of knowledge in domains of cation of supplements, banned or allowed ones, is definitely
sports supplementation. The young athletes had issues one of the main strategies in changing that perspective.
related to understanding of roles and intended benefits
of different supplements. The results of this study cor- Study limitations
roborate the study of Tawlik et al. [4] who encountered Possible study limitation can be found in an uneven num-
the same misconception about the role of proteins as an ber of participants from each country and the distribution
energy drive substance for physical activity and not for of athletes between sports. Hence, the comparisons were
muscle growth and repair. The lack of congruence be- made mostly by sex and age; however, the results obtained
tween intended use and perceived knowledge was also in this study may serve to obtain valuable guidelines to-
observed by Petróczi et al. [7]. Consequently, ongoing wards future global trends about sports supplementation.
education about the roles of nutrients is advised. Other Comparisons made between sports were excluded from
studies tried to assess the knowledge by investigating self- this study due to the excessive extent that this manuscript
perceived knowledge by athletes. In one by Dascombe et would have given the specifics of each sport, and the
al. [8] 36.0% of athletes were still largely uneducated with sociological differences between them that influence the
regards to their sports supplement routine and in another choice and manner of supplements intake. However, the
by Slater et al. [13] more than 60% had little or limited results about the number of supplements used in each
knowledge about the subject. As it can be noticed the sport were included to underline valuable trends in sup-
coach and the Internet were the main sources of informa- plements consumption among different sports.
tion for the athletes who properly used supplements. The
relationship between the coach and the athlete was Conclusion
already addressed, and the Internet has become the main In conclusion, the results of this survey study indicate that
source of information, so it is not surprising that young supplementation is widespread among young athletes
athletes also utilize that resource. It is worth mentioning (82.2%) and not restricted to specific demographics or
that the education of coaches on this subject is of great sport. The athletic performance is the main motivation,
importance considering that many coaches do not have however the level of knowledge young athletes have about
enough knowledge to give appropriate supplements rec- the proper and intended use of sports supplements reveals
ommendations [29, 30]. Compared to 75.0% of athletes in the knowledge gap and the necessity of enforcing ongoing
the study by Nieper [21] who had access to sports education about sports supplementation.
dieticians, only 27.9% of them in this study had the same
opportunity. This stresses the underrepresentation of spe- Practical applications
cialized staff in sports clubs, especially in the developing
countries. One of the objective reasons may lie in the fact  The protein supplements are widespread among
that many sport clubs do not have enough financial re- young athletes.
sources to have qualified professionals such as dieticians  The coach is the main source of information about
at their disposal. However, both studies confirm a low supplementation practices
utilization of their services, and a possible explanation  The enhancement of athletic performance is the
may lie in the fact that the athletes are not familiar enough main reason of using sports supplements by
with the spectrum of the services that dieticians provide. young athletes.
 The level of knowledge about the proper and
Doping and ethics intended use of sports supplements is inadequate.
Without a proper guidance when taking dietary supple-  Ongoing education about sports supplements by all
ments there is a great risk of a positive doping and adverse athletes and coaches is necessary for maximizing
effects on athletes’ health. Knowledge and implementation athletic performance and minimizing the risk of
of WADA regulations is nowadays mandatory for any ath- positive doping test.
lete competing at the international level. The percentage of  Insufficient knowledge causes ethical dilemma about
athletes familiar with these regulations implicates the need the misuse of sports supplements.
for further implementation of these regulations in all educa-
tional programs. However, the authors did not find any
study concerning ethical questions about possible doping. Additional file
This study provides one of the first results about ethical con-
Additional file 1: The survey. (XLSX 28 kb)
cerns in youth sports, showing that 11.8% of athletes would
Jovanov et al. Journal of the International Society of Sports Nutrition (2019) 16:27 Page 9 of 9

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Competing interests
23. Huang SH, Johnson K, Pipe AL. The use of dietary supplements and
The authors declare that they have no competing interests.
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Author details
1 24. Cribb PJ, Williams AD, Hayas A. A creatine-protein-carbohydrate
Institute of Food Technology in Novi Sad, University of Novi Sad, Bulevar
supplement enhances responses to resistance training. Med Sci Sports
cara Lazara 1, Novi Sad 21000, Serbia. 2Faculty of Sport and Physical
Exerc. 2007;39(11):1960–8.
Education, University of Novi Sad, Lovćenska 16, Novi Sad 21000, Serbia.
3 25. Diehl K, Thiel A, Zipfel S, Mayer J, Schnell A, Schneider S. Elite adolescent
Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, Novi Sad
athletes’ use of dietary supplements: characteristics, opinions, and sources
21000, Serbia. 4Institute of General and Physical Chemistry, University of
of supply and information. Int J Sport Nutr Exerc Metab. 2012;22(3):165–74.
Belgrade, Studentski trg 12-16, Beograd 11000, Serbia.
26. Zdesar Kotnik K, Jurak G, Starc G, Golja P. Faster, stronger, healthier:
adolescent-stated reasons for dietary supplementation. J Nutr Educ Behav.
Received: 12 March 2019 Accepted: 20 June 2019
2017;49(10):817–26 e1.
27. Burns RD, Schiller MR, Merrick MA, Wolf KN. Intercollegiate student athlete
use of nutritional supplements and the role of athletic trainers and
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