Omega-3 fatty acid supplement use among saudi adults: prevalence, independent associations, and knowledge assessment — a cross-sectional survey

Omega-3 fatty acids (n-3 FAs) are essential polyunsaturated fatty acids with well-documented cardiovascular, cognitive, and anti-inflammatory benefits. Although global consumption of supplements is rising rapidly, the sociodemographic and lifestyle determinants of n-3 FA supplement uptake in Saudi Arabia remain incompletely characterized. This study aimed to: (i) estimate the prevalence and patterns of n-3 FA supplement ever-use across Saudi adult demographic strata; (ii) identify barriers among non-users and conditions facilitating future uptake; (iii) assess knowledge and attitudes toward n-3 FA supplements among ever-users; and (iv) determine independent associations with supplement use. A cross-sectional survey was conducted between January and March 2025. A bilingual (Arabic/English) self-administered online questionnaire adapted from a previously validated instrument (see Additional file 2) was distributed via social media and community networks to 321 adults (≥ 20 years) across all five Saudi geographic regions. A 10-item knowledge and attitudes scale demonstrated good validity (item-total r = 0.516–0.872; all p ≤ 0.003) and reliability (Cronbach’s α = 0.84). Descriptive statistics, chi-square tests with Cramér’s V effect sizes, and binary logistic regression were used for analysis. The prevalence of n-3 FA supplement ever-use was 39.3% (126/321). Age, education, employment, settlement type, marital status, smoking status, physical activity, and quality of life were significantly associated with ever-use (all p ≤ 0.026). In multivariate analysis, physical activity (OR = 1.89, 95% CI 1.37–2.61, p < 0.001), single marital status (OR = 3.00, 95% CI 1.07–8.39, p = 0.036), and married status (OR = 2.08, 95% CI 1.003–4.33, p = 0.049) were significant independent associations. Gender and monthly income were not associated with ever-use, suggesting relative equity in access across demographic strata. Cardiovascular and cognitive health were the leading motivations; supplement aversion (23.6%), lack of interest (22.6%), and insufficient information (22.1%) were the dominant barriers. Overall, 50.8% of non-users reported willingness to initiate supplementation upon a healthcare professional’s recommendation. Physical activity and marital status are the primary independent associations with ever-use of n-3 FA supplements among Saudi adults. High non-user willingness to supplement under professional guidance, combined with 46.0% of ever-users not disclosing supplement use to their healthcare provider, underscores the central role of clinicians in promoting evidence-based, safe supplementation. These findings provide an empirical foundation for culturally tailored public health strategies in Saudi Arabia.