Trends, Patterns, and Public Health Implications of Dietary Supplement Recalls: A Decade-Long Analysis from the Greek National Organization for Medicines (2015-2024)

This retrospective study examines dietary supplement recalls in Greece from 2015 to 2024, focusing on seasonal trends, reasons for recalls, and dosage forms. A total of 602 recalls were analyzed, with sexual enhancement products (39%), weight management supplements (21%), and bodybuilding supplements (10%) representing the majority of cases. Recalls were primarily attributed to adulterants (62%), quality control issues (15%), and violations related to novel food ingredients (9%). The most commonly recalled dosage forms were capsules (56%) and powders (16%). Capsules and powders are prevalent due to their cost-effective manufacturing processes and simpler formulation requirements, while notable was the presence of honeys and pastes which often appeal to consumers seeking 'natural' remedies. Products sold exclusively online accounted for 63% of recalls, highlighting the risks associated with unregulated e-commerce channels. Seasonal patterns revealed increasing trends in recalls during winter, attributed to consumer demand and regulatory focus. The three major product categories showed seasonal trends, though these were not statistically significant. Specifically, sexual dysfunction products exhibited seasonal variation, with peaks in January and April associated with adulterants such as sildenafil and tadalafil. Weight management product recalls were higher in January and December, reflecting post-holiday and pre-New Year health trends, while bodybuilding supplements showed steady activity with slight increases in late summer. These findings underscore the importance of targeted regulatory enforcement during high-risk periods, enhanced consumer awareness campaigns, and strengthened international collaboration to address safety violations. Special attention to online marketplaces and tailored strategies addressing specific product categories and dosage forms are critical to improving public health outcomes and supplement safety.