Different Time Trends of Caloric and Fat Intake Between Statin Users and Nonusers Among US Adults

Abstract

IMPORTANCE Both dietary modification and use of statins can lower blood cholesterol. The increase in caloric intake among the general population is reported to have plateaued in the last decade, but no study has examined the relationship between the time trends of caloric intake and statin use.OBJECTIVE To examine the difference in the temporal trends of caloric and fat intake between statin users and nonusers among US adults. DESIGN, SETTING, AND PARTICIPANTSA repeated cross-sectional study in a nationally representative sample of 27 886 US adults, 20 years or older, from the National Health and Nutrition Examination Survey, 1999 through 2010. EXPOSURES Statin use.MAIN OUTCOMES AND MEASURES Caloric and fat intake measured through 24-hour dietary recall. Generalized linear models with interaction term between survey cycle and statin use were constructed to investigate the time trends of dietary intake for statin users and nonusers after adjustment for possible confounders. We calculated model-adjusted caloric and fat intake using these models and examined if the time trends differed by statin use. Body mass index (BMI) changes were also compared between statin users and nonusers. RESULTSIn the 1999-2000 period, the caloric intake was significantly less for statin users compared with nonusers (2000 vs 2179 kcal/d; P = .007). The difference between the groups became smaller as time went by, and there was no statistical difference after the 2005-2006 period. Among statin users, caloric intake in the 2009-2010 period was 9.6% higher (95% CI, 1.8-18.1; P = .02) than that in the 1999-2000 period. In contrast, no significant change was observed among nonusers during the same study period. Statin users also consumed significantly less fat in the 1999-2000 period (71.7 vs 81.2 g/d; P = .003). Fat intake increased 14.4% among statin users (95% CI, 3.8-26.1; P = .007) while not changing significantly among nonusers. Also, BMI increased more among statin users (+1.3) than among nonusers (+0.4) in the adjusted model (P = .02). CONCLUSIONS AND RELEVANCECaloric and fat intake have increased among statin users over time, which was not true for nonusers. The increase in BMI was faster for statin users than for nonusers. Efforts aimed at dietary control among statin users may be becoming less intensive. The importance of dietary composition may need to be reemphasized for statin users.

Statins and New-Onset Diabetes Mellitus and Diabetic Complications: A Retrospective Cohort Study of US Healthy Adults

“…72 A cross-sectional study (27,886 adults) from the National Health and Nutrition Examination Survey (NHANES) noted that caloric intake, fat intake, and body mass index were higher in statin users compared to nonusers. 2 Lastly, a Mendelian randomization study noted that common variants in the HMGR gene were associated with an LDLlowering effect and an increase in body mass index, insulin resistance, and type 2 diabetes, 73 which further supports the Lipid measurements represent the mean value for each patient throughout the baseline period; these laboratory measurements were only available in 1946 statin users and 3455 nonusers. Lipid measurements were not included in propensity score matching link between statins and a higher risk of diabetes and obesity, and demonstrates that this is an Bon-target^effect.…”

“…1 A recent cross-sectional study noted higher caloric and fat intake and increased body mass index among statin users in contrast to nonusers. 2 Additionally, achieving a "cholesterol goalt hrough swallowing a tablet might result in false self assurance, and may encourage poor dietary choices and a sedentary lifestyle. 3 Several randomized trials and observational studies have noted that statin users have higher hemoglobin [Hb]A 1C and fasting plasma glucose measurements than nonusers.…”

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

“…The analysis of the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) study [39] demonstrated that in participants with and without diabetes risk factors, the overall beneficial effect of statin therapy on vascular events was greater (almost 2.5-fold) than the hazard of developing NOD, and this effect was observed even in a lower-risk primary-prevention population [39]. On the basis of the available data FDA presented the communications warning that statin therapy had been associated with increases in levels of fasting serum glucose and HbA 1c [31,40]. …”

Current Treatment of Dyslipidemia: A New Paradigm for Statin Drug Use and the Need for Additional Therapies

“…Between 1999 and 2000, patients receiving statins had significantly lower caloric intakes than non-statin users, but between 2005 and 2006 this was no longer the case. There appeared to be an increase in daily fat, caloric intake, and body mass index (BMI) between statin users during 1999-2000 and during 2001-2009 compared with individuals not using statins [85]. In a cohort of older men being followed for osteoporosis, those beginning statins experienced a faster deterioration in physical activity than non-users [86].…”