Gluttony in the Time of Statins?

JAMA Intern Med. 2014 Apr 24. doi: 10.1001/jamainternmed.2014.1927. [Epub ahead of print]

Different Time Trends of Caloric and Fat Intake Between Statin Users and Nonusers Among US Adults: Gluttony in the Time of Statins?

Sugiyama T1, Tsugawa Y2, Tseng CH3, Kobayashi Y4, Shapiro MF5.

Author information

• 1Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles2Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan3Depa.
• 2Harvard Interfaculty Initiative in Health Policy, Cambridge, Massachusetts5Center for Clinical Epidemiology, St Luke's Life Science Institute, Tokyo, Japan.
• 3Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles.
• 4Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
• 5Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles6Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angele.

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 PARTICIPANTS 

A 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. 

RESULTS 

In 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 RELEVANCE 

Caloric 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.