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

Study Questions:

What are the differences in the temporal trends of caloric and fat intake between statin users and nonusers among US adults?

Methods:

This was 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. The exposure of interest was statin use. Caloric and fat intake was 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. The investigators 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 = 0.007). 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% confidence interval [CI], 1.8-18.1; p = 0.02) 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 = 0.003). Fat intake increased 14.4% among statin users (95% CI, 3.8-26.1; p = 0.007), 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 = 0.02).

Conclusions:

The authors concluded that caloric and fat intake have increased among statin users over time, which was not true for nonusers.

Perspective:

This analysis suggests that caloric and fat intake among statin users in the 2009-2010 time period was significantly greater than in the 1999-2000 period. The increase in BMI was therefore faster for statin users than for nonusers. It appears that efforts aimed at dietary control among statin users may be becoming less intensive with statins, giving individuals a sense of reassurance to indulge in high-fat diets. The importance of dietary composition may need to be re-emphasized for statin users, and the goal of statin treatment, as with any drug therapy, should be to allow patients to decrease risks that cannot be adequately decreased without medication. Lifestyle modification including a low-fat, low-caloric diet should remain the cornerstone for cardiovascular disease risk reduction.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Nonstatins, Novel Agents, Statins, Diet

Keywords: Dyslipidemias, Life Style, Food Habits, Body Mass Index, Cardiology, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cardiovascular Diseases, Diet, High-Fat, Confidence Intervals, Nutrition Surveys


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