Sugiyama Takehiro, Tsugawa Yusuke, Tseng Chi-Hong, Kobayashi Yasuki, Shapiro Martin F
Division 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.
Harvard Interfaculty Initiative in Health Policy, Cambridge, Massachusetts5Center for Clinical Epidemiology, St Luke's Life Science Institute, Tokyo, Japan.
JAMA Intern Med. 2014 Jul;174(7):1038-45. doi: 10.1001/jamainternmed.2014.1927.
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.
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.
Statin use.
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.
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).
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.
饮食调整和使用他汀类药物均可降低血液胆固醇水平。据报道，过去十年中普通人群的热量摄入增长已趋于平稳，但尚无研究探讨热量摄入的时间趋势与他汀类药物使用之间的关系。
研究美国成年人中他汀类药物使用者与非使用者在热量和脂肪摄入时间趋势上的差异。
设计、设置和参与者：一项重复横断面研究，样本来自1999年至2010年的美国国家健康与营养检查调查，为具有全国代表性的27886名20岁及以上美国成年人。
他汀类药物使用情况。
通过24小时饮食回顾来测量热量和脂肪摄入。构建带有调查周期与他汀类药物使用交互项的广义线性模型，在调整可能的混杂因素后，研究他汀类药物使用者和非使用者饮食摄入的时间趋势。我们使用这些模型计算模型调整后的热量和脂肪摄入量，并检验时间趋势是否因他汀类药物使用情况而异。还比较了他汀类药物使用者和非使用者之间的体重指数（BMI）变化。
在1999 - 2000年期间，他汀类药物使用者的热量摄入显著低于非使用者（分别为2000千卡/天和2179千卡/天；P = 0.007）。随着时间推移，两组之间的差异变小，在2005 - 2006年之后无统计学差异。在他汀类药物使用者中，2009 - 2010年期间的热量摄入比1999 - 2000年期间高9.6%（95%置信区间，1.8 - 18.1；P = 0.02）。相比之下，在同一研究期间非使用者中未观察到显著变化。在1999 - 2000年期间，他汀类药物使用者摄入的脂肪也显著更少（分别为71.7克/天和81.2克/天；P = 0.003）。他汀类药物使用者的脂肪摄入量增加了14.4%（95%置信区间，3.8 - 26.1；P = 0.007），而非使用者的脂肪摄入量无显著变化。此外，在调整模型中他汀类药物使用者的BMI增加幅度（+1.3）大于非使用者（+0.4）（P = 0.02）。
随着时间推移，他汀类药物使用者的热量和脂肪摄入量增加，而非使用者并非如此。他汀类药物使用者的BMI增加速度比非使用者更快。针对他汀类药物使用者的饮食控制措施可能变得不够严格。对于他汀类药物使用者，可能需要重新强调饮食成分的重要性。
