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Do Statins Make You Fatter?

Monday, April 28, 2014 // Uncategorized

Often when I prescribe proton pump inhibitors (PPI’s) such as Nexium or Prilosec for reflux patients remark< “Great, now I can eat whatever I want.”  Giving a medication may enable patients to disregard normal dietary advice to avoid foods that bring it on and eat foods that they normally wouldn’t.  Likewise, people on medications to lower cholesterol when faced the results of impressive cholesterol reduction with medication may choose to eat foods that they otherwise wouldn’t which results in weight gain.  The statins don’t cause the weight gain, but a change in behavior as evidenced by the following JAMA article summarized in Journal Watch.

Calorie, Fat Consumption Up Among Statin Users By Amy Orciari Herman

Calorie and fat consumption increased significantly from 1999 to 2010 among statin users — but not among nonusers — according to a JAMA Internal Medicine study. The researchers conclude that “the importance of dietary composition may need to be reemphasized for statin users.”The researchers evaluated 24-hour dietary recall data from nearly 28,000 adults participating in U.S. nutrition surveys over the 12-year period. They found that among statin users, caloric intake was 10% greater, and fat intake 14% greater, in 2009-2010 than in 1999-2000. No significant increases were observed among nonusers. In addition, statin users had a greater increase in BMI than nonusers did (1.3 vs. 0.4 units).The authors speculate that statin use “may have undermined the perceived need to follow dietary recommendations.” They add that the aim of statin therapy “should be to allow patients to decrease risks that cannot be decreased without medication, not to empower them to put butter on their steaks.” – See more at: http://www.jwatch.org/fw108758/2014/04/28/calorie-fat-consumption-among-statin-users#sthash.Pq2IIJKJ.dpuf

Here is the abstract of the original JAMA article:

Between Statin Users and Nonusers Among US Adults:  Gluttony in the Time of Statins? FREE ONLINE FIRST

Takehiro Sugiyama, MD, MSHS1,2,3; Yusuke Tsugawa, MD, MPH4,5; Chi-Hong Tseng, PhD1; Yasuki Kobayashi, MD, PhD2; Martin F. Shapiro, MD, PhD1,6
[+-] Author Affiliations

1Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles
2Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
3Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
4Harvard Interfaculty Initiative in Health Policy, Cambridge, Massachusetts
5Center for Clinical Epidemiology, St Luke’s Life Science Institute, Tokyo, Japan
6Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
JAMA Intern Med. Published online April 24, 2014. doi:10.1001/jamainternmed.2014.1927
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Published online

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.

Figures in this Article

The National Cholesterol Education Program Adult Treatment Panel guideline,1– 4 which was updated by 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline recently,5 has consistently recommended dietary modification as a key component of antihyperlipidemic therapy. Since 2001, these guidelines also have stated that statins are more effective than other pharmacotherapies.3 Statin use has grown rapidly in the United States over the past 25 years,6,7 while caloric intake has increased overall in US adults from the 1970s through the 1990s8 reaching a plateau starting in the 1999-2000 period.9 The proportion of calories from fat ingested by US adults decreased from the 1970s to the 1990s,8 followed by a stable trend since the 1999-2000 period.9 To our knowledge, no studies have examined whether the temporal trend in food intake is related to statin use, although previous studies have investigated the cross-sectional and short-term relationship between statin use and food intake.10– 12 In this context, we examined whether the time trends of caloric and fat intake differed between statin users and nonusers.

BOTTOM LINE: IT’S MEDICATION AND LIFESTYLE MODIFICATION THAT MAKES THE DIFFERENCE!

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