LDL, Saturated Fat, Medication, Diet & Human Nature

[JeffN]

The following graph is on saturated fat intake levels, LDL levels, and the use of cholesterol lowering medications (CLM) and is from the report below. It sums up on one of the issues that makes adopting this way of eating so difficult.

From 1976-1980 to 1988-1994, when we first starting getting the advice to lower our intake of saturated fat, we made some improvement. The percentage of Americans meeting the goal of the AHA to lower the amount of saturated fat in their diet to less than 10% went from 25% to 41%. And, as a result of these efforts, the percent of Americans with a high LDL dropped from 59% to 42%.

Great.

Notice that during the same period of time, the use of Cholesterol Lowering Medications (CLM's) was barely in use with 0% of the population using them in 1976-1980 period, which rises to just 5% in the 1988-1994 period. They were just getting started and gaining popularity.

Then what happens?

Over the next 20 years, CLM's become commonplace in the population to where in 2010, 23% of the population is using them. During that same 20 year period, the amount of Americans with high LDL continues to drop from 42% to 27%

However, because people can now take a CLM, they no longer believe they have to change their diet. We see the impact of this, as the percentage of Americans meeting the saturated fat goal of the AHA, does not change over the next 20 years. There was no more Americans reaching this reduced level of sat fat in their diet.

So, this graph clearly shows then when faced with the choice of changing your diet or taking a pill to make your numbers better, people chose to take a pill.



Full Report

Trends in High LDL Cholesterol, Cholesterol-lowering Medication Use, and Dietary Saturated-fat Intake:
United States, 1976–2010
NCHS Data Brief
Number 117, March 2013

http://www.cdc.gov/nchs/data/databriefs/db117.htm

Key findings

Data from the National Health and Nutrition Examination Survey, 1976–1980, 1988–1994, 2001–2004, and 2007–2010
For adults aged 40–74:

- The prevalence of high low-density lipoprotein cholesterol, or LDL–C, decreased from 59% to 27% from the late 1970s through 2007–2010.

- The percentage of adults using cholesterol-lowering medication increased from 5% to 23% from the late 1980s through 2007–2010.

- The percentage of adults consuming a diet low in saturated fat increased from 25% to 41% from the late 1970s through 1988–1994.

- No significant changes in the percentage of adults consuming a diet low in saturated fat were observed from 1988–1994 through 2007–2010.

In Health
Jeff

[JeffN]

And the trend continues not only for diet but for exercise too...

This analysis followed ~28,000 U.S. adults for more than 10 years. They found the calorie intake by statin users increased by 9.6% and the fat intake increased by 14.4%, while neither of these changed significantly among those not on statins during that same time period. The increase of BMI was faster for statin-users than for non-users.

In Health
Jeff

Is There Gluttony in the Time of Statins? Different Time Trends of Caloric and Fat Intake between Statin-users and Non-users among US Adults
JAMA Intern Med. 2014 Jul; 174(7): 1038–1045.
doi: 10.1001/jamainternmed.2014.1927
PMCID: PMC4307794
NIHMSID: NIHMS647022

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307794/

Abstract

Importance
Both dietary modification and statins can lower blood cholesterol. The increase in caloric intake among 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 non-users among US adults.

Design
A repeated cross-sectional study.

Setting
A nationally representative sample of the National Health and Nutrition Examination Survey from 1999 through 2010.

Participants
27,886 US adults aged 20 years or older.

Exposure
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 non-users after adjustment for possible confounders. We calculated model-adjusted caloric and fat intake using these models, and examined if the time trends differ by statin use. Body mass index (BMI) changes were also compared between statin-users and non-users.

Results
In 1999-2000, the caloric intake was significantly less for statin-users compared with non-users (2,000 vs. 2,179 kcal/day, p=.007). The difference between the groups became smaller as time went by, and there was no statistical difference after 2005-2006. Among statin-users, caloric intake in 2009-2010 was 9.6% higher (95% confidence interval (CI): 1.8 to 18.1, p=.02) than that in 1999-2000. In contrast, no significant change was observed among non-users during the same study period. Statin-users also consumed significantly less fat in 1999-2000 (71.7 vs. 81.2 g/day, p=.003). Fat intake increased 14.4% in statin-users (95% CI: 3.8 to 26.1, p=.007) while not changing significantly in non-users. BMI also increased more in statin-users (1.3 kg/m2) than non-users (0.4 kg/m2) 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 non-users. The increase of BMI was faster for statin-users than for non-users. 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.


on Exercise

Same for exercise

Comparing the Trend of Physical Activity and Caloric Intake between Lipid-Lowering Drug Users and Nonusers among Adults with Dyslipidemia: Korean National Health and Nutrition Examination Surveys (2010–2013)
Korean J Fam Med. 2016 Mar; 37(2): 105–110.
Published online 2016 Mar 25. doi: 10.4082/kjfm.2016.37.2.105
PMCID: PMC4826989


Abstract

Background
The purpose of this study was to compare the physical activity and caloric intake trends of lipid-lowering drug users with those of non-users among Korean adults with dyslipidemia.

Methods
This study was a repeated cross-sectional study with a nationally representative sample of 2,635 Korean adults with dyslipidemia based on the 2010–2013 Korea National Health and Nutrition Examination Survey. Physical activity was assessed using the International Physical Activity Questionnaire, and caloric intake was estimated through 24-hour dietary recall. All statistical analyses were conducted using IBM SPSS ver. 21.0 (IBM Co., Armonk, NY, USA). The changes in physical activity and caloric intake were investigated for lipid-lowering drug users and non-users using generalized linear models.

Results
The proportion of lipid-lowering drug users in the 2010–2013 survey population increased from 3.5% to 5.0% (P<0.001). Among adults of dyslipidemia, total of 1,562 participants (56.6%) reported taking lipid-lowering drugs, and 1,073 (43.4%) reported not taking lipid-lowering drugs. Drug users were more likely to be older and less educated and to have a diagnosis of diabetes, higher body mass index, and lower low density lipoprotein cholesterol level. Physical activity trends were tested separately for the lipid-lowering drug users and non-users, and a significant decrease was found among the drug users during the study period. Physical activity among the drug users in 2013 was 38% lower (1,357.3±382.7 metabolic equivalent [MET]; P for trend=0.002) than in 2010 (2,201.4±442.6 MET). In contrast, there was no statistically significant difference between drug users and non-users in the trend of caloric intake during the same period.

Conclusion
Physical activity significantly decreased among lipid-lowering drug users between 2010 and 2013, which was not observed among non-users. The importance of physical activity may need to be re-emphasized for lipid-lowering drug users.