Given the success of statins in both primary and secondary prevention of cardiovascular morbidity and mortality,^1-6 their use is progressively increasing, especially among older Americans.⁷ With such widespread use, even small risks are apparent alongside benefits. One emerging risk is an increased incidence of diabetes mellitus (DM). There is evidence that incident DM associated with statin use may be more common in the elderly, in women, and in Asians.^8-12 A recent analysis suggests that preexisting metabolic risk factors control incident DM rate with statin medication.¹³ It is unclear if this risk varies with individual statins or if this is a dose-driven class effect.^9,14 Although experimental and clinical studies find that individual statins act differently on glucose homeostasis as a function of relative lipophilicity and/or potency of action,¹⁵ other findings differ. A recent meta-analysis of 17 randomized controlled trials by Mills et al¹⁶ found a class effect increase of new-onset DM with statins (odds ratio [OR], 1.09; 95% CI, 1.02-1.16) similar to that reported by Sattar et al.⁹ Possibly, the grouping of statins masks the effect variation of individual statins. Still, at some given dose threshold, differences may be overcome, as implied by a meta-analysis of 5 trials comparing intensive to moderate dosing regimens using mainly atorvastatin and simvastatin.^13,17 Notably, meta-analysis results display intertrial and intratrial variability in diagnostic and statistical methods and do not consistently consider confounding factors. Moreover, contributing sample sizes do not permit balanced comparison by statin type, sex, race/ethnicity, and age. Similarly, single studies may uncover only part of a greater topography.

Background:High sensitivity C-reactive protein (CRP) is a marker of acute inflammation recently recognized as an independent predictor of future cardiovascular disease and diabetes. The identification of modifiable factors, such as diet, that influence serum CRP concentrations may provide the means for reducing the risk of these diseases. Data on longitudinal associations between dietary fiber intake and CRP are currently lacking. Objective:The purpose of this study was to examine longitudinal associations between dietary fiber intake and CRP. Design:Data collection took place at baseline and quarterly (every 13 wk) thereafter for a total of 5 visits, each including measurements of body composition, CRP, diet, and physical activity. Relations between serum CRP and dietary fiber were assessed by using linear mixed models and logistic regression, adjusted for covariates. Results:A total of 524 subjects had multiple measurements of CRP and dietary factors. The average total dietary fiber intake was 16.11 g/d. Average serum CRP was 1.78 mg/L. We observed an inverse association between intake of total dietary fiber (separately for soluble and insoluble fiber) and CRP concentrations in both cross-sectional and longitudinal analyses. The likelihood of elevated CRP concentrations was 63% lower (OR: 0.37; 95% CI: 0.16, 0.87) in participants in the highest quartile of total fiber intake than in participants in the lowest quartile. Conclusions:Our results suggest that dietary fiber is protective against high CRP, which supports current recommendations for a diet high in fiber.

Background: Large international variations in rates of prostate cancer incidence and mortality suggest that environmental factors have a strong influence on the development of this disease. The purpose of this study was to identify predictive variables for prostate cancer mortality in data from 59 countries. Methods: Data on prostate cancer mortality, food consumption, tobacco use, socioeconomic factors, reproductive factors, and health indicators were obtained from United Nations sources. Linear regression models were fit to these data. The influence of each variable fit in the regression models was assessed by multiplying the regression coefficient b by the 75th ( X₇₅ ) and 25th ( X₂₅ ) percentile values of the variable. The difference, bX₇₅ − bX₂₅ , is the estimated effect of the variable across its interquartile range on mortality rates measured as deaths per 100 000 males aged 45−74 years. Reported P values are two-sided. Results: Prostate cancer mortality was inversely associated with estimated consumption of cereals ( bX 75 − bX 25 = − 7.31 deaths; P = .001), nuts and oilseeds ( bX₇₅ − bX₂₅ = − 1.72 deaths; P = .003), and fish ( bX₇₅ − bX₂₅ = − 1.47 deaths; P = .001). In the 42 countries for which we had appropriate data, soy products were found to be significantly protective ( P = .0001), with an effect size per kilocalorie at least four times as large as that of any other dietary factor. Besides variables related to diet, we observed an association between prostate cancer mortality rates and a composite of other health-related, sanitation, and economic variables ( P = .003). Conclusions: The specific food-related results from this study are consistent with previous information and support the current dietary guidelines and hypothesis that grains, cereals, and nuts are protective against prostate cancer. The findings also provide a rationale for future study of soy products in prostate cancer prevention trials.

To describe seasonal variation in food intake, physical activity, and body weight in a predominantly overweight population. A longitudinal observational study. Most of the study participants were recruited from a health maintenance organization (HMO) in central Massachusetts, USA. Additional individuals of Hispanic descent were recruited from outside of the HMO population to increase the ethnic diversity of this sample. Data from 593 participants, aged 20–70, were used for this investigation. Each participant was followed quarterly (five sampling points: baseline and four consecutive quarters) for 1-year period. Body weight measurements and three 24-h dietary and physical activity recalls were obtained on randomly selected days (including 2 weekdays and 1 weekend day) per quarter. Sinusoidal regression models were used to estimate peak-to-trough amplitude and phase of the peaks. Daily caloric intake was higher by 86 kcal/day during the fall compared to the spring. Percentage of calories from carbohydrate, fat and saturated fat showed slight seasonal variation, with a peak in the spring for carbohydrate and in the fall for total fat and saturated fat intake. The lowest physical activity level was observed in the winter and the highest in the spring. Body weight varied by about 1/2 kg throughout the year, with a peak in the winter (P<0.001 winter versus summer). Greater seasonal variation was observed in subjects who were male, middle aged, nonwhite, and less educated. Although there is seasonal variation in diet, physical activity and body weight, the magnitude of the change is generally small in this population. US National Heart, Lung and Blood Institute.