Diabetes aktuell 2019; 17(08): 327-332
DOI: 10.1055/a-1031-7725
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Weniger Kohlenhydrate in der Therapie des Diabetes?

Was sind Vor- und Nachteile?
Anja Bosy-Westphal
1   Christian-Albrechts-Universität zu Kiel, Institut für Humanernährung und Lebensmittelkunde
,
Manfred J. Müller
1   Christian-Albrechts-Universität zu Kiel, Institut für Humanernährung und Lebensmittelkunde
› Author Affiliations
Further Information

Publication History

Publication Date:
18 December 2019 (online)

ZUSAMMENFASSUNG

Lifestyle-Diäten mit einer Einschränkung des Kohlenhydratverzehrs (Low Carb, Paleo, ketogen) erfreuen sich insbesondere zur Kontrolle des Körpergewichts zunehmender Beliebtheit. Bei Patienten mit Typ-2-Diabetes sollen sie nicht nur zur Gewichtsreduktion beitragen, sondern auch zu einer verbesserten Einstellung der Glykämie und einer Senkung des Insulinbedarfs führen. Was sind die Vor- und Nachteile einer Reduktion der Kohlenhydrataufnahme bei Patienten mit Typ-2-Diabetes? Wenn die Kohlenhydrate ersetzt werden, wovon sollte stattdessen mehr verzehrt werden? Kann eine kohlenhydratreiche Diät bei Patienten mit Typ-2-Diabetes heute noch empfohlen werden? Der Beitrag versucht, diese Fragen in Kürze zu beantworten und rückt den Fokus der Diskussion weg von der reinen Betrachtung der Makronährstoffrelation hin zur Bedeutung der Kohlenhydrat- und Fettqualität und einer individualisierten Ernährungstherapie. Darüber hinaus bieten sowohl die Stratifizierung metabolischer Phänotypen des Prädiabetes als auch die differenzierte bioinformatische Analyse von Ernährungsmustern anstelle von rein korrelativen nährstoffbasierten Auswertungen neue Ansätze für die Ernährungsforschung.

 
  • Literatur

  • 1 Simpson HC, Simpson RW, Lousley S. et al A high carbohydrate leguminous fibre diet improves all aspects of diabetic control. Lancet 1981; 1: 1-5 doi:10.1016/s0140-6736(81)90112-4
  • 2 Feinman RD, Pogozelski WK, Astrup A. et al Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition 2015; 31: 1-13 doi:10.1016/j.nut.2014.06.011
  • 3 Davies MJ, D’Alessio DA, Fradkin J. et al Management of hyperglycemia in type 2 diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2018; 41: 2669-2701 doi:10.2337/dci18-0033
  • 4 Evert AB, Dennison M, Gardner CD. et al Nutrition therapy for adults with diabetes or prediabetes: A Consensus Report. Diabetes Care 2019; 42: 731-754 doi:10.2337/dci19-0014
  • 5 Kahn BB, Flier JS. Obesity and insulin resistance. J Clin Invest 2000; 106: 473-481 doi:10.1172/JCI10842
  • 6 Hall KD, Bemis T, Brychta R. et al Calorie for calorie, dietary fat restriction results in more body fat loss than carbohydrate restriction in people with obesity. Cell Metab 2015; 22: 427-436 doi:10.1016/j.cmet.2015.07.021
  • 7 Hall KD, Chen KY, Guo J. et al Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr 2016; 104: 324-333 doi:10.3945/ajcn.116.133561
  • 8 Kim JY, Nasr A, Tfayli H. et al Increased lipolysis, diminished adipose tissue insulin sensitivity, and impaired β-cell function relative to adipose tissue insulin sensitivity in obese youth with impaired glucose tolerance. Diabetes 2017; 66: 3085-3090 doi:10.2337/db17-0551
  • 9 Abdul-Ghani MA, Molina-Carrion M, Jani R. et al Adipocytes in subjects with impaired fasting glucose and impaired glucose tolerance are resistant to the anti-lipolytic effect of insulin. Acta Diabetol 2008; 45: 147-150 doi:10.1007/s00592-008-0033-z
  • 10 Hjorth MF, Due A, Larsen TM. et al Pretreatment fasting plasma glucose modifies dietary weight loss maintenance success: results from a stratified RCT. Obesity (Silver Spring) 2017; 25: 2045-2048 doi:10.1002/oby.22004
  • 11 Hjorth MF, Ritz C, Blaak EE. et al Pretreatment fasting plasma glucose and insulin modify dietary weight loss success: results from 3 randomized clinical trials. Am J Clin Nutr 2017; 106: 499-505 doi:10.3945/ajcn.117.155200
  • 12 Estruch R, Corella D, Salas-Salvado J. et al Pretreatment fasting plasma glucose determines weight loss on high-fat diets: The PREDIMED Study. Obesity 2017; 25: 2045-2048
  • 13 Astrup A. The role of dietary fat in obesity. Semin Vasc Med 2005; 5: 40-47 doi:10.1055/s-2005-871740
  • 14 Max Rubner-Institut 2008 Nationale Verzehrsstudie Teil II. Im Internet www.bmel.de/SharedDocs/Downloads/Ernaehrung/NVS_ErgebnisberichtTeil2.pdf?__blob=publicationFile Stand: 21.11.2019
  • 15 Snell-Bergeon JK, Chartier-Logan C, Maahs DM. et al Adults with type 1 diabetes eat a high-fat atherogenic diet that is associated with coronary artery calcium. Diabetologia 2009; 52: 801-809 doi:10.1007/s00125-009-1280-4
  • 16 Meisinger C, Rospleszcz S, Wintermeyer E. et al Isocaloric substitution of dietary carbohydrate intake with fat intake and MRI-determined total volumes of visceral, subcutaneous and hepatic fat content in middle-aged adults. Nutrients 2019: 11 pii:E1151. doi:10.3390/nu11051151
  • 17 Mazidi M, Kengne AP, Mikhailidis DP. et al Dietary food patterns and glucose/insulin homeostasis: a cross-sectional study involving 24,182 adult Americans. Lipids Health Dis 2017; 16: 192 doi:10.1186/s12944-017-0571-x
  • 18 Gannon MC, Nuttall FQ. Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. Diabetes 2004; 53: 2375-2382 doi:10.2337/diabetes.53.9.2375
  • 19 Qian F, Korat AA, Malik V. et al Metabolic effects of monounsaturated fatty acid-enriched diets compared with carbohydrate or polyunsaturated fatty acid-enriched diets in patients with type 2 diabetes: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care 2016; 39: 1448-1457 doi:10.2337/dc16-0513
  • 20 Ginsberg HN. Insulin resistance and cardiovascular disease. J Clin Invest 2000; 106: 453-458 doi:10.2337/dc16-0513
  • 21 Sainsbury E, Kizirian NV, Partridge SR. et al Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract 2018; 139: 239-252 doi:10.1016/j.diabres.2018.02.026
  • 22 Esposito K, Maiorino MI, Petrizzo M. et al The effects of a Mediterranean diet on the need for diabetes drugs and remission of newly diagnosed type 2 diabetes: follow-up of a randomized trial. Diabetes Care 2014; 37: 1824-1830 doi:10.2337/dc13-2899
  • 23 Campmans-Kuijpers MJ, Sluijs I, Nöthlings U. et al The association of substituting carbohydrates with total fat and different types of fatty acids with mortality and weight change among diabetes patients. Clin Nutr 2016; 35: 1096-1102 doi:10.1016/j.clnu.2015.08.003
  • 24 Jiao J, Liu G, Shin HJ. et al Dietary fats and mortality among patients with type 2 diabetes: analysis in two population based cohort studies. BMJ 2019; 366: l4009 doi:10.1136/bmj.l4009
  • 25 Seidelmann SB, Claggett B, Cheng S. et al Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health 2018; 3: e419-e428 doi:10.1016/S2468-2667(18)30135-X
  • 26 Dehghan M, Mente A, Zhang X. et al Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet 2017; 390: 2050-2062 doi:10.1016/S0140-6736(17)32252-3
  • 27 Hu FB. Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care 2011; 34: 1249-1257 doi:10.2337/dc11-0442
  • 28 Mohan V, Unnikrishnan R, Shobana S. et al Are excess carbohydrates the main link to diabetes & its complications in Asians?. Indian J Med Res 2018; 148: 531-538 doi:10.4103/ijmr.IJMR_1698_18
  • 29 Jung CH, Choi KM. Impact of high-carbohydrate diet on metabolic parameters in patients with type 2 diabetes. Nutrients 2017: 9 pii:E322. doi:10.3390/nu9040322
  • 30 Lousley SE, Jones DB, Slaughter P. et al High carbohydrate-high fibre diets in poorly controlled diabetes. Diabet Med 1984; 1: 21-25 doi:10.1111/j.1464-5491.1984.tb01916.x
  • 31 Satija A, Hu FB. Cardiovascular benefits of dietary fiber. Curr Atheroscler Rep 2012; 14: 505-514 doi:10.1007/s11883-012-0275-7
  • 32 Riccardi G, Rivellese AA. Effects of dietary fiber and carbohydrate on glucose and lipoprotein metabolism in diabetic patients. Diabetes Care 1991; 14: 1115-1125 doi:10.2337/diacare.14.12.1115
  • 33 Browning JD, Baker JA, Rogers T. et al Short-term weight loss and hepatic triglyceride reduction: evidence of a metabolic advantage with dietary carbohydrate restriction. Am J Clin Nutr 2011; 93: 1048-1052
  • 34 Browning JD, Davis J, Saboorian MH. et al A low-carbohydrate diet rapidly and dramatically reduces intrahepatic triglyceride content. Hepatology 2006; 44: 487-488 doi:10.1002/hep.21264
  • 35 Mardinoglu A, Wu H, Bjornson E. et al An Integrated Understanding of the Rapid Metabolic Benefits of a Carbohydrate-Restricted Diet on Hepatic Steatosis in Humans. Cell Metab 2018; 27: 559-571.e5 doi:10.1016/j.cmet.2018.01.005
  • 36 Ryan MC, Itsiopoulos C, Thodis T. et al The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. J Hepatol 2013; 59: 138-143 doi:10.1016/j.jhep.2013.02.012
  • 37 Bozzetto L, Prinster A, Annuzzi G. et al Liver fat is reduced by an isoenergetic MUFA diet in a controlled randomized study in type 2 diabetic patients. Diabetes Care 2012; 35: 1429-1435 doi:10.2337/dc12-0033
  • 38 Bozzetto L, Costabile G, Luongo D. et al Reduction in liver fat by dietary MUFA in type 2 diabetes is helped by enhanced hepatic fat oxidation. Diabetologia 2016; 59: 2697-2701 doi:10.1007/s00125-016-4110-5
  • 39 Rosqvist F, Kullberg J, Ståhlman M. et al Overeating saturated fat promotes fatty liver and ceramides compared to polyunsaturated fat: a randomized trial. J Clin Endocrinol Metab 2019; 104: 6207-6219 doi:10.1210/jc.2019-00160
  • 40 Bawden S, Stephenson M, Falcone Y. et al Increased liver fat and glycogen stores after consumption of high versus low glycaemic index food: A randomized crossover study. Diabetes Obes Metab 2017; 19: 70-77 doi:10.1111/dom.12784
  • 41 Lagerpusch M, Enderle J, Eggeling B. et al Carbohydrate quality and quantity affect glucose and lipid metabolism during weight regain in healthy men. J Nutr 2013; 143: 1593-1601 doi:10.3945/jn.113.179390
  • 42 Wheeler ML Dunbar SA, Jaacks LM. et al Macronutrients, food groups, and eating patterns in the management of diabetes: a systematic review of the literature, 2010. Diabetes Care 2012; 35: 434-445 doi:10.2337/dc11-2216
  • 43 Zeevi D, Korem T, Zmora N. et al Personalized nutrition by prediction of glycemic responses. Cell 2015; 163: 1079-1094 doi:10.1016/j.cell.2015.11.001