Ernährungsempfehlungen beim metabolisch-vaskulären Syndrom

Zur Prävention und Therapie metabolisch-vaskulärer Erkrankungen wurde jahrelang ein fett- und kalorienarmes Ernährungsmuster mit konkreten Vorgaben zu isolierten Nährstoffen propagiert wie bspw. dem Cholesterin oder den gesättigten Fettsäuren. Dieser Beitrag soll zeigen, dass lebensmittel- bzw. essmusterbasierte Empfehlungen ohne spezifische Angaben zu Nährstoffrelationen oder Kalorien sinnvoller sind.

Abstract

Cardiovascular disease is the number one cause of death globally. Poor diet constitutes a key factor in the initiation and progression of cardiovascular disease and has become the leading risk factor for disability and death worldwide. Therefore, addressing suboptimal nutrition is of key prognostic relevance in primary and secondary prevention of metabolic vascular syndrome.

Metabolic vascular syndrome is a multidimensional network of acquired cardiometabolic risk factors closely related to insulin resistance (IR) and compensatory hyperinsulinemia. IR, being the underlying cause of metabolic vascular syndrome and certain types of cancer, should attract the attention of every clinician. As changes in lipoprotein metabolism are one of the earliest indicators of metabolic dysfunction, a relevant biomarker for identifying individuals with IR is the TAG/HDL-C ratio.

Hyperinsulinemia – and concomitant metabolic vascular risk – can be effectively treated by lifestyle intervention. If IR is present, dietary carbohydrate restriction has consistently been shown to be superior to dietary fat restriction in reversing metabolic dysfunction. The beneficial effects of carbohydrate restricted diets on metabolic vascular risk are independent of BMI – diet quality therefore confers patient benefit beyond weight reduction.

Targeting IR with a low glycemic load, real food diet will reduce overall energy density and will improve all risk factors of metabolic vascular syndrome. In particular, replacing refined carbohydrates with healthy fats in the context of a Mediterranean style-, low carbohydrate and calorie-unrestricted dietary pattern has been shown to significantly reduce burden of metabolic vascular disease. The effect of single nutrients on isolated lipid surrogate markers such as LDL-C does not capture their global effect on metabolic vascular risk.

Kernaussagen

• Gute Lebensmittelqualität nimmt einen günstigen Einfluss auf das metabolisch-vaskuläre Risiko – dieser Effekt ist körpergewichtsunabhängig.

• Zur Beurteilung der Lebensmittelqualität stellt der Kaloriengehalt ebenso wie der Gehalt an isolierten Nährstoffen wie den gesättigten Fettsäuren und dem Cholesterin kein geeignetes Maß dar. Es ist somit nicht sinnvoll, traditionelle Lebensmittel, welche natürlicherweise einen höheren Gehalt an diesen Nährstoffen aufweisen, pauschal als gesundheitlich bedenklich einzuordnen.

• Das primäre Ziel sollte vielmehr darin bestehen, den Konsum verarbeiteter Lebensmittel zu senken, welche i. d. R. zuckerreich, stärkereich, ballaststoffarm und reich an industriellen Transfettsäuren sind.

• Der LDL-C-erhöhende Effekt einiger gesättigter Fettsäuren spiegelt nicht deren Effekt auf das globale metabolisch-vaskuläre Risiko wider.

• Die empfohlene Mindestmenge von 0,8 g Protein/kg Körpergewicht reicht nicht aus, um strukturelle und metabolische Körperfunktionen optimal zu unterstützen.

• Kohlenhydrate sind nicht essenziell – die Menge alimentärer Kohlenhydrate ist individuell an die Stoffwechselsituation anzupassen. Ein Biomarker, welcher das Vorliegen einer metabolischen Dysfunktion (Insulinresistenz) mit hoher Sensitivität und Spezifität sehr frühzeitig erfasst, ist der TAG/HDL-C-Quotient. Liegt eine Insulinresistenz vor, ist die Reduktion der glykämischen Last die sinnvollste ernährungstherapeutische Maßnahme – der positive Einfluss einer alimentären Kohlenhydratreduktion auf die Risikofaktoren des metabolisch-vaskulären Syndroms ist unabhängig vom Körpergewicht.

• Gemüsereiche Essmuster mit einer niedrigen glykämischen Last, bei denen raffinierte stärke- und zuckerhaltige Nahrungsmittel durch Proteine und Fette ersetzt werden, sind besonders empfehlenswert. Sie haben sich zur längerfristigen Gewichtskontrolle sowie zur Senkung des metabolisch-vaskulären Risikos als effektiver erwiesen als fettreduzierte Essmuster mit konkreten Nährstoff- und Kalorienvorgaben.

Schlüsselwörter

metabolisch-vaskuläres Syndrom - Insulinresistenz - Ernährung - Kohlenhydratqualität, Essmuster

Keywords

metabolic vascular syndrome - insulin resistance - nutrition - carbohydrate quality - dietary patterns

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