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DOI: 10.1055/s-2002-36273
Macht Fett fett und fettarm schlank?
Does fat make you fat and low-fat make you thin?Publication History
Publication Date:
19 December 2002 (online)

Die Prävalenz von Übergewicht nimmt zur Zeit in den industrialisierten Ländern weltweit zu [1]. Insbesondere bei Kindern und Jugendlichen sind dramatische Zunahmen zu beobachten [Übersicht in [2]]. Die Entwicklung von Übergewicht ist ein multifaktoriell bedingter Prozess, der einerseits von genetischen Komponenten, andererseits von Umweltbedingungen bestimmt wird. Genetische Faktoren erklären primär, welche Individuen innerhalb einer Gesellschaft bei vergleichbaren Umweltbedingungen adipös werden. Wenn Übergewicht aber weltweit trotz nachweislicher genetischer Unterschiede überall gleichzeitig drastisch ansteigt, müssen vor allem die Umwelt- und Lebensstileinflüsse für diese Entwicklung verantwortlich gemacht werden [3].
In den letzten Jahren hat sich in der Ernährungslehre die These verbreitet, die Höhe der Fettzufuhr stelle einen relevanten, wenn nicht sogar den wichtigsten Umwelt- bzw. Lebensstilfaktor für die Entstehung von Übergewicht dar. So formuliert beispielsweise die Deutsche Gesellschaft für Ernährung (DGE) ihre 5. Regel zur „gesunden, vollwertigen Ernährung”: „Zuviel Nahrungsfett macht allerdings fett...”. Die Fett-These basiert vorwiegend auf der Erkenntnis, dass Fett mit 9 kcal/g eine mehr als doppelt so hohe Energiedichte aufweist, als Kohlenhydrate und Eiweiß mit jeweils 4 kcal/g. Weiterhin wird angeführt, dass Fett besonders gut schmeckt, aber nicht so gut sättigt wie Kohlenhydrate oder Eiweiß und daher die Nahrungsaufnahme bei der nachfolgenden Mahlzeit nicht oder weniger gut reduziert. Eine fettreiche Kost würde entsprechend dazu beitragen, „unbemerkt” auf Dauer eine positive Energiebilanz zu erzielen. Des weiteren wird argumentiert, dass die Fettoxidation schlecht reguliert ist und dass für die Einlagerung von Fett in Adipozyten relativ wenig Energie verbraucht wird [Übersicht in [4]].
Vor diesem Hintergrund empfehlen die DGE und andere Fachgesellschaften zur Prävention wie auch zur Therapie eine „fettreduzierte, kohlenhydratliberale” Kost. Diese Expertenpositionen sind in jüngster Zeit von verschiedener Seite heftig kritisiert worden, da eine wachsende Zahl von Studien diese Thesen nicht nur nicht stützen, sondern sogar eindeutig widersprechen [3]. Um die Validität dieser Empfehlungen zu überprüfen, bietet es sich an, eine kritische Bestandsaufnahme der Datenlage im Sinne der Evidenz-basierten Medizin (EBM) durchzuführen.
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