Dtsch Med Wochenschr 2021; 146(06): 389-397
DOI: 10.1055/a-1248-5539
Dossier

Prävention nicht übertragbarer chronischer Erkrankungen durch „gesunde“ Ernährung

Diet and Nutrition in the Prevention of Non-Communicable Diseases (NCD)
Anja Bosy-Westphal
,
Manfred J. Müller

Übergewicht betrifft mehr als 50 % der Erwachsenen in Deutschland, 20 Millionen Menschen sind adipös, zwischen 10 und 30 % haben Stoffwechsel- und Herzkreislauferkrankungen. Diese nicht-übertragbaren Krankheiten („non-communicable diseases“, NCD) sind hochanteilig durch eine der Gesundheit abträgliche Ernährung verursacht und unnötig. Da die Produktion von Lebensmitteln und auch deren Konsum eng mit den aktuellen Problemen von Umwelt, Klima und ungebremstem ökonomischem Wachstum verknüpft sind, können nachhaltig wirksame Maßnahmen der Prävention von NCD nur in größeren Kontexten realisiert werden. Aus dieser Sicht ist es an uns Ärzten, sowohl die Patienten ernährungsmedizinisch angemessen zu behandeln als auch den notwendigen gesellschaftlichen Wandel zum Erhalt der Gesundheit von Mensch und Umwelt mitzugestalten.

Abstract

Today, more than 50 % of adults in Germany are overweight, 20 million people are obese and 10 to 30 % suffer from non-communicable diseases (NCD). Unhealthy dietary patterns contribute to NCD, thus, NCD are at least partly avoidable. During the last decades nutrition research has changed from nutrients to foods identifying healthy food patterns characterizing healthy diets, e. g., Mediterranean diet, DASH diet and/or the New Nordic Diet. Scientifically, these diets have been shown to be effective strategies of primary and secondary prevention of NCD. Based on this evidence prevention of NCD is now urgently needed at the population level. However, effective public health strategies of prevention and health promotion go beyond daily medical practice and require re-thinking of our food system within a greater context of our environment and climate. To become sustainable, strategies and measures of behavior prevention addressing individuals have to be extended to measures against the obesogenic environment and its systemic drivers within our food system. Thus, social and political changes are needed for a better future health of the nation. Physicians may take the leadership to be prepared to add to a whole of society approach of prevention and health promotion.



Publication History

Article published online:
18 March 2021

© 2021. Thieme. All rights reserved.

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  • Literatur

  • 1 GBD 2017 Risk Factor Collaborators: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1923-1994
  • 2 Willett W, Rockström J, Loken B. et al. Food in the Anthropocene: The EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet 2019; 393: 447-492
  • 3 Swinburn B, Kraak VI, Allender S. et al. The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report. Lancet 2019; 393: 791-846
  • 4 Fardet A, Rock E. Ultra-Processed Foods and Food System Sustainability: What Are the Links?. Sustainability 2020; 12: 6280
  • 5 Astrup A, Magkos F, Bier DM. et al. Saturated Fats and Health: A Reassessment and Proposal for Food-Based Recommendations JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 76: 844-857
  • 6 Monteiro CA, Moubarac JC, Levy RB. et al. Household availability of ultra-processed foods and obesity in nineteen European countries. Public Health Nutr 2018; 21: 18-26
  • 7 Chen X, Zhang Z, Yang H. et al. Consumption of ultra-processed foods and health outcomes: a systematic review of epidemiological studies. Nutr J 2020; 19: 86
  • 8 Hall KD, Ayuketah A, Brychta R. et al. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metabol 2019; 30: 67-77. e3
  • 9 White M, Aguirre E, Finegood DT. et al. What role should the commercial food system play in promoting health through better diet?. BMJ 2020; 368: m545
  • 10 Khoury CK, Bjorkman AD, Dempewolf H. et al. Increasing homogeneity in global food supplies and the implications for food security. Proc Natl Acad Sci 2016; 111: 4001-4006
  • 11 Mozzafarian D. Dietary and policy priorities to reduce the global crisis of obesity and diabetes. Nat Food 2020; 1: 38-50
  • 12 Müller MJ. Jetzt ist der Mensch noch nicht jener Mensch – Nachdenken über eine Verhältnisprävention der Adipositas. Adipositas – Ursachen, Folgeerkrankungen, Therapie. 13. Stuttgart, New York: Thieme; 2019: 118-126
  • 13 Al-Shaar L, Satija A, Wang DD. et al. Red meat intake and risk of coronary heart disease among US men: prospective cohort study. Br Med J 2020; 371: m4141
  • 14 Satija A, Bupathiraju SN, Spiegelman D. et al. Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults. J Am Coll Cardiol 2017; 70: 411-422
  • 15 Shan Z, Li Y, Baden MY. et al. Association Between Healthy Eating Patterns and Risk of Cardiovascular Disease. JAMA Intern Med 2020; 180: 1090-1100
  • 16 Schulze MB, Martínez-González MA, Fung TT. et al. Food based dietary patterns and chronic disease prevention. BMJ 2018; 361: k2396
  • 17 Estruch R, Ros E, Salas-Salvado J. et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extravirgin olive oil or nuts. N Engl J Med 2018; 378: e34
  • 18 Rees K, Takeda A, Martin N. et al. Mediterranean‐style diet for the primary and secondary prevention of cardiovascular disease. Cochrane Data Syst Rev 2019; 3 DOI: 10.1002/14651858.CD009825.pub3.
  • 19 Ozemek C, Laddu DR, Arena R. et al. The role of diet for prevention and management of hypertension. Curr Opin Cardiol 2018; 33: 388-393
  • 20 Filippou CD, Tsioufis CP, Thomopoulos CP. et al. Dietary Approaches to Stop Hypertension (DASH) Diet and Blood Pressure Reduction in Adults with and without Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr 2020; 11: 1150-1160
  • 21 Lankinen M, Uusitupa M, Schwab U. Nordic diet and iflammation- A review of observational and interventions studies. Nutrients 2019; 11: 1369
  • 22 Shah B, Newman JD, Woolf K. et al. Anti-Inflammatory Effects of a Vegan Diet Versus the American Heart Association–Recommended Diet in Coronary Artery Disease Trial. J Am Heart Assoc 2018; 7: e011367
  • 23 Sukhato K, Akksilp K, Dellow A. et al. Efficiency of different dietary patterns on lowering of blood pressure level: an umbrella review. Am J Clin Nutr 2020; 112: 1584-1598
  • 24 Trichopoulou A, Costacou T, Bamia C. et al. Adherence to a Mediterranean Diet and Survival in a Greek Population. N Engl J Med 2003; 348: 2599-2608
  • 25 Merlotti D, Cosso R, Eller-Vainicher C. et al. Energy Metabolism and Ketogenic Diets: What about the Skeletal Health? A Narrative Review and a Prospective Vision for Planning Clinical Trials on this Issue. Int J Mol Sci 2021; 22: 435
  • 26 Martin-McGill KJ, Bresnahan R, Levy RG. et al. Ketogenic diets for drug-resistant epilepsy. Cochrane Data Syst Rev 2020; 6: CD001903
  • 27 Goldberg IJ, Ibrahim N, Bredefeld C. et al. Ketogenic diets, not for everyone. J Clin Lipidol 2020; DOI: 10.1016/j.jacl.2020.10.005.
  • 28 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
  • 29 Schwinghackl L, Bogensberger B, Hoffmann G. Diet Quality as Assessed by the Healthy Eating Index, Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension Score, and Health Outcomes: An Updated Systematic Review and Meta-Analysis of Cohort Studies. J Acad Nutr Diet 2018; 118: 74-100
  • 30 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
  • 31 Berry SE, Valdes AM, Drew DA. et al. Human postprandial responses to food and potential for precision nutrition. Nat Med 2020; 26: 964-973
  • 32 Wolever T. Personalized nutrition by prediction of glycaemic responses: Fact or fantasy. Eur J Clin Nutr 2016; 70: 411-413