Ernährung in der Onkologie – die Bedeutung von Mikronährstoffen

Zusammenfassung

Im Verlauf der Erkrankung entwickeln viele onkologische Patienten eine tumorassoziierte Malnutrition, gekennzeichnet durch eine defizitäre Versorgung an Makro- und Mikronährstoffen. Der defizitäre Ernährungsstatus und das damit in Zusammenhang stehende „cancer cachexia syndrome” ist von klinischer Bedeutung, da hierdurch das Ansprechen auf antineoplastische Verfahren wie die Radio- und die Chemotherapie vermindert, deren Nebenwirkungen verstärkt und die Lebensqualität sowie die Prognose der Patienten negativ beeinflusst wird. Entsprechend kommt der supportiven Ernährungstherapie von onkologischen Patienten eine zentrale Bedeutung zu. Dabei stoßen neben Energiesubstraten auch Vitamine, Mineralstoffe sowie langkettige Omega-3-Fettsäuren auf ein wachsendes Interesse, wobei der Nutzen entsprechender Supplemente kontrovers diskutiert wird. Ausgehend von einer Darstellung der Ätiopathogenese und der ernährungsphysiologischen Konsequenzen einer tumorassoziierten Malnutrition ist es Ziel dieses Beitrags, einen Überblick zur Bedeutung von Mikronährstoffen bei onkologischen Patienten zu vermitteln. Während bei eingeschränkter Nahrungsauswahl der Einsatz eines Multivitamin-Multimineral-Supplements mit physiologischen Dosierungen, d. h. Nährstoffmengen, die in etwa der Höhe der Tagesempfehlungen entsprechen, eine sinnvolle und sichere Maßnahme darstellt, sollte auf den Einsatz einzelner, hochdosierter Mikronährstoffe verzichtet werden. Eine Ausnahme bildet hierbei Vitamin D. Auch zur Verbesserung der postoperativen Wundheilung sowie zur Eindämmung der Kachexie sind höhere Mengen an Mikronährstoffen erforderlich als für gesunde Personen empfohlen.

Summary

In the course of cancer disease, many oncological patients develop a tumor-associated malnutrition characterized by an insufficient supply of macro- and micronutrients. The inadequate nutritional status and the cancer anorexia-cachexia syndrome related to it are clinically relevant, as the response to antineoplastic measures, such as radiation and chemotherapy, is diminished, their side effects aggravated and the patient's quality of life and prognosis is negatively affected. Therefore, the supportive nutrition care of oncological patients is of central importance. In this context, vitamins, minerals and long-chain omega-3 fatty acids are becoming more and more relevant in oncology although the benefit of such supplements is discussed controversially. Starting from a description of the etiopathogenesis and the pathophysiological consequences of cancer-associated malnutrition, the present article presents an overview of the importance of micronutrients for oncological patients. In the case of reduced food intake and/or inappropriate food choice the use of a multivitamin-multimineral supplement administered in physiological doses, i. e. nutrient quantities approximately corresponding to the recommended daily allowances, can be generally recommended. However, to enhance postoperative wound healing, it seems that cancer patients require higher amounts of micronutrients than healthy individuals. Because vitamin D deficiency is highly prevalent in oncological patients, improvement of vitamin D status is of special interest.

Schlüsselwörter

Tumorkachexie - Malnutrition - Vitamine - Spurenelemente - Omega-3-Fettsäuren

Keywords

cancer cachexia - malnutrition - vitamins - trace elements - omega 3 fatty acids

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