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Ernährung & Medizin 2015; 30(4): 161-164
DOI: 10.1055/s-0035-1558540
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Haug Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG Stuttgart

Immunonutrition

Mathias Plauth
1   Klinik für Innere Medizin, Städtisches Klinikum Dessau
,
Melanie Wäsch
2   Städtisches Klinikum Dessau
› Author Affiliations
Further Information

Publication History

Publication Date:
22 December 2015 (online)

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Das Konzept

Ursprünglich wurde der Begriff Immunonutrition für das Marketing eines Produkts für die enterale Ernährung eingeführt. Inzwischen wird allgemein mit „Immunonutrition“ das Konzept bezeichnet, durch den Einsatz spezifischer Nährstoffe die Aktivität des Immunsystems therapeutisch zu modulieren ([1], [2]). In der ernährungsmedizinischen Praxis steht die Immunonutrition vor dem Problem, dass vielfach Kombinationen mehrerer Wirkkomponenten zum Einsatz kamen, ohne dass Wirksamkeit und Dosisoptimum der Einzelkomponenten zuvor evaluiert wurden. Deshalb schlagen Experten vor, diesen unpräzisen Begriff zu verlassen und propagieren stattdessen das Konzept der Pharmakonutrition, bei welchem jede Wirkkomponente und auch ihre Kombination hinsichtlich Wirksamkeit und Dosierung untersucht werden ([3]–[5]). Leider zeichnet sich ab, dass der Begriff Pharmakonutrition ersatzweise für Immunonutrition verwendet und seiner gewünschten Präzision beraubt wird.

Einen wesentlichen Impuls erhielt die Immunonutrition aus der Erkenntnis, dass der Darm neben der Nährstoff- und Wasserabsorption für den Gesamtorganismus auch essenzielle Aufgaben in der Barrierefunktion gegen die feindliche Umgebung und der Immunkompetenz wahrnimmt (▶ Info [ 1 ]).

3 Kardinalziele der Immunonutrition

  • mukosale Barrierefunktion

  • zelluläre Immunfunktion

  • lokale und systemische Entzündungshemmung

Folgende wirksame Substanzen wurden einzeln oder meist in Kombinationen untersucht:

  • Glutamin

  • Arginin

  • Glycin

  • n-3 mehrfach ungesättigte Fettsäuren (n-3 PUFA)

  • Nukleotide

In diesem Beitrag werden die pathophysiologisch begründeten Argumente für die einzelnen Wirkstoffe kurz referiert.

Zoom Image
Immunonutrition: Pathophysiologisch spricht viel für eine Gabe von Supplementen, z. B. in der Intensivmedizin. Die Studienlage jedoch lässt bisher nur wenige Einsatzmöglichkeiten als sinnvoll erscheinen. (© Thieme Verlagsgruppe/Studio Blofield)
 

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