Ernährung bei rheumatischen Erkrankungen

Zusammenfassung

Einflüsse der Ernährung auf das Risiko, eine rheumatische Erkrankung zu entwickeln, sind in erster Linie für die rheumatoide Arthritis (RA), in geringerem Maße auch für Spondyloarthritiden (SpA) und entzündliche Bindegewebserkrankungen gesichert. Die Inzidenz der RA ist mit kindlicher Unterernährung und niedrigem Geburtsgewicht assoziiert, die der SpA mit der Dauer des Stillens im Säuglings-alter. Einzelne Nahrungskomponenten wie Seefisch mit hohem Fettgehalt, Zitrusfrüchte oder geringe Alkoholmengen können protektiv auf das RA-Risiko wirken. Raucher haben ein per se deutlich erhöhtes Risiko für eine RA, welches durch vermehrte Kochsalzzufuhr und Übergewicht potenziert wird. Zahlreiche Interventionsstudien haben versucht, den Nutzen einzelner Kostformen bei etablierter RA nachzuweisen. Dazu gehören neben verschiedenen Fastenformen auch Elementardiäten, Eliminationsdiäten und andere hypoaller-gene Kostformen sowie Studien zu veganer und glutenfreier Ernährung. Die Mehrzahl dieser Untersuchungen ist in Qualität und Aussagekraft unbefriedigend geblieben. Allerdings ist eine an den Prinzipien der Mittelmeerkost ausgerichtete Ernährung wahrscheinlich von Nutzen für RA-Patienten, auch wenn die positiven Effekte in erster Linie die Reduktion des kardiovaskulären Risikos betreffen. Nahrungsergänzungsmittel werden häufig für die Anwendung bei etablierter RA beworben, allerdings lassen sich positive Effekte nur für Fischölkapseln in ausreichend hoher Dosierung von Omega-3-Fettsäuren nachweisen. Die Zufuhr von Eisenpräparaten und Vitamin D sollte nicht unkritisch erfolgen, sondern an objektiven Kriterien ausgerichtet werden. Probiotika sind aufgrund neuer Erkenntnisse zu Pathogenese rheumatischer Erkrankungen in kleineren Studien bei RA und SpA zum Einsatz gekommen, haben jedoch bisher keinen überzeugenden Wirksamkeitsnachweis gezeigt.

Summary

The influence of nutrition on the risk to develop rheumatoid arthritis (RA), spondyloarthropathies (SpA) or connective tissue diseases has been investigated in a variety of studies. The incidence of RA is associated with a low body weight at birth and with malnutrition during childhood. The duration of nursing has a small but measurable impact on the risk to develop SpA. Some food components such as marine fish or small amounts of alcohol are protective with respect to the RA risk. Smoking augments the risk to develop chronic inflammatory joint disease. In addition, a high body mass index as well as a high intake of salt increases the risk of smokers to develop RA. Several interventional studies have investigated the influence of fasting, elementary and hypoallergenic diets as well as mediterranean diet on the course of RA. The majority of theses studies has weaknesses with respect to sample size and study design. However, several aspects argue for the propagation of mediterranean diet, and short periods of fasting can be recommended in over-weight patients with otherwise stable disease. There are only few nutritional supplements with proven efficacy in inflammatory joint diseases. Fish oil capsules are able to exert positive effects on the course of RA, provided they are applied in sufficient dosage over a period of three to six months. The supplementation of vitamin D and iron has to be in accordance with therapeutic guidelines. So far, the intake of probiotics has no proven efficacy in inflammatory joint diseases.

Schlüsselwörter

Rheumatische Erkrankungen - Ernährung - Ätiologie - Review

Keywords

Rheumatic diseases - nutrition - etiology - review

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