Ernährungstherapie bei diabetischer Nephropathie

Zusammenfassung

Die diabetische Nephropathie stellt eine große Herausforderung für die Ernährungsmedizin dar. Heute gilt als gesichert, dass eine hohe Eiweißaufnahme bei Menschen mit Diabetes mellitus neben anderen Risikofaktoren die Entwicklung und Progression einer diabetischen Nephropathie fördert. Dabei zeichnet sich ab, dass rotes Fleisch ungünstiger ist als Geflügel oder Fisch und dass pflanzliches Eiweiß die Nierenfunktion nicht beeinträchtigt. Auch wenn die Datenlage noch unbefriedigend ist, wird als wichtigste ernährungsmedizinische Maßnahme bei beginnender wie bei klinisch-manifester Nephropathie eine eiweißnormalisierte Kost (0,8 g/kg/Tag) empfohlen. Bei fortgeschrittener, präterminaler Niereninsuffizienz sollte dagegen die Eiweißzufuhr wegen der Gefahr einer Katabolie eher moderat erhöht werden. Daneben sollten die Empfehlungen für eine diabetesgerechte Kost, die weitgehend der vollwertigen Kost der DGE entsprechen, beachtet werden.

Abstract

Diabetic nephropathy presents a challenge to nutritional medicine. We know very well that among other risk factors a high protein intake favours the development and progression of this serious complication in subjects with diabetes mellitus. However, there is growing evidence that the different sources of dietary protein have different effects on renal function. Red meat is more burdensome than white meat (chicken and fish), whereas vegetable protein does not exert any adverse effect on renal function. Although still poorly supported by controlled clinical trials, the major dietary recommendation for patients with incipient or clinical diabetic nephropathy is to reduce/normalise protein intake to 0.8 g/kg/day. In patients with advanced or end-stage renal disease a moderate increase in protein intake due to the elevated risk of catabolism may be appropriate. In addition, all other current recommendations for a healthy diet in subjects with diabetes should be considered to reduce the high risk for cardio-vascular diseases.

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