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DOI: 10.1055/a-1516-2581
Lang bekannt und meist ungenutzt: Lebensstilmaßnahmen zur Unterstützung der lipidsenkenden Therapie
Long known and mostly unused: lifestyle measures to support lipid-lowering therapyDyslipidämien sind in den westlichen Industrieländern weit verbreitete Stoffwechselstörungen. Lebensstilmaßnahmen wie die Steigerung der körperlichen Aktivität und die Verbesserung der Ernährung waren jahrelang die einzige Maßnahme zu ihrer Behandlung. Wegen ihrer gesundheitsfördernden Wirkung sehen die Leitlinien zur Behandlung von Dyslipidämien Lebensstilmaßnahmen als Grundlage jeder medikamentösen Therapie an. In diesem Beitrag werden die Prinzipien der Ernährungstherapie von Dyslipidämien beschrieben.
Abstract
Dyslipidemias are common metabolic disorders in Western industrialized countries. Lifestyle measures such as increasing physical activity and improving diet were for many years the only measure for their treatment. Because of their health-promoting effects, guidelines for the treatment of dyslipidemias consider lifestyle measures to be the basis of any drug therapy. Due to the numerous efficient options for intensive lipid-lowering medication, lifestyle measures are recommended by responsible physicians, but their implementation is usually not intensively pursued due to the large time commitment; in contrast to sustained recommendations for increasing physical activity and normalizing body weight, nutritional therapists are too rarely consulted as specialists despite the significant effects our diet has on cardiovascular risk factors such as LDL-cholesterol, triglycerides and blood pressure. In this review, the principles of nutritional therapy of dyslipidemias are described, and it is outlined how recent studies support the plausibility and evidence of the individual measures.
Schlüsselwörter
Lebensstil - Ernährung - körperliche Aktivität - Hypercholesterinämie - Hypertriglyzeridämie - DyslipidämieKey words
lifestyle - nutrition - physical activity - hypercholesterolemia - hypertriglyceridemia - dyslipidemiaPublication History
Article published online:
07 June 2022
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Literatur
- 1 Mach F, Baigent C, Catapano AL. et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41: 111-188 DOI: 10.1093/eurheartj/ehz455.
- 2 Novartis Pharma GmbH. Inclisiran (Leqvio®). Modul 3 A: Primäre Hypercholesterinämie (heterozygot familiär und nicht-familiär) und gemischte Dyslipidämie. Dossier zur Nutzenbewertung gemäß § 35a SGB V; 27.01.2021. Im Internet (Stand: 23.03.2022): https://www.g-ba.de/downloads/92-975-4403/2021-01-27_Modul3_Inclisiran.pdf
- 3 Amarin Pharmaceuticals Ireland Limited. Icosapent-Ethyl (Vazkepa®). Modul 3 A: Reduzierung des Risikos für kardiovaskuläre Ereignisse bei mit Statinen behandelten erwachsenen Patienten mit hohem kardiovaskulären Risiko und erhöhten Triglyceridwerten (≥ 150 mg/dl [≥ 1,7 mmol/l]). Dossier zur Nutzenbewertung gemäß § 35a SGB V; 27.08.2021
- 4 Schmidt N, Schmidt B, Dressel A. et al. Familial hypercholesterolemia in primary care in Germany. Diabetes and cardiovascular risk evaluation: Targets and Essential Data for Commitment of Treatment (DETECT) study. Atherosclerosis 2017; 266: 24-30 DOI: 10.1016/j.atherosclerosis.2017.08.019.
- 5 Wolfram G, Bechthold A, Boeing H. et al. Evidence-based guideline of the German Nutrition Society: fat intake and prevention of selected nutrition-related diseases. Ann Nutr Metab 2015; 67: 141-204 DOI: 10.1159/000437243.
- 6 Hauner H, Bechthold A, Boeing H. et al. Evidence-based guideline of the German Nutrition Society: carbohydrate intake and prevention of nutrition-related diseases. Ann Nutr Metab 2012; 60 (Suppl. 01) 1-58 DOI: 10.1159/000335326.
- 7 Kempner W. Treatment of kidney disease and hypertensive vascular disease with rice diet. North Carolina Med J 1944; 5: 11-19
- 8 Kempner W. Treatment of heart and kidney disease and of hypertensive and arteriosclerotic vascular disease with the rice diet. Ann Intern Med 1949; 31: 821-856 DOI: 10.7326/0003-4819-31-5-821.
- 9 Hauner H, Beyer-Reiners E, Bischoff G. et al. Leitfaden Ernährungstherapie in Klinik und Praxis (LEKuP). Aktuel Ernahrungsmed 2019; 44: 384-419 DOI: 10.1055/a-1030-5207.
- 10 Deutsche Gesellschaft für Ernährung, Österreichische Gesellschaft für Ernährung, Schweizerische Gesellschaft für Ernährungsforschung, Schweizerische Vereinigung für Ernährung, Hrsg. Referenzwerte für die Nährstoffzufuhr. 2. Aufl., 7. aktualisierte Ausgabe. Bonn: 2021
- 11 Nordmann AJ, Nordmann A, Briel M. et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 2006; 166: 285-293 DOI: 10.1001/archinte.166.3.285.
- 12 Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr 1992; 56: 320-328 DOI: 10.1093/ajcn/56.2.320.
- 13 Look AHEAD Research Group, Wing RR, Bolin P. et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369: 145-154 DOI: 10.1056/NEJMoa1212914.
- 14 Batsis JA, Gill LE, Masutani RK. et al. Weight loss interventions in older adults with obesity: a systematic review of randomized controlled trials since 2005. J Am Geriatr Soc 2017; 65: 257-268 DOI: 10.1111/jgs.14514.
- 15 Clarke R, Frost C, Collins R. et al. Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies. BMJ 1997; 314: 112-117 DOI: 10.1136/bmj.314.7074.112.
- 16 Rong Y, Chen L, Zhu T. et al. Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies. BMJ 2013; 346: e8539 DOI: 10.1136/bmj.e8539.
- 17 Zhong VW, Van Horn L, Cornelis MC. et al. Associations of dietary cholesterol or egg consumption with incident cardiovascular disease and mortality. JAMA 2019; 321: 1081-1095 DOI: 10.1001/jama.2019.1572.
- 18 Ruggiero E, Di Castelnuovo A, Costanzo S. et al. Egg consumption and risk of all-cause and cause-specific mortality in an Italian adult population. Eur J Nutr 2021; 60: 3691-3702 DOI: 10.1007/s00394-021-02536-w.
- 19 Zhuang P, Wu F, Mao L. et al. Egg and cholesterol consumption and mortality from cardiovascular and different causes in the United States: A population-based cohort study. PLoS Med 2021; 18: e1003508 DOI: 10.1371/journal.pmed.1003508.
- 20 Dehghan M, Mente A, Rangarajan S. et al. Association of egg intake with blood lipids, cardiovascular disease, and mortality in 177000 people in 50 countries. Am J Clin Nutr 2020; 111: 795-803 DOI: 10.1093/ajcn/nqz348.
- 21 Godos J, Micek A, Brzostek T. et al. Egg consumption and cardiovascular risk: a dose-response meta-analysis of prospective cohort studies. Eur J Nutr 2021; 60: 1833-1862 DOI: 10.1007/s00394-020-02345-7.
- 22 Mensink RP. Effects of stearic acid on plasma lipid and lipoproteins in humans. Lipids 2005; 40: 1201-1205 DOI: 10.1007/s11745-005-1486-x.
- 23 Chowdhury R, Warnakula S, Kunutsor S. et al. Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Ann Intern Med 2014; 160: 398-406 DOI: 10.7326/M13-1788.
- 24 de Souza RJ, Mente A, Maroleanu A. et al. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ 2015; 351: h3978 DOI: 10.1136/bmj.h3978.
- 25 Wang DD, Li Y, Chiuve SE. et al. Association of specific dietary fats with total and cause-specific mortality. JAMA Intern Med 2016; 176: 1134-1145 DOI: 10.1001/jamainternmed.2016.2417.
- 26 Hooper L, Summerbell CD, Thompson R. et al. Reduced or modified dietary fat for preventing cardiovascular disease. Sao Paulo Med J 2016; 134: 182-183 DOI: 10.1590/1516-3180.20161342T1.
- 27 Hooper L, Martin N, Jimoh OF. et al Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 2020; 5: CD011737 . Update in: Cochrane Database Syst Rev 2020; 8: CD011737 DOI: 10.1002/14651858.CD011737.pub2.
- 28 Kim Y, Je Y, Giovannucci EL. Association between dietary fat intake and mortality from all-causes, cardiovascular disease, and cancer: A systematic review and meta-analysis of prospective cohort studies. Clin Nutr 2021; 40: 1060-1070 DOI: 10.1016/j.clnu.2020.07.007.
- 29 Ramsden CE, Zamora D, Majchrzak-Hong S. et al. Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968–73). BMJ 2016; 353: i1246 DOI: 10.1136/bmj.i1246.
- 30 Ramsden CE, Zamora D, Leelarthaepin B. et al. Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. BMJ 2013; 346: e8707 DOI: 10.1136/bmj.e8707.
- 31 Ramsden CE, Hibbeln JR, Majchrzak SF. et al. n-6 fatty acid-specific and mixed polyunsaturate dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials. Br J Nutr 2010; 104: 1586-1600 DOI: 10.1017/S0007114510004010.
- 32 Hartley L, May MD, Loveman E. et al. Dietary fibre for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2016; 2016: CD011472 DOI: 10.1002/14651858.CD011472.pub2.
- 33 Ho HV, Sievenpiper JL, Zurbau A. et al. A systematic review and meta-analysis of randomized controlled trials of the effect of barley β-glucan on LDL-C, non-HDL-C and apoB for cardiovascular disease risk reductioni-iv. Eur J Clin Nutr 2016; 70: 1239-1245 DOI: 10.1038/ejcn.2016.89.
- 34 Ho HV, Sievenpiper JL, Zurbau A. et al. The effect of oat β-glucan on LDL-cholesterol, non-HDL-cholesterol and apoB for CVD risk reduction: a systematic review and meta-analysis of randomised-controlled trials. Br J Nutr 2016; 116: 1369-1382 DOI: 10.1017/S000711451600341X.
- 35 Whitehead A, Beck EJ, Tosh S. et al. Cholesterol-lowering effects of oat β-glucan: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2014; 100: 1413-1421 DOI: 10.3945/ajcn.114.086108.
- 36 Reynolds A, Mann J, Cummings J. et al. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet 2019; 393: 434-445 DOI: 10.1016/S0140-6736(18)31809-9.
- 37 Malik VS, Hu FB. Sugar-Sweetened Beverages and Cardiometabolic Health: An Update of the Evidence. Nutrients 2019; 11: 1840 DOI: 10.3390/nu11081840.
- 38 Yang Q, Zhang Z, Gregg EW. et al. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med 2014; 174: 516-524 DOI: 10.1001/jamainternmed.2013.13563.
- 39 Hannou SA, Haslam DE, McKeown NM. et al. Fructose metabolism and metabolic disease. J Clin Invest 2018; 128: 545-555 DOI: 10.1172/JCI96702.
- 40 Dehghan M, Mente A, Zhang X. et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet 2017; 390: 2050-2062 DOI: 10.1016/S0140-6736(17)32252-3.
- 41 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 DOI: 10.1016/S2468-2667(18)30135-X.
- 42 Shan Z, Guo Y, Hu FB. et al. Association of low-carbohydrate and low-fat diets with mortality among US adults. JAMA Intern Med 2020; 180: 513-523 DOI: 10.1001/jamainternmed.2019.6980.
- 43 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 Metab 2019; 30: 67-77.e3 DOI: 10.1016/j.cmet.2019.05.008.
- 44 Bonaccio M, Costanzo S, Di Castelnuovo A. et al. Ultra-processed food intake and all-cause and cause-specific mortality in individuals with cardiovascular disease: the Moli-sani Study. Eur Heart J 2022; 43: 213-224 DOI: 10.1093/eurheartj/ehab783.
- 45 Juul F, Vaidean G, Lin Y. et al. Ultra-processed foods and incident cardiovascular disease in the Framingham Offspring Study. J Am Coll Cardiol 2021; 77: 1520-1531 DOI: 10.1016/j.jacc.2021.01.047.
- 46 Dawczynski C, März W, Lorkowski S. Herzgesunde Ernährung. Informationsflyer für Patienten mit Dyslipidämien. Augsburg: Synlab Labordiagnostik Deutschland. 2022 DOI: 10.13140/RG.2.2.24621.97762
- 47 Shaw K, Gennat H, O'Rourke P. et al. Exercise for overweight or obesity. Cochrane Database Syst Rev 2006; 4: CD003817 DOI: 10.1002/14651858.CD003817.pub3.
- 48 Huffman KM, Hawk VH, Henes ST. et al. Exercise effects on lipids in persons with varying dietary patterns-does diet matter if they exercise? Responses in Studies of a Targeted Risk Reduction Intervention through Defined Exercise I. Am Heart J 2012; 164: 117-124 DOI: 10.1016/j.ahj.2012.04.014.
- 49 Kraus WE, Houmard JA, Duscha BD. et al. Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med 2002; 347: 1483-1492 DOI: 10.1056/NEJMoa020194.
- 50 Fikenzer K, Fikenzer S, Laufs U. et al. Effects of endurance training on serum lipids. Vascul Pharmacol 2018; 101: 9-20 DOI: 10.1016/j.vph.2017.11.005.
- 51 Liang M, Pan Y, Zhong T. et al. Effects of aerobic, resistance, and combined exercise on metabolic syndrome parameters and cardiovascular risk factors: a systematic review and network meta-analysis. Rev Cardiovasc Med 2021; 22: 1523-1533 DOI: 10.31083/j.rcm2204156.
- 52 Li D, Chen P. The effects of different exercise modalities in the treatment of cardiometabolic risk factors in obese adolescents with sedentary behavior-a systematic review and meta-analysis of randomized controlled trials. Children 2021; 8: 1062 DOI: 10.3390/children8111062.
- 53 Verband für Ernährung und Diätetik e.V. Ärztliche Notwenigkeitsbescheinigung für Ernährungsintervention nach §43 SGB V. Im Internet (Stand: 23.03.2022): https://www.vfed.de/de/vfed/berufspraxis/allgemeine-downloads?file=files/website_data/downloads/VFED/%C3%84rztliche%20Notwendigkeitsbescheinigung%20f%C3%BCr%20Ern%C3%A4hrungsintervention%20nach%20%C2%A7%2043%20SGB%20V.pdf