Auswirkungen kohlenhydratreduzierter und kohlenhydratmodifizierter Diäten auf kardiovaskuläre Biomarker

Zusammenfassung

Zahlreiche randomisiert-kontrollierte Studien (RCTs) kommen zu dem Schluss, das kohlenhydratreduzierte (low carb, LC) Diäten in der Kontrolle kardiovaskulärer Risikofaktoren mindestens so effektiv sind wie fettreduzierte (low fat, LF) Kostformen. Für die vorliegende Übersichtsarbeit wurde in der Datenbank MEDLINE nach Metaanalysen von RCTs mit folgenden Stichwörtern gesucht: „low carbohydrate diet“ und „glycemic index diet“. Insgesamt konnten 17 Metaanalysen inkludiert werden. Im Großteil der Studien wurden signifikante Vorteile der LC- bzw. kohlenhydratmodifizierten Diäten gegenüber den LF-Diäten im Hinblick auf die Veränderung kardiovaskulärer Biomarker/Risikofaktoren wie HDL-Cholesterin, Triglyzeride, Nüchternglukose, Nüchterninsulin und glykosyliertes Hämoglobin beobachtet. Teilweise wurde allerdings von erhöhten Gesamt- und LDL-Cholesterinwerten in den LC-Gruppen berichtet, was u. a. auf eine erhöhte Zufuhr an gesättigten Fettsäuren zurückgeführt werden kann. Durch eine anteilsmäßige Erhöhung der Zufuhr an einfach und mehrfach ungesättigten Fettsäuren könnte diesen negativen Auswirkungen vorgebeugt werden. Die amerikanische Diabetesgesellschaft hat 2008 die LC-Diät offiziell in ihre Empfehlungen mitaufgenommen. Es bleibt abzuwarten, ob weitere Fachgesellschaften folgen, und ob möglicherweise auch der damit eng assoziierte glykämische Index in neuen Empfehlungen Platz finden wird. Die Evidenz aus Metaanalysen folgend kann es als wahrscheinlich angesehen werden, dass eine Kohlenhydratmodifikation protektive Effekte in der Primärprävention ernährungsabhängiger Krankheiten ausübt.

Abstract

Numerous randomized controlled trials (RCTs) concluded that low carbohydrate (LC) diets are at least as effective as low fat (LF) diets with respect to their beneficial impact on biomarkers and risk factors of cardiovascular diseases and other nutrition-related disorders. For this review, a literature query for meta-analyses of RCTs was performed using the electronic database MEDLINE using the following search terms: “low carbohydrate diet” and “low glycemic index diet”. A total of 17 meta-analyses could be included in this report. In most of these, improvements in cardiovascular risk factors, i. e. HDL-cholesterol, triacylglycerols, fasting glucose, fasting insulin and glycosylated hemoglobin turned out to be more pronounced following LC/low glycemic index diets as compared to LF/high glycemic index protocols. However, this was sometimes associated with a detrimental variation in total and LDL-cholesterol, possibly due to the high amount of saturated fat consumed by the LC groups. It seems reasonable to speculate that by increasing the amount of monounsaturated and polyunsaturated fats in the diet, these adverse effects might be avoided. In 2008, the American Diabetes Association incorporated LC diets into their official recommendations. It remains to be seen whether other international authorities will include LC regimens and the associated glycemic index in their recommendations as well. The present summary of meta-analyses provides probable evidence that carbohydrate modified diets have beneficial effects in the primary prevention of non-communicable diseases.

Schlüsselwörter

kohlenhydratreduzierte Diät - fettreduzierte Diät - Metaanalyse - Herz-Kreislauf-Erkrankungen - glykämischer Index - Adipositas

Keywords

low carb - low fat - meta-analysis - cardiovascular disease - glycemic index - obesity

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