Zusammenfassung
Herz-Kreislauf-Erkrankungen und Krebs bestimmen die Lebensdauer der meisten älteren
Menschen. Durch Prävention von Krankheiten kann die Lebenserwartung erhöht und die
Lebensqualität erhalten werden. Im Mittelpunkt der gesundheitsbezogenen Lebensqualität
steht die Bewegungsfähigkeit eines Menschen. Ziel dieser Übersichtsarbeit ist es,
Einflussfaktoren auf die Lebensdauer und Lebensqualität älterer Menschen darzustellen
und zu diskutieren. Das relative kardiovaskuläre Risiko ist signifikant um 54 %, 62
% und 75 % reduziert, wenn 3, 4 oder 5 günstige Lebensstilfaktoren zusammentreffen.
Je günstiger die Lebensstilfaktoren, desto sicherer ist ein längeres Leben mit Lebensqualität.
Das Fehlen von 4 oder 5 klassischen Risikofaktoren erhöht die Lebenserwartung um bis
zu 9,5 Jahre. Das Risikofaktorenprofil wird durch eine vollwertige Ernährung, regelmäßige
körperliche Bewegung und Nichtrauchen vorteilhaft beeinflusst. Je genauer die gängigen
Ernährungsempfehlungen eingehalten werden, desto geringer ist das Risiko an Herzinfarkt,
Schlaganfall und Krebs zu sterben. Das allgemeine Sterberisiko wird durch regelmäßiges
zügiges Gehen, Treppensteigen und anstrengende körperliche Aktivität mit einem hohen
Energieverbrauch signifikant gesenkt. Zwischen dem Bodymass-Index (BMI) und der Gesamtmortalität
besteht eine U-förmige Beziehung. Ein steigender BMI erhöht auch das Risiko für eine
Bewegungseinschränkung. Ältere Menschen mit einem hohen Risikofaktorenprofil sind
früher auf die Hilfe von Dritten angewiesen als solche mit einem mittleren oder niedrigen
Risikofaktorenprofil.
Abstract
Coronary heart disease and cancer determine the life span of most elderly humans.
The life expectancy can be increased and the quality of life can be preserved by prevention
of diseases. Physical mobility is located in the focus of the health-referred quality
of life. The object of this review is to present and discuss factors of influence
on the life span and quality of life of elderly humans. It has been shown that the
relative cardiovascular risk is significantly reduced by 54 %, 62 % and 75 %, respectively,
if 3, 4 or 5 health-promoting life-style factors come together. Healthful living prevents
disability and 5 associated with advanced age. Absence of four to five classical risk
factors increases the life expectancy by as much as 9.5 years. The risk profile is
influenced favourably by wholesome nutrition, regular physical activity and non-smoking.
Following exactly the current dietary guidelines decreases the risk of mortality of
coronary heart disease, stroke and cancer. The all-cause mortality risk is significantly
lowered by regular walking, stairs climbing and vigorous physical activity with a
high energy expenditure. Between the body mass index (BMI) and the total mortality
there is an U-shaped relationship. A rising BMI increases also the risk for disability.
Those who have a high BMI suffer earlier onset of disability.
Literatur
- 1
Crepaldi G, Maggi S, Rozzini R, Trabucchi M.
Reducing disability among the elderly in Europe.
Lancet.
1998;
351
375
- 2
Khaw K T.
Epidemiological aspects of ageing.
Philos Trans R Soc Lond B Biol Sci.
1997;
352
1829-1835
- 3
Cella D F.
Quality of life: the concept.
J Palliat Care.
1992;
8
8-13
- 4
Stampfer M J, Hu F B, Manson J E, Rimm E B, Willett W C.
Primary prevention of coronary heart disease in women through diet and lifestyle.
N Engl J Med.
2000;
343
16-22
- 5
Hu F B, Stampfer M J, Manson J E. et al .
Trends in the incidence of coronary heart disease and changes in diet and lifestyle
in women.
N Engl J Med.
2000;
343
530-537
- 6
Stamler J, Stamler R, Neaton J D. et al .
Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality
and life expectancy: findings for 5 large cohorts of young adult and middle-aged men
and women.
JAMA.
1999;
282
2012-2018
- 7
Meng L, Maskarinec G, Lee J, Kolonel L N.
Lifestyle factors and chronic diseases: application of a composite risk index.
Prev Med.
1999;
29
296-304
- 8
Paffenberger R S, Hyde R T, Wing A L, Lee I M, Jung D L, Kampert J B.
The association of changes in physical-activity level and other lifestyle characteristics
with mortality among men.
N Engl J Med.
1993;
328
538-545
- 9
Troiano R P, Frongillo E A, Sobal J, Levitsky D A.
The relationship between body weight and mortality: a quantitative analysis of combined
information from existing studies.
Int J Obes Relat Metab Disord.
1996;
20
63-75
- 10
Baik I, Ascherio A, Rimm E B. et al .
Adiposity and mortality in men.
Am J Epidemiol.
2000;
152
264-271
- 11
Stevens J, Cai J, Pamuk E R, Williamson D F, Thun M J, Wood J L.
The effect of age on the association between body-mass index and mortality.
N Engl J Med.
1998;
338
1-7
- 12
French S A, Folsom A R, Jeffery R W, Williamson D F.
Prospective study of intentionality of weight loss and mortality in older women: the
Iowa Women's Health Study.
Am J Epidemiol.
1999;
149
504-514
- 13
Williamson D F, Pamuk E, Thun M, Flanders D, Byers T, Heath C.
Prospective study of intentional weight loss and mortality in overweight white men
aged 40 - 64 years.
Am J Epidemiol.
1999;
149
491-503
- 14
Folsom A R, French S A, Zheng W, Baxter J E, Jeffery R W.
Weight variability and mortality: the Iowa Women's Health Study.
Int J Obes Relat Metab Disord.
1996;
20
704-709
- 15
Ho S C, Woo J, Sham A.
Risk factor change in older persons, a perspective from Hong Kong: weight change and
mortality.
J Gerontol.
1994;
49
M269-M272
- 16
Allison D B, Zannolli R, Faith M S. et al .
Weight loss increases and fat loss decreases all-cause mortality rate: results from
two independent cohort studies.
Int J Obes Relat Metab Disord.
1999;
23
603-611
- 17
Chyou P H, Burchfiel C M, Yano K. et al .
Obesity, alcohol consumption, smoking, and mortality.
Ann Epidemiol.
1997;
7
311-317
- 18
Huijbregts P, Feskens E, Rasanen L. et al .
Dietary pattern and 20 year mortality in elderly men in Finland, ltaly, and The Netherlands:
longitudinal cohort study.
BMJ.
1997;
315
13-17
- 19
Kant A K, Schatzkin A, Graubard B I, Schairer C.
A prospective study of diet quality and mortality in women.
JAMA.
2000;
283
2109-2115
- 20
Trichopoulou A, Kouris B A, Wahlqvist M L. et al .
Diet and overall survival in elderly people.
BMJ.
1995;
311
1457-1460
- 21
Osler M, Schroll M.
Diet and mortality in a cohort of elderly people in a north European community.
Int J Epidemiol.
1997;
26
155-159
- 22
Lasheras C, Fernandez S, Patterson A M.
Mediterranean diet and age with respect to overall survival in institutionalized,
nonsmoking elderly people.
Am J Clin Nutr.
2000;
71
987-992
- 23
Jacob D RJ, Meyer K A, Kushi L H, Folsom A R.
Is whole grain intake associated with reduced total and cause-specific death rates
in older women? The Iowa Women's Health Study.
Am J Public Health.
1999;
89
322-329
- 24
Key T J, Thorogood M, Appleby P N, Burr M L.
Dietary habits and mortality in 11 000 vegetarians and health conscious people: results
of a 17 year follow up.
BMJ.
1996;
313
775-779
- 25
Fortes C, Forastiere F, Farchi S, Rapiti E, Pastori G, Perucci C A.
Diet and overall survival in a cohort of very elderly people.
Epidemiology.
2000;
11
440-445
- 26
Wallstrom P, Wirfalt E, Janzon L. et al .
Fruit and vegetable consumption in relation to risk factors for cancer: a report from
the Mal mo diet and cancer study.
Public Health Nutr.
2000;
3
263-271
- 27
Blair S N, Kampert J B, Kohl H W. et al .
lnfluences of cardiorespiratory fitness and other precursors on cardiovascular disease
and all-cause mortality in men and women.
JAMA.
1996;
276
205-210
- 28
Blair S N, Kohl H W, Paffenbarger R S, Clark D G, Cooper K H, Gibbons L W.
Physical fitness and all-cause mortality. A prospective study of healthy men and women.
JAMA.
1989;
262
2395-2401
- 29
Blair S N.
C. H. McCloy Research Lecture: physical activity, physical fitness, and health.
Res Q Exerc Sport.
1993;
64
365-376
- 30
Kampert J B, Blair S N, Barlow C E, Kohl H W.
Physical activity, physical fitness, and all-cause and cancer mortality: a prospective
study of men and women.
Ann Epidemiol.
1996;
6
452-457
- 31
Hakim A A, Curb J D, Petrovitch H. et al .
Effects of walking on coronary heart disease in elderly men: the Honolulu Heart Program.
Circulation.
1999;
100
9-13
- 32
Manson J E, Hu F B, Rich-Edwards J W. et al .
A prospective study of walking as compared with vigorous exercise in the prevention
of coronary heart disease in women.
N Engl J Med.
1999;
341
650-658
- 33
Lee I M, Paffenbarger R S.
Associations of light, moderate, and vigorous intensity physical activity with longevity.
The Harvard Alumni Health Study.
Am J Epidemiol.
2000;
151
293-299
- 34
Lee C D, Blair S N, Jackson A S.
Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease
mortality in men.
Am J Clin Nutr.
1999;
69
373-380
- 35
Kushi L H, Fee R M, Folsom A R, Mink P J, Anderson K E, Sellers T A.
Physical activity and mortality in postmenopausal women.
JAMA.
1997;
277
1287-1292
- 36
Villeneuve P J, Morrison H I, Craig C L, Schaubel D E.
Physical activity, physical fitness, and risk of dying.
Epidemiology.
1998;
9
626-631
- 37
Vita A J, Terry R B, Hubert H B, Fries J F.
Aging, health risks, and cumulative disability.
N Engl J Med.
1998;
338
1035-1041
- 38
Launer L J, Harris T, Rumpel C, Madans J.
Body mass index, weight change, and risk of mobility disability in middle-aged and
older women. The epidemiologic follow-up study of NHANES I.
JAMA.
1994;
271
1093-1098
- 39
LaCroix A Z, Guralnik J M, Berkman L F, Wallace R B, Satterfield S.
Maintaining mobility in late life. II. Smoking, alcohol consumption, physical activity,
and body mass index.
Am J Epidemiol.
1993;
137
858-869
- 40
Fine J T, Colditz G A, Coakley E H. et al .
A prospective study of weight change and health-related quality of life in women.
JAMA.
1999;
282
2136-2142
- 41
Han T S, Tijhuis M A, Lean M E, Seidell J C.
Quality of life in relation to overweight and body fat distribution.
Am J Public Health.
1998;
88
1814-1820
- 42
Visser M, Langlois J, Guralnik J M. et al .
High body fatness, but not low fat-free mass, predicts disability in older men and
women: the Cardiovascular Health Study.
Am J Clin Nutr.
1998;
68
584-590
- 43
Visser M, Harris T B, Langlois J. et al .
Body fat and skeletal muscle mass in relation to physical disability in very old men
and women of the Framingham Heart Study.
J Gerontol A Biol Sci Med Sci.
1998;
53
M214-M221
- 44
Allaire S H, LaValley M P, Evans S R. et al .
Evidence for decline in disability and improved health among persons aged 55 to 70
years: the Framingham Heart Study.
Am J Public Health.
1999;
89
1678-1683
- 45
Leveille S G, Guralnik J M, Ferrucci L, Langlois J A.
Aging successfully until death in old age: opportunities for increasing active life
expectancy.
Am J Epidemiol.
1999;
149
654-664
- 46
Miller M E, Rejeski W J, Reboussin B A, Ten Have T R, Ettinger W H.
Physical activity, functional limitations, and disability in older adults.
J Am Geriatr Soc.
2000;
48
1264-1272
Prof. Dr. G. Wolfram
Technische Universität München · Lehrstuhl für Ernährungslehre
Alte Akademie 16
85350 Freising-Weihenstephan