Ernährungsempfehlungen beim metabolisch-vaskulären Syndrom

Zur Prävention und Therapie metabolisch-vaskulärer Erkrankungen wurde jahrelang ein fett- und kalorienarmes Ernährungsmuster mit konkreten Vorgaben zu isolierten Nährstoffen propagiert wie bspw. dem Cholesterin oder den gesättigten Fettsäuren. Dieser Beitrag soll zeigen, dass lebensmittel- bzw. essmusterbasierte Empfehlungen ohne spezifische Angaben zu Nährstoffrelationen oder Kalorien sinnvoller sind.

Abstract

Cardiovascular disease is the number one cause of death globally. Poor diet constitutes a key factor in the initiation and progression of cardiovascular disease and has become the leading risk factor for disability and death worldwide. Therefore, addressing suboptimal nutrition is of key prognostic relevance in primary and secondary prevention of metabolic vascular syndrome.

Metabolic vascular syndrome is a multidimensional network of acquired cardiometabolic risk factors closely related to insulin resistance (IR) and compensatory hyperinsulinemia. IR, being the underlying cause of metabolic vascular syndrome and certain types of cancer, should attract the attention of every clinician. As changes in lipoprotein metabolism are one of the earliest indicators of metabolic dysfunction, a relevant biomarker for identifying individuals with IR is the TAG/HDL-C ratio.

Hyperinsulinemia – and concomitant metabolic vascular risk – can be effectively treated by lifestyle intervention. If IR is present, dietary carbohydrate restriction has consistently been shown to be superior to dietary fat restriction in reversing metabolic dysfunction. The beneficial effects of carbohydrate restricted diets on metabolic vascular risk are independent of BMI – diet quality therefore confers patient benefit beyond weight reduction.

Targeting IR with a low glycemic load, real food diet will reduce overall energy density and will improve all risk factors of metabolic vascular syndrome. In particular, replacing refined carbohydrates with healthy fats in the context of a Mediterranean style-, low carbohydrate and calorie-unrestricted dietary pattern has been shown to significantly reduce burden of metabolic vascular disease. The effect of single nutrients on isolated lipid surrogate markers such as LDL-C does not capture their global effect on metabolic vascular risk.

Schlüsselwörter

metabolisch-vaskuläres Syndrom - Insulinresistenz - Ernährung - Kohlenhydratqualität, Essmuster

Keywords

metabolic vascular syndrome - insulin resistance - nutrition - carbohydrate quality - dietary patterns

• Literatur

• 1 Mozaffarian D. Dietary and policy Priorities for cardiovascular disease, diabetes, and obesity: A comprehensive review. Circulation 2016; 133: 187-225
• 2 Scholz GH, Hanefeld M. Metabolic vascular syndrome: New insights into a multidimensional network of risk factors and diseases. Visceral Med 2016; 32: 319-326
• 3 Austin GL, Ogden LG, Hill JO. Trends in carbohydrate, fat, and protein intakes and association with energy intake in normalweight, overweight, and obese individuals: 1971 – 2006. Am J Clin Nutr 2011; 93: 836-843
• 4 Harcombe Z. Dietary fat guidelines have no evidence base: where next for public health nutritional advice?. British journal of sports medicine 2017; 51: 769-774
• 5 Heart and Stroke Foundation Canada. Saturated fat, heart disease and stroke, Position Statement. 2015
• 6 Kromhout D, Spaaij CJK, de Goede J. et al. The 2015 Dutch food-based dietary guidelines. Eur J Clin Nutr 2016; 70: 869-878
• 7 Mozaffarian D, Ludwig DS. The 2015 US Dietary Guidelines: Lifting the ban on total dietary fat. J Am Med Assoc 2015; 313: 2421-2422
• 8 Mozaffarian D. Foods, nutrients, and health: when will our policies catch up with nutrition science?. Lancet Diabetes & Endocrinology 2016; 5: 85-88
• 9 Praagman J, Beulens JW, Alssema M. et al. The association between dietary saturated fatty acids and ischemic heart disease depends on the type and source of fatty acid in the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort. Am J Clin Nutr 2016; 103: 356-365
• 10 Mozaffarian D. Diverging global trends in heart disease and type 2 diabetes: the role of carbohydrates and saturated fats. Lancet Diabet Endocrinol 2015; 3: 586-588
• 11 Volk BM, Kunces LJ, Freidenreich DJ. et al. Effects of step-wise increases in dietary carbohydrate on circulating saturated Fatty acids and palmitoleic Acid in adults with metabolic syndrome. PloS one 2014; 9: e113605
• 12 Lee JJ, Lambert JE, Hovhannisyan Y. et al. Palmitoleic acid is elevated in fatty liver disease and reflects hepatic lipogenesis. Am J Clin Nutr 2015; 101: 34-43
• 13 Mensink RP, Zock PL, Kester AD. et al. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a metaanalysis of 60 controlled trials. Am J Clin Nutr 2003; 77: 1146-1155
• 14 Mente A, Dehghan M, Rangarajan S. et al. Association of dietary nutrients with blood lipids and blood pressure in 18 countries: a cross-sectional analysis from the PURE study. Lancet Diabetes Endocrinol 2017; 5: 774-787
• 15 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
• 16 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. Br Med J (Clinical research ed) 2015; 351: h3978
• 17 Siri-Tarino PW, Sun Q, Hu FB. et al. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr 2010; 91: 535-546
• 18 Schwingshackl L, Hoffmann G. Monounsaturated fatty acids, olive oil and health status: a systematic review and metaanalysis of cohort studies. Lipids Health Dis 2014; 13: 154
• 19 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 – 1973). Br Med J (Clinical research ed) 2016; 353: i1246
• 20 von Schacky C. The Omega-3 Index as a risk factor for cardiovascular diseases. Prostaglandins & Other Lipid Mediators 2011; 96: 94-98
• 21 Albert CM, Campos H, Stampfer MJ. et al. Blood levels of longchain n-3 fatty acids and the risk of sudden death. N Engl J Med 2002; 346: 1113-1118
• 22 Kleber ME, Delgado GE, Lorkowski S. et al. Omega-3 fatty acids and mortality in patients referred for coronary angiography. The Ludwigshafen Risk and Cardiovascular Health Study. Atherosclerosis 2016; 252: 175-181
• 23 Schuchardt JP, Hahn A. Bioavailability of long-chain omega-3 fatty acids. Prostaglandins, Leukot Essent Fatty Acids 2013; 89: 1-8
• 24 Berryman CE, Agarwal S, Lieberman HR. et al. Diets higher in animal and plant protein are associated with lower adiposity and do not impair kidney function in US adults. Am J Clin Nutr 2016; 104: 743-749
• 25 Layman DK, Anthony TG, Rasmussen BB. et al. Defining meal requirements for protein to optimize metabolic roles of amino acids. Am J Clin Nutr 2015; 101: 1330S-1338S
• 26 Markova M, Pivovarova O, Hornemann S. et al. Isocaloric diets high in animal or plant protein reduce liver fat and inflammation in individuals with type 2 diabetes. Gastroenterol 2017; 152: 571-585.e8
• 27 Feinman RD, Pogozelski WK, Astrup A. et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition 2015; 31: 1-13
• 28 Noakes TD, Windt J. Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review. Br J Sports Med 2017; 51: 133-139
• 29 von Bibra H, Saha S, Hapfelmeier A. et al. Impact of the triglyceride/high-density lipoprotein cholesterol ratio and the hypertriglyceridemic-waist phenotype to predict the metabolic syndrome and insulin resistance. Horm Metab Res 2017; 49: 542-549
• 30 Barazzoni R, Deutz NE, Biolo G. et al. Carbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group. Clin Nutr 2017; 36: 355-363
• 31 Basu S, Yoffe P, Hills N. et al. The relationship of sugar to population-level diabetes prevalence: an econometric analysis of repeated cross-sectional data. PloS one 2013; 8: e57873
• 32 Stanhope KL, Bremer AA, Medici V. et al. Consumption of fructose and high fructose corn syrup increase postprandial triglycerides, LDL-cholesterol, and apolipoprotein-B in young men and women. J Clin Endocrinol Metab 2011; 96: E1596-E1605
• 33 Schwarz JM, Noworolski SM, Erkin-Cakmak A. et al. Effects of Dietary Fructose Restriction on Liver Fat, De Novo Lipogenesis, and Insulin Kinetics in Children With Obesity. Gastroenterology 2017; 153: 743-752
• 34 Shulman GI. Ectopic fat in insulin resistance, dyslipidemia, and cardiometabolic disease. N Engl J Med 2014; 371: 2237-2238
• 35 Petersen MC, Vatner DF, Shulman GI. Regulation of hepatic glucose metabolism in health and disease. Nat Rev Endocrinol 2017; 13: 572-587
• 36 Lustig RH. Sickeningly Sweet: Sickeningly Sweet: Does Sugar Cause Type 2 Diabetes? Yes. Canadian journal of diabetes 2016; 40: 282-286
• 37 White MG, Shaw JA, Taylor R. Type 2 diabetes: The pathologic basis of reversible beta-cell dysfunction. Diab Care 2016; 39: 2080-2088
• 38 Adams LA, Anstee QM, Tilg H. et al. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut 2017; 66: 1138-1153
• 39 Kuhn JP, Meffert P, Heske C. et al. Prevalence of fatty liver disease and hepatic iron overload in a Northeastern German population by using quantitative MR imaging. Radiology 2017; 284: 706-716
• 40 Adiels M, Olofsson SO, Taskinen MR. et al. Overproduction of very low-density lipoproteins is the hallmark of the dyslipidemia in the metabolic syndrome. Arteriosclerosis, Thrombosis, and Vascular Biol 2008; 28: 1225-1236
• 41 Tehrani DM, Zhao Y, Blaha MJ. et al. Discordance of low-density lipoprotein and high-density lipoprotein cholesterol particle versus cholesterol concentration for the prediction of cardiovascular disease in patients with metabolic syndrome and diabetes mellitus (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol 2016; 117: 1921-1927
• 42 de Graaf J, Couture P, Sniderman A. A diagnostic algorithm for the atherogenic apolipoprotein B dyslipoproteinemias. Nature Clin Pract Endocrinol Metab 2008; 4: 608-618
• 43 Mora S, Szklo M, Otvos JD. et al. LDL particle subclasses, LDL particle size, and carotid atherosclerosis in the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2007; 192: 211-217
• 44 Tabas I, Williams KJ, Boren J. Subendothelial lipoprotein retention as the initiating process in atherosclerosis: update and therapeutic implications. Circulation 2007; 116: 1832-1844
• 45 Mozaffarian D, Hao T, Rimm EB. et al. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med 2011; 364: 2392-2404
• 46 Estruch R, Ros E, Salas-Salvado J. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; 368: 1279-1290
• 47 Estruch R, Martinez-Gonzalez MA, Corella D. et al. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabet Endocrinol 2016; 4: 666-676
• 48 Malhotra A, Redberg RF, Meier P. Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions. Br J Sports Med 2017; 51: 1111-1112