Zusammenfassung
Während das Adipositasrisiko des Einzelnen wesentlich durch genetische Risikofaktoren
mitbestimmt ist, wird die derzeitige Adipositasepidemie entscheidend durch ungünstige
Lebensstilfaktoren ausgelöst. Gesundheitliche Empfehlungen haben sich bisher vor allem
auf eine Erhöhung der körperlichen Aktivität und eine Verminderung der Nahrungszufuhr
an Fett und Zucker konzentriert. Im Gegensatz zu den allgemein akzeptierten Kampagnen
zur Steigerung der körperlichen Aktivität gibt es zur Frage der Fett- und Zuckerzufuhr
jedoch kontroverse Diskussionen. Während verschiedene Metaanalysen einen Zusammenhang
zwischen Fettzufuhr und Körpergewicht herstellen, wurde die wissenschaftliche Evidenz
in jüngerer Zeit in Frage gestellt. Insbesondere wird die Frage aufgeworfen, ob wir
den Fokus mehr auf die Energiedichte oder die Zusammensetzung der Makronährstoffe
der Nahrung richten sollten. Die kürzlich abgeschlossene NUGENOB-Studie hat trotz
aller neuer Diätmoden erneut gezeigt, das eine Kalorie eine Kalorie bleibt, egal ob
sie aus Fetten oder aus Kohlenhydraten stammt. Von größerer Bedeutung aber ist die
Regulation des Körpergewichts unter weniger kontrollierten Ad-libitum-Bedingungen.
Hier zeigt die Wissenschaft klar auf, dass die erste Priorität auf einer Begrenzung
der Fettzufuhr und nicht der Kohlenhydratzufuhr liegen sollte. Einige Studien assoziieren
eine passive Überkonsumption von Energie mit einer Ernährung mit hohem glykämischen
Index. Allerdings ist die Literatur zu diese Thema kontrovers und stützt diese Schlussfolgerung
überwiegend nicht, mit der Ausnahme entsprechender Wirkungen von Getränken mit hohem
glykämischen Index. Einige jüngere Studien haben sich mit der Proteinzufuhr der Nahrung
beschäftigt. Eine Ad-libitum-Nahrungszufuhr mit hohem Proteingehalt fördert die Sättigung
und die Thermogenese und resultiert in besserer Gewichtskontrolle bzw. Gewichtsabnahme.
Abstract
Whilst susceptibility to obesity is determined largely by genetic factors, the current
obesity epidemic is significantly influenced by adverse lifestyle factors. So far
health guidelines have focused on changing two particular lifestyles factors: increase
levels of physical activity and reduce intake of fat and sugar. In contrast to the
public action to increase physical activity there is much more debate on the fat and
sugar intake. Although a number of meta-analysis on the relationship between fat intake
and body weight control clearly showed a direct association, the scientific evidence
has been seriously challenged in recent years. These doubts have dramatically posed
the question whether we should focus explicitly on energy density or more to the macronutrient
composition. The recent finished NUGENOB study has showed again despite all diet hypes
that a calorie is still a calorie whether it comes from fat or carbohydrate. Of more
importance is to observe body weight maintenance under less well controlled ad lib
situations. Under such circumstances the science tells us clearly that one should
reduce in the first place fat and not carbohydrate intake. Secondary to the fat/carbohydrate
ratio is the question of type of carbohydrate. Some studies attribute passive over-consumption
of energy to a diet with a high Glycemic Index. The literature, however, is conflicting
and mostly not confirming this opinion except for the intake of high glycemic drinks.
Recently in the search for new dietary concepts to challenge the obesity problem the
attention has been focussed on the level of protein in the diet. Ad libitum diets
with high protein content have been shown to enhance satiety and increase thermogenesis,
and also produce better weight control and weight loss.
Schlüsselwörter
Adipositas - Nahrungsfette - Nahrungskohlenhydrate - Zucker - Energiebilanz
Key words
Obesity - dietary fat - dietary carbohydrates - sugar - energy balance
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Wim H. M. SarisMD, PhD
Dept Human Biology, Nutrition and Toxicology Research Institute NUTRIM
PO box 616
6200 MD Maastricht · The Netherlands
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Email: W.Saris@hb.unimaas.nl
