Mehr Fett

Zusammenfassung

Entspricht die Empfehlung „weniger Fett – mehr Kohlenhydrate“ noch dem heutigen Kenntnisstand? Der Beitrag stellt Ergebnisse großer Kohorten- und klinischer Diätstudien vor, die die Auswirkungen der Fettzufuhr neu bewerten lassen. Danach muss das Risikopotenzial von gesättigten Fettsäuren infrage gestellt werden und somit auch die Empfehlung, mehr Kohlenhydrate zu verzehren.

Schlüsselwörter

Fettsäuren - Cholesterin - koronare Herzkrankheit - metabolisches Syndrom - Insulinresistenz - Ernährungsempfehlungen

• Literatur

• 1 DGE. Evidenzbasierte Leitlinie: Fettkonsum und Prävention ausgewählter ernährungsmitbedingter Krankheiten. Deutsche Gesellschaft für Ernährung e.V.; 11/2006 www.dge.de
• 2 DGE. Referenzwerte für die Nährstoffzufuhr. 3.. korr. Nachdruck Neustadt/Weinstraße: Neuer Umschau Buchverlag; 2008
• 3 DGE. Aktuelle Meta-Analysen und systematische Übersichtsarbeiten bestätigen DGE-Leitlinie zum Fettkonsum. Statement der Deutschen Gesellschaft für Ernährung e.V.. 2010 http://www.dge.de/pdf/ws/100315_SFA_Statement.pdf
• 4 Hayward RA, Krumholz HM. Three reasons to abandon low-density lipoprotein targets: an open letter to the Adult Treatment Panel IV of the National Institutes of Health. Circ Cardiovasc Qual Outcomes 2012; 5: 2-5
• 5 Genest J, Frohlich J, Fodor G, McPherson R. Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease: summary of the 2003 update. CMAJ 2003; 169: 921-924
• 6 EFSA. Scientific opinion on dietary reference values for fats, including saturated fatty acids, polyunsaturated fatty acids, mono-unsaturated fatty acids, trans fatty acids, and cholesterol. EFSA Journal 2010; 8: 1461
• 7 Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 2003; 77: 1146-1155
• 8 Hoenselaar R. Saturated fat and cardiovascular disease: the discrepancy between the scientific literature and dietary advice. Nutrition 2012; 28: 118-123
• 9 Katan MB, Zock PL, Mensink RP. Effects of fats and fatty acids on blood lipids in humans: an overview. Am J Clin Nutr 1994; 60: 1017S-1022S
• 10 Paul O, Lepper MH, Phelan WH et al. A longitudinal study of coronary heart disease. Circulation 1963; 28: 20-31
• 11 Kannel WB, Gordon T. The Framingham Diet Study: Diet and the regulation of serum cholesterol. The Framingham Study. An epidemiologic investigation of cardiovascular disease. Section 24. Washington DC: Dept of Health, Education and Welfare; 1970
• 12 Ascherio A, Rimm EB, Giovannucci EL et al. Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States. BMJ 1996; 313: 84-90
• 13 Oh K, Hu FB, Manson JE et al. Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the Nurses‘ Health Study. Am J Epidemiol 2005; 161: 672-679
• 14 Worm N. Ernährung und koronare Herzkrankheit: Wie sinnvoll ist Diät?. Versicherungsmedizin 1995; 47: 116-122
• 15 Ravnskov U. The questionable role of saturated and polyunsaturated fatty acids in cardiovascular disease. J Clin Epidemiol 1998; 51: 443-460
• 16 Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 2009; 169: 659-669
• 17 Skeaff CM, Miller J. Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomised controlled trials. Ann Nutr Metab 2009; 55: 173-201
• 18 Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr 2010; 91: 535-546
• 19 Stamler J. Diet-heart: a problematic revisit. Am J Clin Nutr 2010; 91: 497-499
• 20 Katan MB, Brouwer IA, Clarke R et al. Saturated fat and heart disease. Am J Clin Nutr 2010; 92: 459-460; author reply 460–461
• 21 Elwood PC, Pickering JE, Givens DI, Gallacher JE. The consumption of milk and dairy foods and the incidence of vascular disease and diabetes: an overview of the evidence. Lipids 2010; 45: 925-939
• 22 Jakobsen MU, O‘Reilly EJ, Heitmann BL et al. Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr 2009; 89: 1425-1432
• 23 Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med 2010; 7: e1000252
• 24 Turpeinen O, Karvonen MJ, Pekkarinen M et al. Dietary prevention of coronary heart disease: the Finnish Mental Hospital Study. Int J Epidemiol 1979; 8: 99-118
• 25 Leren P. The Oslo diet-heart study. Eleven-year report. Circulation 1970; 42: 935-942
• 26 Halperin M, Cornfield J, Mitchell SC. Effect of diet on coronary-heart-disease mortality. Lancet 1973; 2: 438-439
• 27 Mozaffarian D, Wu JH. Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events. J Am Coll Cardiol 2011; 58: 2047-2067
• 28 Bendsen NT, Christensen R, Bartels EM, Astrup A. Consumption of industrial and ruminant trans fatty acids and risk of coronary heart disease: a systematic review and meta-analysis of cohort studies. Eur J Clin Nutr 2011; 65: 773-783
• 29 Ramsden CE, Hibbeln JR, Majchrzak SF, Davis JM. 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
• 30 Ramsden CE, Hibbeln JR, Majchrzak-Hong SF. All PUFAs are not created equal: absence of CHD benefit specific to linoleic acid in randomized controlled trials and prospective observational cohorts. World Rev Nutr Diet 2011; 102: 30-43
• 31 German JB, Dillard CJ. Saturated fats: a perspective from lactation and milk composition. Lipids 2010; 45: 915-923
• 32 German JB. Dietary lipids from an evolutionary perspective: sources, structures and functions. Maternal & Child Nutrition 2011; 7 (Suppl. 2): 2-16
• 33 von Schacky C. The Omega-3 Index as a risk factor for cardiovascular diseases. Prostaglandins & Other Lipid Mediators 2011; 96: 94-98
• 34 Blasbalg TL, Hibbeln JR, Ramsden CE et al. Changes in consumption of omega-3 and omega-6 fatty acids in the United States during the 20th century. Am J Clin Nutr 2011; 93: 950-962
• 35 Kuipers RS, de Graaf DJ, Luxwolda MF et al. Saturated fat, carbohydrates and cardiovascular disease. Netherlands J Med 2011; 69: 372-378
• 36 Volek JS, Phinney SD, Forsythe CE et al. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids 2009; 44: 297-309
• 37 Forsythe CE, Phinney SD, Feinman RD et al. Limited effect of dietary saturated fat on plasma saturated fat in the context of a low carbohydrate diet. Lipids 2010; 45: 947-962
• 38 Gonder U, Worm N. Mehr Fett! Liebeserklärung an einen zu Unrecht verteufelten Nährstoff. Lünen: Systemed; 2010
• 39 Hanefeld M, Schaper F, Ceriello A. Geschichte und Definition(en) des metabolischen Syndroms. Internist (Berl) 2007; 48: 117-125
• 40 Moebus S, Hanisch J, Bramlage P et al. Regional differences in the prevalence of the metabolic syndrome in primary care practices in Germany. Dtsch Arztebl Int 2008; 105: 207-213
• 41 Krauss RM. Dietary and genetic probes of atherogenic dyslipidemia. Arterioscler Thromb Vasc Biol 2005; 25: 2265-2272
• 42 Krauss RM, Blanche PJ, Rawlings RS et al. Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. Am J Clin Nutr 2006; 83: 1025-1031
• 43 Ströhle A, Worm N. Metabolisches Syndrom: Pathophysiologische Grundlagen und rationale Empfehlungen zur Ernährungstherapie. Deutsche Apotheker Zeitung 2012; 152: 50-67
• 44 Garg A. High-monounsaturated-fat diets for patients with diabetes mellitus: a meta-analysis. Am J Clin Nutr 1998; 67 (3 Suppl.): 577S-582S
• 45 Cao Y, Mauger DT, Pelkman CL et al. Effects of moderate (MF) versus lower fat (LF) diets on lipids and lipoproteins: a meta-analysis of clinical trials in subjects with and without diabetes. J Clin Lipidol 2009; 3: 19-32
• 46 Kodama S, Saito K, Tanaka S et al. Influence of fat and carbohydrate proportions on the metabolic profile in patients with type 2 diabetes: a meta-analysis. Diabetes Care 2009; 32: 959-965
• 47 Nordmann AJ, Suter-Zimmermann K, Bucher HC et al. Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med 2011; 124: 841-851 e2
• 48 Kastorini CM, Milionis HJ, Esposito K et al. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol 2011; 57: 1299-1313
• 49 Feinman RD, Volek JS. Carbohydrate restriction as the default treatment for type 2 diabetes and metabolic syndrome. Scand Cardiovasc J 2008; 42: 256-263