Ernährungsempfehlungen – Übergewicht und Herzerkrankungen – wie sollte die Ernährung aussehen?

Die optimale Ernährung zur Minderung des kardiovaskulären Risikos ist noch nicht durch eine ausreichende interventionelle Studienlage zu definieren. Aus epidemiologischen Studien, prospektiven Kohortenstudien und metabolischen Interventionsstudien lassen sich aber eindeutige Hinweise für Ernährungsempfehlungen ableiten. Eine Ernährungsumstellung zur Verminderung des Gesamtrisikos zielt auf eine langfristige Verbesserung der alltäglichen Ernährungsgewohnheiten in Richtung auf eine kalorienangepasste mediterrane Kost. Dies gilt für Gesunde und für Patienten mit Gefäßatherosklerose.

Randomisierte Interventionsstudien sind jedoch notwendig, um insbesondere für Patienten mit CV–Erkrankungen in der Sekundärprävention bei unterschiedlichen Stoffwechselsituationen differenzierte Ernährungsempfehlungen zu erarbeiten.

The best possible nutritional plan to reduce cardiovascular risk has not yet been defined by interventional studies. However, clear indications for nutritional recommendations can be obtained from epidemiological studies, prospective cohort studies and metabolic intervention studies. A suitably modified nutritional plan to reduce the overall risk aims at a long–term improvement of daily eating habits directed at low–calory Mediterranean–type food. This applies to healthy persons and patients suffering from vascular atherosclerosis. However, randomised interventional studies are mandatory to arrive at differentiated nutritional recommendations for patients suffering from cardiovascular diseases as secondary preventive measures for a variety of metabolic situations.

mediterranean type food - abdominal adipositas - inflammatory markers - polyunsaturated fat - glycemic index

Literatur

• 1 Brand–Miller J, Fatima K, Middlemiss C. et al. . Effect of alcoholic beverages on post–prandial glycemia and insulinemia in lean, young, healthy adults.  Am J Clin Nutr. 2007;  85 1545-1551
• 2 Buettner HJ, Mueller C, Gick M, Ferenc M. et al. . The Impact of Obesity on Mortality in UA/Non–ST–Segment Elevation Myocardial Infarction.  Eur Heart J. 2007;  28 1694-1701
• 3 Carluccio MA, Siculella L, Ancora MA. et al. . Olive oil and red wine antioxidant polyphenols inhibit endothelial activation: antiatherogenic properties of Mediterranean diet phytochemicals.  Arterioscler Thromb Vasc Biol. 2003;  23 622-629
• 4 Cortés B, Núñez I, Cofán M, Gilabert R. et al. . Acute Effects of High–Fat Meals Enriched With Walnuts or Olive Oil on Postprandial Endothelial Function.  JACC. 2006;  48 1666-1671
• 5 Covas M–I, Nyyssönen K, Poulsen HE. et al. . The Effect of Polyphenols in Olive Oil on Heart Disease Risk Factors. A Randomized Trial.  Ann Intern Med. 2006;  145 333-341
• 6 Dai J, Miller AH, Bremner JD, Goldberg J. et al. . Adherence to the Mediterranean Diet Is Inversely Associated With Circulating Interleukin–6 Among Middle–Aged Men. A Twin Study.  Circulation. 2008;  117 2007
• 7 De Lorgeril M, Salen P, Martin J–L, Mamelle N. et al. . Mediterranean diet, traditional risk factors and the rate of cardiovascular complications after myocardial infarction – Final report of the Lyon Diet Heart Study.  Circulation. 1999;  99 779-785
• 8 Djoussé L, Gaziano JM.. Breakfast Cereals and Risk of Heart Failure in the Physicians' Health Study.  Arch Intern Med. 2007;  167 2080-2085
• 9 Ebbeling CB, Leidig MM, Feldman HA, Lovesky MM, Ludwig DS.. Effects of a low glycemic load vs. low fat diet in obese young adults. A randomized trial.  JAMA. 2007;  297 2092-2102
• 10 Estruch R, Martinez–Gonzalez MA, Corella D, Salas–Salvado J. et al. . Effects of a Mediterranean–Style Diet on Cardiovascular Risk Factors – A Randomized Trial.  Ann Intern Med. 2006;  145 1-11
• 11 Fitó M, Guxens M, Corella D, Sáez G. et al. . Effect of a Traditional Mediterranean Diet on Lipoprotein Oxidation: A Randomized Controlled Trial.  Arch Intern Med. 2007;  167 1195-1203
• 12 Fuentes F, Lopez–Miranda J, Sanchez E. et al. . Mediterranean and low–fat diets improve endothelial function in hypercholesterolemic men.  Ann Intern Med. 2001;  134 1115-1119
• 13 Howard BV, Van Horn L, Hsia J, Manson JE. et al. . Low–Fat Dietary Pattern and Risk of Cardiovascular Disease: The Women's Health Initiative Randomized Controlled Dietary Modification Trial.  JAMA. 2006;  295 655-666
• 14 Hu FB.. The Mediterranean Diet and Mortality – Olive Oil and Beyond.  N Engl J Med. 2003;  348
• 15 Hu FB, Stampfer MJ, Manson JE, Rimm E. et al. . Dietary Fat Intake and the Risk of Coronary Heart Disease in Women.  N Engl J Med. 1997;  337 1491-1499
• 16 Jakulj F, Zernicke K, Bacon SL, van LE Wielingen. et al. . A High–Fat Meal Increases Cardiovascular Reactivity to Psychological Stress in Healthy Young Adults.  J Nutr. 2007;  137
• 17 Josse A, Kendall C, Augustin L, Ellis P, Jenkins D.. Almonds and post–prandial glycemia–a dose–response study.  Metabolism. 2007;  56 400-404
• 18 Kelly S, Summerbell CD, Brynes A, Whittaker V, Frost G.. Wholegrain cereals for coronary heart disease.  Cochrane Database of Systematic Reviews. 2007;  2
• 19 Knoops KT, de Groot LC, Kromhout D. et al. . Mediterranean diet, lifestyle factors, and 10–year mortality in elderly European men and women: the HALE project.  JAMA. 2004;  292 1433-1439
• 20 Ludwig DS.. The Glycemic Index: Physiological Mechanisms Relating to Obesity, Diabetes, and Cardiovascular Disease.  JAMA. 2002;  287 2414-2423
• 21 Lutsey PL, Steffen LM, Stevens J.. Dietary Intake and the Development of the Metabolic Syndrome The Atherosclerosis Risk in Communities Study.  Circulation. 2008;  117 754-761
• 22 Mitrou PN, Kipnis V, Thiébaut ACM, Reedy J. et al. . Mediterranean dietary pattern and prediction of all–cause mortality in a US population. Results from the NIH–AARP diet and health study.  Arch Int Med. 2007;  167 2461-2468
• 23 Mokdad AH, Marks JS, Stroup DF, Gerberding JL.. Actual Causes of Death in the United States, 2000.  JAMA. 2004;  291 1238-1245
• 24 Monnier L, Mas E, Ginet C. et al. . Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes.  JAMA. 2006;  295 1681-1687
• 25 Moreno JA, Lopez–Miranda J, Gomez P, Benkhalti F. et al. . Effect of phenolic compounds of virgin olive oil on LDL oxidation resistance.  Med Clin (Barc). 2003;  120 128-131
• 26 Mozaffarian D, Psaty BM, Rimm EB. et al. . Fish Intake and Risk of Incident Atrial Fibrillation.  Circulation. 2004;  110 368-373
• 27 Mozaffarian MD, Rimm EB, Herrington DM.. Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal women.  Am J Clin Nutrition. 2004;  80 1175-1184
• 28 Nicholls SJ, Lundman P, Harmer JA, Cutri B. et al. . Consumption of Saturated Fat Impairs the Anti–Inflammatory Properties of High–Density Lipoproteins and Endothelial Function.  JACC. 2006;  48 715-720
• 29 Okie S.. New York to Trans Fats: You're Out!.  N Engl J Med. 2007;  356 2017-2021
• 30 Östman E, Granfeldt Y, Persson L, Björck I.. Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects.  Eur J Clin Nutr. 2005;  59 983-988
• 31 Petroni A, Blasevich M, Salami M, Papini N. et al. . Inhibition of platelet aggregation and eicosanoid production by phenolic components of olive oil.  Thromb Res. 1995;  78 151-160
• 32 Ruano J, Lopez–Miranda J, Fuentes F, Moreno JA. et al. . Phenolic content of virgin olive oil improves ischemic reactive hyperemia inhypercholesterolemic patients.  JACC. 2005;  46 1864-1868
• 33 Steffen LM, Folsom AR, Cushman M. et al. . Greater Fish, Fruit, and Vegetable Intakes Are Related to Lower Incidence of Venous Thromboembolism. The Longitudinal Investigation of Thromboembolism Etiology.  Circulation. 2007;  115 188-195
• 34 Sun Q, Ma J, Campos H, Hankinson SE. et al. . A prospective study of trans fatty acids in erythrocytes and risk of coronary heart disease.  Circulation. 2007;  115 1858-1865
• 35 Tay J, Brinkworth GD, Noakes M, Keogh J, Clifton PM.. Metabolic effects of weight loss on a very–low–carbohydrate diet compared with an isocaloric high–carbohydrate diet in abdominally obese subjects.  J Am Coll Cardiol. 2008;  51 59-67
• 36 Trichopoulou A, Costacou T, Bamia C, Trichopoulos D.. Adherence to a Mediterranean Diet and Survival in a Greek Population.  N Engl J Med. 2003;  348 2599-2608
• 37 Trichopoulou A, Orfanos P, Norat T. et al. . Modified Mediterranean diet and survival: EPIC–elderly prospective cohort study.  BMJ. 2005;  330 991-997
• 38 Van de Werf F. et al. . Management of acute M I in patients presenting with ST–sagment elevation.  Eur Heart J. 2003;  24 28-66
• 39 Visioli F, Galli C, Bornet F. et al. . Olive oil phenolics are dosedependently absorbed in humans.  FEBS Lett. 2000;  468 159-160
• 40 Weinbrenner T, Fito M, de la Torre R. et al. . Olive oils high in phenolic compounds modulate oxidative/ antioxidative status in men.  J Nutr. 2004;  134 2314-2321
• 41 Wirth A, Gohlke H.. Rolle des Körpergewichts für die Prävention der koronaren Herzkrankheit.  Z Kardiol. 2005;  94

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