Vegetarische und vegane Ernährung – Vor- und Nachteile für die Knochen

Zusammenfassung

Auf fleischfreie Kost und Nahrungsmittel ohne tierische Produkte wird von einer wachsenden Zahl von Bürgern und Bürgerinnen zurückgegriffen. Damit einher gehen Veränderungen des Eiweiß- und Knochenstoffwechsels bei Betroffenen. Aufgrund der vielfältigen Kostformen und häufig auch des veränderten Lebensstils sind Aussagen zu Risiken die Knochen betreffend problematisch. Oft werden den fleischfreien Nahrungsmitteln bestimmte Nährstoffe und Mineralien zugesetzt. Eine antioxidative Wirkung der vegetarischen Kost ist für den Stoffwechsel wahrscheinlich und günstig. Studien zu Frakturen zeigen zumindest in einer großen Studie eine erhöhte Zahl von Brüchen bei veganer Ernährung. Risiken entstehen durch ein geringeres Gewicht und eine verminderte Kalzium- und Eiweißaufnahme. Menschen, die sich vegan ernähren, werden Krafttraining sowie Eiweiß- und Kalzium-Supplementierung empfohlen. Eine abschließende Bewertung dieser Kost- und Lebensformen im Hinblick auf das Risiko, eine Osteoporose zu entwickeln, ist derzeit problematisch und sollte mit Zurückhaltung getroffen werden.

Abstract

Meat-free diets and diets that avoid all animal products, are being followed by a growing number of people. This is accompanied by changes in protein and bone metabolism. Due to the wide variety of diets and the frequently coexisting lifestyle changes, it is difficult to make statements about the risks to bones. Missing nutrients and minerals are often added to the substitutes. It is likely that a vegetarian diet has an antioxidant effect and is beneficial for the metabolism. In general, fewer falls and fractures were found, although the results of one large study revealed an increased number of fractures among participants following a vegan diet. The risk differences are likely due to a lower BMI and a lower intake of calcium and protein. Therefore a recommendation for strength training and calcium and protein supplementation is indicated for individuals following a vegan diet. At present, it is difficult to conclusively evaluate these diets and lifestyles with regard to the risk of developing osteoporosis, and this should thus only attempted with great caution.

Schlüsselwörter

vegetarische - vegane Ernährung - Osteoporose - Frakturrisiko

Key words

vegetarian - vegan diet - osteoporosis - fracture risk

Publication History

Received: 15 May 2022

Accepted: 01 August 2022

Article published online:
08 September 2022

• Literatur

• 1 Kahleova H, Rembert E, Alwarith J. et al. Effects of a Low-Fat Vegan Diet on Gut Microbiota in Overweight Individuals and Relationships with Body Weight, Body Composition, and Insulin Sensitivity. A Randomized Clinical Trial. Nutrients 2020; 12 DOI: 10.3390/nu12102917.
• 2 Clarys P, Deliens T, Huybrechts I. et al. Comparison of nutritional quality of the vegan, vegetarian, semi-vegetarian, pesco-vegetarian and omnivorous diet. Nutrients 2014; 6: 1318-1332 DOI: 10.3390/nu6031318.
• 3 De Laet C, Kanis JA, Odén A. et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 2005; 16: 1330-1338 DOI: 10.1007/s00198-005-1863-y.
• 4 Aguirre JI, Plotkin LI, Stewart SA. et al. Osteocyte apoptosis is induced by weightlessness in mice and precedes osteoclast recruitment and bone loss. J Bone Miner Res 2006; 21: 605-615 DOI: 10.1359/jbmr.060107.
• 5 Hart NH, Newton RU, Tan J. et al. Biological basis of bone strength: anatomy, physiology and measurement. J Musculoskelet Neuronal Interact 2020; 20: 347-371
• 6 Schoenau E, Neu CM, Rauch F. et al. The development of bone strength at the proximal radius during childhood and adolescence. J Clin Endocrinol Metab 2001; 86: 613-618 DOI: 10.1210/jcem.86.2.7186.
• 7 Schiessl H, Frost H, Jee W. Estrogen and Bone-Muscle Strength and Mass Relationships. Bone 1998; 22: 1-6 DOI: 10.1016/s8756-3282(97)00223-8.
• 8 Frost HM. Bone “mass” and the “mechanostat”: a proposal. Anat Rec 1987; 219: 1-9 DOI: 10.1002/ar.1092190104.
• 9 Casper RC. Might Starvation-Induced Adaptations in Muscle Mass, Muscle Morphology and Muscle Function Contribute to the Increased Urge for Movement and to Spontaneous Physical Activity in Anorexia Nervosa?. Nutrients 2020; 12 DOI: 10.3390/nu12072060.
• 10 Wong AKO, Cawthon PM, Peters KW. et al. Bone-muscle indices as risk factors for fractures in men: the Osteoporotic Fractures in Men (MrOS) Study. J Musculoskelet Neuronal Interact 2014; 14: 246-254
• 11 Heinrich-Böll-Stiftung, Bund für Umwelt und Naturschutz Deutschland & Le Monde Diplomatique. Fleischatlas – Daten und Fakten über Tiere als Nahrungsmittel 2021. Jugend, Klima und Ernährung. Im Internet: https://www.boell.de/sites/default/files/2021-01/Fleischatlas2021_0.pdf
• 12 Thorpe DL, Knutsen SF, Beeson WL. et al. Effects of meat consumption and vegetarian diet on risk of wrist fracture over 25 years in a cohort of peri- and postmenopausal women. Public Health Nutr 2008; 11: 564-572 DOI: 10.1017/S1368980007000808.
• 13 Le LT, Sabaté J. Beyond meatless, the health effects of vegan diets: findings from the Adventist cohorts. Nutrients 2014; 6: 2131-2147 DOI: 10.3390/nu6062131.
• 14 Huang R-Y, Yang K-C, Chang H-H. et al. The Association between Total Protein and Vegetable Protein Intake and Low Muscle Mass among the Community-Dwelling Elderly Population in Northern Taiwan. Nutrients 2016; 8 DOI: 10.3390/nu8060373.
• 15 Mariotti F, Gardner CD. Dietary Protein and Amino Acids in Vegetarian Diets-A Review. Nutrients 2019; 11 DOI: 10.3390/nu11112661.
• 16 Chuang T-L, Lin C-H, Wang Y-F. Effects of vegetarian diet on bone mineral density. Tzu Chi Med J 2021; 33: 128-134 DOI: 10.4103/tcmj.tcmj_84_20.
• 17 Ratajczak AE, Zawada A, Rychter AM. et al. Milk and Dairy Products: Good or Bad for Human Bone? Practical Dietary Recommendations for the Prevention and Management of Osteoporosis. Nutrients 2021; 13 DOI: 10.3390/nu13041329.
• 18 Menzel J, Abraham K, Stangl GI. et al. Vegan Diet and Bone Health-Results from the Cross-Sectional RBVD Study. Nutrients 2021; 13 DOI: 10.3390/nu13020685.
• 19 Weikert C, Trefflich I, Menzel J. et al. Vitamin and Mineral Status in a Vegan Diet. Dtsch Arztebl Int 2020; 117: 575-582 DOI: 10.3238/arztebl.2020.0575.
• 20 Bauer DC, Browner WS, Cauley JA. et al. Factors associated with appendicular bone mass in older women. The Study of Osteoporotic Fractures Research Group. Ann Intern Med 1993; 118: 657-665 DOI: 10.7326/0003-4819-118-9-199305010-00001.
• 21 Lupsa BC, Insogna K. Bone Health and Osteoporosis. Endocrinol Metab Clin North Am 2015; 44: 517-530 DOI: 10.1016/j.ecl.2015.05.002.
• 22 Sinaki M, Fitzpatrick LA, Ritchie CK. et al. Site-specificity of bone mineral density and muscle strength in women: job-related physical activity. Am J Phys Med Rehabil 1998; 77: 470-476 DOI: 10.1097/00002060-199811000-00002.
• 23 Arnett TR, Dempster DW. Effect of pH on bone resorption by rat osteoclasts in vitro. Endocrinology 1986; 119: 119-124 DOI: 10.1210/endo-119-1-119.
• 24 Burckhardt P. The role of low acid load in vegetarian diet on bone health: a narrative review. Swiss Med Wkly 2016; 146: w14277 DOI: 10.4414/smw.2016.14277.
• 25 Fenton TR, Tough SC, Lyon AW. et al. Causal assessment of dietary acid load and bone disease: a systematic review & meta-analysis applying Hill’s epidemiologic criteria for causality. Nutr J 2011; 10: 41 DOI: 10.1186/1475-2891-10-41.
• 26 New SA. Intake of fruit and vegetables: implications for bone health. Proc Nutr Soc 2003; 62: 889-899 DOI: 10.1079/PNS2003310.
• 27 Ho-Pham LT, Nguyen PLT, Le TTT. et al. Veganism, bone mineral density, and body composition: a study in Buddhist nuns. Osteoporos Int 2009; 20: 2087-2093 DOI: 10.1007/s00198-009-0916-z.
• 28 Appleby P, Roddam A, Allen N. et al. Comparative fracture risk in vegetarians and nonvegetarians in EPIC-Oxford. Eur J Clin Nutr 2007; 61: 1400-1406 DOI: 10.1038/sj.ejcn.1602659.
• 29 Wang Y-F, Chiu J-S, Chuang M-H. et al. Bone mineral density of vegetarian and non-vegetarian adults in Taiwan. Asia Pac J Clin Nutr 2008; 17: 101-106
• 30 Weikert C, Walter D, Hoffmann K. et al. The relation between dietary protein, calcium and bone health in women: results from the EPIC-Potsdam cohort. Ann Nutr Metab 2005; 49: 312-318 DOI: 10.1159/000087335.
• 31 Fabiani R, Naldini G, Chiavarini M. Dietary Patterns in Relation to Low Bone Mineral Density and Fracture Risk: A Systematic Review and Meta-Analysis. Adv Nutr 2019; 10: 219-236 DOI: 10.1093/advances/nmy073.
• 32 Chuang T-L, Koo M, Chuang M-H. et al. Changes in Bone Mineral Density and Trabecular Bone Score over Time between Vegetarian and Non-Vegetarian Middle-Aged and Older Women: A Three-Year Retrospective Medical Record Review. Int J Environ Res Public Health 2022; 19 DOI: 10.3390/ijerph19042445.
• 33 Ma X, Tan H, Hu M. et al. The impact of plant-based diets on female bone mineral density: Evidence based on seventeen studies. Medicine (Baltimore) 2021; 100: e27480 DOI: 10.1097/MD.0000000000027480.
• 34 Movassagh EZ, Baxter-Jones ADG, Kontulainen S. et al. Vegetarian-style dietary pattern during adolescence has long-term positive impact on bone from adolescence to young adulthood: a longitudinal study. Nutr J 2018; 17: 36 DOI: 10.1186/s12937-018-0324-3.
• 35 Ho-Pham LT, Vu BQ, Lai TQ. et al. Vegetarianism, bone loss, fracture and vitamin D: a longitudinal study in Asian vegans and non-vegans. Eur J Clin Nutr 2012; 66: 75-82 DOI: 10.1038/ejcn.2011.131.
• 36 Dash N, Kushwaha AS. Stress fractures – a prospective study amongst recruits. Medical Journal Armed Forces India 2012; 68: 118-122 DOI: 10.1016/S0377-1237(12)60021-5.
• 37 Tong TYN, Appleby PN, Armstrong MEG. et al. Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study. BMC Med 2020; 18: 353 DOI: 10.1186/s12916-020-01815-3.
• 38 Liu N, Zeng F, Zhang K. et al. A community-based cross-sectional study for relationship of frequency of vegetables intake and osteoporosis in a Chinese postmenopausal women sample. BMC Womens Health 2016; 16: 28 DOI: 10.1186/s12905-016-0307-5.
• 39 Pohl A, Schünemann F, Bersiner K. et al. The Impact of Vegan and Vegetarian Diets on Physical Performance and Molecular Signaling in Skeletal Muscle. Nutrients 2021; 13 DOI: 10.3390/nu13113884.
• 40 Tong TY, Key TJ, Sobiecki JG. et al. Anthropometric and physiologic characteristics in white and British Indian vegetarians and nonvegetarians in the UK Biobank. Am J Clin Nutr 2018; 107: 909-920 DOI: 10.1093/ajcn/nqy042.
• 41 Sim M, Blekkenhorst LC, Lewis JR. et al. Vegetable Diversity, Injurious Falls, and Fracture Risk in Older Women: A Prospective Cohort Study. Nutrients 2018; 10 DOI: 10.3390/nu10081081.
• 42 Pacifici R. Role of Gut Microbiota in the Skeletal Response to PTH. J Clin Endocrinol Metab 2021; 106: 636-645 DOI: 10.1210/clinem/dgaa895.
• 43 Malmir H, Ejtahed H-S, Soroush A-R. et al. Probiotics as a New Regulator for Bone Health: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med 2021; 2021: 3582989 DOI: 10.1155/2021/3582989.
• 44 Collins FL, Rios-Arce ND, Schepper JD. et al. The Potential of Probiotics as a Therapy for Osteoporosis. Microbiol Spectr 2017; 5 DOI: 10.1128/microbiolspec.BAD-0015-2016.
• 45 Ding K, Hua F, Ding W. Gut Microbiome and Osteoporosis. Aging Dis 2020; 11: 438-447 DOI: 10.14336/AD.2019.0523.
• 46 Tomova A, Bukovsky I, Rembert E. et al. The Effects of Vegetarian and Vegan Diets on Gut Microbiota. Front Nutr 2019; 6: 47 DOI: 10.3389/fnut.2019.00047.