Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE, der DGN und der DGG

Zusammenfassung

Fragestellung: Neurologische Erkrankungen können zu Schluckstörungen mit konsekutiver Aspiration führen und gehen mit einem erhöhten Risiko für Mangelernährung einher. Die vorliegende Leitlinie soll evidenzbasierte Empfehlungen zur klinischen Ernährung in der Neurologie geben. Der akute Schlaganfall, der Morbus Parkinson, die Chorea Huntington und die Multiple Sklerose wurden als neurologische Erkrankungen ausgewählt, da hier die Ernährung eine besondere Rolle spielt.

Methodik: Es wurde eine systematische Literaturrecherche zur Ernährung bei den genannten Krankheitsbildern durchgeführt. Die Ergebnisse wurden in einer interdisziplinären Arbeitsgruppe aus Neurologen und Ernährungsmedizinern diskutiert. Auf dieser Basis wurden von der Arbeitsgruppe Empfehlungen erarbeitet, die auf der Konsensuskonferenz am 14. September 2011 vorgestellt, diskutiert und z. T. modifiziert wurden. Die modifizierten Empfehlungen wurden am 16. Juni 2012 auf einer 2. Konsensuskonferenz verabschiedet.

Ergebnisse: Die Leitlinie enthält 75 Empfehlungen zur Ernährung von Patienten mit neurologischen Erkrankungen. Bei Erkrankungen, die zu einer Dysphagie führen, sollten zeitnah ein Screening und ein Assessment auf Dysphagie erfolgen. Ausgehend von den erhobenen Befunden ist die Ernährung entsprechend zu modifizieren. Dies reicht von Texturmodifikationen über Sondenernährung bis zur Notwendigkeit einer parenteralen Ernährung. Patienten mit Morbus Parkinson und Chorea Huntington haben bereits in frühen Krankheitsstadien ein erhöhtes Risiko für Mangelernährung. Um diese zu vermeiden, werden auch hier ein regelmäßiges Screening, Assessment und bei Bedarf entsprechende ernährungsmedizinische Interventionen empfohlen. Bei der Einnahme von L-Dopa-haltigen Medikamenten ist auf die Interaktion mit eiweißhaltiger Nahrung zu achten. Bei Multipler Sklerose liegt für den Einsatz von „Spezialdiäten“ oder Nahrungssupplementen keine ausreichende wissenschaftliche Evidenz vor, sie werden deshalb generell nicht empfohlen.

Schlussfolgerung: Durch ein frühzeitiges Screening und Assessment auf Dysphagie und auf Mangelernährung kann die Ernährung von Patienten mit neurologischen Erkrankungen optimiert werden. Die Texturmodifikation von Speisen und Getränken, Trinknahrung, Ernährung über nasogastrale Sonden, über PEG-Sonden, PEJ-Sonden und parenterale Ernährung stellen mögliche ernährungsmedizinische Interventionen dar. Sämtliche Interventionen sollten bei entsprechender Indikation frühzeitig eingeleitet werden.

Abstract

Purpose: Neurologic diseases can lead to swallowing disorders. This may cause aspiration during oral intake of food and fluid and involves a higher risk for malnutrition. The present guideline is supposed to give evidence-based recommendations for clinical nutrition in neurology. Acute stroke, Parkinsonʼs disease, Chorea Huntington and Multiple Sclerosis were chosen because here nutrition can become an import issue.

Methods: A systematic literature search about nutrition and the mentioned disease patterns was conducted. The results were discussed in an interdisciplinary working group that consisted of neurologists and physicians with expertise for nutritional medicine. On this basis the working group developed recommendations, which were presented, discussed and partly modified at the consensus conference on September 14^th, 2011. The revised form of these recommendations was passed at a second consensus conference on June 16^th, 2012.

Results: The guideline includes 75 recommendations for patients with neurologic diseases. If the existing disease leads to dysphagia, screening and assessment of dysphagia should be performed early. Nutritional intervention has to be adapted according to medical findings. This ranges from texture modification and tube feeding to necessity for parenteral nutrition. Patients with Morbus Parkinson and Chorea Huntington have a higher risk for malnutrition already in early stages of disease. Regular screening, assessment and, if needed, nutritional interventions are recommended to avoid malnutrition. When using L-Dopa-containing medication the interactions with food proteins have to be taken into account. There is no adequate scientific evidence for the application of specific diets or nutritional supplements in Multiple Sclerosis, therefore such interventions cannot be recommended in general.

Conclusion: Nutrition for patients with neurologic diseases can be optimized by early screening and assessment of dysphagia and malnutrition. The texture modification of food and drinks, oral nutritional supplements, nutrition through a nasogastric tube, PEG tube, PEJ tube and parenteral nutrition are possible nutritional medical interventions. All indicated interventions shoud be introduced early.

Schlüsselwörter

Leitlinie - Schlaganfall - Morbus Parkinson - Chorea Huntington - Multiple Sklerose - Dysphagie

Keywords

guideline - stroke - Parkinson’s disease - Chorea Huntington - Multiple Sclerosis - dysphagia

^* DGEM Steering Committee: Bischoff SC, Lochs H, Weimann A, Adolph M, Ockenga J, Sieber C.

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