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
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