Lang bekannt und meist ungenutzt: Lebensstilmaßnahmen zur Unterstützung der lipidsenkenden Therapie

Dyslipidämien sind in den westlichen Industrieländern weit verbreitete Stoffwechselstörungen. Lebensstilmaßnahmen wie die Steigerung der körperlichen Aktivität und die Verbesserung der Ernährung waren jahrelang die einzige Maßnahme zu ihrer Behandlung. Wegen ihrer gesundheitsfördernden Wirkung sehen die Leitlinien zur Behandlung von Dyslipidämien Lebensstilmaßnahmen als Grundlage jeder medikamentösen Therapie an. In diesem Beitrag werden die Prinzipien der Ernährungstherapie von Dyslipidämien beschrieben.

Abstract

Dyslipidemias are common metabolic disorders in Western industrialized countries. Lifestyle measures such as increasing physical activity and improving diet were for many years the only measure for their treatment. Because of their health-promoting effects, guidelines for the treatment of dyslipidemias consider lifestyle measures to be the basis of any drug therapy. Due to the numerous efficient options for intensive lipid-lowering medication, lifestyle measures are recommended by responsible physicians, but their implementation is usually not intensively pursued due to the large time commitment; in contrast to sustained recommendations for increasing physical activity and normalizing body weight, nutritional therapists are too rarely consulted as specialists despite the significant effects our diet has on cardiovascular risk factors such as LDL-cholesterol, triglycerides and blood pressure. In this review, the principles of nutritional therapy of dyslipidemias are described, and it is outlined how recent studies support the plausibility and evidence of the individual measures.

Schlüsselwörter

Lebensstil - Ernährung - körperliche Aktivität - Hypercholesterinämie - Hypertriglyzeridämie - Dyslipidämie

Key words

lifestyle - nutrition - physical activity - hypercholesterolemia - hypertriglyceridemia - dyslipidemia

Publication History

Article published online:
07 June 2022

• Literatur

• 1 Mach F, Baigent C, Catapano AL. et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41: 111-188
• 2 Novartis Pharma GmbH. Inclisiran (Leqvio®). Modul 3 A: Primäre Hypercholesterinämie (heterozygot familiär und nicht-familiär) und gemischte Dyslipidämie. Dossier zur Nutzenbewertung gemäß § 35a SGB V; 27.01.2021. Im Internet (Stand: 23.03.2022): https://www.g-ba.de/downloads/92-975-4403/2021-01-27_Modul3_Inclisiran.pdf
• 3 Amarin Pharmaceuticals Ireland Limited. Icosapent-Ethyl (Vazkepa®). Modul 3 A: Reduzierung des Risikos für kardiovaskuläre Ereignisse bei mit Statinen behandelten erwachsenen Patienten mit hohem kardiovaskulären Risiko und erhöhten Triglyceridwerten (≥ 150 mg/dl [≥ 1,7 mmol/l]). Dossier zur Nutzenbewertung gemäß § 35a SGB V; 27.08.2021
• 4 Schmidt N, Schmidt B, Dressel A. et al. Familial hypercholesterolemia in primary care in Germany. Diabetes and cardiovascular risk evaluation: Targets and Essential Data for Commitment of Treatment (DETECT) study. Atherosclerosis 2017; 266: 24-30
• 5 Wolfram G, Bechthold A, Boeing H. et al. Evidence-based guideline of the German Nutrition Society: fat intake and prevention of selected nutrition-related diseases. Ann Nutr Metab 2015; 67: 141-204
• 6 Hauner H, Bechthold A, Boeing H. et al. Evidence-based guideline of the German Nutrition Society: carbohydrate intake and prevention of nutrition-related diseases. Ann Nutr Metab 2012; 60 (Suppl. 01) 1-58
• 7 Kempner W. Treatment of kidney disease and hypertensive vascular disease with rice diet. North Carolina Med J 1944; 5: 11-19
• 8 Kempner W. Treatment of heart and kidney disease and of hypertensive and arteriosclerotic vascular disease with the rice diet. Ann Intern Med 1949; 31: 821-856
• 9 Hauner H, Beyer-Reiners E, Bischoff G. et al. Leitfaden Ernährungstherapie in Klinik und Praxis (LEKuP). Aktuel Ernahrungsmed 2019; 44: 384-419
• 10 Deutsche Gesellschaft für Ernährung, Österreichische Gesellschaft für Ernährung, Schweizerische Gesellschaft für Ernährungsforschung, Schweizerische Vereinigung für Ernährung, Hrsg. Referenzwerte für die Nährstoffzufuhr. 2. Aufl., 7. aktualisierte Ausgabe. Bonn: 2021
• 11 Nordmann AJ, Nordmann A, Briel M. et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 2006; 166: 285-293
• 12 Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr 1992; 56: 320-328
• 13 Look AHEAD Research Group, Wing RR, Bolin P. et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369: 145-154
• 14 Batsis JA, Gill LE, Masutani RK. et al. Weight loss interventions in older adults with obesity: a systematic review of randomized controlled trials since 2005. J Am Geriatr Soc 2017; 65: 257-268
• 15 Clarke R, Frost C, Collins R. et al. Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies. BMJ 1997; 314: 112-117
• 16 Rong Y, Chen L, Zhu T. et al. Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies. BMJ 2013; 346: e8539
• 17 Zhong VW, Van Horn L, Cornelis MC. et al. Associations of dietary cholesterol or egg consumption with incident cardiovascular disease and mortality. JAMA 2019; 321: 1081-1095
• 18 Ruggiero E, Di Castelnuovo A, Costanzo S. et al. Egg consumption and risk of all-cause and cause-specific mortality in an Italian adult population. Eur J Nutr 2021; 60: 3691-3702
• 19 Zhuang P, Wu F, Mao L. et al. Egg and cholesterol consumption and mortality from cardiovascular and different causes in the United States: A population-based cohort study. PLoS Med 2021; 18: e1003508
• 20 Dehghan M, Mente A, Rangarajan S. et al. Association of egg intake with blood lipids, cardiovascular disease, and mortality in 177000 people in 50 countries. Am J Clin Nutr 2020; 111: 795-803
• 21 Godos J, Micek A, Brzostek T. et al. Egg consumption and cardiovascular risk: a dose-response meta-analysis of prospective cohort studies. Eur J Nutr 2021; 60: 1833-1862
• 22 Mensink RP. Effects of stearic acid on plasma lipid and lipoproteins in humans. Lipids 2005; 40: 1201-1205
• 23 Chowdhury R, Warnakula S, Kunutsor S. et al. Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Ann Intern Med 2014; 160: 398-406
• 24 de Souza RJ, Mente A, Maroleanu A. et al. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ 2015; 351: h3978
• 25 Wang DD, Li Y, Chiuve SE. et al. Association of specific dietary fats with total and cause-specific mortality. JAMA Intern Med 2016; 176: 1134-1145
• 26 Hooper L, Summerbell CD, Thompson R. et al. Reduced or modified dietary fat for preventing cardiovascular disease. Sao Paulo Med J 2016; 134: 182-183
• 27 Hooper L, Martin N, Jimoh OF. et al Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 2020; 5: CD011737 . Update in: Cochrane Database Syst Rev 2020; 8: CD011737
• 28 Kim Y, Je Y, Giovannucci EL. Association between dietary fat intake and mortality from all-causes, cardiovascular disease, and cancer: A systematic review and meta-analysis of prospective cohort studies. Clin Nutr 2021; 40: 1060-1070
• 29 Ramsden CE, Zamora D, Majchrzak-Hong S. et al. Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968–73). BMJ 2016; 353: i1246
• 30 Ramsden CE, Zamora D, Leelarthaepin B. et al. Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. BMJ 2013; 346: e8707
• 31 Ramsden CE, Hibbeln JR, Majchrzak SF. et al. 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
• 32 Hartley L, May MD, Loveman E. et al. Dietary fibre for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2016; 2016: CD011472
• 33 Ho HV, Sievenpiper JL, Zurbau A. et al. A systematic review and meta-analysis of randomized controlled trials of the effect of barley β-glucan on LDL-C, non-HDL-C and apoB for cardiovascular disease risk reductioni-iv. Eur J Clin Nutr 2016; 70: 1239-1245
• 34 Ho HV, Sievenpiper JL, Zurbau A. et al. The effect of oat β-glucan on LDL-cholesterol, non-HDL-cholesterol and apoB for CVD risk reduction: a systematic review and meta-analysis of randomised-controlled trials. Br J Nutr 2016; 116: 1369-1382
• 35 Whitehead A, Beck EJ, Tosh S. et al. Cholesterol-lowering effects of oat β-glucan: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2014; 100: 1413-1421
• 36 Reynolds A, Mann J, Cummings J. et al. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet 2019; 393: 434-445
• 37 Malik VS, Hu FB. Sugar-Sweetened Beverages and Cardiometabolic Health: An Update of the Evidence. Nutrients 2019; 11: 1840
• 38 Yang Q, Zhang Z, Gregg EW. et al. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med 2014; 174: 516-524
• 39 Hannou SA, Haslam DE, McKeown NM. et al. Fructose metabolism and metabolic disease. J Clin Invest 2018; 128: 545-555
• 40 Dehghan M, Mente A, Zhang X. et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet 2017; 390: 2050-2062
• 41 Seidelmann SB, Claggett B, Cheng S. et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health 2018; 3: e419-e428
• 42 Shan Z, Guo Y, Hu FB. et al. Association of low-carbohydrate and low-fat diets with mortality among US adults. JAMA Intern Med 2020; 180: 513-523
• 43 Hall KD, Ayuketah A, Brychta R. et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab 2019; 30: 67-77.e3
• 44 Bonaccio M, Costanzo S, Di Castelnuovo A. et al. Ultra-processed food intake and all-cause and cause-specific mortality in individuals with cardiovascular disease: the Moli-sani Study. Eur Heart J 2022; 43: 213-224
• 45 Juul F, Vaidean G, Lin Y. et al. Ultra-processed foods and incident cardiovascular disease in the Framingham Offspring Study. J Am Coll Cardiol 2021; 77: 1520-1531
• 46 Dawczynski C, März W, Lorkowski S. Herzgesunde Ernährung. Informationsflyer für Patienten mit Dyslipidämien. Augsburg: Synlab Labordiagnostik Deutschland. 2022
• 47 Shaw K, Gennat H, O'Rourke P. et al. Exercise for overweight or obesity. Cochrane Database Syst Rev 2006; 4: CD003817
• 48 Huffman KM, Hawk VH, Henes ST. et al. Exercise effects on lipids in persons with varying dietary patterns-does diet matter if they exercise? Responses in Studies of a Targeted Risk Reduction Intervention through Defined Exercise I. Am Heart J 2012; 164: 117-124
• 49 Kraus WE, Houmard JA, Duscha BD. et al. Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med 2002; 347: 1483-1492
• 50 Fikenzer K, Fikenzer S, Laufs U. et al. Effects of endurance training on serum lipids. Vascul Pharmacol 2018; 101: 9-20
• 51 Liang M, Pan Y, Zhong T. et al. Effects of aerobic, resistance, and combined exercise on metabolic syndrome parameters and cardiovascular risk factors: a systematic review and network meta-analysis. Rev Cardiovasc Med 2021; 22: 1523-1533
• 52 Li D, Chen P. The effects of different exercise modalities in the treatment of cardiometabolic risk factors in obese adolescents with sedentary behavior-a systematic review and meta-analysis of randomized controlled trials. Children 2021; 8: 1062
• 53 Verband für Ernährung und Diätetik e.V. Ärztliche Notwenigkeitsbescheinigung für Ernährungsintervention nach §43 SGB V. Im Internet (Stand: 23.03.2022): https://www.vfed.de/de/vfed/berufspraxis/allgemeine-downloads?file=files/website_data/downloads/VFED/%C3%84rztliche%20Notwendigkeitsbescheinigung%20f%C3%BCr%20Ern%C3%A4hrungsintervention%20nach%20%C2%A7%2043%20SGB%20V.pdf