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Ernährung & Medizin 2005; 20(4): 185-186
DOI: 10.1055/s-2005-925536
Diabetes Forum

© Hippokrates Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG

Ballaststoffe und Prävention des Typ-2-Diabetes

Dietary fibre and the prevention of type 2 diabetes mellitusMartin O. Weickert1 , 2 , Andreas F.H. Pfeiffer1 , 2
  • 1Deutsches Institut für Ernährungsforschung, Abteilung Klinische Ernährung, Potsdam-Rehbrücke, Nuthetal
  • 2Abteilung für Endokrinologie, Diabetes und Ernährungsmedizin, Campus Benjamin Franklin, Charité-Universitätsmedizin, Berlin
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Publikationsverlauf

Publikationsdatum:
04. Dezember 2006 (online)

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Zusammenfassung

Eine vermehrte Ballaststoffeinnahme ist in epidemiologischen Studien konsistent mit einem verringerten Risiko für Typ-2-Diabetes und kardiovaskuläre Erkrankungen assoziiert. Für lösliche Ballaststoffe konnten günstige Effekte auf den postprandialen Blutzuckeranstieg sowie auf Nüchternlipide, z.B. Gesamt- und LDL-Cholesterin, gezeigt werden. Interessanterweise sind jedoch in großen epidemiologischen Studien hauptsächlich unlösliche Getreideballaststoffe mit einer Risikoreduktion für die genannten Erkrankungen assoziiert, trotz fehlender Effekte dieser Ballaststoffe auf Blutfette oder glykämischen Index. Aufgrund der hier dargestellten Daten und der gezeigten Dosisabhängigkeit der Effekte könnte die Einnahme unlöslicher Ballaststoffe in den gängigen Empfehlungen unterrepräsentiert sein. Neben weiteren Maßnahmen eines gesunden Lebensstils, insbesondere von Gewichtskontrolle, körperlicher Aktivität sowie Nikotinverzicht und Reduktion der Zufuhr gesättigter Fette scheint eine vermehrte Einnahme von unlöslichen Ballaststoffen eine effektive und bezahlbare Maßnahme gegen die Epidemie des Typ-2-Diabetes.

Summary

Available data indicate a clearly negative association of dietary fibre intake and risk of type 2 diabetes and cardiovascular disease. Intake of soluble dietary fibres has been demonstrated to have beneficial effects on postprandial glycemia and certain fasting lipids, such as total and LDL cholesterol concentrations. However, despite an absence of effects on these parameters, it is primarily the insoluble cereal fibre that is consistently linked to risk reduction of type 2 diabetes and cardiovascular disease in large epidemiological observations. Thus, the intake of insoluble dietary fibres may be underrepresented in current recommendations. Changes in lifestyle with body weight control and physical exercise as the most important factors, smoking cessation, and changes in dietary habits including a restricted intake of saturated fat and increased consumption of insoluble cereal fibres is likely to be an effective, safe, and low cost approach to markedly reduce the epidemic of type 2 diabetes.

Schlüsselwörter

Lösliche und unlösliche Ballaststoffe - Diabetes mellitus Typ 2 - Insulinresistenz - Lebensstil - glykämischer Index

Key words

Dietary fibre - cereal fibre - type 2 diabetes - insulin resistance - lifestyle - glycemic index

Literatur

  • 1 [Anonymous] . Nutrition recommendations and principles for people with diabetes mellitus. American Diabetes Association.  Tenn Med. 2000;  93 430-433
    PubMedGoogle Scholar
  • 2 [Anonymous] . Obesity: preventing and managing the global epidemic. Report of a WHO consultation.  World Health Organ Tech Rep Ser 894. 2000;  i-xii 1-253
    PubMedGoogle Scholar
  • 3 [Anonymous] . Position of the American Dietetic Association: medical nutrition therapy and pharmacotherapy.  J Am Diet Assoc. 1999;  99 227-230
    CrossrefPubMedGoogle Scholar
  • 4 [Anonymous] . Recommendations for the nutritional management of patients with diabetes mellitus.  Eur J Clin Nutr. 2000;  54 353-355
    CrossrefPubMedGoogle Scholar
  • 5 Ajani UA, Hennekens CH, Spelsberg A, Manson JE. Alcohol consumption and risk of type 2 diabetes mellitus among US male physicians.  Arch Intern Med. 2000;  160 1025-1030
    CrossrefPubMedGoogle Scholar
  • 6 Astrup A, Finer N. Redefining type 2 diabetes: 'diabesity' or 'obesity dependent diabetes mellitus'?.  Obes Rev. 2000;  1 57-59
    CrossrefPubMedGoogle Scholar
  • 7 Brehm BJ, Seeley RJ, Daniels SR, D'Alessio DA. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women.  J Clin Endocrinol Metab. 2003;  88 1617-1623
    CrossrefPubMedGoogle Scholar
  • 8 Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis.  Am J Clin Nutr. 1999;  69 30-42
    PubMedGoogle Scholar
  • 9 Colditz GA, Willett WC, Stampfer MJ. et al. . Weight as a risk factor for clinical diabetes in women.  Am J Epidemiol. 1990;  132 501-513
    CrossrefPubMedGoogle Scholar
  • 10 Dansinger ML, Gleason JA, Griffith JL. et al. . Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial.  JAMA. 2005;  293 43-53
    CrossrefPubMedGoogle Scholar
  • 11 Drucker DJ. Biological actions and therapeutic potential of the glucagon-like peptides.  Gastroenterology. 2002;  122 531-544
    PubMedGoogle Scholar
  • 12 Dunaif G, Schneeman BO. The effect of dietary fiber on human pancreatic enzyme activity in vitro.  Am J Clin Nutr. 1981;  34 1034-1035
    PubMedGoogle Scholar
  • 13 Foster GD, Wyatt HR, Hill JO. et al. . A randomized trial of a low-carbohydrate diet for obesity.  N Engl J Med. 2003;  348 2082-2090
    CrossrefPubMedGoogle Scholar
  • 14 Franz MJ, Bantle JP, Beebe CA. et al. . Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications.  Diabetes Care. 2003;  26 51-61
    PubMedGoogle Scholar
  • 15 Hedley AA, Ogden CL, Johnson CL. et al. . Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002.  JAMA. 2004;  291 2847-2850
    CrossrefPubMedGoogle Scholar
  • 16 Hollenbeck CB, Coulston AM. The clinical utility of the glycemic index and its application to mixed meals.  Can J Physiol Pharmacol. 1991;  69 100-107
    PubMedGoogle Scholar
  • 17 Hu FB, Manson JE, Stampfer MJ, Colditz G. et al. . Diet, lifestyle, and the risk of type 2 diabetes mellitus in women.  N Engl J Med. 2001;  345 790-797
    CrossrefPubMedGoogle Scholar
  • 18 Hu FB, van RM Dam, Liu S. Diet and risk of Type II diabetes: the role of types of fat and carbohydrate.  Diabetologia. 2001;  44 805-817
    CrossrefPubMedGoogle Scholar
  • 19 Jenkins DJ, Kendall CW, Axelsen M. et al. . Viscous and nonviscous fibres, nonabsorbable and low glycaemic index carbohydrates, blood lipids and coronary heart disease.  Curr Opin Lipidol. 2000;  11 49-56
    CrossrefPubMedGoogle Scholar
  • 20 Jenkins DJ, Wolever TM, Taylor RH. et al. . Glycemic index of foods: a physiological basis for carbohydrate exchange.  Am J Clin Nutr. 1981;  34 362-366
    PubMedGoogle Scholar
  • 21 Kelly S, Frost G, Whittaker V, Summerbell C. Low glycaemic index diets for coronary heart disease. Cochrane Database Syst Rev 2004
    Google Scholar
  • 22 Krauss RM, Eckel RH, Howard B. et al. . AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association.  Circulation. 2000;  102 2284-2299
    CrossrefPubMedGoogle Scholar
  • 23 Lau C, Faerch K, Glumer C. et al. . Dietary glycemic index, glycemic load, fiber, simple sugars, and insulin resistance: the Inter99 study.  Diabetes Care. 2005;  28 1397-1403
    PubMedGoogle Scholar
  • 24 Liu S, Stampfer MJ, Hu FB, Giovannucci E. et al. . Whole-grain consumption and risk of coronary heart disease: results from the Nurses' Health Study.  Am J Clin Nutr. 1999;  70 412-419
    PubMedGoogle Scholar
  • 25 Liu S, Willett WC, Stampfer MJ, Hu FB. et al. . A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women.  Am J Clin Nutr. 2000;  71 1455-1461
    PubMedGoogle Scholar
  • 26 Manson JE, Rimm EB, Stampfer MJ, Colditz GA. et al. . Physical activity and incidence of non-insulin-dependent diabetes mellitus in women.  Lancet. 1991;  338 774-778
    CrossrefPubMedGoogle Scholar
  • 27 Marlett JA, McBurney MI, Slavin JL. Position of the American Dietetic Association: health implications of dietary fiber.  J Am Diet Assoc. 2002;  102 993-1000
    CrossrefPubMedGoogle Scholar
  • 28 Meyer KA, Kushi LH, Jacobs Jr. DR. et al. . Carbohydrates, dietary fiber, and incident type 2 diabetes in older women.  Am J Clin Nutr. 2000;  71 921-930
    PubMedGoogle Scholar
  • 29 Mokdad AH, Bowman BA, Ford ES. et al. . The continuing epidemics of obesity and diabetes in the United States.  JAMA. 2001;  286 1195-1200
    CrossrefPubMedGoogle Scholar
  • 30 Montonen J, Knekt P, Jarvinen R. et al. . Whole-grain and fiber intake and the incidence of type 2 diabetes.  Am J Clin Nutr. 2003;  77 622-629
    PubMedGoogle Scholar
  • 31 Morris JN, Marr JW, Clayton DG. Diet and heart: a postscript.  Br Med J. 1977;  2 1307-1314
    PubMedGoogle Scholar
  • 32 Rimm EB, Chan J, Stampfer MJ, Colditz GA, Willett WC. Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men.  BMJ. 1995;  310 555-559
    CrossrefPubMedGoogle Scholar
  • 33 Salmeron J, Ascherio A, Rimm EB. et al. . Dietary fiber, glycemic load, and risk of NIDDM in men.  Diabetes Care. 1997;  20 545-550
    CrossrefPubMedGoogle Scholar
  • 34 Salmeron J, Manson JE, Stampfer MJ. et al. . Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women.  JAMA. 1997;  277 472-477
    CrossrefPubMedGoogle Scholar
  • 35 Samaha FF, Iqbal N, Seshadri P. et al. . A low-carbohydrate as compared with a low-fat diet in severe obesity.  N Engl J Med. 2003;  348 2074-2081
    CrossrefPubMedGoogle Scholar
  • 36 Schulze MB, Liu S, Rimm EB. et al. . Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women.  Am J Clin Nutr. 2004;  80 348-356
    PubMedGoogle Scholar
  • 37 Sherwin RS, Anderson RM, Buse JB. et al. . Prevention or delay of type 2 diabetes.  Diabetes Care. 2004;  27 47-54
    PubMedGoogle Scholar
  • 38 Song Y, Manson JE, Buring JE, Liu S. Dietary magnesium intake in relation to plasma insulin levels and risk of type 2 diabetes in women.  Diabetes Care. 2004;  27 59-65
    CrossrefPubMedGoogle Scholar
  • 39 Stern L, Iqbal N, Seshadri P. et al. . The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial.  Ann Intern Med. 2004;  140 778-785
    PubMedGoogle Scholar
  • 40 Stevens J, Ahn K, Juhaeri, Houston D. et al. . Dietary fiber intake and glycemic index and incidence of diabetes in African-American and white adults: the ARIC study.  Diabetes Care. 2002;  25 1715-1721
    CrossrefPubMedGoogle Scholar
  • 41 Streppel MT, Arends LR, van't Veer P. et al. . Dietary fiber and blood pressure: A meta-analysis of randomized placebo-controlled trials.  Arch Intern Med. 2005;  165 150-156
    CrossrefPubMedGoogle Scholar
  • 42 Thorburn A, Muir J, Proietto J. Carbohydrate fermentation decreases hepatic glucose output in healthy subjects.  Metabolism. 1993;  42 780-785
    CrossrefPubMedGoogle Scholar
  • 43 van Dam RM, Hu FB. Coffee consumption and risk of type 2 diabetes: a systematic review.  JAMA. 2005;  294 97-104
    CrossrefPubMedGoogle Scholar
  • 44 van Dam RM, Visscher AW, Feskens EJ. et al. . Dietary glycemic index in relation to metabolic risk factors and incidence of coronary heart disease: the Zutphen Elderly Study.  Eur J Clin Nutr. 2000;  54 726-731
    CrossrefPubMedGoogle Scholar
  • 45 Venter CS, Vorster HH, Cummings JH. Effects of dietary propionate on carbohydrate and lipid metabolism in healthy volunteers.  Am J Gastroenterol. 1990;  85 549-553
    PubMedGoogle Scholar
  • 46 Vessby B. Dietary fat and insulin action in humans.  Br J Nutr. 2000;  83 91-96
    PubMedGoogle Scholar
  • 47 Wei M, Gibbons LW, Mitchell TL. et al. . Alcohol intake and incidence of type 2 diabetes in men.  Diabetes Care. 2000;  23 18-22
    PubMedGoogle Scholar
  • 48 Weickert MO, Mohlig M, Koebnick C. et al. . Impact of cereal fibre on glucose-regulating factors.  Diabetologia. 2005;  48 2343-2353
    CrossrefPubMedGoogle Scholar
  • 49 Weigle DS, Breen PA, Matthys CC. et al. . A high-protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin and ghrelin concentrations.  Am J Clin Nutr. 2005;  82 41-48
    PubMedGoogle Scholar
  • 50 Wolk A, Manson JE, Stampfer MJ, Colditz GA. et al. . Long-term intake of dietary fiber and decreased risk of coronary heart disease among women.  JAMA. 1999;  281 1998-2004
    CrossrefPubMedGoogle Scholar

Dr. med. Martin O. Weickert

Deutsches Institut für Ernährungsforschung

Abteilung Klinische Ernährung

Arthur-Scheunert-Allee 114-116

Potsdam-Rehbrücke

14558 Nuthetal

eMail: m.weickert@mail.dife.de

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