Zusammenfassung
Dyslipoproteinämien sind in der Bevölkerung weit verbreitet und gehen mit einem erhöhten Koronarrisiko einher. Bis auf seltene Formen sind die Dyslipoproteinämien durch Ernährungstherapie beeinflussbar. Eine vollwertige Ernährung ist deshalb die Basis jeder Therapie einer Fettstoffwechselstörung. Die ernährungstherapeutischen Maßnahmen zielen auf eine Senkung des LDL-Cholesterins durch eine fettreduzierte und fettmodifizierte Ernährung ab. Niedrige HDL-Cholesterinwerte sind bevorzugt durch Gewichtsreduktion und vermehrte körperliche Aktivität anzuheben. Hyperchylomikronämien werden durch den Einsatz von mittelkettigen Triglyzeriden und erhöhte VLDL-Triglyzeride durch Gewichtsreduktion und vernünftigen Umgang mit Süßigkeiten und Alkohol behandelt. Über den Einfluss auf die Lipoproteine im Plasma hinaus wirken die verschiedenen Fettsäuren auch auf weitere für die Atherogenese wichtige Faktoren, wie die Blutviskosität, die Thrombozytenaggregation, den Blutdruck bis hin zur Genexpression von Zytokinen. Durch eine erhöhte Zufuhr von n-3 Fettsäuren können tödliche Infarkte verhindert und die Lebenserwartung erhöht werden. Weitere Nahrungsfaktoren, wie antioxidative Vitamine, sekundäre Pflanzenstoffe und Ballaststoffe haben ebenfalls eine koronarprotektive Wirkung. Bei Patienten mit Dyslipoproteinämie sollten die Lipoproteine im Plasma nicht die einzigen Zielgrößen sein. Vielmehr sollte das präventive Potenzial einer vollwertigen Ernährung unter Bevorzugung von Lebensmitteln pflanzlicher Herkunft und konsequenter Umsetzung einer fettmoderaten und fettmodifizierten Ernährung in Kombination mit ausreichender körperlicher Aktivität insgesamt genutzt werden.
Abstract
Dyslipoproteinaemias are common and are associated with an enhanced risk of coronary heart disease. Generally, with only rare exceptions, their course may be influenced by nutritional therapy. Hence, any treatment of dyslipoproteinaemias must, first of all, lower LDL cholesterol levels by reducing and modifying fat in the diet. Lower HDL cholesterol levels are achieved by reducing the body weight and via enhanced physical activity. Hyperchylomicroaemias are treated by means of medium-chain triglycerides and enhanced VLDL triglycerides by weight reduction and a moderate intake of sweets and alcohol. Various fatty acids do not only influence lipoproteins in the blood plasma; they also act on other factors that are of importance in atherogenesis, such as viscosity of the blood, thrombocyte aggregation, blood pressure and even the gene expression of cytokines. Fatal infarctions can be prevented and life expectancy increased by enhanced supply of n-3 fatty acids. Other nutritional factors are also coronary protectors, such as antioxidative vitamins, secondary plant constituents and dietary fibres. The plasma lipoproteins should not be the only targets in the treatment of dyslipoproteinaemia; it is essential to fully utilise the preventive potentials of wholefood nutrition prominently featuring food from the plant kingdom and of a single-minded pursuit of a diet with moderate and modified fats, combined at the same time with adequate physical activity.
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Prof. Dr. G. Wolfram
Institut für Ernährungswissenschaft · Techn. Universität München
85350 Freising-Weihenstephan
