Subscribe to RSS
DOI: 10.1055/s-2007-986446
© Georg Thieme Verlag Stuttgart · New York
Diabetes mellitus Typ 2 - Bedeutung der Fette in der Prävention
Publication History
Publication Date:
23 August 2007 (online)
![](https://www.thieme-connect.de/media/diabetakt/200703/lookinside/thumbnails/10.1055-s-2007-986446-1.jpg)
Im Stadium des Prädiabetes lassen sich trotz normoglykämischer Blutzuckerwerte pathologische Veränderungen wie eine gestörte Glukosetoleranz, eine Verminderung der Insulinsensitivität und eine gesteigerte Insulinsekretion identifizieren.
Fettarme Kostformen mit einem Gesamtfettgehalt von weniger als 30 % der täglichen Energiezufuhr stellen ein effektives Mittel zur Senkung des Risikos für die Entwicklung des Diabetes mellitus Typ 2 dar.
Ein Austausch gesättigter Fette durch ungesättigte Fette führt ohne Kalorienrestriktion nicht zu einer Senkung des Diabetesrisikos. Entscheidend in der Prävention ist bereits eine moderate Gewichtsreduktion von 5-10 % des Ausgangskörpergewichts. Diese hat eine Verbesserung der diabetesrelevanten Stoffwechselparameter (orale Glukosetoleranz, freie Fettsäuren im Plasma, Plasmaglukose und Insulinspiegel) zur Folge. Einer Veränderung des Fettsäuremusters (Senkung des Verzehrs gesättigter Fette und Steigerung der Aufnahme ungesättigter Fette) kann auf Basis der vorliegenden Literaturanalyse nur eine untergeordnete Rolle in der Diabetesprävention zugesprochen werden. Dennoch ist diese Veränderung im Verzehr-verhalten besonders entscheidend in der Prävention koronarer Herzerkrankungen.
Literatur
- 1 Benjamin SM, Valdez R, Geiss LS, Rolka DB, Venkat Narayan. Estimated Number of Adults With Prediabetes in the U.S. in 2000. Diabetes Care. 2003; 26 645-649
- 2 The Diabetes Prevention Program: Strategies to Identify Adults at High Risk for Type 2 Diabetes. Diabetes Care. 2005; 28 138-144
- 3 Haffner SM.. Can reducing peaks prevent type 2 diabetes: implication from recent diabetes prevention trials. IJCP Supplement. 2002; 129 33-39
- 4 Johanson EH, Jansson PA, Löhn L, Matsuzawa Y. et al. . Fat Distribution, Lipid Accumulation in the Liver, and Exercise Capacity Do Not Explain the Insulin Resistance in Healthy Males with Family History for Type 2 Diabetes. J Endocrinol Metab. 2003; 88
- 5 Roberts SB, McCrory MA, Saltzman E.. The Influence of Dietary Composition on Energy Intake and Body Weight. J of Am Coll of Nutrition. 2002; 21
- 6 Treuth MS, Sunehag AL, Trautwein LM, Bier DM.. Metabolic adaption to high-fat and high-carbohydrate diets in children and adolescents. Am J Clin Nutr. 2003; 77 479-489
- 7 WHO Technical report Series 916: Diet, Nutrition and the prevention of chronic diseases. 2002
- 8 Yang EJ, Kerver JM, Park YK, Kayitsinga J. et al. . Carbohydrate intake and biomarkers of glykemic control among US adults: the third National Health and Nutrition Examination Survey (NHANES III). Am J Clin Nutr. 2003; 77 1426-1433
- 9 Ellrot T, Pudel V.. Kohlenhydratearme Diäten (Low-Carb) zur Gewichtsreduktion. Ernährungsumschau. 2005; 52 48-51
- 10 Georg P, Ludvik B.. Lipide und Diabetes. J für Kardiologie. 2000; 7 519-522
- 11 Gerhard GT, Ahmann A, Meeuws K, McMurry MP.. Effects of a low-fat diet compared with those of a high-monounsaturated fat diet on body weight, plasma lipids and lipoproteins, and glycemic control in type 2 diabetes. Am J Clin Nutr. 2004; 80 668-673
- 12 Santos MS, Lichtenstein AH, Leka LS, Goldin B. et al. . Immunological Effects of Low-Fat Diets with and without Weight Loss. J of Am Coll of Nutrition. 2003; 22 174-182
- 13 Vidon C, Boucher P, Peroni O, Diraison F, Beylot M.. Effects of isoenergetic high-carbohydrate compared with high-fat diets on human cholesterol synthesis and expression of key regulatory genes of cholesterol metabolism. Am J Clin Nutr. 2001; 73 878-884
- 14 Ros E.. Dietary cis-monounsaturated fatty acids and metabolic control in type 2 diabetes. Am J Clin Nutr. 2003; 78
- 15 Tsihlias EB, Gibbs AL, McBurney MI, Wolever TMS.. Comparison of high- and low-glycemic-index breakfast cereals with monounsaturated fat in the long-term dietary management of type 2 diabetes. Am J Clin Nutr. 2000; 72 439-449
- 16 Bilz S.. Bedeutung der ektopen Fettablagerung in Leber und Skelettmuskulatur für die Pathogenese des Metabolischen Syndroms. Ernährung & Medizin. 2005; 20 179-184
- 17 Hawkins M, Tonelli J, Kishore P, Stein D. et al. . Constribution of Elevated Free Fatty Acid Levels to the Lack of Glucose Effectiveness in Type 2 Diabetes. Diabetes. 2003; 52 2748-2758
- 18 Bisshop PH, Metz de J, Ackermans MT, Endert E. et al. . Dietary fat content alters insulin-mediated glucose metabolism in healthy men. Am J Clin Nutr. 2001; 73 554-559
- 19 Tuomiletho J. et al.(Finish Diabetes Prevention Study Group). . Prevention of type 2 diabetes mellitus by changes in livestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001; 344 1343-1350
- 20 Knowler WC;. et al.(Diabetes Prevention Program Research Group). . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346 393-403
- 21 Ellrott T, Pudel V.. Kohlenhydratarme Diäten (Low-Carb) zur Gewichtsreduktion. Ernährungs-Umschau. 2005; 52 48-51
- 22 Djurie Z, Lababidi S, Heilbrun LK, Depper JB. et al. . Effect of Low-Fat and/or Low-Energy Diets on Anthropometric Measures in Participants of the Women's Diet Study. In: J Am College of Nutr 2002; 21 38-46
- 23 Thanopoulou AC. et al. . Dietary Fat Intake as Risk Factor for the Development of Diabetes. Diabetes Care. 2003; 26 302-307
- 24 Pfeiffer AFH.. Primärprävention des Typ-2-Diabetes mellitus - Was lässt sich durch Nahrungsfaktoren erreichen?. Ernährungs-Umschau. 2004; 51 3-5
- 25 Fisher EB, Walker EA, Bostrom A, Fischhoff B. et al. . Behavioral Science Research in the Prevention of Diabetes. Diabetes Care. 2002; 25 599-606
- 26 Tuomiletho J. et al.(Finish Diabetes Prevention Study Group). . Prevention of type 2 diabetes mellitus by changes in livestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001; 344 1343-1350
- 27 Knowler WC. et al.(Diabetes Prevention Program Research Group). . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346 393-403
- 28 Davis MJ, Tringham JR, Troughton J, Khunti KK.. Prevention of Type 2 diabetes mellitus. A review of the evidence and its application in a UK setting. Diabetic Medicine. 2004; 21 403-414
- 29 Petermann F.. Patientenschulung und Patientenberatung - Ziele, Grundlagen und Perspektiven. 2. vollst. überarb. u. erw. Auflage, Göttingen:. Hogrefe-Verlag 1997: 3-21
- 30 Franz M, Warshaw H, Daly A, Green-Pastors J. et al. . Evolution of diabetes medical nutrition therapy. Postgraduate Medical Journal. 2003; 79 30-35
- 31 Haffner SM, Mykkänen L, Festa A, Burke JA, Stern MP.. Insulin-Resistant Prediabetic Subjects Have More Atherogenic Risk Faktors Than Insulin-Sensitive Prediabetic Subjects. Circulation 2000: 975-980
- 32 Hanefeld M, Koehler C, Fuecker K, Henkel E. et al. . Insulin Secretion and Insulin Sensitivity Pattern is different in Isolated Impaired Glucose Tolerance and Impaired Fasting Glucose. Diabetes Care. 2003; 26 868-874
- 33 Gregg E, Gerzoff R, Caspersen C, Williamson D, Narayan K.. Relationship of walking to mortality among US adults with diabetes. Archives of internal medicine. 2003; 163 1440-1447
- 34 Pan XR. et al. . Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997; 20 537-544
- 35 Swinburn BA, Metcalf PA., Ley SJ.. Long-Term (5-Year) Effects of a Reduced Fat Diet Intervention in Individuals With Glucose Intolerance. Diabetes Care. 2001; 24 619-624
- 36 Bray GA, Popkin BM.. Dietary fat intake does affect obesity!. Am J Clin Nutr. 1998; 68 1157-1173
- 37 Saris WH, Astrup A, Prentice AM, Zunft HJ. et al. . Randomized controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates on body weight and blood lipids: the CARMEN study. The Carbohydrate Ratio Management in European National diets. Int J Obes Relat Metab Disord. 2000; 24 1310-1318
- 38 Bray GA, Lovejoy JC, Most-Windhauser M, Smith SR. et al. . A 9-mo randomized Clinical trial comparing fat-substituted and fat-reduced diets in healthy obese men: the Ole Study. Am j Clin Nutr. 2002; 76
- 39 Schaefer EJ.. Lipoproteins, nutrition, and heart disease. Am J Clin Nutr. 2002; 75 191-212
- 40 Torgerson JS, Hauptman J, Boldrin MN, Sjöström L.. XENical in the Prevention of Diabetes in Obese Subjects (XENDOS) Study. Diabetes Care. 2004; 27 155-161
- 41 Berg A, Frey I, Deibert P, Landmann U, König D. et al. . Gewichtsreduktion ist machbar. Ernährungs-Umschau. 2003; 50
- 42 Pelkman CL, Fishell VK, Maddox DH, Pearson TA. et al. . Effects of moderate-fat (from monounsaturated fat) and low-fat weight-loss diets on the serum lipid profile in overweight and obese men and women. Am J Clin Nutr. 2004; 79 204-212
- 43 Johnston CS, Tjonn SL, Swan PD.. High-Protein, Low-Fat Diets are effective for Weight Loss and Favorably Alter Biomarkers in Healthy Adults. Am Soc for Nutrition Sciences 2004: 586-591
- 44 Fansworth E, Luscombe ND, Noakes N, Wittert G. et al. . Effect of a high-protein, energy-restricted diet on body composition, glycemic control, and lipid concentrations in overweight and obese hyperinsulinemic men and women. Am J Clin Nutr. 2003; 78 31-39
- 45 German JB, Dillard CJ.. Saturated fats: what dietary intake?. Am J Clin Nutr. 2004; 80 550-559
- 46 Harding AH, Day NE, Khaw KT, Bingham S. et al. . Dietary Fat and Risk of Clinical Type 2 Diabetes. Am J of Epidemiol. 2004; 159 73-82
- 47 Toeller M. et al. . Evidenz-basierte Ernährungsempfehlungen zur Behandlung und Prävention des Diabetes mellitus. Diabetes und Stoffwechsel. 2005; 14 75-94
- 48 Salmeron J, Hu FB, Manson JE, Stampfer MJ. et al. . Dietary fat intake and risk of type 2 diabetes in women. Am J Clin Nutr. 2001; 73 1019-1026
- 49 McIntosh GH, Noakes M, Royle PJ, Foster PR.. Whole-grain rye and wheat foods and markers of bowel health in overweight middle-aged men. Am J Clin Nutr. 2003; 77 967-974
- 50 Simopoulos AP.. Essential fatty acids in health and chronic disease. Am J Clin Nutr. 1999; 70
- 51 Deutsche Gesellschaft für Ernährung (DGE). Referenzwerte für die Nährstoffzufuhr. 1. Aufl. Frankfurt aM: Umschau/Braus. 2000
- 52 Nkondjock A, Receveur O.. Fish-seadfood consumption, obesity, and risk of type 2 diabetes: an ecological study. Diabetes Metab. 2003; 29 635-642
- 53 Parillo M, Ricciardi G.. Diet composition and risk of type 2 diabetes: epidemiological and clinical evidence. Brit J of Nutrition. 20004; 92 7-19
- 54 Lovejoy JC, Most MM, Lefevre M, Greenway FL, Rood JC.. Effect of diets enriched in almonds on insulin action and serum lipids in adults with normal glucose tolerance or type 2 diabetes. Am J Clin Nutr. 2002; 76 1000-1006
- 55 Madigan C, Ryan M, Owens D, Collins P, Tomkin GH.. Dietary Unsaturated Fatty Acids in Type 2 Diabetes. Diabetes Care. 2000; 23 1472-1477
- 56 Song Y, Manson JE, Buring JE, Liu S.. A Prospective Study of red meat consumption and Type 2 Diabetes in Middle-aged and elderly women. Diabetes Care. 2004; 27 2108-2115
- 57 Mann JI.. Can dietary intervention produce long-term reduction in insulin resistance?. Brit J Nutr. 2000; 83
Korrespondenz
Dr. med. Peter E. H. Schwarz
Medizinische Klinik III Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden
Fetscherstraße 74
01307 Dresden
Email: peter.schwarz@uniklinikum-dresden.de