Abstract

Zur Prävention und Therapie metabolisch-vaskulärer Erkrankungen wurde jahrelang ein fett- und kalorienarmes Ernährungsmuster mit konkreten Vorgaben zu isolierten Nährstoffen propagiert wie bspw. dem Cholesterin oder den gesättigten Fettsäuren. Dieser Beitrag soll zeigen, dass lebensmittel- bzw. essmusterbasierte Empfehlungen ohne spezifische Angaben zu Nährstoffrelationen oder Kalorien sinnvoller sind.

Cardiovascular disease is the number one cause of death globally. Poor diet constitutes a key factor in the initiation and progression of cardiovascular disease and has become the leading risk factor for disability and death worldwide. Therefore, addressing suboptimal nutrition is of key prognostic relevance in primary and secondary prevention of metabolic vascular syndrome.

Metabolic vascular syndrome is a multidimensional network of acquired cardiometabolic risk factors closely related to insulin resistance (IR) and compensatory hyperinsulinemia. IR, being the underlying cause of metabolic vascular syndrome and certain types of cancer, should attract the attention of every clinician. As changes in lipoprotein metabolism are one of the earliest indicators of metabolic dysfunction, a relevant biomarker for identifying individuals with IR is the TAG/HDL-C ratio.

Hyperinsulinemia – and concomitant metabolic vascular risk – can be effectively treated by lifestyle intervention. If IR is present, dietary carbohydrate restriction has consistently been shown to be superior to dietary fat restriction in reversing metabolic dysfunction. The beneficial effects of carbohydrate restricted diets on metabolic vascular risk are independent of BMI – diet quality therefore confers patient benefit beyond weight reduction.

Targeting IR with a low glycemic load, real food diet will reduce overall energy density and will improve all risk factors of metabolic vascular syndrome. In particular, replacing refined carbohydrates with healthy fats in the context of a Mediterranean style-, low carbohydrate and calorie-unrestricted dietary pattern has been shown to significantly reduce burden of metabolic vascular disease. The effect of single nutrients on isolated lipid surrogate markers such as LDL-C does not capture their global effect on metabolic vascular risk.