Fette und Kohlenhydrate in Ernährungskonzepten für Tumorpatienten

 

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Zusammenfassung

Bei Karzinompatienten können Störungen des Glukosestoffwechsels wesentliche Auswirkungen auf das Körpergewicht und die Relationen zwischen den Körperkompartimenten haben. Das sollte beim Entwurf von Ernährungskonzepten beachtet werden. Zusätzlich sind dabei Einflüsse einzelner Nährstoffe auf das Tumorwachstum von Interesse. Wir stellen hier 2 Ernährungskonzepte vor: ein prozentuales Kohlenhydrat / Fett-Energie-Verhältnis von 50 / 50 und die ketogene Kost. Für unsere Vorschläge war u. a. der bei Tumorpatienten gemessene Nettoaustausch von Substraten seitens der peripheren Gewebe, des Splanchnikusgebiets und der Karzinome wegweisend. Postabsorptiv wird bei Tumorkranken vom Ganzkörper und der Muskulatur Glukose vermindert aufgenommen und vermindert oxidiert. Die Insulinresistenz geht den ersten Zeichen der Mangelernährung voraus. Offenbar im Gefolge der reduzierten Glukoseverfügbarkeit nimmt die Fettoxidation zu. Nach oraler Glukosebelastung und bei parenteraler Ernährung ist die Glukoseverwertung vor allem wegen einer verringerten Glykogensynthesekapazität der Leber und der Muskulatur erheblich gestört. Die Fettverwertung, beurteilt nach der Fett-Clearance, ist dagegen gesteigert. Maligne Tumoren behalten Glukose in großer Menge ein und metabolisieren sie vorzugsweise glykolytisch, da es in Tumorzellen oft Blockaden der oxidativen Phosphorylierung gibt. Unter dem Einfluss einer parenteralen Ernährung setzten menschliche Karzinome Fettsäuren netto frei. Vor diesem metabolischen Hintergrund empfehlen sich Ernährungsformen mit viel Fett. Eine fettreiche Kost war in einer randomisierten klinischen Studie bezüglich des Körpergewichts und der Körperzellmasse einer isokalorischen Normalkost überlegen. Die ketogene Diät umgeht das Hindernis der gestörten Glukoseverwertung noch ausgiebiger. Zusätzlich beeinträchtigen fettreiche Kostformen die Glykolyse und das Wachstum der Tumoren.

Abstract

In cancer patients, abnormalities in glucose metabolism have substantial effects on both body weight and composition. Such effects as well as the influence of specific nutrients on tumor growth should be taken into account in forming nutritional strategies. We therefore propose 2 nutritional concepts: (I) a high-fat diet (fat / carbohy-drate caloric ratio 50 / 50) and (II) a ketogenic diet. Our proposals are partly based on the net balances of substrates measured across the peripheral tissues, the splanchnic area and carcinomas in tumor patients. Postabsorptively, whole body and muscle glucose uptake and oxidation are reduced in cancer patients. Insulin resistance occurs before the onset of malnutrition. An increase in lipid oxidation appears to be a consequence of the decline in glucose availability. After an oral glucose load as well as during parenteral nutrition, glucose utilization is severely impaired mainly due to a decrease in both hepatic and muscular glycogen synthesis capacity. By contrast, lipid utilization as judged from lipid clearance is enhanced. Malignant tumors retain glucose avidly and use it via enhanced glycolysis, since oxidative phosphorylation is often inhibited. Parenteral nutrition resulted in a net release of free fatty acids from human carcinomas. This metabolic background favors nutritional regimens high in fat. In a randomized clinical trial such a regimen was superior to isocaloric normal feeding with regard to body weight and cell mass. By using a ketogenic diet the blockade of glucose utilization can be bypassed even more. Additionally, diets high in fat interfere with both tumor glycolysis and tumor growth.

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Prof. Dr. med. Eggert Holm

Universitätsklinikum Mannheim

Bergstraße 161

69121 Heidelberg

Email: eggert.holm@urz.uni-heidelberg.de

Prof. Dr. rer. hum. biol. Ulrike Kämmerer

Frauenklinik des Universitätsklinikums Würzburg

Josef-Schneider-Straße 4

97080 Würzburg

Email: u.kaemmerer@mail.uni-wuerzburg.de