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Ernährung und psychische Erkrankungen

Schwerpunkt depressive Störungen

Nutrition and mental diseases

Focus depressive disorders

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Zusammenfassung

Gegenwärtig wird ein möglicher Einsatz ernährungsbasierter Interventionen als ergänzende Maßnahme im Rahmen der Therapie psychischer Störungen diskutiert. Zugrunde liegende pathobiologische Mechanismen sind derzeit nicht abschließend geklärt. Plausibel ist ein Einfluss von Nährstoffen und Ernährungsmustern auf immun- und inflammatorische Prozesse, das Mikrobiom, die Leptin-melanokortinerge- und Hypothalamus-Hypophysen-Nebennierenrinden-Achse sowie auf Neurotransmitter des cholinergen, noradrenergen, dopaminergen bzw. serotonergen Systems und Neurotrophine.

In Beobachtungsstudien erwiesen sich traditionelle Ernährungsmuster wie die mediterrane Ernährung als protektiv für die seelische Gesundheit. In Bezug auf einzelne Nährstoffe zeigten Interventionsstudien bei Supplementation mit langkettigen, mehrfach ungesättigten Omega-3-Fettsäuren bei Depressionen kleine, aber signifikante Effekte. Die Studienlage bezüglich einer antidepressiven Wirkung einer Vitamin-D-Supplementation ist bislang insgesamt inkonsistent.

Abstract

Dietary interventions are currently being discussed as additional treatment options for mental disorders. The pathological mechanisms are not yet fully understood. It is hypothesized that certain nutrients and dietary pattern influence immune and inflammatory processes, the microbiome, the leptin-melanocortinergic axis and hypothalamic-pituitary axis, as well as neurotransmitters of the cholinergic, noradrenergic, dopaminergic and serotonergic signaling cascades and neurotrophins. Observational studies have shown that traditional dietary patterns, such as the Mediterranean diet have a protective effect on mental health. Supplementation with long-chain polyunsaturated omega-3 fatty acids showed small to medium but significant effect sizes in meta-analyses from depression trials. The evidence with respect to the antidepressive effect of vitamin D supplementation is currently inconclusive.

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Authors and Affiliations

  1. Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, LVR-Klinikum Essen, Kliniken und Institut der Universität Duisburg-Essen, Essen, Deutschland

    L. Libuda, J. Antel, J. Hebebrand & M. Föcker

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  1. L. Libuda
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  2. J. Antel
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  3. J. Hebebrand
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Correspondence to L. Libuda.

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Interessenkonflikt

L. Libuda, J. Antel, J. Hebebrand und M. Föcker geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

CME-Fragebogen

CME-Fragebogen

Welche Regelkreise/Prozesse werden durch den Energiegehalt einer Mahlzeit unmittelbar beeinflusst?

Die Stressachse

Das Komplementsystem

Die homöostatische Regulation

Das Belohnungssystem

Die Expressionsraten von Wachstumsfaktoren

Welche klinischen Hinweise hat man für den Zusammenhang zwischen subchronischem Entzündungsstatus und einer depressiver Störung?

Die Serotoninspiegel im Plasma sind ungewöhnlich hoch.

Biomarker für die Transkription inflammatorischer Zytokine werden bei depressiven Patienten vermehrt gefunden.

Die HPA-Achse ist runterreguliert.

n-3 LC-PUFA sind im Plasma kaum noch nachweisbar.

Es werden weniger Eicosanoide gebildet.

Welchen Vorteil haben Ernährungsmusteranalysen im Vergleich zu Untersuchungen von Effekten einzelner Nährstoffe oder Lebensmittel?

Sie berücksichtigen Interaktionen von Nährstoffen und Lebensmitteln untereinander.

Sie sind für den Untersucher leichter durchzuführen.

Sie sind unabhängig von kulturellen Einflüssen.

Sie beruhen nicht auf Selbstangaben der Patienten.

Ernährungsmuster werden nicht durch Alter und Geschlecht beeinflusst.

Was versteht man unter dem a priori--Ansatz der Ernährungsmusteranalyse?

Fokussierung auf die Untersuchung einzelner Lebensmittel und Nährstoffe.

Vergleich der individuellen Ernährung mit vorab definierten Standards.

Zusammenfassung beobachteter Daten in einer Population durch statistische Modellierung.

Eine grundsätzlich retrospektive Erfassung der individuellen Ernährung.

Neben einer Ernährungserhebung erfolgen Blutanalysen zur Bestimmung des Ernährungsmusters.

Was ist für die mediterrane Ernährung charakteristisch?

Hoher Verzehr tierischer Lebensmittel

Hoher Anteil pflanzlicher Lebensmittel

Maiskeimöl wird als Hauptfettquelle verwendet

Hohe Zufuhr gesättigter Fettsäuren

Wein wird in großen Mengen getrunken

Die Fettsäurezusammensetzung welches Kompartiments gilt als Indikator für die langfristige n-3 LC-PUFA Versorgung?

Haare

Speichel

Plasma

Serum

Erythrozyten

Wie hoch ist der Grenzwert des IoM für eine optimale Vitamin-D-Versorgung und worauf beruht er?

Mindestens 40 nmol/l; reduziertes Risiko von Herzkreislauferkrankungen.

Mindestens 50 nmol/l; Vermeidung von Erkrankungen des Skeletts.

Mindestens 60 nmol/l; Senkung der Häufigkeit von Infektionserkrankungen.

Mindestens 70 nmol/l; reduziertes Typ-2-Diabetes-Risiko.

Mindestens 80 nmol/l; reduziertes Risiko von Nierenerkrankungen.

Wie ist die wissenschaftliche Evidenz für Ernährungseffekte auf Depressionen zu bewerten?

Die Evidenz für Effekte von Ernährungsmustern, Vitamin D und n-3 LC-PUFA ist insgesamt überzeugend.

Die Evidenz für Effekte von Ernährungsmuster und n-3 LC-PUFA ist überzeugend, die Evidenz für Vitamin D dagegen widersprüchlich.

Die Evidenz für Effekte der n-3 LC-PUFA ist überzeugend, für Ernährungsmuster unzureichend und für Vitamin D widersprüchlich, bei qualitativ hochwertigen Interventionsstudien aber vielversprechend.

Die Evidenz für Effekte von Ernährungsmuster ist überzeugend, während die Evidenz für Vitamin D und n-3 LC-PUFA widersprüchlich ist.

Die Evidenz für Effekte von Ernährungsmuster, Vitamin D und n-3 LC-PUFA ist insgesamt widersprüchlich.

Welche methodischen Schwächen hatten bisherige Interventionsstudien zu den Effekten von n-3 LC-PUFA-Supplementen und Vitamin D häufig?

Die Studienergebnisse wurden nicht statistisch ausgewertet und die Gruppenzugehörigkeit nicht randomisiert zugeordnet.

Die Studiendauer war insgesamt zu lang und es haben nur Männer teilgenommen.

Die Studien wurden nicht placebokontrolliert durchgeführt und der Nährstoffstatus am Ende der Studie nicht kontrolliert.

Die Nährstoffmenge in den verwendeten Supplementen war zu hoch und die Nebenwirkungen zu stark.

Die Probandenzahl war gering und der Versorgungsstatus vor Studienbeginn wurde nicht berücksichtigt.

Welche Lebensmittelgruppe ist gleichzeitig eine gute Quelle für Vitamin D und für n-3 LC-PUFA FA?

Gemüse

Obst

Reis

Fisch

Hülsenfrüchte

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Libuda, L., Antel, J., Hebebrand, J. et al. Ernährung und psychische Erkrankungen. Nervenarzt 88, 87–101 (2017). https://doi.org/10.1007/s00115-016-0262-2

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