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Ernährung und Bauchaortenaneurysma

Nutrition and abdominal aortic aneurysms

  • Gefäßmedizinische Evidenz
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Zusammenfassung

Fragestellung

Ziel dieser Übersicht ist es, den aktuellen Wissensstand zu Ernährung und Ernährungsinterventionen bei der Risikopopulation der Patienten mit Bauchaortenaneurysma (AAA) zu referieren.

Material und Methoden

Literaturrecherche in Medline (PubMed) unter den Schlüsselwörtern „abdominal aortic aneurysm (title/abstract) AND nutrition“ für Publikationen der letzten 10 Jahre.

Ergebnisse

Patienten mit AAA wird dringend der DASH-Ernährungsplan (hoher Konsum an Obst, Gemüse, Vollkorn, fettarmen Milchprodukten, Nüssen und Hülsenfrüchten) empfohlen, in der ARIC-Studie ließ sich so eindeutig die Inzidenz an AAA reduzieren. Der von der WHO empfohlene Konsum von 400 g Obst und Gemüse/Tag war in populationsbezogenen Kohortenstudien eindeutig mit einer geringeren AAA-Inzidenz assoziiert. Auch wenn Alkoholkonsum grundsätzlich nicht empfohlen werden sollte, so ist doch wahrscheinlich ein mäßiger Konsum von maximal 15–20 g Alkohol täglich mit einer erniedrigten AAA-Inzidenz assoziiert. Der Wert einer Omega-3-Fettsäuren-reichen Ernährung ist umstritten, jedoch ist es umgekehrt wichtig, bei AAA-Patienten hohe Serumspiegel von Omega-6-Fettsäuren (Arachidonsäure) zu vermeiden. Obwohl in der Aortenwand bei AAA-Patienten eine überschüssige Produktion von freien Sauerstoffradikalen nachgewiesen werden konnte, hatte in den vorliegenden Studien die Supplementierung der Ernährung mit synthetischen Antioxidanzien (wie z. B. Vitamin C oder Carotinoide) keinen Effekt auf die AAA-Inzidenz oder Wachstumsrate.

Schlussfolgerungen

Vor allem bei offener Versorgung des AAA (aber auch in geringerem Maße bei EVAR) führt eine Mangelernährung des Patienten zu einer signifikant höheren Morbidität und Mortalität. Bei Patienten mit elektiver AAA-Versorgung sollte deshalb präoperativ der Serumalbuminspiegel bestimmt und bei Hypalbuminämie (als einem Marker der Mangelernährung) eine präoperative Ernährungsintervention eingeleitet werden.

Abstract

Objectives

The purpose of this review is to present the current state of nutrition and nutritional interventions in the risk population of patients with an abdominal aortic aneurysm (AAA).

Materials and methods

Literature search in Medline (PubMed) under the keywords “abdominal aortic aneurysm (title/abstract) AND nutrition” for publications over the last 10 years.

Results

Patients with AAA are strongly recommended to use the DASH nutrition plan (high consumption of fruits, vegetables, whole grain, low-fat dairy products, nuts and legumes), which clearly reduced the incidence of AAA in the ARIC study. The consumption of 400 g of fruits and vegetables/day as recommended by the WHO was clearly associated with a lower AAA incidence in population-based cohort studies. Alcohol consumption should generally not be recommended; nevertheless, a moderate intake of a maximum of 15–20 g alcohol/day is probably associated with a reduced AAA incidence. The value of an omega-3 fatty acid-rich diet is controversial but conversely it is important to avoid high serum levels of omega-6 fatty acids (arachidonic acid) in AAA patients. Although an excess free oxygen radical production could be demonstrated in the aortic wall of AAA patients, diet supplementation with synthetic antioxidants (such as vitamin C or carotenoids) had no effect on AAA incidence or growth rate in the present studies.

Conclusions

Patients with malnutrition have a significantly higher morbidity and mortality especially with open aneurysm repair of the AAA and also to a lesser extent with endovascular repair. Therefore, in patients with elective AAA repair serum albumin levels should be determined preoperatively and a preoperative nutritional intervention should be initiated in cases of severe hypoalbuminemia (as a marker of malnutrition).

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Authors and Affiliations

  1. Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    P. Daniels, E. S. Debus &  R. T. Grundmann

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  1. P. Daniels
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Correspondence to R. T. Grundmann.

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P. Daniels, E.S. Debus und R.T. Grundmann geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Daniels, P., Debus, E.S. & Grundmann, R.T. Ernährung und Bauchaortenaneurysma. Gefässchirurgie 24, 329–337 (2019). https://doi.org/10.1007/s00772-019-0526-9

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