Das Medizinportal


Welche besonderen Risiken bestehen für maligne Erkrankungen bei Adipositas, metabolischem Syndrom und Diabetes mellitus?
Norbert Stefan

  1. Hunter DJ, Reddy KS. Noncommunicable diseases. N Engl J Med. 2013 Oct 3; 369(14):1336–43.
  2. United Nations General Assembly. Political declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. September 16, 2011 (http://www.un.org/ga/search/view_doc.asp?symbol=A/66/L.1).
  3. 65th World Health Assembly closes with new global health measures. Geneva: World Health Association, May 26, 2012 (http://www.who.int/mediacentre/news/releases/2012/wha65_closes_20120526/en/index.html).
  4. Kontis V, Mathers CD, Rehm J, Stevens GA, Shield KD, Bonita R, Riley LM, Poznyak V, Beaglehole R, Ezzati M.  Contribution of six risk factors to achieving the 25×25 non-communicable disease mortality reduction target: a modelling study. Lancet. 2014 Aug 2; 384(9941):427–37.
  5. Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011; 94:311–321.
  6. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011; 61: 69–90.
  7. Heron M. Deaths: leading causes for 2007. Natl Vital Stat Rep. 2011; 59:1–95.
  8. Arnold M, Pandeya N, Byrnes G et al. Global burden of cancer attributable to high body-mass index in 2012: a population-based study. Lancet Oncol. 16, 36–46 (2015).
  9. Tanumihardjo SA, Anderson C, Kaufer-Horwitz M et al. Poverty, obesity, and malnutrition: an international perspective recognizing the paradox. J. Am. Diet. Assoc. 107, 1966–1972 (2007).
  10. Esposito K, Ciardiello F, Giugliano D, Unhealthy diets: a common soil for the association of metabolic syndrome and cancer. Endocrine 46, 39–42 (2014)
  11. Renehan A, Smith U, Kirkman MS.  Linking diabetes and cancer: a consensus on complexity. Lancet 375(9733), 2201–2.
  12. (2010). Joslin EP, Lombard HL, Burrows RE, Manning MD. Diabetes and cancer. N Engl J Med 1959; 260: 486–488.
  13. Wideroff L, Gridley G, Mellemkjaer L et al. Cancer incidence in a population-based cohort of patients hospitalized with diabetes mellitus in Denmark. J Natl Cancer Inst 1997;89:1360–1365.
  14. Coughlin SS, Calle EE, Teras LR, Petrelli J, Thun MJ. Diabetes mellitus as a predictor of cancer mortality in a large cohort of US adults. Am J Epidemiol. 2004;159:1160–1167.
  15. Jee SH, Ohrr H, Sull JW, Yun JE, Ji M, Samet JM. Fasting serum glucose level and cancer risk in Korean men and women. JAMA 2005;293:194-202
  16. Vigneri P, Frasca F, Sciacca L, Pandini G, Vigneri R. Diabetes and cancer. Endocr Relat Cancer. 2009;16:1103–1123.
  17. Rapp K, Schroeder J, Klenk J, Ulmer H, Concin H, Diem G, Oberaigner W, Weiland SK. Fasting blood glucose and cancer risk in a cohort of more than 140,000 adults in Austria. Diabetologia. 2006;49:945–952.
  18. Stocks T, Rapp K, Bjørge T, Manjer J, Ulmer H, Selmer R, Lukanova A, Johansen D, Concin H, Tretli S, Hallmans G, Jonsson H, Stattin P. Blood glucose and risk of incident and fatal cancer in the metabolic syndrome and cancer project (me-can): analysis of six prospective cohorts. PLoS Med. 2009;6:e1000201.
  19. Lega IC, Wilton AS, Austin PC et al., The temporal relationship between diabetes and cancer. Cancer. 17, 2731–2738 (2016).
  20. Heuson JC, Legros N. Influence of insulin deprivation on growth of the 7, 12-dimethylbenz(a)anthraceneinduced mammary carcinoma in rats subjected to alloxan diabetes and food restriction. Cancer Research 1972; 32: 226–232.
  21. Goodwin PJ, Ennis M, Pritchard KI et al. Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol 2002; 20:42–51.
  22. Ullrich A, Bell JR, Chen EY et al. Human insulin receptor and its relationship to the tyrosine kinase family of oncogenes. Nature 1985; 313: 756–761.
  23. Vander Heiden MG, Cantley LC, Thompson CB. Understanding the Warburg effect: the metabolic requirements of cell proliferation. Science 2009; 324:1029–1033.
  24. Stefan N, Häring HU, Hu FB, Schulze MB. Divergent associations of height with cardiometabolic disease and cancer: epidemiology, pathophysiology, and global implications. Lancet Diabetes Endocrinol. 2016 May; 4(5):457–67.

Was bringen ernährungsmedizinische Konzepte bei Adipositas? 
H. Hauner

  1. NCD Risk Factor Collaboration. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet 2016; 387:1377–1396.
  2. Mensink GBM, Schienkiewitz A, Haftenberger M, Lampert T, Ziese T, Scheidt-Nave C. Übergewicht und Adipositas in Deutschland: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland. Bundesgesundheitsbl 2013;56:786¬794.
  3. Effertz T, Engel S, Verheyen F, Linder R. The costs and consequences of obesity in Germany: a new approach from a prevalence and life-cycle perspective. Eur J Health Econ 2016; 17:1141–1158.
  4. Yates N, Teuner CM, Hunger M, Holle R, Stark R, Laxy M, Hauner H, Peters A, Wolfenstetter SB. The economic burden of obesity in Germany: results from the population-based KORA studies. Obes Facts 2016; 9:397–409.
  5. Prentice AM, Jebb SA. Fast foods, energy density and obesity: a possible mechanistic link. Obes Rev 2003; 4:187–194.
  6. Kral TV, Roe LS, Rolls BJ. Combined effects of energy density and portion size on energy intake in women. Am J Clin Nutr 2004; 79:962–968.
  7. Mozzafarian D, Hao T, Rimm EB, Willett WC, Hu FB. Chenges in diet and lifestyle and long-term weight gain in women and men. N Engl J Med 2011; 364:2392–2404.
  8. Duffey KJ, Popkin BM. Energy density, portion size, and eating occasions: contributions to increased energy intake in the United States, 1977–2006. PLoS Med 2011; 8:e1001050.
  9. Wirth A, Wabitsch M, Hauner H. Klinische Leitlinie: Prävention und Therapie der Adipositas. Dtsch Arztebl Int 2014; 111:705–713.
  10. Jensen MD, Ryan DH, Apovian CM et al. 2013 AHA/ACC/TOS Guideline for the management of overweight and obesity in adults: a Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation 2014; 129 Suppl. 2:S102–S138. 
  11. Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med 2017; 376: 254–266.
  12. Johnston BC, Kanters S, Bandayrel K et al. Comparison of weight loss among named diet programs on overweight and obese adults. JAMA 2014;312:923–933.
  13. Stern L, Iqbal N, Seshadri P et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: One-year follow-up of a randomized trial. Ann Intern Med 2004; 140:778–785.
  14. Noto H, Goto A, Tsujimoto T, Noda M. Low-carbohydrate diets and all-cause mortality: a systematic review and metaanalysis of observational studies. PLoS One 2013; 8:e55030.
  15. Krieger JW, Sitren HS, Daniels MJ, Langkamp-Henken B. Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression. Am J Clin Nutr 2006; 83:260–274.
  16. Shai I, Schwarzfuchs D, Henkin Y et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008; 359:229–241.
  17. Huang RY, Huang CC, Hu FB, Chavarro JE. Vegetarian diets and weight reduction: a meta-analysis of randomized controlled trials. J Gen Intern Med 2016; 31:109–116.
  18. Sacks FM, Bray GA, Carey VJ et al. Comparison of weight loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009; 360:859–873.
  19. Heymsfield SB, van Mierlo CAJ, van der Knaap HCM et al. Weight management using a meal replacement strategy: meta and pooling analysis from six studies. Int J Obes Relat Metab Disord 2003; 27:537–549.
  20. Wadden TA, van Itallie TB, Blackburn GL. Responsible and irresponsible use of very-low-calorie diets in the treatment of obesity. JAMA 1990; 263:83–85.
  21. Leibel RL, Rosenbaum M, Hirsch J. Changes in energy expenditure resulting from altered body weight. N Engl J Med 1995; 332:621–628.
  22. Thomas JG, Bond DS, Phelan S, Hill JO, Wing RR. Weight-loss maintenance for 10 years in the National Weight Control Registry. Am J Prev Med 2014; 46:17–24.
  23. Vanwormer JJ, French SA, Pereira MA, Welsh EM. The impact of regular self-weighing on weight management: a systematic literature review. Int J Behav Nutr Phys Act 2008;5: 54.

Medikamentöse und operative Therapie bei Adipositas und metabolischem Syndrom
Jens Aberle, Dominik Dahl und Anne Lautenbach

  1. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH.  The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis.  BMC Public Health. 2009;9:88. doi: 10.1186/1471-2458-9-88.
  2. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH.  The disease burden associated with overweight and obesity.  JAMA. 1999 Oct 27; 282(16):1523–1529.
  3. Colditz GA, Willett WC, Rotnitzky A, Manson JE.  Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. 1995; 122(7):481–486.
  4. Thomsen M, Nordestgaard BG.  Myocardial infarction and ischemic heart disease in overweight and obesity with and without metabolic syndrome. JAMA Intern Med. 2014;174(1):15-22. doi: 10.1001/jamainternmed.2013.10522.
  5. Slagter SN, van Vliet-Ostaptchouk JV, van Beek AP, Keers JC, Lutgers HL, van der Klauw MM, Wolffenbuttel BH.  Health-Related Quality of Life in Relation to Obesity Grade, Type 2 Diabetes, Metabolic Syndrome and Inflammation.  PLoS One. 2015; 10(10):e0140599. doi: 10.1371/journal.pone.0140599. eCollection 2015.
  6. Wadden TA, Hollander P, Klein S, Niswender K, Woo V, Hale PM, Aronne L; NN8022-1923 Investigators. Weight maintenance and additional weight loss with liraglutide after low-calorie-diet-induced weight loss: the SCALE Maintenance randomized study. Int J Obes (Lond). 2013;37(11):1443-1451. doi: 10.1038/ijo.2013.120.
  7. Södlerlund A, Fischer A, Johansson T. Physical activity, diet and behaviour modification in the treatment of overweight and obese adults: a systematic review. Perspect Public Health. 2009;129(3):132–142.
  8. Van Can J, Sloth B, Jensen CB, Flint A, Blaak EE, Saris WH.  Effects of the once-daily GLP-1 analog liraglutide on gastric emptying, glycemic parameters, appetite and energy metabolism in obese, non-diabetic adults.  Int J Obes (Lond). 2014;38(6):784–793. doi: 10.1038/ijo.2013.162. 
  9. Secher A, Jelsing J, Baquero AF, Hecksher-Sørensen J, Cowley MA, Dalbøge LS, Hansen G, Grove KL, Pyke C, Raun K, Schäffer L, Tang-Christensen M, Verma S, Witgen BM, Vrang N, Bjerre Knudsen L.  The arcuate nucleus mediates GLP-1 receptor agonist liraglutide-dependent weight loss.  J Clin Invest. 2014; 124(10):4473–88. 
  10. Pi-Sunyer X, Astrup A, Fujioka K, Greenway F, Halpern A, Krempf M, Lau DC, le Roux CW, Violante Ortiz R, Jensen CB, Wilding JP; SCALE Obesity and Prediabetes NN8022-1839 Study Group.  A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. N Engl J Med. 2015; 373(1):11–22.
  11. Greenway FL1, Fujioka K, Plodkowski RA, Mudaliar S, Guttadauria M, Erickson J, Kim DD, Dunayevich E; COR-I Study Group. Lancet. Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial.2010 Aug 21; 376(9741):595–605. 
  12. Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–234. 
  13. Rubino F, Nathan DM, Eckel RH, et al. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Diabetes Care. 2016;39(6):861–877.
  14. Parent B, Martopullo I, Weiss NS, Khandelwal S, Fay EE, Rowhani-Rahbar A. Bariatric Surgery in Women of Childbearing Age, Timing Between an Operation and Birth, and Associated Perinatal Complications. JAMA Surg. 2016 Oct 19. doi: 10.1001/jamasurg.2016.3621.
  15. Feichtinger M, Stopp T, Hofmann S, Springer S, Pils S, Kautzky-Willer A, Kiss H, Eppel W, Tura  A, Bozkurt L, Göbl CS. Altered glucose profiles and risk for hypoglycaemia during oral glucose tolerance testing in pregnancies after gastric bypass surgery. Diabetologia. 2017 Jan; 60(1):153–157. 

 Körperliche Aktivität und gesundes Leben: Das Rezept für Bewegung 
H.Löllgen, P. Zupet, J.Wismach, N.Bachl, G. Predel 

  1.  Löllgen H :Bedeutung und Evidenz der körperlichen Aktivität  zur Prävention und Therapie von Erkrankungen  Dtsch med. Wschr. 2013, 138:2253–2259.
  2. Piepoli M F,Hoes,  AW (Chairs) 2016 European guidelines on cardiovascular disease prevention in clinical practice guidelines  Europ Heart J 2016;37:2315–2381.
  3. Löllgen H, Bachl. N: Kardiovaskuläre Prävention und regelmäßige körperliche Aktivität : Herz 2016;41:664–670.
  4. Cummiskey J: The exercise deficiency syndrom (in Vorber.)
  5. Vina J, Sanchis –Gomar F, Maretinez-Bello V, Gomez-Cabrera MC: Exercise acts as a drug; the pharmacological benefits of exercise. Br J Pharmacol 2012.
  6. Löllgen H,Wismach J, Kunstmann W: Das Rezept für Bewegung. Einsatzmöglichkeiten für Arzt und Patient.Klinikarzt 2013, 42:416–420.
  7. Swinburn BA, Walter LG, Aroll B, Tilyard MW, Russell DG: The green prescription study: a randomized controlled trial of written exercise advice provided by general practitioners Am J Publ Health 1998, 88: 288–291.
  8. Swinburn BA, Walter LG, Arroll B,Tilyard MW, Russell DG : Green prescriptions: attitudes and perceptions of general practitioners towards prescribing exercise. Br J Gen Pract 1997,47: 567–569.
  9. Swedish National Institute of Public Health (ed.): Physical activity in the prevention and treatment of disease, Stockholm, 2010 (FYSS-Buch).
  10. Wismach J : Berlin komm(t) auf die Beine. Dtsch Zschr Sportmed, 59,2009,4.
  11. Löllgen, H. :Mitgliederjournal des SÄB Nordrhein, 2005 Heft 2.
  12. Rödjer L,Jonsdottir IH,Börjesson M: Physical activity on prescription (PAP): self –  reported physical activity and quality of life in a Swedish primary care population, 2 year follow -up. Scand J Prim Health Care 2016; doi.org/10.1080/02183432.2016.1253820.
  13. Sorensen JB, Skovgaard  T, Puggaard L . Exercise on prescription in general practice. A systematic review. Scand J Prim Health Care 2006, 27: 326–330.
  14. Löllgen H, Böckenhoff A, Knapp G.  Primary prevention by physical activity: An   updated meta-analysis with different intensity categories. Int.J Sports Med 2009, 30:213–224.
  15. Kokkinos,PF, Faselis C, Myers J, Narayan P, Sui X, Zhang J, Lavie CJ, Moore H, Karasik P, Fletcher R.:Cardiorespiratory fitness and incidence of major adverse cardiovascular events in US veterans: A cohort study.  Mayo Clin Proc 2016;doi.org/101016/j.mayocp.2016.09.013.
  16. Pescatello LS (Hrsg): ACSM's Guidelines for exercise testing and prescription.9th ed.,Wolters Kluwer,  Baltimore, 2014.
  17. Löllgen H,   Krause R.Rezept für B ewegung Bewegung und körperliche Aktivität als „Polypill“. DG fN–Mitteilungen 4/2016.  
  18. Khan K, Weiler R, Blair SN: Prescribing exercise in primary care   Br Med J. 2011, 343:    d4141.
  19. Rowe GC,Safdar A, Arany Z: Running Forward. New Frontiers in Endurance Exercise Biology Circulation 2014;129:798–810.

Bewegung ist eine elementare Säule der Herzinsuffizienztherapie
Halle M., Duvinage A.

  1. Lam CS, Donal E, Kraigher-Krainer E, Vasan RS. Epidemiology and clinical course of heart failure with preserved ejection fraction. European journal of heart failure. 2011;13(1):18–28.
  2. Bleumink GS, Knetsch AM, Sturkenboom MC, Straus SM, Hofman A, Deckers JW, et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study. European heart journal. 2004;25(18):1614–9.
  3. Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, et al. Outcome of heart failure with preserved ejection fraction in a population-based study. The New England journal of medicine. 2006;355(3):260–9.
  4. Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. European heart journal. 2011;32(6):670–9.
  5. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European heart journal. 2016.
  6. Brinker SK, Pandey A, Ayers CR, Barlow CE, DeFina LF, Willis BL, et al. Association of cardiorespiratory fitness with left ventricular remodeling and diastolic function: the Cooper Center Longitudinal Study. JACC Heart failure. 2014;2(3):238–46.
  7. Kraigher-Krainer E, Lyass A, Massaro JM, Lee DS, Ho JE, Levy D, et al. Association of physical activity and heart failure with preserved vs. reduced ejection fraction in the elderly: the Framingham Heart Study. European journal of heart failure. 2013;15(7):742–6.
  8. Arbab-Zadeh A, Dijk E, Prasad A, Fu Q, Torres P, Zhang R, et al. Effect of aging and physical activity on left ventricular compliance. Circulation. 2004;110(13):1799–805.
  9. Edelmann F, Gelbrich G, Dungen HD, Frohling S, Wachter R, Stahrenberg R, et al. Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. Journal of the American College of Cardiology. 2011;58(17):1780–91.
  10. Kitzman DW, Brubaker P, Morgan T, Haykowsky M, Hundley G, Kraus WE, et al. Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in Obese Older Patients With Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial. JAMA : the journal of the American Medical Association. 2016;315(1):36–46.
  11. Paulus WJ, Tschope C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. European heart journal. 2007;28(20):2539–50.
  12. Suchy C, Massen L, Rognmo O, Van Craenenbroeck EM, Beckers P, Kraigher-Krainer E, et al. Optimising exercise training in prevention and treatment of diastolic heart failure (OptimEx-CLIN): rationale and design of a prospective, randomised, controlled trial. European journal of preventive cardiology. 2014;21(2 Suppl):18–25.
  13. Davies EJ, Moxham T, Rees K, Singh S, Coats AJ, Ebrahim S, et al. Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis. European journal of heart failure. 2010;12(7):706–15.
  14. O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA: the journal of the American Medical Association. 2009;301(14):1439-50.
  15. Wisloff U, Stoylen A, Loennechen JP, Bruvold M, Rognmo O, Haram PM, et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation. 2007;115(24):3086–94.
  16. Ellingsen O, Halle M, Conraads VM, Stoylen A, Dalen H, Delagardelle C, et al. High Intensity Interval Training in Heart Failure Patients with Reduced Ejection Fraction. Circulation. 2017.
  17. Care A, Catalucci D, Felicetti F, Bonci D, Addario A, Gallo P, et al. MicroRNA-133 controls cardiac hypertrophy. Nature medicine. 2007;13(5):613–8.
  18. Wever-Pinzon O, Drakos SG, Kfoury AG, Nativi JN, Gilbert EM, Everitt M, et al. Morbidity and mortality in heart transplant candidates supported with mechanical circulatory support: is reappraisal of the current United network for organ sharing thoracic organ allocation policy justified? Circulation. 2013;127(4):452–62.
  19. Kirklin JK, Naftel DC, Kormos RL, Pagani FD, Myers SL, Stevenson LW, et al. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) analysis of pump thrombosis in the HeartMate II left ventricular assist device. The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation. 2014;33(1):12–22.
  20. Christle JW, Boscheri A, Pressler A, Grinninger C, Schramm R, Hagl CM, et al. Interval exercise training increases maximal and submaximal exercise performance in heart failure with biventricular assist device therapy. International journal of cardiology. 2015;187:104–5.