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Prävention und Behandlung der Kachexie

Bewegungs- und Ernährungstherapie

Prevention and treatment of cachexia

Exercise and nutritional therapy

  • Schwerpunkt: Palliativmedizin
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Kachexie ist ein multifaktorielles, komplexes Syndrom, das zu einem fortschreitenden Verlust an körperlicher Leistungsfähigkeit und Lebensqualität führt und die Prognose der Betroffenen deutlich verschlechtert. Die Prävalenz der Kachexie ist teilweise sehr hoch, bei Patienten mit malignen Tumoren liegt sie bei bis zu 80 %.

Fragestellung

Welche Bedeutung kommt der Bewegungs- und Ernährungstherapie in der Prävention und Therapie der Kachexie zu?

Material und Methoden

Es erfolgte eine Auswertung der aktuellen Literatur zur Bewegungs- und Ernährungstherapie bei Patienten mit Kachexie oder fortgeschrittenen Erkrankungen, bei denen eine hohe Prävalenz der Kachexie wahrscheinlich ist.

Ergebnisse

Es mangelt an wissenschaftlicher Evidenz für den Nutzen von Bewegungstherapie bei Kachexie. Problematisch war bei den relevanten Studien häufig, dass Kachexie nicht nach gültigen Kriterien definiert wurde. Allerdings zeigen erste Studien einen Nutzen von Training bei Patienten mit fortgeschrittenen Erkrankungen, bei denen eine hohe Kachexieprävalenz wahrscheinlich ist. Bezüglich einer Ernährungsintervention scheint eine alleinige Maßnahme geringen Nutzen zu haben. Der Nutzen von ω‑3-Fettsäuren wird kontrovers diskutiert.

Schlussfolgerungen

Wenngleich die Datenlage zu den Effekten einer Bewegungs- und Ernährungstherapie bei Kachexie noch unzureichend ist, gibt es doch zahlreiche und substanzielle Hinweise auf ihren Nutzen. Insgesamt untermauern die vorliegenden Daten die Notwendigkeit eines multimodalen Behandlungsansatzes mit den Komponenten Bewegung, Ernährung und pharmakologische Therapie. Die Notwendigkeit prospektiver Studien ist groß.

Abstract

Background

Cachexia is a multifactorial and complex syndrome characterized by progressive functional impairment and ongoing loss in quality of life, which lead to a deterioration of the prognosis for affected patients. The prevalence of cachexia can be very high and is up to 80 % in patients with malignant tumors.

Objective

The aim of the study was to assess the relevance of exercise and nutrition in the prevention and therapy of cachexia.

Methods

An evaluation of the current literature on exercise and nutritional therapy in patients with cachexia or with advanced stage diseases where a high prevalence of cachexia is probable, was carried out.

Results

There is a lack of scientific evidence for the benefits of exercise in cachexia. A major problem of relevant studies was that cachexia was frequently not defined according to valid criteria; however, data indicate a benefit of exercise training in patients with advanced diseases associated with a high prevalence of cachexia. A solely nutritional intervention and dietary counselling seem to be of minimal benefit. The administration of omega 3 fatty acids is controversially discussed.

Conclusion

Although there is a lack of data on the effects of exercise and nutritional therapy in cachexia, there is evidence for the benefits. The present data indicate the necessity for the use of a multimodal treatment including exercise, nutritional and pharmacological therapy in cachexia. There is a great necessity for prospective studies

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Authors and Affiliations

  1. Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    B. Wilms,  S. M. Schmid, K. Luley & H. Lehnert

  2. Medizinische Onkologie, Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    J. Wiskemann

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Correspondence to S. M. Schmid.

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Interessenkonflikt

B. Wilms, S.M. Schmid, K. Luley, J. Wiskemann und H. Lehnert geben an, dass kein Interessenkonflikt besteht.

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

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M. Hallek, Köln

H. Lehnert, Lübeck

C. Sieber, Nürnberg

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Wilms, B., Schmid, S.M., Luley, K. et al. Prävention und Behandlung der Kachexie. Internist 57, 971–977 (2016). https://doi.org/10.1007/s00108-016-0130-y

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