Original ResearchClinical—Alimentary TractA High-Fiber Diet Does Not Protect Against Asymptomatic Diverticulosis
Section snippets
Methods
The Diet and Health Studies, Phases III–V (DHS) were cross-sectional studies to assess environmental and lifestyle factors associated with colorectal adenomas. The study methods have been published in detail elsewhere,12, 13, 14 but are summarized here in brief. The DHS recruited patients undergoing an outpatient colonoscopy at the University of North Carolina Hospitals in Chapel Hill, North Carolina. DHS III was conducted between1998 and 2000, DHS IV between 2001 and 2002, and DHS V between
Results
There were 2104 participants; 878 cases of diverticulosis and 1226 controls without diverticula noted in their colonoscopy reports. Of the participants with diverticulosis, 246 (28%) had a record of many (≥3) diverticula, 354 (40%) had few (1 or 2), and the remaining 278 (32%) did not have their diverticular disease quantified. Participants with diverticulosis were more likely to be older, white, overweight or obese, to use tobacco, and to take NSAIDS compared with those without diverticula (
Discussion
In this colonoscopy-based study, a high-fiber diet did not protect against asymptomatic diverticulosis. Instead, we found that a high-fiber diet was associated with a higher prevalence of diverticula. The association was both dose-dependent and stronger when limited to cases with ≥3 diverticula. The risk was increased for total fiber, fiber from grains, soluble fiber, and insoluble fiber. Although constipation is conventionally thought to predispose to diverticulosis, we found that less
References (47)
Natural history of diverticular disease of the colon
Clin Gastroenterol
(1975)- et al.
A population-based study of perforated diverticular disease incidence and associated mortality
Gastroenterology
(2009) - et al.
Burden of digestive diseases in the United States part II: lower gastrointestinal diseases
Gastroenterology
(2009) - et al.
The burden of selected digestive diseases in the United States
Gastroenterology
(2002) - et al.
Symptomless diverticular disease and intake of dietary fibre
Lancet
(1979) - et al.
A diet high in fruits and low in meats reduces the risk of colorectal adenomas
J Nutr
(2007) Dietary guidelines and the results of food consumption surveys
Am J Clin Nutr
(1991)- et al.
Validation of the Stanford 7-day recall to assess habitual physical activity
Ann Epidemiol
(2001) - et al.
A prospective study of diet and the risk of symptomatic diverticular disease in men
Am J Clin Nutr
(1994) - et al.
A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men
Ann Epidemiol
(1995)
Diagnosis and management of diverticular disease of the colon in adultsAd Hoc Practice Parameters Committee of the American College of Gastroenterology
Am J Gastroenterol
Post-mortem studies on the colon with special reference to diverticular disease
Proc R Soc Med
Natural history of diverticulosis of the colon
Am J Dig Dis
Diverticular disease and diverticulitis
Am J Gastroenterol
Clinical practiceDiverticulitis
N Engl J Med
Diverticular disease: three studiesPart I—Relation to other disorders and fibre intake
Br Med J
Fecal beta-sitosterol in patients with diverticular disease of the colon and in vegetarians
Scand J Gastroenterol
Does physical activity modify the association between body mass index and colorectal adenomas?
Nutr Cancer
Consumption of trans-fatty acid and its association with colorectal adenomas
Am J Epidemiol
Comparative validation of the Block, Willett, and National Cancer Institute food frequency questionnaires: the Eating at America's Table Study
Am J Epidemiol
International physical activity questionnaire: 12-country reliability and validity
Med Sci Sports Exerc
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration
Ann Intern Med
Total energy intake: implications for epidemiologic analyses
Am J Epidemiol
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Colonic diverticular bleeding: An update on pathogenesis and management
2023, Disease-a-MonthPrevalence of and Risk Factors for Incidental Colonic Diverticulosis
2022, Journal of Surgical ResearchAssociations between intestinal microbiota, fecal properties, and dietary fiber conditions: The Japanese traditional medicine Junchoto ameliorates dietary fiber deficit–induced constipation with F/B ratio alteration in rats
2022, Biomedicine and PharmacotherapyCitation Excerpt :At initial administration, JCT temporarily reduced the α-diversity index Chao1, although the alteration was not retained after repeated administration. In a previous study, the intestinal microbiota in healthy Japanese men and women were stratified using the Bristol Stool Scale; the study results revealed that there were no differences in the α-diversity index and correlation between the body mass index and F/B ratio among the study groups [22]. On the other hand, a different study concluded that the stool consistency correlated negatively with the α-diversity index [32].
Reply
2022, Clinical Gastroenterology and HepatologyBowel Movement Frequency Linked to Increased Diverticulitis Risk in 2 Prospective Cohort Studies
2022, Clinical Gastroenterology and HepatologyFrequency of Bowel Movements and Risk of Diverticulitis
2022, Clinical Gastroenterology and HepatologyCitation Excerpt :The robustness of these findings was further supported by several sensitivity analyses. The long-held notion that more frequent bowel movements are associated with lower risk of asymptomatic diverticulosis has recently been challenged by cross-sectional studies that found that more frequent bowel movements were associated with higher risk of symptomatic11,12 or asymptomatic13–15 diverticular disease. Data on the association of bowel movements and diverticulitis are scant.
Conflicts of interest The authors disclose no conflicts.
Funding This research was supported by grants from the National Institutes of Health (P30 DK034987; T32 DK07634, R01 CA44684).