Gastroenterology

Gastroenterology

Volume 142, Issue 2, February 2012, Pages 266-272.e1
Gastroenterology

Original Research
Clinical—Alimentary Tract
A High-Fiber Diet Does Not Protect Against Asymptomatic Diverticulosis

https://doi.org/10.1053/j.gastro.2011.10.035Get rights and content

Background & Aims

The complications of diverticulosis cause considerable morbidity in the United States; health care expenditures for this disorder are estimated to be $2.5 billion per year. Many physicians and patients believe that a high-fiber diet and frequent bowel movements prevent the development of diverticulosis. Evidence for these associations is poor. We sought to determine whether low-fiber or high-fat diets, diets that include large quantities of red meat, constipation, or physical inactivity increase risk for asymptomatic diverticulosis.

Methods

We performed a cross-sectional study of 2104 participants, 30–80 years old, who underwent outpatient colonoscopy from 1998 to 2010. Diet and physical activity were assessed in interviews using validated instruments.

Results

The prevalence of diverticulosis increased with age, as expected. High intake of fiber did not reduce the prevalence of diverticulosis. Instead, the quartile with the highest fiber intake had a greater prevalence of diverticulosis than the lowest (prevalence ratio = 1.30; 95% confidence interval, 1.13–1.50). Risk increased when calculated based on intake of total fiber, fiber from grains, soluble fiber, and insoluble fiber. Constipation was not a risk factor. Compared to individuals with <7 bowel movements per week, individuals with >15 bower movements per week had a 70% greater risk for diverticulosis (prevalence ratio = 1.70; 95% confidence interval, 1.24–2.34). Neither physical inactivity nor intake of fat or red meat was associated with diverticulosis.

Conclusions

A high-fiber diet and increased frequency of bowel movements are associated with greater, rather than lower, prevalence of diverticulosis. Hypotheses regarding risk factors for asymptomatic diverticulosis should be reconsidered.

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

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    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).

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