Gastroenterology

Gastroenterology

Volume 136, Issue 1, January 2009, Pages 115-122.e1
Gastroenterology

Clinical—Alimentary Tract
Obesity Increases the Risks of Diverticulitis and Diverticular Bleeding

https://doi.org/10.1053/j.gastro.2008.09.025Get rights and content

Background & Aims

Studies of obesity and diverticular complications are limited. We assessed the relationship between body mass index (BMI), waist circumference, and waist-to-hip ratio and diverticulitis and diverticular bleeding.

Methods

A prospective cohort study of 47,228 male health professionals (40–75 years old) who were free of diverticular disease in 1986 (baseline) was performed. Men reporting newly diagnosed diverticular disease on biennial follow-up questionnaires were sent supplemental questionnaires. Weight was recorded every 2 years, and data on waist and hip circumferences were collected in 1987.

Results

We documented 801 incident cases of diverticulitis and 383 incident cases of diverticular bleeding during 18 years of follow-up. After adjustment for other risk factors, men with a BMI ≥30 kg/m2 had a relative risk (RR) of 1.78 (95% confidence interval [CI], 1.08–2.94) for diverticulitis and 3.19 (95% CI, 1.45–7.00) for diverticular bleeding compared with men with a BMI of <21 kg/m2. Men in the highest quintile of waist circumference, compared with those in the lowest, had a multivariable RR of 1.56 (95% CI, 1.18–2.07) for diverticulitis and 1.96 (95% CI, 1.30–2.97) for diverticular bleeding. Waist-to-hip ratio was also associated with the risk of diverticular complications when the highest and lowest quintiles were compared, with a multivariable RR of 1.62 (95% CI, 1.23–2.14) for diverticulitis and 1.91 (95% CI, 1.26–2.90) for diverticular bleeding. Adjustment for BMI did not change the associations seen for waist-to-hip ratio.

Conclusions

In this large prospective cohort, BMI, waist circumference, and waist-to-hip ratio significantly increased the risks of diverticulitis and diverticular bleeding.

Section snippets

Study Population

The study cohort consisted of 51,529 male dentists, veterinarians, pharmacists, optometrists, osteopathic physicians, and podiatrists who have been prospectively followed up as part of the Health Professionals Follow-up Study. At baseline in 1986, participants were between the ages of 40 and 75 years and returned detailed questionnaires concerning diet, lifestyle, and medical history. Medical information has been updated biennially and dietary information every 4 years via self-administered

Results

During 730,446 person-years of follow-up, we identified 801 incident cases of diverticulitis and 383 incident cases of diverticular bleeding. At baseline, 3.7% of men had a BMI <21 kg/m2, 29.8% a BMI between 23 and 25 kg/m2, and 8.1% a BMI of at least 30 kg/m2. The associations between baseline characteristics and BMI, waist circumference, and waist-to-hip ratio were similar (Table 1). Men with elevated BMI, waist circumference, and/or waist-to-hip ratio were on average more likely to be

Discussion

In this large prospective cohort of men, we found that BMI was independently associated with the risk of diverticulitis and diverticular bleeding. Positive associations were also found between weight gain, waist circumference, and waist-to-hip ratio, further implicating body fat as a risk factor for diverticular complications. The strength of the relationship between obesity and each anthropometric measurement was similar after adjustment for other potential confounders and when restricting the

References (50)

  • W.H. Aldoori et al.

    A prospective study of diet and the risk of symptomatic diverticular disease in men

    Am J Clin Nutr

    (1994)
  • W.H. Aldoori et al.

    A prospective study of dietary fiber types and symptomatic diverticular disease in men

    J Nutr

    (1998)
  • J.N. Davis et al.

    Normal-weight adults consume more fiber and fruit than their age- and height-matched overweight/obese counterparts

    J Am Diet Assoc

    (2006)
  • R.L. Levy et al.

    The association of gastrointestinal symptoms with weight, diet, and exercise in weight-loss program participants

    Clin Gastroenterol Hepatol

    (2005)
  • N.H. Stollman et al.

    Diagnosis and management of diverticular disease of the colon in adultsAd Hoc Practice Parameters Committee of the American College of Gastroenterology

    Am J Gastroenterol

    (1999)
  • N.J. Shaheen et al.

    The burden of gastrointestinal and liver diseases, 2006

    Am J Gastroenterol

    (2006)
  • C.E. Welch et al.

    An appraisal of resection of the colon for diverticulitis of the sigmoid

    Ann Surg

    (1953)
  • J.L. Horner

    Natural history of diverticulosis of the colon

    Am J Dig Dis

    (1958)
  • Overweight, obesity, and health riskNational Task Force on the Prevention and Treatment of Obesity

    Arch Intern Med

    (2000)
  • D.S. Michaud et al.

    Physical activity, obesity, height, and the risk of pancreatic cancer

    JAMA

    (2001)
  • J.R. Korzenik

    Case closed?Diverticulitis: epidemiology and fiber

    J Clin Gastroenterol

    (2006)
  • R.E. Ley et al.

    Microbial ecology: human gut microbes associated with obesity

    Nature

    (2006)
  • C. Dobbins et al.

    The relationship of obesity to the complications of diverticular disease

    Colorectal Dis

    (2006)
  • P.R. Schauer et al.

    Virulent diverticular disease in young obese men

    Am J Surg

    (1992)
  • J. Schweitzer et al.

    Acute diverticulitis in the young adult is not “virulent”

    Am Surg

    (2002)
  • Cited by (0)

    The authors disclose the following: Supported by grants from the Agency for Healthcare Research and Quality (K08 HS14062 to L.L.S.), the National Cancer Institute (PO1CA055075 to E.L.G. and K24 CA113433 to S.S.), and the National Heart, Lung, and Blood Institute (R01 HL035464 to E.L.G.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute, the National Institutes of Health, or the Agency for Healthcare Research and Quality. The funding sources had no role in the design, conduct, or reporting of this study.

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