Dietary Risk Factors: Fiber and Beyond

Abstract

The incidence of diverticulosis continues to rise throughout western nations with collateral increases in the frequency of diverticulitis. However, the mechanism behind the transition from asymptomatic diverticulosis to complicated diverticulitis is incompletely understood. Dietary intake has long been investigated as one of, if not the main, links in the continuum of disease. As the world's diet continues to evolve with increasingly prevalent processed and high-fat food, longitudinal studies have emerged with a goal of finally explaining how diet influences the development of diverticulitis. While low-fiber, high-fat diets are believed to play a role in the development of an index episode of diverticulitis, the role in recurrent disease remains uncertain. More recent avenues of interest include the role of the microbiome, probiotics, and adjunct treatments such as 5-ASA and rifaximin. While robust longitudinal studies have identified an association between low-fiber, high-fat diets and the development of index diverticulitis, the impact of dietary composition and modification on disease recurrence remains unclear and fails to meet the threshold for societal recommendations.

Keywords

diverticulosis - diverticulitis - diet - fiber

Publikationsverlauf

Artikel online veröffentlicht:
04. Oktober 2024

• References

• 1 Ma W, Nguyen LH, Song M. et al. Intake of dietary fiber, fruits, and vegetables and risk of diverticulitis. Am J Gastroenterol 2019; 114 (09) 1531-1538
• 2 Painter NS, Burkitt DP. Diverticular disease of the colon: a deficiency disease of Western civilization. BMJ 1971; 2 (5759) 450-454
• 3 Peery AF, Barrett PR, Park D. et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology 2012; 142 (02) 266-72.e1
• 4 Koprowski MA, Affleck A, Tsikitis VL. Emerging evidence and recent controversies in diverticulitis: a 5-year review. Ann Gastroenterol 2022; 35 (01) 8-16
• 5 Thornblade LW, Simianu VV, Davidson GH, Flum DR. Elective surgery for diverticulitis and the risk of recurrence and ostomy. Ann Surg 2021; 273 (06) 1157-1164
• 6 Zidar N. Why do we have to look deep to understand diverticulitis?. Am J Gastroenterol 2019; 114 (08) 1347-1348
• 7 Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Trichopoulos DV, Willett WC. A prospective study of diet and the risk of symptomatic diverticular disease in men. Am J Clin Nutr 1994; 60 (05) 757-764
• 8 Strate LL, Keeley BR, Cao Y, Wu K, Giovannucci EL, Chan AT. Western dietary pattern increases, and prudent dietary pattern decreases, risk of incident diverticulitis in a prospective cohort study. Gastroenterology 2017; 152 (05) 1023-1030.e2
• 9 Cao Y, Strate LL, Keeley BR. et al. Meat intake and risk of diverticulitis among men. Gut 2018; 67 (03) 466-472
• 10 Grundy A, Poirier AE, Khandwala F, McFadden A, Friedenreich CM, Brenner DR. Cancer incidence attributable to insufficient fibre consumption in Alberta in 2012. CMAJ Open 2017; 5 (01) E7-E13
• 11 Nomura AMY, Hankin JH, Henderson BE. et al. Dietary fiber and colorectal cancer risk: the multiethnic cohort study. Cancer Causes Control 2007; 18 (07) 753-764
• 12 Schatzkin A, Mouw T, Park Y. et al. Dietary fiber and whole-grain consumption in relation to colorectal cancer in the NIH-AARP Diet and Health Study. Am J Clin Nutr 2007; 85 (05) 1353-1360
• 13 Terry P, Giovannucci E, Michels KB. et al. Fruit, vegetables, dietary fiber, and risk of colorectal cancer. J Natl Cancer Inst 2001; 93 (07) 525-533
• 14 Bharucha AE, Lacy BE. Mechanisms, evaluation, and management of chronic constipation. Gastroenterology 2020; 158 (05) 1232-1249.e3
• 15 Roberson JL, Maguire LM. Does alteration of the microbiome cause diverticular disease?. Clin Colon Rectal Surg 2023; 36 (02) 146-150
• 16 Jones RB, Fodor AA, Peery AF. et al. An aberrant microbiota is not strongly associated with incidental colonic diverticulosis. Sci Rep 2018; 8 (01) 4951
• 17 Aune D, Sen A, Leitzmann MF, Tonstad S, Norat T, Vatten LJ. Tobacco smoking and the risk of diverticular disease: a systematic review and meta-analysis of prospective studies. Colorectal Dis 2017; 19 (07) 621-633
• 18 Aune D, Sen A, Leitzmann MF, Norat T, Tonstad S, Vatten LJ. Body mass index and physical activity and the risk of diverticular disease: a systematic review and meta-analysis of prospective studies. Eur J Nutr 2017; 56 (08) 2423-2438
• 19 Hall J, Hardiman K, Lee S. , et al. Prepared on behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. Dis Colon Rectum 2020; 63 (06) 728-747
• 20 Narula N, Marshall JK. Role of probiotics in management of diverticular disease. J Gastroenterol Hepatol 2010; 25 (12) 1827-1830
• 21 Tursi A, Brandimarte G, Giorgetti GM, Elisei W, Aiello F. Balsalazide and/or high-potency probiotic mixture (VSL#3) in maintaining remission after attack of acute, uncomplicated diverticulitis of the colon. Int J Colorectal Dis 2007; 22 (09) 1103-1108
• 22 Di Mario F, Aragona G, Leandro G. et al. Efficacy of mesalazine in the treatment of symptomatic diverticular disease. Dig Dis Sci 2005; 50 (03) 581-586
• 23 Tursi A, Brandimarte G, Elisei W. et al. Randomised clinical trial: mesalazine and/or probiotics in maintaining remission of symptomatic uncomplicated diverticular disease—a double-blind, randomised, placebo-controlled study. Aliment Pharmacol Ther 2013; 38 (07) 741-751
• 24 Bianchi M, Festa V, Moretti A. et al. Meta-analysis: long-term therapy with rifaximin in the management of uncomplicated diverticular disease. Aliment Pharmacol Ther 2011; 33 (08) 902-910