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A High-Fiber Diet Does Not Protect Against Asymptomatic Diverticulosis

Published:November 07, 2011DOI:https://doi.org/10.1053/j.gastro.2011.10.035

      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.

      Keywords

      Abbreviations used in this paper:

      BMI (body mass index), CI (confidence interval), DHS (Diet and Health Studies), MET (metabolic equivalent), NSAID (nonsteroidal anti-inflammatory drug), PR (prevalence ratio)
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      Linked Article

      • Dietary Fiber and Asymptomatic Diverticulosis
        GastroenterologyVol. 143Issue 3
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          I read with great interest (a) the article by Peery et al,1 which indicates that a high-fiber diet is associated with greater, rather than lower, prevalence of diverticulosis and suggests hypotheses regarding risk factors for asymptomatic diverticulosis should be reconsidered; and (b) the excellent editorial by Strate.2 Although this study has strengths, including the reported wide range in the dietary fiber intake, with examination of overall fiber as well as fiber subtypes, I have 2 serious concerns about its limitations.
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