Diverticulosis and Diverticular Disease
Causes and Risk Factors
Factors currently known to increase risk of diverticulosis include advancing age, obesity (especially central or visceral obesity), and smoking (Comstock 2014; Nagata 2014; Spiller 2015; Medina-Fernandez 2015; Nagata 2013).
Several factors increase the risk of progression from diverticulosis to diverticular disease (Peery 2013; von Rahden 2012):
Low-fiber diet. In a study of 47 033 healthy adults followed for an average of 11.6 years, those with the highest dietary fiber intake (>25 g daily) were 41% less likely to be hospitalized for diverticular disease compared with those with the lowest intake (<14 g daily) (Crowe 2011). A four-year study in over 43 000 participants found that those with the highest intake of insoluble fiber had an approximately 40% lower risk of diverticular disease (Aldoori 1998).
Sedentary lifestyle. Several studies have found that increased physical activity appears to be protective against diverticular disease (Aldoori, Giovannucci, Rimm, Ascherio 1995; Williams 2009).
Obesity. Most studies show that higher body mass index, obesity, and abdominal obesity increase the risk of diverticular disease and its complications (Spiller 2015; Bose 2013; Dobbins 2006; Strate, Liu, Aldoori, Syngal 2009; Sorser 2009).
Smoking. Most studies suggest smokers are at increased risk of complications of diverticular disease, particularly perforation, but also abscess and hospitalization (Turunen 2010; Papagrigoriadis 1999; Collins 2015; Hjern 2011; Aldoori, Giovannucci, Rimm, Wing 1995).
Alcohol. Research into alcohol consumption and risk of diverticular disease has been inconclusive (Aldoori 2002; Strate 2012), though a study that included 23 people under age 50 found that in that age group, chronic alcohol consumption was associated with greater than three-fold odds of having an episode of acute diverticulitis (Pisanu 2013).
Non-steroidal anti-inflammatory drugs (NSAIDs), pain relievers, and steroids. The use of aspirin and other NSAIDs such as ibuprofen; opioid pain relievers such as codeine; and corticosteroids, especially inhaled steroids used to treat asthma, appear to increase the risk of diverticulitis and its complications (Hjern 2015; Kvasnovsky 2014; Strate 2011).