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Key findings

  • Among participants in a gastrointestinal disease registry, overweight and obesity were associated with significantly increased prevalence of diverticulosis even after adjusting for traditional risk factors
  • Compared with participants who had a normal body mass index, overweight participants had three times the risk of diverticulosis; obese participants had over four times the risk
  • The prevalence of diverticulosis was higher among individuals with lower amounts of physical activity, but that association did not reach statistical significance

Research into risk factors for colonic diverticulosis is scarce, and studies of the role of obesity and physical activity have shown inconsistent results. Now, using prospectively collected lifestyle data, gastroenterologist Hamed Khalili, MD, MPH, and colleagues have determined that there's a significant association between obesity and diverticulosis. The study was published in Clinical Gastroenterology and Hepatology.

Using the GI Disease and Endoscopy Registry at Massachusetts General Hospital, researchers identified 223 adults at average risk who:

  • Underwent routine colonoscopy
  • Did not have a serious gastrointestinal disease
  • Completed a detailed questionnaire on lifestyle and medical diagnoses.

The average age of the cohort was 61. Altogether, 39.5% of participants were overweight (body mass index [BMI] 25.0–29.9 kg/m2) and 32.3% were obese (BMI ≥30.0 kg/m2).

Dr. Khalili's group confirmed diverticulosis in 86 participants (38.6%). The rates of diverticulosis were 22.2% in the normal BMI group, 42.1% in the overweight group and 48.6% in the obese group.

The researchers conducted multivariable analysis that adjusted for age, physical activity, BMI, dietary pattern (Western standard diet, low red meat or no red meat), smoking and number of daily bowel movements. Compared with participants who had a normal BMI, the odds ratio of diverticulosis was 3.02 (95% CI, 1.33–6.88) among overweight participants and 4.43 (95% CI, 1.88–10.49) among obese participants.

When investigating the influence of physical activity, the research group confirmed diverticulosis among 50% of participants with <9 metabolic equivalent task hours (MET-h) per week, 36.9% of those with 9.0 to 26.9 MET-h per week and 31.9% of those with ≥27.0 MET-h per week. However, in multivariable analysis, there was no significant association between physical activity and the prevalence of diverticulosis.

The association between BMI and diverticulosis does not imply causation. Even so, these findings do reveal that obesity could play a role in the pathogenesis of diverticulosis.

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