New Female-centric Research Provides Dietary Guidance for Preventing Diverticulitis

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In 2017, researchers at Massachusetts General Hospital reported in Nature that adherence to a healthy lifestyle, including higher fiber intake, is linked to a substantial decrease in the risk of diverticulitis in men. Andrew T. Chan, MD, MPH, professor of medicine, director for Cancer Epidemiology in the Mass General Cancer Center, chief of the Clinical and Translational Epidemiology Unit (CTEU) in the Department of Medicine and vice chief for clinical research in the Division of Gastroenterology, and colleagues found that the association included both the less severe forms of diverticulitis treated in the outpatient setting and more severe cases that led to hospitalization.

Women are more likely than men to develop severe diverticulitis, especially at older ages. Even so, little is known about how fiber intake influences the risk of the disease in women.

In The American Journal of Gastroenterology, Dr. Chan, Wenjie Ma, MBBS, ScD, research fellow at Massachusetts General Hospital, and colleagues now report that higher intake of fiber is associated with a lower incidence of diverticulitis in women, with apparent variations in the effects of fiber from different food sources.

Study Design

The researchers analyzed data from the Nurses' Health Study, a cohort of U.S. female registered nurses who were 30 to 55 years old at enrollment in 1976. Every two years since then, participants have been mailed detailed questionnaires about their health. Every four years, participants are asked to complete 131-item food frequency questionnaires. In 2008, 2012 and 2014 they were asked questions about diverticulitis and diverticulosis.

In this analysis, as a baseline, the researchers examined data on 50,019 women who had an average age of 55 starting in 1990. The participants were followed until June 2014.

Quintiles of Fiber Intake

The participants were first categorized into quintiles according to their energy-adjusted fiber intake. Compared with women in the lowest quintile of dietary fiber intake, the risk of diverticulitis was reduced by:

• 14% for women in the highest quintile of total fiber intake
• 10% for women in the highest quintile of cereal fiber intake
• 17% for women in the highest quintile of fruit fiber intake
• 8% for women in the highest quintile of vegetable fiber intake, which was not a statistically significant reduction

An Alternative Classification

In a separate analysis the researchers categorized participants into three groups according to daily fiber intake:

• <18 g (18 g was the average intake at baseline)
• 18 g to 24 g
• ≥25 g (25 g is the recommended total fiber intake for women)

Compared with women who consumed less than 18 g of fiber per day, those consuming ≥25 g had a 13% reduced risk of developing diverticulitis.

Specific Foods

The risk of diverticulitis was reduced by a significant 5% for every serving increase of total fruit intake daily. Increased intake of apples or pears, and increased intake of prunes, were significantly associated with a lower risk of diverticulitis, independent of total fruit intake.

Fruit juice and vegetable intake were not significantly associated with the risk of diverticulitis.

Counseling Patients

These findings support the U.S. government's recommendation to maintain sufficient fiber intake from diet, especially cereals and fruit.

Overall intake of fruit may be more important than individual fruits in influencing the risk of diverticulitis. Apples and pears did have the strongest associations, but in this study those fruits were by far the most commonly consumed, contributing to 26% of total fruit fiber intake.

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