title: Alcohol consumption is a risk factor for colonic diverticulosis.
abstract: OBJECTIVE
  The exact factors predisposing to colonic diverticulosis other than age are unknown.
  
  
  METHODS
  Cross-sectional study of asymptomatic subjects undergoing screening colonoscopy. A detailed dietary and social questionnaire was completed on all participants. A worldwide review of the literature was performed to further investigate any association between identified risk factors and diverticulosis.
  
  
  RESULTS
  Seven hundred forty-six consecutive individuals were enrolled (mean age, 61.1±8.3 y; female: male=0.98). Overall, the prevalence of diverticulosis was 32.8% (95% CI, 29.5-36.2). Diverticula were left-sided, right-sided, or both in 71.5%, 5.8%, and 22.7% of affected subjects, respectively. On univariate analysis, age, sex, adenomatous polyps, advanced neoplasia (adenoma≥1 cm, villous histology, or cancer), aspirin, and alcohol use were significantly associated with diverticulosis. Diet, body mass index, physical activity, and bowel habits were not associated with the disease. On multivariate analysis, increasing age (P<0.001), advanced neoplasia (P=0.021), and alcohol consumption (P<0.001) were significantly associated with diverticulosis. The adjusted odds ratio for diverticulosis in alcohol users was 1.91 (1.36 to 2.69), with increasing prevalence with higher alcohol consumption (P-value for trend=0.001). When the prevalence of diverticulosis reported from 18 countries was analyzed against alcohol use, there was a strong correlation with national per-capita alcohol consumption rates (Pearson correlation coefficient r=0.68; P=0.002).
  
  
  CONCLUSIONS
  Alcohol use is a significant risk factor for colonic diverticulosis and may offer a partial explanation for the existing East-West paradox in disease prevalence and phenotype. Further studies are needed to investigate this association and its putative pathophysiological mechanisms.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon. as08@aub.edu.lb
authors.forename: Ala I
authors.initials: AI
authors.lastname: Sharara
authors.forename: Mustapha M
authors.initials: MM
authors.lastname: El-Halabi
authors.forename: Nabil M
authors.initials: NM
authors.lastname: Mansour
authors.forename: Ahmad
authors.initials: A
authors.lastname: Malli
authors.forename: Ola A
authors.initials: OA
authors.lastname: Ghaith
authors.forename: Jana G
authors.initials: JG
authors.lastname: Hashash
authors.forename: Karim
authors.initials: K
authors.lastname: Maasri
authors.forename: Assaad
authors.initials: A
authors.lastname: Soweid
authors.forename: Kassem
authors.initials: K
authors.lastname: Barada
authors.forename: Fadi H
authors.initials: FH
authors.lastname: Mourad
authors.forename: Lara
authors.initials: L
authors.lastname: El Zahabi
mesh_terms: D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D003113:Colonoscopy; D003430:Cross-Sectional Studies; D043963:Diverticulosis, Colonic / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires