title: Constipation and a low-fiber diet are not associated with diverticulosis.
abstract: OBJECTIVE
  Asymptomatic diverticulosis is commonly attributed to constipation caused by a low-fiber diet, although evidence for this mechanism is limited. We examined the associations between constipation and low dietary fiber intake with risk of asymptomatic diverticulosis.
  
  
  METHODS
  We performed a cross-sectional study that analyzed data from 539 individuals with diverticulosis and 1569 without (controls). Participants underwent colonoscopy and assessment of diet, physical activity, and bowel habits. Our analysis was limited to participants with no knowledge of their diverticular disease to reduce the risk of biased responses.
  
  
  RESULTS
  Constipation was not associated with an increased risk of diverticulosis. Participants with less frequent bowel movements (<7/wk) had reduced odds of diverticulosis compared with those with regular bowel movements (7/wk) (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.40-0.80). Those reporting hard stools also had reduced odds (OR, 0.75; 95% CI, 0.55-1.02). There was no association between diverticulosis and straining (OR, 0.85; 95% CI, 0.59-1.22) or incomplete bowel movement (OR, 0.85; 95% CI, 0.61-1.20). We found no association between dietary fiber intake and diverticulosis (OR, 0.96; 95% CI, 0.71-1.30) in comparing the highest quartile with the lowest (mean intake, 25 vs 8 g/day).
  
  
  CONCLUSIONS
  In our cross-sectional, colonoscopy-based study, neither constipation nor a low-fiber diet was associated with an increased risk of diverticulosis.
authors.affiliation: University of North Carolina School of Medicine, Chapel Hill, North Carolina. Electronic address: anne_peery@med.unc.edu.
authors.forename: Anne F
authors.initials: AF
authors.lastname: Peery
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Ahnen
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Galanko
authors.forename: Adrian N
authors.initials: AN
authors.lastname: Holm
authors.forename: Aasma
authors.initials: A
authors.lastname: Shaukat
authors.forename: Leila A
authors.initials: LA
authors.lastname: Mott
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Barry
authors.forename: David A
authors.initials: DA
authors.lastname: Fried
authors.forename: John A
authors.initials: JA
authors.lastname: Baron
mesh_terms: D000328:Adult; D000368:Aged; D003113:Colonoscopy; D003248:Constipation / Q000150:complications*; D003430:Cross-Sectional Studies; D004043:Dietary Fiber / Q000008:administration & dosage*; D004240:Diverticulum / Q000453:epidemiology*; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D018570:Risk Assessment
keywords: BMI; CI; Database Analysis; Diverticular Disease; NSAID; OR; Risk Factors; body mass index; confidence interval; nonsteroidal anti-inflammatory drug; odds ratio
references.citation: East Afr Med J. 1998 Sep;75(9):540-3
references.pmid: 10493058
references.citation: Digestion. 1982;24(1):42-6
references.pmid: 6813167
references.citation: Ann Intern Med. 2007 Oct 16;147(8):W163-94
references.pmid: 17938389
references.citation: Lancet. 1979 Mar 10;1(8115):511-4
references.pmid: 85104
references.citation: Gut. 1969 Jul;10(7):534-42
references.pmid: 5806933
references.citation: Scand J Gastroenterol. 1977;12(7):857-64
references.pmid: 594654
references.citation: JAMA. 2008 Aug 27;300(8):907-14
references.pmid: 18728264
references.citation: Gut. 1995 Feb;36(2):276-82
references.pmid: 7883230
references.citation: Arq Gastroenterol. 1984 Oct-Dec;21(4):157-63
references.pmid: 6536253
references.citation: Am J Prev Med. 2000 Jan;18(1):38-45
references.pmid: 10808981
references.citation: Lancet. 1969 Sep 13;2(7620):586-8
references.pmid: 4186011
references.citation: Scand J Gastroenterol. 1976;11(6):581-6
references.pmid: 981962
references.citation: Gastroenterology. 2009 Jan;136(1):115-122.e1
references.pmid: 18996378
references.citation: Gastroenterology. 2012 Feb;142(2):205-7
references.pmid: 22185897
references.citation: Afr J Med Med Sci. 1989 Dec;18(4):241-4
references.pmid: 2558553
references.citation: J R Coll Surg Edinb. 1985 Apr;30(2):118-22
references.pmid: 2991507
references.citation: Nat Clin Pract Gastroenterol Hepatol. 2005 Nov;2(11):536-44
references.pmid: 16355159
references.citation: Ann Epidemiol. 1995 May;5(3):221-8
references.pmid: 7606311
references.citation: Dis Colon Rectum. 2001 Dec;44(12):1814-20
references.pmid: 11742167
references.citation: Scand J Surg. 2010;99(1):14-7
references.pmid: 20501352
references.citation: Br J Surg. 2011 Jul;98(7):997-1002
references.pmid: 21462366
references.citation: Epidemiology. 1990 Jan;1(1):58-64
references.pmid: 2081241
references.citation: Med Sci Sports Exerc. 2003 Aug;35(8):1381-95
references.pmid: 12900694
references.citation: Ann Surg. 1953 Sep;138(3):332-43
references.pmid: 13080959
references.citation: Gastroenterology. 2012 Feb;142(2):266-72.e1
references.pmid: 22062360
references.citation: Am J Clin Nutr. 1994 Nov;60(5):757-64
references.pmid: 7942584
references.citation: Dis Colon Rectum. 2008 Apr;51(4):450-5
references.pmid: 18157570
references.citation: Am J Gastroenterol. 2009 May;104(5):1221-30
references.pmid: 19367267
references.citation: Gastroenterology. 2012 Nov;143(5):1179-1187.e3
references.pmid: 22885331
references.citation: Dig Dis. 2012;30(1):24-8
references.pmid: 22572681
references.citation: Korean J Intern Med. 2010 Jun;25(2):140-6
references.pmid: 20526386
references.citation: Gastroenterology. 1965 Aug;49:169-77
references.pmid: 14323727
references.citation: Arq Gastroenterol. 1994 Oct-Dec;31(4):135-44
references.pmid: 7575173
references.citation: Am J Epidemiol. 1986 Jul;124(1):17-27
references.pmid: 3521261
references.citation: Dig Dis Sci. 2011 Jul;56(7):2120-3
references.pmid: 21221792
references.citation: Dis Colon Rectum. 2000 Oct;43(10):1412-8
references.pmid: 11052519
references.citation: Br Med J. 1971 May 22;2(5759):450-4
references.pmid: 4930390