Korean J Gastroenterol.  2019 Sep;74(3):142-148. 10.4166/kjg.2019.74.3.142.

Risk Factors for Asymptomatic Colon Diverticulosis

• Bae HJ
• Kim ST
• Hong SG
• Lee H
• Choi HS
• Cho YK
• Kim TH
• Chung SH

• KMID: 2458694
• DOI: http://doi.org/10.4166/kjg.2019.74.3.142

Abstract

BACKGROUND/AIMS
The etiology of colon diverticulosis is related to a range of genetic, biological, and environmental factors, but the risk factors for asymptomatic diverticulosis of the colon are unclear. This study examined the risk factors for asymptomatic colon diverticulosis.
METHODS
This retrospective study included examinees who underwent a colonoscopy for screening at the health check-up center of SAM Hospital between January 2016 and December 2016. The examinees with colon diverticulosis found by colonoscopy were compared with those without diverticulosis. The comparison factors were age, gender, alcohol consumption, smoking status, medical history, lipid profile, body mass index, visceral fat area, waist-hip ratio, and severity of a fatty liver.
RESULTS
This study included 937 examinees and the overall prevalence of diverticulosis was 8.1% (76/937). Fatty liver was found in 69.7% (53/76) in cases of colon diverticulosis and 50.3% (433/861) in the control group (p=0.001). The average waist-hip ratio was 0.92±0.051 in colon diverticulosis and 0.90±0.052 in the control group (p=0.052). Multivariate analysis revealed the waist-hip ratio (OR=1.035, 95% CI 1.000-1.070, p=0.043), moderate fatty liver (OR=2.238, 95% CI 1.026-4.882, p=0.043), and severe fatty liver (OR=5.519, 95% CI 1.236-21.803, p=0.025) to be associated with an increased risk of asymptomatic colon diverticulosis.
CONCLUSIONS
The waist-hip ratio, moderate fatty liver, and severe fatty liver are risk factors for asymptomatic colon diverticulosis. Central obesity, which can be estimated by the waist-hip ratio, and fatty liver might affect the pathogenesis of asymptomatic colon diverticulosis.

Keyword

Diverticulum; Waist-hip ratio; Fatty liver

MeSH Terms

Alcohol Drinking
Body Mass Index
Colon*
Colonoscopy
Diverticulum*
Fatty Liver
Intra-Abdominal Fat
Mass Screening
Multivariate Analysis
Obesity, Abdominal
Prevalence
Retrospective Studies
Risk Factors*
Smoke
Smoking
Waist-Hip Ratio
Smoke

Figure

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  Fig. 1 Prevalence of asymptomatic colon diverticulosis.

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  Fig. 2 Incidence of directions in asymptomatic colon diverticulosis.

Reference

1. Strate LL, Modi R, Cohen E, Spiegel BM. Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights. Am J Gastroenterol. 2012; 107:1486–1493.

2. Spiller RC. Changing views on diverticular disease: impact of aging, obesity, diet, and microbiota. Neurogastroenterol Motil. 2015; 27:305–312.

3. Stollman N, Raskin JB. Diverticular disease of the colon. Lancet. 2004; 363:631–639.

4. Ye H, Losada M, West AB. Diverticulosis coli: update on a “Western” disease. Adv Anat Pathol. 2005; 12:74–80.

5. Nagata N, Niikura R, Aoki T, et al. Increase in colonic diverticulosis and diverticular hemorrhage in an aging society: lessons from a 9-year colonoscopic study of 28,192 patients in Japan. Int J Colorectal Dis. 2014; 29:379–385.

6. Kim SY, Kim YS, Kim HT, et al. A prospective study of factors influencing on the clinical characteristics of colonic diverticulosis. Korean J Gastroenterol. 2013; 62:97–103.

7. Song JH, Kim YS, Lee JH, et al. Clinical characteristics of colonic diverticulosis in Korea: a prospective study. Korean J Intern Med. 2010; 25:140–146.

8. Martel J, Raskin JB. History, incidence, and epidemiology of diverticulosis. J Clin Gastroenterol. 2008; 42:1125–1127.

9. Kopylov U, Ben-Horin S, Lahat A, Segev S, Avidan B, Carter D. Obesity, metabolic syndrome and the risk of development of colonic diverticulosis. Digestion. 2012; 86:201–205.

10. Granlund J, Svensson T, Olén O, et al. The genetic influence on diverticular disease--a twin study. Aliment Pharmacol Ther. 2012; 35:1103–1107.

11. Hjern F, Wolk A, Håkansson N. Obesity, physical inactivity, and colonic diverticular disease requiring hospitalization in women: a prospective cohort study. Am J Gastroenterol. 2012; 107:296–302.

12. Strate LL, Liu YL, Aldoori WH, Syngal S, Giovannucci EL. Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology. 2009; 136:115–122.e1.

13. Nagata N, Niikura R, Shimbo T, et al. Alcohol and smoking affect risk of uncomplicated colonic diverticulosis in Japan. PLoS One. 2013; 8:e81137.

14. Wang FW, Chuang HY, Tu MS, et al. Prevalence and risk factors of asymptomatic colorectal diverticulosis in Taiwan. BMC Gastroenterol. 2015; 15:40.

15. Lee SH, Yun SJ, Kim DH, Jo HH, Park YS. Severity of nonalcoholic fatty liver disease on sonography and risk of coronary heart disease. J Clin Ultrasound. 2017; 45:391–399.

16. Nagata N, Sakamoto K, Arai T, et al. Visceral abdominal obesity measured by computed tomography is associated with increased risk of colonic diverticulosis. J Clin Gastroenterol. 2015; 49:816–822.

17. Burkitt D. Diverticular disease of the colon epidemiological evidence relating it to fibre-depleted diets. Trans Med Soc Lond. 1973; 89:81–84.

18. Lee SP, Ahn YW, Lee OY, Lee KN. The relationship between colonic diverticulosis and abdominal visceral and subcutaneous fat accumulation measured by abdominal CT scan. Turk J Gastroenterol. 2014; 25:192–197.

19. Sahin A, Tunc N, Demirel U, Kursat Poyrazoglu O, Yalniz M, Halil Bahcecioglu I. Relationship between diverticulosis and nonalcoholic fatty liver disease in elderly patients. J Int Med Res. 2018; 46:1545–1554.

20. Tursi A, Mastromarino P, Capobianco D, et al. Assessment of fecal microbiota and fecal metabolome in symptomatic uncomplicated diverticular disease of the colon. J Clin Gastroenterol. 2016; 50 Suppl 1:S9–S12.

21. Barbara G, Scaioli E, Barbaro MR, et al. Gut microbiota, metabolome and immune signatures in patients with uncomplicated diverticular disease. Gut. 2017; 66:1252–1261.

22. Arslan N. Obesity, fatty liver disease and intestinal microbiota. World J Gastroenterol. 2014; 20:16452–16463.

23. Ilan Y. Leaky gut and the liver: a role for bacterial translocation in nonalcoholic steatohepatitis. World J Gastroenterol. 2012; 18:2609–2618.

24. Teixeira C, Trabulo D, Ribeiro S, et al. Colonic diverticulosis and the metabolic syndrome: an association? Rev Esp Enferm Dig. 2017; 109:768–771.

25. Sharara AI, El-Halabi MM, Mansour NM, et al. Alcohol consumption is a risk factor for colonic diverticulosis. J Clin Gastroenterol. 2013; 47:420–425.

26. Peery AF, Barrett PR, Park D, et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology. 2012; 142:266–272.e1.

27. Mathur R, Amichai M, Chua KS, Mirocha J, Barlow GM, Pimentel M. Methane and hydrogen positivity on breath test is associated with greater body mass index and body fat. J Clin Endocrinol Metab. 2013; 98:E698–E702.

28. Pimentel M, Lin HC, Enayati P, et al. Methane, a gas produced by enteric bacteria, slows intestinal transit and augments small intestinal contractile activity. Am J Physiol Gastrointest Liver Physiol. 2006; 290:G1089–G1095.

29. Weaver GA, Krause JA, Miller TL, Wolin MJ. Incidence of methanogenic bacteria in a sigmoidoscopy population: an association of methanogenic bacteria and diverticulosis. Gut. 1986; 27:698–704.

30. Shoelson SE, Herrero L, Naaz A. Obesity, inflammation, and insulin resistance. Gastroenterology. 2007; 132:2169–2180.

31. Delvaux M. Diverticular disease of the colon in Europe: epidemiology, impact on citizen health and prevention. Aliment Pharmacol Ther. 2003; 18 Suppl 3:71–74.

32. Commane DM, Arasaradnam RP, Mills S, Mathers JC, Bradburn M. Diet, ageing and genetic factors in the pathogenesis of diverticular disease. World J Gastroenterol. 2009; 15:2479–2488.

33. Dore MP, Pes GM, Marras G, et al. Risk factors associated with colonic diverticulosis among patients from a defined geographic area. Tech Coloproctol. 2016; 20:177–183.

34. Nakaji S, Danjo K, Munakata A, et al. Comparison of etiology of right-sided diverticula in Japan with that of left-sided diverticula in the West. Int J Colorectal Dis. 2002; 17:365–373.

35. Comstock SS, Lewis MM, Pathak DR, Hortos K, Kovan B, Fenton JI. Cross-sectional analysis of obesity and serum analytes in males identifies sRAGE as a novel biomarker inversely associated with diverticulosis. PLoS One. 2014; 9:e95232.