Intest Res.  2020 Jan;18(1):121-129. 10.5217/ir.2019.00106.

Vegetarianism as a protective factor for asymptomatic colonic diverticulosis in Asians: a retrospective cross-sectional and case-control study

• Bong J
• Kang HW
• Cho H
• Nam JH
• Jang DK
• Kim JH
• Lee JK
• Lim YJ
• Koh MS
• Lee JH

• KMID: 2501374
• DOI: http://doi.org/10.5217/ir.2019.00106

Abstract

Background/Aims
Dietary fiber intake is considered a protective factor for diverticular disease such as diverticulitis. However, evidence for an inverse connection between dietary fiber consumption and asymptomatic colonic diverticulosis is lacking. Specifically, few studies have investigated this subject in Asians with different presentations of diverticulosis. Therefore, we assessed the protective effects of a vegetarian diet for asymptomatic colonic diverticulosis in Buddhist monks who are obligatory vegetarians for spiritual reasons compared with the general population.
Methods
A retrospective, cross-sectional, case-control study was conducted in age- and sex-matched Buddhist monks and the general population who underwent colonoscopy for screening at a Korean health promotion center from August 2005 to June 2018. We compared the prevalence of asymptomatic diverticulosis between the 2 groups using a self-administered questionnaire.
Results
In this study, a total of 1,316 individuals were included (Buddhist monks of 658 and general population of 658) with a mean age of 52.6±9.5 years. The prevalence of asymptomatic diverticulosis in Buddhist monks was lower compared with the general population (6.7% [44/658] vs. 10.8% [71/658], P=0.008). Buddhist monks had a higher rate of high body mass index (BMI) and metabolic syndrome. By a multivariate regression analysis model, a nonvegetarian diet (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.21–2.72, P=0.004), old age (OR, 4.53; 95% CI, 1.36–15.12; P=0.014), male sex (OR, 1.91; 95% CI, 1.28–2.85; P=0.002), and a high BMI (OR, 1.50; 95% CI, 1.01–2.23; P=0.047) were independent predictors of asymptomatic diverticulosis. Moreover, a nonvegetarian diet was associated with both right-sided and left-sided diverticulosis.
Conclusions
A nonvegetarian diet may increase a risk of asymptomatic colonic diverticulosis in Asians.

Keyword

Diet, vegetarian; Buddhism; Asymptomatic; Diverticulosis

Figure

• 

  Fig. 1. Flow diagram of study population in this study.

Reference

1. Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol. 1975; 4:53–69.

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

3. Floch MH, Bina I. The natural history of diverticulitis: fact and theory. J Clin Gastroenterol. 2004; 38(5 Suppl 1):S2–S7.

4. Sandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive diseases in the United States. Gastroenterology. 2002; 122:1500–1511.

5. Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology. 2009; 136:741–754.

6. Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012; 143:1179–1187.

7. Kang JY, Hoare J, Tinto A, et al. Diverticular disease of the colon--on the rise: a study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther. 2003; 17:1189–1195.

8. Shaheen NJ, Hansen RA, Morgan DR, et al. The burden of gastrointestinal and liver diseases, 2006. Am J Gastroenterol. 2006; 101:2128–2138.

9. Levy N, Stermer E, Simon J. The changing epidemiology of diverticular disease in Israel. Dis Colon Rectum. 1985; 28:416–418.

10. Fong SS, Tan EY, Foo A, Sim R, Cheong DM. The changing trend of diverticular disease in a developing nation. Colorectal Dis. 2011; 13:312–316.

11. Toda S, Ito Y, Mizuno M, et al. Asymptomatic diverticulosis identified by computed tomography is not a risk factor for enteric peritonitis. Nephrol Dial Transplant. 2012; 27:2511–2516.

12. Kiguli-Malwadde E, Kasozi H. Diverticular disease of the colon in Kampala, Uganda. Afr Health Sci. 2002; 2:29–32.

13. Song JH, Huh JG, Kim YS, et al. Clinical characteristics of colonic diverticular disease diagnosed with colonoscopy. Intest Res. 2008; 6:110–115.

14. 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.

15. Liu PH, Cao Y, Keeley BR, et al. Adherence to a healthy lifestyle is associated with a lower risk of diverticulitis among men. Am J Gastroenterol. 2017; 112:1868–1876.

16. Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Trichopoulos DV, Willett WC. A prospective study of diet and the risk of symptomatic diverticular disease in men. Am J Clin Nutr. 1994; 60:757–764.

17. Painter NS, Burkitt DP. Diverticular disease of the colon: a deficiency disease of Western civilization. Br Med J. 1971; 2:450–454.

18. Fisher N, Berry CS, Fearn T, Gregory JA, Hardy J. Cereal dietary fiber consumption and diverticular disease: a lifespan study in rats. Am J Clin Nutr. 1985; 42:788–804.

19. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005; 112:2735–2752.

20. Kwoen YT, Han SI, Chung SK, Bahk YW. Changing incidence of diverticular disease of the colon in Korea: a serial radiologic study (report III). J Korean Radiol Soc. 1988; 24:840–843.

21. 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.

22. 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.

23. Seo HK. Dietary life in Buddhist temple. J Korean Soc Food Cult. 1995; 10:497–503.

24. Han SJ, Lee SY. A study on dietary behavior and food preference of Sramanera·Sramanerika monks in nationwide Buddhist monk’s universities. Korean J Community Nutr. 2017; 22:387–400.

25. Seo HK. Food culture of Buddhism. Asian Comp Folk. 2003; 24:197–226.

26. Lee Y, Krawinkel M. Body composition and nutrient intake of Buddhist vegetarians. Asia Pac J Clin Nutr. 2009; 18:265–271.

27. 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.

28. Comparato G, Pilotto A, Franzè A, Franceschi M, Di Mario F. Diverticular disease in the elderly. Dig Dis. 2007; 25:151–159.

29. Yamamichi N, Shimamoto T, Takahashi Y, et al. Trend and risk factors of diverticulosis in Japan: age, gender, and lifestyle/metabolic-related factors may cooperatively affect on the colorectal diverticula formation. PLoS One. 2015; 10:e0123688.

30. Jacobs DO. Clinical practice: diverticulitis. N Engl J Med. 2007; 357:2057–2066.

31. Welch CE, Allen AW, Donaldson GA. An appraisal of resection of the colon for diverticulitis of the sigmoid. Ann Surg. 1953; 138:332–343.

32. Painter NS, Truelove SC, Ardran GM, Tuckey M. Segmentation and the localization of intraluminal pressures in the human colon, with special reference to the pathogenesis of colonic diverticula. Gastroenterology. 1965; 49:169–177.

33. Choi CS, Choi SC, Seo GS, et al. Association between diverticulosis and colonic neoplasm in Koreans. Korean J Gastroenterol. 2007; 49:364–368.

34. Kim JS, Cha SG, Kim YT, et al. The prevalence and clinical features of diverticular disease of the colon. Korean J Gastroenterol. 1993; 25:305–314.

35. Yang F, Zheng Y, Jiang X, et al. Sex differences in risk factors of uncomplicated colonic diverticulosis in a metropolitan area from Northern China. Sci Rep. 2018; 8:138.

36. Aune D, Sen A, Leitzmann MF, Norat T, Tonstad S, Vatten LJ. Body mass index and physical activity and the risk of diverticular disease: a systematic review and meta-analysis of prospective studies. Eur J Nutr. 2017; 56:2423–2438.

37. Sun Z, Welty FK, Dolnikowski GG, Lichtenstein AH, Schaefer EJ. Effects of a National Cholesterol Education Program Step II Diet on apolipoprotein A-IV metabolism within triacylglycerol-rich lipoproteins and plasma. Am J Clin Nutr. 2001; 74:308–314.

38. Yoon JS, Lee WJ. A nutritional survey of Buddhist nuns. J Nutr Health. 1982; 15:268–276.

39. Jung JG, Kang HW, Hahn SJ, et al. Vegetarianism as a protective factor for reflux esophagitis: a retrospective, cross-sectional study between Buddhist priests and general population. Dig Dis Sci. 2013; 58:2244–2252.

40. Lee CG, Hahn SJ, Song MK, et al. Vegetarianism as a protective factor for colorectal adenoma and advanced adenoma in Asians. Dig Dis Sci. 2014; 59:1025–1035.

41. Jo HB, Lee JK, Choi MY, et al. Is the prevalence of gallbladder polyp different between vegetarians and general population? Korean J Gastroenterol. 2015; 66:268–273.

42. Park HY, Lee SY, Lee YH. A study of dietary life and state of health of Buddhist nuns in the Seoul area. J East Asian Soc Dietary Life. 2002; 12:343–351.

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

44. Hjern F, Wolk A, Håkansson N. Smoking and the risk of diverticular disease in women. Br J Surg. 2011; 98:997–1002.

45. Kinjo K, Matsui T, Hisabe T, et al. Risk factors for severity of colonic diverticular hemorrhage. Intest Res. 2018; 16:458–466.