Excessive Body Weight and Diverticular Disease

Abstract

<b><i>Background:</i></b> The worldwide proportion of overweight adults almost doubled from 22% in 1975 to 39% in 2016. Comparably, for the USA and Germany in 2016, the proportion was 68 and 56.8%, respectively. In Olmsted County, Minnesota, the prevalence of diverticulitis also doubled between 1980 and 2007, from 19 to 40%. Obesity substantially increases the risk of multiple gastrointestinal (GI) diseases and non-GI diseases. In a narrative review, we examined the evidence on whether obesity also increases the risk for the development of diverticulosis or diverticular disease and its outcome. <b><i>Summary:</i></b> Evidence suggests that being overweight (body mass index ≥25 kg/m<sup>2</sup>) or obese (≥30 kg/m<sup>2</sup>), especially viscerally obese, is a risk factor for diverticulosis, diverticular disease and diverticulitis, diverticular bleeding, more severe or complicated disease, recurrent disease, and for worse outcomes after surgery. <b><i>Key Messages:</i></b> There is a well-founded association between overweight and diverticular disease as well as diverticulosis. It is not clear whether overweight per se or confounders linked with it are responsible for the association. However, means to fight the overweight and obesity epidemic might also help to reduce the prevalence of morbidity and mortality from diverticular disease.

Phenome-wide Mendelian randomization study of plasma triglycerides and 2,600 disease traits

“…For example, studies had documented positive correlations between leiomyoma risk and plasma TG levels (Uimari et al, 2016) (Tonoyan et al, 2021) (Peshkova et al, 2020). Others had shown diverticular disease risk is positively associated with BMI, body fat percentage, and visceral fat area (Shih et al, 2022) (Freckelton et al, 2018) (Böhm, 2021). Similarly, kidney stones have been associated with the triglyceride-glucose (TyG) index (Qin et al, 2021), and atrial tachycardias have been associated with VLDL levels in metabolic syndrome patients (Lee et al, 2017) (Park & Lee, 2018).…”

S3-Leitlinie Divertikelkrankheit/Divertikulitis – Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV)

“…Schließlich konnte eine Analyse der Nurses Health Study an 1048 Patienten ebenfalls eine Assoziation zwischen Übergewicht und rezidivierenden Divertikulitiden nachweisen. Hierbei hatten Frauen mit einem BMI ≥ 30,0 kg/m 2 ein höheres Risiko für eine Rezidivdivertikulitis (HR 1,66), (95 % CI, 1,09–2,51; p = 0,002) im Vergleich zu Frauen mit einem BMI < 22,5 kg/m 2 , HR 1,44 (95 % CI, 1,16–1,79; p = < 0,001), 167 252 .…”

Trends and Disparities in Colonic Diverticular Disease Hospitalizations in Patients With Morbid Obesity: A Decade-Long Joinpoint Analysis

“…Reports are conflicting on the relationship between obesity and asymptomatic diverticulosis [10]. Some studies have shown that there is no relationship [11], while others have demonstrated an increased incidence of asymptomatic diverticulosis in obese patients [12,13].…”

“…There is more clarity of evidence linking CDD to obesity. Obesity has been associated with progression from colonic diverticula to CDD, diverticular hemorrhage, diverticulitis, perforations, more severe or complicated disease, recurrent diverticulitis, and worse outcomes following surgical intervention [11,[13][14][15]. However, it is unclear if morbid obesity (MO) is associated with worse outcomes in patients admitted for CDD.…”