Risk factors of admission for acute colonic diverticulitis in a population-based cohort study: The North Trondelag Health Study, Norway

Abstract

AIMTo assess risk factors of hospital admission for acute colonic diverticulitis.METHODSThe study was conducted as part of the second wave of the population-based North Trondelag Health Study (HUNT2), performed in North Trondelag County, Norway, 1995 to 1997. The study consisted of 42570 participants (65.1% from HUNT2) who were followed up from 1998 to 2012. Of these, 22436 (52.7%) were females. The cases were defined as those 358 participants admitted with acute colonic diverticulitis during follow-up. The remaining participants were used as controls. Univariable and multivariable Cox regression analyses was used for each sex separately after multiple imputation to calculate HR.RESULTSMultivariable Cox regression analyses showed that increasing age increased the risk of admission for acute colonic diverticulitis: Comparing with ages < 50 years, females with age 50-70 years had HR = 3.42, P < 0.001 and age > 70 years, HR = 6.19, P < 0.001. In males the corresponding values were HR = 1.85, P = 0.004 and 2.56, P < 0.001. In patients with obesity (body mass index ≥ 30) the HR = 2.06, P < 0.001 in females and HR = 2.58, P < 0.001 in males. In females, present (HR = 2.11, P < 0.001) or previous (HR = 1.65, P = 0.007) cigarette smoking increased the risk of admission. In males, breathlessness (HR = 2.57, P < 0.001) and living in rural areas (HR = 1.74, P = 0.007) increased the risk. Level of education, physical activity, constipation and type of bread eaten showed no association with admission for acute colonic diverticulitis.CONCLUSIONThe risk of hospital admission for acute colonic diverticulitis increased with increasing age, in obese individuals, in ever cigarette smoking females and in males living in rural areas.

Body mass index and physical activity and the risk of diverticular disease: a systematic review and meta-analysis of prospective studies

“…Out of 2433 records identified by the search, we included eleven publications (nine studies) in total [ 11 , 14 , 16 – 24 ], six prospective studies [ 11 , 16 , 18 – 20 , 22 ] in the analyses of BMI and diverticular disease incidence, two studies in the analysis of BMI and diverticulitis [ 17 , 21 ], and three studies [ 14 , 17 , 18 ] on BMI and diverticular disease complications and five studies [ 11 , 16 , 18 , 22 , 24 ] on physical activity and diverticular disease incidence and two studies on vigorous physical activity and diverticulitis [ 21 , 23 ] (Tables 1 , 2 ; Fig. 1 ).…”

“…Two studies were included in the analysis of BMI and diverticulitis [ 17 , 21 ] and included 1159 cases and 89,798 participants. The summary RR for the highest vs. lowest BMI category was 2.09 (95% CI: 1.63–2.68, I 2 = 0%, p heterogeneity = 0.47).…”

“…Overweight and obesity have been associated with increased risk of diverticular disease as well [ 12 ]. Several case–control [ 13 – 15 ] and cohort studies [ 11 , 16 – 21 ], but not all [ 22 ] have reported increased risk of diverticular disease with greater body mass index. However, studies have differed with regard to the strength of the reported associations with risk estimates ranging between 33 and 340% increases in the relative risk among obese persons [ 11 , 16 – 20 ].…”

“…However, studies have differed with regard to the strength of the reported associations with risk estimates ranging between 33 and 340% increases in the relative risk among obese persons [ 11 , 16 – 20 ]. On the other hand, some studies have suggested an inverse association between physical activity and diverticular disease [ 18 , 22 – 24 ], however, not all studies found a significant association [ 11 , 16 , 21 ]. Because relatively few risk factors for diverticular disease have been firmly established and because clarification of potential preventive measures that could modify the risk of the disease is important, we conducted a systematic review and meta-analysis of prospective studies of body mass index, physical activity, and the risk of diverticular disease.…”

Course of the Diverticular Disease: What is changing?

“…In another study, of 144 patients detected with asymptomatic DD in a screening colonoscopy study and over a mean follow-up of 7.0±1.7 years, 4.2% developed AD or diverticular bleeding. No variables, including constipation, collected at baseline colonoscopy were associated with these events [24] In a Norwegian population based study conducted to detect risk factors of hospital admission for AD, increased age, obesity, smoking in females and living in rural areas in males, but not constipation were associated with increased risk [25]. In a small study conducted in Asiatic Korean people, constipation was not associated with the development of rightsided diverticulitis [26].…”