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Adherence to a Healthy Lifestyle is Associated With a Lower Risk of Diverticulitis among Men

Liu, Po-Hong MD, MPH1,2,11; Cao, Yin MPH, ScD2,3,4,5,11; Keeley, Brieze R MD6; Tam, Idy MS7; Wu, Kana MD, MPH, PhD4; Strate, Lisa L MD, MPH8,11; Giovannucci, Edward L MD, ScD1,4,9,11; Chan, Andrew T MD, MPH1,2,3,10,11

American Journal of Gastroenterology: December 2017 - Volume 112 - Issue 12 - p 1868–1876
doi: 10.1038/ajg.2017.398
ORIGINAL CONTRIBUTIONS: SMALL BOWEL
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Objectives: Diverticulitis is a common disease with high clinical burden. We evaluated the joint contribution of multiple lifestyle factors to risks of incident diverticulitis. We also estimated the proportion of diverticulitis preventable by lifestyle modifications.

Methods: We prospectively examined the association between lifestyle factors (red meat, dietary fiber intake, vigorous physical activity (activity with metabolic equivalent ≥6), body mass index (BMI), and smoking) and risk of diverticulitis among participants in the Health Professionals Follow-Up Study.

Results: We documented 907 incident cases of diverticulitis during 757,791 person-years. High intake of red meat, low intake of dietary fiber, low vigorous physical activity, high BMI, and smoking were independently associated with increased risks of diverticulitis (allP<0.05). Low-risk lifestyle was defined as average red meat intake <51 g per day, dietary fiber intake in the top 40% of the cohort (about 23 g per day), vigorous physical activity in the highest 50% among participants with non-zero vigorous physical activity (roughly 2 h of exercise weekly), normal BMI between 18.5–24.9 kg m−2, and never-smoker. There was an inverse linear relationship between number of low-risk lifestyle factors and diverticulitis incidence (Pfor trend<0.001). Compared with men with no low-risk lifestyle factors, the multivariable relative risks of diverticulitis were 0.71 (95% confidence interval (CI): 0.59–0.87) for men with 1 low-risk lifestyle factor; 0.66 (95% CI: 0.55–0.81) for 2 low-risk factors; 0.50 (95% CI: 0.40–0.62) for 3 low-risk factors; 0.47 (95% CI: 0.35–0.62) for 4 low-risk factors, and 0.27 (95% CI: 0.15–0.48) for 5 low-risk factors. Adherence to a low-risk lifestyle could prevent 50% (95% CI: 20–71%) of incident diverticulitis.

Conclusions: Adherence to a low-risk lifestyle is associated with reduced incidence of diverticulitis.

1Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA

2Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA

3Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA

4Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA

5Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA

6Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA

7Tufts University School of Medicine, Boston, Massachusetts, USA

8Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA

9Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

10Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA

Correspondence: Andrew T. Chan, MD, MPH, Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, USA. E-mail: achan@mgh.harvard.edu

11These authors contributed equally to this work

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A599

Received 07 June 2017; accepted 01 September 2017

Gurantor of the article: Andrew T. Chan, MD, MPH.

Specific author contributions: Drs Liu, Cao, and Chan had full access to all of the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: P.H.L., Y.C., L.L.S., E.L.G., and A.T.C. Acquisition of data: L.L.S., B.R.K., I.T., and A.T.C. Analysis and interpretation of data: all coauthors. Drafting of the manuscript: P.H.L. Critical revision of the manuscript for important intellectual content: all coauthors. Statistical analysis: P.H.L. and Y.C. Obtained funding: L.L.S., E.L.G., and A.T.C. Administrative, technical, or material support: Y.C., L.L.S., E.L.G., and A.T.C. Study supervision: Y.C., L.L.S., E.L.G., and A.T.C.

Financial support: This work was supported by grants R01 DK101495, R01 DK084157, K24 DK098311, and UM1 CA167552 from the National Institutes of Health. Dr. Chan is a Stuart and Suzanne Steele MGH Research Scholar.

Potential competing interests: The study sponsors have no role in the study design, collection, analysis, and interpretation of data. A.T.C. previously served as a consultant for Bayer Healthcare, Aralaz Pharmaceuticals, and Pfizer for work unrelated to the topic of this manuscript. This study was not funded by Bayer Healthcare, Aralez Pharmaceuticals, or Pfizer.

© The American College of Gastroenterology 2017. All Rights Reserved.
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