Abstract
Recent evidence showed that dietary habits play a role as risk factors for the development of diverticular complications. This systematic review aims to assess the effect of dietary habits in the prevention of diverticula complications (i.e., acute diverticulitis and diverticula bleeding) in patients with diverticula disease. PubMed and Scopus databases were searched up to 19 January 2021, 330 records were identified, and 8 articles met the eligibility criteria and were subjected to data extraction. The quality of the studies was evaluated by the Newcastle-Ottawa quality assessment form. No study meets the criteria for being a high-quality study. A high intake of fiber was associated to a decreased risk of diverticulitis or hospitalization due to diverticular disease, with a protective effect for fruits and cereal fiber, but not for vegetable fiber; whereas, a high red meat consumption and a generally Western dietary pattern were associated with an increased risk of diverticulitis. Alcohol use seemed to be associated to diverticular bleeding, but not to recurrent diverticulitis or diverticular complications. Further high-quality studies are needed to better define these associations. It is mandatory to ascertain the role of dietary habits for the development of recurrent acute diverticulitis and diverticular bleeding.
Highlights
Colonic diverticulosis is a common condition, especially in Western countries, and its prevalence increases with age, affecting up to 65% of people older than 80 years of age [1]
Recent evidence showed that dietary habits and other modifiable lifestyle factors play an important role as risk factors for the development of diverticular complications [8]
Five studies were excluded because it was not possible to distinguish between diverticulosis, symptomatic uncomplicated diverticular disease and complicated diverticular disease [15,17,28,29,30]
Summary
Colonic diverticulosis is a common condition, especially in Western countries, and its prevalence increases with age, affecting up to 65% of people older than 80 years of age [1]. The majority of individuals with diverticulosis remain asymptomatic throughout life, approximately 15–20% of the patients will develop abdominal symptoms without overt inflammation (a condition termed symptomatic uncomplicated diverticular disease) and about 5% develop complications including acute diverticulitis or diverticular bleeding [2,3,4]. The pathogenesis of diverticular complications remains poorly defined, diverticular bleeding and diverticulitis have demonstrated distinct clinical risk factors and etiopathogenesis [6,7]. Fiber intake is the risk factor that has been most studied. Previous systematic review assessed whether a high-fiber diet can improve symptoms in patients with symptomatic uncomplicated diverticular disease [11,12] or might prevent diverticular disease [13,14] without a clear distinction between symptomatic uncomplicated diverticular disease and diverticular complications as acute diverticulitis or diverticular bleeding. Data regarding alcohol consumption and diverticular disease showed discordant findings, with some studies showing a positive association [15,16] and others not [17], with uncertain effects regarding coffee consumption
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