Vegetarian Diet May Lower Risk for Diverticular Disease

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Following a vegetarian diet and having a high intake of dietary fiber are

associated with a lower risk for diverticular disease, according to the

results of a prospective cohort study reported online July 19 in the *BMJ.*

" Diverticular disease has been termed a 'disease of western civilisation'

because of its high prevalence in countries like the United Kingdom and

United States compared with certain parts of Africa, " write Francesca L.

Crowe, nutritional epidemiologist at the Cancer Epidemiology Unit, Nuffield

Department of Clinical Medicine, University of Oxford, Oxford, United

Kingdom, and colleagues. " We examined the associations of vegetarianism and

the intake of dietary fibre (defined as non-starch polysaccharides) with the

risk of diverticular disease using information from hospital admission data

and death certificates for England and Scotland in men and women taking part

in the European Prospective Investigation into Cancer and Nutrition

(EPIC)-Oxford cohort. "

The study cohort consisted of 47,033 men and women living in England or

Scotland and enrolled in EPIC-Oxford, a cohort of predominantly

health-conscious participants recruited throughout the United Kingdom. Of

these, 15,459 (33%) reported consuming a vegetarian diet at baseline. A

130-item, validated food frequency questionnaire was used to estimate

dietary fiber intake.

Linkage with hospital records and death certificates allowed identification

of cases of diverticular disease. Multivariate proportional hazards

regression models allowed estimation of hazard ratios (HRs) and 95%

confidence intervals (CIs) for the risk for diverticular disease by diet

group and quintiles of dietary fiber intake.

Of 812 cases of diverticular disease identified during follow-up (mean

duration, 11.6 years), 806 were hospital admissions and 6 were deaths.

Compared with meat eaters, vegetarians had a 31% lower risk for diverticular

disease, after adjustment for confounding variables including smoking,

alcohol use, and body mass index (relative risk, 0.69; 95% CI, 0.55 - 0.86).

Meat eaters between the ages of 50 and 70 years had a 4.4% cumulative

probability of hospitalization or death from diverticular disease vs 3.0%

for vegetarians.

The risk for diverticular disease was also inversely associated with dietary

fiber intake. Compared with participants in the lowest quintile of dietary

fiber intake (< 14 g/day for both women and men), those in the highest

quintile (≥ 25.5 g/day for women and ≥ 26.1 g/day for men) had a 41% lower

risk for diverticular disease (HR, 0.59; 95% CI, 0.46 - 0.78; *P* < .001

trend).

Vegetarian diet and higher fiber intake were each significantly associated

with a lower risk for diverticular disease, after mutual adjustment.

" Consuming a vegetarian diet and a high intake of dietary fibre were both

associated with a lower risk of admission to hospital or death from

diverticular disease, " the study authors write.

Limitations of this study include unmeasured confounding, possible lack of

generalizability, the possibility that vegetarians would undergo fewer tests

and/or that meat eaters would have more gastrointestinal tract symptoms

resulting in a diagnosis of diverticular disease, and undetermined validity

of a diagnosis of diverticular disease from hospital records.

In an accompanying editorial, J. Humes and Joe West, from Nottingham

University Hospital, in Nottingham, United Kingdom, note that the findings

must be interpreted in the light of these limitations.

" At a population level, if the available absolute risks are converted into a

number needed to treat, about 71 meat eaters would have to become

vegetarians to prevent one diagnosis of diverticular disease as measured in

this study, " Drs. Humes and West write. " ...Overall the opportunity for

preventing the occurrence of diverticular disease and other conditions, such

as colorectal cancer, probably lies in the modification of diet, at either a

population or an individual level. However, far more evidence is needed

before dietary recommendations can be made to the general public. "

*Cancer Research UK funded the EPIC study. One of the study authors reports

being a member of the Vegan Society. Drs. Humes and West have disclosed no

relevant financial relationships.*

*BMJ. *2011;343:d4115 <http://www.bmj.com/content/343/bmj.d4115.extract>,

d4131 <http://www.bmj.com/content/343/bmj.d4131>.

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