High Fiber Vegetarian Diet Reduces Risk for Diverticular Disease

Summary
This study attempted to examine the link between dietary fiber in vegetarian diets and the chances of acquiring diverticular diseases, most commonly diverticulitis or diverticulosis. Diverticular disease is associated with pocketing of the walls of the intestine – particularly the colon. The study participants were a large population of which one-third was vegetarian. They were followed up for an average of around 11 years. The results showed that vegetarians had a 31 percent reduced risk of diverticular disease in comparison with meat eaters. Those who ate the highest amounts of dietary fiber had a 41 percent reduced risk of diverticular disease compared to those who ate the least. Hospital admission risks related to diverticular disease were 4.4 percent among meat eaters compared to 3 percent among vegetarians.

Introduction
Diverticular disease is associated with pocketing of the walls of the intestine – particularly the colon. It is commonly associated with cramps and pain. It is commonly seen in the middle-aged and the elderly. The Western diet is thought to be associated with this condition, with both the United States and United Kingdom showing higher prevalence of the condition, compared to African countries. Some small-scale studies have shown that diverticular disease may be associated with a low-fiber diet and that refined carbohydrates may be responsible for increasing the risk of the condition. Small studies have also shown that vegetarians have a lower risk compared to meat eaters. This study was a large long-term follow-up study of meat eaters and vegetarians in a population to assess the association between the risk of the condition and dietary preference.

Methodology
* This study involved following up 47,033 adults residing in Scotland or England for an average of around 11 years. Of these participants, 33 percent (15,459) were found to be vegetarians.
* All the participants had to answer questionnaires regarding their diet at the beginning of the study. The amount of fiber in their diets was also assessed.
* Those who developed diverticular disease were identified from the hospital records.

Key findings
* The results showed that 812 participants developed diverticular disease. Of these, 806 needed hospital admission and six died during the study period.
* It was noted that vegetarians had a 31 percent reduced risk of diverticular disease when compared to meat eaters.
* The risk of hospital admissions related to diverticular disease among those aged between 50 and 70 years were 4.4 percent among meat eaters, as against 3 percent among vegetarians.
* Those who took the highest amounts of dietary fiber (around or more than 25 g/day in females and 26 g in males) had a 41 percent reduced risk of diverticular disease compared to those who took the least (less than 14 g/day in either sex).

Next steps/Shortcomings
The authors speculate that vegetarians may have a lower chance of having symptoms of diverticular disease like diarrhea, constipation, and cramping pains and may thus undergo fewer checkups and investigations.This may mean that the meat eaters were diagnosed more frequently. This could have affected the results of this study. In addition, this study had few cases of complicated diverticular disease that included formation of an abscess in the pockets or developing a rupture or leakage. Further studies with populations who developed these complications are warranted.

Conclusion
This study strengthens the earlier findings that a vegetarian diet including high fiber content is a definite protective factor against the development of diverticular disease of the gut. According to the 2000-2001 UK National Diet and Nutrition Survey, 87 percent of the female population and 72 percent of the male general population does not take in the required amount of dietary fiber, recommended at 18 g per day or more. This trend could be responsible for the rising number of cases diagnosed with diverticular disease. The authors urge recommendations of high-fiber foods like “wholemeal breads, wholegrain (unrefined) cereals, fruits, and vegetables” to the general population to reduce the risk of diverticular disease and its associated complications, death, and hospital admissions.

For More Information:
Diet and Risk of Diverticular Disease in Oxford Cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): Prospective Study of British Vegetarians and Non-vegetarians
Publication Journal: British Medical Journal, 2011
By Francesca L. Crowe; Paul N. Appleby; University of Oxford, England


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