Risk Factors for Asymptomatic Colon Diverticulosis

Abstract

Backgrounds/Aims: The etiology of colon diverticulosis is related to a range of genetic, biological, and environmental factors, but the risk factors for asymptomatic diverticulosis of the colon are unclear. This study examined the risk factors for asymptomatic colon diverticulosis. Methods: This retrospective study included examinees who underwent a colonoscopy for screening at the health check-up center of SAM Hospital between January 2016 and December 2016. The examinees with colon diverticulosis found by colonoscopy were compared with those without diverticulosis. The comparison factors were age, gender, alcohol consumption, smoking status, medical history, lipid profile, body mass index, visceral fat area, waist-hip ratio, and severity of a fatty liver. Results: This study included 937 examinees and the overall prevalence of diverticulosis was 8.1% (76/937). Fatty liver was found in 69.7% (53/76) in cases of colon diverticulosis and 50.3% (433/861) in the control group (p=0.001). The average waist-hip ratio was 0.92±0.051 in colon diverticulosis and 0.90±0.052 in the control group (p=0.052). Multivariate analysis revealed the waist-hip ratio (OR=1.035, 95% CI 1.000-1.070, p=0.043), moderate fatty liver (OR=2.238, 95% CI 1.026-4.882, p=0.043), and severe fatty liver (OR=5.519, 95% CI 1.236-21.803, p=0.025) to be associated with an increased risk of asymptomatic colon diverticulosis. Conclusions: The waist-hip ratio, moderate fatty liver, and severe fatty liver are risk factors for asymptomatic colon diverticulosis. Central obesity, which can be estimated by the waist-hip ratio, and fatty liver might affect the pathogenesis of asymptomatic colon diverticulosis.

Genetic Risk Factors for Diverticular Disease—Emerging Evidence

“…For example, a series of >62,000 colonoscopies performed in China demonstrated <2% of the population had diverticulosis, but >85% was right-sided 15 . Similar studies from Korea and Taiwan have demonstrated higher prevalence, 13-15%, with preserved right-sided dominance 16,17 . The underlying biology behind the anatomic variation is unknown, but right-sided diverticulosis intuitively seems less likely to be due to constipation and mechanical stress, given the liquid nature of stool in the right colon.…”

The Interrelationship Among Non-Alcoholic Fatty Liver Disease, Colonic Diverticulosis and Metabolic Syndrome

“…While the presence of T2DM, hyperlipidemia, smoking status, and alcohol consumption were similar in patients with CD and the control group, HTA was significantly more frequent in patients with ADD. This study reported that moderate and severe fatty liver disease, as well as waist-hip ratio, were risk factors for ADD, highlighting the possible role of central obesity and NAFLD in the pathogenesis of ADD [18]. Contrary to these findings, Sahin et al [21] found that in elderly patients, diverticulosis is a negative predictor of liver steatosis.…”

“…Nevertheless, NASH and cirrhosis that result from chronic inflammation typically develop in advanced age [23]. Colonic diverticulosis is also more common in Western countries, underlying the impact of Western diet, lifestyle, obesity, and MetS on development of CD [9,18,22]. Consequently, it appears that dietary habits and aging significantly influence the occurrence and severity of NAFLD and CD.…”

“…Components of MetS, such as central obesity, dyslipidemia, and arterial hypertension (HTA), increase the risk of CDD. However, the exact impact of metabolic risk factors on the prevalence of CD has not been clearly defined [16][17][18][19].…”

Atypical Presentation of Colonic Diverticular Disease

“…Diverticular disease (DD) is more prevalent in western countries but in Asia, diverticulosis is almost rare, though the prevalence has been increased recently along with the overall increase in prevalence throughout the world. 5 The current accepted causes of diverticula formation are the transmission of muscular contraction pressure to the wall of the colon, inducing the formation of diverticula usually at the weakest point of the wall where penetration of the blood vessels occurs. It is also considered as a multifactorial disease.…”