Intake of dietary fiber, fruits, and vegetables, and risk of diverticulitis

Background & Aims Although low fiber intake has been considered a risk factor for diverticulitis, prospective evidence is limited and conflicting, with little known about variation in the protective effects according to food sources. We assessed the associations of intakes of fiber and major food sources of fiber including fruits and vegetables with risk of diverticulitis.

Methods We followed 50,019 women in the Nurses’ Health Study (1990-2014) and 48,292 men in the Health Professionals Follow-up Study (1986-2014) who were free of diverticulitis, cancer, and inflammatory bowel disease at baseline. Incident diverticulitis was identified through self-report with validity confirmed by review of medical records.

Results During a mean follow-up time of 22 years, we documented 4,343 incident cases of diverticulitis in women and 1,142 cases in men. Compared to participants in the lowest quintile, the multivariable HRs (95% CIs) of diverticulitis in the highest quintile of total fiber intake were 0.86 (0.78-0.95; P-trend=0.002) among women and 0.63 (0.51-0.79; P-trend<0.001) among men. Fiber from different food sources, except for vegetable fiber in women, was associated with a decreased risk of diverticulitis. Furthermore, total whole fruit intake was associated with reduced risk of diverticulitis in both cohorts with a multivariable HR for diverticulitis of 0.95 (0.92-0.98; P-trend<0.001) in women and 0.91 (0.86-0.96; P-trend<0.001) in men for every serving increase of total whole fruit intake per day.

Conclusions Higher intake of dietary fiber and fiber from different food sources are associated with a lower risk of diverticulitis. A greater intake of whole fruit is also associated with reduced risk.