Environmental Factors and Lifestyles

Well-conducted observational studies and subsequent meta-analyses have confirmed the role of lifestyle risk factors in diverticular disease. Environmental factors such as geography, urbanization, and migration may also play a role in the spectrum of diverticular disease, but the evidence supporting their role is less secure. Lifestyle risk factors linked to diverticular disease include Western dietary patterns (red meat with high fat content), obesity (in particular, central obesity), smoking, and medications. In contrast, risk-reducing lifestyle factors include diets rich in fibers from fruits, vegetables, and cereals, as well as vigorous physical activity. The role played by alcohol in diverticular disease is less clear. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin have been consistently associated with diverticulitis and complicated and perforated diverticular disease, along with diverticular hemorrhage. Similarly, the regular use of opioid and corticosteroid drugs has been associated with diverticulitis and perforated diverticular disease, whereas calcium channel blockers (CCBs), statins, and metformin may reduce the risk of diverticulitis. Adhering to and/or adopting healthy lifestyles, addressing all of the above-mentioned risk factors, has been reported to lower the risk of incident diverticulitis by up to 73%. This chapter provides a review of each risk factor and highlights practical advice for patient care.