Walid H. Aldoori

Obesity Increases the Risks of Diverticulitis and Diverticular Bleeding

BACKGROUND & AIMS Studies of obesity and diverticular complications are limited. We assessed the relationship between body mass index (BMI), waist circumference, and waist-to-hip ratio and diverticulitis and diverticular bleeding. METHODS A prospective cohort study of 47,228 male health professionals (40-75 years old) who were free of diverticular disease in 1986 (baseline) was performed. Men reporting newly diagnosed diverticular disease on biennial follow-up questionnaires were sent supplemental questionnaires. Weight was recorded every 2 years, and data on waist and hip circumferences were collected in 1987. RESULTS We documented 801 incident cases of diverticulitis and 383 incident cases of diverticular bleeding during 18 years of follow-up. After adjustment for other risk factors, men with a BMI >or= 30 kg/m(2) had a relative risk (RR) of 1.78 (95% confidence interval [CI], 1.08-2.94) for diverticulitis and 3.19 (95% CI, 1.45-7.00) for diverticular bleeding compared with men with a BMI of <21 kg/m(2). Men in the highest quintile of waist circumference, compared with those in the lowest, had a multivariable RR of 1.56 (95% CI, 1.18-2.07) for diverticulitis and 1.96 (95% CI, 1.30-2.97) for diverticular bleeding. Waist-to-hip ratio was also associated with the risk of diverticular complications when the highest and lowest quintiles were compared, with a multivariable RR of 1.62 (95% CI, 1.23-2.14) for diverticulitis and 1.91 (95% CI, 1.26-2.90) for diverticular bleeding. Adjustment for BMI did not change the associations seen for waist-to-hip ratio. CONCLUSIONS In this large prospective cohort, BMI, waist circumference, and waist-to-hip ratio significantly increased the risks of diverticulitis and diverticular bleeding.

Prospective study of physical activity and the risk of symptomatic diverticular disease in men.

The relationship between physical activity and risk of symptomatic diverticular disease has not been investigated directly. This association was examined in a prospective cohort of 47,678 American men, 40 to 75 years of age, and free of diagnosed diverticular disease, colon or rectal polyp, ulcerative colitis, and cancer before 1988. During four years of follow up, 382 newly diagnosed cases of symptomatic diverticular disease were documented. After adjustment for age, energy adjusted dietary fibre, and energy adjusted total fat, overall physical activity was inversely associated with the risk of symptomatic diverticular disease (for highest versus lowest extremes, relative risk (RR) = 0.63 (95% confidence interval (CI) 0.45, 0.88). Most of the inverse association was attributable to vigorous activity, for extreme categories RR = 0.60 (95% CI 0.41, 0.87). For activity that was not vigorous the RR was 0.93 (95% CI 0.67, 1.69). Several specific activities were inversely associated with the risk of diverticular disease, but jogging and running combined was the only individual activity that was statistically significant (p for trend = 0.03). For men in the lowest quintile for dietary fibre intake and total physical activity (compared with those in the opposite extreme), the RR was 2.56 (95% CI 1.36, 4.82). Physical activity, along with a high fibre diet, may be an important factor in the prevention of symptomatic diverticular disease.

Nut, corn and popcorn consumption and the incidence of diverticular disease

CONTEXT Patients with diverticular disease are frequently advised to avoid eating nuts, corn, popcorn, and seeds to reduce the risk of complications. However, there is little evidence to support this recommendation. OBJECTIVE To determine whether nut, corn, or popcorn consumption is associated with diverticulitis and diverticular bleeding. DESIGN AND SETTING The Health Professionals Follow-up Study is a cohort of US men followed up prospectively from 1986 to 2004 via self-administered questionnaires about medical (biennial) and dietary (every 4 years) information. Men reporting newly diagnosed diverticulosis or diverticulitis were mailed supplemental questionnaires. PARTICIPANTS The study included 47,228 men aged 40 to 75 years who at baseline were free of diverticulosis or its complications, cancer, and inflammatory bowel disease and returned a food-frequency questionnaire. MAIN OUTCOME MEASURES Incident diverticulitis and diverticular bleeding. RESULTS During 18 years of follow-up, there were 801 incident cases of diverticulitis and 383 incident cases of diverticular bleeding. We found inverse associations between nut and popcorn consumption and the risk of diverticulitis. The multivariate hazard ratios for men with the highest intake of each food (at least twice per week) compared with men with the lowest intake (less than once per month) were 0.80 (95% confidence interval, 0.63-1.01; P for trend = .04) for nuts and 0.72 (95% confidence interval, 0.56-0.92; P for trend = .007) for popcorn. No associations were seen between corn consumption and diverticulitis or between nut, corn, or popcorn consumption and diverticular bleeding or uncomplicated diverticulosis. CONCLUSIONS In this large, prospective study of men without known diverticular disease, nut, corn, and popcorn consumption did not increase the risk of diverticulosis or diverticular complications. The recommendation to avoid these foods to prevent diverticular complications should be reconsidered.

A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men

The relationship between smoking, caffeine, and alcohol intake and the risk of symptomatic diverticular disease has not been investigated directly. We examined these associations in a prospective cohort of 47,678 US men, 40 to 75 years old. During 4 years of follow-up (1988 to 1992), we documented 382 newly diagnosed cases of symptomatic diverticular disease. After adjustments for age, physical activity, and energy-adjusted intake of dietary fiber and total fat, alcohol intake (comparing those who drink > 30 g of alcohol/d to nondrinkers) was only weakly and nonsignificantly associated with risk of symptomatic diverticular disease (relative risk (RR) = 1.36; 95 percent confidence interval (CI), 0.94 to 1.97; P for trend = 0.37). We observed no association between caffeine, specific caffeinated beverages, and decaffeinated coffee and the risk of symptomatic diverticular disease. Current smoking was not appreciably associated with risk of symptomatic diverticular disease compared to nonsmokers (RR = 1.25; 95 percent CI, 0.75 to 2.09) after adjustment for age, physical activity, and energy-adjusted intake of dietary fiber and total fat. In a subset analysis restricted to men who had undergone sigmoidoscopy or colonoscopy, a modest positive association was seen between smoking and risk of symptomatic diverticular disease. These results suggest that smoking, caffeine, and alcohol intake are not associated with any substantially increased risk of symptomatic diverticular disease.

Physical Activity Decreases Diverticular Complications

OBJECTIVES:Little is known about the effect of physical activity on diverticular complications. This study prospectively examined the associations between physical activity and diverticular bleeding and diverticulitis.METHODS:We studied 47,228 US males in the Health Professionals Follow-up Study cohort who were aged 40–75 years and free of diverticular disease, gastrointestinal cancer, and inflammatory bowel disease at baseline in 1986. Men reporting newly diagnosed diverticular disease on biennial follow-up questionnaires were sent supplemental questionnaires outlining details of diagnosis and treatment. Physical activity was assessed every 2 years. Men recorded the average time per week spent in eight recreational activities, and flights of stairs climbed per day. Cox proportional hazards regression was used to calculate relative risks (RRs).RESULTS:During 18 years of follow-up, 800 cases of diverticulitis and 383 cases of diverticular bleeding were identified. Total cumulative physical activity was associated with a decreased risk of diverticulitis and diverticular bleeding. After adjustment for potential confounders, the RR for men in the highest quintile of total activity (≥57.4 metabolic equivalent hours per week (MET-h/week) was 0.75 (95% confidence interval, CI, 0.58–0.95) for diverticulitis and 0.54 (95% CI, 0.38–0.77) for bleeding, as compared with men in the lowest quintile (≤8.2 MET-h/week). Vigorous activity was inversely related to diverticulitis in a high vs. low comparison (multivariable RR, 0.66; 95% CI, 0.51–0.86) and bleeding (multivariable RR, 0.61; 95% CI, 0.41–0.90), whereas nonvigorous activity was not. These results were similar for recent (simple updated) and baseline activity.CONCLUSIONS:Data from this large prospective cohort suggest that physical activity lowers the risk of diverticulitis and diverticular bleeding. Vigorous activity appears to account for this association.

A prospective study of alcohol, smoking, caffeine, and the risk of duodenal ulcer in men.

The associations between smoking, caffeine, and alcohol intake and the risk of duodenal ulcer have rarely been investigated prospectively. We examined these associations in a prospective cohort of 47,806 men, 40–75 years of age, using a mailed baseline questionnaire in 1986, with follow‐up every 2 years through 1992. During 6 years of follow‐up, we documented 138 newly diagnosed cases of duodenal ulcer. After adjustment for age, energy‐adjusted dietary fiber, body mass index, and use of aspirin or other nonsteroidal antiinflammatory drugs, current smoking was not associated with a substantial risk of duodenal ulcer [relative risk (RR) = 1.07; 95% confidence interval (CI) = 0.61–1.89]. Overall, past smokers were not at increased risk compared with never‐smokers (RR = 0.99; 95% CI = 0.69–1.42). Adjusting for other risk factors, alcohol intake (comparing those who drink >30 gm of alcohol per day to nondrinkers) was not associated with higher risk of duodenal ulcer (RR = 0.74; 95% CI = 0.42–1.29). We observed little association between caffeine, caffeine‐containing beverages, and decaffeinated coffee and the risk of duodenal ulcer. These results indicate that smoking is not associated with a substantial increase in risk of duodenal ulcer, nor is high intake of alcohol and caffeine.

The Protective Role of Dietary Fiber in Diverticular Disease

Diverticular disease is one of the most common disorders of the colon among the elderly in Western societies (1). In North America diverticular disease is estimated to occur in one third of all persons older than 45 years of age, and in two thirds of all persons older than 85 years of age (2). In the great majority of cases the condition is symptomless (3), and only between 10 to 25 percent of affected individuals develop symptoms (2). Symptomatic diverticular disease results in 200,000 hospitalizations in the USA annually (4).

Child Nutrition and Armed Conflicts in Iraq

The object of the study was to assess the nutritional status of children 0-5 years, who were attending maternal and child health clinics in Basrah city, 6 months after the cessation of the Gulf War, and took the form of a cross-sectional study. The study population consisted of 723 children, the majority of whom were between 0 and 36 months of age, attending maternal and child health clinics (MCHC) in Basrah city for routine immunizations. Each MCHC was visited on a separate day and all children attending on that day were included in the study. A proportion (8 per cent) of the study population were wasted, most of them in the 12-24-month age category. Twenty-four per cent of the children were stunted. Stunting and low weight-for-age were significantly higher among children of low socio-economic households. Comparison of these data with an earlier nutritional survey in the area showed that the nutritional status of children in Basrah city has deteriorated as a result of successive armed conflicts. There is need to monitor the health and nutritional status of children, and take appropriate action in order to protect them.

Peptic Ulcer Disease and the Risk of Bladder Cancer in a Prospective Study of Male Health Professionals

Helicobacter pylori is a risk factor for gastric and duodenal ulcers, but gastric ulcers generally occur in individuals who have low acid production and diffuse gastritis, whereas duodenal ulcers are more likely to occur with high acid output and antrum-predominant gastritis. Low acid production, gastritis, and ulcer healing each contribute to poor antioxidant absorption, oxidative stress, and elevated nitrite levels in the stomach. N-Nitrosamines are known carcinogens, and nitrate ingestion has been related to bladder cancer risk. Consequently, we hypothesized that the gastric conditions associated with gastric ulcers may contribute to elevated bladder cancer risk. We thus examined the association between self-reported history of peptic ulcer disease and the risk of bladder cancer (414 cases) over 14 years of follow-up in the Health Professional Follow-Up Study. Cox proportional hazards models were performed to adjust for known risk factors of bladder cancer. Men who reported a gastric ulcer before 1986 had a significantly higher risk of bladder cancer compared with those with no history of gastric ulcer (relative risk = 1.55, 95% confidence interval = 1.03–2.33, controlling for smoking and other potential confounders). No association was observed for duodenal ulcers (multivariate relative risk = 0.97, 95% confidence interval = 0.68–1.38). The ulcers in this study were based solely on self-report and not medical records; consequently, misclassification of ulcers may have occurred. Although intriguing, these findings need to be replicated.

The Gulf War, child nutrition and feeding practices in Iraq

Abstract We conducted a cross-sectional study, which included 420 children to investigate the association between feeding practices and growth of children 0–18 months of age, who were attending maternal and child health clinics (MCHCs) in Basrah city, Iraq, 6 months after the Gulf War in 1991. Children who were bottle-fed, had lower mean Z-scores for all anthropometric indices compared to children who were breast-fed. Similar results were observed for mixed bottle and breast feeding compared with breast feeding for weight-for-height and weight-for-age indices. The beneficial effect of breast feeding for all growth indices was not limited to the youngest age group, but was observed across all age categories. This association was modified by socio-economic status. Based on this study, breast feeding should be promoted for children up to 18 months of age and older, given its potential for averting child malnutrition and mortality. Breast feeding promotion should be coupled with nutrition supplementation for both pregnant and lactating women at risk. Nutrition supplementation should also be provided to infants 4–6 months of age and older to ensure adequate caloric intake. Given the current economic situation in Iraq, adequate resources need to be ensured by the international community in order to sustain these public health efforts.