Introduction
Methods
Search strategy
Study selection
Data extraction
Statistical analysis
Results
References, publication year, country/region | Study name | Follow-up period | Study size, gender, age, number of cases | Assessment of weight and height | Study quality | Exposure | Description of quantiles of categories | RR (95% CI) | Adjustment for confounders |
---|---|---|---|---|---|---|---|---|---|
Aldoori WH et al. [22], 1995, USA | Health Professionals Follow-up Study | 1988–1992, 4 years of follow-up | 47,678 men, age 42–77 years: 382 diverticular disease cases | Self-reported (validated) | 7 | BMI | 22.0 | 1.00 | Age, physical activity, dietary fiber, total fat |
23.7 | 1.15 (0.81–1.62) | ||||||||
25.1 | 1.23 (0.87–1.72) | ||||||||
26.5 | 1.23 (0.88–1.72) | ||||||||
29.4 | 1.22 (0.87–1.70) | ||||||||
Rosemar A et al. [16], 2008, Sweden | The Multifactorial Prevention Trial | 1970–1973–1998, max 28 years of follow-up | 7494 men, age 47–55 years: 112 hospitalizations for diverticular disease | Measured | 8 | BMI | <20 | 3.0 (0.7–12.5) | Age, smoking, diastolic blood pressure |
20–22.5 | 1.0 | ||||||||
22.5–25 | 2.3 (0.9–6.0) | ||||||||
25–27.5 | 3.0 (1.2–7.6) | ||||||||
27.5–30 | 3.2 (1.2–8.6) | ||||||||
>30 | 4.4 (1.6–12.3) | ||||||||
Strate LL et al. [17], 2009, USA | Health Professionals Follow-up Study | 1986–2004, ~15.5 years of follow-up | 47,228 men, age 40–75 years: 801 diverticulitis cases 383 cases of diverticular bleeding | Self-reported | 7 | BMI, diverticulitis | <21 | 1.00 | Age, study period, calories, fat, fiber, red meat, physical activity, NSAID use, acetaminophen |
21–22.9 | 1.29 (0.77–2.14) | ||||||||
23–24.9 | 1.40 (0.86–2.28) | ||||||||
25–27.4 | 1.48 (0.92–2.39) | ||||||||
27.5–29.9 | 1.58 (0.97–2.59) | ||||||||
≥30.0 | 1.78 (1.08–2.94) | ||||||||
BMI, diverticular bleeding | <21 | 1.00 | |||||||
21–22.9 | 1.68 (0.75–3.76) | ||||||||
23–24.9 | 1.83 (0.85–3.97) | ||||||||
25–27.4 | 2.38 (1.11–5.09) | ||||||||
27.5–29.9 | 1.91 (0.87–4.23) | ||||||||
≥30.0 | 3.19 (1.45–7.00) | ||||||||
Waist circumference, diverticulitis | ≤34.25 inches | 1.00 | |||||||
34.5–36 | 1.22 (0.92–1.62) | ||||||||
36.25–37.75 | 1.22 (0.91–1.64) | ||||||||
38–40 | 1.20 (0.91–1.59) | ||||||||
≥40.25 | 1.56 (1.18–2.07) | ||||||||
Waist circumference, diverticular bleeding | ≤34.25 inches | 1.00 | |||||||
34.5–36 | 0.91 (0.57–1.44) | ||||||||
36.25–37.75 | 1.44 (0.93–2.23) | ||||||||
38–40 | 1.36 (0.90–2.08) | ||||||||
≥40.25 | 1.96 (1.30–2.97) | ||||||||
WHR, diverticulitis | <0.89 | 1.00 | |||||||
0.89–0.92 | 1.22 (0.92–1.63) | ||||||||
0.93–0.95 | 1.30 (0.97–1.73) | ||||||||
0.96–0.98 | 1.41 (1.06–1.87) | ||||||||
>0.98 | 1.62 (1.23–2.14) | ||||||||
WHR, diverticular bleeding | <0.89 | 1.00 | |||||||
0.89–0.92 | 1.05 (0.66–1.67) | ||||||||
0.93–0.95 | 1.37 (0.88–2.13) | ||||||||
0.96–0.98 | 1.43 (0.92–2.20) | ||||||||
>0.98 | 1.91 (1.26–2.90) | ||||||||
Crowe FL et al. [11], 2011, United Kingdom | EPIC-Oxford | 1993–1999–2009, 11.6 years of follow-up | 47,033 men and women, age ≥ 20 years: 812 diverticular disease cases | Measured and self-reported | 7 | BMI | <20 | 0.63 (0.42–0.93) | Age, sex, method of recruitment, region of residence, smoking |
20.0–22.5 | 1.00 | ||||||||
22.5–25.0 | 1.23 (1.00-1.51) | ||||||||
25.0–27.5 | 1.54 (1.24–1.92) | ||||||||
≥27.5 | 1.67 (1.34–2.08) | ||||||||
Humes DJ et al. [14], 2011, United Kingdom | UK General Practice Research Database | 1990–2005, ~15 years of follow-up | 899 perforated diverticular disease cases 8980 population controls Age ≥ 45 years | Measured/ self-reported | 7 | BMI | <25 | 1.00 | Age, sex |
25–29.9 | 0.98 (0.82–1.17) | ||||||||
≥30 | 1.34 (1.06–1.69) | ||||||||
Hjern F et al. [18], 2012, Sweden | Swedish Mammography Cohort | 1997–2009, 12 years of follow-up | 36,592 women, mean age 61.8 years: 626 diverticular disease cases | Self-reported | 9 | BMI, diverticular disease requiring hospitalization | <20 | 1.01 (0.70–1.45) | Age, dietary fiber, diabetes, hypertension, acetylsalicylic acid, NSAIDs, steroid medication, alcohol, smoking status, physical activity, education |
20–24.99 | 1.00 | ||||||||
25–29.99 | 1.29 (1.08–1.54) | ||||||||
≥30 | 1.33 (1.03–1.72) | ||||||||
BMI, diverticular disease with abscess/perforation | <20 | 2.24 (1.10–4.56) | |||||||
20-24.99 | 1.00 | ||||||||
25-29.99 | 1.49 (0.94–2.39) | ||||||||
≥30 | 2.00 (1.08–3.73) | ||||||||
Korda RJ et al. [19], 2012, Australia | The 45 and Up Study | 2006–2009, 2.3 years of follow-up | 246,361 men and women, age ≥ 45 years: 804 diverticular disease hospitalizations | Self-reported | 5 | BMI, age 45–64 years | 18.5–<25.0 | 1.00 | Age, sex, region of residence, household income, smoking, alcohol, private health insurance status |
25.0–<30.0 | 1.42 (1.06–1.90) | ||||||||
≥30.0 | 2.18 (1.63–2.91) | ||||||||
BMI, age 65–79 years | 18.5–<25.0 | 1.00 | |||||||
25.0–<30.0 | 1.20 (0.91–1.58) | ||||||||
≥30.0 | 1.97 (1.47–2.63) | ||||||||
BMI, age ≥ 80 years | 18.5–<25.0 | 1.00 | |||||||
25.0–<30.0 | 1.40 (1.01–1.95) | ||||||||
≥30.0 | 1.57 (1.00-2.48) | ||||||||
Reeves GK et al. [20], 2014, United Kingdom | Million Women’s Study | 1996–2001–2008, 9.2 years of follow-up | 1,251,619 women, age 50–64 years: 26,179 diverticular disease hospitalizations | Self-reported | 7 | BMI | <22.5 | 0.89 (0.86–0.91) | Age, geographical region, SES, age at 1st birth, parity, smoking status, alcohol intake, physical activity, time since menopause, HRT use |
22.5–24.9 | 1.00 (0.98–1.03) | ||||||||
25.0-29.9 | 1.23 (1.21–1.26) | ||||||||
30.0-34.9 | 1.43 (1.38–1.47) | ||||||||
≥35.0 | 1.56 (1.49–1.63) | ||||||||
Per 5 units | 1.22 (1.20–1.24) | ||||||||
Jamal Talabani A et al. [21], 2016, Norway | The North-Trondelag Health Study | 1995–1997–1998–2012, ~14 years of follow-up | 42,570 men and women, age ≥20 years: 358 acute diverticulitis cases | Measured | 8 | BMI, women | <25.0 | 1.00 | Age, hard physical activity, smoking status, problems with breathlessness, problems with constipation, type of bread, education, living area |
25.0-29.9 | 1.25 (0.90–1.73) | ||||||||
≥30.0 | 2.06 (1.46–2.91) | ||||||||
BMI, men | <25.0 | 1.00 | |||||||
25.0-29.9 | 1.46 (0.92–2.32) | ||||||||
≥30.0 | 2.58 (1.53–4.34) |
References, publication year, country | Study name | Study period | Number of participants, gender, age, number of cases | Study quality | Physical activity exposure | Quantity | Relative risk (95% confidence interval) | Adjustment for confounders |
---|---|---|---|---|---|---|---|---|
Aldoori WH et al. [22], 1995, USA | Health Professionals Follow-up Study | 1988–1992, 4 years of follow-up | 47,678 men, age 42–77 years: 382 diverticular disease cases | 7 | Total leisure-time physical activity | 0.9 MET-h/week | 1.00 | Age, dietary fiber, total fat |
4.8 | 0.91 (0.68–1.21) | |||||||
11.3 | 0.71 (0.52–0.97) | |||||||
22.6 | 0.74 (0.54–1.01) | |||||||
46.8 | 0.63 (0.45–0.88) | |||||||
Nonvigorous activity | 0.1 MET-h/week | 1.00 | ||||||
1.4 | 1.15 (0.84–1.58) | |||||||
3.4 | 0.79 (0.56–1.12) | |||||||
7.6 | 1.09 (0.79–1.49) | |||||||
20.8 | 0.93 (0.67–1.69) | |||||||
Vigorous activity | 0 MET-h/week | 1.00 | ||||||
3.5 | 0.78 (0.60–1.02) | |||||||
15.0 | 0.88 (0.67–1.15) | |||||||
41.0 | 0.60 (0.41–0.87) | |||||||
Rosemar A et al. [16], 2008, Sweden | The Multifactor Primary Prevention Trial | 1970–1973–1998, 28 years of follow-up | 7494 men, age 47–55 years: 112 diverticular disease hospitalizations | 8 | Leisure-time physical activity | Sedentary | 1.0 | Age, smoking, diastolic blood pressure |
Moderate | 0.9 (0.6–1.4) | |||||||
Active | 1.2 (0.7–2.0) | |||||||
Williams PT et al. [24], 2009, USA | National Runners’ Health Study | 1991–1994–1999–2002, 7.7 years of follow-up | 9072 men and 1664 women, age ≥ 50 years: 127/21 diverticular disease cases | 5 | Running distance | Per 1 km/day | 0.938, p = 0.04 | Age, sex, pack-years of cigarette smoking, meat, fish, fruit, alcohol |
≥8 vs. <2 km/day | 0.52, p = 0.05 | |||||||
Per 1 km/day | 0.945, p = 0.08 | + BMI | ||||||
Strate LL et al. [12], 2009, USA | Health Professionals Follow-up Study | 1986–2004, 18 years of follow-up | 47,228 men, age 40–75 years: 800 diverticulitis cases 383 diverticular bleeding cases | 7 | Total leisure-time physical activity, diverticulitis | ≤8.2 METs/week | 1.00 | Age, study period, sedentary behavior, BMI, NSAID use, acetaminophen, dietary fat, fiber, red meat, combined nut/corn/popcorn consumption, total energy |
8.3–19.0 | 1.08 (0.87–1.34) | |||||||
19.1–33.5 | 0.97 (0.77–1.21) | |||||||
33.6–57.3 | 0.98 (0.78–1.23) | |||||||
≥57.4 | 0.75 (0.58–0.95) | |||||||
Vigorous physical activity | 0 METs/week | 1.00 | ||||||
0.1–4.0 | 0.91 (0.74–1.12) | |||||||
4.1–10.0 | 0.99 (0.81–1.22) | |||||||
10.1–28.0 | 0.89 (0.72–1.10) | |||||||
≥28.0 | 0.66 (0.51–0.86) | |||||||
Nonvigorous physical activity | 0–2.9 METs/week | 1.00 | ||||||
3.0–7.9 | 0.94 (0.75–1.18) | |||||||
8.0–15.9 | 0.91 (0.73–1.15) | |||||||
16.0–29.9 | 0.90 (0.71–1.13) | |||||||
≥30.0 | 0.96 (0.76–1.21) | |||||||
Total leisure-time physical activity, diverticular bleeding | ≤8.2 METs/week | 1.00 | ||||||
8.3–19.0 | 0.91 (0.68–1.22) | |||||||
19.1–33.5 | 0.71 (0.52–0.98) | |||||||
33.6–57.3 | 0.66 (0.48–0.92) | |||||||
≥57.4 | 0.54 (0.38–0.77) | |||||||
Vigorous physical activity | 0 METs/week | 1.00 | ||||||
0.1–4.0 | 1.04 (0.79–1.37) | |||||||
4.1–10.0 | 0.70 (0.51–0.97) | |||||||
10.1–28.0 | 0.81 (0.59–1.10) | |||||||
≥28.0 | 0.61 (0.41–0.90) | |||||||
Nonvigorous physical activity | 0–2.9 METs/week | 1.00 | ||||||
3.0–7.9 | 0.90 (0.65–1.25) | |||||||
8.0–15.9 | 0.89 (0.64–1.23) | |||||||
16.0–29.9 | 0.96 (0.70–1.33) | |||||||
≥30.0 | 0.77 (0.55–1.07) | |||||||
Crowe FL et al. [11], 2011, United Kingdom | EPIC-Oxford Study | 1993–1999–2009, 11.6 years of follow-up | 47,033 men and women, age ≥ 20 years: 812 diverticular disease cases | 7 | Physical activity | Inactive | 1.00 | Age, sex, method of recruitment, region of residence, smoking |
Active | 0.87 (0.74–1.02) | |||||||
Hjern F et al. [18], 2012, Sweden | Swedish Mammography Cohort | 1997–2009, 12 years of follow-up | 36,592 women, mean age 61.8 years: 626 diverticular disease cases | 9 | Physical activity, hospital requiring diverticular disease Physical activity, diverticular disease with abscess/perforation | ≤ 30 min/d | 1.42 (1.18–1.69) | Age, dietary fiber, diabetes mellitus, hypertension, acetylsalicylic acid, NSAID use, steroid medication, alcohol, smoking status, BMI, education |
> 30 min/d | 1.00 | |||||||
≤ 30 min/d | 0.77 (0.47–1.27) | |||||||
> 30 min/d | 1.00 | |||||||
Jamal Talabani A et al. [21], 2016, Norway | The North-Trondelag Health Study | 1995–1997–1998–2012, ~14 years of follow-up | 42,570 men and women, age ≥ 20 years: 358 acute diverticulitis cases | 7 | Hard physical activity, women Hard physical activity, men | <1 h/week | 1.00 | Age, BMI, smoking status, problems with breathlessness, problems with constipation, type of bread, education, living area |
≥1 | 0.67 (0.39–1.15) | |||||||
<1 h/week | 1.00 | |||||||
≥1 | 1.03 (0.67–1.57) |
BMI
Physical activity
Subgroup analyses, sensitivity analyses, and study quality
BMI | |||||
---|---|---|---|---|---|
n
| RR (95% CI) |
I
2 (%) |
P
h
a
|
P
h
b
| |
All studies | 6 | 1.28 (1.18–1.40) | 77.0 | 0.001 | |
Sex | |||||
Men | 2 | 1.14 (0.94–1.39) | 0 | 0.53 | 0.02/NCc
|
Women | 2 | 1.20 (1.18–1.22) | 0 | 0.48 | |
Men and women | 2 | 1.41 (1.30–1.52) | 4.9 | 0.31 | |
Assessment of weight/height | |||||
Measured | 1 | 1.63 (1.18–2.25) | 0.80 | ||
Self-reported | 4 | 1.23 (1.14–1.32) | 70.9 | 0.02 | |
Measured and self-reported | 1 | 1.51 (1.29–1.77) | |||
Assessment of the diverticular disease | |||||
Linkage to medical records/hospitalizations | 5 | 1.31 (1.19–1.44) | 81.1 | <0.0001 | 0.39 |
Self-report (validated) | 1 | 1.12 (0.91–1.38) | |||
Duration of follow-up | |||||
<10 years of follow-up | 3 | 1.25 (1.12–1.39) | 79.4 | 0.008 | 0.48 |
≥10 years of follow-up | 3 | 1.38 (1.10–1.73) | 80.7 | 0.006 | |
Geographic location | |||||
Europe | 4 | 1.28 (1.15–1.43) | 75.4 | 0.007 | 0.48 |
America | 1 | 1.12 (0.91–1.38) | |||
Asia | 1 | 1.38 (1.26–1.50) | |||
Number of cases | |||||
Cases < 250 | 1 | 1.40 (0.73–2.67) | 0.64 | ||
Cases 250 < 500 | 1 | 1.12 (0.91–1.38) | |||
Cases ≥ 500 | 4 | 1.28 (1.17–1.41) | 83.2 | <0.0001 | |
Study quality | |||||
0–3 points | 0 | 0.61 | |||
4–6 | 1 | 1.38 (1.26–1.50) | |||
7–9 | 5 | 1.26 (1.14–1.38) | 68.4 | 0.01 | |
Adjustment for confounders | |||||
Age | |||||
Yes | 6 | 1.28 (1.18–1.40) | 77.0 | 0.001 | NC |
No | 0 | ||||
Education | |||||
Yes | 1 | 1.16 (1.05–1.28) | 0.39 | ||
No | 5 | 1.32 (1.18–1.48) | 81.0 | <0.0001 | |
Alcohol | |||||
Yes | 3 | 1.24 (1.14–1.35) | 79.7 | 0.007 | 0.40 |
No | 3 | 1.39 (1.11–1.73) | 67.8 | 0.05 | |
Smoking | |||||
Yes | 5 | 1.31 (1.19–1.44) | 81.1 | <0.0001 | 0.39 |
No | 1 | 1.20 (1.06–1.35) | |||
Diabetes | |||||
Yes | 1 | 1.16 (1.05–1.28) | 0.39 | ||
No | 5 | 1.32 (1.18–1.48) | 81.0 | <0.0001 | |
Aspirin use | |||||
Yes | 1 | 1.16 (1.05–1.28) | 0.39 | ||
No | 5 | 1.32 (1.18–1.48) | 81.0 | <0.0001 | |
NSAID use | |||||
Yes | 1 | 1.16 (1.05–1.28) | 0.39 | ||
No | 5 | 1.32 (1.18–1.48) | 81.0 | <0.0001 | |
Acetaminophen | |||||
Yes | 0 | NC | |||
No | 6 | 1.28 (1.18–1.40) | 77.0 | 0.001 | |
Physical activity | |||||
Yes | 3 | 1.20 (1.18–1.22) | 0 | 0.63 | 0.01 |
No | 3 | 1.42 (1.32–1.53) | 0 | 0.40 | |
Meat | |||||
Yes | 0 | NC | |||
No | 6 | 1.28 (1.18–1.40) | 77.0 | 0.001 | |
Fiber | |||||
Yes | 2 | 1.15 (1.05–1.26) | 0 | 0.78 | 0.17 |
No | 4 | 1.37 (1.20–1.56) | 85.4 | <0.0001 |
Physical activity | ||||||
---|---|---|---|---|---|---|
n
| RR (95% CI) |
I
2
(%) |
P
h
a
|
P
h
b
| ||
All studies | 5 | 0.76 (0.63–0.93) | 54.3 | 0.07 | ||
Sex | ||||||
Men | 2 | 0.84 (0.45–1.58) | 75.7 | 0.04 | 0.86/0.78c
| |
Women | 1 | 0.70 (0.59–0.85) | ||||
Men and women | 2 | 0.74 (0.47–1.18) | 55.3 | 0.14 | ||
Duration of follow-up | ||||||
<10 years of follow-up | 2 | 0.61 (0.45–0.82) | 0 | 0.61 | 0.35 | |
≥10 years of follow-up | 3 | 0.83 (0.66–1.04) | 62.8 | 0.07 | ||
Geographic location | ||||||
Europe | 3 | 0.83 (0.66–1.04) | 62.8 | 0.07 | 0.46 | |
America | 2 | 0.61 (0.45–0.82) | 0 | 0.61 | ||
Asia | 0 | |||||
Number of cases | ||||||
Cases < 250 | 2 | 0.81 (0.36–1.83) | 73.8 | 0.05 | 0.76 | |
Cases 250 < 500 | 1 | 0.63 (0.45–0.88) | ||||
Cases ≥ 500 | 2 | 0.78 (0.63–0.97) | 67.5 | 0.08 | ||
Study quality | ||||||
0–3 points | ||||||
4–6 | 1 | 0.52 (0.27–1.00) | ||||
7–9 | 4 | 0.79 (0.64–0.96) | 58.6 | 0.06 | ||
Adjustment for confounders | ||||||
Age | ||||||
Yes | 5 | 0.76 (0.63–0.93) | 54.3 | 0.07 | NC | |
No | 0 | |||||
Education | ||||||
Yes | 2 | 0.78 (0.63–0.97) | 67.5 | 0.08 | 0.98 | |
No | 3 | 0.74 (0.47–1.16) | 61.5 | 0.07 | ||
Alcohol | ||||||
Yes | 2 | 0.69 (0.57–0.82) | 0 | 0.39 | 0.17 | |
No | 3 | 0.84 (0.63–1.11) | 58.2 | 0.09 | ||
Smoking | ||||||
Yes | 4 | 0.80 (0.64–0.99) | 57.5 | 0.07 | 0.83 | |
No | 1 | 0.63 (0.45–0.88) | ||||
Diabetes | ||||||
Yes | 1 | 0.70 (0.59–0.85) | 0.32 | |||
No | 4 | 0.79 (0.60–1.04) | 55.7 | 0.08 | ||
Aspirin use | ||||||
Yes | 1 | 0.70 (0.59–0.85) | 0.32 | |||
No | 4 | 0.79 (0.60–1.04) | 55.7 | 0.08 | ||
NSAID use | ||||||
Yes | 1 | 0.70 (0.59–0.85) | 0.22 | |||
No | 4 | 0.79 (0.60–1.04) | 55.7 | 0.08 | ||
Acetaminophen | ||||||
Yes | 0 | NC | ||||
No | 5 | 0.76 (0.63–0.93) | 54.3 | 0.07 | ||
BMI | ||||||
Yes | 1 | 0.70 (0.59–0.85) | 0.22 | |||
No | 4 | 0.79 (0.60–1.04) | 55.7 | 0.08 | ||
Meat | ||||||
Yes | 1 | 0.52 (0.27–1.00) | 0.46 | |||
No | 4 | 0.79 (0.64–0.96) | 58.6 | 0.06 | ||
Fiber | ||||||
Yes | 2 | 0.68 (0.58–0.80) | 0 | 0.59 | 0.22 | |
No | 3 | 0.86 (0.61–1.19) | 47.6 | 0.15 |