Original Contribution | Published:

Colon/Small Bowel

Adherence to a Healthy Lifestyle is Associated With a Lower Risk of Diverticulitis among Men

The American Journal of Gastroenterology volume 112, pages 18681876 (2017) | Download Citation



Diverticulitis is a common disease with high clinical burden. We evaluated the joint contribution of multiple lifestyle factors to risks of incident diverticulitis. We also estimated the proportion of diverticulitis preventable by lifestyle modifications.


We prospectively examined the association between lifestyle factors (red meat, dietary fiber intake, vigorous physical activity (activity with metabolic equivalent ≥6), body mass index (BMI), and smoking) and risk of diverticulitis among participants in the Health Professionals Follow-Up Study.


We documented 907 incident cases of diverticulitis during 757,791 person-years. High intake of red meat, low intake of dietary fiber, low vigorous physical activity, high BMI, and smoking were independently associated with increased risks of diverticulitis (all P<0.05). Low-risk lifestyle was defined as average red meat intake <51 g per day, dietary fiber intake in the top 40% of the cohort (about 23 g per day), vigorous physical activity in the highest 50% among participants with non-zero vigorous physical activity (roughly 2 h of exercise weekly), normal BMI between 18.5–24.9 kg m−2, and never-smoker. There was an inverse linear relationship between number of low-risk lifestyle factors and diverticulitis incidence (P for trend<0.001). Compared with men with no low-risk lifestyle factors, the multivariable relative risks of diverticulitis were 0.71 (95% confidence interval (CI): 0.59–0.87) for men with 1 low-risk lifestyle factor; 0.66 (95% CI: 0.55–0.81) for 2 low-risk factors; 0.50 (95% CI: 0.40–0.62) for 3 low-risk factors; 0.47 (95% CI: 0.35–0.62) for 4 low-risk factors, and 0.27 (95% CI: 0.15–0.48) for 5 low-risk factors. Adherence to a low-risk lifestyle could prevent 50% (95% CI: 20–71%) of incident diverticulitis.


Adherence to a low-risk lifestyle is associated with reduced incidence of diverticulitis.

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We thank the participants and staff of the Health Professionals Follow-Up Study for their valuable contributions.

Author information

Author notes

    • Po-Hong Liu
    • , Yin Cao
    • , Lisa L Strate
    • , Edward L Giovannucci
    •  & Andrew T Chan

    These authors contributed equally to this work


  1. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA

    • Po-Hong Liu
    • , Edward L Giovannucci
    •  & Andrew T Chan
  2. Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA

    • Po-Hong Liu
    • , Yin Cao
    •  & Andrew T Chan
  3. Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA

    • Yin Cao
    •  & Andrew T Chan
  4. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA

    • Yin Cao
    • , Kana Wu
    •  & Edward L Giovannucci
  5. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA

    • Yin Cao
  6. Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA

    • Brieze R Keeley
  7. Tufts University School of Medicine, Boston, Massachusetts, USA

    • Idy Tam
  8. Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA

    • Lisa L Strate
  9. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

    • Edward L Giovannucci
  10. Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA

    • Andrew T Chan


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Competing interests

Gurantor of the article: Andrew T. Chan, MD, MPH.

Specific author contributions: Drs Liu, Cao, and Chan had full access to all of the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: P.H.L., Y.C., L.L.S., E.L.G., and A.T.C. Acquisition of data: L.L.S., B.R.K., I.T., and A.T.C. Analysis and interpretation of data: all coauthors. Drafting of the manuscript: P.H.L. Critical revision of the manuscript for important intellectual content: all coauthors. Statistical analysis: P.H.L. and Y.C. Obtained funding: L.L.S., E.L.G., and A.T.C. Administrative, technical, or material support: Y.C., L.L.S., E.L.G., and A.T.C. Study supervision: Y.C., L.L.S., E.L.G., and A.T.C.

Financial support: This work was supported by grants R01 DK101495, R01 DK084157, K24 DK098311, and UM1 CA167552 from the National Institutes of Health. Dr. Chan is a Stuart and Suzanne Steele MGH Research Scholar.

Potential competing interests: The study sponsors have no role in the study design, collection, analysis, and interpretation of data. A.T.C. previously served as a consultant for Bayer Healthcare, Aralaz Pharmaceuticals, and Pfizer for work unrelated to the topic of this manuscript. This study was not funded by Bayer Healthcare, Aralez Pharmaceuticals, or Pfizer.

Corresponding author

Correspondence to Andrew T Chan.

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