Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland.
Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Clin Gastroenterol Hepatol. 2022 Feb;20(2):325-333.e5. doi: 10.1016/j.cgh.2021.01.003. Epub 2021 Jan 5.
The etiology of diverticulitis is poorly understood. The long-held belief that constipation and low-fiber diet are risk factors for diverticulosis has recently been challenged by studies that suggest that more frequent bowel movements predispose to diverticulosis. We aim to prospectively explore the association between bowel movement frequency and incident diverticulitis.
We studied participants of the Nurses' Health Study (NHS) and Health Professional Follow-up Study (HPFS). Participants' medical history, lifestyle factors and diet were used in Cox proportional hazards regression models to estimate multivariable-adjusted hazard ratios(HRs) and 95% confidence intervals(CI).
In the NHS during over 24 years of follow-up encompassing 1,299,922 person-years, we documented 5,214 incident cases of diverticulitis, and in the HPFS over 14 years encompassing 368,661 person-years of follow-up, we documented 390 incident cases of diverticulitis. We observed an inverse association between the frequency of bowel movements and risk of diverticulitis. In the NHS, compared with women who had daily bowel movements, those with more than once daily bowel movements had a HR of 1.30 (95% CI, 1.19, 1.42) and those with less frequent bowel movements had a HR of 0.89 (95% CI, 0.82, 0.95; p-trend < 0.0001). In the HPFS, the corresponding HRs were 1.29 (95% CI, 1.04, 1.59) and 0.61 (95% CI, 0.36, 1.03; p-trend = 0.003). The association between bowel movements and diverticulitis was not modified by categories of age, BMI, physical activity, laxative use or fiber intake.
More frequent bowel movements appear to be a risk factor for subsequent diverticulitis both in men and women. Further studies are needed to understand the potential mechanisms that may underlie this association.
憩室炎的病因尚不清楚。长期以来，人们一直认为便秘和低纤维饮食是憩室病的危险因素，但最近的研究表明，更频繁的排便会导致憩室病。我们旨在前瞻性地探讨排便频率与憩室炎发病之间的关系。
我们研究了护士健康研究（NHS）和健康专业人员随访研究（HPFS）的参与者。使用 Cox 比例风险回归模型，根据参与者的病史、生活方式因素和饮食，估计多变量调整后的风险比（HR）和 95%置信区间（CI）。
在 NHS 超过 24 年的随访期间（共 1,299,922 人年），我们记录了 5,214 例憩室炎发病病例，在 HPFS 超过 14 年的随访期间（共 368,661 人年），我们记录了 390 例憩室炎发病病例。我们观察到排便频率与憩室炎发病风险之间呈负相关。在 NHS 中，与每天排便的女性相比，每天排便一次以上的女性发生憩室炎的 HR 为 1.30（95%CI，1.19，1.42），排便频率较低的女性发生憩室炎的 HR 为 0.89（95%CI，0.82，0.95；p-trend<0.0001）。在 HPFS 中，相应的 HR 分别为 1.29（95%CI，1.04，1.59）和 0.61（95%CI，0.36，1.03；p-trend=0.003）。排便与憩室炎之间的关联不受年龄、BMI、体力活动、泻药使用或纤维摄入量类别影响。
在男性和女性中，更频繁的排便似乎是随后发生憩室炎的一个危险因素。需要进一步研究以了解可能导致这种关联的潜在机制。
