Lifestyle, genetic susceptibility, and risk of diverticular disease: a prospective cohort study

BACKGROUND: Emerging evidence indicates that diverticular disease is attributed to both environmental and genetic factors. The impact of modifiable lifestyle factors on diverticular disease has not been fully elucidated, particularly regarding the role of genetic predisposition. MATERIALS AND METHODS: We performed a prospective cohort study using data from the UK Biobank, which included 472 612 participants. The impacts of 17 lifestyle factors on diverticular disease were evaluated using Cox regression models. Sensitivity analysis was performed with a specific focus on complicated diverticulitis with perforation and abscess. Stratified analyses were performed according to polygenic risk score (PRS) tertiles. RESULTS: Over a median follow-up of 13.6 years, we identified 23 742 cases of diverticular disease, including 832 cases of complicated diverticulitis. After adjusting for age, sex, BMI, ethnicity, household income, and PRS tertiles, smoking, alcohol, frequent insomnia, sedentary behavior, and tea consumption were associated with an increased risk of diverticular disease. Conversely, intermediate sleep duration, coffee consumption, and a healthy diet were associated with a lower diverticular disease risk. For complicated diverticulitis, smoking and frequent sleeplessness/insomnia remained as significant risk factors. A healthy diet, particularly one rich in fruits and wholegrains, was associated with reduced risk of complicated diverticulitis. The effects of smoking, sleeplessness or insomnia, and consumption of refined grains, processed meats, and unprocessed red meats on diverticular disease may be modified by genetic predisposition. CONCLUSIONS: Adopting an optimal lifestyle is associated with a lower risk of developing diverticular disease, while the impact of certain lifestyle factors may be modified by genetic predisposition.