Epidemiology

Prevalence increases with age, being <10% in those younger than 40 years of age, approximately 50% at 50 years of age, and 50% to 66% at over 80 years of age in developed countries.[4]

One study reported diverticular disease prevalence of 12% to 49% in Europe.[5] Although earlier studies describe diverticular disease as being rare in rural Africa and Asia (with highest prevalence in the US, Europe, and Australia), data indicate an overall increased prevalence in these regions.[6][7][8][9][10]

Vegetarians have been shown to have a lower incidence of diverticular disease.[11][12][13] Right-sided diverticular disease, which is more common in Asia, is shown to be associated with meat consumption in Asian populations.[14]

There is no overall sex difference in prevalence of diverticular disease;[4] however, in older adults there is a female preponderance.[15]

Prevalence of fever and leukocytosis in older patients with acute diverticulitis varies from 30% to 50%. Rarely, a more aggressive form of diverticular disease manifests in younger obese males (<40 years of age).[16]

Risk factors

This is the strongest risk factor. Incidence of diverticular disease increases in older people and is extremely rare in children.[4] This may be due to decreasing mechanical strength of the colonic walls. Changes in collagen structure may cause age-associated decreases in the colonic wall strength.[31]

The evidence is mostly based upon observational studies.[32][33][34] Low-fibre consumption results in low stool weight and increased transit time, which in turn results in increased segmental pressure in the colon leading to diverticula formation.[28][29]

Salt-, meat-, and sugar-rich diets are associated with increased incidence of diverticulosis. This diet results in low stool weight and increased transit time, which in turn results in increased segmental pressure in the colon leading to diverticula formation.[28][29]

Obesity is a predisposing factor.[19]

Modest increases in body mass index (BMI) may increase the risk of diverticular disease, as well as the risk of diverticular disease complications.[20] Perforations and recurrent diverticulitis are more common in people with a BMI greater than 30, and these people are also at increased risk of diverticular bleeding.[35][36]

There is a strong association between non-steroidal anti-inflammatory drug (NSAID) and opioid analgesia use and perforation of colonic diverticula.[37][38] NSAIDs are also associated with diverticular bleeding.[39][40]

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