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GE J Port Gastrenterol.

2012;19(2):6265

ISSN: 0872-8178
Volume 19
Ano XIX
N 3 Maro Abril 2012 Portuguese Journal of Gastroenterology

Imagem: Sfilis heptica simulando metastizao


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rgo Oficial

ARTIGO ORIGINAL

Visceral fat: A key factor in diverticular disease of the colon

Miguel Afonso,* Joana Pinto, Ricardo Veloso, Teresa Freitas, Joo Carvalho, Jos Fraga

Servio de Gastrenterologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia/Espinho, Portugal

Received April 11, 2011; accepted July 7, 2011

KEYWORDS Abstract
Obesity; Background and aim: Diverticular disease of the colon is a common disease, representing an
Visceral fat; important health problem in Western countries. The authors aimed to study the visceral fat and
Abdominal parameters of obesity in the diverticular disease of the colon.
ultrasonography; Methods: Casecontrol study of unselected mediumrisk subjects who underwent colonoscopy
Diverticular disease for screening of colorectal cancer during 1 year. Subjects were inquired by a nutritionist about
nutritional habits. Anthropometric variables were evaluated. Visceral and subcutaneous fat
were assessed by ultrasound by the same gastroenterologist. Statistics: x2, t test, logistic
multivariate regression, odds ratio (OR).
Results: Included 303 individuals, 46.9% female, mean age 606.6 years. Sixtyfour (21%)
individual had diverticular disease of the colon. People with diverticula were significantly older
(P=0.01), had more visceral fat (P<0.01), waist circumference (P=0.01) and total fat consumption
(P=0.01). Logistic regression analysis showed age and visceral fat as independent risk factors for
diverticular disease of the colon. The probability of occurrence of disease was 3times higher in
individuals in the 3rd tertile of age (older than 63 years old) than those younger than 56 years old
(1st tertile of age) OR 3.1, 95% CI 1.56.5. For visceral fat, those individuals in the 3rd tertile
had a twofold risk of having diverticular disease of the colon (OR 2.3, 95% CI 1.025.2) than
those in 1st tertile. There was no significant difference for sex, body mass index, subcutaneous
fat or fiber intake.
Conclusion: Older age and higher visceral fat were independent risk factors for the occurrence
of diverticular disease of the colon.
2011 Published by Elsevier Espaa, S.L. on behalf of Sociedade Portuguesa de Gastrenterologia.
All rights reserved.

*Corresponding author.
Email address: miguelalvesafonso@gmail.com (M. Afonso).

Artigo relacionado com: Fibra, obesidade e doena diverticular mudana de paradigma

08728178/$ see front matter 2011 Published by Elsevier Espaa, S.L. on behalf of Sociedade Portuguesa de Gastrenterologia.
Visceral fat: A key factor in diverticular disease of the colon63

PALAVRASCHAVE Obesidade visceral: factor de risco para doena diverticular do clon


Obesidade;
Gordura visceral; Resumo
Ecografia abdominal; Introduo e objectivos: A doena diverticular do clon uma doena comum, representando
Doena diverticular um importante problema de sade nos pases ocidentais. Os autores pretenderam estudar a
do clon relao da gordura visceral e outros parmetros de obesidade na doena diverticular do clon.
Mtodos: Estudo de indivduos no seleccionados, de mdio risco que efectuaram colonoscopia para
rastreio de cancro colorectal, durante um ano. Os indivduos responderam a inqurito nutricional
por nutricionista. Foram avaliadas variveis antropomtricas. A gordura visceral e subcutnea foram
avaliadas atravs de ecografia abdominal efectuada pelo mesmo gastroenterologista. Anlise
estatstica: x2, teste t, regresso logstica multivariada, odds ratio (OR).
Resultados: Includos 303indivduos, 46,9% eram do sexo feminino, idade mdia 606,6anos.
Sessenta e quatro (21%) apresentavam doena diverticular do clon. Os indivduos com
diverticulose eram mais idosos (p=0,01), tinham mais gordura visceral (p<0,01), maior
permetro de cinta (p=0,01) e consumo de gordura (p=0,01). A idade e a gordura visceral
foram factores de risco independentes para doena diverticular do clon. A presena de
diverticulose clica foi 3vezes maior nos indivduos no 3. tercil de idade (> 63anos) do que
naqueles com menos de 56anos (1. tercil) OR=3,1, IC 95% 1,56,5. Relativamente gordura
visceral, os indivduos no 3. tercil tiveram um risco duas vezes maior (OR 2,3, IC 95% 1,025,2)
do que aqueles no 1. tercil. No houve diferena significativa quanto ao sexo, ndice de massa
corporal, gordura subcutnea ou consumo de fibra.
Concluso: A idade e a gordura visceral foram fatores de risco independentes para a ocorrncia
de doena diverticular do clon.
2011 Publicado por Elsevier Espaa, S.L. em nome da Sociedade Portuguesa de Gastrenterologia.
Todos os direitos reservados.

Introduction Subjects were inquired by a nutritionist about nutritional


habits using a validated questionnaire. The same nutritionist
Diverticular disease of the colon (DDC) is common in Western evaluated anthropometric variables (BMI, waist and hip
countries, with a prevalence of up to 50% in the elderly, circumference).
affecting generally the left colon.13In 80% of individuals Visceral fat (VF) and subcutaneous fat (SF) were assessed
the disease remains asymptomatic, but the remaining by ultrasound by the same gastroenterologist.
can develop complications of DDC as diverticulitis with Both investigators were blind for colonoscopic findings.
perforation, obstruction or abscesses formation; and acute
diverticular bleeding (315% of patients).4,5One estimate Data collection
puts European DDC associated mortality at 23600deaths
annually.6 We collected data on age and gender.
Age is a major risk factor for DDC. Some observational A standard questionnaire was carried out by a nutritionist.
studies found that lower intake of dietary fiber correlates Total caloric intake, fat and dietary fiber consumption were
with higher prevalence of DDC. However, some argue that evaluated.
dietary fiber consumption may be inversely related to total
energy consumption and hence adiposity.7Some studies Anthropometric data
showed that BMI,8waist circumference,9and waisttohip
ratio9significantly increased the risks of complicated DDC, In this study, all participants had their anthropometric
but there appears to be no published data on the relationship data taken in the same day. BMI was calculated as weight
between obesity and asymptomatic DDC. divided by height squared. Waist circumference was
The authors aimed to study visceral fat (VF) and parameters measured at the midpoint between the lateral iliac crest
of obesity in the diverticular disease of the colon as well as and lowest rib; hip circumference, at the level of the
the dietary consumption of fat in DDC. trochanter major.
Obesity was defined as BMI >30kg/m2using World Health
Organization criteria as BMI 30kg/m2.
Materials and methods
Visceral and subcutaneous fat
In total, 303unselected caucasian subjects underwent
colonoscopy for colorectal cancer screening (reaching Visceral and subcutaneous fat were assessed by abdominal
at least proximal sigmoid colon) at the Gastroenterology ultrasound (Pro Focus BK Medical, Herlem, Denmark) using
Department, between April 2009and March 2010. a 3.5MHz probe located 1cm above the umbilicus.
64 M. Afonso et al

The subcutaneous fat thickness was defined as the distance lesser subcutaneous fat (P<0.01). Waist circumference was
between the skin and the external face of the rectus higher in men (P=0.07) but hip circumference was higher in
abdominis muscle. The visceral fat thickness was defined as women (P<0.05). Waisttohip ratio was lower in the female
the distance between the internal face of rectus abdominis (P<0.05).
muscle and the anterior wall of the aorta.
Risk factors of diverticular disease of the colon
Colonoscopy
The characteristics of the patients with or without DDC are
Colonoscopy was performed after using polyethylene listed in Table 2.
glycolcontaining lavage solution for colon preparation by use In the univariate analysis, there was a significant difference
of electronic video endoscopes (Model Exera CFQ 145/160, between groups for age (P=0.01), visceral fat (P<0.01), waist
Olympus Optical Co, Hamburg, Germany). circumference (P=0.01), waisttohip ratio (P=0.04) and total
All participants gave their informed consent. fat consumption (P=0.01). There was no significant difference
for gender, BMI, subcutaneous fat, hip circumference or fiber
Statistical analysis intake.
Individuals in the third tertile of age (63years) showed
The data were evaluated using descriptive statistical 3times increased risk of DDC (OR 3.1; 95%CI 1.46.4)
methods (meanSD, ranges). For correlation analysis compared to those in the first tertile (<56years).
we used Pearson Correlation. Unpaired Studentss ttest After adjustment for age, visceral fat confirmed to be a
was used to compare means. Frequency distribution was risk factor for diverticular disease (P<0.01).
calculated by the x2test or Fishers exact probability test. Subjects in the third tertile of visceral fat (46.9mm)
Level of significance was set at P<0.05. Various risk factors demonstrated a more than 2fold increase in risk of DDC (OR
were also evaluated using multivariate regression analysis. 2.3; 95%CI 1.025.2) compared to those in the first tertile
Bivariate analysis was carried out, using the odds ratio (<32.7mm).
(OR) to test for associations between age, visceral fat and
the presence of diverticular disease of colon. An OR with
a 95% confidence interval that did not include the value of Discussion
1.00in its range was considered statistically significant.
Statistical calculations were performed using SPSS Version The study confirmed older age as a risk factor of diverticular
17.0for Windows (SPSS Inc Chicago, USA). disease as demonstrated in previous studies. 13In the
present study, subjects older than 63years old had a 3times
increased risk of DDC compared to those younger than
Results 56years old.
Several previous studies evaluated the association between
Of the 303subjects, sixtyfour (21%) had diverticular disease obesity and DDC or its complications.
of the colon. One hundred and forty two (46.9%) were female A prospective cohort study of 47228male health
and the mean age was 606.6years. professionals showed that waist circumference, and
waisttohip ratio significantly increased the risks of
Obesity and distribution of fat diverticulitis and diverticular bleeding.9
Rosemar et al. followed a cohort of 7494men for a
Mean BMI was 27.7kg/m2, with a prevalence of obesity of period of 28years.8One hundred and twelve patients were
25%. Other anthropometric parameters are discriminated in
Table 1.
Visceral fat had the strongest correlation with waist Table 2 Clinical variables in subjects with and without
circumference (r=0.6P<0.01) but correlated as well with BMI diverticular disease of the colon: univariate analysis
(r=0.43P<0.01) and hip circumference (r=0.39P<0.01).
There was significant difference for BMI between men and DDC DDC P value
women (P<0.01). Men had significantly more visceral fat but Age (years) 62.56.2 59.36.5 0.01
BMI (kg/m2) 28.13.5 27.63.9 0.4 (NS)
Waist circumference 99.68.4 95.59.2 0.01
Table 1 Obesity parameters in studied population
(cm)
Hip circumference 103.68.0 101.87.5 0.16 (NS)
Mean SD
Waisttohip ratio 0.960.06 0.930.06 0.04
Age (years) 60 6.6 Visceral fat (mm) 49.220.4 39.817.2 <0.01
BMI (kg/m2) 27.7 3.8 Subcutaneous fat (mm) 15.54.3 15.75.5 0.8 (NS)
Waist circumference (cm) 96.5 9.1
Hip circumference (cm) 102.2 7.6 Caloric intake (cal) 2543538 2311659 0.1 (NS)
Waisttohip ratio 0.94 0.06 Total fat intake (g) 89.229.8 74.923.2 0.01
Visceral fat (mm) 41.7 18.3 Fiber intake (g) 27.58.3 25.78.9 0.4 (NS)
Subcutaneous fat (mm) 15.6 5.2
BMI, body mass index; DDC, diverticular disease of the colon;
BMI, body mass index; SD, standard deviation. NS, non significant.
Visceral fat: A key factor in diverticular disease of the colon65

hospitalized because of complicated diverticular disease of results in order to understand the importance of diet and fat
the colon. In those patients, BMI was an independent risk distribution in the pathogenesis of diverticular disease and
factor. its complications.
A retrospective study by Dobbins et al. found that
patients with perforations and recurrent diverticulitis were
significantly more obese.10 Conflicts of interest
Several studies consistently shown a correlation between
visceral fat and chronic subclinical inflammationasvisceral The authors have no conflicts of interest to declare.
fat produces elevated serum levels of several proinflammatory
cytokines.1114Narayan and Floch15noticed more frequent
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