Professional Documents
Culture Documents
2012;19(2):6265
ISSN: 0872-8178
Volume 19
Ano XIX
N 3 Maro Abril 2012 Portuguese Journal of Gastroenterology
ARTIGO ORIGINAL
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
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).
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
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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