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Lisa L. Strate, MD, MPH; Yan L. Liu, MS; Sapna Syngal, MD, MPH; Walid H. Aldoori, MD, MPA, ScD; Edward L. Giovannucci, MD, ScD

JAMA. 2008;300(8):907-914.

Context  Patients with diverticular disease are frequently advised to avoid eating nuts, corn, popcorn, and seeds to reduce the risk of complications. However, there is little evidence to support this recommendation.

Objective  To determine whether nut, corn, or popcorn consumption is associated with diverticulitis and diverticular bleeding.

Design and Setting  The Health Professionals Follow-up Study is a cohort of US men followed up prospectively from 1986 to 2004 via self-administered questionnaires about medical (biennial) and dietary (every 4 years) information. Men reporting newly diagnosed diverticulosis or diverticulitis were mailed supplemental questionnaires.

Participants  The study included 47 228 men aged 40 to 75 years who at baseline were free of diverticulosis or its complications, cancer, and inflammatory bowel disease and returned a food-frequency questionnaire.

Main Outcome Measures  Incident diverticulitis and diverticular bleeding.

Results  During 18 years of follow-up, there were 801 incident cases of diverticulitis and 383 incident cases of diverticular bleeding. We found inverse associations between nut and popcorn consumption and the risk of diverticulitis. The multivariate hazard ratios for men with the highest intake of each food (at least twice per week) compared with men with the lowest intake (less than once per month) were 0.80 (95% confidence interval, 0.63-1.01; P for trend = .04) for nuts and 0.72 (95% confidence interval, 0.56-0.92; P for trend = .007) for popcorn. No associations were seen between corn consumption and diverticulitis or between nut, corn, or popcorn consumption and diverticular bleeding or uncomplicated diverticulosis.

Conclusions  In this large, prospective study of men without known diverticular disease, nut, corn, and popcorn consumption did not increase the risk of diverticulosis or diverticular complications. The recommendation to avoid these foods to prevent diverticular complications should be reconsidered.

Author Affiliations: University of Washington School of Medicine, Seattle (Dr Strate); Division of Gastroenterology, Department of Medicine, Harborview Medical Center, Seattle (Dr Strate); Departments of Nutrition (Ms Liu and Dr Giovannucci) and Epidemiology (Dr Giovannucci), Harvard School of Public Health, Boston, Massachusetts; Harvard Medical School, Boston (Drs Syngal and Giovannucci); Division of Gastroenterology (Dr Syngal) and Channing Laboratory (Dr Giovannucci), Department of Medicine, Brigham and Women's Hospital, Boston; Division of Population Sciences, Dana Farber Cancer Institute, Boston (Dr Syngal); and Wyeth Consumer Healthcare Inc, Mississauga, Ontario, Canada (Dr Aldoori).

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