Introduction
Symptomatic Uncomplicated Diverticular Disease (SUDD) is a widespread gastrointestinal condition linked to sedentary lifestyles and unhealthy dietary patterns, often requiring medications. Mediterranean Diet (MedDiet) and physical activity (PA) have been proposed as potential protective factors against various diseases, including SUDD.
Aims & Methods
The aim is to evaluate if a counseling program which encourages MedDiet and PA can influence SUDD symptoms, drug use and quality of life.
In this prospective, monocentric, observational study, we enrolled consecutive patients with diagnosis of SUDD at colonoscopy. They were divided into two groups: the Study Group (SG) received a 3-month lifestyle counseling promoting MedDiet and regular PA, while the Control Group (CG) followed a free diet. Lifestyle counseling consisted of 3 medical visits (every 6 weeks) and 4 phone calls (every 2 weeks). Patients were evaluated at baseline (T0), 12 weeks (T12, end of counseling) and 52 weeks (T52). We collected clinical data and anthropometric data, MediLite score (a validated adherence score for MedDiet), questionnaires assessing PA and symptom burden expressed both as specific item and as multiparametric scores including Irritable Bowel Syndrome Severity Scoring Scale (IBS-SSS) and Visual Analogical Scale for patients with SUDD (VAS-DICA), and SF-12 for the assessment of quality of life.
Results
84 patients (F=48) were enrolled, of whom 41 subjects were included in SG while 43 in CG. At T12, while CG characteristics remain unchanged, the Medi-Lite score in SG rose from 9,12±2,0 to 10,3±2,23 (p=0,011) and daily walking time increased, with 92,5% of SG reporting walking for 30–60 minutes daily compared to 42,5% at T0 (p< 0,001). At T52, SG had still a high % of patients with high adherence to MedDiet (MediLite >10) (from 46,34% to 56,01%, p<0.001) and PA adherence was 63,41% (p=0,001). Compared to CG, SG showed a reduction of abdominal pain (SG/CG at T0 51,22/58,14%, at T12 24,4/46,51%, p=0,012, at T52 31,71/53,49%, p=0,018), constipation (at T0 19,51/25,58%, at T52 7,32/44,19% p<0,001), and IBS-SSS score (at T0 141±98,5/150±94,1, at T12 71±61,6/123±104, p=0,002, at T52 69,1±52,4/101±97,5, p<0,001). Subjects in SG who reported medication use for SUDD dropped from 43,9% to 26,83% at T12 and 24,39 at T52 (p<0,05) while an increase of overall medication use was observed in the CG (from 25,58 to 51,16, and 83,72% at T0, T12, and T54, respectively), in particular regarding the use of rifaximin (from 6,98% to 13,95% and 34,88%), both at T12 (p=0,01) and T52 (p<0,001). Overall, the CG had a higher rate of diverticular disease complications including acute diverticulitis, need for hospitalization and surgery: 12 vs 1 patient in the CG vs SG, respectively (at T52=0,001).
Conclusion
Higher adherence to MedDiet and PA are associated with symptom relief, reduced use of medication, and reduction of disease-associated complications in patients with SUDD, suggesting a therapeutical role of MedDiet and PA which goes beyond the already recognized preventive action. Clinical benefits of a 3-month counseling may still be present at 1 year.
