Authors: Marinaccio C, Altomare A, Neri B, Restaneo L, Biasutto D, Carotti S, Cicala M, Fanali C, Guarino MPL
Journal: Neurogastroenterology & Motility
Year: 2025
Volume: 37
Article number: e70171
DOI: 10.1111/nmo.70171
Study at a Glance
- Study type: Narrative review
- Population studied: Patients with symptomatic uncomplicated diverticular disease (SUDD)
- Intervention or approach studied: Dietary fibre and polyphenols
- Main outcome(s): Role of diet in the development and management of SUDD
Why was this study done?
Symptomatic uncomplicated diverticular disease (SUDD) is increasingly common in Western countries and significantly affects quality of life. Low fibre intake has been identified as a modifiable risk factor in disease development and progression.
Dietary fibre affects bowel motility and stool consistency, potentially reducing diverticula formation and symptom severity. Polyphenols are plant compounds with antioxidant and anti-inflammatory properties that may protect the gut lining and influence gut microbiota.
Marinaccio and colleagues conducted this review to explore emerging evidence on dietary fibre and polyphenols in SUDD management.
How was the study performed?
The authors conducted a narrative review by searching Pubmed and Scopus databases for published studies. They used search terms including diverticulosis, diverticula, SUDD, diverticulitis, combined with diet, fibre, and polyphenols. The search included English-language papers with no date restrictions.
What did the researchers find?
The authors reported that whilst the exact pathophysiology of SUDD remains unclear, contributing factors include genetic predisposition, low-level inflammation, and gut microbiota imbalances.
Dietary fibre has historically been linked to lower diverticular disease risk. Fibre retains water in the bowel, increasing stool weight and reducing transit time. This lowers bowel pressure, potentially preventing diverticula formation. Gut bacteria ferment fibre into short-chain fatty acids, which maintain bowel lining integrity.
Two systematic reviews examining fibre in SUDD management suggested potential benefits for symptom improvement and bowel habit regulation. However, significant limitations included variations in fibre types and amounts, inconsistent study designs, and lack of standardised treatment approaches, limiting the strength of evidence.
Polyphenols are found in fruits (apples, pears, prunes), vegetables, whole grains, cocoa, walnuts, and flaxseeds. They have strong antioxidant properties, reducing oxidative stress and inflammation whilst positively affecting gut microbiota and supporting gut barrier function.
The authors suggested that combining fibre-rich and polyphenol-rich foods may support gut health synergistically. Fibre acts as a prebiotic, whilst polyphenols are broken down by gut bacteria into compounds with enhanced protective effects. Whole fruits, particularly apples, pears, and prunes, have shown protective effects against diverticulitis in some studies.
The authors acknowledged implementation challenges. Many individuals with diverticular disease restrict their diet from fear of triggering symptoms, sometimes avoiding beneficial foods. They emphasised the importance of nutritional counselling to help patients gradually reintroduce fibre and polyphenol-rich foods in a personalised, symptom-sensitive manner.
What did the authors conclude?
The authors concluded that dietary fibre is recognised for its benefits in improving bowel movement, influencing gut microbiota, and reducing bowel pressure. Polyphenols, with their antioxidant and anti-inflammatory properties, may further support gut health.
Current studies are limited by differences in design and methods, preventing strong conclusions. Individual responses to dietary components vary; therefore, personalised nutrition strategies are essential. Tailoring dietary recommendations to individual tolerances and needs ensures optimal fibre and polyphenol intake, potentially improving outcomes and promoting long-term adherence.
Further research is needed to better understand the role of fibre and polyphenols in preventing and managing SUDD.
Key Takeaways
- Dietary fibre may help reduce symptoms of diverticular disease by improving bowel movement, supporting gut bacteria, and lowering pressure in the bowel.
- Polyphenols, found in plant-based foods such as fruits, vegetables, and whole grains, have antioxidant and inflammation-reducing properties that may protect the gut lining.
- The combination of fibre-rich and polyphenol-rich foods may work together to support gut health and reduce the risk of disease progression.
- Personalised dietary advice is important to help patients reintroduce beneficial foods in a way that takes their individual symptoms and tolerances into account.
- More high-quality research is needed to confirm the benefits of fibre and polyphenols in the management of symptomatic uncomplicated diverticular disease.
This Scientific Publication Summary is an objective summary of the published study for personal and educational use. It does not constitute medical advice, endorsement of the intervention, or a recommendation to alter clinical practice.