Download Diverticulitis: Diet

QUICK
LESSON
Diverticulitis: Diet
Description/Etiology
Diverticula are herniations that occur in the mucosa and submucosa of the colon. When
diverticula are present, the condition is referred to as diverticulosis. Diverticulosis is a
common, typically asymptomatic intestinal disorder associated with advancing age. About
10–25% of individuals with diverticulosis develop diverticulitis, which is inflammation
of the diverticula. Diverticulitis can result in abscess, adhesion, fistula, and hemorrhage.
Unlike diverticulosis, diverticulitis is accompanied by cramping, nausea, vomiting,
abdominal distention, bleeding, fever, and general abdominal upset. (For more information
on diverticulitis, see Quick Lesson About … Diverticulitis: an Overview ).
During an acute episode of diverticulitis, the patient is usually prescribed a clear liquid
diet to allow for bowel rest. As the inflammation subsides, the patient adds fiber to the diet
gradually in order to prevent abdominal cramping and distention. When the patient is able to
consume a normal diet, it is recommended that he/she adopt a high-fiber diet that contains
18–30 g/day of fiber.
Facts and Figures
ICD-9
562.11
ICD-10
K57.32
Authors
Tanja Schub, BS
Cinahl Information Systems, Glendale, CA
Cherie Marcel, BS
Cinahl Information Systems, Glendale, CA
The risk of developing diverticulosis for persons over the age of 60 is about 40%, and 60%
for individuals 80 years of age and older. Researchers who conducted a prospective cohort
study of 47,033 adults living in England or Scotland concluded that a vegetarian diet is
associated with a 31% lower risk of diverticular disease compared with a diet that contains
meat (Crowe et al., 2011). In Asia, diverticulitis is more likely to effect the ascending colon
and in Western countries, the descending colon is most commonly affected.
Risk Factors
All persons with diverticulosis are at risk of developing diverticulitis. Diverticulosis
frequently occurs after many years of constipation and is believed to be the result of a diet
that is high in fat and red meat. Obesity, inadequate fiber intake, alcohol consumption,
age exceeding 60 years, and being a man are also factors associated with increased risk of
diverticular disease.
Signs and Symptoms/Clinical Presentation
Reviewers
Darlene Strayer, RN, MBA
Cinahl Information Systems, Glendale, CA
Eva Beliveau, RN, MSN, CNE
Professor of Nursing, Northern Essex
Community College
Nursing Executive Practice Council
Glendale Adventist Medical Center,
Glendale, CA
Editor
Diane Pravikoff, RN, PhD, FAAN
Cinahl Information Systems, Glendale, CA
Signs and symptoms include abdominal pain (usually in the lower left quadrant), diarrhea,
constipation, anorexia, nausea, vomiting, bleeding, and fever.
Assessment
› Patient History
• Ask about the following:
–Medical conditions (e.g., hypertension, thyroid disorder, diabetes mellitus, heart or
renal failure)
–Symptoms (e.g., vomiting, diarrhea, constipation, pain), if any, including onset and
characteristics, which can have a negative effect on dietary intake
–Level and type of regular physical activity
• Conduct a diet analysis by asking the patient to complete a diet history
April 8, 2016
Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2016, Cinahl Information Systems. All rights
reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by
any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice
or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare
professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206
–Useful tools for evaluating the patient’s dietary strengths and weaknesses include a food frequency questionnaire and a
3-day diet recall (i.e., patient recall of all foods and beverages consumed in a 3-day period that includes 1 weekend day)
› Physical Findings of Particular Interest
• Chronic constipation frequently precedes diverticulosis
› Laboratory Tests That May Be Ordered
• CBC with hemoglobin and hematocrit will be ordered to assess for anemia, malnutrition, and infection
Treatment Goals
› Promote Symptomatic Relief and Educate
• Monitor vital signs, weight fluctuation, and laboratory test results; report abnormalities to the treating physician
• Evaluate for pain and other discomfort and provide analgesics and other prescribed medications, when appropriate, for
relief
• Assess for anxiety and depression and provide emotional support
• Review the diet analysis results to assess dietary patterns
–When appropriate, request referral to a dietitian for diet assessment and patient education about meal planning and
making healthy food choices
–Educate about the diagnosis of diverticulitis, strategies for reducing the risk of diverticulitis, the importance of gradually
introducing fiber in the diet, and individualized prognosis
Food for Thought
› It used to be commonly thought that eating nuts, corn, popcorn, berries, or seeds could cause diverticulitis, but there is no
evidence supporting this. The current recommendation is to consume a diet that includes a wide variety of fruits, vegetables,
and whole grains to provide adequate fiber intake and reduce constipation
› Recent research doesn’t support the theory that dietary fiber is protective against developing diverticula; however, evidence
does indicate that consuming adequate dietary fiber is associated with a lower risk of developing diverticular disease
› In general, persons who consume a diet high in fiber have the tendency to practice healthier lifestyle habits overall. They are
frequently more physically active, eat a diet that is lower in fat and higher in fruits and vegetables, abstain from smoking,
and consume less alcohol and caffeine
Red Flags
› Patients may be afraid to eat a high-fiber diet because they have been told to eat a low-residue diet with no nuts, seeds, corn,
or berries. Providing dietary education regarding the importance of eating a high-fiber diet can help to alleviate these fears
What Do I Need to Tell the Patient/Patient’s Family?
› Achieve and maintain a healthy weight
› As tolerated, participate in regular physical activity for at least 150 minutes/week
› Eat a calorie-appropriate diet that includes fish and other lean proteins, unsaturated fats (including omega-3), complex
carbohydrates (e.g., whole unrefined grains), legumes, nuts and seeds, and a variety of fruits and vegetables
• Gradually increase daily fiber intake to prevent abdominal cramping and distention
› Drink adequate water to prevent or relieve constipation
› Limit alcohol consumption to 1 drink/day if female and two drinks/day if male
› Stop using tobacco if currently using
References
1. Barroso, A. O., & Quigley, E. M. M. (2015). Diverticula and diverticulitis: Time for a reappraisal. Gastroenterology & Hepatology, 11(10), 680-688.
2. Bazzano, L. A., He, J., Ogden, L. G., Loria, C. M., & Whelton, P. K. (2003). Dietary fiber intake and reduced risk of coronary heart disease in US men and women: The National
Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Archives of Internal Medicine, 163(16), 1897-1904.
3. Beitz, J. M. (2014). Management of patients with intestinal and rectal disorders. In J. L. Hinkle & K. H. Cheever (Eds.), Brunner & Suddarth's textbook of medical-surgical
nursing (13th ed., Vol. 1, pp. 1296-1299). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
4. Chen-Maynard, D. (2015). Gastrointestinal diseases. In E. D. Schlenker & J. Gilbert (Eds.), Williams' essentials of nutrition and diet therapy (11th ed., pp. 471-472). St. Louis,
MO: Mosby, an imprint of Elsevier Inc.
5. Crowe, F. L., Appleby, P. N., Allen, N. E., & Key, T. J. (2011). Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and
Nutrition (EPIC): Prospective study of British vegetarians and non-vegetarians. BMJ: British Journal of Medicine, 343, d4131. doi:10.1136/bmj.d4131
6. Gonzales, E. R., & Alavi, K. (2011). Evaluation and treatment of uncomplicated diverticular disease. Seminars in Colon & Rectal Surgery, 22(3), 162-168. doi:10.1053/
j.scrs.2011.05.005
7. Janes, S. E. J., Meagher, A., & Frizelle, F. A. (2006). Management of diverticulitis. British Medical Journal, 332(7536), 271-275.
8. Kent, V. P. (2012). Diagnosis: Diverticular disease. Nursing Made Incredibly Easy, 10(3), 26-33. doi:10.1097/01.NME.0000413344.52446.97
9. Lomangino, K. (2011). Large cohort confirms: High fiber intake predicts lower risk of diverticular disease. Clinical Nutrition Insight, 37(10), 5-6.
10. Lutz, C. A., Mazur, E. E., & Litch, N. A. (Eds.). (2015). Diet in gastrointestinal disease. In Nutrition & diet therapy (6th ed., pp. 479-480). Philadelphia, PA: F. A. Davis Company.
11. Piercy, D. I. (2014). Gastrointestinal disorders. In S. M. Nettina (Ed.), Lippincott manual of nursing practice (10th ed., pp. 686-688). Philadelphia, PA: Wolters Kluwer Health/
Lippincott Williams & Wilkins.
12. Tarleton, S., & DiBaise, J. K. (2011). Invited review: Low-residue diet in diverticular disease: Putting an end to a myth. Nutrition in Clinical Practice, 26(2), 137-142.
doi:10.1177/0884533611399774
13. Zieve, D., & Eltz, D. R. (2014). Diverticulitis. MedlinePlus. Retrieved February 23, 2016, from http://www.nlm.nih.gov/medlineplus/ency/article/000257.htm