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. 2025 May 19;51(1):207.
doi: 10.1007/s00068-025-02884-w.

Prospective analysis of adiposity metrics for complicated acute colonic diverticulitis: Should WSES Classification and visceral adiposity be integrated for predictive analyses?

Damla Beyazadam  1 , Tunc Eren  2 , Nuray Colapkulu Akgul  3 , Sukriye Julide Sagiroglu  4 , Nesrin Gunduz  5 , Ozgur Ekinci  2 , Orhan Alimoglu  2
Affiliations

Prospective analysis of adiposity metrics for complicated acute colonic diverticulitis: Should WSES Classification and visceral adiposity be integrated for predictive analyses?

Damla Beyazadam et al. Eur J Trauma Emerg Surg. .

Abstract

Background: Colonic diverticulitis is correlated with age, body mass index (BMI), and increased visceral or subcutaneous fat. Obesity contributes to diverticulosis, diverticulitis and its complications onset, as visceral fat activates inflammatory pathways that exacerbate these conditions. The aim of this study was to evaluate the association of visceral adiposity and BMI on complications of acute colonic diverticulitis.

Method: A prospective cohort study was conducted on patients with acute diverticulitis admitted to the general surgery ward of a university hospital in Istanbul from September 2017 to February 2022. A total of 208 patients were classified into uncomplicated and complicated diverticulitis per the World Society of Emergency Surgery guidelines. After documenting demographic, clinical, and laboratory data, along with BMI and computed tomography measurements of visceral and subcutaneous fat areas (VFA, SFA), we conducted a statistical analysis to assess the relationships between VFA, SFA, and BMI in both groups.

Results: Complicated diverticulitis group was found to have significantly lower values of BMI and VFA (p = 0.037 and p = 0.046 respectively). Similarly, BMI and VFA values of patients who underwent all interventional procedures including percutaneous drainage and surgery were found to be significantly lower than the conservative treatment group (p = 0.007, p = 0.025 respectively). V/S < 0.68 is an independent predictor in the complicated group.

Conclusion: Our study shows that complicated diverticulitis cases have lower BMI and visceral fat area. We suggest that increased visceral adipose tissue may serve a protective role by preventing these diverticula from developing into more complicated forms. Therefore, visceral adiposity metrics can be integrated in the predictive analyses.

Keywords: Body mass index; Complicated diverticulitis; Obesity; Visceral adiposity; WSES.

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Conflict of interest statement

Declarations. Ethics approval: The study was approved by the Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital’s Ethics Committee with the approval number 2021/0223. Consent: Written informed consent was obtained from participants prior to the study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient Population
Fig. 2
Fig. 2
a Measurement of subcutaneous and visceral fat areas in axial computed tomography sections obtained at the L3-L4 vertebral level in a case of complicated diverticulitis presented with obstruction. b Measurement of subcutaneous and visceral fat area in axial computed tomography sections obtained from the L3-L4 vertebral level in a case of uncomplicated diverticulitis
Fig. 3
Fig. 3
ROC Analysis of Biomarkers and Adiposity Metrics in Diverticulitis
See this image and copyright information in PMC

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