Genetic and Lifestyle Risks Stratify Severe Diverticulitis

Ueland TE, Shelley JP, Mosley JD, et al. Genetic Risk, Healthy Lifestyle, and Risk Stratification for Diverticulitis. J Am Coll Surg. January 2025.

This study used a polygenic risk score plus a lifestyle score (Life’s Essential 8) to examine long-term risk of severe diverticulitis in the UK Biobank. Among 225,592 participants followed a median of 14 years, 2,584 developed severe diverticulitis. Patients with combined high genetic risk and unfavorable lifestyle had the highest risk, with a hazard ratio of 4.71 (95% CI 4.15–5.35) and a cumulative incidence of 3.50% versus 0.75% in the remainder of the cohort. The combined effect exceeded what would be expected from simply adding genetic and lifestyle effects (RERI 0.98, 95% CI 0.39–1.57).

From a surgeon’s standpoint, the main value is not to drive operative decision-making in isolation, but to improve risk communication and focus on prevention counseling. If a patient has high inherited susceptibility, lifestyle still appears to matter, and the highest-risk group is where aggressive counseling around modifiable factors may be most effective. This is a population-level risk tool rather than a direct trigger for elective colectomy, but it supports the concept that future diverticulitis counseling could become more individualized using combined genetic and lifestyle profiles.