Title: Relationship of Coffee Consumption with Colonic Diverticulosis
Version: 5 Date: 24 Jun 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
Introduction
-Lack of clear rationale: While mechanisms linking coffee and colonic physiology are cited,
a stronger mechanistic argument or existing indirect evidence linking coffee to diverticulosis
would help justify the study.
-Insufficient gap analysis: The claim “this is the first study” is strong but not thoroughly
substantiated through a systematic literature review.
-Repetitive content: Some mechanistic explanations (e.g., brain-gut axis and Nrf2 system) seem
tangential and not tied to diverticulosis pathogenesis.
Materials and Methods
-Cross-sectional design limitation: This inherently limits causal inference but is only
acknowledged later in the discussion. It should be stated earlier.
Questionnaire limitations:
-Not validated.
-Not standardized.
-Potential recall bias not controlled.
Exclusion of important dietary variables:
-No assessment of fiber, meat, fruits, or vegetables.
-These are known risk factors for diverticulosis.
-Lack of details on caffeine calculation method: The basis of caffeine content assignment to
each beverage is not described in enough detail.
Selection bias:
-Tertiary care center patients may not be representative.
-Older/symptomatic patients are more likely to be scoped.
Limited control of confounders: No adjustments were made for BMI, metabolic disease,
medications affecting GI motility, or comorbidities.
No stratification by age: Important given age is a dominant risk factor.
Overlooked beverages: While green tea and energy drinks are excluded due to cultural context,
their exclusion is not data-supported and may still introduce bias.
Discussion
-Reverse causality not adequately addressed: The acknowledgment is brief and speculative
without mitigation strategies (e.g., sensitivity analysis).
-Overinterpretation of null results: Absence of evidence is not evidence of absence—this should
be emphasized more clearly.
-Unclear significance of black tea finding: Discussion of black tea’s protective role is
inconclusive and not biologically explained.
-No mention of caffeine metabolism variability: Genetic or habitual tolerance to caffeine could
impact outcomes but is unaddressed.
-References not critically discussed: Some cited studies (e.g., Aldoori et al.) pertain to
diverticular disease, not specifically diverticulosis.
-Exercise finding underexplored: Significant result that deserves more detailed contextualization
and could be a major finding.
Conclusion
-Overconfident tone: The conclusion should more clearly reflect the study’s cross-sectional
nature and limitations.
-No mention of how findings could guide future interventions: The practical implications for
clinicians or public health are not expanded upon.
Title: Relationship of Coffee Consumption with Colonic Diverticulosis
Version: 5 Date: 24 Jun 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
Introduction
-Lack of clear rationale: While mechanisms linking coffee and colonic physiology are cited,
a stronger mechanistic argument or existing indirect evidence linking coffee to diverticulosis
would help justify the study.
-Insufficient gap analysis: The claim “this is the first study” is strong but not thoroughly
substantiated through a systematic literature review.
-Repetitive content: Some mechanistic explanations (e.g., brain-gut axis and Nrf2 system) seem
tangential and not tied to diverticulosis pathogenesis.
Materials and Methods
-Cross-sectional design limitation: This inherently limits causal inference but is only
acknowledged later in the discussion. It should be stated earlier.
Questionnaire limitations:
-Not validated.
-Not standardized.
-Potential recall bias not controlled.
Exclusion of important dietary variables:
-No assessment of fiber, meat, fruits, or vegetables.
-These are known risk factors for diverticulosis.
-Lack of details on caffeine calculation method: The basis of caffeine content assignment to
each beverage is not described in enough detail.
Selection bias:
-Tertiary care center patients may not be representative.
-Older/symptomatic patients are more likely to be scoped.
Limited control of confounders: No adjustments were made for BMI, metabolic disease,
medications affecting GI motility, or comorbidities.
No stratification by age: Important given age is a dominant risk factor.
Overlooked beverages: While green tea and energy drinks are excluded due to cultural context,
their exclusion is not data-supported and may still introduce bias.
Discussion
-Reverse causality not adequately addressed: The acknowledgment is brief and speculative
without mitigation strategies (e.g., sensitivity analysis).
-Overinterpretation of null results: Absence of evidence is not evidence of absence—this should
be emphasized more clearly.
-Unclear significance of black tea finding: Discussion of black tea’s protective role is
inconclusive and not biologically explained.
-No mention of caffeine metabolism variability: Genetic or habitual tolerance to caffeine could
impact outcomes but is unaddressed.
-References not critically discussed: Some cited studies (e.g., Aldoori et al.) pertain to
diverticular disease, not specifically diverticulosis.
-Exercise finding underexplored: Significant result that deserves more detailed contextualization
and could be a major finding.
Conclusion
-Overconfident tone: The conclusion should more clearly reflect the study’s cross-sectional
nature and limitations.
-No mention of how findings could guide future interventions: The practical implications for
clinicians or public health are not expanded upon.
Please review this paper.
user
Title: Relationship of Coffee Consumption with Colonic Diverticulosis
Version: 5 Date: 24 Jun 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
Introduction
-Lack of clear rationale: While mechanisms linking coffee and colonic physiology are cited,
a stronger mechanistic argument or existing indirect evidence linking coffee to diverticulosis
would help justify the study.
-Insufficient gap analysis: The claim “this is the first study” is strong but not thoroughly
substantiated through a systematic literature review.
-Repetitive content: Some mechanistic explanations (e.g., brain-gut axis and Nrf2 system) seem
tangential and not tied to diverticulosis pathogenesis.
Materials and Methods
-Cross-sectional design limitation: This inherently limits causal inference but is only
acknowledged later in the discussion. It should be stated earlier.
Questionnaire limitations:
-Not validated.
-Not standardized.
-Potential recall bias not controlled.
Exclusion of important dietary variables:
-No assessment of fiber, meat, fruits, or vegetables.
-These are known risk factors for diverticulosis.
-Lack of details on caffeine calculation method: The basis of caffeine content assignment to
each beverage is not described in enough detail.
Selection bias:
-Tertiary care center patients may not be representative.
-Older/symptomatic patients are more likely to be scoped.
Limited control of confounders: No adjustments were made for BMI, metabolic disease,
medications affecting GI motility, or comorbidities.
No stratification by age: Important given age is a dominant risk factor.
Overlooked beverages: While green tea and energy drinks are excluded due to cultural context,
their exclusion is not data-supported and may still introduce bias.
Discussion
-Reverse causality not adequately addressed: The acknowledgment is brief and speculative
without mitigation strategies (e.g., sensitivity analysis).
-Overinterpretation of null results: Absence of evidence is not evidence of absence—this should
be emphasized more clearly.
-Unclear significance of black tea finding: Discussion of black tea’s protective role is
inconclusive and not biologically explained.
-No mention of caffeine metabolism variability: Genetic or habitual tolerance to caffeine could
impact outcomes but is unaddressed.
-References not critically discussed: Some cited studies (e.g., Aldoori et al.) pertain to
diverticular disease, not specifically diverticulosis.
-Exercise finding underexplored: Significant result that deserves more detailed contextualization
and could be a major finding.
Conclusion
-Overconfident tone: The conclusion should more clearly reflect the study’s cross-sectional
nature and limitations.
-No mention of how findings could guide future interventions: The practical implications for
clinicians or public health are not expanded upon.
assistant