Meta-analysisindependent cross-checkabstract checked I-ORG-121 standard review
Diet and appendicitis
Revisiting Diet and Appendicitis: A Systematic Review and Meta-Analysis.
Overview
Pitesa R et al.. World J Surg 2025 · PMID 41265933 · DOI 10.1002/wjs.70166
Low-fibre western diets may be linked to appendicitis, but the evidence is weak and inconsistent.
Does the study support the specific claim? Partly · Methodological quality: low
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Review diet and appendicitis risk
- How was the study done?
Systematic review and meta-analysis
- How many people, animals or samples were studied?
21 studies
- What was actually found?
Possible link with low fibre; not statistically clear
- How large was the observed effect?
MD -4.53 g fibre (not significant)
- What do the results mean in everyday life?
Diet might matter but is not proven
- What are the study's limitations?
High risk of bias, heterogeneity
- What does it say about Elawady's specific claim?
Weak indirect support; not about infant formula
- Do the results apply to Germany and Europe?
Moderate
- What can explicitly not be concluded from this study?
Cannot show that diet prevents appendicitis
Scientific in-depth review
1. Full reference
- Authors
- Pitesa R et al.
- Journal
- World J Surg
- Year
- 2025
- Identifier
- PMID 41265933 DOI 10.1002/wjs.70166
- Verification
- verified – PubMed efetch 2026-10-26; Crossref works API 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Not stated in abstract.
2. Research question
Is diet (fibre, western dietary pattern) associated with acute appendicitis?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis of observational and ecological studies (PROSPERO CRD420251024372)
- Population
Human studies of diet and appendicitis
- Country
Multinational
- Period
Search to December 2024
- Sample size
21 studies
- Inclusion and exclusion criteria
Case-control, cohort and ecological studies
4. Methods and endpoints
- Exposure / intervention
Dietary fibre, western dietary pattern
- Comparator
Higher fibre / non-western diets
- Endpoints
Risk/incidence of acute appendicitis
- Statistical methods
Meta-analysis, meta-regression, ROBINS-E
5. Actual results
- Results
Most studies high risk of bias. Meta-analysis of 4 case-control studies: lower fibre intake in appendicitis patients (MD -4.53 g, 95% CI -10.98 to 1.94; p = 0.11; I2 98.3%). Ecological meta-regression suggested a trend toward lower incidence with higher fibre. Narrative synthesis linked low-fibre, high-meat or sugar-dense diets with higher risk.
- Absolute risks
Not reported
- Authors' conclusion
Largely observational evidence suggests an inverse association between fibre and appendicitis and higher risk with meat- and sugar-rich diets; large uncertainty and low-quality data.
6. Strengths
- Registered
- Comprehensive search
7. Weaknesses
- High risk of bias
- Extreme heterogeneity
- Pooled estimate not significant
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Review well conducted, but primary evidence very weak.
9. Assessment of the statistical interpretation
The only pooled estimate was not statistically significant and had I2 98%.
10. Relevance to the specific claim
The only systematic evidence on diet and appendicitis risk; nothing on infant formula or cereals.
11. Independent contrary findings
n/a
12. Transferability to Germany and Europe
Mixed populations.
13. Overall methodological judgement
Diet may play a role in appendicitis, but evidence is very weak and does not address infant feeding.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | low |
| Risk of bias | high |
| Precision of results | low |
| Directness | indirect |
| Reproducibility | unknown |
| Consistency with the overall evidence | mixed |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Prospective cohorts on childhood diet.