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. 2023 Aug 14:10:1167372.
doi: 10.3389/fnut.2023.1167372. eCollection 2023.

Association between sulfur microbial diet and the risk of colorectal cancer precursors in older adults

Yi Xiao  1 , Hongmei He  1 , Ling Xiang  2 , Haitao Gu  1 , Zhiquan Xu  1 , Haoyun Luo  1 , Xiaorui Ren  1 , Bo Li  1 , Qi Wei  1 , Zhiyong Zhu  1 , He Zhou  3   4 , Yunhao Tang  1 , Zhihang Zhou  5 , Linglong Peng  1 , Yaxu Wang  1 , Yahui Jiang  1
Affiliations

Association between sulfur microbial diet and the risk of colorectal cancer precursors in older adults

Yi Xiao et al. Front Nutr. .

Abstract

Background: Sulfur microbial diet (SMD), related to the enrichment of sulfur-metabolizing gut bacteria, has been confirmed to be linked to an elevated risk of early-onset colorectal adenoma in young females. However, it remains unclear whether SMD is associated with the risk of colorectal adenoma in older people, who are at greater risk for colorectal cancer.

Methods: All data on participants in this study were retrieved from the intervention arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening test. Participants' adherence to this dietary pattern was assessed using SMD score. Hazard ratios (HR) and 95% confidence intervals (CI) were adopted in Cox proportional hazards regression models to assess the link between SMD score and the incidence of colorectal adenoma in participants included in the study. Specific stratified analyses were constructed to assess whether this association changed in different conditions, whereas the robustness of the association was examined through sensitivity analyses.

Results: The mean baseline age of participants was 62.1 (SD 5.2) years (range 54.0-75.0 years). During 19,468,589 person-years of follow-up, 992 colorectal adenoma cases were documented in a total of 17,627 included participants. In a fully adjusted model, an increased risk of colorectal adenoma was determined in participants in the highest quartile of SMD score in comparison with those in the lowest quartile (HRquartile4 vs. HRquartile1 = 1.23; 95% CI: 1.02, 1.47; p = 0.017 for trend). This positive association between SMD score and adenoma risk was more evident in participants who were current or former smokers (p = 0.029 for interaction).

Conclusion: In this study, our results support a role for the SMD in the carcinogenicity of colorectal cancer precursors among older adults. Nevertheless, these results require validation through more research.

Keywords: cancer prevention; colorectal cancer precursors; dietary pattern; epidemiology; sulfur microbial diet.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flow chart of identifying subjects included in our study. PLCO, prostate, lung, colorectal, and ovarian; BQ, baseline questionnaire; DQX, dietary questionnaire.
Figure 2
Figure 2
The timeline and follow-up scheme of our study.
Figure 3
Figure 3
Dose–response analysis on the association of SMD score with the risk of colorectal adenoma (including total adenoma, advanced adenoma and non-advanced adenoma). Hazard ratios was adjusted for age, sex, race, education levels, smoking status, pack-years of smoking, BMI, aspirin use, history of hypertension, history of diabetes, family history of colorectal cancer, total energy intake, history of diverticulitis or diverticulosis, history of colonoscopy in past 3 years, and physical activity level.
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