biostudies-literatureNguyen LHNIDDK NIH HHSCrohns & Colitis FoundationNIAAA NIH HHSNCI NIH HHS1423-1432.e4https://www.ebi.ac.uk/biostudies/studies/S-EPMC8545755biostudies-literatureUnknown161(5)<h4>Background & aims</h4>Diet may contribute to the increasing incidence of colorectal cancer (CRC) before age 50 (early-onset CRC). Microbial metabolism of dietary sulfur produces hydrogen sulfide (H₂S), a gastrointestinal carcinogen that cannot be easily measured at scale. As a result, evidence supporting its role in early neoplasia is lacking.<h4>Methods</h4>We evaluated long-term adherence to the sulfur microbial diet, a dietary index defined a priori based on increased abundance of 43 bacterial species involved with sulfur metabolism, with risk of CRC precursors among 59,013 individuals who underwent lower endoscopy in the Nurses' Health Study II (1991-2015), a prospective cohort study with dietary assessment every 4 years through validated food frequency questionnaires anGastroenterologyThe Sulfur Microbial Diet Is Associated With Increased Risk of Early-Onset Colorectal Cancer Precursors.PMC8545755R03 CA197879K07 CA218377K23 DK125838R01 CA202704563526U01 CA176726R21 AA027608R21 CA222940R00 CA215314R37 CA246175690389R35 CA253185R21 CA230873P30 DK043351R01 CA248857Wu KGiovannucci ELWillett WCHur JChan ATHuttenhower CIzard JMa WMehta RSSong MSikavi DRCao YRimm EBGarrett WSWang YNguyen LHfalseThe Sulfur Microbial Diet Is Associated With Increased Risk of Early-Onset Colorectal Cancer Precursors.<h4>Background & aims</h4>Diet may contribute to the increasing incidence of colorectal cancer (CRC) before age 50 (early-onset CRC). Microbial metabolism of dietary sulfur produces hydrogen sulfide (H₂S), a gastrointestinal carcinogen that cannot be easily measured at scale. As a result, evidence supporting its role in early neoplasia is lacking.<h4>Methods</h4>We evaluated long-term adherence to the sulfur microbial diet, a dietary index defined a priori based on increased abundance of 43 bacterial species involved with sulfur metabolism, with risk of CRC precursors among 59,013 individuals who underwent lower endoscopy in the Nurses' Health Study II (1991-2015), a prospective cohort study with dietary assessment every 4 years through validated food frequency questionnaires an2021-01-01T00:00:00Z2021 Nov2025-04-05T11:27:20.66Z2025-04-05T11:27:20.66ZS-EPMC85457553427334710.1053/j.gastro.2021.07.008