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Epidemiological evidence linking SMD to esophageal cancer (EC) risk is limited. This study evaluates the association in a large American PLCO cohort using an SMD score, Cox regression, subgroup and sensitivity analyses to assess robustness and potential modifiers.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/association-between-sulfur-microbial-diet-and-the-risk-of-esophageal-cancer-a-prospective-cohort-study-in-101752-american-adults/332707/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/association-between-sulfur-microbial-diet-and-the-risk-of-esophageal-cancer-a-prospective-cohort-study-in-101752-american-adults/332707.png","ImageObject",300,407,{"name":92,"@type":93},"Skyler","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is sulfur microbial diet (SMD) and why is it relevant to esophageal cancer?","Question",{"text":112,"@type":113},"SMD is a dietary pattern linked to the intestinal load of sulfur-metabolizing microbes. The study highlights that diet–microbe interactions may play an important role in esophageal carcinogenesis through sulfur-related microbial activity.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the association between SMD and esophageal cancer risk assessed?",{"text":117,"@type":113},"Participants’ adherence to the SMD pattern was quantified using an SMD score in the PLCO Cancer Screening Trial cohort. Cox hazards regression models were then used to examine incidence of EC, ESCC, and EA, with subgroup and sensitivity analyses.",{"name":119,"@type":110,"acceptedAnswer":120},"What did the results show about EC, ESCC, and EA risk across SMD score quartiles?",{"text":121,"@type":113},"In the fully adjusted model, higher SMD score quartiles were associated with increased risk of EC and ESCC, while no statistically significant increase was found for EA. The study also reported that sensitivity analyses supported the main finding.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},332707,1790385818,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":41,"preview_page_count":4},2336464648746,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Ren etal. Nutrition Journal (2024) 23:139 Nutrition Journal  \n[https://doi.org/10.1186/s12937-024-01035-y](https://doi.org/10.1186/s12937-024-01035-y)  \nRESEARCH Open Access  \nAssociation between sulfur microbial diet and the risk of esophageal cancer: a prospective cohort study in 101,752 American adults  \nXiaorui Ren 1†, Li Xin 1†, Linglong Peng 1, Yi Xiao 1, Zhihang Zhou2, Haoyun Luo 1, Zhiyong Zhu 1, Qi Wei 1, Yahui Jiang 1, Hongmei He 1, Ling Xiang3, Yaxu Wang 1, Yunhao Tang 1* and Haitao Gu 1*  \nAbstract  \nBackground Sulfur microbial diet (SMD) is a dietary pattern closely related to the intestinal load of sulfurmetabolizing microbes in humans. Diet and microbes may play an important role in the carcinogenesis of esophagus. However, epidemiological studies on SMD and esophageal cancer (EC) risk are scarce. Here, we evaluated this association based on a large American cohort.  \nMethods In the cohort of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, a SMD score was calculated to evaluate participants’ compliance of SMD pattern, with higher scores presenting greater adherence. Cox hazards regression model was used to explore the association between the SMD score and the incidence of EC, esophageal squamous cell carcinoma (ESCC), and esophageal adenocarcinoma (EA) . Subgroup analyses were conducted to figure out potential modifiers interacting with SMD on EC. Sensitivity analyses were used to testify the robustness of our main result.  \nResults Among 101,752 participants, 154 EC cases, consisted of 41 ESCC cases and 97 EA cases, were identified with mean follow-up of 8.9 years. In the fully adjusted model, the highest versus the lowest quartiles ofthe SMD score were found to be associated with an increased risk of EC and ESCC (EC: HRQ4 vs. Q1: 1.64; 95% CI: 1.05, 2.56; P = 0.016 for trend; ESCC: HRQ4 vs. Q1: 2.37; 95% CI: 1.02, 5.47; P = 0.031 for trend), while not significantly associated with increases risk of EA (HRQ4 vs. Q1: 1.41; P = 0.144 for trend). The main result remained through a series of sensitivity analyses. Subgroup analyses showed a stronger association between SMD and EC in participants with no regular consumption of aspirin (HRQ4 vs. Q1: 1.90; 95% CI: 1.04, 3.47) than in those using aspirin regularly (HRQ4 vs. Q1: 1.37; 95% CI: 0.71, 2.66) (P = 0.008 for interaction) .  \n†Xiaorui Ren and Li Xin contributed equally to this work.  \n*Correspondence:  \nYunhao Tang [303790@hospital.cqmu.edu.cn](303790@hospital.cqmu.edu.cn)[ ](303790@hospital.cqmu.edu.cn)Haitao Gu [ght302211@cqmu.edu.cn](ght302211@cqmu.edu.cn)  \nFull list of author information is available at the end of the article  \n© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/.  \nRen et al. Nutrition Journal (2024) 23:139 Page 2 of 12  \nConclusion Adherence to the SMD pattern may be associated with increased risks of EC and ESCC, particularly for EC in individuals who do not regularly consume aspirin.  \nKeywords Sulfur ","cbCaiuWKLOCUAQiN","https://ap.wps.com/l/cbCaiuWKLOCUAQiN","pdf",1457497,12,"English","# Abstract\n## Background\n## Methods\n## Results\n## Conclusion\n# Introduction","[{\"question\":\"What is sulfur microbial diet (SMD) and why is it relevant to esophageal cancer?\",\"answer\":\"SMD is a dietary pattern linked to the intestinal load of sulfur-metabolizing microbes. The study highlights that diet–microbe interactions may play an important role in esophageal carcinogenesis through sulfur-related microbial activity.\"},{\"question\":\"How was the association between SMD and esophageal cancer risk assessed?\",\"answer\":\"Participants’ adherence to the SMD pattern was quantified using an SMD score in the PLCO Cancer Screening Trial cohort. Cox hazards regression models were then used to examine incidence of EC, ESCC, and EA, with subgroup and sensitivity analyses.\"},{\"question\":\"What did the results show about EC, ESCC, and EA risk across SMD score quartiles?\",\"answer\":\"In the fully adjusted model, higher SMD score quartiles were associated with increased risk of EC and ESCC, while no statistically significant increase was found for EA. The study also reported that sensitivity analyses supported the main finding.\"}]","Association between sulfur microbial diet and the risk of esophageal cancer - a prospective cohort study in 101,752 American adults | PDF",1789999150]