Sulfur microbial diet and ischemic stroke risk
4 affiliations
- 1Department of Neurosurgery, Ningbo No. 2 Hospital, Wenzhou Medical University, Ningbo, Zhejiang, China
- 2School of Public Health, Wannan Medical College, Wuhu, China
- 3Department of Clinical Epidemiology, Ningbo No. 2 Hospital, Wenzhou Medical University, Ningbo, Zhejiang, China
- 4Center for Cardiovascular and Cerebrovascular Epidemiology and Translational Medicine, Guoke Ningbo Life Science and Health Industry Research Institute, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
Abstract
Background: This study aimed to evaluate the association of dietary pattern linked to sulfur-metabolizing gut microbiota (SMD) with incident ischemic stroke, its dose–response relationship, and population heterogeneity.
Methods: This study included 208,415 participants. The SMD score was constructed based on repeated 24-h dietary recall questionnaires (Oxford WebQ) and categorized into quartiles. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Restricted cubic spline analyses were performed to assess the dose–response relationship. Subgroup analyses, sensitivity analyses, and food substitution analyses were further conducted.
Results: During a mean follow-up of 11.45 years, a total of 3,273 incident ischemic stroke cases were identified. After full multivariable adjustment, compared with participants in the lowest quartile (Q1), those in the highest quartile (Q4) had a 13% higher hazard of ischemic stroke (HR = 1.13, 95% CI: 1.02, 1.25, p = 0.019). Each 1-standard deviation increase in the SMD score was associated with a 4% higher hazard of ischemic stroke (HR = 1.04, 95% CI: 1.01, 1.08, p = 0.018), with a significant linear trend (P for trend = 0.013). Restricted cubic spline analysis suggested an approximately linear association (P for nonlinearity = 0.232). Subgroup analyses showed heterogeneity by ethnicity (P for interaction = 0.003), whereas interactions by age and sex were not statistically significant. Sensitivity analyses yielded generally consistent estimates. Substitution analysis indicated an HR below 1 when low-calorie beverages were replaced with an equivalent energy intake of other vegetables (HR = 0.90, 95% CI: 0.81, 1.01, p = 0.063).
Conclusion: Higher adherence to the SMD was associated with a higher hazard of ischemic stroke in this large prospective cohort, with an approximately linear dose–response relationship. The association was modest and showed some sensitivity to exposure measurement precision, indicating that replication in independent cohorts is warranted.
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BibTeX
@article{wang2026sulfur,
title = {{Sulfur microbial diet and ischemic stroke risk}},
author = {Kai Wang and Zhiyuan Guo and Liyuan Han and Boding Wang},
journal = {Frontiers in Nutrition},
year = {2026},
month = oct,
doi = {10.3389/fnut.2026.1885612},
url = {https://doi.org/10.3389/fnut.2026.1885612},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Sulfur microbial diet and ischemic stroke risk
AU - Kai Wang
AU - Zhiyuan Guo
AU - Liyuan Han
AU - Boding Wang
PY - 2026
DA - 2026/10/22
JO - Frontiers in Nutrition
DO - 10.3389/fnut.2026.1885612
UR - https://doi.org/10.3389/fnut.2026.1885612
AB - Background: This study aimed to evaluate the association of dietary pattern linked to sulfur-metabolizing gut microbiota (SMD) with incident ischemic stroke, its dose–response relationship, and population heterogeneity. Methods: This study included 208,415 participants. The SMD score was constructed based on repeated 24-h dietary recall questionnaires (Oxford WebQ) and categorized into quartiles. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Restricted cubic spline analyses were performed to assess the dose–response relationship. Subgroup analyses, sensitivity analyses, and food substitution analyses were further conducted. Results: During a mean follow-up of 11.45 years, a total of 3,273 incident ischemic stroke cases were identified. After full multivariable adjustment, compared with participants in the lowest quartile (Q1), those in the highest quartile (Q4) had a 13% higher hazard of ischemic stroke (HR = 1.13, 95% CI: 1.02, 1.25, p = 0.019). Each 1-standard deviation increase in the SMD score was associated with a 4% higher hazard of ischemic stroke (HR = 1.04, 95% CI: 1.01, 1.08, p = 0.018), with a significant linear trend (P for trend = 0.013). Restricted cubic spline analysis suggested an approximately linear association (P for nonlinearity = 0.232). Subgroup analyses showed heterogeneity by ethnicity (P for interaction = 0.003), whereas interactions by age and sex were not statistically significant. Sensitivity analyses yielded generally consistent estimates. Substitution analysis indicated an HR below 1 when low-calorie beverages were replaced with an equivalent energy intake of other vegetables (HR = 0.90, 95% CI: 0.81, 1.01, p = 0.063). Conclusion: Higher adherence to the SMD was associated with a higher hazard of ischemic stroke in this large prospective cohort, with an approximately linear dose–response relationship. The association was modest and showed some sensitivity to exposure measurement precision, indicating that replication in independent cohorts is warranted.
SN - 2296-861X
ER -