Diet Pattern Linked to Higher Lung Cancer Risk Loses Statistical Significance Once Overall Diet Quality Is Counted

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PASCAL POCHARD-CASABIANCA | AFP via Getty Images Share on Twitter Share on Facebook Share on Pocket A diet pattern tied to sulfur-processing gut bacteria was linked to higher lung cancer risk in a study of 95,612 U.S. adults, but the connection lost statistical significance once researchers accounted for overall diet quality. The study in Nutrition Journal, published Oct. 12, used data from a large federal cancer screening trial.

That second result is the real story for readers. A link that weakens when another factor is added often means the original signal was partly driven by something else, a problem scientists call confounding.

For anyone trying to lower cancer risk, the practical takeaway has not changed. The study does not show that any food pattern causes lung cancer, and smoking remains the dominant, well-established risk.

Researchers analyzed adults who enrolled in the National Cancer Institute’s Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, which recruited people ages 55 to 74 between 1993 and 2001. Participants completed a 124-item food questionnaire, and researchers scored how closely each diet matched a pattern linked to sulfur-metabolizing gut microbes.

The pattern was built from 25 food groups. Researchers recorded 1,561 lung cancer diagnoses through 2009 and 2,109 lung cancer deaths through 2018. Deaths outnumber diagnoses because death records were tracked for nine more years.

People in the top fifth of scores had a 23% higher risk of lung cancer and a 19% higher risk of lung cancer death than those in the bottom fifth. The authors described the highest scores as associated with “modestly higher lung cancer incidence and lung cancer-related mortality.”

The headline numbers come with major caveats. When researchers added overall diet quality to their models, the associations weakened and were no longer statistically significant, News-Medical reported in its review of the paper.

People in the highest group also differed in meaningful ways. They were younger, more often male, and had a higher body mass index, along with higher rates of smoking, diabetes, and high blood pressure, factors that can muddy any diet result.

Smoking is the biggest issue. The authors acknowledged that incompletely measured smoking may still affect the results, and the link to lung cancer deaths was strongest among heavy smokers, which raises the possibility that tobacco exposure explains part of the signal. Food-level results added more uncertainty: after correcting for multiple tests, only yellow vegetable intake remained tied to lower lung cancer mortality.

Other limits matter too. Diet was measured only once, the cohort was mostly white, and researchers did not directly measure gut microbes or sulfur compounds. News-Medical noted that the study’s observational design limits conclusions about cause and effect.

Observational studies can reveal patterns worth testing, but they cannot prove cause and effect. People who eat one way often differ in income, exercise, smoking and access to care, and statistical adjustment can only partly correct for those differences.

This study is a useful example because it shows the shrinkage in real time. A 23% figure can sound alarming, yet the same paper reports that the continuous measures did not reach statistical significance and that the link faded after a broader diet adjustment. Unadjusted lung cancer rates rose from 1.20 to 3.03 per 1,000 person-years from the lowest to the highest group, but adjusted differences were far smaller.

Readers can ask a few questions about any diet study. Was it observational or a randomized trial? How large was the effect? What happened after adjusting for smoking and overall diet? Has the finding been repeated in other groups?

The study was conducted by researchers at Chongqing Medical University in China and Erasmus University Medical Center in the Netherlands. The first author was supported by a China Scholarship Council grant, and the authors reported no competing interests.

The strongest protections against lung cancer are well established. Not smoking, quitting if you smoke, and avoiding secondhand smoke matter far more than any diet pattern, according to the CDC, which also lists radon and some workplace exposures as risks.

Adults ages 50 to 80 with a significant smoking history may qualify for yearly low-dose CT screening under U.S. Preventive Services Task Force guidelines. Screening for eligible adults is generally covered by insurance as preventive care, and anyone who smokes can get free help quitting by calling 1-800-QUIT-NOW.

Home radon test kits are inexpensive, and many state health departments offer them at low or no cost. A balanced diet rich in vegetables, fruits, and whole grains supports overall health, but this study gives no reason to change eating habits specifically to prevent lung cancer.

The authors called for studies that repeat diet measurements and directly measure gut bacteria and sulfur compounds. Until then, the finding is a hypothesis to test, not a basis for new dietary advice.

A diet pattern tied to sulfur-processing gut bacteria was linked to modestly higher lung cancer risk. The link lost statistical significance after adjusting for overall diet quality.

No causal link was shown. The study was observational and could not rule out effects from smoking and other factors.

The study included 95,612 U.S. adults from a federal cancer screening trial that enrolled people ages 55 to 74. Most participants were white.

Should I change my diet because of this study?

Current guidance has not changed. A balanced diet is healthy, but avoiding tobacco and radon matters far more for lung cancer risk.

Adults ages 50 to 80 with a significant smoking history may qualify for yearly low-dose CT scans. Talk with a clinician about eligibility and insurance coverage.