Women and men exhibit distinct gut microbial profiles linked to colorectal cancer development

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Paper Summary

Conflicts of Interest

Identified Weaknesses

Rating Explanation

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Paper Summary

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Ladies' Gut Bugs React Differently to Pre-Cancerous Colon Lesions

In this study of people who tested positive for blood in their stool, men were more likely to have precancerous colorectal lesions than women. While both men and women had distinct gut bacteria profiles, only women's gut microbiome varied depending on whether they had lesions. Some specific bacteria seemed linked to lesions differently in men and women.

Possible Conflicts of Interest

The bowel preparation used for colonoscopy in the BCSN trial was provided free of charge by Ferring Pharmaceuticals. However, the authors state that the funders had no role in study design, data collection, analysis, interpretation, or writing of the article.

Identified Weaknesses

Cross-sectional design

This limits the ability to draw firm conclusions about cause-and-effect relationships between sex, the gut microbiome, and colorectal lesion development. It is possible that unmeasured factors could be influencing the observed associations.

Potential selection bias due to two-stage recruitment

This could lead to biased results if the characteristics of the participants who were included in both studies are systematically different from those who were only included in the BCSN. This might affect the generalizability of the findings.

Residual confounding

Despite adjustments for various factors, it is impossible to completely rule out the influence of other factors that may be related to both the gut microbiome and colorectal lesions. This means the study can show correlations but not definite causation.

Limited analysis of advanced serrated lesions

Advanced serrated lesions are less common than other types of advanced lesions and may have different underlying causes and associations with the gut microbiome. Excluding them could provide a clearer picture of the relationship between the gut microbiome and the more common types of advanced lesions.

Rating Explanation

This study provides valuable insights into sex-specific differences in the gut microbiome and their association with colorectal lesions. The large sample size, use of metagenomic sequencing, and detailed lifestyle/demographic data are strengths. However, limitations like the cross-sectional design, potential selection bias, and the possibility of residual confounding prevent a higher rating. The mediation analysis showed only modest trends.

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