• Department of Clinical Nutrition, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
• Department of Infectious Diseases, Institute for Viral Hepatitis, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
• Yubei District Center for Disease Control and Prevention, Chongqing, China.

This study aimed to determine the associations between sulfur microbial diet (SMD) and all-cause, cardiovascular disease, and cancer mortality. A total of 91 891 adults were included from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. To evaluate adherence to this dietary pattern, the SMD score was calculated with higher scores indicating greater compliance. The hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards regression. After a median follow-up of 15.0 years, 20 706 all-cause deaths were noted. The participants in the highest quartile of the SMD score had an enhanced risk of death from all causes (HR: 1.12, 95% CI: 1.07, 1.17) and cancer (HR: 1.15, 95% CI: 1.06, 1.24) than those in the lowest quartile. Dose-response analysis indicated a nonlinear association between the SMD score and both all-cause and cancer mortality. Subgroup analyses demonstrated a significant positive association between the SMD score and all-cause mortality in participants aged 65 years and older. Higher adherence to the SMD is linked to increased risks of all-cause and cancer mortality in the US population. These study findings suggest that intestinal sulfur-metabolizing bacteria may play a role in the association between diet and health outcomes.