This study investigates the gut microbiome changes along the colorectal adenoma-carcinoma sequence using a metagenome-wide association study (MGWAS). The researchers analyzed stool samples from healthy controls, advanced adenoma patients, and carcinoma patients, identifying microbial genes, strains, and functions that are enriched in each group. They found that high intake of red meat relative to fruits and vegetables is associated with the outgrowth of bacteria that may contribute to a more hostile gut environment. The study suggests that fecal microbiome-based strategies could be useful for early diagnosis and treatment of colorectal adenoma or carcinoma. Key findings include the identification of microbial species and functions specific to each stage of the adenoma-carcinoma sequence, and the development of a classifier that can accurately distinguish between healthy controls, advanced adenoma, and carcinoma samples. Additionally, the study highlights the impact of dietary factors, such as red meat consumption, on gut microbial alterations, and the potential role of gut microbiota in colorectal carcinogenesis.This study investigates the gut microbiome changes along the colorectal adenoma-carcinoma sequence using a metagenome-wide association study (MGWAS). The researchers analyzed stool samples from healthy controls, advanced adenoma patients, and carcinoma patients, identifying microbial genes, strains, and functions that are enriched in each group. They found that high intake of red meat relative to fruits and vegetables is associated with the outgrowth of bacteria that may contribute to a more hostile gut environment. The study suggests that fecal microbiome-based strategies could be useful for early diagnosis and treatment of colorectal adenoma or carcinoma. Key findings include the identification of microbial species and functions specific to each stage of the adenoma-carcinoma sequence, and the development of a classifier that can accurately distinguish between healthy controls, advanced adenoma, and carcinoma samples. Additionally, the study highlights the impact of dietary factors, such as red meat consumption, on gut microbial alterations, and the potential role of gut microbiota in colorectal carcinogenesis.