Prediction of metabolic syndrome: A machine learning approach to help primary prevention

Aims: To describe the performance of machine learning (ML) applied to predict future metabolic syndrome (MS), and to estimate lifestyle changes effects in MS predictions.Methods: We analyzed data from 17,182 adults attending a checkup program sequentially (37,999 visit pairs) over 17 years. Variables on sociodemographic attributes, clinical, laboratory, and lifestyle characteristics were used to develop ML models to predict MS [logistic regression, linear discriminant analysis, k-nearest neighbors, decision trees, Light Gradient Boosting Machine (LGBM), Extreme Gradient Boosting]. We have tested the effects of changes in lifestyle in MS prediction at individual levels.Results: All models showed adequate calibration and good discrimination, but the LGBM showed better perfor-mance (Sensitivity = 87.8 %, Specificity = 70.2 %, AUC-ROC = 0.86). Causal inference analysis showed that increasing physical activity level and reducing BMI by at least 2 % had an effect of reducing the predicted probability of MS by 3.8 % (95 % CI =-4.8 %;-2.7 %).Conclusion: ML models based on data from a checkup program showed good performance to predict MS and allowed testing for effects of lifestyle changes in this prediction. External validation is recommended to verify models' ability to identify at-risk individuals, and potentially increase their engagement in preventive measures.