Application of a Machine Learning Technology in the Definition of Metabolically Healthy and Unhealthy Status: A Retrospective Study of 2567 Subjects Suffering from Obesity with or without Metabolic Syndrome

Abstract

The key factors playing a role in the pathogenesis of metabolic alterations observed in many patients with obesity have not been fully characterized. Their identification is crucial, and it would represent a fundamental step towards better management of this urgent public health issue. This aim could be accomplished by exploiting the potential of machine learning (ML) technology. In a single-centre study (n = 2567), we used an ML analysis to cluster patients with metabolically healthy (MHO) or metabolically unhealthy (MUO) obesity, based on several clinical and biochemical variables. The first model provided by ML was able to predict the presence/absence of MHO with an accuracy of 66.67% and 72.15%, respectively, and included the following parameters: HOMA-IR, upper body fat/lower body fat, glycosylated haemoglobin, red blood cells, age, alanine aminotransferase, uric acid, white blood cells, insulin-like growth factor 1 (IGF-1) and gamma-glutamyl transferase. For each of these parameters, ML provided threshold values identifying either MUO or MHO. A second model including IGF-1 zSDS, a surrogate marker of IGF-1 normalized by age and sex, was even more accurate with a 71.84% and 72.3% precision, respectively. Our results demonstrated high IGF-1 levels in MHO patients, thus highlighting a possible role of IGF-1 as a novel metabolic health parameter to effectively predict the development of MUO using ML technology.

Keywords: artificial intelligence; insulin-like growth factor 1; metabolic syndrome.

Figure 1

(A) Distribution of IGF-1 zSDS in the overall study population. (B). Distribution of IGF-1 zSDS in the MUO and MHO subgroups. Abbreviations: IGF-1 zSDS, insulin-like growth factor 1 z standard deviation score; MUO, metabolically unhealthy obese group; MHO, metabolically healthy obese group. Variables are expressed as percentile of total population.

Figure 2

(A) Model no. 1 with the most relevant variables and threshold values that predict the development of MUO. (B) Model no. 2 with the most relevant variables and threshold values that predict the development of MUO. Abbreviations: yrs, years; HOMA-IR, model assessment of insulin resistance; HbA1c, haemoglobin A1C; RBC, red blood cell; ALT, alanine aminotransferase; WBC, white blood cell; γGT, gamma-glutamyl transferase; AST, aspartate aminotransferase, IGF-1 zSDS, insulin-like growth factor 1 z standard deviation score; MUO, metabolically unhealthy obese group; MHO, metabolically healthy obese group. IGF-1, insulin-like growth factor 1.