Abstract
BACKGROUND: Preserved ratio impaired spirometry (PRISm) has been identified as a potential precursor to chronic obstructive pulmonary disease (COPD) and demonstrates a significant correlation with unfavorable clinical outcomes. Modification of PRISm-related risk factors is a higher priority in public health than treating PRISm itself. Dietary fatty acids (FAs) affect human health through a variety of physiological pathways. However, no prior research has investigated the associations of FAs and their subclasses with PRISm, particularly the combined effects of different types of FAs. METHODS: Data analysis was conducted on 8,836 individuals drawn from the NHANES dataset spanning the years 2007 to 2012. Logistic regression and smooth curve fitting were first used to assess relationships of individual FA intake with PRISm. Multiple comparisons were adjusted using the Benjamini-Hochberg (BH) correction. Threshold effect analysis was conducted to explore potential nonlinear associations. Subsequently, innovative implementation of the principal component analysis (PCA), Weighted Quantile Sum (WQS) regression, and Bayesian Kernel Machine Regression (BKMR) approaches were employed to assess the joint impact of the various intake of FAs, as well as total saturated, monounsaturated, and polyunsaturated FAs on PRISm. To facilitate the prediction of PRISm, six distinct machine learning algorithms were constructed, followed by the application of SHAP analysis to elucidate the contribution of individual predictors. For improved clinical utility, the most effective model was further implemented as an online tool. RESULTS: The weighted prevalence of PRISm observed in this study was 8.81%. The results from the single-exposure models demonstrated that most FAs were negatively associated with PRISm, and these associations remained significant after BH correction. In all three models, saturated FAs revealed impressive protective associations with PRISm. LightGBM was identified as the most effective machine learning model. Among all variables, race was the most influential factor and butyric acid (SFA 4:0) was identified as the most critical FA subclass. CONCLUSIONS: Adequate dietary intake of FAs may reduce the prevalence of PRISm. Furthermore, an interactive Web-based application enables healthcare professionals to estimate individuals' odds of having PRISm and to design personalized dietary interventions based on their specific needs.