Causal relationship between metabolic syndrome and gastric cancer: insights from comprehensive analysis and biomarker identification.

[BACKGROUND] Metabolic syndrome (MetS) is characterized by a cluster of metabolic abnormalities, including obesity, insulin resistance, dyslipidemia, and hypertension. Increasing epidemiological evidence suggests a potential association between MetS and gastric cancer (GC); however, whether this association is causal and the underlying molecular mechanisms remain unclear. This study aimed to investigate the causal relationship between MetS and GC, and to identify potential molecular biomarkers.

[METHODS] Mendelian randomization (MR) was applied to assess the causal effect of genetic susceptibility to MetS on GC risk. Differentially expressed genes (DEGs) were identified, followed by weighted gene co-expression network analysis (WGCNA) and protein-protein interaction (PPI) network construction to screen hub genes. To enhance the robustness of complex transcriptomic data, 113 combinations of machine learning (ML) algorithms were systematically evaluated, and the optimal model was selected to extract feature genes, assess their expression levels and diagnostic performance, and further explore potential biological functions and signaling mechanisms. Single-cell RNA sequencing (scRNA-seq) and immune cell infiltration analyses were used to evaluate the cellular distribution and immune relevance of the feature genes.

[RESULTS] MR analysis revealed that genetic susceptibility to MetS increased the risk of GC (odds ratio: 1.62, 95% confidence interval: 1.12-2.33, P=0.01). A total of 1,712 DEGs and 1,314 module genes were identified, yielding 72 intersecting genes, from which the top 15 hub genes were screened. The Stepglm[backward] + XGBoost model achieved the best performance with an average area under the curve (AUC) of 0.93. Ultimately, four feature genes-, , , and -were identified and validated by quantitative reverse transcription polymerase chain reaction (qRT-PCR), showing high expression of , , and and low expression of in GC cell lines, all of which exhibited high diagnostic value. These genes were mainly enriched in key processes such as cell cycle regulation, metabolic reprogramming, immune signaling, and extracellular matrix interactions. They were mainly distributed among specific immune cells, epithelial cells, and fibroblast populations, and showed significant associations with the infiltration levels of multiple immune cell subtypes.

[CONCLUSIONS] These findings may facilitate risk stratification and early diagnosis in populations at high risk for MetS-associated GC, and provide a foundation for targeted prevention and mechanistic studies.