Wang Guoqing ^1,2 Xiang-Long Yi ^1,2*

• ¹ Xinjiang Medical University, Ürümqi, China
• ² First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Region, China

The aim of this study is to develop and validate a novel multivariable prediction model capable of accurately estimating the probability of cataract development, utilizing parameters such as blood biochemical markers and age. Design: This population-based cross-sectional study comprised 9,566 participants drawn from the National Health and Nutrition Examination Survey (NHANES) across the 2005 to 2008 cycles. Methods: Demographic information and laboratory test results from the patients were collected and analyzed using LASSO regression and multivariate logistic regression to accurately capture the influence of biochemical indicators on the outcomes. The SHAP (Shapley Additive Explanations) scale was employed to assess the importance of each clinical feature, excluding age. A multivariate logistic regression model was then developed and visualized as a nomogram. To assess the model's performance, its discrimination, calibration, and clinical utility were evaluated using receiver operating characteristic (ROC) curves, 10-fold cross-validation, Hosmer-Lemeshow calibration curves, and decision curve analysis (DCA), respectively. Results: Logistic regression analysis identified age, erythrocyte folate (nmol/L), blood glucose (mmol/L), and blood urea nitrogen (mmol/L) as independent risk factors for cataract, and these variables were incorporated into a multivariate logistic regression-based nomogram for cataract risk prediction. The area under the receiver operating characteristic (ROC) curve (AUC) for cataract risk prediction was 0.917 (95% CI: 0.9067-0.9273) in the training cohort, and 0.9148 (95% CI: 0.8979-0.9316) in the validation cohort. The Hosmer-Lemeshow calibration curve demonstrated a good fit, indicating strong model calibration. Ten-fold cross-validation confirmed the logistic regression model's robust predictive performance and stability during external validation. Decision curve analysis (DCA) demonstrated that the nomogram prediction model provided greater clinical benefit for predicting cataract risk when the patient's threshold probability ranged from 0.10 to 0.90. Conclusions: This study identified blood urea nitrogen (mmol/L), serum glucose (mmol/L), and erythrocyte folate (mmol/L) as significant risk factors for cataract. A risk prediction model was developed, demonstrating strong predictive accuracy and clinical utility, offering clinicians a reliable tool for early and effective diagnosis. Cataract development may be delayed by reducing levels of blood urea nitrogen, serum glucose, and erythrocyte folate through lifestyle improvements and dietary modifications.