{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T18:06:39Z","timestamp":1780682799019,"version":"3.54.1"},"reference-count":18,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: In Saudi Arabia, noncommunicable diseases (NCDs) are an increasing public health concern, with almost 70% of deaths related to chronic diseases. The study aimed to analyze 33-year trends in NCD risk factors and apply machine learning (ML) models to identify ecological associates of premature NCD-related mortality, sex-specific analyses and project trajectories to 2030. Methods: A longitudinal ecological time-series design which used WHO Global Health Observatory (GHO) NCD Indicators (1990\u20132022; select lipid indicators from 1980). Five supervised regression ML models\u2014OLS, LASSO, Ridge, Random Forest, and Gradient Boosting\u2014were trained with TimeSeriesSplit cross-validation (five folds) to preserve temporal order and prevent data leakage. A formal PELT changepoint algorithm confirmed trend breakpoints. Linear projections to 2030 were estimated with 95% prediction intervals. Results: Adult obesity increased by +20.6 percentage points (pp) over 33 years. Under a no-policy-change scenario, female obesity is projected at 50.3% by 2030 (95% PI: 50.0\u201350.5%). Premature NCD mortality declined by \u22125.9 pp. Under TimeSeriesSplit CV, all models yielded negative R2, confirming LOOCV R2 = 0.98 reflected shared time-trend artefacts; the ML component is reframed as descriptive feature-importance analysis. The obesity sex gap (female minus male) was the strongest ecological associate of premature NCD mortality. Diabetes treatment coverage showed a strong inverse ecological association (r = \u22120.913). Conclusions: NCD risk factors in Saudi Arabia are evolving in complex ways. Targeted interventions addressing sex-specific disparities and healthcare system performance are urgently needed to meet national and global NCD targets.<\/jats:p>","DOI":"10.3390\/jcm15114387","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T17:18:16Z","timestamp":1780679896000},"page":"4387","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal Trends in Noncommunicable Disease Risk Factors and Premature Mortality in Saudi Arabia: A 33-Year Ecological Time-Series Study with Machine Learning Prediction"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4865-1190","authenticated-orcid":false,"given":"Nader","family":"Alnomasy","sequence":"first","affiliation":[{"name":"Medical Surgical Nursing Department, College of Nursing, University of Ha\u2019il, Hail 81451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7259-769X","authenticated-orcid":false,"given":"Sudharani B.","family":"Banappagoudar","sequence":"additional","affiliation":[{"name":"Department of Nursing, College of Applied Medical Sciences, King Faisal University, Al Ahsa 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9121-268X","authenticated-orcid":false,"given":"Habib","family":"Alrashedi","sequence":"additional","affiliation":[{"name":"Medical Surgical Nursing Department, College of Nursing, University of Ha\u2019il, Hail 81451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soha Kamel Mosbah","family":"Mahmoud","sequence":"additional","affiliation":[{"name":"Community Health Nursing Department, College of Nursing, University of Ha\u2019il, Hail 81451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0492-7615","authenticated-orcid":false,"given":"Ebtsam","family":"Abouhashish","sequence":"additional","affiliation":[{"name":"College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia"},{"name":"King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia"},{"name":"Ministry of National Guard Health Affairs, Jeddah 22384, Saudi Arabia"},{"name":"Faculty of Nursing, Alexandria University, Alexandria 21526, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2168-5195","authenticated-orcid":false,"given":"Suebsarn","family":"Ruksakulpiwat","sequence":"additional","affiliation":[{"name":"Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E169","DOI":"10.5888\/pcd11.140176","article-title":"Burden of disease, injuries, and risk factors in the Kingdom of Saudi Arabia, 1990\u20132010","volume":"11","author":"Memish","year":"2014","journal-title":"Prev. 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