Screening of significant gastric metabolites and their associated genera for gastric lesion progression. (A) The 9 differential metabolites in IM lesions before or after interventions showed 49 pairs of significant correlations with 14 differential gastric genera. (B) Alterations of 9 metabolites and 14 associated genera were screened by LASSO regression, with 7 metabolites and 7 genera showing significant associations with risk of lesion progression to IM. (C) These significantly altered metabolites and genera were selected by multivariate unconditional logistic regression adjusted for age, gender, and the effect of anti-H. pylori treatment with Cer(d18:1/22:0), Cer(d18:1/24:1), Hex2Cer(d18:1/22:0), HexCer(d18:1/24:1) and Fusobacterium, Helicobacter, Neisseria, and Streptococcus showing significant associations with risk of lesion progression to IM. (D) The selected 4 metabolites, 4 genera, and their 11 significant interactions according to panel A were further enrolled in a multivariate unconditional logistic regression model with 4 genus-metabolite interactions showing significant associations with risk of lesion progression to IM.