Nutritional markers of undiagnosed type 2 diabetes in adults : Findings of a machine learning analysis with external validation and benchmarking
(2021) In PLoS ONE 16(5). p.1-21- Abstract
OBJECTIVES: Using a nationally-representative, cross-sectional cohort, we examined nutritional markers of undiagnosed type 2 diabetes in adults via machine learning.
METHODS: A total of 16429 men and non-pregnant women ≥ 20 years of age were analysed from five consecutive cycles of the National Health and Nutrition Examination Survey. Cohorts from years 2013-2016 (n = 6673) was used for external validation. Undiagnosed type 2 diabetes was determined by a negative response to the question "Have you ever been told by a doctor that you have diabetes?" and a positive glycaemic response to one or more of the three diagnostic tests (HbA1c > 6.4% or FPG >125 mg/dl or 2-hr post-OGTT glucose > 200mg/dl). Following comprehensive... (More)
OBJECTIVES: Using a nationally-representative, cross-sectional cohort, we examined nutritional markers of undiagnosed type 2 diabetes in adults via machine learning.
METHODS: A total of 16429 men and non-pregnant women ≥ 20 years of age were analysed from five consecutive cycles of the National Health and Nutrition Examination Survey. Cohorts from years 2013-2016 (n = 6673) was used for external validation. Undiagnosed type 2 diabetes was determined by a negative response to the question "Have you ever been told by a doctor that you have diabetes?" and a positive glycaemic response to one or more of the three diagnostic tests (HbA1c > 6.4% or FPG >125 mg/dl or 2-hr post-OGTT glucose > 200mg/dl). Following comprehensive literature search, 114 potential nutritional markers were modelled with 13 behavioural and 12 socio-economic variables. We tested three machine learning algorithms on original and resampled training datasets built using three resampling methods. From this, the derived 12 predictive models were validated on internal- and external validation cohorts. Magnitudes of associations were gauged through odds ratios in logistic models and variable importance in others. Models were benchmarked against the ADA diabetes risk test.
RESULTS: The prevalence of undiagnosed type 2 diabetes was 5.26%. Four best-performing models (AUROC range: 74.9%-75.7%) classified 39 markers of undiagnosed type 2 diabetes; 28 via one or more of the three best-performing non-linear/ensemble models and 11 uniquely by the logistic model. They comprised 14 nutrient-based, 12 anthropometry-based, 9 socio-behavioural, and 4 diet-associated markers. AUROC of all models were on a par with ADA diabetes risk test on both internal and external validation cohorts (p>0.05).
CONCLUSIONS: Models performed comparably to the chosen benchmark. Novel behavioural markers such as the number of meals not prepared from home were revealed. This approach may be useful in nutritional epidemiology to unravel new associations with type 2 diabetes.
(Less)
- author
- De Silva, Kushan ; Lim, Siew ; Mousa, Aya ; Teede, Helena ; Forbes, Andrew ; Demmer, Ryan T ; Jönsson, Daniel LU and Enticott, Joanne
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- keywords
- Adult, Algorithms, Benchmarking/methods, Biomarkers/metabolism, Blood Glucose/metabolism, Cohort Studies, Cross-Sectional Studies, Diabetes Mellitus, Type 2/metabolism, Female, Glycated Hemoglobin/metabolism, Humans, Logistic Models, Machine Learning, Male, Middle Aged, Nutrition Surveys, Prediabetic State/metabolism
- in
- PLoS ONE
- volume
- 16
- issue
- 5
- article number
- e0250832
- pages
- 1 - 21
- publisher
- Public Library of Science (PLoS)
- external identifiers
-
- pmid:33951067
- scopus:85105302917
- ISSN
- 1932-6203
- DOI
- 10.1371/journal.pone.0250832
- language
- English
- LU publication?
- no
- id
- bfbf818a-b8c5-4e36-a49a-e2bf2a0c3683
- date added to LUP
- 2024-07-04 10:41:39
- date last changed
- 2024-07-05 04:02:16
@article{bfbf818a-b8c5-4e36-a49a-e2bf2a0c3683,
abstract = {{<p>OBJECTIVES: Using a nationally-representative, cross-sectional cohort, we examined nutritional markers of undiagnosed type 2 diabetes in adults via machine learning.</p><p>METHODS: A total of 16429 men and non-pregnant women ≥ 20 years of age were analysed from five consecutive cycles of the National Health and Nutrition Examination Survey. Cohorts from years 2013-2016 (n = 6673) was used for external validation. Undiagnosed type 2 diabetes was determined by a negative response to the question "Have you ever been told by a doctor that you have diabetes?" and a positive glycaemic response to one or more of the three diagnostic tests (HbA1c > 6.4% or FPG >125 mg/dl or 2-hr post-OGTT glucose > 200mg/dl). Following comprehensive literature search, 114 potential nutritional markers were modelled with 13 behavioural and 12 socio-economic variables. We tested three machine learning algorithms on original and resampled training datasets built using three resampling methods. From this, the derived 12 predictive models were validated on internal- and external validation cohorts. Magnitudes of associations were gauged through odds ratios in logistic models and variable importance in others. Models were benchmarked against the ADA diabetes risk test.</p><p>RESULTS: The prevalence of undiagnosed type 2 diabetes was 5.26%. Four best-performing models (AUROC range: 74.9%-75.7%) classified 39 markers of undiagnosed type 2 diabetes; 28 via one or more of the three best-performing non-linear/ensemble models and 11 uniquely by the logistic model. They comprised 14 nutrient-based, 12 anthropometry-based, 9 socio-behavioural, and 4 diet-associated markers. AUROC of all models were on a par with ADA diabetes risk test on both internal and external validation cohorts (p>0.05).</p><p>CONCLUSIONS: Models performed comparably to the chosen benchmark. Novel behavioural markers such as the number of meals not prepared from home were revealed. This approach may be useful in nutritional epidemiology to unravel new associations with type 2 diabetes.</p>}},
author = {{De Silva, Kushan and Lim, Siew and Mousa, Aya and Teede, Helena and Forbes, Andrew and Demmer, Ryan T and Jönsson, Daniel and Enticott, Joanne}},
issn = {{1932-6203}},
keywords = {{Adult; Algorithms; Benchmarking/methods; Biomarkers/metabolism; Blood Glucose/metabolism; Cohort Studies; Cross-Sectional Studies; Diabetes Mellitus, Type 2/metabolism; Female; Glycated Hemoglobin/metabolism; Humans; Logistic Models; Machine Learning; Male; Middle Aged; Nutrition Surveys; Prediabetic State/metabolism}},
language = {{eng}},
number = {{5}},
pages = {{1--21}},
publisher = {{Public Library of Science (PLoS)}},
series = {{PLoS ONE}},
title = {{Nutritional markers of undiagnosed type 2 diabetes in adults : Findings of a machine learning analysis with external validation and benchmarking}},
url = {{http://dx.doi.org/10.1371/journal.pone.0250832}},
doi = {{10.1371/journal.pone.0250832}},
volume = {{16}},
year = {{2021}},
}