Evaluating the Dietary Factors Most Closely Associated with Diabetes Mellitus Using a Decision-Making Tree Algorithm

The development of type 2 diabetes mellitus (T2DM) is associated with lifestyle factors, including dietary patterns. A diet rich in macro- and micronutrients has been reported to reduce the risk of T2DM. Therefore, this study aimed to identify the dietary factors most closely associated with T2DM in subjects within the MASHAD cohort using a decision tree algorithm.  This cross-sectional study was conducted on 9704 individuals from the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD), of whom 5936 participants completed a 24h dietary recall questionnaire. Macronutrients and micronutrients were estimated using Diet Plan 6 software. A decision tree algorithm was utilized to evaluate the most crucial dietary nutrient intakes concerning T2DM.  The algorithm showed a high specificity (81.34%) but low sensitivity (34.21%), which could predict T2DM with a low-to-moderate diagnostic ability (AUC=0.58). Based on the decision tree, eight features, including dietary potassium, total sugar, sucrose, riboflavin, thiamin, sodium, total nitrogen, and magnesium, were T2DM’s most critical dietary components.  Based on the results, consuming sugar, salt, and vitamin B was the most critical related dietary intake to T2DM. Dietary interventions may be a cost-effective strategy for preventing T2DM.