{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T16:05:36Z","timestamp":1775059536754,"version":"3.50.1"},"reference-count":44,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T00:00:00Z","timestamp":1749081600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp;amp; Obste"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Emerging evidence suggests dietary components may modulate inflammatory conditions, yet the role of phosphorus in pelvic inflammatory disease (PID) remains unclear. This study investigated the association between dietary phosphorus intake and PID prevalence while developing machine learning (ML) models for PID risk prediction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 2629 non\u2010pregnant women from the National Health and Nutrition Examination Survey 2015\u20132018 were analyzed. PID was defined using self\u2010reported physician diagnosis. Dietary phosphorus intake was quantified using two 24\u2010h recalls. Multivariable weighted logistic regression, subgroup analyses, and smooth curve fitting were employed to assess linear\/nonlinear associations. Six ML algorithms\u2014Random Forest (RF), LightGBM, Decision Tree, XGBoost, SGD Classifier, and Gradient Boosting\u2014were trained using phosphorus intake and demographic features. Model performance was evaluated based on the accuracy, precision, recall, F1\u2010score, and AUC. Feature importance was interpreted using Shapley Additive Explanations (SHAP) values.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Higher dietary phosphorus intake was inversely associated with PID prevalence. In fully adjusted models, each 1\u2009mg\/day increase in phosphorus reduced PID odds by 0.1% (adjusted odds ratio [aOR] 0.99, 95% confidence interval [CI]: 0.9988\u20130.9999, <jats:italic>P<\/jats:italic>\u2009=\u20090.017), with the highest quartile (Q4) showing 56.0% lower odds than Q1 (aOR 0.44, 95% CI: 0.221\u20130.875, <jats:italic>P<\/jats:italic>\u2009=\u20090.022). Age significantly modified this association (<jats:italic>P<\/jats:italic>\u2009=\u20090.003), with stronger effects observed in older adults. The RF model achieved optimal prediction performance (accuracy\u2009=\u200998.3%, AUC\u2009=\u20090.984), with phosphorus intake ranked among the top three predictive features.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These findings provide the first epidemiologic evidence that adequate dietary phosphorus intake may protect against PID, particularly in older women. The integration of ML models with nutritional data demonstrates high predictive accuracy for PID risk, paving the way for personalized dietary interventions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.70245","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T10:43:57Z","timestamp":1749120237000},"page":"1250-1261","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pelvic inflammatory disease prevalence and dietary phosphorus: A cross\u2010sectional analysis of the National Health and Nutrition Examination Survey, 2015\u20132018"],"prefix":"10.1002","volume":"170","author":[{"given":"Hui\u2010Min","family":"Mai","sequence":"first","affiliation":[{"name":"Department of Gynecology The Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University  Qingyuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong\u2010Ping","family":"Zha","sequence":"additional","affiliation":[{"name":"Department of Gynecology The Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University  Qingyuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Le\u2010Lin","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Gynecology The Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University  Qingyuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ya\u2010Fang","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Gynecology The Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University  Qingyuan China"},{"name":"Department of Clinical Medicine The Third School of Clinical Medicine,Guangzhou Medical University  Guangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ze\u2010Ru","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gynecology The Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University  Qingyuan China"},{"name":"Department of Clinical Medicine The Second School of Clinical Medicine,Guangzhou Medical University  Guangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Gynecology The Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University  Qingyuan China"},{"name":"Department of Clinical Medicine The First School of Clinical Medicine,Guangzhou Medical University  Guangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gynecology The Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University  Qingyuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong\u2010Bin","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Gynecology The Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University  Qingyuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian\u2010Wei","family":"Lao","sequence":"additional","affiliation":[{"name":"Department of Gynecology The Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University  Qingyuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qing\u2010Lan","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Gynecology The Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University  Qingyuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cai\u2010Rong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gynecology The Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University  Qingyuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai\u2010Shu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery The Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University  Qingyuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cui","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Gynecology The Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University  Qingyuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1753-4887.2012.00473.x"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6603a3"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1411426"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0954422410000272"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2018.03.035"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.109.196675"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.113.073148"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2017.07.025"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu15173735"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu14235026"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/molecules28227486"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiab031"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.023227"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/1476-511X-11-3"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.06.030"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.18632\/aging.205621"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.101934"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0299566"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2024.1430730"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11356-023-30176-6"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2023.1273509"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.926351"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.16188"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000038981"},{"issue":"161","key":"e_1_2_10_26_1","first-page":"1","article-title":"National health and nutrition examination survey: analytic guidelines, 1999\u20102010","volume":"2","author":"Johnson CL","year":"2013","journal-title":"Vital Health Stat Ser 2 Data Eval Methods Res"},{"key":"e_1_2_10_27_1","unstructured":"ChawlaNV BowyerKW HallLO KegelmeyerWP.SMOTE: synthetic minority over\u2010sampling technique.arXiv2011; 1106.1813. Accessed June 1 2011.https:\/\/ui.adsabs.harvard.edu\/abs\/2011arXiv1106.1813C"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1010933404324"},{"key":"e_1_2_10_29_1","first-page":"3149","volume-title":"Proceedings of the 31st International Conference on Neural Information Processing Systems","author":"Ke G","year":"2017"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1022643204877"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1145\/2939672.2939785"},{"key":"e_1_2_10_32_1","doi-asserted-by":"crossref","unstructured":"ZadroznyB ElkanC.Transforming classifier scores into accurate multiclass probability estimates. Eighth international conference on knowledge discovery & data mining2002; 694.","DOI":"10.1145\/775047.775151"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1214\/aos\/1013203451"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2014.03.021"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.4030"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12603-012-0035-y"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.3390\/metabo11040255"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11914-017-0398-4"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.3945\/an.113.004002"},{"issue":"12","key":"e_1_2_10_40_1","first-page":"1871","article-title":"The diagnostic role of vitamin D and cathelicidin levels in pelvic inflammatory disease","volume":"61","author":"\u00c7ekmez Y","year":"2015","journal-title":"Clin Lab"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fsi.2024.109387"},{"issue":"2","key":"e_1_2_10_42_1","first-page":"95","article-title":"Importance of nutrients and nutrient metabolism on human health","volume":"91","author":"Chen Y","year":"2018","journal-title":"Yale J Biol Med"},{"issue":"6","key":"e_1_2_10_43_1","first-page":"357","article-title":"Pelvic inflammatory disease: diagnosis, management, and prevention","volume":"100","author":"Curry A","year":"2019","journal-title":"Am Fam Physician"},{"issue":"4","key":"e_1_2_10_44_1","article-title":"Pelvic inflammatory disease in pregnancy: a systematic review focusing on perinatal outcomes","volume":"4","author":"Marcinkowski KA","year":"2022","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.112.053934"}],"container-title":["International Journal of Gynecology &amp; Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.70245","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T14:30:16Z","timestamp":1757082616000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/ijgo.70245"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,5]]},"references-count":44,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1002\/ijgo.70245"],"URL":"https:\/\/doi.org\/10.1002\/ijgo.70245","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,5]]},"assertion":[{"value":"2025-03-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}