{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:37:48Z","timestamp":1787067468435,"version":"build-2736575974"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T00:00:00Z","timestamp":1684368000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Previous studies have found mixed associations between body mass index (BMI) and adolescent idiopathic scoliosis (AIS) incidence and progression. The aim of this study was to examine the association between BMI and the incidence of posterior spine fusion (PSF) among pediatric patients with AIS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective cohort study of patients diagnosed with AIS at a single large tertiary care center between January 1, 2014 and December 31, 2020. BMI-for-age percentiles were used to categorize BMI into four categories: underweight (&lt;5th percentile), healthy weight (\u22655th to &lt;85th percentile), overweight (\u226585th to &lt;95th percentile), and obese (\u226595th percentile). Chi-square and t-tests were used to compare distributions of baseline characteristics by incident PSF outcome status. Multivariable logistic regression assessed the association between BMI category at baseline and incident PSF adjusting for sex, age at diagnosis, race\/ethnicity, health insurance type, vitamin D supplementation, and low vitamin D levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 2,258 patients met the inclusion criteria with 2,113 patients (93.6%) who did not undergo PSF during the study period and 145 patients (6.4%) who did undergo PSF. At baseline, 7.3% of patients were categorized as underweight, 73.2% were healthy weight, 10.2% were overweight, and 9.3% were obese. Compared to those in the healthy weight group, there was no significant association between PSF and being underweight (adjusted odds ratio [AOR] 1.64, 95% CI 0.90\u20132.99, p = 0.107), being overweight (AOR 1.25, 95% CI 0.71\u20132.20, p = 0.436), or being obese (AOR 1.19, 95% CI 0.63\u20132.27, p = 0.594).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study did not find a statistically significant association between underweight, overweight, or obese BMI category and incident PSF among patients with AIS. These findings add to the current mixed evidence on the relationship between BMI and surgical risk and may support the recommendation of conservative treatment to patients regardless of BMI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0286001","type":"journal-article","created":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T13:41:32Z","timestamp":1684417292000},"page":"e0286001","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Association between body mass index and posterior spine fusion among patients with adolescent idiopathic scoliosis"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7190-4512","authenticated-orcid":true,"given":"Carrie 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[cited 2022 Dec 13]. https:\/\/www.cdc.gov\/growthcharts\/clinical_charts.htm"},{"issue":"7906","key":"pone.0286001.ref018","article-title":"Adolescent idiopathic scoliosis","volume":"346","author":"F Altaf","year":"2013","journal-title":"BMJ"},{"issue":"5","key":"pone.0286001.ref019","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.spinee.2013.06.043","article-title":"Disease severity and treatment in adolescent idiopathic scoliosis: the impact of race and economic status","volume":"15","author":"JM Zavatsky","year":"2015","journal-title":"Spine J"},{"issue":"4","key":"pone.0286001.ref020","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1097\/BRS.0000000000000729","article-title":"The association between insurance status and complications, length of stay, and costs for pediatric idiopathic scoliosis","volume":"40","author":"SK Cho","year":"2015","journal-title":"Spine (Phila Pa 1976)"},{"issue":"27","key":"pone.0286001.ref021","doi-asserted-by":"crossref","first-page":"e21016","DOI":"10.1097\/MD.0000000000021016","article-title":"The association of obesity with health insurance coverage and demographic characteristics: a statewide cross-sectional study","volume":"99","author":"EK Mylona","year":"2020","journal-title":"Medicine (Baltimore)"},{"issue":"6","key":"pone.0286001.ref022","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1097\/BRS.0000000000002853","article-title":"Do Overweight Adolescent Idiopathic Scoliosis (AIS) Patients Have an Increased Perioperative Risk for Posterior Spinal Fusion (PSF) Surgery?: A Propensity Score Matching Analysis of 374 AIS Patients","volume":"44","author":"CYW Chan","year":"2019","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"pone.0286001.ref023","article-title":"Effect of body mass index on surgical outcomes after posterior spinal fusion for adolescent idiopathic scoliosis","volume":"43","author":"G Ramos RD la","year":"2017","journal-title":"Neurosurg Focus"},{"issue":"10","key":"pone.0286001.ref024","doi-asserted-by":"crossref","first-page":"e865","DOI":"10.1097\/BPO.0000000000001958","article-title":"Surgical Outcomes of Obese Patients With Adolescent Idiopathic Scoliosis From Endemic Areas of Obesity in the United States","volume":"41","author":"TC McDonald","year":"2021","journal-title":"J Pediatr Orthop"},{"issue":"3","key":"pone.0286001.ref025","doi-asserted-by":"crossref","first-page":"E156","DOI":"10.1097\/BRS.0000000000001721","article-title":"Is Obesity in Adolescent Idiopathic Scoliosis Associated With Larger Curves and Worse Surgical Outcomes?","volume":"42","author":"Y Li","year":"2017","journal-title":"Spine (Phila Pa 1976)"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0286001","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T13:41:56Z","timestamp":1684417316000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0286001"}},"subtitle":[],"editor":[{"given":"Chris A","family":"Rees","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,5,18]]},"references-count":25,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0286001","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,18]]}}}