青少年身体不满、饮食失调和抑郁症状与体重指数之间的纵向关联
青少年身体不满、饮食失调和抑郁症状与体重指数之间的纵向关联：一项英国双胞胎队列研究
Longitudinal associations between adolescent body dissatisfaction, eating disorder and depressive symptoms, and BMI: a UK twin cohort study
——《柳叶刀/精神病学》第13卷第1期，2026年1月——
【摘要】背景：青少年时期对自身体型的不满与日后的心理健康问题和体重增加相关，但这些关联的因果关系尚不明确。本研究旨在探讨16岁时对自身体型的不满与成年早期饮食失调、抑郁症状以及体重指数（BMI）之间的纵向关联，并严格控制潜在的混杂因素，包括共同的遗传影响（目标1和2）。随后，我们量化了这些关联中由遗传和环境因素解释的比例（目标3）。方法：我们使用了“双胞胎早期发展研究”（Twins Early Development Study）的数据。该研究是一项基于人群的出生队列研究，研究对象为1994年至1996年间出生于英格兰和威尔士的双胞胎。纳入标准为：参与者需具备完整的16岁时对自身体型的不满数据（通过饮食失调诊断量表（EDS）中的四个条目评估，这些条目反映了对体重和体型的担忧），以及关于结局和混杂因素的插补数据。研究结果包括21岁时的进食障碍症状（采用12项改良版进食障碍量表-2）、抑郁症状（采用8项简式情绪与感受问卷）以及21岁和26岁时的BMI（自报身高和体重）。我们对所有样本进行了单变量和多变量线性混合效应模型分析（目标1），并分别对同卵双胞胎和异卵双胞胎进行了组内双胞胎差异分析（目标2）。随后，我们采用双变量和多变量双胞胎模型来估计加性遗传和环境因素所解释的方差和协方差比例（目标3）。研究设计和结果解释过程中，没有参与者具有相关生活经历。研究结果：我们纳入了2183对双胞胎（1314名女性，占60.2%；869名男性，占39.8%；93.5%为白人，61.7%为异卵双胞胎）。平均而言，身体不满程度每增加1分，进食障碍症状评分就会升高1.99分（95% CI 1.73–2.26），抑郁症状评分会升高0.59分（0.46–0.73），BMI也会升高0.27 kg/m²（0.16–0.38）。在同卵双胞胎和异卵双胞胎的差异分析中，较高的身体不满程度也与更严重的进食障碍和抑郁症状相关。对于BMI，这种关联在同卵双胞胎中较小，且估计精度较低。双生子模型分析表明，身体不满与这些特质（尤其是饮食失调症状）之间的大部分协方差可由共同的遗传因素解释，而非共同环境因素的影响较小。解读：我们的研究结果表明，身体不满可能与饮食失调和抑郁症状的发生存在因果关系；因此，减少身体不满的发生可能有助于改善青少年的心理健康状况。
[Summary] Background: Body dissatisfaction is associated with later mental health problems and weight gain in young people, but the causality of these associations is unclear. We aimed to investigate the longitudinal associations between body dissatisfaction at age 16 years and later eating disorder and depressive symptoms, and BMI in young adulthood, with rigorous control for potential confounders including shared genetic influences (in objectives 1 and 2). We then quantified the proportion of these associations explained by genetic and environmental factors (objective 3). Methods: We used data from the Twins Early Development Study, a population-based birth cohort of twins born in England and Wales between 1994 and 1996. Participants were included if they had complete data on body dissatisfaction at age 16 years—assessed via four items from the Eating Disorder Diagnostic Scale capturing weight and shape concerns—and imputed data on outcomes and confounders. Outcomes included eating disorder symptoms at age 21 years (12-item modified version of the Eating Disorder Inventory—2), depressive symptoms (8-item Short Mood and Feelings Questionnaire), and BMI (self-reported height and weight) at ages 21 years and 26 years. We used univariable and multivariable linear mixed-effects models in the full sample (objective 1), and within-pair twin-difference analyses in monozygotic and dizygotic twins separately (objective 2). We then used bivariate and multivariate twin modelling to estimate the proportion of variance and covariance explained by additive genetic and environmental factors (objective 3). No participants with lived experience were involved in the design or interpretation of the research. Findings: We included 2183 twins (1314 females, 60·2%; 869 males, 39·8%; 93·5% White, 61·7% dizygotic). A one-point increase in body dissatisfaction was associated with, on average, a 1·99-point (95% CI 1·73–2·26) higher eating disorder symptom score, a 0·59-point (0·46–0·73) higher depressive symptom score, and a 0·27 kg/m2 (0·16–0·38) higher BMI. In monozygotic and dizygotic twin difference analyses, higher body dissatisfaction was also associated with more severe eating disorder and depressive symptoms. For BMI, the association was smaller and less precisely estimated in monozygotic twins. Twin modelling indicated that most of the covariance between body dissatisfaction and these traits—particularly eating disorder symptoms—was explained by shared genetic factors, with a smaller contribution from non-shared environmental influences. Interpretation: Our findings suggest that body dissatisfaction might causally increase eating disorder and depressive symptoms; thus, reducing its emergence could lead to improvements in adolescent mental health outcomes.
论文原文：Ilaria Costantini, Thalia C Eley, Jean-Baptiste Pingault, Neil M Davies, Helen Bould, Cynthia M Bulik, et al. (2026). Longitudinal associations between adolescent body dissatisfaction, eating disorder and depressive symptoms, and BMI: a UK twin cohort study. The Lancet / Psychiatry, Volume 13, Issue 1, Pages 37-46, January 2026.
https://doi.org/10.1016/S2215-0366(25)00333-5
（翻译兼责任编辑：MART）
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