青少年身體不滿、飲食失調和抑鬱症狀與體重指數之間的縱向關聯：一項英國雙胞胎隊列研究

Longitudinal associations between adolescent body dissatisfaction, eating disorder and depressive symptoms, and BMI: a UK twin cohort study

——《柳葉刀/精神病學》第13卷第1期，2026年1月——

Volume 13, Issue 1, January 2026

【摘要】背景：青少年時期對自身體型的不滿與日後的心理健康問題和體重增加相關，但這些關聯的因果關係尚不明確。本研究旨在探討16歲時對自身體型的不滿與成年早期飲食失調、抑鬱症狀以及體重指數（BMI）之間的縱向關聯，並嚴格控制潛在的混雜因素，包括共同的遺傳影響（目標1和2）。隨後，我們量化了這些關聯中由遺傳和環境因素解釋的比例（目標3）。方法：我們使用了“雙胞胎早期發展研究”（Twins Early Development Study）的數據。該研究是一項基於人群的出生隊列研究，研究對象為1994年至1996年間出生於英格蘭和威爾士的雙胞胎。納入標準為：參與者需具備完整的16歲時對自身體型的不滿數據（通過飲食失調診斷量表（EDS）中的四個條目評估，這些條目反映了對體重和體型的擔憂），以及關於結局和混雜因素的插補數據。研究結果包括21歲時的進食障礙症狀（採用12項改良版進食障礙量表-2）、抑鬱症狀（採用8項簡式情緒與感受問卷）以及21歲和26歲時的BMI（自報身高和體重）。我們對所有樣本進行了單變量和多變量線性混合效應模型分析（目標1），並分別對同卵雙胞胎和異卵雙胞胎進行了組內雙胞胎差異分析（目標2）。隨後，我們採用雙變量和多變量雙胞胎模型來估計加性遺傳和環境因素所解釋的方差和協方差比例（目標3）。研究設計和結果解釋過程中，沒有參與者具有相關生活經歷。研究結果：我們納入了2183對雙胞胎（1314名女性，占60.2%；869名男性，占39.8%；93.5%為白人，61.7%為異卵雙胞胎）。平均而言，身體不滿程度每增加1分，進食障礙症狀評分就會升高1.99分（95% CI 1.73–2.26），抑鬱症狀評分會升高0.59分（0.46–0.73），BMI也會升高0.27 kg/m²（0.16–0.38）。在同卵雙胞胎和異卵雙胞胎的差異分析中，較高的身體不滿程度也與更嚴重的進食障礙和抑鬱症狀相關。對於BMI，這種關聯在同卵雙胞胎中較小，且估計精度較低。雙生子模型分析表明，身體不滿與這些特質（尤其是飲食失調症狀）之間的大部分協方差可由共同的遺傳因素解釋，而非共同環境因素的影響較小。解讀：我們的研究結果表明，身體不滿可能與飲食失調和抑鬱症狀的發生存在因果關係；因此，減少身體不滿的發生可能有助於改善青少年的心理健康狀況。

[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. 

論文原文：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

（翻譯兼責任編輯：MART）

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