Bao Jiamin, Gan Pinky, Feng Junkai, Wang Yixuan, Luo Yanfeng, Zang Yinyin
School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behaviour and Mental Health and Key Laboratory of Machine Perception (Ministry of Education), Peking University, No. 5 Yiheyuan Road, Haidian District, Beijing, 100871, China.
BMC Med. 2025 Aug 15;23(1):480. doi: 10.1186/s12916-025-04319-0.
Eating disorders (EDs) are a growing health concern among children and adolescents globally, yet their prevalence and associated factors in China remain underexplored. This study aimed to update epidemiological data on screening-detected EDs and to examine multilevel associated factors in a large, representative sample of Chinese adolescents.
Cross-sectional data were drawn from the 2021-2022 Child to Adult Mental and Physical Health Study (CAMPS). Using a geographically stratified sampling approach with sample weights calibrated to 2020 Census demographics, we recruited 41,406 adolescents aged 10-19 across eastern, central, and western China. Probable EDs were assessed using the SCOFF questionnaire, with clinical significance evaluated through anxiety and depression scales. Psychosocial functioning was compared between adolescents with and without probable EDs. Associated factors spanning individual, family, and regional levels were examined using multivariate logistic regression.
The prevalence of probable EDs was 21.18% (95% CI: 20.33-22.04), decreasing to 11.33% (95% CI: 10.68-11.99) when considering clinical significance. Adolescents with probable EDs exhibited significantly poorer psychosocial functioning compared to their peers, including lower academic engagement and higher self-harm, externalizing behaviors, and suicide risk (Cohen's ds ≥ 0.28, ps < 0.001). Being female (OR = 1.88, 95% CI: 1.32-2.68, p < 0.001), having higher BMI (OR = 1.02, 95% CI: 1.01-1.03, p < 0.001), increased mobile phone use (OR = 1.06, 95% CI: 1.05-1.07, p < 0.001), lower familial subjective socioeconomic status (SES) (OR = 0.92, 95% CI: 0.89-0.96, p < 0.001), lower subjective SES in school (OR = 0.91, 95% CI: 0.87-0.95, p < 0.001), and living in less developed regions (OR = 0.23, 95% CI: 0.08-0.70, p = 0.010) were significantly associated with increased risk of probable EDs. Cohabitating with the father (ORs = 0.65 to 0.77, ps < 0.033) was protective in some provinces.
This study reveals a substantial burden of probable EDs among Chinese adolescents, with weighted prevalence rates comparable to global estimates and markedly higher than a decade ago. These findings underscore the importance of prioritizing EDs as a public health concern in China and advocate for targeted, multilevel interventions that address both individual and socio-ecological associated factors.
饮食失调（EDs）是全球儿童和青少年中日益受到关注的健康问题，然而其在中国的患病率及相关因素仍未得到充分研究。本研究旨在更新关于筛查发现的饮食失调的流行病学数据，并在一个具有代表性的中国青少年大样本中研究多层次相关因素。
横断面数据取自2021 - 2022年儿童到成人身心健康研究（CAMPS）。采用地理分层抽样方法，并根据2020年人口普查人口统计数据校准样本权重，我们在中国东部、中部和西部招募了41406名10 - 19岁的青少年。使用SCOFF问卷评估可能的饮食失调情况，并通过焦虑和抑郁量表评估临床意义。比较了有和没有可能的饮食失调的青少年的心理社会功能。使用多变量逻辑回归研究了个体、家庭和地区层面的相关因素。
可能的饮食失调患病率为21.18%（95%置信区间：20.33 - 22.04），考虑临床意义时降至11.33%（95%置信区间：10.68 - 11.99）。与同龄人相比，可能患有饮食失调的青少年表现出明显较差的心理社会功能，包括较低的学业参与度以及较高的自我伤害、外化行为和自杀风险（科恩d值≥0.28，p值<0.001）。女性（比值比 = 1.88，95%置信区间：1.32 - 2.68，p < 0.001）、较高的体重指数（比值比 = 1.02，95%置信区间：1.01 - 1.03，p < 0.001）、手机使用增加（比值比 = 1.06，95%置信区间：1.05 - 1.07，p < 0.001）、较低的家庭主观社会经济地位（SES）（比值比 = 0.92，95%置信区间：0.89 - 0.96，p < 0.001）、学校中较低的主观SES（比值比 = 0.91，95%置信区间：0.87 - 0.95，p < 0.001）以及生活在欠发达地区（比值比 = 0.23，95%置信区间：0.08 - 0.70，p = 0.010）与可能的饮食失调风险增加显著相关。在一些省份，与父亲同住（比值比 = 0.65至0.77，p值<0.033）具有保护作用。
本研究揭示了中国青少年中可能的饮食失调的沉重负担，加权患病率与全球估计值相当，且明显高于十年前。这些发现强调了在中国将饮食失调作为公共卫生问题优先处理的重要性，并倡导针对个体和社会生态相关因素的有针对性的多层次干预措施。
