Associations of Adverse Childhood Experiences and Lifestyle With Probable Eating Disorders in Chinese Adolescents: A Longitudinal Study

ABSTRACT Background To examine the independent association of adverse childhood experiences (ACEs) and lifestyle patterns with incident probable eating disorders among adolescents, and to explore whether healthy lifestyle affects incident probable eating disorders that vary by ACEs exposure levels. Methods This longitudinal study included 7726 adolescents (mean [SD] age at baseline, 15.89 [0.60] years) without eating disorders at baseline. At baseline, we collected 11 ACE indicators and 6 healthy lifestyle behaviors (i.e., appropriate sleep duration, sufficient moderate‐to‐vigorous physical activity, less screen time, no smoking, no drinking, and a balanced diet). The Sick, Control, One, Fat, Food (SCOFF) questionnaire was used to measure probable eating disorders at baseline and at a 4‐month follow‐up. Generalized mixed logistic models, as well as stratified and joint analyzes, were performed, with mediation and interaction analyzes. Results Among the included participants, 917 adolescents (11.87%) developed probable eating disorders during follow‐up. Accumulation of ACEs was independently associated with an increased risk of incident probable eating disorders (OR = 1.20, 95% CI: 1.14–1.27), even after adjusting for lifestyle behaviors. Conversely, a higher healthy lifestyle score was independently associated with a lower risk of incident probable eating disorders (OR = 0.82, 95% CI: 0.76–0.88). Stratified analyzes showed that adolescents with a favorable lifestyle had a consistently reduced risk of incident probable eating disorders compared with those with an unfavorable lifestyle, with the association particularly pronounced among those exposed to ACEs. Conclusions The results highlight that reducing exposure to ACEs and encouraging healthy lifestyle behaviors may help prevent eating disorders among adolescents.