Estimating the effects of behavioral symptoms of eating disorders during adolescence and young adulthood on markers of male and female reproductive health Restricted; Files Only
Thornburgh, Sarah (Summer 2025)
Abstract
The overarching goal of this dissertation was to evaluate the prospective associations between disordered eating behaviors in adolescence and reproductive endpoints in adulthood. Leveraging a large, prospective cohort, we investigated the associations of binge eating, self-induced vomiting, and laxative use with erectile function and with polycystic ovary syndrome.
Aim 1: Based on our analysis, we concluded that males who engaged in binge eating during adolescence had worse erectile function. The strength of this association was most pronounced among boys who binge ate more than monthly (aMD: -2.15, 95% CI: -5.00, 0.71). However, laxative use and self-induced vomiting were not appreciably associated with erectile function. Neither comorbid mental health diagnoses nor sexual orientation significantly modified the association between binge eating and erectile dysfunction.
Aim 2: We found that girls who engaged in binge eating more than monthly during adolescence had increased odds of developing PCOS (aOR: 1.59, 95% CI: 1.09, 2.33) compared to those who never engaged in binge eating. Unexpectedly, infrequent laxative use was associated with decreased the odds of PCOS (aOR: 0.45, 95% CI: 0.29, 0.72) while frequent laxative use increased the odds of PCOS (aOR: 1.67, 95% CI: 0.89, 3.14) compared to never users. There was no evidence of statistically significant effect modification by childhood body size.
Aim 3: We investigated whether common study designs in PCOS research, specifically adjusting for hormonal contraception use and excluding users of hormonal contraception, result in biased results. Our simulation, combined with an applied example, provide evidence that when the exposure is associated with hormonal contraception use, both strategies result in bias. However, we identified one exception, specifically scenarios in which the exposure of interest is rare, and the exposure is strongly associated with an increased likelihood of using hormonal contraception. We conclude that moving forward, PCOS studies should potentially limit the methodological practice of controlling for and excluding based on hormonal contraception use in their studies.
Table of Contents
Chapter 1: Introduction and Background. 1
Motivation and Aims. 1
Introduction to Eating Disorders. 3
Introduction to Erectile Function. 8
Introduction to Polycystic Ovary Syndrome. 9
Public Health Implications. 10
Chapter 2: Disordered Eating Behaviors during Childhood and Adolescence and Erectile Function: A Prospective Cohort Study. 12
Abstract 13
Introduction. 15
Methods. 16
Study Population. 16
Assessment of Disordered Eating Behaviors. 17
Assessment of Erectile Function. 19
Covariates. 19
Statistical Analysis. 20
Results. 21
Discussion. 22
Chapter 3: Disordered Eating Behaviors during Childhood and Adolescence and Risk of Polycystic Ovary Syndrome: A Prospective Cohort Study. 35
Abstract 36
Introduction. 38
Methods. 39
Study Population. 39
Assessment of Disordered Eating Behaviors. 39
Assessment of Polycystic Ovary Syndrome. 40
Covariates. 41
Statistical Analysis. 41
Sensitivity Analyses. 42
Results. 43
Discussion. 45
Chapter 4: Evaluating Misclassification and Selection Bias in Studies of Polycystic Ovary Syndrome: A Simulation Study. 57
Abstract 58
Introduction. 60
Methods. 62
Aims. 62
Data Generating Mechanism. 62
Estimands. 64
Methods. 65
Performance Measures. 65
Study Population. 66
Assessment of Childhood Body Size. 67
Assessment of Physician-Diagnosed PCOS. 67
Assessment of Hormonal Contraception Use. 67
Covariates. 67
Statistical Analysis. 68
Results. 68
Ignore Model. 68
Conditional Model. 68
Subset Model. 69
Analysis of Childhood Body Size and PCOS. 70
Discussion. 70
Chapter 5: Summary of Results, Future Research. 88
Review of Major Findings. 88
Limitations. 90
Strengths. 90
Future Directions. 91
Public Health Impact. 92
References 93
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File download under embargo until 21 August 2027 | 2025-07-01 19:06:53 -0400 | File download under embargo until 21 August 2027 |
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