Sleep, Food Insecurity, and Weight Status: Findings from the Family Life, Activity, Sun, Health, and Eating Study

Associations of social determinants of health and childhood obesity: a cross-sectional analysis of the 2021 National Survey of Children's Health

CONTEXT

Childhood obesity is a growing health problem in the United States, with those affected having an increased likelihood of developing chronic diseases at a younger age. Social determinants of health (SDOH) are known to influence overall health. Families who are of low socioeconomic status (SES) have also been shown to be more likely to experience food insecurity.

OBJECTIVES

Our primary objective was to utilize the National Survey of Children's Health (NSCH) 2021 data to determine the current associations between childhood obesity and SDOH. Secondarily, we estimated the prevalence of select SDOH among children with obesity.

METHODS

We conducted a cross-sectional analysis of 2021 NSCH to extract data related to the SDOH domains. We extracted sociodemographic variables to utilize as controls and constructed logistic regression models to determine associations, via odds ratios, between SDOH and childhood obesity.

RESULTS

Within the binary regression models, children with obesity (≥95th percentile) were more likely than children without obesity to experience SDOH in all domains. After controlling for sociodemographic variables, children with obesity were significantly more likely to experience food insecurity when compared to children without obesity (adjusted odds ratio [AOR]=1.39; 95 % confidence interval [CI]: 1.13-1.17).

CONCLUSIONS

In line with the current American Academy of Pediatrics (AAP) Clinical Practice Guidelines (CPG), improving policies for nutrition programs and addressing the lack of access to nutritious foods may alleviate some food insecurity. Ensuring that children have access to sufficient nutritious foods is critical in addressing childhood obesity and thus decreasing risk of chronic disease.

Food insecurity and its impact on substance use and suicidal behaviours among school-going adolescents in Africa: evidence from the Global School-Based Student Health Survey

The study sought to assess the prevalence and factors associated with Food Insecurity (FI) and further quantify its impact on substance use and suicidal behaviours (ideation, planning, and repeated attempted suicide) among school-going adolescents in Africa. The study involved a secondary analysis of cross-sectional data from the Global School-Based Student Health Survey (GSHS) conducted in Africa. Substance use and suicidal behaviours were the main outcomes. We employed the Double Selection Least Absolute Shrinkage and Selection Operator Poisson regression (DSLASSOPM) model to assess risk factors associated with FI and further employed Coarsened Exact Matching involving DSLASSOPM to assess the influence of FI on the study outcomes. Meta-analysis was conducted to obtain between-country heterogeneity in the prevalence of FI and the prevalence ratio of substance use and suicidal behaviours. The study involved 34,912 school-going adolescents. The pooled 30-day prevalence estimate of FI was 11.1% (95% CI  9.1-18.6), ranging from 6.7% (95% CI 5.0-8.3) in Tanzania to 18.4% (95% CI 14.4-22.4) in Benin. The most common associated factors included the experience of insomnia and the number of times injured. The pooled prevalence ratio of substance use, suicidal ideation, suicidal planning, and repeated attempted suicide among adolescents experiencing food insecurity were 1.92(95% CI 1.69-2.16), 1.56(95% CI 1.46-1.66), 1.50 (95% CI 1.41-1.58), and 1.90 (95% CI 1.73-2.07) respectively. A considerable heterogeneity between the sub-regions prevalence ratio for suicidal ideation and planning was also observed (I2 = 0, p value > 0.05). The study observed a high prevalence of food insecurity in West Africa with negligible heterogeneity between the countries. A significant positive association between FI and the study outcomes (substance use and suicidal behaviours) was observed. The study recommends country-specific social and school-based health interventions to screen risk factors associated with food insecurity for early identification. Measures to achieve Sustainable Development Goal 2 (Zero Hunger) by 2030 are key in these African countries and is likely to yield demographic dividends through improvement in mental health among school-going adolescents.

Associations between food insecurity and Sleep Duration, Quality, and Disturbance among older adults from six low- and middle-income countries

OBJECTIVES

Although food insecurity has been associated with poor sleep outcomes in young and middle-aged adults, few studies have examined this relationship in older adults. This study aimed to examine the relationship between food insecurity and sleep duration, quality, and disturbance among older adults in six low-income countries (LMICs).

DESIGN AND SETTING

We analyzed nationally representative cross-sectional data from 33,460 adults (≥50 years) from the Study on global AGEing and adult health (SAGE).

MEASUREMENTS

Food insecurity (FI) was assessed using two questions regarding the frequency of eating less and hunger caused by a lack of food. Sleep outcomes included self-reported sleep duration, sleep quality, and sleep disturbances (difficulty falling asleep, frequent sleep interruptions, and early awakening) assessed based on self-reports over two nights. Multivariable logistic regression was used to assess country-specific relationships between food insecurity and sleep outcomes, and random-effects models were used to estimate pooled associations.

RESULTS

The prevalence of FI among older adults in the overall population was 16.2%. In pooled analyses, FI was significantly associated with long sleep duration ≥ 9 h (OR=1.58, 95% CI: 1.30 to 1.93; P=0.001). There were also significant pooled associations between FI and poor sleep quality (OR=1.34, 95% CI: 1.14 to 1.56; P < 0.001) and sleep disturbances (OR=1.44, 95% CI: 1.08 to 1.91; P = 0.014).

CONCLUSIONS

In conclusion, the current study found that FI is adversely associated with sleep duration, quality and disturbances in older adults, with some heterogeneity by country. The findings suggest food policies and intervention programs are needed for vulnerable households.

Food insecurity and insomnia-related symptoms among adults from low- and middle-income countries

Little is known about the relationship between food insecurity and sleep problems in low- and middle-income countries, while the mediators of this association are largely unknown. Therefore, we investigated the association between food insecurity and insomnia-related symptoms in six low- and middle-income countries (i.e., China, Ghana, India, Mexico, Russia, South Africa), and the potential mediators of this relationship. Cross-sectional, nationally representative data from the Study on Global AGEing and Adult Health (2007-2010) were analysed. Past 12-month food insecurity was assessed with two questions on the frequency of eating less, and on hunger owing to a lack of food. Insomnia-related symptoms referred to severe or extreme sleep problems in the past 30 days. Multivariable logistic regression and mediation analysis were conducted. Data on 42,489 adults aged ≥18 years were analysed (mean [standard deviation] age 43.8 [14.4] years; 50.1% females). The prevalence of any food insecurity and insomnia-related symptoms was 11.9% and 4.4%, respectively. After adjustment, compared with no food insecurity, moderate (odds ratio = 1.53, 95% confidence interval = 1.11-2.10) and severe food insecurity (odds ratio = 2.35, 95% confidence interval = 1.56-3.55) were significantly associated with insomnia-related symptoms. Anxiety, perceived stress, and depression mediated 27.7%, 13.5%, and 12.5% of the relationship between any food insecurity and insomnia-related symptoms, respectively (total percentage = 43.3%). Food insecurity was positively associated with insomnia-related symptoms in adults from six low- and middle-income countries. Anxiety, perceived stress, and depression explained a substantial proportion of this relationship. Addressing food insecurity itself or the identified potential mediators among people with food insecurity may lead to a reduction in sleep problems among adults in low- and middle-income countries, pending confirmation with longitudinal studies.

The Mediating Effect of Sleep Duration on the Association between Food Insecurity and Childhood Obesity

Background: Childhood obesity has increased globally during the past four decades. Food insecurity could heighten the risk of obesity. However, little is known about the underlying mechanism. This study aims to investigate the mediating role of sleep duration in the association between food insecurity and childhood obesity and whether there are differences by age, sex, and race/ethnicity. Method: Data from the National Survey of Children's Health for the years 2016-2020 were used, including children 10-17 years of age. We employed causal mediation analysis within a counterfactual framework to decompose the total effect of food insecurity into natural direct and indirect effects and estimate the proportion mediated. Result: The prevalence of obesity was 15.8% in our study sample. Children with food insecurity had 78% higher odds [odds ratio (OR) = 1.78, 95% confidence interval (CI): 1.70-1.86] of having obesity compared with children who were food secure. Overall, only 6.13% of this association was mediated by sleep duration. The association between food insecurity and obesity was stronger in females (OR = 1.96, 95% CI: 1.84-2.10) than males (OR = 1.66, 95% CI: 1.56-1.75), but the proportion mediated by sleep duration was larger in males (7.13%) than females (5.22%). Evidence of mediation was more pronounced in children 10-11 years of age and non-Hispanic Asian children (proportion mediated = 14.85% and 11.21%, respectively). Conclusion: Food insecurity is associated with an increased prevalence of obesity among children. Although a small proportion of this association is mediated by sleep duration, these results suggest that sleep should be considered when assessing the link between food insecurity and childhood obesity.