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

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.

Association of food insecurity and sleep difficulty among 189,619 school-going adolescents: a study from the global in-school students survey

Introduction

Adolescents' sleep disturbances are associated with chronic and dramatic physical, emotional, and mental development and school performance consequences. Although food insecurity could significantly contribute to these effects, few studies have explored the effect of food insecurity on sleep disturbances among adolescents. The study aimed to examine the relationship between adolescents' food insecurity and sleep disturbance.

Methods

Data on 189,619 adolescents were drawn from the cross-sectional global adolescent health surveys conducted between 2015 and 2018 in 35 countries and territories. Univariate and multivariable multinomial regression models were fitted to examine the hypothesized associations.

Results

Overall pooled prevalence of moderate [45.2% (95%CI = 43-47)] and severe [5.8% (95%CI = 5-6)] food insecurity levels were reported. About [52.6% (95%CI = 51-54)] moderate and [8.6% (95%CI = 8-9)] severe worry-induced sleep disturbances were found. Considering the fully adjusted multinomial logistic model, moderate food insecurity was significantly associated with moderate (AOR = 1.70 CI = 1.59-1.81; p < 0.0001) and severe (AOR = 1.63 CI = 1.42-1.87; p < 0.0001) sleep disturbances. Also, adolescents reporting severe levels of food insecurity had moderate (AOR = 1.88 CI = 1.68-2.11; p < 0.0001) and severe (AOR = 4.07 CI = 4.74-6.11; p < 0.0001) sleep disturbances. Females and those aged between 15 and 17 years and 18 or more were at higher risk of moderate and severe sleep disturbances in the context of food insecurity.

Conclusion

Reducing food insecurity could be an effective policy strategy for enhancing adolescent sleep quality.

Household food insecurity and childhood obesity/overweight among children with special healthcare needs: Results from a nationally representative sample of 10-17 years old U.S. children

BACKGROUND

Food insecurity is linked to an increased risk of childhood obesity and other adverse health issues.

OBJECTIVES

To examine the disproportionate impact of food insecurity on childhood obesity among children with special healthcare needs (CSHCN).

METHODS

In this cross-sectional study, we pooled data from 4 years (2016 to 2019) of the National Survey of Children's Health (NSCH) for a nationally representative sample of 10 to 17 years old noninstitutionalized U.S. children (N = 68 942). Using logistic regression models, we examined the odds of childhood obesity or overweight by including an interaction between family food situation and CSHCN status.

RESULTS

Among 10-17 years old U.S. children, 31% (95% confidence interval [CI]: 30.1%-31.9%) had obesity or overweight, 24.1% had special healthcare needs, 27.2% were from families with food insecurity, and 6.4% were from families with food insufficiency. CSHCN were more likely to be impacted by obesity or overweight than non-CSHCN (Odds Ratio [OR] = 1.29, 95% CI = 1.18-1.141). Moreover, children living in food insecurity (OR = 1.75, 95% CI = 1.52-1.92) and food insufficiency (OR = 2, 95% CI = 1.67-2.4) were more likely than those living in food-secure families to be impacted by obesity or overweight. CSHCN living in food insecurity were significantly more likely to be impacted by obesity or overweight than non-CSHCN in similar households.

CONCLUSIONS

It appears that food insecurity can put CSHCN at disproportionately greater risk of obesity or overweight than non-CSHCN. The findings underscore considering CSHCN status in conjunction with household food insecurity in designing and implementing medical interventions or public policies targeted at childhood obesity or overweight.