Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Barcelona, Spain.
Department of Physical Medicine and Rehabilitation, Lariboisière-Fernand Widal Hospital, AP-HP, University Paris Cité, Paris, France.
J Sleep Res. 2023 Aug;32(4):e13852. doi: 10.1111/jsr.13852. Epub 2023 Feb 21.
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.
人们对中低收入国家食物不安全与睡眠问题之间的关系知之甚少，而这一关联的中介因素在很大程度上尚不明确。因此，我们调查了六个中低收入国家（中国、加纳、印度、墨西哥、俄罗斯和南非）中食物不安全与失眠相关症状之间的关联，以及这一关系的潜在中介因素。本研究分析了全球老龄化与成人健康研究（2007-2010 年）的横断面、全国代表性数据。过去 12 个月的食物不安全情况通过两个问题来评估，分别是进食频率降低的次数和因缺乏食物而感到饥饿的次数。失眠相关症状是指过去 30 天内出现严重或极度睡眠问题。采用多变量逻辑回归和中介分析进行分析。共分析了 42489 名年龄≥18 岁的成年人的数据（平均[标准差]年龄 43.8[14.4]岁；50.1%为女性）。任何食物不安全和失眠相关症状的患病率分别为 11.9%和 4.4%。调整后，与没有食物不安全相比，中度（比值比=1.53，95%置信区间=1.11-2.10）和严重食物不安全（比值比=2.35，95%置信区间=1.56-3.55）与失眠相关症状显著相关。焦虑、感知压力和抑郁分别解释了任何食物不安全与失眠相关症状之间关系的 27.7%、13.5%和 12.5%（总百分比=43.3%）。在六个中低收入国家的成年人中，食物不安全与失眠相关症状呈正相关。焦虑、感知压力和抑郁解释了这一关系的很大一部分。在食物不安全人群中解决食物不安全本身或已确定的潜在中介因素，可能会降低中低收入国家成年人的睡眠问题，但尚需通过纵向研究加以证实。
