Domingo Divine Grace C, Chen Tuo-Yu, Cruz Grace, Mgabhi Philile S, Lim Kian Lee, Mandiwa Chrispin, Saito Yasuhiko
Department of Global Health and Health Security, Taipei Medical University, Taipei, Taiwan.
Institute of Human Nutrition and Food, University of the Philippines Los Baños, Laguna, Philippines.
J Glob Health. 2025 Aug 29;15:04235. doi: 10.7189/jogh.15.04235.
Although research has shown that food insecurity may lead to sleep problems due to poor mental health, it remains unclear whether physical health mediates this relationship. We investigated whether depressive symptoms and frailty phenotypes mediated the association of food insecurity with sleep deficiency among community-dwelling older adults in the Philippines.
We analysed data from the baseline survey of a longitudinal study of ageing and health in the Philippines involving a nationally representative sample of older adults aged ≥60 years (n = 3599). Sleep deficiency was conceptualised as self-reported sleeping of <6 hours, complaining about falling and staying asleep, and/or having non-restorative sleep. Food insecurity was defined as household hunger and lack of food over the past three months. Frailty phenotypes were operationalised using modified Fried's criteria, and depressive symptoms using the Centre for Epidemiological Studies-Depression Scale. Covariates included sociodemographics (age, sex, education, wealth, living arrangements, and urbanity), health (pain, chronic diseases, and body mass index), and lifestyles (naps, smoking, and drinking). Mediation analysis using the PROCESS macro was conducted to estimate the direct and indirect effects in the moderated mediation models.
Bootstrapping results showed significant indirect effects of food insecurity on sleep deficiency through depressive symptoms (bootstrap estimate (b) = 0.09, standard error (SE) = 0.02; 95% confidence interval (CI) = 0.05, 0.14) and frailty phenotypes (b = 0.03, SE = 0.01; 95% CI = 0.01, 0.06). However, the direct effect of food insecurity on sleep deficiency was insignificant (b = 0.31, SE = 0.16; 95% CI = -0.003, 0.64).
The results indicated that food insecurity is associated with sleep deficiency, with frailty phenotype and depressive symptoms playing a potential mediating role. However, further research is needed to establish causal pathways. Preventing frailty and depression may help improve sleep health among individuals who are food insecure.
尽管研究表明，由于心理健康状况不佳，粮食不安全可能导致睡眠问题，但身体健康是否介导这种关系仍不清楚。我们调查了在菲律宾社区居住的老年人中，抑郁症状和虚弱表型是否介导了粮食不安全与睡眠不足之间的关联。
我们分析了菲律宾一项关于老龄化与健康的纵向研究基线调查的数据，该研究涉及一个具有全国代表性的60岁及以上老年人样本（n = 3599）。睡眠不足被定义为自我报告睡眠时间<6小时、抱怨入睡困难和/或睡眠质量差。粮食不安全被定义为家庭饥饿以及过去三个月缺乏食物。虚弱表型采用改良的弗里德标准进行评估，抑郁症状采用流行病学研究中心抑郁量表进行评估。协变量包括社会人口统计学特征（年龄、性别、教育程度、财富、居住安排和城市化程度）、健康状况（疼痛、慢性病和体重指数）以及生活方式（午睡、吸烟和饮酒）。使用PROCESS宏进行中介分析，以估计调节中介模型中的直接和间接效应。
自抽样法结果显示，粮食不安全通过抑郁症状对睡眠不足有显著的间接效应（自抽样估计值（b）= 0.09，标准误（SE）= 0.02；95%置信区间（CI）= 0.05，0.14）以及通过虚弱表型也有显著间接效应（b = 0.03，SE = 0.01；95% CI = 0.01，0.06）。然而，粮食不安全对睡眠不足的直接效应不显著（b = 0.31，SE = 0.16；95% CI = -0.003，0.64）。
结果表明，粮食不安全与睡眠不足有关，虚弱表型和抑郁症状可能起到中介作用。然而，需要进一步研究以确定因果途径。预防虚弱和抑郁可能有助于改善粮食不安全人群的睡眠健康。
