Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.