| Aims:Frailty is a complex clinical condition,characterized by decreased function of multiple body systems and a reduced ability to adapt to external stresses.With the increasing incidence of frailty continues to rise and its negative impact on health becomes apparent,people have paid more attention to the problem of frailty.Previous studies have shown that sleep conditions were associated with frailty,that chronic inflammation played an important role in the underlying pathogenesis of both,and that the body’s level of inflammation was also largely influenced by diet.Much evidence suggests that both dietary inflammation and sleep problems are significant for frailty risk,but there was no studies exploring the relationship between the three and the role that exists between the relationships.Therefore,the purpose of this study was to clarify the effects of dietary inflammation and sleep conditions on frailty through the National Health Nutrition Examination Survey(NHANES)database,to explore the interaction or mediating role,and to provide data and theoretical support for frailty prevention strategies.Methods:Data for this study were obtained from the NHANES database from 2005-2008,and a total of 9007 study subjects who met the inclusion and exclusion criteria were screened.The study divided the study subjects into healthy and frail groups by the 36-item frailty index(FI).Sleep quality,sleep duration,and potential inflammation levels of dietary components were measured by Pittsburgh Sleep Quality Index(PSQI),selfreport on questionnaire questions,and Dietary Inflammatory Index(DII),respectively.The study analyzed the relationship among dietary inflammation,sleep status(sleep quality & sleep duration),and frailty using logistic regression models.The interaction term of dietary inflammation and sleep condition was added to the logistic regression model to analyze the multiplicative interaction of dietary inflammation with sleep quality and sleep duration on frailty;the additive interaction of dietary inflammation and sleep condition was evaluated by calculating the relative excess risk(RERI),attribution ratio(AP),and synergistic effect index(S).In addition,the mediating effects of PSQI and sleep duration between DII and frailty were also analyzed.Data processing and statistical analysis for this study were performed by IBM SPSS 24.0 and R 4.0.5software and two-sided P values < 0.05 were considered a statistically significant difference.Results:1.A total of 9007 study subjects were involved in our study,4400 men and 4607 women,with a median age of 45 years.Frailty was present in 35.38% of the study subjects and poor sleep quality was higher in 61.39% of the study subjects.The frailty group had a higher DII,and PSQI compared to the healthy group(P<0.001).The composition ratio of pro-inflammatory diets,poor sleep quality and sleep duration<7h/>8h were higher in the frailty group(P<0.001).2.After adjusting for age,sex,race,BMI,total energy intake,alcohol consumption,smoking status and physical activity,the OR(95%CI)for the risk of frailty was 1.23(1.04,1.55)for those on a pro-inflammatory diet compared with those on an antiinflammatory diet;the OR(95%CI)for the risk of frailty was 1.80(1.53,2.12)for those on a poor sleep quality compared with those on a good sleep quality;the OR(95% CI)for the risk of frailty for individuals with <7h />8 h of sleep was 1.38(1.16,1.64)compared to those with 7-8 hours of sleep.3.There were both multiplicative(P=0.003)and additive interactions for the effects of dietary inflammation and sleep quality on frailty(RERI=0.76,95% CI: 0.33,1.18;S=3.03,95% CI: 1.26,7.28;AP=0.36,95%CI: 0.20,0.51).There was no multiplicative and additive interaction for the effects of dietary inflammation and sleep duration on frailty,but the OR for frailty was 1.34(P=0.013)for the anti-inflammatory diet & sleep duration <7h/>8h group and 1.69(P<0.001)for the pro-inflammatory diet& sleep duration <7h/>8h group compared to the anti-inflammatory diet & sleep duration 7-8h group.4.After adjusting for age,sex,race,BMI,total energy intake,alcohol consumption,smoking status and physical activity,there was a mediating effect of PSQI in the effect of DII on frailty(β=0.004,95%CI: 0.003,0.005)and a mediating proportion of 16.67%.There was a mediating effect of sleep duration in the effect of DII on frailty(β=0.002,95%CI: 0.002,0.003)and the mediating proportion was 8.33%.Conclusions:1.About one-third of the adults in this study had frailty problems,and most of the study subjects had poor sleep quality;the subjects with frailty problems tended to be middle-aged,elderly,with pro-inflammatory diets and sleep problems.2.Inflammatory diets and sleep problems such as poor sleep quality,and short or long sleep duration were risk elements for frailty;there were multiplicative and additive interactions between dietary inflammation and sleep quality on frailty,and the direction of interaction was consistent;there was no interaction between dietary inflammation and sleep duration,but the findings suggested that anti-inflammatory diets could reduce the adverse effects of short or long sleep duration on frailty.3.There were significant mediating effects of both sleep quality and sleep duration between dietary inflammation and risk of frailty,and pro-inflammatory diets not only directly led to frailty,but also indirectly led to increased risk of frailty by causing sleep problems such as poor sleep quality or short sleep duration and drowsiness. |
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