Good sleep needed to maintain optimal nutritional status in older adults

Sleep disorders usually go hand in hand with malnutrition in older adults, according to a study, highlighting the importance that this population get good sleep quality and sufficient amount of it in order to maintain good nutritional status.

The study included 6,792 community-dwelling adults (mean age, 62.4 years; 62.5 percent women) from the West China Health and Aging Trend (WCHAT) study. Of these, 3,201 (47.1 percent) were considered poor sleepers, having Pittsburgh Sleep Quality Index (PSQI) scores >5, and 1,831 (27.0 percent) were at risk of malnutrition according to the Mini Nutritional Assessment Short Form (MNA-SF scores <12).

Compared with well-nourished participants, those at risk of malnutrition tended to have poor sleep quality (p<0.05), reporting either few or long sleep hours (<6 hours or ≥9 hours; p<0.05). The latter were also more likely to be older, female, single, and have greater chronic diseases burden (at least two).

Multivariable logistic regression model adjusted for potential confounders showed that the likelihood that participants with poor sleep quality were at risk of malnutrition was 1.6 times greater than those who had good sleep quality (odds ratio [OR], 1.62, 95 percent confidence interval [CI], 1.44–1.82).

Furthermore, short and long sleep durations were also confirmed to be associated with malnutrition risk (<6 hours: OR, 1.42, 95 percent CI, 1.16–1.73; >9 hours: OR, 1.24, 95 percent CI, 1.05–1.47).

Although unclear, several possible mechanisms could justify the association between sleep disorders and nutritional status. First, sleep deprivation ups total daily energy expenditure, which then drops during recovery sleep. In older adults, increased energy expenditure may increase the risk of malnutrition. [J Physiol 2011;589:235-244]

Furthermore, sleep disturbances heighten the expression of circulating inflammatory cytokines, such as C-reactive protein, interleukin-6, and tumour necrosis factor-α. Persistent inflammatory status, in turn, promotes malnutrition through increased resting energy expenditure and muscle catabolism. [Biol Psychiatry 2016;80:40-52; J Parenter Enteral Nutr 2015;39:56-62]

Lastly, sleep disorders may adversely affect appetite and dietary quality. [J Nutr Health Aging 2020;24:152-159; J Clin Nurs 2016;25:1703-1712; Appetite 2020;153:104748]