# Dietary diversity modifies the association between household solid fuel use and sleep health in older adults

## TL;DR

This study finds that using solid fuels for cooking is linked to poor sleep quality in older adults, but a diverse diet can help reduce this negative effect.

## Contribution

The study reveals that dietary diversity can moderate the negative impact of solid fuel use on sleep health in older adults.

## Key findings

- Exposure to solid cooking fuels was associated with poor self-reported sleep quality.
- Higher dietary diversity scores were linked to better sleep quality and duration.
- Clean fuels combined with a diverse diet significantly improved sleep outcomes compared to solid fuels with low dietary diversity.

## Abstract

Sleep health was crucial for healthy aging, yet it can be influenced by environmental factors and dietary habits. Evidence linking between cooking fuel use, dietary diversity, and sleep health, however, remains limited. This study aimed to investigate the aforementioned associations and to further assess the potential moderating role of dietary diversity.

We included 9,121 adults aged ≥65 years from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Information on household fuel use and sleep health were collected by validated questionnaires, and dietary diversity was assessed with a simplified food frequency questionnaire. We used logistic regression models to examine the associations of solid cooking fuel use and dietary diversity with sleep health.

Among the 9,121 participants included in the study, 4,848 (53.15%) reported good self-reported sleep quality and 3,324 (36.44%) reported adequate sleep duration. Exposure to solid cooking fuels was associated with poor self-reported sleep quality (odds ratio [OR] = 0.86; 95% confidence interval [CI] = 0.78–0.95). In contrast, a higher dietary diversity score (DDS) was associated with better self-reported sleep quality (OR = 1.50; 95%CI = 1.37–1.64) and adequate sleep duration (OR = 1.18; 95%CI = 1.07–1.30). Similarly, a higher anti-inflammatory dietary diversity score (AIDDS) showed significant associations with better self-reported sleep quality (OR = 1.53; 95%CI = 1.39–1.67) and adequate sleep duration (OR = 1.22; 95%CI = 1.11–1.34). Notably, participants with combined exposure to clean cooking fuels and a high DDS/AIDDS had substantially greater odds of better self-reported sleep quality and adequate sleep duration than those exposed to solid fuels with a low DDS/AIDDS (P for interaction < 0.05).

Our study indicates that exposure to solid cooking fuels was associated with poor self-reported sleep quality among older adults. Furthermore, higher dietary diversity may attenuate this adverse association, suggesting it is a promising target for public health interventions.