Adherence to the Alternate Mediterranean Diet and Multidimensional Sleep Health Among US Adults from the 2017-2018 National Health and Nutrition Examination Survey: Exploring Racial/Ethnic Disparities

BACKGROUND: Adherence to the Mediterranean diet has been linked to better sleep health. However, the relationship between adherence to the alternate Mediterranean diet (aMED) and specific sleep health dimensions remains understudied, particularly among racial/ethnic minority adult populations in the United States (US). OBJECTIVE: The objective was to examine associations between aMED adherence and multiple dimensions of sleep health in US adults and assess differences by race/ethnicity. DESIGN: A cross-sectional analysis using data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of the noninstitutionalized US population, was conducted. Dietary intake was assessed via two 24-hour recalls to calculate a modified aMED score, and sleep health was measured using self-reported dimensions summarized into a composite score. PARTICIPANTS/SETTING: The analytic study sample included 3005 adults (aged 18 years and older) from the 2017-2018 NHANES cycle. Analyses were survey-weighted to yield estimates representative of US adults who completed two 24-hour dietary recalls. MAIN OUTCOME MEASURES: Sleep health was assessed using 5 self-reported dimensions (ie, regularity, timing, duration, satisfaction, and alertness) summarized into a composite multidimensional sleep health score, with a score ≥3 indicating overall "good" sleep health. STATISTICAL ANALYSES PERFORMED: Survey-weighted logistic regression models were used to examine the associations between aMED adherence and sleep health dimensions as well as the overall multidimensional sleep health score, while adjusting for confounding variables. All models incorporated NHANES strata, clusters, and the 2-day dietary recall weight (WTDR2D) to account for the complex survey design and obtain nationally representative estimates. Effect modification by race/ethnicity was assessed using both interaction terms and stratified models. RESULTS: In survey-weighted analyses, the mean (SE) age was 47.1 (0.6) years; 51.3% were male. The weighted mean aMED score was 4.0, and 71% of adults were classified as having good sleep health. Higher aMED scores were significantly associated with greater odds of achieving recommended sleep duration (odds ratio [OR] per 1-point increase 1.1; 95% CI, 1.0 to 1.2; P = .03). Stratified analyses revealed that moderate/high aMED adherence was significantly associated with a greater odds of achieving recommended sleep duration among racial/ethnic minority adults (OR, 1.3; 95%, CI 1.1 to 1.7; P = .01), but not among non-Hispanic White adults (OR 1.1; 95% CI, 0.7 to 1.9; P = .68). No significant associations were observed for other sleep domains or the overall multidimensional sleep health score. CONCLUSIONS: Higher aMED adherence was associated with greater odds of achieving recommended sleep duration, with this association observed among racial/ethnic minority adults, but not among non-Hispanic White adults. Given the cross-sectional design, temporality cannot be established. Longitudinal studies incorporating objective sleep measures are needed to further evaluate these associations.