Protein Intake and Diet Quality Mediate the Relationship Between Sleep and Handgrip Strength in Adults in the HANDLS Study

<b>Objective:</b> The aim of this study is to determine if protein intake, diet quality, or engagement in physical activity mediate the relationship between sleep quality or duration and handgrip strength. <b>Methods:</b> The sample consisted of 2171 middle-aged persons examined in the 2013-2017 Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) prospective cohort study. Those with sleep apnea (<i>n</i> = 222) and missing data were excluded, resulting in an analytical sample of 1308. Handgrip strength, an objectively measured variable, was determined using a Jamar Hydraulic Hand Dynamometer and expressed relative to body mass index (based on measured height and weight). Sleep quality and duration were measured using the Pittsburgh Sleep Quality Index questionnaire. Protein intake was calculated from two 24 h recalls collected using the USDA Automated Multiple-Pass Method and expressed as g per kg of body weight. Diet quality was assessed using the Healthy Eating Index (HEI) and the energy-adjusted Dietary Inflammatory Index (e-DII). Physical activity was self-reported and expressed as meeting the Life Simple 7 criterion (≥150 min/week, 0-149 min/week, 0 min/week). Mediation analysis was conducted using the Hayes PROCESS macro, model #4, for SPSS Version 4.2. Adjustment for the self-reported covariates of age (years); sex at birth (male, female); race (African American, White); poverty status (<125% or >125% US HHS Poverty Guidelines); current cigarette smoker (yes, no); marijuana, opiate, and/or cocaine user (yes, no); medical conditions including diabetes, hypertension, and/or metabolic syndrome (yes, no); and mean energy (kcal, only protein model) was performed. <b>Results:</b> Protein intake, expressed as g per kg of body weight, mediated the relationship between sleep quality and sleep duration and handgrip strength (indirect effect = -0.0017 ± 0.0006, CI 95% (-0.0030, -0.0006, <i>p</i> < 0.05); indirect effect = 0.0057 ± 0.0019, CI 95% (0.0023, 0.0098, <i>p</i> < 0.05, respectively)). Diet quality, as measured using the HEI, mediated the relationship between sleep duration and handgrip strength (indirect effect = 0.0013 ± 0.0007, CI 95% (0.0001, 0.0030, <i>p</i> < 0.05). <b>Conclusions:</b> Protein intake and a healthy diet mediate the relationship between sleep and handgrip strength, suggesting that these factors may play a role in preserving muscle strength.