Night-shift work and its association with metabolic syndrome.

Introduction: Shift work is associated with increased incidence of obesity and other features of the metabolic syndrome. Health problems in shift workers are caused by several factors, one of these factors is the stress hormone cortisol. Aim of the work: to assess the association between night shift work and the changes in body mass index (BMI), fasting blood glucose, lipid (total cholesterol, HDL, and triglycerides) levels, cortisol hormone secretion, uric acid blood level and salivary cortisol level. Materials & Methods: this study was conducted on 160 male security personnel, their age ranging from 35 to 40 years in Cairo . Regarding the work schedule 80 subjects worked daytime for 8 hours, whereas 80 individuals worked only night shift for 12 hour with one day off, for at least continuous 5 years. Results: the results showed no significant difference between night shift and day workers as regard age and working years. As regard body mass index (BMI) there was highly significant difference (<0.001) between night and day workers. There was no significant difference between night and day shift workers as regard total cholesterol level, triglycerides, and fasting blood glucose (P< 0.05) where as there is a significant difference between night and day shift workers as regard HDL –cholesterol (P<0.05) and a highly significant difference between night and day shift workers as regard uric acid blood level (P<0.001).A significant difference was detected in salivary cortisol levels among night shift workers where the salivary cortisol level is higher in the evening than in the morning, also there is a significant difference in salivary cortisol level among day shift workers where the salivary cortisol level is higher in the morning than in the evening (P<0.05). Conclusion: Our results suggest an association between long-term shift work and increased body mass index, elevation cortisol level, HDL–cholesterol, fasting blood glucose and uric acid level. Further studies are needed to understand the biological mechanisms involved and the complex behavioral and social adaptations experienced by night-shift workers. Regular screening health programs should be done to maintain the health of shift workers.

Association of Metabolic Syndrome With Proximal and Synchronous Colorectal Neoplasm

BackgroundNight shift work induces physiological and psychological stress by altering sleep and biological rhythms and is associated with hypertension, diabetes, obesity, and cardiovascular diseases. Few studies have been conducted on the control of hypertension and diabetes. This study aimed to examine the effect of night shift work on the control rate of hypertension and diabetes.MethodsSubjects comprised workers aged 20–65 years who underwent specific health examination at a single facility in seven different affiliated examination centers from 1 January to 31 December 2016. Workers were categorised into day workers and night shift workers. Demographic and medical history were taken, and physical examination was done. Blood pressure (BP) and fasting glucose were measured. The control rate of each disease was evaluated based on treatment goals presented in the treatment guidelines of the Korean Society of Hypertension and the Korean Diabetes Association (systolic BP < 140 mmHg and diastolic BP < 90 mmHg; fasting glucose ≤ 130 mg/dL).ResultsAmong 631,418 subjects, 11.2% (70,450) were night shift workers. Of whom 6.1% (4,319) were taking antihypertensive medication and 2.5% (1,775) were taking diabetes medication. Among patients taking antihypertensive medications, the proportion of those whose BP was controlled to suit treatment goals was 81.7% (26,635) of day workers and 77.4% (3,343) of night shift workers, which was significantly different (p < 0.001). Among patients taking diabetes medications, the proportion of those whose blood glucose was controlled to suit treatment goals was 37.4% (4,489) of day workers and 36.5% (647) of night shift workers, but the difference was not significant. The control rates for patients taking antihypertensive medications (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.68–0.80) were lower among night shift workers than day workers with adjustment for age, sex, smoking history, alcohol consumption, exercise, and obesity. However, there were no differences in control rates for patients taking diabetes medications (OR: 0.99, 95% CI: 0.87–1.10) between day workers and night shift workers.ConclusionsNight shift work can have an effect on the uncontrolled BP in workers taking antihypertensive medications. Therefore, additional efforts for disease control are necessary for night shift workers with hypertension.

Our friend and colleague Wayne Fenton asked to write this article for the Journal because of his desire to educate other psychiatrists about the treatment of schizophrenia, including what he recognized to be a growing problem with the metabolic syndrome. This lifelong passion, which he pursued from his psychiatry residency at Yale, through his directorship of Chestnut Lodge, to his position at NIMH as Director of the Division of Adult Translational Research and Associate Director for Clinical Affairs, ended tragically with his killing during an evaluation of a psychotic young man. Wayne had worked tirelessly to secure support for new drug discovery in the NIMH programs that he directed. The Journal will be initiating in 2007 a series of articles on the discovery of new mental illness treatments. We will dedicate this series to Wayne's memory and include with it a memorial of his life and contributions to the treatment of mental illness.

&lt;div&gt;Abstract&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Night shift work has been associated with an increased risk for breast and prostate cancer. The effect of circadian disruption on sex steroid production is a possible underlying mechanism, underinvestigated in humans. We have assessed daily rhythms of sex hormones and melatonin in night and day shift workers of both sexes.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Methods:&lt;/b&gt; We recruited 75 night and 42 day workers, ages 22 to 64 years, in different working settings. Participants collected urine samples from all voids over 24 hours on a working day. Urinary concentrations of 16 sex steroid hormones and metabolites (estrogens, progestagens, and androgens) and 6-sulfatoxymelatonin were measured in all samples. Mean levels and peak time of total and individual metabolite production were compared between night and day workers.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; Night workers had higher levels of total progestagens [geometric mean ratio (GMR) 1.65; 95% confidence intervals (CI), 1.17–2.32] and androgens (GMR: 1.44; 95% CI, 1.03–2.00), compared with day workers, after adjusting for potential confounders. The increased sex hormone levels among night shift workers were not related to the observed suppression of 6-sulfatoxymelatonin. Peak time of androgens was significantly later among night workers, compared with day workers (testosterone: 12:14 hours; 10:06-14:48 vs. 08:35 hours; 06:52-10:46).&lt;/p&gt;&lt;p&gt;&lt;b&gt;Conclusions:&lt;/b&gt; We found increased levels of progestagens and androgens as well as delayed peak androgen production in night shift workers compared with day workers.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Impact:&lt;/b&gt; The increase and mistiming of sex hormone production may explain part of the increased risk for hormone-related cancers observed in night shift workers. &lt;i&gt;Cancer Epidemiol Biomarkers Prev; 24(5); 854–63. ©2015 AACR&lt;/i&gt;.&lt;/p&gt;&lt;/div&gt;

Night shift work is associated with increased health risks. Here we examined the association of metabolic risk factors and immune cell counts, with both night shift work and particular characteristics thereof: frequency, duration and consecutive night shifts. We performed a cross-sectional study using data from 10,201 non-shift workers and 1062 night shift workers of the Lifelines Cohort study. Linear regression analyses, adjusted for demographic, lifestyle and occupational factors, were used to study associations of night shift work characteristics with metabolic risk factors and immune cell counts. Night shift workers had an increased BMI, waist circumference and immune cell counts compared to non-shift workers. This was especially seen in night shift workers who had a higher frequency of night shifts per month (≥ 5: BMI: B = 0.81 kg/m2 (95%-CI = 0.43–1.10); waist circumference: B = 1.58 cm (95%-Cl = 0.34–1.71; leukocytes: B = 0.19 × 109 cells/L (95%-CI = 0.04–0.34 × 109)) and worked more consecutive night shifts (> 3: BMI: B = 0.92 kg/m2 (95%-CI = 0.41–1.43); waist circumference: B = 1.85 cm (95%-Cl = 0.45–3.24); leukocytes: B = 0.32 × 109 cells/L (95%-CI = 0.09–0.55 × 109)). This association was less pronounced in long-term night shift workers (≥ 20 years). Our findings provide evidence for the association between night shift work characteristics and BMI, waist circumference and leukocytes (including, monocytes, lymphocytes, and basophil granulocytes).

Case Presentation: E.C. is a 53-year-old postmenopausal female, referred for treatment of hypertension, with a family history of type 2 diabetes, hypertension, and coronary heart disease (CHD). Until learning that her blood pressure was “too high” during a routine physical examination, she felt well, and her postmenopausal symptoms had responded to hormone replacement therapy. She was not overweight (her body mass index [BMI] was 23.7 kg/m2), and the only abnormality on physical examination was a blood pressure of 145/95 RAR. Laboratory results revealed a normal blood count and urinalysis, with the following fasting plasma concentrations of relevant metabolic variables (in mg/dL): glucose 102, triglycerides (TG) 238, low-density lipoprotein cholesterol (LDL-C) 147, and high-density lipoprotein cholesterol (HDL-C) 52. E.C. is hypertensive and hypertriglyceridemic and at increased risk for CHD. Less obvious is that these metabolic abnormalities are highly likely to be the manifestations of a more fundamental defect—resistance to insulin-mediated glucose disposal and compensatory hyperinsulinemia, changes that greatly increase CHD risk.1,2⇓ The importance of insulin resistance as a CHD risk factor was first explicated in 1998, and the cluster of abnormalities likely to appear as manifestations of the defect in insulin action designated as syndrome X.1 Support for this notion has grown almost as fast as the names used to describe the phenomenon. The Adult Treatment Panel III (ATP III) has recently3 recognized the importance as CHD risk factors of a “constellation of lipid and nonlipid risk factors of metabolic origin,” designated this cluster of abnormalities as “the metabolic syndrome,” and indicated that “this syndrome is closely linked to insulin resistance.” Table 1 lists the criteria the ATP III stipulated be used to diagnose the metabolic syndrome, and a recent report4 has applied these criteria to the database of the Third National Health and Nutrition …

Background Emerging evidence now suggests an association between Mycosis fungoides (MF) and metabolic risk factors. Objective To investigate a possible association between MF and metabolic syndrome (MetS). Patients and methods This study was designed as an observational, case-control study. It included thirty MF patients and 39 controls who were assessed for body mass index (BMI), waist circumference, blood pressure, fasting blood glucose, triglycerides (TG), total cholesterol, high and low density lipoproteins, serum leptin level and insulin resistance. Results Our results revealed that serum leptin level (P=0.029), TG (P=0.004), cholesterol (P=0.001) and LDL (P=0.019), waist circumference in males (P&lt;0.003), hypertension (P=0.039) and frequency of metabolic syndrome (P=0.042), are statistically significantly higher in MF patients than controls. Conclusion Our results indicate that patients with MF may be at higher risk for metabolic syndrome. Concurrently, screening for metabolic syndrome is recommended for all MF cases for early detection of cardiovascular risk.

Night shift work has often been associated with increasing degree and frequency of various psychologic complaints. The study examined whether psychologic states after night work are related to adaptive alterations of the cardiovascular and neuroendocrine systems. We studied 18 healthy nurses (age 29+/-2 years) engaged in a modified rapid shift rotation system (day work, 8:15-17:15; evening work, 16:00-22:00; night work, 21:30-8:30). Blood pressure, heart rate, RR interval variability (L/H and HF power spectrum for sympathetic and vagal activities), and physical activity were measured using a multibiomedical recorder for 24 h from the start of work during the night and day shifts. Plasma ACTH and cortisol concentrations were measured at the end of each shift and at 8:30 AM on a day of rest. Each subject's psychologic state was assessed using a validated questionnaire. Among the parameters measured, scores for confusion, depression, anger-hostility, fatigue and tension-anxiety were highest, and scores for vigor lowest, after a night shift. Systolic blood pressure and heart rate during work were lower during night shift than during day shift (119+/-2 vs. 123+/-1 mmHg, p<0.05 and 75+/-1 vs. 84+/-2 bpm, p<0.001, respectively). Both parameters were lower still (p<0.005 and p<0.05) when measured outside of the hospital under waking conditions following a night shift than following a day shift, even though the levels of physical activity were similar. The HF power spectrum of RR interval variability was greater not only during work (24.2+/-2.1 vs. 18.5+/-1.8 ms, p<0.005) but also during the awake period (29.1+/-2.5 vs. 24.4+/-2.6 ms, p<0.005) after the night shift compared with the day shift. Plasma ACTH and cortisol concentrations were lower after night work than in the day of rest (7.3+/-1.2 vs. 11.5+/-2.3 pg/ml, p<0.1 and 11.1+/-1.1 vs. 14.4+/-1.1 mg/dl, p< 0.05). Systolic and diastolic blood pressures during night shift work and the subsequent awake period correlated positively with scores for vigor and negatively with scores for confusion (p<0.05). Plasma ACTH and cortisol concentrations did not correlate with any psychologic scores. We conclude that psychologic disturbances after night work were associated with altered cardiovascular and endocrine responses in healthy nurses. Some of the psychologic complaints may be attributable to lower waking blood pressure.

Although adiponectin is generally known as a predictor of metabolic syndrome, potential of adiponectin as a predictor for metabolic syndrome in type 2 diabetes is debated. The purpose of this study is to determine the association between adiponectin and metabolic syndrome in patients with type 2 diabetes. Adiponectin and the risk of metabolic syndrome were examined among 1013 type 2 diabetes patients who visited Huh's Diabetes Center from January 2003 to June 2006. Adiponectin levels were classified into quartile groups, and metabolic syndrome was defined according to the standard of National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III. Insulin sensitivity was directly assessed using the short insulin tolerance test (SITT) (Kitt: %/ min). Adiponectin was significantly correlated with metabolic syndrome components. The age-adjusted correlations between adiponectin and clinical parameters including metabolic components were significant; adiponectin was negatively correlated with waist circumference, diastolic blood pressure and triglyceride, and positively correlated with high-density lipoprotein (HDL) cholesterol. Subjects with metabolic syndrome showed lower adiponectin levels than those without metabolic syndrome. After multivariate adjustment, participants with lower adiponectin levels also had a higher risk for metabolic syndrome (OR for lowest quartiles 2.21; 95% CI, 1.51-3.24). Metabolic syndrome risk was stronger among those with low adiponectin and severe insulin resistance simultaneously. This study has shown additive effects of adiponectin and insulin resistance on metabolic syndrome. In type 2 diabetic patients, the adiponectin was a useful predictor of metabolic syndrome independent of potential confounding variables.

Background: hypothyroidism is of concern in our society; it has an effect on metabolic parameters. Objective: this study aimed to predict the prevalence of metabolic syndrome (MetS) among patients with hypothyroidism in Jeddah, Saudi Arabia and to determine the effect of treating hypothyroidism on MetS. Methods: we conducted this cross-sectional study, in which MetS was defined by presence of at least three of the five AHA/NHLBI criteria. We included patients with hypothyroidism that were managed in an outpatient department or admitted in King Abdulaziz University Hospital from 1 March to 30 April 2016. We measured lipid parameters, blood pressure (BP), waist circumference (WC) and serum fasting blood glucose (FBG). Results: in total 57 patients were included in our study, of which 47 (82%) were females. the majority of patients were greater than 50 years of age (n=35, 60%). We found that 36.8% of patients uncontrolled for hypothyroidism had high levels of TSH (serum level of TSH >5 mlu/L) , while 64.9% of patients who were controlled for hypothyroidism had normal levels of TSH (serum level of TSH 0.5 - 5 mlu/L). Overall, 71.9% (n=41) of hypothyroidism patients had MetS. However, we found that 51.8% (n=21) uncontrolled hypothyroidism patients suffered from MetS and 48.2% (n= 20) patients controlled for hypothyroidism suffered from MetS. However, 70.68 %, 31.03%, 34.48%, 79.31% and 70.6% of participants had abnormal waist circumference (WC), hypertriglyceridemia, abnormal high-density lipoprotein (HDL), hypertension and elevated serum levels of fasting blood sugar, respectively Conclusion: hypothyroidism plays an important role in MetS. Future advanced studies including larger numbers of patients are needed to test the effect of treating hypothyroidism on MetS. Routine screening for cardiovascular risk factors in patients with hypothyroidism may unmask MetS.

An Evidence-Based Review of Exercise and Metabolic Syndrome

PurposeThe metabolic syndrome (MS) has been accepted as an important cause of benign prostatic hyperplasia (BPH) in old age. However, there are no studies of the influence of MS on prostate volume in relatively young adults. We evaluated the relationship between parameters of MS and prostate volume in men under 50 years of age who visited our health promotion center.Materials and MethodsA total of 968 men aged 30 to 49 years were enrolled from March 2009 to June 2010. Prostate volume by transrectal ultrasonography of the prostate, serum prostate-specific antigen, digital rectal examination, urinalysis, and MS-related parameters were investigated. We evaluated the correlations of prostate volume with MS and MS-related parameters.ResultsProstate volume was not significantly larger in the MS group (18.4 cc; range: 14.3-23.1 cc) than in the non-MS group (17.8 cc; range, 13.6-21.6 cc). The prostate volumes in subjects with abnormal fasting plasma glucose (FPG) (18.9 cc; range, 14.3-22.7 cc) and abnormal waist circumference (WC) (19.5 cc; range, 15.6-23.7 cc) were significantly larger than those of subjects with normal parameters (16.9 [range, 12.7-20.4] cc and 17.5 [range, 13.3-21.2] cc, respectively; p=0.001). The logistic regression analysis showed the FPG level and WC to have a significantly positive correlation with the prostate volume (odds ratios: 1.441 [95% CI: 1.303-1.643] and 2.305 [95% CI: 1.470-3.614], respectively).ConclusionsGroups with abnormal FPG and WC had larger prostate volumes than did normal groups. The abnormal FPG and WC could be more important factors than MS in prostate volume enlargement in relatively young adults.

The prevalence of metabolic syndrome increases after menopause; however, the role of concomitant subclinical hypothyroidism has not been completely elucidated. The aim of the study was to identify associations between thyrotropin, immune status, inflammation, and metabolic syndrome in postmenopausal women. The specific goals were: to assess thyrotropin (TSH) and interleukin-6 (IL-6) concentrations in the serum of subclinical hypothyroid postmenopausal women with and without metabolic syndrome and compare them with euthyroid controls; to test whether immune status is related to metabolic syndrome in postmenopausal women and determine the role of IL-6; to examine the relationships between TSH and different features of metabolic syndrome: insulin resistance, waist circumferences, waist-to-hip ratio (WHR), BMI, metabolic parameters (triglycerides, total cholesterol and high-density lipoprotein cholesterol), and inflammatory cytokines (IL-6). Three hundred and seventy-two postmenopausal women were included in the study: 114 women had subclinical hypothyroidism (10.0 uIU/mL > TSH ≥ 4.5 uIU/mL, normal fT4), and 258 women were in euthyreosis (TSH 0.35-4.5 uIU/mL, normal fT4); both groups were matched by age. Anthropometric measurements were conducted (BMI, waist circumference, WHR) and blood pressure was measured. In all subjects the following were assessed in serum: lipid profile, glucose, insulin, TSH, fT4, thyroid antibodies (T-Abs) - TPO-Abs, TG-Abs, and IL-6 concentrations. The prevalence of metabolic syndrome was 49.12% in subclinical hypothyroid women and 46.89% in euthyroid women. However, the proportion of subjects with one or two abnormalities was significantly higher in the subclinical hypothyroid group (45.61%) than in the euthyroid group (32.17%). When we compared subclinical hypothyroid women with and without metabolic syndrome, subjects with metabolic syndrome had higher BMI, abdominal circumferences, WHR, and HOMA-I. They presented higher systolic and diastolic blood pressure. Serum concentrations of cholesterol, triglycerides, fasting glucose, IL-6, TSH, T-Abs were also higher and serum cHDL was lower. There were no significant differences in fT4 concentrations. A similar comparison was made for euthyroid women with and without metabolic syndrome. Higher BMI, waist circumference, WHR, HOMA-I, and systolic blood pressure were observed in subjects with metabolic syndrome. Serum concentrations of TSH, triglycerides, glucose, and IL-6 were also higher, but the concentration of cHDL was significantly lower. There were no significant differences in fT4, T-Abs, cholesterol levels, and diastolic pressure. When we compared euthyroid women T-Abs (+) and T-Abs (-), the prevalence of metabolic syndrome was similar (48.68% vs. 46.15%). There were no differences in BMI, waist circumference, WHR, lipid profile, glucose, and HOMA-I, fT4. However, thyroid autoimmunity was associated with elevated TSH and IL-6 levels. When we analysed subclinical hypothyroid women with and without thyroid autoimmunity, there were no significant differences in glucose and lipid profile. However, Hashimoto`s subjects were more obese, had higher waist circumference, WHR, HOMA-I, and higher prevalence of metabolic syndrome. Serum concentrations of TSH and IL-6 were also higher and fT4 was lower. Among all of the women, serum TSH concentration was significantly correlated with BMI, waist circumference, WHR, systolic blood pressure, cholesterol, triglycerides, and TPO-Abs. When the variables of subjects with upper quartile of TSH were compared with lower quartile of TSH, we found significantly higher BMI, waist circumference, WHR, increased concentration of IL-6, cholesterol, triglycerides, and T-Abs, and concentrations of cHDL and fT4 were lower. OR for metabolic syndrome in subjects with upper quartile TSH vs. lower quartile was 1.35 (95% confidence interval [CI] 1.10-1.60). Our study confirms that metabolic syndrome in both euthyroid and subclinical hypothyroid women is connected with obesity, visceral fat accumulation, and higher TSH and IL-6 concentrations. Immune thyroiditis is associated with higher TSH and IL-6 levels. Obese subclinical hypothyroid women with Hashimoto`s thyroditis have a higher prevalence of metabolic syndrome when compared with subclinical hypothyroid women without thyroid autoimmunity. It is possible that in the crosstalking between subclinical hypothyroidism and metabolic syndrome, enhanced proinflammatory cytokine release in the course of immunological thyroiditis plays a role.

Objective To examine the incidence of metabolic syndrome (MS) in incipient female patients with rheumatoid arthritis (RA), and study the relationship between MS and disease activity of RA. Methods The clinical data of 102 incipient female RA patients (RA group) and 125 healthy controls (control group) were retrospectively analyzed. The incidence of MS was compared between 2 groups, and the clinical and laboratory data were analyzed between patients with MS and patients without MS. Results There were no statistical differences in age, body mess index (BMI), waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose (FBG), triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) between 2 groups (P >0.05). The incidences of waist circumference ≥ 80 cm, TG ≥ 1.70 mmol/L, HDL-C ≤ 1.30 mmol/L, MS according to the National Cholesterol Education Program Adult Treatment Panel Ⅲ (NCEP-ATP Ⅲ) standard and MS according to the Chinese Diabetes Society (CDS) standard in RA group were significantly higher than those in control group: 39.2% (40/102) vs. 25.6% (32/125), 37.3% (38/102) vs. 24.0% (30/125), 34.3% (35/102) vs. 21.6% (27/125), 34.3% (35/102) vs. 22.4% (28/125) and 27.5% (28/102) vs. 16.0% (20/125)%, and there were statistical differences (P 0.05). The RA patients were divided into RA with MS (35 cases) and RA without MS (67 cases) according to the MS diagnostic standard of NCEP-ATPⅢ. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and blood uric acid in RA with MS patients were significantly higher than those in RA without MS patients: (68.1 ± 26.3) mm/h vs. (40.1 ± 30.6) mm/h, 4.260 mg/L vs. 1.505 mg/L and (330.5 ± 69.1) μmol/L vs. (269.0 ± 67.5) μmol/L, and there were statistical differences (P 0.05). Conclusions The incidence of MS in incipient female patients with RA is higher than that in healthy controls, and RA patients are more prone to abdominal obesity, TG increasing and HDL-C decreasing. The inflammatory index and blood uric acid levels in RA with MS patients are significantly higher than those in RA without MS patients. Key words: Arthritis, rheumatoid; Metabolic syndrome X; Retrospective studies