Esquirol Yolande, Bongard Vanina, Mabile Laurence, Jonnier Bernard, Soulat Jean-Marc, Perret Bertrand
INSERM, U563, Universite Toulouse III Paul-Sabatier, Centre de Physiopathologie de Toulouse Purpan, Toulouse, France.
Chronobiol Int. 2009 Apr;26(3):544-59. doi: 10.1080/07420520902821176.
The impact of shift work on cardiovascular disease (CVD) risk factors and metabolic syndrome are not yet completely understood. The objectives of this study were to evaluate the impact of shift work on metabolic syndrome according to two different definitions in a population of strictly rotating shift workers (3x8 h) compared to paired counterparts working only day hours, and to study whether shift work itself is a determinant of metabolic syndrome after taking into account a large panel of confusing factors. We conducted a cross-sectional study comparing 98 strictly rotating shift workers to 100 regular day-workers (all subjects had a long experience of their working rhythms) within the same petrochemical plant. Clinical, behavioral, occupational, and biological data were collected, and a detailed nutritional investigation was done. Shift and day workers were comparable in terms of major CVD factors, and both had a 10 yr Framingham risk scoring of 11%. Shift workers reported an increased job strain and higher total and at-work physical activity. Alterations in metabolic parameters were evident with a rise in triglycerides, free fatty acids, and gamma glutamyl transpeptidase and lower HDL-cholesterol. Multiple logistic regression analysis demonstrated that shift work was associated with occurrence of metabolic syndrome, as defined by the National Cholesterol Education Program-ATPIII criteria, OR: 2.38 (1.13-4.98), but not using the more recent score from the International Diabetes Federation, which gives a major emphasis on abdominal obesity. Total energy intake and contributions of the major nutrients did not differ between the two groups, with the notable exception of saturated lipids (+10% in shift workers). Meal distribution was clearly different: energy intake was more fractionated within the day, with a lesser contribution of breakfast and lunch but with increased intakes during intermediate light meals, particularly in the afternoon and night. Multivariate analyses were performed to test for the influence of dietary rhythms on the development of an NCEP-ATPIII metabolic syndrome. Dietary intakes at breakfast and during intermediate light meals appear to be "protective" against metabolic syndrome, while a high load at dinner favors its occurrence. A high intake at lunch is particularly deleterious to shift workers. However, in all tested models, shift work remained significantly associated with metabolic syndrome, after taking into account potential covariates like job strain, physical activity, quantitative dietary parameters, and meal distribution. A specific follow-up of shift workers should be recommended to occupational physicians.
轮班工作对心血管疾病（CVD）危险因素和代谢综合征的影响尚未完全明确。本研究的目的是在一组严格实行三班倒（3×8小时）的轮班工人中，根据两种不同定义评估轮班工作对代谢综合征的影响，并与仅上白班的配对对象进行比较，同时研究在考虑大量混杂因素后，轮班工作本身是否为代谢综合征的一个决定因素。我们在同一家石化厂开展了一项横断面研究，将98名严格实行三班倒的轮班工人与100名正常白班工人进行比较（所有受试者都长期保持其工作节奏）。收集了临床、行为、职业和生物学数据，并进行了详细的营养调查。轮班工人和白班工人在主要心血管疾病因素方面具有可比性，两者的10年弗明汉风险评分均为11%。轮班工人报告工作压力增加，总体及工作时的身体活动量更大。代谢参数出现改变，甘油三酯、游离脂肪酸和γ-谷氨酰转肽酶升高，高密度脂蛋白胆固醇降低。多因素逻辑回归分析表明，按照美国国家胆固醇教育计划成人治疗组第三次报告（NCEP-ATPIII）标准定义，轮班工作与代谢综合征的发生相关，比值比（OR）为2.38（1.13 - 4.98），但采用更侧重于腹型肥胖的国际糖尿病联盟的最新评分标准时则不相关。两组之间的总能量摄入及主要营养素的贡献没有差异，但饱和脂肪除外（轮班工人中饱和脂肪增加10%）。进餐分布明显不同：一天内能量摄入更分散，早餐和午餐的贡献较小，但中间加餐时摄入量增加，尤其是下午和夜间。进行多因素分析以检验饮食节奏对NCEP-ATPIII代谢综合征发生的影响。早餐和中间加餐时的饮食摄入似乎对代谢综合征有“保护”作用，而晚餐摄入过多则易导致其发生。午餐摄入过多对轮班工人尤其有害。然而，在所有测试模型中，在考虑工作压力、身体活动、定量饮食参数和进餐分布等潜在协变量后，轮班工作仍与代谢综合征显著相关。应建议职业医生对轮班工人进行专门随访。
