Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
BMJ. 2018 Nov 21;363:k4641. doi: 10.1136/bmj.k4641.
To prospectively evaluate the joint association of duration of rotating night shift work and lifestyle factors with risk of type 2 diabetes risk, and to quantitatively decompose this joint association to rotating night shift work only, to lifestyle only, and to their interaction.
Prospective cohort study.
Nurses' Health Study (1988-2012) and Nurses' Health Study II (1991-2013).
143 410 women without type 2 diabetes, cardiovascular disease, or cancer at baseline.
Rotating night shift work was defined as at least three night shifts per month in addition to day and evening shifts in that month. Unhealthy lifestyles included current smoking, physical activity levels below 30 minutes per day at moderate to vigorous intensity, diet in the bottom three fifths of the Alternate Healthy Eating Index score, and body mass index of 25 or above.
Incident cases of type 2 diabetes were identified through self report and validated by a supplementary questionnaire.
During 22-24 years of follow-up, 10 915 cases of incident type 2 diabetes occurred. The multivariable adjusted hazard ratios for type 2 diabetes were 1.31 (95% confidence interval 1.19 to 1.44) per five year increment of duration of rotating night shift work and 2.30 (1.88 to 2.83) per unhealthy lifestyle factor (ever smoking, low diet quality, low physical activity, and overweight or obesity). For the joint association of per five year increment rotating night shift work and per unhealthy lifestyle factor with type 2 diabetes, the hazard ratio was 2.83 (2.15 to 3.73) with a significant additive interaction (P for interaction <0.001). The proportions of the joint association were 17.1% (14.0% to 20.8%) for rotating night shift work alone, 71.2% (66.9% to 75.8%) for unhealthy lifestyle alone, and 11.3% (7.3% to 17.3%) for their additive interaction.
Among female nurses, both rotating night shift work and unhealthy lifestyle were associated with a higher risk of type 2 diabetes. The excess risk of rotating night shift work combined with unhealthy lifestyle was higher than the addition of risk associated with each individual factor. These findings suggest that most cases of type 2 diabetes could be prevented by adhering to a healthy lifestyle, and the benefits could be greater in rotating night shift workers.
前瞻性评估轮班夜间工作的持续时间和生活方式因素与 2 型糖尿病风险的联合关联，并定量分解这种联合关联，以轮班夜间工作、生活方式或两者的相互作用。
前瞻性队列研究。
护士健康研究（1988-2012 年）和护士健康研究 II（1991-2013 年）。
无 2 型糖尿病、心血管疾病或癌症的 143410 名女性。
轮班夜间工作定义为当月至少有三次夜间工作，加上白天和晚上的工作。不健康的生活方式包括当前吸烟、每天中度至剧烈强度的体育活动水平低于 30 分钟、替代健康饮食指数评分处于倒数三分之一的饮食，以及体重指数为 25 或以上。
通过自我报告和补充问卷确认了 2 型糖尿病的新发病例。
在 22-24 年的随访期间，发生了 10915 例 2 型糖尿病新发病例。轮班夜间工作持续时间每增加 5 年，2 型糖尿病的多变量调整风险比为 1.31（95%置信区间 1.19 至 1.44）；每个不健康生活方式因素（吸烟、低饮食质量、低身体活动和超重或肥胖）的风险比为 2.30（1.88 至 2.83）。对于轮班夜间工作每增加 5 年和每个不健康生活方式因素与 2 型糖尿病的联合关联，风险比为 2.83（2.15 至 3.73），且具有显著的相加交互作用（P ＜0.001）。轮班夜间工作的联合关联比例为 17.1%（14.0%至 20.8%），不健康生活方式的联合关联比例为 71.2%（66.9%至 75.8%），两者相加交互作用的联合关联比例为 11.3%（7.3%至 17.3%）。
在女性护士中，轮班夜间工作和不健康的生活方式都与 2 型糖尿病的风险增加有关。轮班夜间工作与不健康生活方式相结合的风险高于每个单独因素相关的风险。这些发现表明，通过坚持健康的生活方式，可以预防大多数 2 型糖尿病病例，而在轮班夜间工作者中，这些益处可能更大。
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