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轮班类型、睡眠、情绪和饮食在一组轮班护士中的关联。

Associations between shift type, sleep, mood, and diet in a group of shift working nurses.

机构信息

University of South Australia, Behaviour-Brain-Body Research Centre, Sleep and Chronobiology Laboratory, Magill, SA, 5072, Australia.

出版信息

Scand J Work Environ Health. 2019 Jul 1;45(4):402-412. doi: 10.5271/sjweh.3803. Epub 2019 Feb 26.

Abstract

Objectives Unhealthy dietary profiles contribute to the elevated risk of chronic diseases for shift workers. There has been limited investigation into factors associated both with shift work and diet, such as sleep and mood, that may further influence food intake among shift workers. The aim of this study was to explore the relationship between shift work, sleep, mood, and diet. Methods Shift working nurses [N=52; 46 female; age: mean 39.8 (SD 12.4) years] participated in a 14-day, repeated measures, within- and between-subjects design study. Analyses included data from 40 nurses over 181 shifts. Food diaries were completed for a minimum of three days per shift type (morning, afternoon, night). Foodworks nutrition software was used to determine energy intake in kilojoules and macronutrient intake (as a percentage of total energy intake). Mood (happiness, anxiety, depressive mood, stress, and tiredness) was measured using visual analog scales. Sleep was estimated using actigraphy. Demographic and work-related variables (covariates) were measured using a modified version of the Standard Shiftwork Index. A path analysis was conducted using generalized structural equation modelling with a random effect of participant ID. Predictors were selected using purposive selection of covariates (an alternative to stepwise modelling) and final models included important predictors only. Results Compared to night and morning shifts, results showed that working an afternoon shift was associated with a lower energy intake (β= -1659.4, P<0.01) and lower levels of stress (β= -5.6, P<0.01). Higher levels of stress were associated with a higher energy intake (β=35.3, P<0.01) and a higher percentage of fat (ß=0.1, P=0.05) and saturated fat (β=0.1, P<0.01). Compared to the other shift types, morning shift was associated with lower carbohydrates (β= -4.3, P<0.01) and night shift was associated with lower protein (β= -2.7, P=0.03). Lower sleep efficiency was associated with a higher carbohydrate intake (β= -0.4, P<0.01) and a lower protein intake (β=0.25, P<0.01) Conclusions Results suggest that compared to nights and mornings, afternoon shifts were associated with reduced energy consumption. Negative mood (stress, depression, and anxiety) mediated the association between shift type and energy intake. Negative mood was also associated with higher fat intake. Dietary interventions for shift workers should consider the role of mood as well as shift type.

摘要

目的

不健康的饮食结构会增加轮班工人患慢性病的风险。对于与轮班工作和饮食相关的因素,如睡眠和情绪,以及它们可能进一步影响轮班工人的食物摄入,目前的研究还很有限。本研究旨在探讨轮班工作、睡眠、情绪和饮食之间的关系。

方法

参与这项 14 天重复测量、内-间-被试设计研究的轮班护士共有 52 名(46 名女性;年龄:平均 39.8(SD 12.4)岁)。分析包括了 40 名护士在 181 个班次中的数据。每位护士至少在三种班次类型(早班、中班、夜班)下完成三天的饮食记录。使用 Foodworks 营养软件来确定能量摄入量(以千焦耳为单位)和宏量营养素摄入量(占总能量摄入量的百分比)。使用视觉模拟量表来测量情绪(幸福感、焦虑、抑郁情绪、压力和疲劳)。使用活动记录仪来估计睡眠。使用改良后的标准轮班工作指数(Standard Shiftwork Index)来测量人口统计学和与工作相关的变量(协变量)。使用广义结构方程模型进行路径分析,参与者 ID 为随机效应。使用有目的的协变量选择(替代逐步建模)选择预测因子,最终模型仅包括重要的预测因子。

结果

与夜班和早班相比,结果显示,中班与较低的能量摄入(β= -1659.4,P<0.01)和较低的压力水平(β= -5.6,P<0.01)有关。较高的压力水平与较高的能量摄入(β=35.3,P<0.01)和较高的脂肪(β=0.1,P=0.05)和饱和脂肪(β=0.1,P<0.01)摄入有关。与其他班次类型相比,早班与较低的碳水化合物摄入(β= -4.3,P<0.01)有关,而夜班与较低的蛋白质摄入(β= -2.7,P=0.03)有关。较低的睡眠效率与较高的碳水化合物摄入(β= -0.4,P<0.01)和较低的蛋白质摄入(β=0.25,P<0.01)有关。

结论

结果表明,与夜班和早班相比,中班与能量消耗减少有关。负面情绪(压力、抑郁和焦虑)中介了班次类型与能量摄入之间的关系。负面情绪也与较高的脂肪摄入有关。针对轮班工人的饮食干预措施应考虑情绪以及班次类型的作用。

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