Metabolic disturbances in male workers with rotating three-shift work. Results of the WOLF study

  • Berndt H. Karlsson
  • Anders K. Knutsson
  • Bernt O. Lindahl
  • Lars S. Alfredsson
Original Article



The aim of the present study was to investigate the relationship between important metabolic risk factors for coronary heart disease (CHD) and type 2 diabetes in shift workers and day workers.


Cross-sectional data from a sub-population in the WOLF study consisting of 665 day workers and 659 three-shift workers in two plants were analysed.


A higher proportion of shift workers than day workers had high triglyceride levels (≥1.7 mmol/l), low levels of HDL-cholesterol (<0.9 mmol/l) and abdominal obesity (waist/hip ratio>0.9). The risk of low HDL-cholesterol was doubled in shift workers, (odds ratio (OR): 2.02, 95% confidence interval (95% CI): 1.24–3.28) after being adjusted for age, socio-economic factors, physical activity, current smoking, social support and job strain. High levels of triglycerides were also significantly associated with shift work (OR: 1.40, 95% CI: 1.08–1.83). The OR for abdominal obesity was 1.19, (95% CI: 0.92–1.56). The prevalence of hyperglycaemia (serum glucose ≥7.0 mmol/l) was similar in day and shift workers. No significant interaction was seen between shift work and abdominal obesity with regard to the associations with triglycerides and HDL-cholesterol.


We found a significant association between shift work and lipid disturbances (i.e. low HDL-cholesterol and high triglyceride levels). We did not find any association with hyperglycaemia.


Shift work Metabolic factors Abdominal obesity job strain 



This study was supported by a grant from the Swedish Work Environmental Fund. The authors would like to express their gratitude to the participants and the supportive management of the MoDo company. The collaborative part of this research was supported by the European Science Foundation Scientific Program 'Social Variations in Health Expectancy in Europe.'


  1. Alberti GMM, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part1: Diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation. Diabet Med 15:539–553PubMedGoogle Scholar
  2. Alfredsson LS, Hammar N, Fransson EIM, de Faire UH, Hallqvist J, Knutsson A, Nilsson T, Theorell T, Westerholm P (2002) Job strain and major risk factors for coronary heart disease. Baseline results from the Wolf study. Scand J Work Environ Health 28:238–248PubMedGoogle Scholar
  3. Boden G, Ruiz J, Urbain J-L, Xinhua C (1996) Evidence for a circadian rhythm of insulin. Am J Phys: E246–E252Google Scholar
  4. Bursey RG (1990) A cardiovascular study of shift workers with respect to coronary artery disease risk factor prevalence. J Soc Occup Med 40:65–67PubMedGoogle Scholar
  5. Bøggild H, Knutsson A (1999) Shiftwork, risk factors and cardiovascular disease. Scand J Work Environ Health 25:85–99PubMedGoogle Scholar
  6. Bøggild H, Suadicani P, Hein H, Gyntelberg F (1999) Shiftwork, social class and ischaemic heart disease in middle aged and elderly men; a 22 year follow up in the Copenhagen male study. Occup Environ Med 56:640–645PubMedGoogle Scholar
  7. Cesana G, Panza G, Ferrario M, Zanettini R, Arnoldi M, Grieco A (1985) Can glycosylated hemoglobin be a job stress parameter? J Occup Med 27:357–360PubMedGoogle Scholar
  8. Costa G, Betta A, Uber D, Alexopoulos C (1990) Estimate of coronary risk in a group of Italian shiftworkers. In: Costa G, Cesana G, Kogi K, Wedderburn A (eds) Shiftwork: health, sleep and performance. Lang, Frankfurt am Main, pp 363–369Google Scholar
  9. De Backer G, Kornitzer M, Dramaix M, Peeters H, Kittel F (1987) Irregular working hours and lipid levels in men. In: G Schling, H Mörl (eds) Expanding horizons in atherosclerosis research. Springer, Berlin, pp 217–224Google Scholar
  10. Hampton SM, Morgan LM, Lawrance N, Anastasiadou T, Norris F, Deacon S, Ribeiro D, Arendt J (1996) Postprandial hormone and metabolic responses in simulated shiftwork. J Endocrinol 151:257–267Google Scholar
  11. Karlsson B, Knutsson A, Lindahl B (2001) Is there an association between shift work and having a metabolic syndrome? Results from a population based study of 27 485 people. Occup Environ Med 58:747–752PubMedGoogle Scholar
  12. Kawachi I, Colditz G, Stampfer M, Willet W, Manson J, Speizer F, Hennekens C (1995) Prospective study of shiftwork and risk of coronary heart disease in women. Circulation 92:3178–3182PubMedGoogle Scholar
  13. Knutsson A (1989) Shiftwork and coronary heart disease. Scand J Soc Med Suppl 44:1–36PubMedGoogle Scholar
  14. Knutsson A, Bøggild H (2000) Shiftwork and cardiovascular disease: review of disease mechanisms. Rev Environ Health 15:359–372PubMedGoogle Scholar
  15. Knutsson A, Åkerstedt T, Jonsson BJ (1988) Prevalence of risk factors for coronary artery disease among day and shift workers. Scand J Work Environ Health 14:317–321PubMedGoogle Scholar
  16. Knutsson A, Andersson H, Berglund U (1990) Serum lipoproteins in day and shiftworkers: a prospective study. Br J Ind Med 47:132–134PubMedGoogle Scholar
  17. Lasfargues G, Vol S, Cacès E, Le Clésiau H, Lecomte P, Tichet J (1996) Relations among nightwork, dietary habits, biological measures, and health status. Int J Behav Med 3:123–134Google Scholar
  18. Lennernäs MAC (1993) Nutrition and shiftwork. Thesis, Uppsala University, SwedenGoogle Scholar
  19. Lindahl B, Asplund K, Eliasson M, Evrin P-E (1996) Insulin resistance syndrome and fibrinolytic activity: the Northern Sweden MONICA study. Int J Epidemiol 25:1–9Google Scholar
  20. Mikuni E, Ohoshi T, Hayashi K, Miyamura K (1983) Glucose intolerance in an employed population. Tohoku J Exp Med 141 [Suppl]:251–256Google Scholar
  21. Nakamura K, Shimai S, Kikuchi S, Tominaga K, Takahashi H, Tanaka M, Nakano S, Motohashi Y, Nakadaira H, Yamamoto M (1997) Shiftwork and risk factors for coronary heart disease in Japanese blue-collar workers: serum lipids and anthropometric characteristics. Occup Med 47:142–146Google Scholar
  22. Niedhammer I, Lert F, Marne M-J (1996) Prevalence of overweight and weight gain in relation to night work in nurses' cohort. Int J Obes 20:625–633Google Scholar
  23. Orth-Gomér K (1983) Intervention on coronary risk factors by adapting a shift schedule to biologic rhythmicity. Psychosom Med 45:407–415PubMedGoogle Scholar
  24. Parkes K (2002) Shift work and age as interactive predictors of body mass index among offshore workers. Scand J Work Environ Health 28:64–71PubMedGoogle Scholar
  25. Ribeiro D, Hampton S, Morgan L, Deacon S, Arendt J (1998) Altered postprandial hormone and metabolic responses in a simulated shiftwork. J Endocrinol 158:305–310PubMedGoogle Scholar
  26. Rivera-Col A, Funtes-Arderiu L, Diez-Noguera A (1994) Circadian rhythmic variation in serum concentrations of clinically important lipids. Clin Chem 40:1549–1553PubMedGoogle Scholar
  27. Romon M, Nuttens M-C, Fievet C, Pot P, Bard J, Furon D, Fruchart J-C (1992) Increased triglyceride levels in shift workers. Am J Med 93:259–262PubMedGoogle Scholar
  28. Rosmonds R, Lapidus L, Björntorp P (1996) The influence of occupational and social factors on obesity and body fat distribution in middle aged men. Int J Obes Relat Metab Disord 20:599–607PubMedGoogle Scholar
  29. Thelle D, Førde O, Try K, Lehman E (1976) The Tromsø heart study. Acta Med Scand 200:107–118PubMedGoogle Scholar
  30. Theorell T, Åkerstedt T (1976) Day and night work: changes in cholesterol, uric acid, glucose and potassium in serum and in circadian patterns of urinary catecholamine excretion. Acta Med Scand 200:47–53PubMedGoogle Scholar
  31. Theorell T, Tsutsumi A, Hallqvist J, Reuterwall C, Hogstedt C, Freedlund P (1998) Decision latitude, job strain and myocardial infarction: a study of working men in Stockholm. The SHEEP Study Group. Stockholm heart epidemiology program. Am J Public Health 88:382–388PubMedGoogle Scholar
  32. van Amelsvoort L, Schouten E, Kok F (1999) Duration of shiftwork related to body mass index and waist to hip ratio. Int J Obes 23:973–978CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Berndt H. Karlsson
    • 1
  • Anders K. Knutsson
    • 1
  • Bernt O. Lindahl
    • 2
  • Lars S. Alfredsson
    • 3
  1. 1.Occupational Medicine, Department of Public Health and Clinical MedicineUniversity of UmeåUmeåSweden
  2. 2.Behavioural Medicine, Department of Public Health and Clinical MedicineUniversity of UmeåUmeåSweden
  3. 3.Division of Cardiovascular Epidemiology, Institute of Environmental MedicineKarolinska InstituteStockholmSweden

Personalised recommendations