Time of exposure to night work and carotid atherosclerosis: a structural equation modeling approach using baseline data from ELSA-Brasil

  • Aline Silva-Costa
  • Joanna Guimarães
  • Dora Chor
  • Maria de Jesus Mendes da Fonseca
  • Isabela Bensenor
  • Itamar Santos
  • Sandhi Barreto
  • Rosane Härter Griep
Original Article
  • 52 Downloads

Abstract

Purpose

The study of cardiovascular diseases (CVD) associated with night work is difficult due to the long period required for conditions to manifest and the healthy-worker effect. Analyzing asymptomatic pre-clinical changes in the atherosclerotic process is a way to assess the pathways between exposure to night work and CVD.

Aim

To evaluate the associations between night work and subclinical atherosclerosis measured by carotid intima-media thickness (CIMT) using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Methods

We conducted cross-sectional analyses using baseline data (2008–2010) from 9785 civil servants, aged 35–74 years. The associations between time of exposure to night work and mean CIMT were examined using a structural equation model.

Results

The sample included 4259 men and 5526 women, mean age of 51.6 years. A total of 1778 (18.2%) individuals were exposed to night work (594 current and 1184 former night workers), and the mean years of night work exposed was 11.47 (SD = 9.45) years. On average, mean CIMT was 0.606 (SD = 0.130) mm. Among men, the increase in exposure to night work was significantly associated with an increase in BMI and CIMT. Among women, night work was not associated with increased CIMT. In relation to the indirect associations, results suggest a possible mediation by BMI, diabetes and hypertension on the association between the years of night work and mean CIMT only among men.

Conclusion

Night work was associated with increased CIMT only among men. These findings add to the knowledge of the possible pathways that link night work and carotid atherosclerosis. Additionally, these results contribute to the recognition of work schedules as a public health problem that should be addressed by the medical community and policy makers.

Keywords

Carotid intima-media thickness Atherosclerosis Work schedule Night shift work 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they do not have any competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. Amani R, Gill T (2013). Shiftworking, nutrition and obesity: implications for workforce health- a systematic review. Asia Pac J ClinNutr, 22(4), 505–515.  https://doi.org/10.6133/apjcn.2013.22.4.11 Google Scholar
  2. Aquino EM, Barreto SM, Bensenor IM, Carvalho MS, Chor D et al (2012) Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): objectives and design. Am J Epidemiol 175(1476–6256):315–324.  https://doi.org/10.1093/aje/kwr294 CrossRefGoogle Scholar
  3. Baltar VT, Xun WW, Johansson M, Ferrari P, Chuang SC et al (2013) A structural equation modelling approach to explore the role of B vitamins and immune markers in lung cancer risk. Eur J Epidemiol 28(8):677–688.  https://doi.org/10.1007/s10654-013-9793-z CrossRefGoogle Scholar
  4. Bensenor IM, Griep RH, Pinto KA, Faria CP, Felisbino-Mendes M et al (2013) Rotinas de organização de exames e entrevistas no centro de investigação ELSA-Brasil. Rev SaúdePública 47:37–47.  https://doi.org/10.1590/S0034-8910.2013047003780 Google Scholar
  5. Bentzon JF, Otsuka F, Virmani R, Falk E (2014) Mechanisms of plaque formation and rupture.Circ Res.114(12):1852–1866. https://doi.org/10.1161/CIRCRESAHA.114.302721
  6. Bonham MP, Bonnell EK, Huggins CE (2016) Energy intake of shift workers compared to fixed day workers: a systematic review and meta-analysis. ChronobiolInt 15:1–15.  https://doi.org/10.1080/07420528.2016.1192188 Google Scholar
  7. Cain SW, Filtness AJ, Phillips CL, Anderson C (2015) Enhanced preference for high-fat foods following a simulated night shift. Scand J Work Environ Health 41(3):288–293.  https://doi.org/10.5271/sjweh.3486 CrossRefGoogle Scholar
  8. Cardoso LO, Carvalho MS, Cruz OG, Melere C, Luft VC et al (2016) Eating patterns in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): an exploratory analysis. Cad SaúdePública 32(5):e00066215. doi. https://doi.org/10.1590/0102-311X00066215 Google Scholar
  9. Chor D, Alves MG, de M, Giatti, Cade L, Nunes NV MA et al (2013) Questionnaire development in ELSA-Brasil: challenges of a multidimensional instrument. Rev SaúdePública 47:27–36.  https://doi.org/10.1590/S0034-8910.2013047003835 Google Scholar
  10. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Both ML et al (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35(8):1381–1395CrossRefGoogle Scholar
  11. Fedeli LG, Vidigal PG, Leite CM, Castilhos CD, Pimentel RA et al (2013) Logistics of collection and transportation of biological samples and the organization of the central laboratory in the ELSA- Brasil. Rev SaudePublica 47(2):63–71.  https://doi.org/10.1590/S0034-8910.2013047003807 Google Scholar
  12. Folsom AR, Kronmal RA, Detrano RC, O’Leary DH, Bild DE et al (2008) Coronary artery calcification compared with carotid intima-media thickness in the predictionof cardiovascular disease incidence: the Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med 168(12):1333–1339CrossRefGoogle Scholar
  13. Gepner AD, Young R, Delaney JA, Tattersall MC, Blaha MJ, Post WS, Stein JH (2015) A comparison of coronary artery calcium presence, carotid plaque presence, and carotid intima-media thickness for cardiovascular disease prediction in the multi-ethnic study of atherosclerosis (MESA). Circ Cardiovasc Imaging 8(1):e002262.  https://doi.org/10.1161/CIRCIMAGING.114.002262 CrossRefGoogle Scholar
  14. Haupt CM, Alte D, Dörr M, Robinson DM, Felix SB et al (2008) The relation of exposure to shift work with atherosclerosis and myocardial infarction in a general population. Atherosclerosis 201(1):205–211.  https://doi.org/10.1016/j.atherosclerosis.2007.12.059 CrossRefGoogle Scholar
  15. Hemiö K, Puttonen S, Viitasalo K, Härmä M, Peltonen M, Lindström J (2015) Food and nutrient intake among workers with different shift systems. Occup Environ Med 72(7):513–520.  https://doi.org/10.1136/oemed-2014-102624 CrossRefGoogle Scholar
  16. Jankowiak S, Backé E, Liebers F, Schulz A, Hegewald J et al (2016) Current and cumulative night shift work and subclinical atherosclerosis: results of the Gutenberg Health Study. Int Arch Occup Environ Health 89(8):1169–1182CrossRefGoogle Scholar
  17. Laermans J, Depoortere I (2016) Chronobesity: role of the circadian system in the obesity epidemic. Obes Rev 17:108–125.  https://doi.org/10.1111/obr.12351 CrossRefGoogle Scholar
  18. Lester SJ, Eleid MF, Khandheria BK, Hurst RT (2009) Carotid intima-media thickness and coronary artery calcium score as indications of subclinical atherosclerosis. Mayo Clin Proc 84(3):229–233.  https://doi.org/10.1016/S0025-6196(11)61139-7 CrossRefGoogle Scholar
  19. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M (2007) Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 115(4):459–467CrossRefGoogle Scholar
  20. Lowden A, Moreno C, Holmbäck U, Lennernäs M, Tucker P (2010) Eating and shift work - effects on habits, metabolism and performance. Scand J Work Environ Health 36:150–162CrossRefGoogle Scholar
  21. MacCallum RC, Browne MW, Sugawara HM (1996) Power analysis and determination of sample size for covariance structure modeling. Psychol Methods 130–149Google Scholar
  22. Mill JG, Pinto K, Griep RH, Goulart A, Foppa M et al (2013) Medical assessments and measurements in ELSA-Brasil. RevSaude Publica 47:54–62.  https://doi.org/10.1590/S0034-8910.2013047003851 Google Scholar
  23. Mita T, Katakami N, Shiraiwa T, Yoshii H, Onuma T et al (2016) Sitagliptin attenuates the progression of carotid intima-media thickening in insulin-treated patients with type 2 diabetes: the sitagliptin preventive study of intima-media thickness evaluation (spike): randomized controlled trial. Diabetes Care 39(3):455–464. https://doi.org/10.2337/dc15-2145 CrossRefGoogle Scholar
  24. Molina MdelC, Benseñor IM, Cardoso Lde O, Velazquez-Melendez G, Drehmer M et al. (2013) Reproducibility and relative validity of the Food Frequency Questionnaire used in the ELSA-Brasil. Cad Saude Publica 29(2):379–389CrossRefGoogle Scholar
  25. Pereira AC, Gomez LM, Bittencourt MS, Staniak HL, Sharovsky R et al (2016) Age, gender, and race-based coronary artery calcium score percentiles in the brazilian longitudinal study of adult health (ELSA-Brasil). Clin Cardiol 39(6):352–359. https://doi.org/10.1002/clc.22539 CrossRefGoogle Scholar
  26. Proper KI, van de Langenberg D, Rodenburg W, Vermeulen RC, van der Beek AJ et al (2016) The relationship between shift work and metabolic risk factors: a systematic review of longitudinal studies. Am J Prev Med 50(5):e147-57.  https://doi.org/10.1016/j.amepre.2015.11.013 CrossRefGoogle Scholar
  27. Puttonen S, Kivimäki M, Elovainio M, Pulkki-Råback L, Hintsanen M et al (2009) Shift work in young adults and carotid artery intima-media thickness: The Cardiovascular Risk in Young Finns study. Atherosclerosis 205(2):608–613.  https://doi.org/10.1016/j.atherosclerosis.2009.01.016 CrossRefGoogle Scholar
  28. Puttonen S, Härmä M, Hublin C (2010) Shift work and cardiovascular disease—pathways from circadian stress to morbidity. Scand J Work Environ Health 36(2):96–108CrossRefGoogle Scholar
  29. Santos IS, Goulart AC, Brunoni AR, Kemp AH, Lotufo PA, Bensenor IM. (2015) Anxiety and depressive symptoms are associated with higher carotid intima-media thickness. Cross-sectional analysis from ELSA-Brasil baseline data. Atherosclerosis 240(2):529–534CrossRefGoogle Scholar
  30. Santos IS, Bittencourt MS, Goulart AC, Schmidt MI, Diniz MFHS. et al. (2017) Insulin resistance is associated with carotid intima-media thickness in non-diabetic subjects. A cross-sectional analysis of the ELSA-Brasil cohort baseline. Atherosclerosis 260:34–40.  https://doi.org/10.1016/j.atherosclerosis.2017.03.011 CrossRefGoogle Scholar
  31. Santos IS, Alencar AP, Rundek T, Goulart AC, Barreto SM, Pereira AC, Benseñor IM, Lotufo PA. Low impact of traditional risk factors on carotid intima-media thickness: the ELSA-Brasil cohort. Arterioscler Thromb Vasc Biol 35(9):2054–2059.  https://doi.org/10.1161/ATVBAHA.115.305765
  32. Schmidt MI, Griep RH, Passos VM, Luft VC, Goulart AC et al (2013) Strategies and development of quality assurance and control in the ELSA-Brasil. Rev SaúdePública 47:105–112.  https://doi.org/10.1590/S0034-8910.2013047003889 Google Scholar
  33. Silva-Costa A, Rotenberg L, Nobre AA, Schmidt MI, Chor D, Griep RH (2015) Gender-specific association between nightwork exposure and type 2 diabetes: results from the longitudinal study of adult health, ELSA-Brasil. Scand J Work Environ Health 41(6):569–578.  https://doi.org/10.5271/sjweh.3520 CrossRefGoogle Scholar
  34. Silva-Costa A, Rotenberg L, Coeli CM, Nobre AA, Griep RH (2016) Night work is associated with glycemic levels and anthropometric alterations preceding diabetes: Baseline results from ELSA- Brasil. ChronobiolInt 33(1):64–72.  https://doi.org/10.3109/07420528.2015.1115765 CrossRefGoogle Scholar
  35. Spence JD (2012) Carotid plaque measurement is superior to IMT. Atherosclerosis 220:34–35CrossRefGoogle Scholar
  36. Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB et al (2008) Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography carotid intima-media thickness task force endorsed by theSociety for Vascular Medicine. J Am SocEchocardiogr 21:93e111Google Scholar
  37. Vyas MV, Garg AX, Iansavichus AV, Costella J, Donner A et al (2012) Shift work and vascular events: systematic review and meta-analysis. BMJ 345:e4800.  https://doi.org/10.1136/bmj.e4800.345:e4800 CrossRefGoogle Scholar
  38. Wang X-S, Armstrong MEG, Cairns BJ, Key TJ, Travis RC (2011) Shift work and chronic disease: the epidemiological evidence. Occup Med 61(2):78–89.  https://doi.org/10.1093/occmed/kqr001 CrossRefGoogle Scholar
  39. Wang A, Arah OA, Kauhanen J, Krause N (2015) Work schedules and 11-year progression of carotid atherosclerosis in middle-aged Finnish men. Am J Ind Med 58(1):1–13.  https://doi.org/10.1002/ajim.22388 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Aline Silva-Costa
    • 1
  • Joanna Guimarães
    • 2
  • Dora Chor
    • 2
  • Maria de Jesus Mendes da Fonseca
    • 2
  • Isabela Bensenor
    • 3
  • Itamar Santos
    • 3
  • Sandhi Barreto
    • 4
  • Rosane Härter Griep
    • 5
  1. 1.Department of Collective HealthFederal University of Triângulo Mineiro (UFTM)UberabaBrazil
  2. 2.Sergio Arouca National School of Public HealthOswaldo Cruz Foundation (FIOCRUZ)Rio de JaneiroBrazil
  3. 3.Center for Clinical and Epidemiological ResearchUniversity of São Paulo (USP)São PauloBrazil
  4. 4.Department of Preventive and Social MedicineFederal University de Minas Gerais (UFMG)Belo HorizonteBrazil
  5. 5.Laboratory of Health and Environmental EducationOswaldo Foundation (FIOCRUZ)Rio de JaneiroBrazil

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