Skip to main content

Advertisement

SpringerLink
Log in

Shiftwork Is Not Associated with Increased Risk of NAFLD: Findings from the National Health and Nutrition Examination Survey

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Aims

There is increased focus on the metabolic impact of shiftwork, especially given the significant number of employees who work nighttime or rotating shifts. Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome. We conducted a cross-sectional study to examine the association between shiftwork and the risk of NAFLD.

Methods

We used aggregated data from the 2005–2006, 2007–2008, and 2009–2010 cycles of the National Health and Nutrition Examination Survey (NHANES). We defined NAFLD by elevated serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels (males: AST > 40 or ALT > 37; females: AST > 31 or ALT > 31) in the absence of excessive alcohol use and viral hepatitis. We defined shiftworkers as participants who self-reported currently working regular night shifts or rotating shifts. We calculated adjusted odds ratios (OR) and 95% confidence intervals (CI) using multivariable logistic regression.

Results

Overall, 8159 participants aged 20–79 years reported working at a job or business using the NHANES Occupation Questionnaire and were included in the analysis. Of these, 11.1% were classified as shiftworkers. Compared to non-shiftworkers, shiftworkers were younger, were less likely to be non-Hispanic White, and have health insurance or health care. The overall prevalence of NAFLD was 15.7%. NAFLD occurred more frequently in shiftworkers (17.0%) than non-shiftworkers (15.5%). However, in the overall multivariable analysis, shiftwork was not associated with the risk of NAFLD (OR 1.11, 95% CI 0.87–1.43).

Conclusions

The findings from this NHANES-based cross-sectional study do not support an association between shiftwork and increased risk of NAFLD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34:274–285.

    Article  CAS  PubMed  Google Scholar 

  2. Ahmed A, Wong RJ, Harrison SA. Nonalcoholic fatty liver disease review: diagnosis, treatment, and outcomes. Clin Gastroenterol Hepatol. 2015;13:2062–2070.

    Article  PubMed  Google Scholar 

  3. Singh S, Allen AM, Wang Z, et al. Fibrosis progression in nonalcoholic fatty liver vs. nonalcoholic steatohepatitis: a systematic review and meta-analysis of paired-biopsy studies. Clin Gastroenterol Hepatol. 2015;13:643–654 e641–649; quiz e639–640.

  4. Younossi ZM, Stepanova M, Negro F, et al. Nonalcoholic fatty liver disease in lean individuals in the United States. Medicine (Baltimore). 2012;91:319–327.

    Article  Google Scholar 

  5. Margariti E, Deutsch M, Manolakopoulos S, Papatheodoridis GV. Non-alcoholic fatty liver disease may develop in individuals with normal body mass index. Ann Gastroenterol. 2012;25:45–51.

    PubMed  PubMed Central  Google Scholar 

  6. Kim HJ, Kim HJ, Lee KE, et al. Metabolic significance of nonalcoholic fatty liver disease in nonobese, nondiabetic adults. Arch Intern Med. 2004;164:2169–2175.

    Article  PubMed  Google Scholar 

  7. Gutierrez-Repiso C, Soriguer F, Rubio-Martin E, et al. Night-time sleep duration and the incidence of obesity and type 2 diabetes. Findings from the prospective Pizarra study. Sleep Med. 2014;15:1398–1404.

    Article  PubMed  Google Scholar 

  8. Donga E, van Dijk M, van Dijk JG, et al. A single night of partial sleep deprivation induces insulin resistance in multiple metabolic pathways in healthy subjects. J Clin Endocrinol Metab. 2010;95:2963–2968.

    Article  CAS  PubMed  Google Scholar 

  9. Wong PM, Manuck SB, DiNardo MM, Korytkowski M, Muldoon MF. Shorter sleep duration is associated with decreased insulin sensitivity in healthy white men. Sleep. 2015;38:223–231.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cappuccio FP, D’Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care. 2010;33:414–420.

    Article  PubMed  Google Scholar 

  11. Jackson CL, Redline S, Kawachi I, Hu FB. Association between sleep duration and diabetes in black and white adults. Diabetes Care. 2013;36:3557–3565.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kim CW, Yun KE, Jung HS, et al. Sleep duration and quality in relation to non-alcoholic fatty liver disease in middle-aged workers and their spouses. J Hepatol. 2013;59:351–357.

    Article  PubMed  Google Scholar 

  13. Imaizumi H, Takahashi A, Tanji N, et al. The association between sleep duration and non-alcoholic fatty liver disease among Japanese men and women. Obes Facts. 2015;8:234–242.

    Article  PubMed  Google Scholar 

  14. Miyake T, Kumagi T, Furukawa S, et al. Short sleep duration reduces the risk of nonalcoholic fatty liver disease onset in men: a community-based longitudinal cohort study. J Gastroenterol. 2015;50:583–589.

    Article  PubMed  Google Scholar 

  15. Bureau of Labor Statistics. Workers on flexible and shift schedules in 2004 summary. In; 2005.

  16. Brum MC, Filho FF, Schnorr CC, Bottega GB, Rodrigues TC. Shift work and its association with metabolic disorders. Diabetol Metab Syndr. 2015;7:45.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Itani O, Kaneita Y, Murata A, Yokoyama E, Ohida T. Association of onset of obesity with sleep duration and shift work among Japanese adults. Sleep Med. 2011;12:341–345.

    Article  PubMed  Google Scholar 

  18. Di Lorenzo L, De Pergola G, Zocchetti C, et al. Effect of shift work on body mass index: results of a study performed in 319 glucose-tolerant men working in a Southern Italian industry. Int J Obes Relat Metab Disord. 2003;27:1353–1358.

    Article  PubMed  Google Scholar 

  19. Niedhammer I, Lert F, Marne MJ. Prevalence of overweight and weight gain in relation to night work in a nurses’ cohort. Int J Obes Relat Metab Disord. 1996;20:625–633.

    CAS  PubMed  Google Scholar 

  20. Dochi M, Suwazono Y, Sakata K, et al. Shift work is a risk factor for increased total cholesterol level: a 14-year prospective cohort study in 6886 male workers. Occup Environ Med. 2009;66:592–597.

    Article  CAS  PubMed  Google Scholar 

  21. Suwazono Y, Dochi M, Sakata K, et al. Shift work is a risk factor for increased blood pressure in Japanese men: a 14-year historical cohort study. Hypertension. 2008;52:581–586.

    Article  CAS  PubMed  Google Scholar 

  22. Karlsson B, Knutsson A, Lindahl B. 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. 2001;58:747–752.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. De Bacquer D, Van Risseghem M, Clays E, Kittel F, De Backer G, Braeckman L. Rotating shift work and the metabolic syndrome: a prospective study. Int J Epidemiol. 2009;38:848–854.

    Article  PubMed  Google Scholar 

  24. Gan Y, Yang C, Tong X, et al. Shift work and diabetes mellitus: a meta-analysis of observational studies. Occup Environ Med. 2015;72:72–78.

    Article  PubMed  Google Scholar 

  25. Kallwitz ER, Daviglus ML, Allison MA, et al. Prevalence of suspected nonalcoholic fatty liver disease in Hispanic/Latino individuals differs by heritage. Clin Gastroenterol Hepatol. 2015;13:569–576.

    Article  PubMed  Google Scholar 

  26. Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol. 2003;98:960–967.

    Article  CAS  PubMed  Google Scholar 

  27. Ong JP, Pitts A, Younossi ZM. Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease. J Hepatol. 2008;49:608–612.

    Article  PubMed  Google Scholar 

  28. Younossi ZM, Stepanova M, Afendy M, et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol. 2011;9:524–530 e521; quiz e560.

  29. U.S. Department of Health and Human Services. Analytic and Reporting Guidelines: The National Health and Nutrition Examination Survey (NHANES). National Center for Health Statistics, Centers for Disease Control and Prevention; 2005.

  30. Parsons MJ, Moffitt TE, Gregory AM, et al. Social jetlag, obesity and metabolic disorder: investigation in a cohort study. Int J Obes (Lond). 2015;39:842–848.

    Article  CAS  Google Scholar 

  31. Leproult R, Holmback U, Van Cauter E. Circadian misalignment augments markers of insulin resistance and inflammation, independently of sleep loss. Diabetes. 2014;63:1860–1869.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Buxton OM, Cain SW, O’Connor SP, et al. Adverse metabolic consequences in humans of prolonged sleep restriction combined with circadian disruption. Sci Transl Med. 2012;4:129ra143.

  33. Sahar S, Sassone-Corsi P. Regulation of metabolism: the circadian clock dictates the time. Trends Endocrinol Metab. 2012;23:1–8.

    Article  CAS  PubMed  Google Scholar 

  34. Tan E, Scott EM. Circadian rhythms, insulin action, and glucose homeostasis. Curr Opin Clin Nutr Metab Care. 2014;17:343–348.

    Article  CAS  PubMed  Google Scholar 

  35. Gamble KL, Berry R, Frank SJ, Young ME. Circadian clock control of endocrine factors. Nat Rev Endocrinol. 2014;10:466–475.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Rao MN, Neylan TC, Grunfeld C, Mulligan K, Schambelan M, Schwarz JM. Subchronic sleep restriction causes tissue-specific insulin resistance. J Clin Endocrinol Metab. 2015;100:1664–1671.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354:1435–1439.

    Article  CAS  PubMed  Google Scholar 

  38. Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004;141:846–850.

    Article  PubMed  Google Scholar 

  39. Hemio K, Puttonen S, Viitasalo K, Harma M, Peltonen M, Lindstrom J. Food and nutrient intake among workers with different shift systems. Occup Environ Med. 2015;72:513–520.

    Article  PubMed  Google Scholar 

  40. Al-Naimi S, Hampton SM, Richard P, Tzung C, Morgan LM. Postprandial metabolic profiles following meals and snacks eaten during simulated night and day shift work. Chronobiol Int. 2004;21:937–947.

    Article  CAS  PubMed  Google Scholar 

  41. Peplonska B, Burdelak W, Krysicka J, et al. Night shift work and modifiable lifestyle factors. Int J Occup Med Environ Health. 2014;27:693–706.

    Article  PubMed  Google Scholar 

  42. Gan Y, Yang C, Tong X, et al. Shift work and diabetes mellitus: a meta-analysis of observational studies. Occup Environ Med. 2014:oemed-2014-102150.

  43. Santhanam P, Driscoll HK, Gress TW, Khthir R. Metabolic disease and shift work: is there an association? An analysis of NHANES data for 2007–2008. Occup Environ Med. 2014;71:661–662.

    Article  PubMed  Google Scholar 

  44. Givens ML, Malecki KC, Peppard PE, et al. Shiftwork, sleep habits, and metabolic disparities: results from the survey of the health of Wisconsin. Sleep Health. 2015;1:115–120.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Knutsson A, Kempe A. Shift work and diabetes—a systematic review. Chronobiol Int. 2014;31:1146–1151.

    Article  PubMed  Google Scholar 

  46. Tucker P, Marquie JC, Folkard S, Ansiau D, Esquirol Y. Shiftwork and metabolic dysfunction. Chronobiol Int. 2012;29:549–555.

    Article  PubMed  Google Scholar 

  47. Pietroiusti A, Neri A, Somma G, et al. Incidence of metabolic syndrome among night-shift healthcare workers. Occup Environ Med. 2010;67:54–57.

    Article  CAS  PubMed  Google Scholar 

  48. Pan A, Schernhammer ES, Sun Q, Hu FB. Rotating night shift work and risk of type 2 diabetes: two prospective cohort studies in women. PLoS Med. 2011;8:e1001141.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Suwazono Y, Sakata K, Okubo Y, et al. Long-term longitudinal study on the relationship between alternating shift work and the onset of diabetes mellitus in male Japanese workers. J Occup Environ Med. 2006;48:455–461.

    Article  PubMed  Google Scholar 

  50. Morikawa Y, Nakagawa H, Miura K, et al. Shift work and the risk of diabetes mellitus among Japanese male factory workers. Scand J Work Environ Health. 2005;31:179–183.

    Article  PubMed  Google Scholar 

  51. van Amelsvoort LG, Schouten EG, Kok FJ. Duration of shiftwork related to body mass index and waist to hip ratio. Int J Obes Relat Metab Disord. 1999;23:973–978.

    Article  PubMed  Google Scholar 

  52. Bertolotti M, Lonardo A, Mussi C, et al. Nonalcoholic fatty liver disease and aging: epidemiology to management. World J Gastroenterol WJG. 2014;20:14185–14204.

    Article  PubMed  Google Scholar 

Download references

Author’s contribution

APT contributed to conception, analysis, and interpretation of the results, manuscript writing, editing, and decision to publish. MB and HES contributed to interpretation of the results, manuscript writing, editing, and decision to publish. FK contributed to manuscript editing and decision to publish. All authors approved the final draft submitted.

Funding

This work is funded in part by the Texas Digestive Disease Center NIH DK58338 (PI: El-Serag), NIDDK K24-04-107 (PI: El-Serag), and Cancer Prevention Research Institute of Texas (CPRIT) Multi-Investigator Research Award (RP150587). The opinions expressed reflect those of the authors and not necessarily those of the Department of Veterans Affairs, the US government, or Baylor College of Medicine.

Guarantor of the article

Aaron P. Thrift, Ph.D.

Author information

Authors and Affiliations

  1. Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA

    Maya Balakrishnan, Hashem B. El-Serag, Fasiha Kanwal & Aaron P. Thrift

  2. Department of Medicine, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA

    Hashem B. El-Serag & Fasiha Kanwal

  3. Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA

    Aaron P. Thrift

Authors
  1. Maya Balakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hashem B. El-Serag
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fasiha Kanwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aaron P. Thrift
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maya Balakrishnan.

Ethics declarations

Conflict of interest

None.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 13 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Balakrishnan, M., El-Serag, H.B., Kanwal, F. et al. Shiftwork Is Not Associated with Increased Risk of NAFLD: Findings from the National Health and Nutrition Examination Survey. Dig Dis Sci 62, 526–533 (2017). https://doi.org/10.1007/s10620-016-4401-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-016-4401-1

Keywords

Search

Navigation