Prevention of diabetes and cardiovascular diseases in occupational health care: feasibility and effectiveness.

AIMS: To evaluate feasibility and effectiveness of lifestyle counseling in occupational setting on decreasing risk for diabetes and cardiovascular disease. METHODS: A health check-up including physical examination, blood tests, questionnaires and health advice was completed on 2312 employees of an airline company. Participants with elevated risk for type 2 diabetes based on FINDRISC score and/or blood glucose measurement (n=657) were offered 1-3 additional lifestyle counseling sessions and 53% of them agreed to participate. After 2.5 years, 1347 employees of 2199 invited participated in a follow-up study. RESULTS: Among women and men with low baseline diabetes risk, cardiovascular risk factors increased slightly during follow-up. Larger proportion of the men who attended interventions lost weight at least 5% compared with the non-attendees (18.4% vs. 8.4%, p=0.031) and their FINDRISC score increased less (0.6 vs. 1.5, p=0.037). Older age associated with participation in follow-up and higher baseline FINDRISC score and presence of clinical and lifestyle risk factors and problems in sleep and mood increased attendance in interventions. CONCLUSIONS: Identification of employees with cardiovascular and diabetes risk, and the low intensity lifestyle intervention were feasible in occupational health-care setting. However, the health benefits were modest and observed only for men with increased risk.

Occupational health care identifies risk for type 2 diabetes and cardiovascular disease.

AIMS: To assess the risk for type 2 diabetes (T2D) and cardiovascular disease (CVD) among employees of a Finnish airline; to study the association of shift work with T2D and CVD risk; and to test the feasibility of risk screening in occupational health care setting. METHODS: Altogether 4169 employees were invited for a health check-up and 2312 participated in this study. The check-up included physical examinations, questionnaires on working hours, sleep, and lifestyle, diabetes risk score FINDRISC, and blood tests. Lifestyle counselling was offered for those with increased T2D risk. RESULTS: Altogether 15% of participants had a high T2D risk (FINDRISC≥15 and/or elevated, but non-diabetic blood glucose), and a further 15% had a moderate T2D risk (FINDRISC 10-14 and normal blood glucose). Of those 60% agreed to attend lifestyle counselling. Metabolic syndrome was more common, lipid profile more unfavorable and hsCRP higher by increasing FINDRISC score category. Risk factor profiles linked to shift work status were not self-evident. CONCLUSIONS: The renewed health check-up process effectively identified those employees with increased T2D and CVD risk who would benefit from lifestyle intervention. The use of FINDRISC questionnaire was a feasible first-step screening method in occupational health care setting.

The relationship between current and former shift work and the metabolic syndrome.

OBJECTIVE: The occurrence of possible health hazards among former shift workers is not well-known. We studied associations of former and current shift work with the metabolic syndrome (MetS). METHODS: Participants were 1811 full-time employees of a large airline company (1009 men). Working times were categorized into five groups: day worker [N=297 (the reference group)], former shift worker (N=341), 2-shift worker (N=418), night-shift worker (N=283), and in-flight worker (N=472). MetS was measured by the International Diabetes Federation (IDF) criteria and the National Institute of Health Adult Treatment Panel III (NCEP) guideline. The prevalence of the syndrome in the study population was 28.5% and 20.8%, respectively. RESULTS: Among male former shift workers, MetS was more prevalent compared to male day workers [IDF: age-adjusted odds ratio (OR) 2.13, 95% confidence interval (95% CI) 1.35-3.37; NCEP: OR 1.83, 95% CI 1.13-2.96]. Associations did not change after additional adjustments for education, smoking, physical activity, alcohol consumption, and insomnia symptoms (IDF: OR 2.00, 95% CI 1.26-3.19; NCEP: 1.67, 95% CI 1.02-2.72). Male 2-shift workers also had an elevated risk of IDF-defined MetS (OR 1.64, 95% CI 1.06-2.55) but the association weakened in the fully adjusted analyses (OR 1.48, 95% CI 0.93-2.24). Prevalence of the MetS was marginally significantly higher among night-shift work (IDF: OR 1.51, 95% CI 0.95-2.34) and was attenuated further with additional adjustments (OR 1.37, 95% CI 0.84-2.22). Among women, no significant differences in prevalence of the MetS between day work and shift work were observed. CONCLUSION: Findings of the cross-sectional study suggest that MetS diagnosed by standardized criteria is more prevalent among former male shift workers than current day workers who have never worked in shifts.

Effect of shiftwork on systemic markers of inflammation.

Shiftwork is associated with an increased risk of cardiovascular diseases, but the possible role of inflammation in this relationship is not well known. We tested the hypothesis that shiftwork would be associated with higher levels of C-reactive protein (CRP) and increased leukocyte count. We analyzed the cross-sectional associations between work arrangements and low-grade inflammation in 1877 airline-company employees separately for men (n = 1037) and women (n = 840). The participants were classified into five categories according to their work schedule: day workers who have not worked in shifts (referent group), former shiftworkers, 2-shift workers, 3-shift workers, and in-flight workers. In models adjusted for age and recent infectious diseases, CRP levels were higher among male 3-shift workers (p = .002) and marginally higher in male 2-shift workers (p = .076). In addition, leukocyte count was higher in 2-shift (p = .005) and 3-shift (p = .021) working men. In women, CRP level was higher in 2-shift workers (p = .028), whereas leukocyte count was lower in flight workers (p = .005). Any separate adjustment additionally for smoking, education, alcohol consumption, physical activity, and obesity did not substantially affect the results of 2- and 3-shift work. In the fully adjusted model, only the association between 3-shift work and CRP in men (p = .021) and 2-shift work and leukocyte count in men (p = .020) and leukocyte count in 3-shift-working women (p = .044) were significant. Our results suggest that 2- and 3-shift work is associated with increased systemic inflammation and the relationship is relatively independent of the considered risk factors of cardiovascular disease.