A study in the March 1 issue of the journal SLEEP shows that African-American and Hispanic young adults with short or long sleep durations had greater increases in belly fat over a five-year period compared with those who reported sleeping six to seven hours a night.

Results show that in participants younger than 40 years of age, both short and long sleep durations were associated with significant increases in body mass index (BMI), as well as in subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) fat accumulation. Compared with people who reported a nightly sleep duration of six to seven hours, those with a self-reported sleep duration of five hours or less per night had an average BMI increase over a five-year period that was 1.8 kg/m2 higher, and greater accumulations of SAT (42 cm2) and VAT (13 cm2); and those who reported sleeping eight hours or more had a BMI increase that was 0.8 kg/m2 higher, as well as greater accumulations of SAT (20cm2) and VAT (6 cm2). No significant relationship existed between sleep duration and abdominal fat change in participants older than 40 years of age.

Lead author Kristen G. Hairston, M.D., assistant professor of internal medicine at Wake Forest University School of Medicine in Winston-Salem, N.C., said that obtaining a sufficient amount of sleep is important for people of all races and ethnicities. However, ethnic minorities disproportionately report extremes in sleep duration, putting them at risk for negative metabolic outcomes such as obesity and type 2 diabetes.

“Appropriate amounts of sleep are important for maintenance of healthy weight,” said Hairston. “In a group of African-American and Hispanic participants, those who slept less than this had greater increases in belly fat over a five-year period.”

Information was obtained from 1,107 people in the IRAS Family Study, an extension of the Insulin Resistance Atherosclerosis Study (IRAS). Data were collected from 332 African-Americans and 775 Hispanics with a mean age of 41.7 years at baseline and an age range from 18 to 81 years. Sixty-two percent of participants were female. Mean sleep duration at baseline was 6.7 hours in response to the question, “On average, about how many hours of sleep do you get a night?” Seventeen percent of the sample reported sleeping five hours or less per night, 55 percent slept six to seven hours per night and 28 percent averaged eight or more hours of sleep per night.

Abdominal computed tomography (CT) scans and BMI were obtained at a five-year interval. Dietary intake was assessed using a short, retrospective, one-year, semi-quantitative food-frequency interview. An estimate of usual frequency of participation in vigorous activities also was obtained. Generalized estimating equations using linear regression models assessed the association between sleep duration and five-year fat accumulation with adjustment for age, race, gender, study site, baseline fat measure, physical activity, total calorie intake, smoking status and education.

In those younger than 40 years old, a short sleep duration of five hours or less was most frequently reported by Hispanic men (30 percent), and a long sleep duration of eight or more hours was most frequently reported by Hispanic women (53 percent). Participants reporting five hours of sleep or less consumed more total calories (2,224 kcal) than those reporting six to seven hours (1,920 kcal) or eight or more hours (2,199 kcal).

The authors proposed that short sleep may impact fat accumulation by promoting increased caloric intake via increased hunger, or by reducing energy expenditure via altered thermoregulation and increased fatigue. Both increased caloric intake and decreased vigorous activity were observed in the short sleep group.

The authors also suggested that it is just as important for doctors to encourage patients to get adequate sleep as it is for them to promote a healthy diet and physical activity. This is particularly relevant when young adults make transitions involving college, marriage and childbearing, because these life stages often are associated with sleep deprivation.

A study in the March 1 issue of the journal Sleep shows that frequent napping is associated with an elevated prevalence of type 2 diabetes and impaired fasting glucose in an older Chinese population.

Results show that the prevalence of type 2 diabetes was 36 percent higher (adjusted odds ratio = 1.36) in participants who reported napping four to six times a week and 28 percent higher (OR = 1.28) in those who napped daily. Similar associations were found between napping and impaired fasting glucose. The observed associations were unaltered in statistical analyses that removed participants with potential ill health and daytime sleepiness, suggesting it is less likely that diabetes leads to daytime sleepiness and raising the possibility that napping may increase the risk of diabetes.

According to the authors, napping in China is a social norm, which is practiced by all ages primarily as a habit started in childhood. In Western countries, napping is less common and is often unplanned and prompted by sleepiness likely caused by aging, deteriorating health status or nighttime complaints.
Lead author Neil Thomas, PhD, reader in epidemiology at the University of Birmingham, U.K., said that additional research is needed to determine if napping itself plays a causative role in the development of type 2 diabetes, or if other factors are involved.

“In many non-Mediterranean, Western countries a large proportion of those that nap are generally older or have other conditions that cause tiredness and create an urge to nap,” said Thomas. “The napping can therefore be a marker of disease.”

This cross-sectional study analyzed baseline data from the Guangzhou Biobank Cohort Study, a collaboration between the Guangzhou Number 12 People’s Hospital and the Universities of Birmingham and Hong Kong. The community-based study took place in Guangzhou, China, where 19,567 participants between the ages of 50 and 93 years were recruited from 2003 to 2004 and 2005 to 2006. The sample comprised 13,972 women with a mean age of 61.4 years and 5,595 men with an average age of 64.2 years.

Participants underwent a half-day assessment, which included a structured interview on lifestyle and medical history, and a physical examination. Self-reported frequency of napping was obtained by questionnaire, and type 2 diabetes was assessed by a fasting blood glucose sample and/or self-reports of physician diagnosis or treatment. Participants were asked to describe their napping habits and daytime sleepiness.

Type 2 diabetes was identified in 13.5 percent of the sample and was more prevalent in people who reported napping daily (15.1 percent) and in those who napped four to six times per week (14.7 percent). Logistic regression models were constructed to assess the relationship between napping and diabetes and impaired fasting glucose, adjusting for demographics, lifestyle, sleep habits, health status, body fat and metabolic markers.

At least one nap per week was reported by 67.2 percent of participants, more commonly in males (76.4 percent) than in females (63.6 percent). About 59.4 percent of these people reported napping daily. Total sleep duration was longer and daytime sleepiness was reported less often in more frequent nappers than in people who never napped.

In a sub-sample of 3,822 participants who were re-contacted for additional information about sleep habits, there was a statistically significant trend of increasing risk of diabetes with longer nap duration. Compared with people who never took naps, the risk of diabetes was 41 percent higher (OR = 1.41) for people who took naps that lasted longer than 30 minutes and 35 percent higher (OR = 1.35) for people whose naps lasted 30 minutes or less.

The authors noted that the association between napping and diabetes was observed despite the fact that nappers had higher levels of physical activity, which has been shown to reduce the risk of diabetes. This suggests that the relationship between napping and diabetes might have been stronger had it not been offset by the protective effects of physical activity. The authors added that there will be profound public health implications in China if the relationship between napping and increased risk of type 2 diabetes is confirmed in longitudinal studies, as the nation is currently affected by an emerging diabetes epidemic.

If you are among those who suffer from sleep deprivation, getting one night of good sleep won’t make up for the deficit. Chronic sleep deficit causes detrimental effects on one’s ability to remain alert and attentive, and leads to cumulative effects on performance that could become a safety risk.

The information comes from a report based on the findings of an analysis performed by U.S. researchers that was recently published in the journal Science Translational Medicine. In a telephone interview, lead author Daniel Cohen, a neurologist at Brigham and Women’s Hospital in Boston, said, “Insufficient sleep over multiple sleep-wake cycles causes performance to deteriorate much faster for every additional hour we spend awake, particularly during the biological night.” According to Cohen, the average person needs about eight hours of sleep nightly to preserve performance. He explained that chronic sleep loss occurs when a person gets only four to seven hours of sleep per night, whereas acute sleep loss occurs when a person is awake for more than 24 hours in a row.

During the study, the researchers followed a group of nine healthy participants, including five men and four women, in a hospital setting for a period of 38 days. They were each given five days to “catch up” on their sleep, followed by 21 days of a sleep cycle of approximately 33 waking hours and 10 sleeping hours.

The study participants were tested every four hours to measure their alertness and attentiveness, with three factors being considered. These included the number of consecutive hours a participant was awake, the period of time of chronic sleep reduction, measured in days or even weeks, and what time of day it was for the participant. Cohen explained, “How those three factors combine determine how well we perform at any moment.” Results revealed that although the majority of the participants were able to make up for acute sleep loss in just one night with 10 hours of sleep, participants having chronic deficit demonstrated deterioration in performance for every waking hour. Although the researchers know that three days is not a sufficient amount of time for recovery from chronic sleep loss, just how many days or weeks may be needed remains unclear.
The results suggest that sleep loss affects people in two different ways, including one that builds over the number of hours spent awake, and another that builds over days, or even weeks of getting too little sleep. The authors believe that the study findings may be of use in the development of healthier schedules for people who work shift jobs, and could also be helpful in the treatment of patients with sleep disorders.

Cohen pointed out that people may not be aware that they are suffering from chronic sleep deficit, as it builds slowly over weeks. He said, “We can falsely feel like we’ve recovered quickly from chronic sleep loss because recent sleep makes us feel relatively restored early the next day.” He then added, “People may be largely unaware that they are chronically sleep-deprived. It’s when they then stay up and try to pull an all-nighter that they are much more vulnerable to sudden sleepiness, inattentiveness, and potentially accidents and errors.”

Obstructive Sleep Apnea (OSA) adversely affects glucose control in patients with type 2 diabetes, according to a study conducted by researchers at the University of Chicago.

The study “demonstrates for the first time that there is a clear, graded, inverse relationship between OSA severity and glucose control in patients with type 2 diabetes,” wrote lead author, Renee S. Aronsohn, M.D., instructor of medicine at the University of Chicago.

The study also confirmed other reports that undiagnosed OSA is very common among patients with type 2 diabetes, indicating that it is largely unrecognized additional medical risk factor in these patients.

The findings have been published online ahead of print publication in the American Thoracic Soceity’s American Journal of Respiratory and Critical Care Medicine.

Dr. Aronsohn and colleagues consecutively recruited patients with type 2 diabetes from outpatient clinics to participate in the study. The participants were interviewed to assess their diabetes history, medical history and medications, and level of physical activity. Height and weight measurements were also taken, and each participant’s sleep/wake cycles were monitored for five days using wrist actigraphy and self-reported sleep logs. Finally, participants underwent an overnight polysomnography test for OSA , and glucose control was assessed by obtaining a blood sample for hemoglobin A1c (HbA1c) measurement, the main clinical marker of glycemic control in diabetes

In total, 60 patients were included in the study’s final analysis. More than three-quarters (77 percent) of participants had OSA, but only five had been previously evaluated for the disease, and none were undergoing treatment. Of the study sample, 38 percent (23) were classified as having mild OSA, 25 percent (15) had moderate OSA and the 13 percent (8) had severe OSA.

The researchers found that more severe OSA was associated with poorer glucose control, implying a role more severe diabetes with potentially more complications. Relative to patients without OSA, the presence of mild, moderate or severe OSA significantly increased mean adjusted HbA1c values by 1.49 percent, 1.93 percent, and 3.69 percent respectively. These effect sizes are comparable to those of widely used hypoglycemic medications, meaning that having OSA may negate the beneficial effects of anti-diabetic drugs.

“Our findings have important clinical implications as they support the hypothesis that reducing the severity of OSA may improve glycemic control,” said Dr. Aronsohn. “Thus effective treatment of OSA may represent a novel and non-pharmacologic intervention in the management of type 2 diabetes.”

“Physicians who manage patients with type 2 diabetes should screen their patients for OSA,” commented John Heffner, M.D., past president of the ATS. “At least 80 percent of their patients, if properly screened and studied, will be found to have OSA, which is a treatable condition. Treating their breathing problem might improve their glycemic control and long-term complications from diabetes.”

Wives of soldiers deployed to Iraq and Afghanistan are more likely to be diagnosed with depression, anxiety, sleep disorders and other mental health conditions than women whose husbands are not deployed, according to a new study by researchers at the University of North Carolina at Chapel Hill and the Uniformed Services University of the Health Sciences.

The study, published Jan. 14, 2010, in The New England Journal of Medicine, examined medical records of the wives of active duty U.S. Army personnel, comparing those whose husbands were serving abroad with those whose husbands were not deployed.

“This study confirms what many people have long suspected,” said Alyssa Mansfield, Ph.D., the study’s lead author, who conducted the research as a doctoral student at the UNC Gillings School of Global Public Health and is now a research epidemiologist at RTI International. “It provides compelling evidence that Army spouses are feeling the impact of recent deployments to Iraq and Afghanistan. The result is more depression, more stress, more sleepless nights.”

Understanding the scope of the problem can help the U.S. military better plan mental health prevention and treatment programs for the families of active duty personnel, she said. The study also may provide insight into families’ long-term medical needs.

The researchers examined medical records of more than 250,000 female spouses of active duty Army personnel for outpatient care received between 2003 and 2006. About 31 percent of the wives’ husbands were not deployed during that period, while about 34 percent were overseas for between one and 11 months and 35 percent were deployed for longer.

Although the three groups were similar in size, the study found almost 3,500 more diagnoses of mental health conditions among wives of soldiers deployed for less than a year, compared to the group of wives of non-deployed soldiers. Also, there were more than 5,300 additional diagnoses among wives of soldiers deployed for a year or longer.

Depression, anxiety, sleep disorders and acute stress reaction and adjustment disorders were the most commonly diagnosed conditions among both groups.

Spouses of deployed military personal naturally fear for their loved ones’ safety, Mansfield said. But they also often face challenges maintaining a household, coping as a single parent and dealing with the marital strain that comes with being apart for an uncertain amount of time.

“The majority of active duty soldiers are married, so we need to pay attention to the needs of their families, both short and long term,” Mansfield said. “These findings should help the military medical system better plan mental health programs not only for treatment, but also for support and prevention.”

Only about 8 percent of high school students get enough sleep on an average school night, a large new study finds. The others are living with borderline-to-serious sleep deficits that could lead to daytime drowsiness, depression, headaches and poor performance at school.

The study, which appears online in the Journal of Adolescent Health, evaluated responses from 12,000 students in grades 9 through 12 who participated in the 2007 national Youth Risk Behavior Survey.

The authors found that 10 percent of adolescents sleep only five hours and 23 percent sleep only six hours on an average school night. More females than males have sleep deficits as do more African-Americans and whites compared to Hispanics. Nearly 20 percent more 12th-grade students have sleep deficits than do those in ninth grade.

The findings of this study were consistent with those reported from the National Sleep Foundation’s 2006 Sleep in America Poll, the authors say, adding that that although no formally accepted sleep guidelines exist, the foundation defines nine hours a night as optimal for adolescents, eight hours as borderline and anything under eight hours as not enough.

“The natural sleep-wake pattern shifts during adolescence, making earlier bed time and wake times more difficult. The result for students with early school start-times is a chronic sleep deficit,” said lead study author Danice Eaton, Ph.D., of the Centers for Disease Control and Prevention.

As students progress through high school, demands on their time from hectic social activities, jobs, homework and family obligations increase and they sleep less to fit them in, as the study shows. Compounded with their delayed sleep-wake pattern, many students are getting up for school when their bodies tell them it is still the middle of the night.

National Sleep Foundation research shows that delaying school start-times by an hour or more increases the amount of sleep adolescents get and improves their performance in school. However, to promote optimal sleep, Eaton said that adolescents should have set bedtimes before 10 p.m. on school nights and consistent wake-sleep times every night.

Brandy Roane, an expert in adolescent sleep patterns at the Munroe-Meyer Institute of Genetics and Rehabilitation of the University of Nebraska Medical Center, said, “Given adolescents’ downward spiraling tendency of depriving themselves of sleep during the week and playing catch-up on the weekend, more research exploring ways to intervene would be beneficial.”

Adolescents and teens that get to bed at a “decent” time are far less likely to encounter depression or even having suicidal thoughts. In the study done at Columbia University Medical Center in New York, researchers found that children’s guardians who set bedtimes of midnight or later were 24% more likely to suffer from depression and 20% more apt to have thoughts of suicide then kids who went to bed 10:00pm or earlier .

Researchers report in the Jan. 1 issue of the journal SLEEP, that sufficient sleep may offer youngsters some protection from depression and thoughts of suicide. Researchers found that teens who stated they slept five or fewer hours per night were 71% more likely to report depression, and 48% more likely to have thoughts of committing suicide, compared to young people reporting eight hours of sleep. “Our results are consistent with the theory that inadequate sleep is a risk factor for depression,” says study researcher James E. Gangwisch, PhD.

Gangwisch and his colleagues studied more than 15,000 students and their parents at US schools from age 12 to 17. The normal sleep duration was seven hours and 53 minutes, against the nine or more hours of nightly sleep recommended for adolescents. Adolescents who went to bed at 10pm or earlier slept on average eight hours and ten minutes which is 33 minutes longer than those who went to bed at 11pm, and 40 minutes more than those who went to bed past midnight.

Gangwisch states, “Adequate quality sleep could therefore be a preventative measure against depression and a treatment for depression.” Of the parents questioned, 54 per cent of parents said their child had to go to bed by 10pm or earlier on weeknights, 21 per cent reported setting a bedtime of 11pm, and 25 per cent reported setting a bedtime of midnight or later.

Researchers believe that sleep deprivation is directly linked to depression and suicidal thoughts, leaving kids less able to cope with daily stress and with more difficulties in engaging with peers and adults. In addition, less sleep is more likely to make them moody.

The research backs up prior findings that demonstrated having trouble sleeping could lead to illnesses including psychiatric conditions, attention deficit disorder, post traumatic stress and depression. Some scientists suggest that a lack of sleep can cause fluctuations in hormones in the body, including those which relate to how we deal with stress. Researchers also think that dreaming about problems may help the body to process painful memories and promote good mental health.

Gangwisch and researchers conclude that parents of adolescents should set earlier bedtimes to make sure their teens get adequate sleep and avoid depression and thoughts of suicide.

Research published in the current issue of the journal, Clinical Science, appears to have found a link between obstructive sleep apnoea and non-alcoholic steatohepatitis. Dr Anne-Christine Piguet and colleagues from the University of Bern, Switzerland, kept mice for a week in low-oxygen atmospheres and found that it led to increased levels of fat and inflammation in their livers.

Apnoea means “without breath” and occurs when the muscles in the airways behind the tongue relax in sleep, causing the person to snore and briefly, to stop breathing.

Nonalcoholic steatohepatitis (NASH) is a common, often “silent” liver disease occurring in around 40% of the population. It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. NASH can be severe and can lead to cirrhosis, in which the liver is permanently damaged and scarred and no longer able to work properly.

Obesity predisposes patients to both fatty liver diseases and obstructive sleep apnoea.

To mimic the effects of low oxygen levels caused by the repeated obstruction of the upper airways in sleep apnoea, the researchers kept mice in a low oxygen environment for seven days. After this time they were found to have more fat and inflammation in their livers compared to mice that had been kept in atmospheres with normal levels of oxygen. When the mice were exposed to low oxygen levels, the genes that controlled fat synthesis in the liver seemed to be more active while those that controlled fat breakdown demonstrated reduced activity.

In addition, the mice exposed to low levels of oxygen became less sensitive to insulin. This is the mechanism by which the body regulates blood sugar and is a cause of diabetes. Metabolic disorders such as diabetes and obesity can cause complications in patients with NASH.

Commenting on the finding, Dr Piguet said, “Hypoxia (lack of oxygen) may be the link leading to accumulation of fat in the liver and to the progression of non-alcoholic steatohepatitis. Our findings show that it is important both to screen obese patients for obstructive sleep apnoea to prevent it contributing to fatty liver disease and to treat those patients who already have NASH for hypoxia which may be making their condition worse”.

Many alcoholic beverages contain byproducts of the materials used in the fermenting process. These byproducts are called “congeners,” complex organic molecules with toxic effects including acetone, acetaldehyde, fusel oil, tannins, and furfural. Bourbon has 37 times the amount of congeners that vodka has. A new study has found that while drinking a lot of bourbon can cause a worse hangover than drinking a lot of vodka, impairment in people’s next-day task performance is about the same for both beverages.

Results will be published in the March 2010 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“While the toxic chemicals called congeners could be poisonous in large amounts, they occur in very small amounts in alcoholic beverages,” explained Damaris J. Rohsenow, professor of community health at the Center for Alcohol and Addiction Studies at Brown University. “There are far more of them in the darker distilled beverages and wines than in the lighter colored ones. While the alcohol alone is enough to make many people feel sick the next day, these toxic natural substances can add to the ill effects as our body reacts to them.”

Rohsenow added that few studies have looked at the effects of high- versus low-congener beverages on next-day hangover or performance, and some of those early studies were not careful to wait until breath alcohol levels (BALs) were close to zero before measuring performance, so results may have included some of alcohol’s direct effects.

“We wanted to investigate next-day effects of bourbon versus vodka while ensuring that BALs were zero or almost zero when we studied performance, and we used a variety of performance measures classified by their relevance to safety,” said Rohsenow. “We wanted to use a new hangover questionnaire that included only the symptoms that had been found to be valid in laboratory studies of hangover. We wanted to find out if bourbon’s effects the next day were due to different effects on sleep, so people’s sleep patterns were recorded while they slept. Finally, we wanted to know if performance impairments the morning after drinking were associated with how hung-over the person felt.”

Researchers recruited and paid 95 (58 women, 37 men) healthy, heavy drinkers to participate in one acclimatization night, followed by two drinking nights. The participants drank bourbon or vodka to an average of 0.11 g% BAL on one night, with a matched placebo on the other night, randomized for type and order. Polysomnography recordings were made overnight; self-report and neurocognitive measures were assessed the next morning.

“First, while alcohol in the beverage did increase how hung-over people reported feeling the next morning compared to drinking a placebo, bourbon made people feel even worse than vodka did,” said Rohsenow. “Second, alcohol in the beverage did make people do worse when they needed to pay attention for a continuous period of time while making rapid accurate choices, but they did no worse after bourbon than after vodka on these tasks. Therefore, while people felt worse, they didn’t perform worse after bourbon than after vodka. However, people were not aware that they were performing worse since they thought their driving ability was not impaired in the morning even though they could not react as well.” She added that other studies have found that professional pilots do worse on aspects of flying that require continuous attention across tasks the morning after drinking to intoxication.

“A third finding was that while alcohol in the beverages made people sleep less well because they woke up more during the night, this was no worse after bourbon than it was after vodka,” Rohsenow said. “This means that bourbon’s greater effects on hangover are not due to it having greater effects on sleep. Fourth, people who reported more hangover symptoms also did worse in their ability to pay attention for a continuous period of time while making rapid accurate choices.”

Regarding this last finding, that people with more hangover symptoms – feelings of headache, nausea, general lousiness, thirst and fatigue – also performed worse when required to pay continuous attention and make choices, Rohsenow said that feeling worse was perhaps distracting them, or that it just hurt more to use the extra energy needed to pay close attention. “A second possibility is that as alcohol was metabolized into other substances in the body before leaving, these substances had a direct effect on the nervous system in addition to increasing hangover so that these were two separate but related after-effects of drinking to intoxication,” she said.

The bottom line, said Rohsenow, is that becoming intoxicated to a .11 g% BAL makes it less safe for a person to engage in behaviors required for safety-sensitive performance the next morning. “Many safety-sensitive occupations require that workers be able to pay close attention to a number of tasks over a period of time, and to respond quickly with the right choices, and drinking to excess was found to impair this performance just after alcohol had left people’s bodies.”

Shift work exposures can accelerate metabolic syndrome (MetS) development among the large population of middle-aged males with elevated alanine aminotransferase (ALT). Elevated serum alanine aminotransferase (e-ALT) is a common abnormality of health examinations in middle-aged working populations. It is unavoidable nowadays that a large number of asymptomatic workers with e-ALT may be asked to do rotating shift work on 24 h production lines. In some previous studies, e-ALT and shift work had been independently assessed for their associations with MetS, which is associated with cardiovascular disease, one of the leading causes of death among working populations.

In terms of workplace health management and job arrangements, a five-year follow-up study assessing the association between rotating shift work (RSW) and MetS development was conducted in Taiwan for male workers. In some previous studies, e-ALT and shift work had been independently assessed for their associations with MetS, which is associated with cardiovascular disease, one of the leading causes of death among working populations.

A research article written by Dr. Yu-Cheng Lin et al from Tao-Yuan General Hospital, Taiwan, which has recently been published in World Journal of Gastroenterology, took both risk factors together into consideration, and demonstrated significant findings. In Lin’s study, after a five-year interval, the workers with baseline e-ALT had significantly unfavorable changes in MetS-component abnormalities, and higher rates of MetS development, vs subjects with normal baseline ALT. Particularly, workers who had both baseline e-ALT and long-term RSW exposures had the highest rate of MetS development among four subgroups divided by e-ALT and RSW. Statistically, e-ALT-plus-RSW workers had a significant risk for MetS development.

Lin et al stated that, MetS development among middle-aged males with e-ALT should be carefully monitored. In terms of job arrangements, long-term shift workers with e-ALT deserve special attention for MetS development. They suggested that all workers with e-ALT should be carefully evaluated and managed for MetS. Particularly, MetS risk assessment must be emphasized for male employees with e-ALT facing long-term rotating shift work exposures.

Public health experts agreed that this is an important area of research, given the amount of shift work performed around the globe, particularly when proponents claim that shift working is ‘beneficial’ to the health and safety of those concerned.