Night Shift Work, Diet, Meal Timing, and Cardiometabolic Risk: An Exploratory Cross-Sectional Study in Italian Cement Workers

Abstract

Rotating shift work, including night shifts, is reported by one-fifth of workers in the EU27 survey and is associated with an increased risk of cardiovascular disease. Irregular meal timing and poor dietary habits related to shift work contribute to metabolic disorders and may further elevate cardiovascular risk. In this pilot study, 14 rotating shift workers including night shifts (NSWs) and 14 regular daytime workers (DWs) underwent assessments of blood pressure, body mass index (BMI), waist (W) and hip (H) circumference, triglycerides, HDL, and LDL cholesterol. All participants also completed questionnaires evaluating nutrient quality, meal timing over a week, and lifestyle factors. In NSWs, a disrupted eating schedule was observed during both workdays and rest days, with frequent lunch skipping in favour of high-fat snacks. Weekly intake of junk food was higher (p < 0.01) and fresh vegetable consumption lower (p < 0.05) in NSWs compared to DWs. BMI, W/H ratio, and triglyceride levels were slightly higher in NSWs. Active smoking was more common among NSWs (50%) than DWs (21%, p < 0.01). Excess body weight, dyslipidemia, and higher smoking prevalence—combined with a long-standing pattern of unhealthy eating may, along with circadian misalignment, contribute to the elevated cardiometabolic risk observed in otherwise healthy NSWs. Implementing workplace policies to improve nutrient quality and meal timing may help reduce the risk of cardiometabolic disorders in this population.

Keywords

shift work / eating time / cardiometabolic risk / metabolic syndrome / nutrients

References

[1] EU-OSHA. Available online: https://oshwiki.osha.europa.eu/en/themes/working-time (accessed on 15 June 2025).

[2] Knutsson A.; Jonsson B.G.; Akerstedt T.; et al. Increased risk of ischaemic heart disease in shift workers. Lancet 1986, 328, 89-92.

[3] Åkerstedt T.; Knutsson A.; Alfredsson L.; et al. Shift work and cardiovascular disease. Scand. J. Work. Environ. Health 1984, 10, 409-414.

[4] Torquati L.; Mielke G.I.; Brown W.J.; et al. Shift work and the risk of cardiovascular disease. A systematic review and meta-analysis including dose-response relationship. Scand. J. Work. Environ. Health 2018, 44, 229-238.

[5] Ferguson J.M.; Costello S.; Neophytou A.M.; et al. Night and rotational work exposure within the last 12 months and risk of incident hypertension. Scand. J. Work. Environ. Health 2019, 45, 256-266.

[6] Vetter C.; Devore E.E.; Wegrzyn L.R.; et al. Association Between Rotating Night Shift Work and Risk of Coronary Heart Disease Among Women. JAMA 2016, 315, 1726-1734.

[7] Rosa D.; Terzoni S.; Dellafiore F.; et al. Systematic review of shift work and nurses’ health. Occup. Med. 2019, 69, 237-243.

[8] Zhao Y.; Lu X.; Wan F.; et al. Disruption of Circadian Rhythms by Shift Work Exacerbates Reperfusion Injury in Myocardial Infarction. J. Am. Coll. Cardiol. 2022, 79, 2097-2115.

[9] Boivin D.B.; Boudreau P.; Kosmadopoulos A. Disturbance of the Circadian System in Shift Work and Its Health Impact. J. Biol. Rhythm. 2022, 37, 3-28.

[10] Ha M.; Park J. Shiftwork and metabolic risk factors of cardiovascular disease. J. Occup. Health 2005, 47, 89-95.

[11] Allada R.; Bass J. Circadian Mechanisms in Medicine. Engl. J. Med. 2021, 384, 550-561.

[12] Flo E.; Bjorvatn B.; Folkard S.; et al. A reliability and validity study of the Bergen Shift Work Sleep Questionnaire in nurses working three-shift rotations. Chronobiol. Int. 2012, 29, 937-946.

[13] Furlan R.; Barbic F.; Piazza S.; et al. Modifications of cardiac autonomic profile associated with a shift schedule of work. Circulation 2000, 102, 1912-1916.

[14] Shiffer D.; Minonzio M.; Dipaola F.; et al. Effects of Clockwise and Counterclockwise Job Shift Work Rotation on Sleep and Work-Life Balance on Hospital Nurses. Int. J. Environ. Res. Public Health 2018, 15, 2308.

[15] Gomes S.; Ramalhete C.; Ferreira I.; et al. Sleep Patterns, Eating Behavior and the Risk of Noncommunicable Diseases. Nutrients 2023, 15, 2462.

[16] Szewczyk-Golec K.; Woźniak A.; Reiter R.J. Inter-relationships of the chronobiotic, melatonin, with leptin and adiponectin: Implications for obesity. J. Pineal Res. 2015, 59, 277-291.

[17] Russo B.; Menduni M.; Borboni P.; et al. Autonomic Nervous System in Obesity and Insulin-Resistance-The Complex Interplay between Leptin and Central Nervous System. Int. J. Mol. Sci. 2021, 22, 5187.

[18] Qian J.; Morris C.J.; Caputo R.; et al. Circadian misalignment increases 24-hour acylated ghrelin in chronic shift workers: A randomized crossover trial. Obesity 2023, 31, 2235-2239.

[19] D’Agostino Sr, R.B.; Vasan R.S.; Pencina M.J.; et al. General cardiovascular risk profile for use in primary care: The Framingham Heart Study. Circulation 2008, 117, 743-753.

[20] Buijs R.M.; Kreier F. The metabolic syndrome: A brain disease? J. Neuroendocrinol. 2006, 18, 715-716.

[21] Iavicoli I.; Spatari G.; Chosewood L.C.; et al. Occupational Medicine and Total Worker Health(R): From preventing health and safety risks in the workplace to promoting health for the total well-being of the worker. La Med. Del Lav. 2022, 113, e2022054.

[22] Fonarow G.C.; Calitz C.; Arena R.; et al. Workplace wellness recognition for optimizing workplace health: A presidential advisory from the American Heart Association. Circulation 2015, 131, e480- e497.

[23] Phoi Y.Y.; Dorrian J.; Rogers M.; et al. Chronotype, temporal patterns of eating and diet composition on work and work-free days. Chronobiol. Int. 2024, 41, 1556-1565.

[24] Saggi M.K.; Phillips C.L.; Comas M.; et al. Does daily energy and macronutrient intake differ between work and non-workdays in shift workers? A mixed methods study. Chronobiol. Int. 2023, 40, 1039-1048.

[25] Kollias A.; Foukarakis E.; Karakousis K.; et al. Implementation of the 2018 ESC/ESH Guidelines for the management of hypertension in primary care: The HYPEDIA study. J. Hum. Hypertens. 2023, 37, 449-454.

[26] Abramson J.H.; Slome C.; Kosovsky C. Food frequency interview as an epidemiological tool. Am. J. Public Health Nations Health 1963, 53, 1093-1101.

[27] Arie S. WHO calls for more action to protect children from online junk food advertising. BMJ 2019, 364, l1221.

[28] WHO. Healthy Diet. Available online: https://iris.who.int/bitstream/handle/10665/325828/EMROPUB_2019_en_23536.pdf (accessed on 12 June 2025).

[29] WHO. Diet, Nutrition and the Prevention of Chronic Diseases:Report of A Joint WHO/FAO Expert Consultation; WHO: Geneva, Switzerland, 2002.

[30] Lotti S.; Moretton M.; Bulgari M.; et al. Association between shift work and eating behaviours, sleep quality, and mental health among Italian workers. Eur. J. Nutr. 2025, 64, 97.

[31] Clark A.B.; Coates A.M.; Davidson Z.E.; et al. Dietary Patterns under the Influence of Rotational Shift Work Schedules: A Systematic Review and Meta-Analysis. Adv. Nutr. 2023, 14, 295-316.

[32] Liu Q.; Shi J.; Duan P.; et al. Is shift work associated with a higher risk of overweight or obesity? A systematic review of observational studies with meta-analysis. Int. J. Epidemiol. 2018, 47, 1956-1971.

[33] Rivera A.S.; Akanbi M.; O’Dwyer L.C.; et al. Shift work and long work hours and their association with chronic health conditions: A systematic review of systematic reviews with meta-analyses. PLoS ONE 2020, 15, e0231037.

[34] Hunger B.; Seibt R. Psychosocial Work Stress and Health Risks—A Cross-Sectional Study of Shift Workers from the Hotel and Catering Industry and the Food Industry. Front. Public Health 2022, 10, 849310.

[35] Xu M.; Yin X.; Gong Y. Lifestyle Factors in the Association of Shift Work and Depression and Anxiety. JAMA Netw. Open 2023, 6, e2328798.

[36] Roskoden F.C.; Krüger J.; Vogt L.J.; et al. Physical Activity, Energy Expenditure, Nutritional Habits, Quality of Sleep and Stress Levels in Shift-Working Health Care Personnel. PLoS ONE 2017, 12, e016998343.

[37] Tobaldini E.; Fiorelli E.M.; Solbiati M.; et al. Short sleep duration and cardiometabolic risk: From pathophysiology to clinical evidence. Nat. Rev. Cardiol. 2019, 16, 213-224.

[38] Guarino D.; Nannipieri M.; Iervasi G.; et al. The Role of the Autonomic Nervous System in the Pathophysiology of Obesity. Front. Physiol. 2017, 8, 665.

[39] Lennernäs M.; Åkerstedt T.; Hambraeus L. Nocturnal eating and serum cholesterol of three-shift workers. Scand. J. Work. Environ. Health 1994, 20, 401-406.

[40] Zitting K.M.; Vetrivelan R.; Yuan R.K.; et al. Chronic circadian disruption on a high-fat diet impairs glucose tolerance. Metabolism 2022, 130, 155158.

[41] Eriksson A.K.; Van Den Donk M.; Hilding A.; et al. Work stress, sense of coherence, and risk of type 2 diabetes in a prospective study of middle-aged Swedish men and women. Diabetes Care 2013, 36, 2683-2689.

[42] Broussard J.L.; Klein S. Insufficient sleep and obesity: Cause or consequence. Obesity 2022, 30, 1914-1916.

[43] Wu Q.J.; Sun H.; Wen Z.Y.; et al. Shift work and health outcomes: An umbrella review of systematic reviews and meta-analyses of epidemiological studies. J. Clin. Sleep Med. 2022, 18, 653-662.

[44] Gopalakrishnan S.; Kannan N.N. Only time will tell: The interplay between circadian clock and metabolism. Chronobiol. Int. 2021, 38, 149-167.

[45] Rudic R.D.; McNamara P.; Curtis A.-M.; et al. BMAL1 and CLOCK, two essential components of the circadian clock, are involved in glucose homeostasis. PLoS Biol. 2004, 2, e377.

[46] Johnston J.D. Physiological links between circadian rhythms, metabolism and nutrition. Exp. Physiol. 2014, 99, 1133-1137.

[47] Kim T.W.; Jeong J.H.; Hong S.C. The impact of sleep and circadian disturbance on hormones and metabolism. Int. J. Endocrinol. 2015, 2015, 591729.

[48] Catalano F.; De Vito F.; Cassano V.; et al. Circadian Clock Desynchronization and Insulin Resistance. Int. J. Environ. Res. Public Health 2022, 20, 29.

[49] Stenvers D.J.; Scheer FA J.L.; Schrauwen P.; et al. Circadian clocks and insulin resistance. Nat. Rev. Endocrinol. 2019, 15, 75-89.

[50] Lewis P.; Oster H.; Korf H.W.; et al. Food as a circadian time cue—Evidence from human studies. Nat. Rev. Endocrinol. 2020, 16, 213-223.

[51] Wehrens SM T.; Christou S.; Isherwood C.; et al. Meal Timing Regulates the Human Circadian System. Curr. Biol. 2017, 27, 1768-1775.e3.

[52] Pan A.; Schernhammer E.S.; Sun Q.; et al. Rotating night shift work and risk of type 2 diabetes: Two prospective cohort studies in women. PLoS Med. 2011, 8, e1001141.

[53] Kecklund G.; Axelsson J. Health consequences of shift work and insufficient sleep. BMJ 2016, 355, i5210.

[54] Holtermann A.; Krause N.; Van Der Beek A.J.; et al. The physical activity paradox: Six reasons why occupational physical activity (OPA) does not confer the cardiovascular health benefits that leisure time physical activity does. Br. J. Sports Med. 2018, 52, 149-150.

[55] Hallman D.M.; Mathiassen S.E.; Gupta N.; et al. Differences between work and leisure in temporal patterns of objectively measured physical activity among blue-collar workers. BMC Public Health 2015, 15, 976.

[56] Quintiliani L.; Poulsen S.; Sorensen G. Healthy Eating Strategies in the Workplace. Int. J. Workplace Health Manag. 2010, 3, 182-196.

[57] Leso V.; Carugno M.; Carrer P.; et al. The Total Worker Health(R) (TWH) approach: A systematic review of its application in different occupational settings. BMC Public Health 2024, 24, 2037.

[58] Rongen A.; Robroek S.J.W.; van Lenthe F.J.; et al. Workplace health promotion: A meta-analysis of effectiveness. Am. J. Prev. Med. 2013, 44, 406-415.

[59] Veronesi G.; Borchini R.; Landsbergis P.; et al. Cardiovascular disease prevention at the workplace: Assessing the prognostic value of lifestyle risk factors and job-related conditions. Int. J. Public Health 2018, 63, 723-732.

[60] Ferrario M.M.; Veronesi G.; Bertù L.; et al. Job strain and the incidence of coronary heart diseases: Does the association differ among occupational classes? A contribution from a pooled analysis of Northern Italian cohorts. BMJ Open 2017, 7, e014119.

[61] Chellappa S.L.; Gao L.; Qian J.; et al. Daytime eating during simulated night work mitigates changes in cardiovascular risk factors: Secondary analyses of a randomized controlled trial. Nat. Commun. 2025, 16, 3186.

[62] Magnavita N.; Di Prinzio R.R.; Arnesano G.; et al. Association of Occupational Distress and Low Sleep Quality with Syncope, Presyncope, and Falls in Workers. Int. J. Environ. Res. Public Health 2021, 18, 12283.