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Review article

Dietary habits of night shift workers – a reason or an excuse for poor nutrition

Svetlana Anđelković1, Maja Babić2
  • Institute for Workers' Health Protection "Niš", Niš, Serbia
  • Institute for Workers' Health Protection "Železnice Srbije", Niš, Serbia

ABSTRACT

The availability of artificial light and light-emitting devices has changed human life in relation to time, enabling 24-hour health care, trade, and production, as well as the expansion of social life around the clock. In Europe, about 21% of the labor force consists of shift workers. 10% of the employed population work evening shifts or the night shift, and 7% of employees in Europe regularly work the night shift. According to the Bureau of Labor Statistics, more than 15 million Americans work the night shift. Shift work, especially night-time work, seriously affects dietary habits.

It is known that night-time work produces a conflict between the socially determined rhythm of eating and the circadian biological rhythms related to the feeling of hunger, satiety, as well as the metabolism itself. Night meals cause disorders of intestinal motility, affect digestion, absorption, but also the utilization of nutrients and possible medical therapy (if the individual has one). From the point of view of chronobiology, humans belong to diurnal species, which to a certain extent explains why night shift workers have a decreased appetite at night, when the human body is programmed for rest and fasting, as well as for endogenous mobilization of glucose. From the psychosocial aspect, shift workers usually experience a discrepancy between their daily routines (including the meal schedule) and those they have with family and friends, which further leads to even more severe disorders of dietary habits.

However, it is difficult to give dietary recommendations regarding nutrition. Firstly, there are no clear views on whether night shift workers should eat during the night hours or not. Secondly, even if night eating is encouraged, definitive evidence is lacking on which types of food should be consumed and which should be avoided. Thirdly, the most nutritious foods may not be available at that time of night. Finally, eating at night certainly has an impact on the metabolism. With all the above in mind, we have tried to provide some useful guidelines regarding these issues.


INTRODUCTION

Over the past three to four billion years, life on Earth has evolved according to a predictable solar day pattern, i.e., being exposed to relatively bright light during the day and to darkness during the night. It has been known for quite some time that all living organisms have an internal biological clock that helps them adjust to the rhythm of the day. Such cyclic changes are called biorhythms. Human circadian rhythm is the most significant example of a biorhythm. The processes and structures that make up circadian rhythms are called circadian clocks. The master biological clock in humans is a cluster of about 20.000 nerve cells based in the hypothalamus and it is called suprachiasmatic nucleus (SCN) [1],[2]. The availability of artificial light and light-emitting devices has changed human life by enabling us to be active 24/7, which leads to circadian misalignment and, eventually, to disturbances in physiological and behavioral functioning of an individual. In many professions (a baker, a doctor, a police officer, a night guard), the night shift is a necessary part of a regular working day, but many other occupations do not have regular hours either, but the work is done in the wee hours as well. In some professions, such as doctors or medical staff, there are rotation schedules, but in some other cases employees are "stuck" working at night, until the morning hours. In Europe, around 21% of the labor force consists of shift workers. 10% of all employees work evening shifts or the night shift, and 7% of European employees regularly work the night shift. According to the Bureau of Labor Statistics, more than 15 million Americans work the night shift [3],[4].

According to the Council of the European Union, shift work is defined [5] as "any method of organizing work in shifts so that employees take turns on same job positions according to a determined schedule". In the past, only a limited number of employees were engaged in shift work. However, in recent years, many sectors have organized their work that way.

In the Republic of Serbia, night-time work is defined by Article 62 of the Employment Act [6], according to which "each work performed between 10 PM and 6 AM of the following day is deemed to be nighttime work". An employer is bound to provide an employee who works at night for at least three hours every workday or one third of the full-time working hours in course of one working week, with the performance of jobs during daytime, should such work, according to the opinion of a competent health-service agency, cause deterioration of the employee’s health condition. Before introducing night-time work, an employer is obliged to request an opinion of the trade union about the measures of safety and protection of life and health of employees who work during night-time.

From a chronobiological point of view, the human species is diurnal (i.e., active during the day), which means that shift work, especially night-time work, requires people to work during the biological night (when circadian clocks promote sleep) and to sleep during the biological day (when circadian clocks promote activity), which may lead to a change in dietary habits and in the nutritive value of food owing to a broad spectrum of biological, social and cultural factors. For example, it was found that night-time work caused a conflict between the determined meal schedule and circadian biological rhythms related to the feeling of hunger, satiety, as well as the metabolism itself [7],[8]. The issue of nutrition has always affected the quality of work and health of employees, taking the following into consideration: different workload, different energy requirements, and different nutrient requirements. However, it is difficult to provide dietary guidelines for night shift workers. Firstly, we do not know whether employees who work at night should eat at all when at work or not. Secondly, there is no definitive proof we would rely on concerning the food they should eat or avoid. Thirdly, the most nutritious foods may not be available at that time of night. Finally, eating at night may improve one’s wellbeing, but damage their metabolism.

Circadian rhythm and enzyme secretion

The central biological clock based in the suprachiasmatic nucleus controls the metabolism by cycling over the period of 24 hours, whereas peripheral body clocks located in tissues throughout the body are synchronized with the master clock when external factors (exposure to light, physical activity, and food intake) follow daily patterns.

At night, circadian processes promote sleep and fasting by means of regulatory hormones such as melatonin and insulin, while feeding and activity dominate daytime hours with the optimization of metabolic processes for energy expenditure, insulin secretion, and cholesterol and glycogen synthesis that occur during the early part of the day. Nocturnal eating and altered sleep time, which are typical of night shift workers, disrupt the synchronization of the central clock and peripheral clocks and impact on the hormones that are affected by poor sleep and food intake.

Each stimulus corresponds to the initiation of enzyme secretion which is in perfect harmony with energy and caloric requirements of a human being, which in turn corresponds to the needs of functioning of their organism.

In the morning, protease secretion occurs to metabolize proteins, as well as lipase secretion which is of importance for metabolizing lipids that will be used during the following night for building cell walls. Circadian oscillations affect lipid metabolism as well. It has been concluded that many proteins associated with lipid metabolism (e.g., ApoB, ApoA1, and ApoA4), intestinal microsomal triglyceride transfer protein and intestinal fatty acid binding protein undergo changes during the day [9],[10],[11]. Moreover, mouse studies show that the absorption of cholesterol and lipids is greater in the dark phase than in the light phase. Some products of lipid metabolism also exhibit a circadian rhythm. For example, the level of circulating non-esterified fatty acids in humans is higher at night due to increased lipolytic activity [12]. These two secretions are preceded by cortisol secretion which is also controlled by the suprachiasmatic nucleus (SCN) located in the hypothalamus. Cortisol is a steroid hormone secreted by the adrenal glands. It regulates many metabolic processes such as glycogenolysis, lipolysis, and proteolysis. The amount and frequency of cortisol secretion are regulated by the circadian rhythm [13],[14]. Circulating cortisol levels are at their highest immediately before waking (between 7 AM and 8 AM). Cortisol level gradually declines during the day, and it is at its lowest during sleep, after midnight (between 2 AM and 4 AM). Cortisol is the key hormone which regulates metabolic events in the body. Elevated levels of cortisol act as a catabolic hormone which reduces lean body mass and increases energy expenditure.

Then there is insulin secretion towards the end of sleep which enables the start of using slow-digested sugars in order to enable the flow of energy necessary for the functioning of all organs throughout the day. Besides, glucose tolerance and insulin secretion vary during the day. In the natural course of metabolism, insulin sensitivity and insulin secretion decrease at night (especially between 3 AM and 5 AM) in comparison with the morning hours. This metabolic process, "the dawn phenomenon", emphasizes the impact of circadian control on glucose metabolism. In natural physiological processes in the body, hormones that function as insulin antagonists (especially growth hormone) exert hyperinsulinemic activity due to a decrease in insulin secretion between 3 AM and 5 AM, so blood sugar levels return to normal. This is in contrast with the additional physiological insulin secretion in non-diabetics or in insulin-dependent individuals. On the other hand, when insulin release is impaired, the effect of growth hormone released at night, especially in patients with diabetes, may not be attenuated. This leads to a pathological circadian rhythm which may lead to hyperglycemia in the morning regardless of the dietary habits [15]. At noon, proteases and amylases are secreted [16],[17] to ensure the assimilation of food. In the afternoon, high levels of cortisol occur, approximately five hours after the last meal, which causes insulin secretion, which in turn requires the use of fast-acting and medium-acting sugars in order to avoid the release of stored proteins and compensate the fatigue associated with the functioning of the organs.

In the evening there is practically no digestive secretion, which significantly slows down the assimilation of food, or in other words, the body will no longer be able to metabolize excessive food intake, both qualitatively and quantitatively. At night, catabolic activity must be present related to the need to mobilize endogenous energy during sleep and fasting, but restorative anabolic processes are also present. During the night, growth hormone (released in this deep sleep phase) and cortisol [18],[19],[20] lead to internal energy mobilization of serum glucose. Available glucose levels are reduced at night and glucose is "spared" so as to provide energy for CNS, which leads to the resistance to nocturnal energy in muscle tissues. This is considered to be the reason for impaired glucose tolerance in night shift workers.

A lack of sleep and night-time work also influence the metabolism of two important hormones in our body – hunger and satiety hormones (leptin and ghrelin) which depend on the circadian rhythm promoting nocturnal fasting and sleep. This may affect appetite disturbance, which is often the case in employees who work the night shift.

Leptin has endocrine and paracrine effects, and it takes part in the regulation of body mass, metabolism and reproductive functions. Increased leptin provides the information that the organism is full, and appetite thus decreases, and vice versa. Leptin is a hormone produced in the adipose tissue; after leptin has been secreted from adipocytes, it crosses the blood-brain barrier, goes to the brain, and is bound to its receptor LEPR. Dysregulation or dysfunction of the receptor (leptin receptor deficiency) may lead to overeating and gaining weight. The circadian rhythm affects leptin levels, so its concentration is lowest in the morning, and it increases during the day being at its highest late in the evening. What affects the 24-hour leptin levels is as follows: a lack of sleep or prolonged sleep, circadian phase, excessive food intake, or calorie restriction. Leptin and insulin affect the brain’s sensitivity to satiety signals [21],[22].

Ghrelin has the structure of a peptide; it consists of 28 amino acids and it is called hunger hormone as it plays an important role in the regulation of appetite. Ghrelin is produced by P/D1 cells in the stomach, and it is an appetite-increasing hormone. An empty stomach secretes ghrelin which informs endocrine glands of the brain about the lack of food in the digestive system and the feeling of hunger occurs. Ghrelin has a shortterm effect, and it affects the daily feeling of hunger. In healthy adults, a 24-hour pattern occurs in circulating ghrelin levels if there is energy balance – ghrelin levels increase between meals, decrease after meals, increase before and during the first few hours of sleep, and decrease during the second half of the sleep episode. Under constant routine conditions, the circadian rhythm of ghrelin increases during the biological day and decreases during the biological night [23],[24]. Under conditions of controlled energy intake or energy equilibrium in healthy adults, circadian misalignment has been reported to have a minimal effect on total circulating ghrelin levels. The hormone ghrelin is related to growth hormone, so it encourages physical development, and high concentrations of ghrelin have been proven to enhance memory and concentration [23].

Homocysteine is a pseudo-amino acid which participates in tissue building in our body. Elevated homocysteine levels are found in night shift workers, those who are over 40 years of age, and who have sleep problems. Homocysteine has circadian nocturnal peak that is elevated due to animal protein consumption in a night-time meal and is considered to be a leading cause of myocardial infarction and stroke [25],[26].

Dietary habits of night shift workers

Bearing in mind the impact of the circadian rhythm on our metabolism, as early as 1960 an interest in dietary habits of night shift workers was increased. The study conducted by Debry et al. [9] was among the first to show that the total energy intake in employees who worked shifts was similar to that of employees who worked daytime shifts, but that they differed significantly in distribution/dynamics of meals over the course of 24 hours. However, the diet of shift workers was found to be richer in animal fats and proteins. Subsequent studies also found that energy intake was not higher in shift workers who already suffered from circadian misalignment compared to those who did not work shifts. However, they may choose less healthy foods, and obesity rates could be higher. These results suggest that, even with no changes in energy intake, weight gain may occur if energy is expended at an inappropriate circadian time. Energy expenditure increases after the morning meal and this is when more calories are burnt and more nutrients are used compared to night-time eating [10],[11]. Although it was previously reported in regular medical check-ups and meta-analyses that the total energy intake in shift workers was similar to that of daytime workers, doubts have arisen concerning this claim. The primary reason for this is the limited number of studies, i.e., a small number of studies focusing exclusively on shift workers (as in shift schedule) and the rotating energy intake in the night shift rather than intakes that are more representative of shift work. What is not well known is how individual shift schedules, especially shift rotations, may affect energy intake and dietary patterns. To date, studies have rarely distinguished between the types of work schedule other than "the day shift" and "the night shift" and they have often mixed rotating and non-rotating shift schedule in their analyses. So, the impact of rotating shift schedules on dietary patterns has not been well established. This is very important considering the fact that some shift workers change work hours from daytime to night-time and that it is associated with poorer metabolic health results and night-time eating [27].

On the other hand, there is a difference between micronutrient intake [28],[29],[30] between employees who worked during the night-time and those who worked the day shift. Seven out of a dozen studies that explored macronutrient intake reported a significant difference in protein intake in night shift workers, including a lower protein intake in women compared to men. Regarding fat intake, there are conflicting opinions, but it has been proven that significantly more fat is consumed during the night shift, as well as that there is significantly higher intake of carbohydrates during the night shift in comparison with the day shift.

In the 1990s, Knutson et al. [31] found that night shift workers consumed less dietary fiber 6 months after they had started working the night shift. Also, in studies conducted later, it was noticed that night shift workers consumed less dietary fiber especially at night. This is mainly due to reduced intake of green vegetables, higher potato consumption, lower fruit intake and increased glucose intake because of higher intake of carbonated and energy drinks and caffeine and higher intake of saturated fats [32],[33],[34]. Linseisen et al. [35] found that the intake of dietary fiber, zinc and vitamins A and D was lower and below the recommended values in a group of workers who constantly worked the night shift. Moreover, in a study conducted by Przeor et al. [36] it was pointed out that shift workers consumed foods characterized by a low level of nutrients such as fiber, Ca, Mg, Fe, vitamin D, folic acid. In addition, the diets of the women who participated in the study, as well as those of the men who participated in it, were unfavorably high in sodium and phosphorus. The reason behind the high intake of the abovementioned substances may lie in the fact that these workers consumed a larger amount of meat products [37]. In recent years, tests have been conducted on the concentration of vitamin D in the diets of night shift workers. It has been concluded that shift workers, especially those who work the night shift, have a lower level of vitamin D compared to those who work the day shift. This is because night shift workers are less exposed to sunlight than those who do not work shifts [38],[39]. In addition, night shift workers tend to adopt irregular meal schedules, eat at night, and consume more unhealthy food, which can lead to reduced vitamin D intake. It is also known that shift workers, especially those who work the night shift, tend to have a higher BMI (body mass index) than the general population, which may lead to increased sequestration of vitamin D in adipose tissue and consequently to lower levels of circulating vitamin D [40]. Due to reduced intake of vitamin D bone metabolism disorders and osteoporosis occur. The risk of increased incidence of bone fractures had not been researched until Bukowska-Damska et al. [41] conducted a study which showed a higher rate of fissures and fractures in female night shift workers compared to those female workers who worked the day shift, suggesting a potential link between osteoporosis and shift work. In addition, several studies have showed a link between low levels of vitamin D and the occurrence of other diseases, such as autoimmune disorders, cardiovascular disease, diabetes mellitus type 2, infectious diseases, cancer, neurological and neuropsychiatric disorders (e.g. schizophrenia, dementia, and depression) [42]. Based on the current knowledge about vitamin D intake in night shift workers, a series of questions opens. There was high heterogeneity not explained by age, gender, BMI, and methods of measuring 25-OH-D levels and a large number of studies were conducted by Koreans, so it is necessary to conduct larger epidemiological studies in order to prove the statements. It is likely that the characteristics of shift work, especially the number of working nights on a monthly basis, play a vital role in vitamin D concentrations in these workers, and for this reason it would be desirable to determine vitamin D concentration as part of check-ups and based on the results carry out a rapid correction of vitamin D deficiency in order to prevent the risk of bone fractures [43].

Several studies have also reported that night shift workers have a tendency to eat more frequently [44],[45], eat less with more snacks than usual ("snacking factor") during the night shift instead of a single large meal, which can be described as consuming "a lot of food in several meals".

Apart from this, it remains to be determined whether repeated exposure to circadian misalignment (for example, when working the night shift) and alignment (days off) chronically alters appetite hormones and energy intake, i.e., sleep should be examined in these workers as there are studies showing harmful effects of poor sleep quality and short sleep duration considering this role has not been quantified yet. Further studies are needed to examine individual differences between the sexes and confirm the relationship between sleepwake patterns and lifestyle factors, such as dietary habits, physical activity and smoking habit [46],[47].

The effect of shift work on workers’ health

Any forced disruption of normal sleep patterns, such as shift work (especially working at night), can lead to circadian misalignment and it is believed that this is partly to be blamed for the development of metabolic syndrome and chronic diseases [48]. Metabolic syndrome is characterized by the simultaneous occurrence of hypertension, diabetes, obesity, and dyslipidemia, and it has been marked as the leading cause of cardiovascular morbidity and mortality. Chronic metabolic disorder is a major health problem worldwide. Compered to people who work the day shift, night shift workers have a higher risk of a number of metabolic disorders and diseases as a consequence of disturbed circadian rhythm and sleep, exposure to psychosocial stress, physical inactivity and insufficient time for rest and revitalization. Despite having the same daily energy intake as people who work the day shift, night shift workers have a 23% increased risk of becoming overweight/obese and a 35% increased risk of developing abdominal obesity compared to daytime workers. Moreover, inflammatory reactions occur in these workers, as well as impaired glucose tolerance and insulin sensitivity [49],[50].

Circadian rhythms play an important role in the regulation of cardiovascular physiology and health. Peripheral clocks are present in each type of cardiovascular cells, and they regulate their functioning, blood pressure, the functions of the heart, circulating catecholamines, blood coagulation markers, and the vascular endothelium. The risk of coronary heart disease may be increased by exposure to light during the night due to the disruption of circadian rhythms, which affects the endothelial function leading to atherosclerotic changes in blood vessels, thrombus formation and the induction of inflammatory responses [51],[52].

Due to metabolic disorders, especially in relation to lipid and glucose intolerance, they are 9% more likely to develop diabetes type 2, they have a 23% increased risk of myocardial infarction, and a 5% increased risk of stroke [53]. There are problems with falling asleep and with the development of mental disorders such as anxiety and depression, and there is an impact on cognitive performances (decreased attention span and difficulty completing tasks), mood swings and alertness [54].

The World Health Organization and the International Agency for Research on Cancer [55] have concluded that night work is probably carcinogenic to humans. Decreased levels of melatonin secretion lead to immunosuppression including decreased activity of natural killer cells which can in turn lead to colorectal cancer, breast cancer and prostate cancer [56]. An analysis of 31 cohort studies revealed that exposure to light during the night significantly increased the risk of breast cancer by 2.9%, in the group of workers who had been working the night shift for more than 10 years by 8.6%, and in workers who rotated shifts by 5.3% [57]. However, the research results are controversial as 26 accepted meta-studies did not notice an increase in cancer incidence in workers who had been working the night shift for a long time [58], so further research in this field is expected.

Tips for healthier dietary habits in the night shift

Night shift workers face many challenges, epecially concerning their health and dietary habits. To them, healthy eating is a real challenge. There are numerous recommendations on how night shift workers may have a balanced and healthy diet [59], which we have tried to present in this review article.

Caffeine should be avoided for at least 6 hours after the night shift and before going to sleep, and it is recommended to have breakfast 1–2 hours before going to bed avoiding "large/extra large meals". It is necessary to have breakfast to avoid waking up too early due to hunger.

After sleeping it is lunch time and lunch should be rich in vegetables, lean meat and inevitable salad in order to provide the organism with energy for the entire day.

A few hours before going to work it is recommended to have the main meal (dinner with family or friends). Foods that are difficult to digest are certainly not suitable for night meals (e.g., almost anything fried), but easy-to-digest foods such as soups, cream soups, yogurt, and rice will not cause stomach heaviness. In order to avoid overeating, it is also important to pay attention to the size of the plate. In other words, eating from a smaller plate can trick our brain into thinking that the meal is bigger than it really is. The plate should be filled in the following way: a half of the plate should contain vegetables in different colors (the vegetables should be steamed, cut, and seasoned with a dressing), and a quarter of the plate should be filled with low-calorie proteins (it is best to choose lean meat with no skin, including protein-rich vegetables such as legumes or tofu). The remaining quarter of the plate should be filled with starchy vegetables or whole-grain food.

Once at work (the night shift means working from 10 PM to 6 AM), early through the shift you will certainly feel hunger which you should deceive with a small meal or snack. For example, this meal should contain boiled eggs, tuna fish, grilled turkey or chicken meat, almond and peanuts (even as peanut butter). A sandwich can be made with the listed ingredients and some fruit could be added to it. Late in the shift, there are additional meals (small bites every few hours to maintain concentration and energy), approximately every 3 hours. It is recommended to avoid food completely, but if there is a need for food then food that is low in energy should be taken between midnight and 6 AM, or food should be consumed at the very beginning and the very end of the shift.

It is much healthier to take food with us (healthy food and healthy snacks). Many employees do not have access to organized restaurants (canteens), or even if they do these restaurants offer fast food. Most employees cannot use a refrigerator at work where they could keep their food. This is why employees should be creative when preparing and keeping food [60].

It is advised to avoid the consumption of sweets on the night shift. Foods that are high in sugar, such as a chocolate bar or a soft drink, could provide a short burst of energy, but later you may feel sluggish. When there are feelings of fatigue and hunger, a snack containing a small portion of proteins will provide enough energy.

A question that is frequently posed by night shift workers is: "Which drinks should I consume?" Water is the basic foodstuff. The organism cannot function properly without water, so it is necessary to take in a sufficient amount of it. It is necessary to drink 1.5–2 liters of liquid every day. Herbs such as mint or fruit can be added to water. Fluid intake can be even higher depending on the needs of the body, e.g., during intense physical efforts or when it is very hot. Water should be taken between meals, not during meals when water that is taken dilutes gastric acid that is necessary for normal digestion.

Caffeine intake should be reduced. In order to stay awake, night shift workers often choose drinks that are rich in caffeine (coffee and energy drinks). Small amounts of caffeine have a stimulating effect and can help mental alertness. During the night shift, it is recommended to consume two small cups of coffee (200 mg), 30–60 minutes before the shift. However, no more than 600 mg a day should be consumed, and the intake should be stopped 4–6 hours before going to sleep. Too much caffeine can disrupt sleep and make a person feel anxious or ill-humored. This is why night shift workers are advised to avoid caffeine-rich drinks and to take tea or decaffeinated coffee instead [61].

It is also important to consider the role of the social context in nutrition, so it is recommended to provide employees with an adequate dining space (dining in a relaxed atmosphere which promotes the activation of the anti-stress system) and to dine away from the workplace with colleagues, in a pleasant environment, if possible.

In addition, night shift workers are advised to take active breaks. During the break, besides nutrition, it is advisable to leave some time for stretching, a quick walk or a relaxed conversation with colleagues. This will contribute to some extra energy that will enable the employee to round the shift, improve their mood and sleep better after the shift [62].

To stay healthy, night shift workers should have a healthy lifestyle outside work – they should have enough rest and sleep, eat well-balanced food, have physical activity, maintain healthy body weight, avoid smoking, reduce or avoid alcohol consumption and preserve mental health.

CONCLUSION

Night shift workers face unique challenges to their health on the biological, psychological, and social level. The food and drink choices they make at work play an important role in maintaining health and energy levels, so awareness should be raised of proper nutrition in both employees and their employers in terms of health promotion at work. Employers should take responsibility for educating employees about the benefits of a healthy diet as this would lead to better health of employees and a decrease in healthcare costs, reduce absenteeism, increase productivity and bring about better concentration in employees, which ultimately leads to increased income. Employers could greatly influence their employees’ dietary habits by deciding to start the night shift before midnight and make it last for not more than 11 hours continuously. It would be desirable to organize canteens within factories (where healthy meals and healthy snacks would be sold) and for the employer to hire a nutritionist who would organize a seminar on nutrition. A nutritionist can provide employees with valuable advice on how nutrition may prevent health problems and improve the quality of life. Better company culture and work environment (a culture of health at the workplace) may attract the best candidates and help the employer keep the best employees.

  • Conflict of interest:
    None declared.

Informations

March 2024

Pages 75-88
  • Keywords:
    circadian biological rhythm, chronobiology, metabolism
  • Received:
    06 March 2024
  • Revised:
    11 March 2024
  • Accepted:
    15 March 2024
  • Online first:
    25 March 2024
  • DOI:
  • Cite this article:
    Anđelković S, Babić M. Dietary habits of night shift workers: A reason or an excuse for poor nutrition. Serbian Journal of the Medical Chamber. 2024;5(1):75-88. doi: 10.5937/smclk5-47858
Corresponding author

Svetlana Anđelković
Institute for Workers’ Health Protection "Niš"
Vojislava Ilića Street, 18000 Niš, Serbia
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


1. Bell-Pedersen D, Cassone VM, Earnest DJ, Golden SS, Hardin PE, Thomas TL, et al. Circadian rhythms from multiple oscillators: lessons from diverse organisms. Nat Rev Genet. 2005 Jul;6(7):544-56. doi: 10.1038/nrg1633. [CROSSREF]

2. Kumar V, Sharma A. Common features of circadian timekeeping in diverse organisms. Current Opinion in Physiology. 2018 Oct 1;5:58-67. doi: 10.1016/j. cophys.2018.07.004.

3. https://ec.europa.eu/eurostat/product?mode=view&code=lfsa_ewpnig doi:10.2908/lfsa_ewpnig [HTTP]

4. https://redline.digital/shift-work-statistics/ [HTTP]

5. The Council of the European Union. Directive 2000/34/EC of the European Parliament and of the Council of 22 June 2000 amending Council Directive 93/104/EC ‘concerning certain aspects of the organisation of working time to cover sectors and activities excluded from that Directive.’. Official Journal 1993;l195:41–5. https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex%3A32000L0034 [HTTP]

6. Zakon o radu (“Sl. glasnik RS”, br. 24/2005, 61/2005, 54/2009, 32/2013, 75/2014, 13/2017 - odluka US, 113/2017 i 95/2018-autentično tumačenje) https://www.paragraf.rs/propisi/zakon_o_radu.html [HTTP]

7. Knutsson A. Health disorders of shift workers. Occup Med (Lond). 2003 Mar;53(2):103-8. doi: 10.1093/occmed/kqg048. [CROSSREF]

8. Bonnell EK, Huggins CE, Huggins CT, McCaffrey TA, Palermo C, Bonham MP. Influences on dietary choices during day versus night shift in shift workers: a mixed methods study. Nutrients. 2017 Feb 26;9(3):193. doi: 10.3390/ nu9030193. [CROSSREF]

9. Debry G, Girault P, Lefort J, Thiébault J. Enquête sur les habitudes alimentaires des travailleurs “a feux continus” [Survey of the food habits of workers on shift work]. Bull Inst Natl Sante Rech Med. 1967 Nov-Dec;22(6):1169-202.

10. Boege HL, Bhatti MZ, St-Onge MP. Circadian rhythms and meal timing: impact on energy balance and body weight. Curr Opin Biotechnol. 2021 Aug;70:1- 6. doi:10.1016/j.copbio.2020.08.009. [CROSSREF]

11. Qian J, Morris CJ, Caputo R, Wang W, Garaulet M, Scheer FAJL. Sex differences in the circadian misalignment effects on energy regulation. Proc Natl Acad Sci U S A. 2019 Nov 19;116(47):23806-23812. doi: 10.1073/pnas.1914003116. [CROSSREF]

12. Pan X, Hussain MM. Clock is important for food and circadian regulation of macronutrient absorption in mice. J Lipid Res. 2009 Sep;50(9):1800-13. doi: 10.1194/jlr.M900085-JLR200. [CROSSREF]

13. Mohd Azmi, N.A.S.; Juliana, N.; Azmani, S.; Mohd Effendy, N.; Abu, I.F.; Mohd Fahmi Teng, N.I.; Das, S. Cortisol on Circadian Rhythm and Its Effect on Cardiovascular System. Int. J. Environ. Res. Public Health 2021, 18, 676. https:// doi.org/10.3390/ijerph18020676. [CROSSREF]

14. O'Byrne NA, Yuen F, Butt WZ, Liu PY. Sleep and Circadian Regulation of Cortisol: A Short Review. Curr Opin Endocr Metab Res. 2021 Jun;18:178-186. doi- :10.1016/j.coemr.2021.03.011. [CROSSREF]

15. Effect of Circadian Rhythm on Metabolic Processes and the Regulation of Energy Balance REVIEW ARTICLES| APRIL 23 2019 Ann Nutr Metab (2019)74(4): 322–330 https://karger.com/anm/article/74/4/322/51852/Effect-of-Circadian-Rhythm-on-Metabolic-Processes https://doi.org/10.1159/000500071. [CROSSREF]

16. Digestive Enzymes: Amylase, Protease, And Lipase https://integrativepro.com/blogs/articles/digestive-enzymes-amylase-protease-lipase.

17. Digestive Enzymes: Types and Function A Necessary Part of DigestionBy Barbara Bolen, PhD Updated on September 06, 2022 Medically reviewed by Jay N. Yepuri, MD https://www-verywellhealth-com.translate.goog/what-are-digestive-enzymes.

18. Weitzman ED, Fukushima D, Nogeire C, Roffwarg H, Gallagher TF, Hellman L. Twenty-four hour pattern of the episodic secretion of cortisol in normal subjects. J Clin Endocrinol Metab. 1971 Jul;33(1):14-22. doi: 10.1210/jcem-33- 1-14. [CROSSREF]

19. Selmaoui B, Touitou Y. Reproducibility of the circadian rhythms of serum cortisol and melatonin in healthy subjects: a study of three different 24-h cycles over six weeks. Life Sci. 2003 Nov 14;73(26):3339-49. doi: 10.1016/j. lfs.2003.05.007. [CROSSREF]

20. Kuo T, McQueen A, Chen TC, Wang JC. Regulation of glucose homeostasis by glucocorticoids. Adv Exp Med Biol. 2015;872:99-126. doi: 10.1007/978-1- 4939-2895-8_5. [CROSSREF]

21. Schwartz MW, Woods SC, Porte D Jr, Seeley RJ, Baskin DG. Central nervous system control of food intake. Nature. 2000 Apr 6;404(6778):661-71. doi: 10.1038/35007534. [CROSSREF]

22. ŞAHİN, T., & TOZCU, D. (2022). Circadian rhythm and obesity. International Journal of Science Letters, 4(1), 202-219. https://doi.org/10.38058/ijsl.1053393 [CROSSREF]

23. Hashiguchi H, Sheng Z, Routh V, Gerzanich V, Simard JM, Bryan J. Direct versus indirect actions of ghrelin on hypothalamic NPY neurons. PLoS One. 2017 Sep 6;12(9):e0184261. doi: 10.1371/journal.pone.0184261. [CROSSREF]

24. Rynders CA, Morton SJ, Bessesen DH, Wright KP Jr, Broussard JL. Circadian Rhythm of Substrate Oxidation and Hormonal Regulators of Energy Balance. Obesity (Silver Spring). 2020 Jul;28 Suppl 1(Suppl 1):S104-S113. doi: 10.1002/ oby.22816. [CROSSREF]

25. Antoniades C, Antonopoulos AS, Tousoulis D, Marinou K, Stefanadis C. Homocysteine and coronary atherosclerosis: from folate fortification to the recent clinical trials. Eur Heart J. 2009 Jan;30(1):6-15. doi: 10.1093/eurheartj/ ehn515. [CROSSREF]

26. Lim JW, Kim CW, Park HO, Chung EY, Chae C, Son J, Shin YH, Park SH, Choi SM. Association between shift work and serum homocysteine level in female electronic manufacturing services workers. Ann Occup Environ Med. 2023 Mar;35(1):e4. https://doi.org/10.35371/aoem.2023.35.e4. [CROSSREF]

27. Cayanan EA, Eyre NAB, Lao V, Comas M, Hoyos CM, Marshall NS, Phillips CL, Shiao JSC, Guo YL, Gordon CJ. Is 24-hour energy intake greater during night shift compared to non-night shift patterns? A systematic review. Chronobiol Int. 2019 Dec;36(12):1599-1612. doi: 10.1080/07420528.2019.1666865. [CROSSREF]

28. Ulusoy HG, Sanlier N, Rakıcıoğlu N. Do Rotating Night Shifts Change Nurses’ Nutritional Status? A Cross-Sectional Study. J Am Nutr Assoc. 2022 Aug;41(6):608-616. doi: 10.1080/07315724.2021.1947413. [CROSSREF]

29. Kosmadopoulos A, Kervezee L, Boudreau P, Gonzales-Aste F, Vujovic N, Scheer FAJL, Boivin DB. Effects of Shift Work on the Eating Behavior of Police Officers on Patrol. Nutrients. 2020 Apr 4;12(4):999. doi: 10.3390/nu12040999. [CROSSREF]

30. Fradkin L, Raz O, Boaz M. Nurses who work rotating shifts consume more energy, macronutrients and calcium when they work the night shift versus day shift. Chronobiol Int. 2019 Feb;36(2):288-295. doi: 10.1080/07420528.2018.1538155. [CROSSREF]

31. Knutson A, Andersson H, Berglund U. Serum lipoproteins in day and shift workers: a prospective study. Br J Ind Med. 1990 Feb;47(2):132-4. doi: 10.1136/oem.47.2.132. [CROSSREF]

32. Balieiro LC, Rossato LT, Waterhouse J, Paim SL, Mota MC, Crispim CA. Nutritional status and eating habits of bus drivers during the day and night. Chronobiol Int. 2014 Dec;31(10):1123-9. doi: 10.3109/07420528.2014.957299. [CROSSREF]

33. Souza RV, Sarmento RA, de Almeida JC, Canuto R. The effect of shift work on eating habits: a systematic review. Scand J Work Environ Health. 2019 Jan 1;45(1):7-21. doi: 10.5271/sjweh.3759. [CROSSREF]

34. Nakamura M, Miura A, Nagahata T, Toki A, Shibata Y, Okada E, Ojima T. Dietary intake and dinner timing among shift workers in Japan. J Occup Health. 2018 Nov 27;60(6):467-474. doi: 10.1539/joh.2018-0070-OA. [CROSSREF]

35. Linseisen J, Wolfram G. Nährstoffzufuhr bei Dauernachtschicht-Arbeitern [Nutrient intake in permanent night shift workers]. Z Ernahrungswiss. 1994 Dec;33(4):299-309. German. doi: 10.1007/BF01614435. [CROSSREF]

36. Przeor M, Goluch-Koniuszy Z. [Evaluation of nutrition and diet of nurses during perimenopause while working in a shift system]. Probl Hig Epidemiol. 2013;94(4):797-801.Polish.

37. Gołąbek KD, Chmielewska A, Karoluk E, Regulska-Ilow B. A multifaceted assessment of the nutritional status, diet and eating habits of midwives working on a shift schedule in Wrocław, Poland: Evaluation of macronutrients, vitamins and minerals in the diets of midwives participating in the study. Int J Occup Med Environ Health2023;36(5):618-631. https://doi.org/10.13075/ijomeh.1896.02117. [CROSSREF]

38. Lee H.J., Choi H., Yoon I.Y. Impacts of serum Vitamin D levels on sleep and daytime sleepiness according to working conditions. J. Clin. Sleep Med. 2020;16:1045–1054. doi: 10.5664/jcsm.8390. [CROSSREF]

39. Martelli M, Salvio G, Santarelli L, Bracci M. Shift Work and Serum Vitamin D Levels: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Jul 22; doi:10.3390/ijerph19158919. [CROSSREF]

40. Doğan Y., Kara M., Culha M.A., Özçakar L., Kaymak B. The relationship between vitamin D deficiency, body composition, and physical/cognitive functions. Arch. Osteoporos. 2022;17:66. doi: 10.1007/s11657-022-01109-6. [CROSSREF]

41. Bukowska-Damska A., Skowronska-Jozwiak E., Kaluzny P., Lewinski A. Night shift work and osteoporosis-bone turnover markers among female blue-collar workers in Poland. Chronobiol. Int. 2022;39:818–825. doi: 10.1080/07420528.2022.2037626. [CROSSREF]

42. Wassif G A, Alrehely M S, Alharbi D M, et al. (October 26, 2023) The Impact of Vitamin D on Neuropsychiatric Disorders. Cureus 15(10): e47716. doi:10.7759/ cureus.47716. [CROSSREF]

43. Clark AB, Coates AM, Davidson ZE, Bonham MP. Dietary Patterns under the Influence of Rotational Shift Work Schedules: A Systematic Review and Meta-Analysis. Adv Nutr. 2023 Mar;14(2):295-316. doi: 10.1016/j.advnut.2023.01.006. [CROSSREF]

44. Takagi K. Influence of shift work on time and frequency of meal taking. J Hum Ergol (Tokyo). 1972 Dec;1(2):195-205.

45. D. van de Langenberg, J.J. Vlaanderen, M.E. Dollé, M.A. Rookus, L.W. van Kerkhof, R.C. Vermeulen Diet, physical activity, and daylight exposure patterns in night-shift workers and day workers Ann. Work. Expo. Health., 63 (1) (2019), pp. 9-21. [CROSSREF]

46. Bahinipati J, Sarangi R, Pathak M, Mohapatra S. Effect of night shift on development of metabolic syndrome among health care workers. J Family Med Prim Care. 2022 May;11(5):1710-1715. doi: 10.4103/jfmpc.jfmpc_375_21. [CROSSREF]

47. Mentzelou M, Papadopoulou SK, Papandreou D, Spanoudaki M, Dakanalis A, Vasios GK, et al. Evaluating the Relationship between Circadian Rhythms and Sleep, Metabolic and Cardiovascular Disorders: Current Clinical Evidence in Human Studies. Metabolites. 2023 Mar 1;13(3):370. doi: 10.3390/metabo13030370. [CROSSREF]

48. Khosravipour M, Khanlari P, Khazaie S, Khosravipour H, Khazaie H. A systematic review and meta-analysis of the association between shift work and metabolic syndrome: The roles of sleep, gender, and type of shift work. Sleep Med Rev. 2021 Jun;57:101427. doi: 10.1016/j.smrv.2021.101427. [CROSSREF]

49. Sun M, Feng W, Wang F, Li P, Li Z, Li M, et al. Meta-analysis on shift work and risks of specific obesity types. Obes Rev. 2018 Jan;19(1):28-40. doi: 10.1111/ obr.12621. [CROSSREF]

50. Chaput, JP., McHill, A.W., Cox, R.C. et al. The role of insufficient sleep and circadian misalignment in obesity. Nat Rev Endocrinol 19, 82–97 (2023). https://doi.org/10.1038/s41574-022-00747-7. [CROSSREF]

51. Sun S, Cao W, Ge Y, Ran J, Sun F, Zeng Q, Guo M, Huang J, Lee RS, Tian L, Wellenius GA. Outdoor light at night and risk of coronary heart disease among older adults: a prospective cohort study. Eur Heart J. 2021 Feb 21;42(8):822- 830. doi: 10.1093/eurheartj/ehaa846. [CROSSREF]

52. Kervezee L, Kosmadopoulos A, Boivin DB. Metabolic and cardiovascular consequences of shift work: The role of circadian disruption and sleep disturbances. Eur J Neurosci. 2020 Jan;51(1):396-412. doi: 10.1111/ejn.14216. [CROSSREF]

53. Gan Y, Yang C, Tong X, Sun H, Cong Y, Yin X, et al. Shift work and diabetes mellitus: a meta-analysis of observational studies. Occup Environ Med. 2015 Jan;72(1):72-8. doi: 10.1136/oemed-2014-102150. [CROSSREF]

54. Moreno CRC, Marqueze EC, Sargent C, Wright KP, Jr, Ferguson SA, Tucker P. Working time society consensus statements: evidence-based effects of shift work on physical and mental health. Ind Health. 2019;57(2):139–157. doi: 10.2486/indhealth.SW-1. [CROSSREF]

55. IARC Monographs Vol 124 group. Carcinogenicity of night shift work. Lancet Oncol. 2019 Aug;20(8):1058-9. doi: 10.1016/S1470-2045(19)30455-3. [CROSSREF]

56. Dun A., Zhao X., Jin X., Wei T., Gao X., Wang Y., Hou H. Association between Night-Shift Work and Cancer Risk: Updated Systematic Review and Meta-Analysis. Front. Oncol. 2020;10:1006. doi: 10.3389/fonc.2020.01006. [CROSSREF]

57. Wei F., Chen W., Lin X. Night-shift work, breast cancer incidence, and all-cause mortality: An updated meta-analysis of prospective cohort studies. Sleep Breath. Schlaf Atm. 2022;26:1509–1526. doi: 10.1007/s11325-021-02523-9. [CROSSREF]

58.Manouchehri E., Taghipour A., Ghavami V., Ebadi A., Homaei F., Latifnejad Roudsari R. Night-shift work duration and breast cancer risk: An updated systematic review and meta-analysis. BMC Women’s Health. 2021;21:89. doi: 10.1186/s12905-021-01233-4. [CROSSREF]

59. https://www.henryford.com/blog/2022/05/tips-for-healthy-eating-whileworking-the-night-shift Tips For Healthy Eating While Working The Night Shift Posted on May 16, 2022 by Henry Ford Health Staff.

60. Add these low-calorie snacks to fill you up for hours!https://www-mynetdiary-com.translate.goog/low-calorie-snacks-that-fill-you-up.html?_x_tr_sl=en&_x_tr_tl=sr&_x_tr_hl=sr&_x_tr_pto=sc [HTTP]

61. How can I eat to optimize my performance on night shift? https://www.hprc-online.org/nutrition/unique-nutrition-needs/how-can-i-eat-optimize-my-performance-night-shift.

62. Easton, D.F., Gupta, C.C., Vincent, G.E. et al. Move the night way: how can physical activity facilitate adaptation to shift work?. Commun Biol 7, 259 (2024). https://doi.org/10.1038/s42003-02. [CROSSREF]


REFERENCES

1. Bell-Pedersen D, Cassone VM, Earnest DJ, Golden SS, Hardin PE, Thomas TL, et al. Circadian rhythms from multiple oscillators: lessons from diverse organisms. Nat Rev Genet. 2005 Jul;6(7):544-56. doi: 10.1038/nrg1633. [CROSSREF]

2. Kumar V, Sharma A. Common features of circadian timekeeping in diverse organisms. Current Opinion in Physiology. 2018 Oct 1;5:58-67. doi: 10.1016/j. cophys.2018.07.004.

3. https://ec.europa.eu/eurostat/product?mode=view&code=lfsa_ewpnig doi:10.2908/lfsa_ewpnig [HTTP]

4. https://redline.digital/shift-work-statistics/ [HTTP]

5. The Council of the European Union. Directive 2000/34/EC of the European Parliament and of the Council of 22 June 2000 amending Council Directive 93/104/EC ‘concerning certain aspects of the organisation of working time to cover sectors and activities excluded from that Directive.’. Official Journal 1993;l195:41–5. https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex%3A32000L0034 [HTTP]

6. Zakon o radu (“Sl. glasnik RS”, br. 24/2005, 61/2005, 54/2009, 32/2013, 75/2014, 13/2017 - odluka US, 113/2017 i 95/2018-autentično tumačenje) https://www.paragraf.rs/propisi/zakon_o_radu.html [HTTP]

7. Knutsson A. Health disorders of shift workers. Occup Med (Lond). 2003 Mar;53(2):103-8. doi: 10.1093/occmed/kqg048. [CROSSREF]

8. Bonnell EK, Huggins CE, Huggins CT, McCaffrey TA, Palermo C, Bonham MP. Influences on dietary choices during day versus night shift in shift workers: a mixed methods study. Nutrients. 2017 Feb 26;9(3):193. doi: 10.3390/ nu9030193. [CROSSREF]

9. Debry G, Girault P, Lefort J, Thiébault J. Enquête sur les habitudes alimentaires des travailleurs “a feux continus” [Survey of the food habits of workers on shift work]. Bull Inst Natl Sante Rech Med. 1967 Nov-Dec;22(6):1169-202.

10. Boege HL, Bhatti MZ, St-Onge MP. Circadian rhythms and meal timing: impact on energy balance and body weight. Curr Opin Biotechnol. 2021 Aug;70:1- 6. doi:10.1016/j.copbio.2020.08.009. [CROSSREF]

11. Qian J, Morris CJ, Caputo R, Wang W, Garaulet M, Scheer FAJL. Sex differences in the circadian misalignment effects on energy regulation. Proc Natl Acad Sci U S A. 2019 Nov 19;116(47):23806-23812. doi: 10.1073/pnas.1914003116. [CROSSREF]

12. Pan X, Hussain MM. Clock is important for food and circadian regulation of macronutrient absorption in mice. J Lipid Res. 2009 Sep;50(9):1800-13. doi: 10.1194/jlr.M900085-JLR200. [CROSSREF]

13. Mohd Azmi, N.A.S.; Juliana, N.; Azmani, S.; Mohd Effendy, N.; Abu, I.F.; Mohd Fahmi Teng, N.I.; Das, S. Cortisol on Circadian Rhythm and Its Effect on Cardiovascular System. Int. J. Environ. Res. Public Health 2021, 18, 676. https:// doi.org/10.3390/ijerph18020676. [CROSSREF]

14. O'Byrne NA, Yuen F, Butt WZ, Liu PY. Sleep and Circadian Regulation of Cortisol: A Short Review. Curr Opin Endocr Metab Res. 2021 Jun;18:178-186. doi- :10.1016/j.coemr.2021.03.011. [CROSSREF]

15. Effect of Circadian Rhythm on Metabolic Processes and the Regulation of Energy Balance REVIEW ARTICLES| APRIL 23 2019 Ann Nutr Metab (2019)74(4): 322–330 https://karger.com/anm/article/74/4/322/51852/Effect-of-Circadian-Rhythm-on-Metabolic-Processes https://doi.org/10.1159/000500071. [CROSSREF]

16. Digestive Enzymes: Amylase, Protease, And Lipase https://integrativepro.com/blogs/articles/digestive-enzymes-amylase-protease-lipase.

17. Digestive Enzymes: Types and Function A Necessary Part of DigestionBy Barbara Bolen, PhD Updated on September 06, 2022 Medically reviewed by Jay N. Yepuri, MD https://www-verywellhealth-com.translate.goog/what-are-digestive-enzymes.

18. Weitzman ED, Fukushima D, Nogeire C, Roffwarg H, Gallagher TF, Hellman L. Twenty-four hour pattern of the episodic secretion of cortisol in normal subjects. J Clin Endocrinol Metab. 1971 Jul;33(1):14-22. doi: 10.1210/jcem-33- 1-14. [CROSSREF]

19. Selmaoui B, Touitou Y. Reproducibility of the circadian rhythms of serum cortisol and melatonin in healthy subjects: a study of three different 24-h cycles over six weeks. Life Sci. 2003 Nov 14;73(26):3339-49. doi: 10.1016/j. lfs.2003.05.007. [CROSSREF]

20. Kuo T, McQueen A, Chen TC, Wang JC. Regulation of glucose homeostasis by glucocorticoids. Adv Exp Med Biol. 2015;872:99-126. doi: 10.1007/978-1- 4939-2895-8_5. [CROSSREF]

21. Schwartz MW, Woods SC, Porte D Jr, Seeley RJ, Baskin DG. Central nervous system control of food intake. Nature. 2000 Apr 6;404(6778):661-71. doi: 10.1038/35007534. [CROSSREF]

22. ŞAHİN, T., & TOZCU, D. (2022). Circadian rhythm and obesity. International Journal of Science Letters, 4(1), 202-219. https://doi.org/10.38058/ijsl.1053393 [CROSSREF]

23. Hashiguchi H, Sheng Z, Routh V, Gerzanich V, Simard JM, Bryan J. Direct versus indirect actions of ghrelin on hypothalamic NPY neurons. PLoS One. 2017 Sep 6;12(9):e0184261. doi: 10.1371/journal.pone.0184261. [CROSSREF]

24. Rynders CA, Morton SJ, Bessesen DH, Wright KP Jr, Broussard JL. Circadian Rhythm of Substrate Oxidation and Hormonal Regulators of Energy Balance. Obesity (Silver Spring). 2020 Jul;28 Suppl 1(Suppl 1):S104-S113. doi: 10.1002/ oby.22816. [CROSSREF]

25. Antoniades C, Antonopoulos AS, Tousoulis D, Marinou K, Stefanadis C. Homocysteine and coronary atherosclerosis: from folate fortification to the recent clinical trials. Eur Heart J. 2009 Jan;30(1):6-15. doi: 10.1093/eurheartj/ ehn515. [CROSSREF]

26. Lim JW, Kim CW, Park HO, Chung EY, Chae C, Son J, Shin YH, Park SH, Choi SM. Association between shift work and serum homocysteine level in female electronic manufacturing services workers. Ann Occup Environ Med. 2023 Mar;35(1):e4. https://doi.org/10.35371/aoem.2023.35.e4. [CROSSREF]

27. Cayanan EA, Eyre NAB, Lao V, Comas M, Hoyos CM, Marshall NS, Phillips CL, Shiao JSC, Guo YL, Gordon CJ. Is 24-hour energy intake greater during night shift compared to non-night shift patterns? A systematic review. Chronobiol Int. 2019 Dec;36(12):1599-1612. doi: 10.1080/07420528.2019.1666865. [CROSSREF]

28. Ulusoy HG, Sanlier N, Rakıcıoğlu N. Do Rotating Night Shifts Change Nurses’ Nutritional Status? A Cross-Sectional Study. J Am Nutr Assoc. 2022 Aug;41(6):608-616. doi: 10.1080/07315724.2021.1947413. [CROSSREF]

29. Kosmadopoulos A, Kervezee L, Boudreau P, Gonzales-Aste F, Vujovic N, Scheer FAJL, Boivin DB. Effects of Shift Work on the Eating Behavior of Police Officers on Patrol. Nutrients. 2020 Apr 4;12(4):999. doi: 10.3390/nu12040999. [CROSSREF]

30. Fradkin L, Raz O, Boaz M. Nurses who work rotating shifts consume more energy, macronutrients and calcium when they work the night shift versus day shift. Chronobiol Int. 2019 Feb;36(2):288-295. doi: 10.1080/07420528.2018.1538155. [CROSSREF]

31. Knutson A, Andersson H, Berglund U. Serum lipoproteins in day and shift workers: a prospective study. Br J Ind Med. 1990 Feb;47(2):132-4. doi: 10.1136/oem.47.2.132. [CROSSREF]

32. Balieiro LC, Rossato LT, Waterhouse J, Paim SL, Mota MC, Crispim CA. Nutritional status and eating habits of bus drivers during the day and night. Chronobiol Int. 2014 Dec;31(10):1123-9. doi: 10.3109/07420528.2014.957299. [CROSSREF]

33. Souza RV, Sarmento RA, de Almeida JC, Canuto R. The effect of shift work on eating habits: a systematic review. Scand J Work Environ Health. 2019 Jan 1;45(1):7-21. doi: 10.5271/sjweh.3759. [CROSSREF]

34. Nakamura M, Miura A, Nagahata T, Toki A, Shibata Y, Okada E, Ojima T. Dietary intake and dinner timing among shift workers in Japan. J Occup Health. 2018 Nov 27;60(6):467-474. doi: 10.1539/joh.2018-0070-OA. [CROSSREF]

35. Linseisen J, Wolfram G. Nährstoffzufuhr bei Dauernachtschicht-Arbeitern [Nutrient intake in permanent night shift workers]. Z Ernahrungswiss. 1994 Dec;33(4):299-309. German. doi: 10.1007/BF01614435. [CROSSREF]

36. Przeor M, Goluch-Koniuszy Z. [Evaluation of nutrition and diet of nurses during perimenopause while working in a shift system]. Probl Hig Epidemiol. 2013;94(4):797-801.Polish.

37. Gołąbek KD, Chmielewska A, Karoluk E, Regulska-Ilow B. A multifaceted assessment of the nutritional status, diet and eating habits of midwives working on a shift schedule in Wrocław, Poland: Evaluation of macronutrients, vitamins and minerals in the diets of midwives participating in the study. Int J Occup Med Environ Health2023;36(5):618-631. https://doi.org/10.13075/ijomeh.1896.02117. [CROSSREF]

38. Lee H.J., Choi H., Yoon I.Y. Impacts of serum Vitamin D levels on sleep and daytime sleepiness according to working conditions. J. Clin. Sleep Med. 2020;16:1045–1054. doi: 10.5664/jcsm.8390. [CROSSREF]

39. Martelli M, Salvio G, Santarelli L, Bracci M. Shift Work and Serum Vitamin D Levels: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Jul 22; doi:10.3390/ijerph19158919. [CROSSREF]

40. Doğan Y., Kara M., Culha M.A., Özçakar L., Kaymak B. The relationship between vitamin D deficiency, body composition, and physical/cognitive functions. Arch. Osteoporos. 2022;17:66. doi: 10.1007/s11657-022-01109-6. [CROSSREF]

41. Bukowska-Damska A., Skowronska-Jozwiak E., Kaluzny P., Lewinski A. Night shift work and osteoporosis-bone turnover markers among female blue-collar workers in Poland. Chronobiol. Int. 2022;39:818–825. doi: 10.1080/07420528.2022.2037626. [CROSSREF]

42. Wassif G A, Alrehely M S, Alharbi D M, et al. (October 26, 2023) The Impact of Vitamin D on Neuropsychiatric Disorders. Cureus 15(10): e47716. doi:10.7759/ cureus.47716. [CROSSREF]

43. Clark AB, Coates AM, Davidson ZE, Bonham MP. Dietary Patterns under the Influence of Rotational Shift Work Schedules: A Systematic Review and Meta-Analysis. Adv Nutr. 2023 Mar;14(2):295-316. doi: 10.1016/j.advnut.2023.01.006. [CROSSREF]

44. Takagi K. Influence of shift work on time and frequency of meal taking. J Hum Ergol (Tokyo). 1972 Dec;1(2):195-205.

45. D. van de Langenberg, J.J. Vlaanderen, M.E. Dollé, M.A. Rookus, L.W. van Kerkhof, R.C. Vermeulen Diet, physical activity, and daylight exposure patterns in night-shift workers and day workers Ann. Work. Expo. Health., 63 (1) (2019), pp. 9-21. [CROSSREF]

46. Bahinipati J, Sarangi R, Pathak M, Mohapatra S. Effect of night shift on development of metabolic syndrome among health care workers. J Family Med Prim Care. 2022 May;11(5):1710-1715. doi: 10.4103/jfmpc.jfmpc_375_21. [CROSSREF]

47. Mentzelou M, Papadopoulou SK, Papandreou D, Spanoudaki M, Dakanalis A, Vasios GK, et al. Evaluating the Relationship between Circadian Rhythms and Sleep, Metabolic and Cardiovascular Disorders: Current Clinical Evidence in Human Studies. Metabolites. 2023 Mar 1;13(3):370. doi: 10.3390/metabo13030370. [CROSSREF]

48. Khosravipour M, Khanlari P, Khazaie S, Khosravipour H, Khazaie H. A systematic review and meta-analysis of the association between shift work and metabolic syndrome: The roles of sleep, gender, and type of shift work. Sleep Med Rev. 2021 Jun;57:101427. doi: 10.1016/j.smrv.2021.101427. [CROSSREF]

49. Sun M, Feng W, Wang F, Li P, Li Z, Li M, et al. Meta-analysis on shift work and risks of specific obesity types. Obes Rev. 2018 Jan;19(1):28-40. doi: 10.1111/ obr.12621. [CROSSREF]

50. Chaput, JP., McHill, A.W., Cox, R.C. et al. The role of insufficient sleep and circadian misalignment in obesity. Nat Rev Endocrinol 19, 82–97 (2023). https://doi.org/10.1038/s41574-022-00747-7. [CROSSREF]

51. Sun S, Cao W, Ge Y, Ran J, Sun F, Zeng Q, Guo M, Huang J, Lee RS, Tian L, Wellenius GA. Outdoor light at night and risk of coronary heart disease among older adults: a prospective cohort study. Eur Heart J. 2021 Feb 21;42(8):822- 830. doi: 10.1093/eurheartj/ehaa846. [CROSSREF]

52. Kervezee L, Kosmadopoulos A, Boivin DB. Metabolic and cardiovascular consequences of shift work: The role of circadian disruption and sleep disturbances. Eur J Neurosci. 2020 Jan;51(1):396-412. doi: 10.1111/ejn.14216. [CROSSREF]

53. Gan Y, Yang C, Tong X, Sun H, Cong Y, Yin X, et al. Shift work and diabetes mellitus: a meta-analysis of observational studies. Occup Environ Med. 2015 Jan;72(1):72-8. doi: 10.1136/oemed-2014-102150. [CROSSREF]

54. Moreno CRC, Marqueze EC, Sargent C, Wright KP, Jr, Ferguson SA, Tucker P. Working time society consensus statements: evidence-based effects of shift work on physical and mental health. Ind Health. 2019;57(2):139–157. doi: 10.2486/indhealth.SW-1. [CROSSREF]

55. IARC Monographs Vol 124 group. Carcinogenicity of night shift work. Lancet Oncol. 2019 Aug;20(8):1058-9. doi: 10.1016/S1470-2045(19)30455-3. [CROSSREF]

56. Dun A., Zhao X., Jin X., Wei T., Gao X., Wang Y., Hou H. Association between Night-Shift Work and Cancer Risk: Updated Systematic Review and Meta-Analysis. Front. Oncol. 2020;10:1006. doi: 10.3389/fonc.2020.01006. [CROSSREF]

57. Wei F., Chen W., Lin X. Night-shift work, breast cancer incidence, and all-cause mortality: An updated meta-analysis of prospective cohort studies. Sleep Breath. Schlaf Atm. 2022;26:1509–1526. doi: 10.1007/s11325-021-02523-9. [CROSSREF]

58.Manouchehri E., Taghipour A., Ghavami V., Ebadi A., Homaei F., Latifnejad Roudsari R. Night-shift work duration and breast cancer risk: An updated systematic review and meta-analysis. BMC Women’s Health. 2021;21:89. doi: 10.1186/s12905-021-01233-4. [CROSSREF]

59. https://www.henryford.com/blog/2022/05/tips-for-healthy-eating-whileworking-the-night-shift Tips For Healthy Eating While Working The Night Shift Posted on May 16, 2022 by Henry Ford Health Staff.

60. Add these low-calorie snacks to fill you up for hours!https://www-mynetdiary-com.translate.goog/low-calorie-snacks-that-fill-you-up.html?_x_tr_sl=en&_x_tr_tl=sr&_x_tr_hl=sr&_x_tr_pto=sc [HTTP]

61. How can I eat to optimize my performance on night shift? https://www.hprc-online.org/nutrition/unique-nutrition-needs/how-can-i-eat-optimize-my-performance-night-shift.

62. Easton, D.F., Gupta, C.C., Vincent, G.E. et al. Move the night way: how can physical activity facilitate adaptation to shift work?. Commun Biol 7, 259 (2024). https://doi.org/10.1038/s42003-02. [CROSSREF]

1. Bell-Pedersen D, Cassone VM, Earnest DJ, Golden SS, Hardin PE, Thomas TL, et al. Circadian rhythms from multiple oscillators: lessons from diverse organisms. Nat Rev Genet. 2005 Jul;6(7):544-56. doi: 10.1038/nrg1633. [CROSSREF]

2. Kumar V, Sharma A. Common features of circadian timekeeping in diverse organisms. Current Opinion in Physiology. 2018 Oct 1;5:58-67. doi: 10.1016/j. cophys.2018.07.004.

5. The Council of the European Union. Directive 2000/34/EC of the European Parliament and of the Council of 22 June 2000 amending Council Directive 93/104/EC ‘concerning certain aspects of the organisation of working time to cover sectors and activities excluded from that Directive.’. Official Journal 1993;l195:41–5. https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex%3A32000L0034 [HTTP]

6. Zakon o radu (“Sl. glasnik RS”, br. 24/2005, 61/2005, 54/2009, 32/2013, 75/2014, 13/2017 - odluka US, 113/2017 i 95/2018-autentično tumačenje) https://www.paragraf.rs/propisi/zakon_o_radu.html [HTTP]

7. Knutsson A. Health disorders of shift workers. Occup Med (Lond). 2003 Mar;53(2):103-8. doi: 10.1093/occmed/kqg048. [CROSSREF]

8. Bonnell EK, Huggins CE, Huggins CT, McCaffrey TA, Palermo C, Bonham MP. Influences on dietary choices during day versus night shift in shift workers: a mixed methods study. Nutrients. 2017 Feb 26;9(3):193. doi: 10.3390/ nu9030193. [CROSSREF]

9. Debry G, Girault P, Lefort J, Thiébault J. Enquête sur les habitudes alimentaires des travailleurs “a feux continus” [Survey of the food habits of workers on shift work]. Bull Inst Natl Sante Rech Med. 1967 Nov-Dec;22(6):1169-202.

10. Boege HL, Bhatti MZ, St-Onge MP. Circadian rhythms and meal timing: impact on energy balance and body weight. Curr Opin Biotechnol. 2021 Aug;70:1- 6. doi:10.1016/j.copbio.2020.08.009. [CROSSREF]

11. Qian J, Morris CJ, Caputo R, Wang W, Garaulet M, Scheer FAJL. Sex differences in the circadian misalignment effects on energy regulation. Proc Natl Acad Sci U S A. 2019 Nov 19;116(47):23806-23812. doi: 10.1073/pnas.1914003116. [CROSSREF]

12. Pan X, Hussain MM. Clock is important for food and circadian regulation of macronutrient absorption in mice. J Lipid Res. 2009 Sep;50(9):1800-13. doi: 10.1194/jlr.M900085-JLR200. [CROSSREF]

13. Mohd Azmi, N.A.S.; Juliana, N.; Azmani, S.; Mohd Effendy, N.; Abu, I.F.; Mohd Fahmi Teng, N.I.; Das, S. Cortisol on Circadian Rhythm and Its Effect on Cardiovascular System. Int. J. Environ. Res. Public Health 2021, 18, 676. https:// doi.org/10.3390/ijerph18020676. [CROSSREF]

14. O'Byrne NA, Yuen F, Butt WZ, Liu PY. Sleep and Circadian Regulation of Cortisol: A Short Review. Curr Opin Endocr Metab Res. 2021 Jun;18:178-186. doi- :10.1016/j.coemr.2021.03.011. [CROSSREF]

15. Effect of Circadian Rhythm on Metabolic Processes and the Regulation of Energy Balance REVIEW ARTICLES| APRIL 23 2019 Ann Nutr Metab (2019)74(4): 322–330 https://karger.com/anm/article/74/4/322/51852/Effect-of-Circadian-Rhythm-on-Metabolic-Processes https://doi.org/10.1159/000500071. [CROSSREF]

16. Digestive Enzymes: Amylase, Protease, And Lipase https://integrativepro.com/blogs/articles/digestive-enzymes-amylase-protease-lipase.

17. Digestive Enzymes: Types and Function A Necessary Part of DigestionBy Barbara Bolen, PhD Updated on September 06, 2022 Medically reviewed by Jay N. Yepuri, MD https://www-verywellhealth-com.translate.goog/what-are-digestive-enzymes.

18. Weitzman ED, Fukushima D, Nogeire C, Roffwarg H, Gallagher TF, Hellman L. Twenty-four hour pattern of the episodic secretion of cortisol in normal subjects. J Clin Endocrinol Metab. 1971 Jul;33(1):14-22. doi: 10.1210/jcem-33- 1-14. [CROSSREF]

19. Selmaoui B, Touitou Y. Reproducibility of the circadian rhythms of serum cortisol and melatonin in healthy subjects: a study of three different 24-h cycles over six weeks. Life Sci. 2003 Nov 14;73(26):3339-49. doi: 10.1016/j. lfs.2003.05.007. [CROSSREF]

20. Kuo T, McQueen A, Chen TC, Wang JC. Regulation of glucose homeostasis by glucocorticoids. Adv Exp Med Biol. 2015;872:99-126. doi: 10.1007/978-1- 4939-2895-8_5. [CROSSREF]

21. Schwartz MW, Woods SC, Porte D Jr, Seeley RJ, Baskin DG. Central nervous system control of food intake. Nature. 2000 Apr 6;404(6778):661-71. doi: 10.1038/35007534. [CROSSREF]

22. ŞAHİN, T., & TOZCU, D. (2022). Circadian rhythm and obesity. International Journal of Science Letters, 4(1), 202-219. https://doi.org/10.38058/ijsl.1053393 [CROSSREF]

23. Hashiguchi H, Sheng Z, Routh V, Gerzanich V, Simard JM, Bryan J. Direct versus indirect actions of ghrelin on hypothalamic NPY neurons. PLoS One. 2017 Sep 6;12(9):e0184261. doi: 10.1371/journal.pone.0184261. [CROSSREF]

24. Rynders CA, Morton SJ, Bessesen DH, Wright KP Jr, Broussard JL. Circadian Rhythm of Substrate Oxidation and Hormonal Regulators of Energy Balance. Obesity (Silver Spring). 2020 Jul;28 Suppl 1(Suppl 1):S104-S113. doi: 10.1002/ oby.22816. [CROSSREF]

25. Antoniades C, Antonopoulos AS, Tousoulis D, Marinou K, Stefanadis C. Homocysteine and coronary atherosclerosis: from folate fortification to the recent clinical trials. Eur Heart J. 2009 Jan;30(1):6-15. doi: 10.1093/eurheartj/ ehn515. [CROSSREF]

26. Lim JW, Kim CW, Park HO, Chung EY, Chae C, Son J, Shin YH, Park SH, Choi SM. Association between shift work and serum homocysteine level in female electronic manufacturing services workers. Ann Occup Environ Med. 2023 Mar;35(1):e4. https://doi.org/10.35371/aoem.2023.35.e4. [CROSSREF]

27. Cayanan EA, Eyre NAB, Lao V, Comas M, Hoyos CM, Marshall NS, Phillips CL, Shiao JSC, Guo YL, Gordon CJ. Is 24-hour energy intake greater during night shift compared to non-night shift patterns? A systematic review. Chronobiol Int. 2019 Dec;36(12):1599-1612. doi: 10.1080/07420528.2019.1666865. [CROSSREF]

28. Ulusoy HG, Sanlier N, Rakıcıoğlu N. Do Rotating Night Shifts Change Nurses’ Nutritional Status? A Cross-Sectional Study. J Am Nutr Assoc. 2022 Aug;41(6):608-616. doi: 10.1080/07315724.2021.1947413. [CROSSREF]

29. Kosmadopoulos A, Kervezee L, Boudreau P, Gonzales-Aste F, Vujovic N, Scheer FAJL, Boivin DB. Effects of Shift Work on the Eating Behavior of Police Officers on Patrol. Nutrients. 2020 Apr 4;12(4):999. doi: 10.3390/nu12040999. [CROSSREF]

30. Fradkin L, Raz O, Boaz M. Nurses who work rotating shifts consume more energy, macronutrients and calcium when they work the night shift versus day shift. Chronobiol Int. 2019 Feb;36(2):288-295. doi: 10.1080/07420528.2018.1538155. [CROSSREF]

31. Knutson A, Andersson H, Berglund U. Serum lipoproteins in day and shift workers: a prospective study. Br J Ind Med. 1990 Feb;47(2):132-4. doi: 10.1136/oem.47.2.132. [CROSSREF]

32. Balieiro LC, Rossato LT, Waterhouse J, Paim SL, Mota MC, Crispim CA. Nutritional status and eating habits of bus drivers during the day and night. Chronobiol Int. 2014 Dec;31(10):1123-9. doi: 10.3109/07420528.2014.957299. [CROSSREF]

33. Souza RV, Sarmento RA, de Almeida JC, Canuto R. The effect of shift work on eating habits: a systematic review. Scand J Work Environ Health. 2019 Jan 1;45(1):7-21. doi: 10.5271/sjweh.3759. [CROSSREF]

34. Nakamura M, Miura A, Nagahata T, Toki A, Shibata Y, Okada E, Ojima T. Dietary intake and dinner timing among shift workers in Japan. J Occup Health. 2018 Nov 27;60(6):467-474. doi: 10.1539/joh.2018-0070-OA. [CROSSREF]

35. Linseisen J, Wolfram G. Nährstoffzufuhr bei Dauernachtschicht-Arbeitern [Nutrient intake in permanent night shift workers]. Z Ernahrungswiss. 1994 Dec;33(4):299-309. German. doi: 10.1007/BF01614435. [CROSSREF]

36. Przeor M, Goluch-Koniuszy Z. [Evaluation of nutrition and diet of nurses during perimenopause while working in a shift system]. Probl Hig Epidemiol. 2013;94(4):797-801.Polish.

37. Gołąbek KD, Chmielewska A, Karoluk E, Regulska-Ilow B. A multifaceted assessment of the nutritional status, diet and eating habits of midwives working on a shift schedule in Wrocław, Poland: Evaluation of macronutrients, vitamins and minerals in the diets of midwives participating in the study. Int J Occup Med Environ Health2023;36(5):618-631. https://doi.org/10.13075/ijomeh.1896.02117. [CROSSREF]

38. Lee H.J., Choi H., Yoon I.Y. Impacts of serum Vitamin D levels on sleep and daytime sleepiness according to working conditions. J. Clin. Sleep Med. 2020;16:1045–1054. doi: 10.5664/jcsm.8390. [CROSSREF]

39. Martelli M, Salvio G, Santarelli L, Bracci M. Shift Work and Serum Vitamin D Levels: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Jul 22; doi:10.3390/ijerph19158919. [CROSSREF]

40. Doğan Y., Kara M., Culha M.A., Özçakar L., Kaymak B. The relationship between vitamin D deficiency, body composition, and physical/cognitive functions. Arch. Osteoporos. 2022;17:66. doi: 10.1007/s11657-022-01109-6. [CROSSREF]

41. Bukowska-Damska A., Skowronska-Jozwiak E., Kaluzny P., Lewinski A. Night shift work and osteoporosis-bone turnover markers among female blue-collar workers in Poland. Chronobiol. Int. 2022;39:818–825. doi: 10.1080/07420528.2022.2037626. [CROSSREF]

42. Wassif G A, Alrehely M S, Alharbi D M, et al. (October 26, 2023) The Impact of Vitamin D on Neuropsychiatric Disorders. Cureus 15(10): e47716. doi:10.7759/ cureus.47716. [CROSSREF]

43. Clark AB, Coates AM, Davidson ZE, Bonham MP. Dietary Patterns under the Influence of Rotational Shift Work Schedules: A Systematic Review and Meta-Analysis. Adv Nutr. 2023 Mar;14(2):295-316. doi: 10.1016/j.advnut.2023.01.006. [CROSSREF]

44. Takagi K. Influence of shift work on time and frequency of meal taking. J Hum Ergol (Tokyo). 1972 Dec;1(2):195-205.

45. D. van de Langenberg, J.J. Vlaanderen, M.E. Dollé, M.A. Rookus, L.W. van Kerkhof, R.C. Vermeulen Diet, physical activity, and daylight exposure patterns in night-shift workers and day workers Ann. Work. Expo. Health., 63 (1) (2019), pp. 9-21. [CROSSREF]

46. Bahinipati J, Sarangi R, Pathak M, Mohapatra S. Effect of night shift on development of metabolic syndrome among health care workers. J Family Med Prim Care. 2022 May;11(5):1710-1715. doi: 10.4103/jfmpc.jfmpc_375_21. [CROSSREF]

47. Mentzelou M, Papadopoulou SK, Papandreou D, Spanoudaki M, Dakanalis A, Vasios GK, et al. Evaluating the Relationship between Circadian Rhythms and Sleep, Metabolic and Cardiovascular Disorders: Current Clinical Evidence in Human Studies. Metabolites. 2023 Mar 1;13(3):370. doi: 10.3390/metabo13030370. [CROSSREF]

48. Khosravipour M, Khanlari P, Khazaie S, Khosravipour H, Khazaie H. A systematic review and meta-analysis of the association between shift work and metabolic syndrome: The roles of sleep, gender, and type of shift work. Sleep Med Rev. 2021 Jun;57:101427. doi: 10.1016/j.smrv.2021.101427. [CROSSREF]

49. Sun M, Feng W, Wang F, Li P, Li Z, Li M, et al. Meta-analysis on shift work and risks of specific obesity types. Obes Rev. 2018 Jan;19(1):28-40. doi: 10.1111/ obr.12621. [CROSSREF]

50. Chaput, JP., McHill, A.W., Cox, R.C. et al. The role of insufficient sleep and circadian misalignment in obesity. Nat Rev Endocrinol 19, 82–97 (2023). https://doi.org/10.1038/s41574-022-00747-7. [CROSSREF]

51. Sun S, Cao W, Ge Y, Ran J, Sun F, Zeng Q, Guo M, Huang J, Lee RS, Tian L, Wellenius GA. Outdoor light at night and risk of coronary heart disease among older adults: a prospective cohort study. Eur Heart J. 2021 Feb 21;42(8):822- 830. doi: 10.1093/eurheartj/ehaa846. [CROSSREF]

52. Kervezee L, Kosmadopoulos A, Boivin DB. Metabolic and cardiovascular consequences of shift work: The role of circadian disruption and sleep disturbances. Eur J Neurosci. 2020 Jan;51(1):396-412. doi: 10.1111/ejn.14216. [CROSSREF]

53. Gan Y, Yang C, Tong X, Sun H, Cong Y, Yin X, et al. Shift work and diabetes mellitus: a meta-analysis of observational studies. Occup Environ Med. 2015 Jan;72(1):72-8. doi: 10.1136/oemed-2014-102150. [CROSSREF]

54. Moreno CRC, Marqueze EC, Sargent C, Wright KP, Jr, Ferguson SA, Tucker P. Working time society consensus statements: evidence-based effects of shift work on physical and mental health. Ind Health. 2019;57(2):139–157. doi: 10.2486/indhealth.SW-1. [CROSSREF]

55. IARC Monographs Vol 124 group. Carcinogenicity of night shift work. Lancet Oncol. 2019 Aug;20(8):1058-9. doi: 10.1016/S1470-2045(19)30455-3. [CROSSREF]

56. Dun A., Zhao X., Jin X., Wei T., Gao X., Wang Y., Hou H. Association between Night-Shift Work and Cancer Risk: Updated Systematic Review and Meta-Analysis. Front. Oncol. 2020;10:1006. doi: 10.3389/fonc.2020.01006. [CROSSREF]

57. Wei F., Chen W., Lin X. Night-shift work, breast cancer incidence, and all-cause mortality: An updated meta-analysis of prospective cohort studies. Sleep Breath. Schlaf Atm. 2022;26:1509–1526. doi: 10.1007/s11325-021-02523-9. [CROSSREF]

58.Manouchehri E., Taghipour A., Ghavami V., Ebadi A., Homaei F., Latifnejad Roudsari R. Night-shift work duration and breast cancer risk: An updated systematic review and meta-analysis. BMC Women’s Health. 2021;21:89. doi: 10.1186/s12905-021-01233-4. [CROSSREF]

59. https://www.henryford.com/blog/2022/05/tips-for-healthy-eating-whileworking-the-night-shift Tips For Healthy Eating While Working The Night Shift Posted on May 16, 2022 by Henry Ford Health Staff.

61. How can I eat to optimize my performance on night shift? https://www.hprc-online.org/nutrition/unique-nutrition-needs/how-can-i-eat-optimize-my-performance-night-shift.

62. Easton, D.F., Gupta, C.C., Vincent, G.E. et al. Move the night way: how can physical activity facilitate adaptation to shift work?. Commun Biol 7, 259 (2024). https://doi.org/10.1038/s42003-02. [CROSSREF]


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