Rotating night shift work and risk of multiple sclerosis in the Nurses’ Health Studies

2019 ◽  
Vol 76 (10) ◽  
pp. 733-738 ◽  
Author(s):  
Kyriaki Papantoniou ◽  
Jennifer Massa ◽  
Elizabeth Devore ◽  
Kassandra L Munger ◽  
Tanuja Chitnis ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Shift Work ◽  
Proportional Hazards ◽  
Night Shift ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Work History ◽  
Night Shift Work ◽  
Increased Risk ◽  
History Of

ObjectivesNight shift work has been suggested as a possible risk factor for multiple sclerosis (MS). The objective of the present analysis was to prospectively evaluate the association of rotating night shift work history and MS risk in two female cohorts, the Nurses’ Health Study (NHS) and NHSII.MethodsA total of 83 992 (NHS) and 114 427 (NHSII) women were included in this analysis. We documented 579 (109 in NHS and 470 in NHSII) incident physician-confirmed MS cases (moderate and definite diagnosis), including 407 definite MS cases. The history (cumulative years) of rotating night shifts (≥3 nights/month) was assessed at baseline and updated throughout follow-up. Cox proportional hazards models were used to estimate HRs and 95% CIs for the association between rotating night shift work and MS risk adjusting for potential confounders.ResultsWe observed no association between history of rotating night shift work and MS risk in NHS (1–9 years: HR 1.03, 95% CI 0.69 to 1.54; 10+ years: 1.15, 0.62 to 2.15) and NHSII (1–9 years: HR 0.90, 95% CI 0.74 to 1.09; 10+ years: 1.03, 0.72 to 1.49). In NHSII, rotating night shift work history of 20+ years was significantly associated with MS risk, when restricting to definite MS cases (1–9 years: HR 0.88, 95% CI 0.70 to 1.11; 10–19 years: 0.98, 0.62 to 1.55; 20+ years: 2.62, 1.06 to 6.46).ConclusionsOverall, we found no association between rotating night shift work history and MS risk in these two large cohorts of nurses. In NHSII, shift work history of 20 or more years was associated with an increased risk of definite MS diagnosis.

scholarly journals Night Shift Work Accelerates Menopausal Age in Health Workers

2021 ◽  
Vol 4 (1) ◽  
pp. 30
Author(s):  
Sri Ratna Dwiningsih ◽  
Samsulhadi Samsulhadi ◽  
Arif Tunjungseto ◽  
Monika Lijuwardi ◽  
Arsana Wiyasa
Keyword(s):  
Nutritional Status ◽  
Shift Work ◽  
Health Workers ◽  
Risk Group ◽  
Lymphoblastic Leukemia ◽  
Night Shift ◽  
Induction Phase ◽  
Night Shift Work ◽  
Increased Risk ◽  
History Of

Introduction: Earlier menopause has been associated with increased risk of cardiovascular disease, osteoporosis, shorter life expectancy and even cognitive decline. There are many factors that cause differences in the age of menopause in women, one of these environmental factors is a history of night shift work as a consequence of a job. It is not yet known whether female medical workers, with a history of night shifts, get earlier menopause.Methods: This case control study was conducted among 57 female night workers of the Dr. Soetomo General Academic Hospital. Data collection was conducted from December 2019 - March 2020. The study sample was postmenopausal health workers (nurse and midwife) and administrators. The instrument used in this study was a list of interview questions. The data was processed using SPSS software release 23.Results: The results show that from 45 children diagnosed with ALL, 53% are of the age ≤ 5 years old, with 58% males and 42% females. 13% of the patients are in the high risk group and 87% are in the standard risk group. Nutritional statuses of patients are 2% of them obese experienced remission after induction phase therapy, 56% normal with 80% of them experienced remission. 40% underweight with 89% of them experienced remission and 11% not experienced remission, 2% malnutrition and experienced remission. There is no correlation between the nutritional status of children with acute lymphoblastic leukemia with the outcome of induction phase (p = 0.798).Conclusion: In conclusion, there is no correlation between nutritional status and remission outcome of patients with ALL in the induction phase of therapy. However, high percentage of underweight patients shows nutrition needs special attention to improve therapy outcomes. 

scholarly journals Increased risk of multiple sclerosis among women with migraine in the Nurses’ Health Study II

2011 ◽  
Vol 18 (1) ◽  
pp. 90-97 ◽  
Author(s):  
Ilya Kister ◽  
Kassandra L Munger ◽  
Joseph Herbert ◽  
Alberto Ascherio
Keyword(s):  
Multiple Sclerosis ◽  
Relative Risk ◽  
Proportional Hazards ◽  
Absolute Risk ◽  
Statistical Significance ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Increased Risk ◽  
The Difference ◽  
Rate Ratios

Background: The prospective Nurses’ Health Study II (NHS-II), which enrolled over 116,000 female nurses, provides a unique opportunity to test the hypothesis of whether migraine is associated with multiple sclerosis (MS) and to explore the temporal aspects of the interrelationship. Objectives: To calculate relative risk of MS among NHS-II participants with and without migraine and to estimate odds ratio (OR) of being diagnosed with migraine in women with and without pre-existing MS. Methods: Cox proportional hazards regression was used to estimate rate ratios and 95% confidence intervals (CIs) of being diagnosed with MS in women with and without pre-existing migraine adjusted for potential confounders. Multivariate adjusted ORs of being diagnosed with migraine in women with and without pre-existing MS were estimated using logistic regression. Results: The prevalence of migraine in women with MS at baseline (26%, p = 0.11) and those diagnosed with MS after enrolment (29%, p < 0.0001) was higher than in the non-MS cases (21%). The relative risk of developing MS in migraineurs was 1.39 times higher than in non-migraineurs (95% CI 1.10–1.77, p = 0.008). The absolute risk of developing MS in women migraineurs over a 15-year follow-up was 0.47% and among non-migraineurs 0.32%. The odds of being diagnosed with migraine was higher in women with pre-existing MS compared with those without MS, but did not reach statistical significance (OR = 1.57, 95% CI 0.97–2.52; p = 0.06). Conclusions: Using a large, cohort of women-nurses, history of migraine was associated with an increased risk of MS. However, the difference in absolute risk of MS in migraineurs and non-migraineurs was small.

scholarly journals A Prospective Study of Periodontal Disease and Risk of Rheumatoid Arthritis

2010 ◽  
Vol 37 (9) ◽  
pp. 1800-1804 ◽  
Author(s):  
ELIZABETH V. ARKEMA ◽  
ELIZABETH W. KARLSON ◽  
KAREN H. COSTENBADER
Keyword(s):  
Rheumatoid Arthritis ◽  
Periodontal Disease ◽  
Prospective Cohort ◽  
Tooth Loss ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Periodontal Surgery ◽  
Increased Risk ◽  
History Of

Objective.To test for an association between periodontal disease (PD) and incident rheumatoid arthritis (RA) in a large prospective cohort.Methods.We conducted a prospective analysis of history of periodontal surgery, tooth loss, and risk of RA among 81,132 women in the Nurses’ Health Study prospective cohort. Periodontal surgery and tooth loss were used as proxies for history of PD. There were 292 incident RA cases diagnosed from 1992 to 2004. Information on periodontal surgery and tooth loss in the past 2 years was collected by questionnaire in 1992. Cox proportional hazards models were used to assess relationships between periodontal surgery, tooth loss, and risk of RA adjusting for age, smoking, number of natural teeth, body mass index, parity, breastfeeding, postmenopausal status, postmenopausal hormone use, father’s occupation, and alcohol intake.Results.Compared with those who reported no history of periodontal surgery or tooth loss, women with periodontal surgery or tooth loss did not have a significantly elevated risk of RA in multivariable-adjusted models (RR 1.24, 95% CI 0.83, 1.83; and RR 1.18, 95% CI 0.47, 2.95, respectively). In analyses stratified by ever and never-smokers, ever-smokers with periodontal surgery had an increased risk that was also nonsignificant. Those with severe PD (both history of periodontal surgery and tooth loss) did not have a significant increased risk.Conclusion.In this large cohort of American women, there was no evidence of an increased risk of later-onset RA among those with a history of periodontal surgery and/or tooth loss.

scholarly journals Association of oral contraceptives and tubal ligation with risk of early natural menopause

2021 ◽  
Author(s):  
C R Langton ◽  
B W Whitcomb ◽  
A C Purdue-Smithe ◽  
L L Sievert ◽  
S E Hankinson ◽  
...  
Keyword(s):  
Oral Contraceptives ◽  
Proportional Hazards ◽  
Reproductive Factors ◽  
Cox Proportional Hazards ◽  
Tubal Ligation ◽  
Health Study ◽  
Early Menopause ◽  
Natural Menopause ◽  
Increased Risk

Abstract STUDY QUESTION What is the association of oral contraceptives (OCs) and tubal ligation (TL) with early natural menopause? SUMMARY ANSWER We did not observe an association of OC use with risk of early natural menopause; however, TL was associated with a modestly higher risk. WHAT IS KNOWN ALREADY OCs manipulate hormone levels, prevent ovulation, and may modify the rate of follicular atresia, while TL may disrupt the blood supply to the ovaries. These mechanisms may be associated with risk of early menopause, a condition associated with increased risk of cardiovascular disease and other adverse health outcomes. STUDY DESIGN, SIZE, DURATION We examined the association of OC use and TL with natural menopause before the age of 45 years in a population-based study within the prospective Nurses’ Health Study II (NHSII) cohort. Participants were followed from 1989 to 2017 and response rates were 85-90% for each cycle. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants included 106 633 NHSII members who were premenopausal and aged 25-42 years at baseline. Use, duration and type of OC, and TL were measured at baseline and every 2 years. Menopause status and age were assessed every 2 years. Follow-up continued until early menopause, age 45 years, hysterectomy, oophorectomy, death, cancer diagnosis, or loss to follow-up. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CIs adjusted for lifestyle, dietary, and reproductive factors. MAIN RESULTS AND THE ROLE OF CHANCE Over 1.6 million person-years, 2579 members of the analytic cohort experienced early natural menopause. In multivariable models, the duration, timing, and type of OC use were not associated with risk of early menopause. For example, compared with women who never used OCs, those reporting 120+ months of OC use had an HR for early menopause of 1.01 (95% CI, 0.87-1.17; P for trend=0.71). TL was associated with increased risk of early menopause (HR = 1.17, 95% CI, 1.06-1.28). LIMITATIONS, REASONS FOR CAUTION Our study population is homogenous with respect to race and ethnicity. Additional evaluation of these relations in more diverse populations is important. WIDER IMPLICATIONS OF THE FINDINGS To our knowledge, this is the largest study examining the association of OC use and TL with early natural menopause to date. While TL was associated with a modest higher risk of early menopause, our findings do not support any material hazard or benefit for the use of OCs. STUDY FUNDING/COMPETING INTEREST(S) The study was sponsored by UO1CA176726 and R01HD078517 from the National Institutes of Health and Department of Health and Human Services. The work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors have no competing interests to report. TRIAL REGISTRATION NUMBER N/A

Is shift-work associated with increased risk of rectal cancer? A meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e15600-e15600
Author(s):  
Chenyu Sun ◽  
Ce Cheng ◽  
Kelly Kozma ◽  
Gopika Chandra ◽  
Na Hyun Kim ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Risk ◽  
Shift Work ◽  
Meta Analysis ◽  
Night Shift ◽  
Fixed Effect Model ◽  
Night Shift Work ◽  
Increased Risk ◽  
Rotating Shift Work ◽  
Trim And Fill

e15600 Background: Globally, more than 1.8 million people were diagnosed of colorectal cancer (CRC) in 2018, with over 30% of CRC in the rectum. Shift-work, involving circadian disruption, sleep deprivation and lifestyle changes, was designated as a probable cause of cancer by The International Agency for Research on Cancer. Previous studies investigating the impact of permanent night-shift work and rotating shift-work on rectal cancer risk showed controversial results. Thus, this meta-analysis was conducted. Methods: A comprehensive literature search on PubMed was conducted to identify all relevant studies published prior to January 2021 according to the established inclusion criteria. The quality assessment was performed by the Newcastle-Ottawa Scale (NOS). The pooled odds ratio (OR) and 95% confidence intervals (CI) were calculated to estimate the association between the shift-work and rectal cancer risk. Based on heterogeneity significance, random-effect or fixed-effect model was used. Subgroup analyses were conducted to explore the night-shift and rotating-shift, respectively. Sensitivity analysis and publication bias detection were performed, and trim and fill analysis was also conducted. All statistical analyses were performed using RevMan software (version 5.3; Cochrane library) and STATA 15.0 statistical software (Stata Corp., College Station, TX), and all P values were two-tailed, the test level was 0.05. Results: Thirty-seven articles were obtained from database searching. Three articles involving 1,063 rectal cancer cases were included. All studies were considered moderate to high quality. All included studies investigated on the association between shift-work and rectal cancer risk. A statistically significant association between shift-work and increased rectal cancer risk was found (OR 1.53, 95%CI: 1.31, 1.79, P< 0.00001, I 2 = 35%). In subgroup analyses, night-shift work was associated with a non-statistically significant increased risk of rectal cancer (OR 1.25, 95%CI: 0.47, 3.32, P = 0.66, I 2 = 93%). In contrast, Rotating-shift was associated with a statistically significant increased rectal cancer risk (OR 1.35, 95%CI: 1.10, 1.65, P = 0.004, I 2 = 6%). Sensitivity analysis confirmed the stability of the result. Funnel plot, Egger's test (t = 1.69, P = 0.341), and Begg's test (z = 1.04, P = 0.296) found no publication bias of analysis. Trim and fill analysis on fixed-effect model showed the pooled OR kept stable after adding two “missing” studies (OR 1.403, 95%CI: 1.224, 1.609, P <0.05). Conclusions: The current meta-analysis demonstrates that shift-work is associated with increased rectal cancer risk. However, no association between night-shift work and rectal cancer risk was found. In contrast, association between rotating-shift work and increased rectal cancer risk was found. More original studies on this topic are needed to further explore shift-work impacts on rectal cancer risk.

O35-2 Current and cumulative night shift work and subclinical atherosclerosis – results of the gutenberg health study

2016 ◽  
Author(s):  
Sylvia Jankowiak ◽  
Eva-Maria Backé ◽  
Falk Liebers ◽  
Andreas Schulz ◽  
Janice Hegewald ◽  
...  
Keyword(s):  
Shift Work ◽  
Subclinical Atherosclerosis ◽  
Night Shift ◽  
Health Study ◽  
Night Shift Work ◽  
Gutenberg Health Study

Abstract MP49: Sugar Sweetened and Artificially Sweetened Beverages and risk of Mortality in US adults

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Vasanti S Malik ◽  
An Pan ◽  
Lawrence de Koning ◽  
Eva Schernhammer ◽  
Walter C Willett ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Total Mortality ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Sweetened Beverages ◽  
Risk Of Mortality ◽  
Regular Consumption ◽  
Increased Risk ◽  
Artificially Sweetened Beverages ◽  
Cvd Mortality

Background: Sugar sweetened beverages (SSBs) are the single largest source of calories and added sugars in the US diet and regular consumption has been associated with weight gain and risk of chronic diseases. Artificially sweetened beverages (ASBs) are often suggested as alternatives to SSB but little is known about their long-term health effects. Whether consumption of SSBs or ASBs is associated with risk of mortality is unknown. Methods: We prospectively followed 38,602 men from the Health Professional’s Follow-up study (1986-2010) and 82,592 women from the Nurses’ Health study (1980-2010) who were free from cardiovascular disease (CVD) and cancer at baseline. Diet was assessed using validated food frequency questionnaires every 4 years and Cox Proportional Hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). Results: We documented 27,691 deaths (6,631 CVD and 10,447 cancer deaths) during 3.14 million person-years. After adjusting for major dietary and lifestyle risk factors, and BMI, baseline diabetes, hypertension and hypercholesterolemia, consumption of SSBs was associated with an increased risk of total mortality, which was mainly driven by CVD mortality among individuals consuming at least 2 servings per day; pooled HRs (95% CIs) across categories (<1/month, 1-4/month, 2-6/week, 1-<2/day and ≥2/day) were 1.00, 0.95 (0.91, 0.98), 0.96 (0.93, 0.99), 1.02 (0.96, 1.08), and 1.18 (1.04, 1.33), respectively (P-trend= 0.0001) for total mortality, and 1.00, 0.97 (0.90, 1.02), 0.96 (0.90, 1.02), 1.04 (0.93, 1.16) and 1.28 (1.09, 1.51), respectively (P-trend=0.007) for CVD mortality. In contrast, ASBs were not associated with mortality; pooled HR’s (95% CIs) across categories (<1/month, 1-4/month, 2-6/week, 1-<2/day and ≥2/day) were 1.00, 0.92 (0.89, 0.95), 0.91 (0.86, 0.97), 0.91 (0.86, 0.95) and 0.99 (0.85, 1.15), respectively (P-trend=0.50) for total mortality and 1.00, 0.86 (0.80, 0.92), 0.87 (0.81, 0.94), 0.96 (0.88, 1.06) and 0.96 (0.74, 1.25), respectively (P-trend=0.99) for CVD mortality. No associations were observed with cancer mortality for either SSBs or ASBs in multi-variable adjusted models. Conclusion: Regular consumption of SSBs is associated with an increased risk of total and CVD mortality, providing additional support for recommendations and policies to limit intake of these beverages.

scholarly journals Sedentary Behaviors, TV Viewing Time, and Risk of Young-Onset Colorectal Cancer

2018 ◽  
Vol 2 (4) ◽  
Author(s):  
Long H Nguyen ◽  
Po-Hong Liu ◽  
Xiaobin Zheng ◽  
NaNa Keum ◽  
Xiaoyu Zong ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Proportional Hazards ◽  
Statistical Tests ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Viewing Time ◽  
Sedentary Behaviors ◽  
Tv Viewing ◽  
Young Onset ◽  
Increased Risk

Abstract Background Colorectal cancer (CRC) diagnosed before age 50 years, or young-onset CRC, is increasing globally with undefined etiology. A sedentary lifestyle is an emerging risk factor for CRC after age 50 years, but its role in young-onset CRC is unknown. Methods We prospectively evaluated sedentary behaviors, primarily time watching television (TV), and risk of young-onset CRC among 89 278 women in the Nurses’ Health Study II ages 25–42 years at recruitment (1991–2011). We used Cox proportional hazards modelling to estimate relative risks (RR) and 95% confidence intervals (CIs). Statistical tests were two-sided. Results We documented 118 young-onset CRCs over 1 262 540 person-years. Sedentary TV viewing time was statistically significantly associated with increased risk of young-onset CRC, after adjusting for putative risk factors, including obesity and physical activity. Compared to no more than 7 hours per week, women with 7.1–14 hours per week of TV time had a multivariable relative risk (RR) of 1.12 (95% confidence interval [CI] = 0.72 to 1.75), further increased for greater than 14 hours per week (RR = 1.69, 95% CI = 1.07 to 2.67, Ptrend = .03). This association was observed among participants without a CRC family history and was more pronounced for rectal cancer (RR for >14 vs ≤7 hours per week 2.44, 95% CI = 1.03 to 5.78, Ptrend = .04). Overweight or obese participants may be more susceptible. Conclusion Independent of exercise and obesity, prolonged sedentary TV viewing time, a surrogate for a more inactive lifestyle, was associated with increased risk of young-onset CRC, particularly of the rectum. These findings provide further evidence on the importance of maintaining an active lifestyle.

scholarly journals Pain in Patients With Type 2 Diabetes-Related Polyneuropathy Is Associated With Vascular Events and Mortality

2020 ◽  
Vol 105 (9) ◽  
pp. 3005-3014
Author(s):  
Brittany R Lapin ◽  
Kevin M Pantalone ◽  
Alex Milinovich ◽  
Shannon Morrison ◽  
Andrew Schuster ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Proportional Hazards ◽  
Negative Binomial ◽  
Cox Proportional Hazards ◽  
Vascular Events ◽  
Proportional Hazards Regression ◽  
Increased Risk ◽  
History Of ◽  
Mortality Hazard Ratio

Abstract Purpose Type 2 diabetes–related polyneuropathy (DPN) is associated with increased vascular events and mortality, but determinants and outcomes of pain in DPN are poorly understood. We sought to examine the effect of neuropathic pain on vascular events and mortality in patients without DPN, DPN with pain (DPN + P), and DPN without pain (DPN-P). Methods A retrospective cohort study was conducted within a large health system of adult patients with type 2 diabetes from January 1, 2009 through December 31, 2016. Using an electronic algorithm, patients were classified as no DPN, DPN + P, or DPN-P. Primary outcomes included number of vascular events and time to mortality. Independent associations with DPN + P were evaluated using multivariable negative binomial and Cox proportional hazards regression models, adjusting for demographics, socioeconomic characteristics, and comorbidities. Results Of 43 945 patients with type 2 diabetes (age 64.6 ± 14.0 years; 52.1% female), 13 910 (31.7%) had DPN: 9104 DPN + P (65.4%) vs 4806 DPN-P (34.6%). Vascular events occurred in 4538 (15.1%) of no DPN patients, 2401 (26.4%) DPN + P, and 1006 (20.9%) DPN-P. After adjustment, DPN + P remained a significant predictor of number of vascular events (incidence rate ratio [IRR] = 1.55, 95% CI, 1.29-1.85), whereas no DPN was protective (IRR = 0.70, 95% CI, 0.60-0.82), as compared to DPN-P. Compared to DPN-P, DPN + P was also a significant predictor of mortality (hazard ratio = 1.42, 95% CI, 1.25-1.61). Conclusions Our study found a significant association between pain in DPN and an increased risk of vascular events and mortality. This observation warrants longitudinal study of the risk factors and natural history of pain in DPN.

scholarly journals Rotating night shift work and adherence to unhealthy lifestyle in predicting risk of type 2 diabetes: results from two large US cohorts of female nurses

BMJ ◽  
2018 ◽  
pp. k4641 ◽  
Author(s):  
Zhilei Shan ◽  
Yanping Li ◽  
Geng Zong ◽  
Yanjun Guo ◽  
Jun Li ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Shift Work ◽  
Night Shift ◽  
Health Study ◽  
Lifestyle Factor ◽  
Unhealthy Lifestyle ◽  
Additive Interaction ◽  
Night Shift Work ◽  
Female Nurses

AbstractObjectivesTo prospectively evaluate the joint association of duration of rotating night shift work and lifestyle factors with risk of type 2 diabetes risk, and to quantitatively decompose this joint association to rotating night shift work only, to lifestyle only, and to their interaction.DesignProspective cohort study.SettingNurses’ Health Study (1988-2012) and Nurses’ Health Study II (1991-2013).Participants143 410 women without type 2 diabetes, cardiovascular disease, or cancer at baseline.ExposuresRotating night shift work was defined as at least three night shifts per month in addition to day and evening shifts in that month. Unhealthy lifestyles included current smoking, physical activity levels below 30 minutes per day at moderate to vigorous intensity, diet in the bottom three fifths of the Alternate Healthy Eating Index score, and body mass index of 25 or above.Main outcome measuresIncident cases of type 2 diabetes were identified through self report and validated by a supplementary questionnaire.ResultsDuring 22-24 years of follow-up, 10 915 cases of incident type 2 diabetes occurred. The multivariable adjusted hazard ratios for type 2 diabetes were 1.31 (95% confidence interval 1.19 to 1.44) per five year increment of duration of rotating night shift work and 2.30 (1.88 to 2.83) per unhealthy lifestyle factor (ever smoking, low diet quality, low physical activity, and overweight or obesity). For the joint association of per five year increment rotating night shift work and per unhealthy lifestyle factor with type 2 diabetes, the hazard ratio was 2.83 (2.15 to 3.73) with a significant additive interaction (P for interaction <0.001). The proportions of the joint association were 17.1% (14.0% to 20.8%) for rotating night shift work alone, 71.2% (66.9% to 75.8%) for unhealthy lifestyle alone, and 11.3% (7.3% to 17.3%) for their additive interaction.ConclusionsAmong female nurses, both rotating night shift work and unhealthy lifestyle were associated with a higher risk of type 2 diabetes. The excess risk of rotating night shift work combined with unhealthy lifestyle was higher than the addition of risk associated with each individual factor. These findings suggest that most cases of type 2 diabetes could be prevented by adhering to a healthy lifestyle, and the benefits could be greater in rotating night shift workers.

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