Japanese Diabetic patients long working hours skipping Break fast
Introduction
In Japan, the association between long working hours (LWHs) and the phenomenon of karoshi (death owing to overwork) because of unhealthy lifestyle choices
(i.e., physical inactivity, unhealthy eating habits and short sleep duration) and prolonged exposure to work‐related psychological stress has received much attention.
Because most adults work for at least one‐third of the day, occupational factors might play an important role in glycemic control1.
However, few epidemiological studies have investigated the effects of working conditions (i.e., working hours, occupation type, employment status and night work) on
the incidence of type 2 diabetes and glycemic control among workers with type 2 diabetes2, 3, 4.
Various lifestyle factors, particularly habitually skipping breakfast (SB) and late evening meals (LEMs), were associated with the onset of obesity and type 2 diabetes.
SB is independently associated with several risk factors for type 2 diabetes, including increased body mass index (BMI), waist circumference and insulin resistance5, 6, 7.
Furthermore, SB is associated with poor glycemic control, even after adjusting for BMI8, 9.
In contrast, owing to a lack of time, impaired appetite and fatigue, LEMs can be associated with SB the following day10. However, in the general Japanese population, hyperglycemia has been associated with LEMs, but not SB.
Therefore, the present hospital‐ and clinic‐based prospective study aimed to identify associations between suboptimal glycemic control and four work characteristics (i.e., number of working hours, type of occupation, status of employment and shift work) and unhealthy lifestyle habits (i.e., habitual SB or LEMs) among young Japanese adults with type 2 diabetes. Furthermore, subanalysis was carried out to assess the relationship between various lifestyle choices, socioeconomic status (SES) and complications of young Japanese adults with type 2 diabetes11.
Discussion
The aim of the present prospective study was to assess the association of lifestyle habits and working conditions with suboptimal glycemic control among young adult outpatients with type 2 diabetes.
Analysis based on sex revealed an association between
LWHs (≥60 h/week) and suboptimal glycemic control in men.
This association was robust when adjusted for BMI, pharmacotherapy and lifestyle factors,
such as physical inactivity, unhealthy eating habits, smoking, alcohol consumption and sleep deprivation.
Thus, LWHs (≥60 h/week) was identified as an independent predictive factor of suboptimal glycemic control.
Few attempts have been made to identify the association between working hours and glycemic control among workers with type 2 diabetes
4.
To the best of our knowledge, this is the first prospective study to assess the association between suboptimal glycemic control and working conditions in adults with type 2 diabetes.
LWHs might result in suboptimal glycemic control owing to greater job stress or strain because of working long hours4.
Although the biological mechanism is not well understood, chronic stress at work could affect glycemic control through negative behavioral habits
, such as increased eating to cope with stress and neuroendocrinological factors, including counter‐regulatory hormones4.
Nevertheless, a meta‐analysis showed no statistically significant associations between work‐related psychosocial stress and job strain with an increased risk of type 2 diabetes14.
Conversely, a recent meta‐analysis reported an evident association between LWHs and type 2 diabetes incidence in the low SES group, although details regarding the mechanisms underlying this association were not mentioned15. The authors determined SES based on the census classification groups (American cohorts),
social class categorization of the Registrar General (British cohorts) and the Australian Standard Classification of Occupations (Australian cohorts). The most common occupations of the low SES group were crafts, operatives, service, labor, farming (American cohorts), non‐skilled manual and partly or skilled manual (British cohorts), and production, transportation, elementary and laborer (Australian cohorts).
In the present study, the association between suboptimal glycemic control and LWHs was significant after adjusting for SES, as described above for British cohorts.
There was an association between LWHs and type 2 diabetes in male workers. Regarding the association between sex differences and health, one must consider the differences in social roles with respect to sex. We hypothesized that men are more commonly subjected to stress because of LWHs than women, because the social roles of men strongly affect work ethics in Japan, where men are considered to be the breadwinner of the family and who should work outside the home to earn a living16.
In other words, these findings increase the possibility that men believe that they are not appropriately rewarded for their labor in regard to LWHs.
Strong associations between working overtime hours and the onset of brain and heart diseases have long been recognized in Japan. Working ≥100 h of overtime for the past 1 month and for ≥80 h of overtime for the past 2–6 months have been correlated with an increased incidence of karoshi 17.
We would like to emphasize that ≥80 h of overtime per month is associated with LWHs (≥60 h/week), which was identified as an independent risk factor for suboptimal glycemic control in the present study.
Similarly, the present study results showed that the association between suboptimal glycemic control and SB concomitant with LEMs was robust when adjusted for BMI, pharmacotherapy and other lifestyle factors, such as physical inactivity, smoking, alcohol consumption and sleep duration.
To the best of our knowledge, this is the first prospective study to report that SB concomitant with LEMs was more significantly associated with suboptimal glycemic control than SB alone.
Habitual SB is considered to be an unhealthy eating habit associated with the incidence of type 2 diabetes and glycemic control5, 6, 7, 8, 9.
One of the mechanisms by which SB could potentially cause or exacerbate type 2 diabetes is the second‐meal phenomenon: the effect of a prior meal in decreasing the increase in blood glucose after a subsequent meal18, which is mediated by plasma‐free fatty acid suppression that induces insulin resistance in humans19. Furthermore, the association between SB intake frequency and metabolic risk factors of obesity, metabolic syndrome, hypertension and type 2 diabetes could be independent of dietary quality8.
The incidence of LEMs can be associated with that of SB the following morning because of several factors, such as a lack of time, impaired appetite and fatigue.
Cross‐sectional studies have shown that SB concomitant with LEMs was significantly associated with metabolic syndrome, and that hyperglycemia in the general Japanese population was associated with LEMs alone, but not SB alone10, 20.
Hence, the present study focused on the possible close
association between SB and eating dinner late at night. SB concomitant with LEMs (a so‐called ‘nocturnal’ life) is related to
SB and consumption of more food in the evening and at night, with sleep from midnight to the next morning. Furthermore, a previous study suggested that blood glucose concentration was maintained at a high level between midnight and early morning, and a nocturnal lifestyle leads to impairment of insulin response to glucose in healthy adults21.
Long working hours and skipping breakfast concomitant with late evening meals are associated with suboptimal glycemic control among young male Japanese patients with type 2 diabetes
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