Metabolic health measurements of shift workers in a national cross-sectional study: Results from the Canadian Health Measures Survey

Background Shift work exposure may be a concern for a range of health effects, including metabolic health outcomes such as insulin resistance, high body weight, and abdominal obesity. Methods We analyzed shift work and indicators of metabolic health (overweight/obesity defined by body mass index, self-reported changes in body mass index (BMI) in previous 1 and 10 years, waist circumference, waist-to-hip ratio, and insulin resistance assessed by the homeostasis model assessment 2 (HOMA-2-IR)) in the cross-sectional Canadian Health Measures Survey (CHMS). We analyzed descriptive characteristics of shift workers (regular night, evening, and rotating shift) and used multivariable linear regression to examine the association between two definitions of shift work exposure and measures of metabolic health, adjusted for age, sex, daily energy expenditure, sleep, and poor dietary quality. Results 5470 anthropometry (2637 fasting) participants in CHMS Cycles 1 and 2 were included, of whom 16.5% worked regular evening, night, or rotating shifts. Shift workers were younger and slept longer hours than non-shift workers. Bivariate associations showed inverse relationships between shift work and BMI, waist circumference, waist-to-hip ratio, and HOMA-2-IR. In adjusted analyses, BMI was inversely related to shift work, and other metabolic health outcomes showed no significant associations. Conclusions Healthy worker effects (including self-selection of exposure) could explain inverse relationships, particularly as the cross-sectional design only allowed assessment of current exposure. Key strengths include the population-based design and measurement of metabolic health indicators. Results underscore the importance of consideration of the health of shift workers following departure from the exposed population.