Rotating night shift work, sleep duration and elevated Gamma-glutamyl transpeptidase among steelworkers: cross-sectional analyses from a Chinese occupational cohort Qinglin Li a,# , Shengkui Zhang a,# , Han Wang a , Chao Xue a , Xiaohong Zhang a , Sheng Qin a , Juxiang Yuan a,* a Department of Epidemiology and Health Statistics, School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China # These authors contributed equally to this work. *Corresponding author: Tel: +13603256766; E-mail: [email protected]; [email protected]BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open doi: 10.1136/bmjopen-2021-053125 :e053125. 11 2021; BMJ Open , et al. Li Q
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Rotating night shift work, sleep duration and elevated
Gamma-glutamyl transpeptidase among steelworkers: cross-sectional
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
Smoking status was divided into "never", "ever" and "current". Drinking status
was evaluated from self-reported information, mainly including the amount and
frequency of alcohol consumed per week and was divided into "never", "ever" and
"current". Those who usually consumed some alcohol at least once a week over the
past 12 months were defined as current drinkers. For current drinkers, the frequency
of drinking status (days/week), usually the average amount of alcohol consumed (g),
and types of beverages were recorded. Alcohol content across different types of
beverages in China was assessed as follows: strong spirits 53%, weak spirits 38%,
rice wine 15%, grape wine 12%, and beer 4%. Based on the beverage type, amount
consumed, and frequency, we were able to derive the amount of pure alcohol (g/week)
consumed per week.[1] Intake levels of two standard drinks (20 g ethanol daily, 140 g
weekly) daily for males and one standard drink daily (70 g weekly) for females were
considered acceptable thresholds for defining non-alcoholics.[2] In this study, we have
eliminated individuals with excessive drinking status.
Occupational hazards (high temperature, noise, dust and carbon monoxide (CO))
exposure: yes or no. Smoking and drinking status: never, ever, current. The
calculation of metabolic equivalents was based on the International Physical Activity
Questionnaire (IPAQ)[3]. Physical activity (MET- hours/week) was divided into "low",
"middle" and "high". DASH score: Score according to (dietary approaches to stop
hypertension, DASH)[4]. Height and weight were measured three times each. The
participants stood upright and barefoot in light clothes. The height and weight data
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
that were ultimately used for analysis were accurate to 0.1 cm and 0.1 kg. Body mass
index (BMI) was defined as body weight (kg) divided by the square of the body
height (m2). Blood pressure measurements were performed three times five-minute
intervals using an electronic sphygmomanometer (OMRON, HBP-1100, China), and
the participants were required to rest for more than ten minutes. Finally, the mean was
obtained for analysis. Diabetes was defined as fasting blood glucose ≥7.0 mmol/L or
if the patient was receiving hypoglycemic therapy. Elevated blood pressure was
defined as current systolic blood pressure ≥140 mmHg, or diastolic blood pressure
≥90 mmHg, or if the patient was receiving antihypertensive therapy. Total cholesterol
(TC) ≥6.22 mmol/L or low-density lipoprotein (LDL-C) ≥4.11 mmol/L or
high-density lipoprotein (HDL-C) ≤1.04 mmol/L or triglycerides (TG) ≥2.32 mmol/L,
or patients undergoing lipid-lowering therapy were considered to demonstrate
dyslipidaemia. Renal function damage: estimated glomerular filtration rate (GFR) <90
ml/min/1.73 m2 was defined as Decreased eGFR[5].
Exposure to dust was defined as workers who may be exposed to productive dust
(inorganic dust, organic dust or mixed dust) during production (GBZ/T 229.1–2010).[6]
The total dust in the air of workplace was collected at the breathing zone with a filter
membrane, and it’s concentration was calculated based on the increased weight of the
filter membrane and the amount of gas collected. When the dust concentration in the
air ≤ 50mg/m3, a filter membrane with a diameter of 37mm or 40mm was used,
otherwise a filter membrane with a diameter of 75mm would be used (GBZ/T192.1–
2007).[7] Exposure to high temperature (heat stress work) was defined as the average
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
wet-bulb globe temperature (WBGT) index of the workplace is equal or greater than
25℃in the process of production (GBZ 2.2–2007).[8] The WBGT index was measured
by black-wet bulb globe thermometer. If there was no productive heat source in the
workplace, three measuring points were selected to take the average value of WBGT
index, while where there was a productive heat source, 3 to 5 measuring points were
selected to take the average value of WBGT index. If the workplace was isolated into
different thermal or ventilated environment, 2 measuring points were selected to take
the average value of WBGT index (GBZ/T 189.7 – 2007).[9] Exposure to industrial
toxicant was defined as workers who may be exposed to a variety of harmful
chemicals (the toxicant specifically refers to carbon monoxide in this population)
during production (GBZ/T 229.2–2010).[10] Carbon monoxide or carbon dioxide in the
air of workplace was pumped into the Non-Dispersive Infrared- Ray (NDIR) analyzer
and selectively absorbs their infrared rays. The concentration of carbon monoxide was
determined according to the absorption value (GBZ/T 160.28–2004).[11] Exposure to
noise was defined as workers who exposed to a noisy environment where the 8h/d or
40h/week equivalent A-weighted sound pressure level is ≥ 80dB, which may be
harmful to health and hearing (GBZ/T 229.4 – 2012).[12] The workplace production
noise was measured by a sound level meter. If the distribution of sound field in the
workplace was uniform (between-field difference of A-sound levels were less than
3dB(A)), three measuring points were selected to take the average value, otherwise it
should be divided into several sound level areas. In each sound field, two measuring
points were selected to take the average value (GBZ/T 189.8–2007).[13]
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
data not shown
Table of contents
Table S1 The results of the differences in means of Gamma-glutamyl transpeptidase
(GGT) according to current shift status and sleep duration
Table S2 Basic characteristic of the study subjects according to Gamma-glutamyl
transpeptidase (GGT) levels
Table S3 ORs of elevated Alanine transaminase (ALT) according to different
exposure metrics of night shift work
Table S4 ORs of elevated Aspartate aminotransferase (AST) according to different
exposure metrics of night shift work
Table S5 ORs of elevated Gamma-glutamyl transpeptidase (GGT) according to
different lifestyle factors
Table S6 Joint effects of different exposure metrics of night shift work and current
drinking status on elevated Gamma-glutamyl transpeptidase (GGT)
Table S7 Joint effects of different exposure metrics of night shift work and current
smoking status on elevated Gamma-glutamyl transpeptidase (GGT)
Table S8 Joint effects of different exposure metrics of night shift work and BMI on
elevated Gamma-glutamyl transpeptidase (GGT)
Table S9 Joint effects of different exposure metrics of night shift work and physical
activity (MET- hours/week) on elevated Gamma-glutamyl transpeptidase (GGT)
Table S10 ORs of elevated GGT according to different exposure metrics of night shift
work and sleep duration without missing participants taking antiretroviral drugs
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
Table S11 ORs of elevated GGT according to different exposure metrics of night shift
work and sleep duration after adjusted for all potential confounders
Figure S1 Duration of night shifts (years) and odds of elevated Gamma-glutamyl
transpeptidase (GGT) from restricted cubic spline models after removed the last 1%
quantile of the duration of night shifts
Figure S2 Cumulative member of night shifts (night) and odds of elevated
Gamma-glutamyl transpeptidase (GGT) from restricted cubic spline models after
removed the last 1% quantile of the cumulative member of night shifts
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
Table S1 The results of the differences in means of Gamma-glutamyl transpeptidase (GGT)
according to current shift status and sleep duration
Characteristics Total (n=7031) GGT levels (U/L), mean P value
Current shift status, n (%) <0.001Never 1155 (16.4) 33.67Ever 1380 (19.6) 34.53Current 4496 (64.0) 34.84
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
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Age (years), median (range) 44.8 (46.3, 59.6) 46.3 (24.9, 60.0) <0.001Working years (years), median(range)
24.3 (0.2, 46.8) 27.2 (0.8, 42.3) <0.001
DASH Score 21.7±2.2 21.2±2.1 <0.001
Values are number of individuals (%). P-values are from chi-square test for categorical variables and rank sum test
or independent-sample T test for continuous variables. DASH, dietary approaches to stop hypertension; MET,
metabolic equivalent of task; BMI: body mass index. Decreased eGFR: decreased estimated glomerular filtration
rate.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
Table S3 ORs of elevated Alanine transaminase (ALT) according to different exposure metrics of
Model 1: unadjusted. Model 2: adjusted for age, sex. Model 3: adjusted for age, sex, smoking status, drinking
status and DASH score. DASH, dietary approaches to stop hypertension.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
Table S4 ORs of elevated Aspartate aminotransferase (AST) according to different exposure
Model 1: unadjusted. Model 2: adjusted for age, sex. Model 3: adjusted for age, sex, smoking status, drinking
status and DASH score. DASH, dietary approaches to stop hypertension.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
Table S5 ORs of elevated Gamma-glutamyl transpeptidase (GGT) according to different lifestyle
Adjusted for age, sex, smoking status, drinking status and DASH score. DASH, dietary approaches to stop
hypertension.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
Table S6 Joint effects of different exposure metrics of night shift work and current drinking status
on elevated Gamma-glutamyl transpeptidase (GGT)
Stratified VariablesTotal Elevated GGT
P for InteractionN (%) OR (95% CI)
Current drinking status Current shift status 0.751
Adjusted for age, sex, smoking status, drinking status and DASH score. DASH, dietary approaches to stop
hypertension.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
Table S7 Joint effects of different exposure metrics of night shift work and current smoking status
Adjusted for age, sex, smoking status, drinking status and DASH score. DASH, dietary approaches to stop
hypertension.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
Table S8 Joint effects of different exposure metrics of night shift work and BMI on elevated
Adjusted for age, sex, smoking status, drinking status and DASH score. DASH, dietary approaches to stop
hypertension; BMI: body mass index.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
Table S9 Joint effects of different exposure metrics of night shift work and physical activity
(MET- hours/week) on elevated Gamma-glutamyl transpeptidase (GGT)
Adjusted for age, sex, smoking status, drinking status and DASH score. DASH, dietary approaches to stop
hypertension; MET, metabolic equivalent of task;
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
Table S10 ORs of elevated GGT according to different exposure metrics of night shift work and
sleep duration without missing participants taking antiretroviral drugs
Model 1: unadjusted. Model 2: adjusted for age, sex. Model 3: adjusted for age, sex, smoking status, drinking
status and DASH score. DASH, dietary approaches to stop hypertension.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
Table S11 ORs of elevated GGT according to different exposure metrics of night shift work and
sleep duration after adjusted for all potential confounders
temperature, noise, dust and CO) and other factors (current shift status or sleep duration). DASH, dietary
approaches to stop hypertension; MET, metabolic equivalent of task; BMI: body mass index.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
Figure S1 Duration of night shifts (years) and odds of elevated Gamma-glutamyl transpeptidase
(GGT) from restricted cubic spline models after removed the last 1% quantile of the duration of
night shifts
The solid lines, the long dashes and the short dashes represent the point estimate of the OR value and the upper
and lower limits of its 95% CI, respectively. Adjusted for age, sex, smoking status, drinking status and DASH
score. DASH, dietary approaches to stop hypertension.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
Figure S2 Cumulative member of night shifts (night) and odds of elevated Gamma-glutamyl
transpeptidase (GGT) from restricted cubic spline models after removed the last 1% quantile of
the cumulative member of night shifts
The solid lines, the long dashes and the short dashes represent the point estimate of the OR value and the upper
and lower limits of its 95% CI, respectively. Adjusted for age, sex, smoking status, drinking status and DASH
score. DASH, dietary approaches to stop hypertension.
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[2] Farrell GC, Chitturi S, Lau GK, et al; Asia-Pacific Working Party on NAFLD.
Guidelines for the assessment and management of non-alcoholic fatty liver disease in
the Asia-Pacific region: executive summary. J Gastroenterol Hepatol. 2007
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open
doi: 10.1136/bmjopen-2021-053125:e053125. 11 2021;BMJ Open, et al. Li Q