Shift workers use of time-restricted eating and cardiometabolic health

14th October 2022

Shift workers use of a time-restricted feeding strategy may help to improve cardiometabolic health according to a recent randomised trial

Shift workers (SWs) including healthcare staff and front-line individuals such as police and fire-fighters are exposed to electric light, especially at night and which may disrupt sleep and biological processes controlled by endogenous circadian clocks, potentially resulting in adverse health outcomes. Moreover, in a population health study with 4155 SWs and 8258 non-shift workers, the former group were 17% more likely to be obese and 27% more likely to have diabetes, suggesting that this pattern of working, which disrupts the circadian rhythm, is associated with adverse cardiovascular outcomes.

Although SWs appear to be at a higher risk of adverse cardiometabolic outcomes, there is a lack of data on potential life-style modification interventions to improve their health. One study in which fire-fighters adopted the Mediterranean diet found that adherence to the diet was associated with markers of decreased cardiometabolic risk.

A lifestyle modification which is attracting research interest is time-restricted feeding (TRF) and epidemiological studies have indicated that maintaining a consistent long overnight fast, which is a form of time-restricted eating, can significantly reduce risks for chronic diseases.

Whether time-restricted eating could improve cardiometabolic markers among shift workers has not been examined and was the subject of the present, randomised trial by a team of US researchers. The researchers explored the feasibility of a 10-hour TRF pattern among fire-fighters who worked a 24-hour shift. Individuals were randomised to standard care, in which there was no restriction on feeding time or the TRF, which was set at 10-hours and maintained for 12 weeks.

Both the TRF and standard care groups were advised to follow a healthy Mediterranean diet and used a smartphone asp (myCircadianClock) to record food intake. Although all individuals were generally healthy, a proportion did have at least one cardiometabolic risk factor such as an elevated body mass index (BMI), hypertension, elevated LDL cholesterol and researchers also examined the impact of TRF among this subgroup.

Shift workers time-restricted feeding and cardiometabolic health

A total of 137 fire-fighters with a mean age of 40.36 years (91% male) were randomised to TRF (70) or standard care and among the whole cohort, 71% had at least one cardiometabolic risk factor.

In the group assigned to TRF, the mean feeding window reduced from a mean of 14.13 hours at baseline to 11.13 after 12 weeks (p < 0.001) whereas it was unchanged in the standard group.

Fasting glucose and insulin levels in both TRF and control groups were not significantly different after 12 weeks. In contrast among the TRF group, diastolic blood pressures were significantly reduced, as was weight and very low LDL cholesterol particle size.

When the researchers focused on the changes among the TRF group with elevated baseline risk factors, they observed significant reductions in fasting glucose, %HbA1c levels, systolic and diastolic blood pressure and C-reactive protein levels.

The authors concluded that TRF was a feasible intervention for 24-hour shift workers and may serve as a novel intervention to prevent cardiometabolic disease.

Citation
Manoogian ENC et al. Feasibility of time-restricted eating and impacts on cardiometabolic health in 24-h shift workers: The Healthy Heroes randomized control trial Cell Metab 2022

Cardiometabolic and social factors combined better for prediction of adverse COVID-19 outcomes

15th July 2022

Combining both cardiometabolic and social determinants of health improves the predictive power of models assessing outcomes in COVID-19

The combination of clinical markers of cardiometabolic disease and social determinants of health provides a better predictive model for adverse outcomes in patients with COVID-19 according to a retrospective analysis by researchers from Alabama, US.

Cardiometabolic diseases such as diabetes have become recognised as a risk factor for both infection and more severe disease in COVID-19. Moreover, it has also become clear that there increased risks of infection and more severe disease based on race, ethnicity and various socioeconomic determinants.

Therefore, combined analyses that incorporate both cardiometabolic and social factors might enable a better understanding of how health disparities impact upon COVID-19 outcomes, yet such analyses are rarely undertaken.

As a result, for the present study, the US team made use of electronic health records incorporating both clinical and social factors and sought to determine the ability of models based on parameters extracted from both factors, were able to predict the subsequent need for hospitalisation, intensive care unit (ICU) admission and mortality after infection with COVID-19.

Using these records, the researchers obtained clinical patient data (e.g., glucose levels, body mass index, blood pressure etc) and to calculate a cardiometabolic disease staging (CMDS) value, used to assign risk levels for diabetes, and all-cause and cardiovascular disease mortality. CMDS values range from 0 to 0.99 with higher values indicating a greater risk of developing diabetes.

Individual-level social determinants of health (SDoH) included factors such as martial, employment and insurance status. A neighbourhood SDoH considered factors such as social vulnerability (an index of poverty) rurality and health care access.

Using regression analysis, the researchers modelled the risk of being hospitalised, admitted to ICU and death, using a CMDS model only and then after addition of both individual and neighbourhood SDoH values to determine whether the predictive power of the model changed and which was assessed by measuring the area under the curve.

Cardiometabolic health and COVID-19-related outcomes

A total of 2,873 patients with a mean age of 58.3 years (40.9% male) were included in the analysis, of whom 13.9% were hospitalised, 13.7% admitted to an ICU and 14.8% who died.

Using the CMDS model, each one standard deviation increase in CMDS score was associated with hospitalisation (odds ratio, OR = 2.0, 95% CI 1.83 – 2.20), ICU admission (OR = 1.88) and death (OR = 1.69).

Based on individual level SDoH, patients with no insurance had a higher odds of being hospitalised (OR = 3.35), an ICU admission (OR = 2.99) and death (OR = 7.27). In addition, the analysis also showed that patients with high social vulnerability were more likely to be hospitalised or admitted to an ICU.

Interestingly, when the CMDS model alone was used to predict hospitalisation, it had an area under the curve (AUC) of 0.776. But when individual level SDoH was added to the model, the predictive power improved and the AUC increased to 0.815 and it increased slightly further when both individual and neighbourhood SDoH were added (AUC = 0.819) and these differences were significant (p < 0.05).

Similar improvements to the predictive power were seen when individual and neighbourhood SDoH were added for both ICU admission and mortality models.

The authors concluded that using both clinical and social factor data improved the predictability of models for determination of the risk of severe outcomes after infection with COVID-19. They added that incorporation of both clinical and social measures could help guide treatment, intervention and prevention efforts to improve both health and inequality.

Citation
Howell CR et al. Associations between cardiometabolic disease severity, social determinants of health (SDoH), and poor COVID-19 outcomes Obesity (Silver Spring) 2022

Omega-3 supplements appear ineffective for depressed patients with cardiometabolic disease

9th June 2022

A meta-analysis has found that, compared with placebo, omega-3 supplements did not improve depression scores in those with cardiometabolic disease

Omega-3 supplements given to patients with cardiometabolic disease and who experience depression do not produce a meaningful improvement in depression scores compared to placebo. This was the conclusion from a systematic review and meta-analysis by researchers from Leicester, UK.

The term cardiometabolic disease encompasses cardiovascular disease, diabetes and chronic renal failure, and which are the top causes of death across the world. Among individuals with cardiometabolic disease, the presence of co-morbid mental health conditions, such as depression, have been found to increase the risk of cardiovascular mortality.

Moreover, cardiometabolic diseases can give rise to depression, as evidenced by the fact that 28% of patients attending a cardiac rehabilitation clinic were found to be suffering from depression. Patients with depression can be easily treated with antidepressants although there is tentative evidence that the use of antidepressants can increase the risk of both cerebrovascular and cardiovascular disease.

One dietary alternative to medical therapy is the use of omega-3 supplements with some data showing that the use of these supplements improved depression symptoms among patients with HIV.

Furthermore and more widely, a 2019 meta-analysis of the use of omega-3 supplements concluded that these supplements have a beneficial effect on depression.

Nevertheless, whether the use of omega-3 supplements in patients with cardiometabolic diseases, and who are depressed, is an effective treatment has not been examined and was the subject of the present analysis.

The UK team undertook a systematic review and meta-analysis of double-blind, randomised trials, in which the supplements were used, to determine the impact on depression scores in this population. The primary outcome was the mean change in depression scores at the point of follow-up.

Omega-3 supplements and depression scores

Only 7 trials were eligible for inclusion in the final analysis which reported on the outcome for 2,574 participants (74% male) with diabetes, coronary heart disease, cardiovascular disease, heart failure and a recent acute myocardial infarction.

All of the trials used omega-3 supplements with doses ranging from 1000 to 3000mg and for 10, 12 or 48 weeks.

Overall, 6 of the 7 trials recorded no statistically significant improvement compared to placebo (p > 0.05) at the end of the intervention. In the one trial where an improvement did occur, there was a 34% reduction in Beck Depression Inventory scale score (p < 0.05).

Commenting on the trials the authors described how they had focused on randomised trials to reduce the risk of bias but despite this restriction, several of the trials were ranked as either ‘moderate’ or ‘high’ for risks of bias.

They concluded that while omega-3 supplements appeared to be safe, the available data did not suggest that such supplements would reduce depression scores in patients with cardiometabolic diseases.

Citation
Arsenyadis F et al. The Effects of Omega-3 Supplementation on Depression in Adults with Cardiometabolic Disease: A Systematic Review of Randomised Control Trials Nutrients 2022.

Sustained weight loss reduces risk of adverse cardiometabolic outcomes

3rd November 2021