Relationship of shift work with liver enzyme abnormalities and nonalcoholic fatty liver disease: A retrospective cohort study of Thai workers in Bangkok, Thailand 10.55131/jphd/2024/220110

Main Article Content

Napas Taechasan
Wiroj Jiamjarasrangsi

Abstract

Shift work, particularly night shift work, has several detrimental health outcomes. This retrospective study investigated the associations of shift work with the incidence rates of liver enzyme abnormalities and nonalcoholic fatty liver disease (NAFLD) using the annual health check-up database between 2009 and 2016 and self-administered questionnaires from two large organizations in Thailand. Among 10,205 participants, 3620 eligible participants, classified into three subgroups by their shift work status, were followed up until abnormal liver outcomes were observed. The incidence rate of abnormal outcomes was calculated, and Cox proportional hazard models were used to assess the associations. Current shift work was not associated with abnormal liver outcomes, including elevated alanine aminotransferase and aspartate aminotransferase levels, elevated lipid accumulation product (e-LAP), and elevated hepatic steatosis index (e-HSI). However, when the frequencies and duration of shift work were investigated, the duration of shift work was associated with NAFLD outcomes. Healthcare personnel with 10–20 years of shift work experience had a higher risk of e-LAP (adjusted hazard ratio [HR] = 1.31, 95% confidence interval [CI] = 1.04–1.65), while workers with more than 20 years of shift work had a lower risk of e-LAP (adjusted HR = 0.77, 95% CI–0.62–0.97). Nonhealthcare shift workers with fewer than 10 years of work exposure had a higher risk of e-HSI (adjusted HR = 4.30, 95% CI = 1.28–14.47). In summary, the shift work status was not associated with liver abnormalities, but the duration of shift work was associated with NAFLD.

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1.
Taechasan N, Jiamjarasrangsi W. Relationship of shift work with liver enzyme abnormalities and nonalcoholic fatty liver disease: A retrospective cohort study of Thai workers in Bangkok, Thailand: 10.55131/jphd/2024/220110. J Public Hlth Dev [Internet]. 2024 Jan. 24 [cited 2024 Oct. 16];22(1):126-44. Available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/265541
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Original Articles
Author Biographies

Napas Taechasan, Health Research and Management Program, Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Health Research and Management Program, Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Wiroj Jiamjarasrangsi, Health Research and Management Program, Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Health Research and Management Program, Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

References

Allen AM, Lazarus JV, Younossi ZM. Healthcare and socioeconomic costs of NAFLD: A global framework to navigate the uncertainties. J Hepatol. 2023;79(1):209-17. doi: 10.1016/j.jhep. 2023.01.026.

Cotter TG, Rinella M. Nonalcoholic Fatty Liver Disease 2020: The State of the Disease. Gastroenterology. 2020;158(7):1851-64. doi: 10.1053/ j.gastro.2020.01.052.

Shah PA, Patil R, Harrison SA. NAFLD-related hepatocellular carcinoma: The growing challenge. Hepatology. 2023;77(1):323-38. doi: 10.1002/hep.32542.

Younossi ZM. Non-alcoholic fatty liver disease - A global public health perspective. J Hepatol. 2019;70(3):531-44. doi: 10.1016/j.jhep.2018.10.033.

Witkowski M, Moreno SI, Fernandes J, Johansen P, Augusto M, Nair S. The Economic Burden of Non-Alcoholic Steatohepatitis: A Systematic Review. Pharmacoeconomics. 2022;40(8):751-76. doi: 10.1007/s40273-022-01140-y.

National Institute for Health and Care Excellence (NICE). Non-alcoholic fatty liver disease (NAFLD): assessment and management, 2016 [Internet]. [cited 2023 Nov 1]. Available from: https://www.nice.org.uk/guidance/ng49.

Bedogni G, Kahn HS, Bellentani S, Tiribelli C. A simple index of lipid overaccumulation is a good marker of liver steatosis. BMC Gastroenterol. 2010;10:98. doi: 10.1186/1471-230X-10-98.

Kahn HS. The "lipid accumulation product" performs better than the body mass index for recognizing cardiovascular risk: a population-based comparison. BMC Cardiovasc Disord. 2005;5:26. doi: 10.1186/1471-2261-5-26.

Kotronen A, Peltonen M, Hakkarainen A, Sevastianova K, Bergholm R, Johansson LM, et al. Prediction of non-alcoholic fatty liver disease and liver fat using metabolic and genetic factors. Gastroenterology. 2009;137(3):865-72. doi: 10.1053/j.gastro.2009.06.005.

Lee JH, Kim D, Kim HJ, Lee CH, Yang JI, Kim W, et al. Hepatic steatosis index: a simple screening tool reflecting nonalcoholic fatty liver disease. Dig Liver Dis. 2010;42(7):503-8. doi: 10.1016/j.dld.2009.08.002.

Dai H, Wang W, Chen R, Chen Z, Lu Y, Yuan H. Lipid accumulation product is a powerful tool to predict non-alcoholic fatty liver disease in Chinese adults. Nutr Metab (Lond). 2017;14:49. doi: 10.1186/s12986-017-0206-2.

Reinke H, Asher G. Circadian Clock Control of Liver Metabolic Functions. Gastroenterology. 2016;150(3):574-80. doi: 10.1053/j.gastro.2015.11.043.

McCommis KS, Butler AA. The Importance of Keeping Time in the Liver. Endocrinology. 2021;162(2). doi: 10.1210/endocr/bqaa230.

Mukherji A, Bailey SM, Staels B, Baumert TF. The circadian clock and liver function in health and disease. J Hepatol. 2019;71(1):200-11. doi: 10.1016/j.jhep.2019.03.020.

International Labour Organization. Yearly statistics 2015 [Internet]. [cited 2022 Sept 4]. Available from: http:// laborsta.ilo.org.

Ministry of Labour. Labour statistics yearbook 2022: The office of permanent secretary, ministry of labour; 2022 [Internet]. [cited 2023 Nov 1]. Available from: https://www. mol.go.th/academician/reportstatic_labour.

Lee S, Messenger JC. Working time around the world: trends in working hours, laws and policies, laws and policies in a global comparative perspective. Routledge: Milton Park; 2007.

Lin YC, Chen PC. Persistent rotating shift work exposure is a tough second hit contributing to abnormal liver function among on-site workers having sonographic fatty liver. Asia Pac J Public Health. 2015;27(2):Np1765-74. doi: 10.1177/1010539512469248.

Wang F, Zhang L, Wu S, Li W, Sun M, Feng W, et al. Night shift work and abnormal liver function: is non-alcohol fatty liver a necessary mediator? Occup Environ Med. 2019;76(2):83-9. doi: 10.1136/oemed-2018-105273.

Zhang P, Wang CY, Li YX, Pan Y, Niu JQ, He SM. Determination of the upper cut-off values of serum alanine aminotransferase and aspartate aminotransferase in Chinese. World J Gastroenterol. 2015;21(8):2419-24. doi: 10.3748/wjg.v21.i8.2419.

Balakrishnan M, El-Serag HB, Kanwal F, Thrift AP. Shiftwork Is Not Associated with Increased Risk of NAFLD: Findings from the National Health and Nutrition Examination Survey. Dig Dis Sci. 2017;62(2):526-33. doi: 10.1007/s10620-016-4401-1.

Choi H, Oh HJ, Shin JS, Lim M, Kim SK, Kang HT, et al. Relationship between shift work and liver enzymes: a cross-sectional study based on the Korea National Health and Examination Survey (2007-2015). Ann Occup Environ Med. 2019;31:e15. doi: 10.35371/aoem.2019.31.e15.

Hanprathet N, Lertmaharit S, Lohsoonthorn V, Rattananupong T, Ammaranond P, Jiamjarasrangsi W. Increased Risk Of Type 2 Diabetes And Abnormal FPG Due To Shift Work Differs According To Gender: A Retrospective Cohort Study Among Thai Workers In Bangkok, Thailand. Diabetes Metab Syndr Obes. 2019;12:2341-54. doi: 10.2147/DMSO. S219524.

Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol. 2017;112(1):18-35. doi: 10.1038/ajg.2016.517.

The International Agency for Research on Cancer (IARC). Painting, firefighting, and shiftwork: IARC monographs on the evaluation of carcinogenic risks to humans; 2010 [Internet]. [cited 2023 Nov 1]. Available from: https://www.ncbi. nlm.nih.gov/pubmed/21381544.

Ebrahimi M, Seyedi SA, Nabipoorashrafi SA, Rabizadeh S, Sarzaeim M, Yadegar A, et al. Lipid accumulation product (LAP) index for the diagnosis of nonalcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis. Lipids Health Dis. 2023;22(1):41. doi: 10.1186/s12944-023-01802-6.

Stata. stcox PH-assumption tests-Tests of proportional-hazards assumption after stcox2022 [Internet]. [cited 2023 June 1]. Available from: https://www. stata.com/manuals/ststcoxph-assumptiontests.pdf.

Powell EE, Wong VW, Rinella M. Non-alcoholic fatty liver disease. Lancet. 2021;397(10290):2212-24. doi: 10.1016/S0140-6736(20)32511-3.

European Association for the Study of the Liver, European Association for the Study of Diabetes, European Association for the Study of Obesity. EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388–402. doi: 10.1007/ s00125-016-3902-y.

Lind L, Johansson L, Ahlström H, Eriksson JW, Larsson A, Risérus U, et al. Comparison of four non-alcoholic fatty liver disease detection scores in a Caucasian population. World J Hepatol. 2020;12(4):149-59. doi: 10.4254/wjh. v12.i4.149.

Xu J, Ni S, Wang Y, Yan M, Yang X, Ge H, et al. Shift work and nonalcoholic fatty liver disease incidence among Chinese rail workers: a 4-year longitudinal cohort study. Int Arch Occup Environ Health. 2023;96(1): 179-90. doi: 10.1007/s00420-022-01913-0.

Burra P, Bizzaro D, Gonta A, Shalaby S, Gambato M, Morelli MC, et al. Clinical impact of sexual dimorphism in non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). Liver Int. 2021;41(8):1713-33. doi: 10.1111/ liv.14943.

Kim K, Lee YJ, Kwon SC, Min YS, Lee HK, Baek G, et al. Correlation between shift work and non-alcoholic fatty liver disease among male workers in the steel manufacturing company of Korea: a cross-sectional study. Ann Occup Environ Med. 2022;34:e33. doi: 10.35371/aoem.2022.34.e33.

Zhang S, Wang Y, Wang Z, Wang H, Xue C, Li Q, et al. Rotating night shift work and non-alcoholic fatty liver disease among steelworkers in China: a cross-sectional survey. Occup Environ Med. 2020;77(5):333-9. doi: 10.1136/ oemed-2019-106220.

Arendt J. Shift work: coping with the biological clock. Occup Med (Lond). 2010;60(1):10-20. doi: 10.1093/ occmed/kqp162.

Chowdhury R, Shah D, Payal AR. Healthy Worker Effect Phenomenon: Revisited with Emphasis on Statistical Methods - A Review. Indian J Occup Environ Med. 2017;21(1):2-8. doi: 10.4103/ijoem.IJOEM_53_16.

Rothman Kj GS, Lash TL. Modern epidemiology. 3rd ed. PA: Lippincott Williams & Wilkins; 2008.