Dietary, Anthropometric, Biochemical and Psychiatric Indices in Shift Work Nurses

doi:10.4236/fns.2013.412158

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Food and Nutrition Sciences, 2013, 4, 1239-1246

Published Online December 2013 (http://www.scirp.org/journal/fns)

http://dx.doi.org/10.4236/fns.2013.412158

Open Access FNS

Dietary, Anthropometric, Biochemical and Psychiatric

Indices in Shift Work Nurses

Mahshid Naghashpour1,2, Reza Amani2,3*, Sorur Nematpour4, Mohammad Hosein Haghighizadeh5

1Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 2Department of Nutrition, School of

Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 3Diabetes Research Center, Ahvaz Jundishapur Uni-

versity of Medical Sciences, Ahvaz, Iran; 4Golestan Medical Center, Jundishapur University of Medical Sciences, Ahvaz, Iran;

5Department of Statistics and Epidemiology, Jundishapur University of Medical Sciences, Ahvaz, Iran.

Email: *rezaamani@hotmail.com

Received June 13th, 2013; revised July 13th, 2013; accepted July 20th, 2013

License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Objectives: The aim of this study was to compare nutrients intake, anthropometric, biochemical and psychiatric indices

between shift working and day-time nurses. Methods: A cross-sectional comparative study was conducted in which

ninety eight female nurses (55 day-time workers and 43 shift workers) from six educational hospitals of Jondi-Shapour

University of medical sciences, Ahvaz, Iran were participated. A questionnaire including dietary, anthropometric, dis-

ease history and lifestyle pattern questions was completed and 3-day 24-hour recalls, Beck Depression Inventory (BDI)

and Hospital Anxiety and Depression Scale (HADS) were collected. Serum hs-CRP and 25(OH)D3 concentrations were

measured by immunoturbidimetric and electrochemiluminescent immunoassay method, respectively. Anthropometric

indices were measured according to World health organization standard protocol. Independent sample t and chi-square

tests were used for statistical analysis. Results: There was a lower dietary intake of thiamin, riboflavin, niacin, folate,

magnesium and iron in shift worker compared with day-time nurses (p < 0.05). No significant differences in serum

hs-CRP concentrations, serum 25(OH)D3 levels, vitamin D deficiency percentage, hemoglobin and hematocrite concen-

trations, and also anthropometric and psychiatric variables were found between two groups. Duration of exposure to

sunlight was significantly higher in shift workers than in day time nurses. Engagement time in weekly physical exercise

was around 11 times greater in day-time nurses compared with the shift work nurses (p = 0.001). Conclusions: This

study showed that shift working is associated with some nutritional deficiencies and sedentary lifestyle among female

nurses.

Keywords: Shift Work; Dietary Intake; Depression; Nurse

1. Introduction

Shift work generally is defined as “work hours that are

scheduled outside of daylight” [1]. Nurses represent an

important part of the hospital workforce and serve as role

models when caring for patients [2]. According to a

study, night working is considered as a kind of challenge

among most nurses and can lead to several forms of

physical and emotional disorders [3]. Shift duties were

positively associated with abnormal eating habits among

hospital nurses. Studies on the effects of shift work on

eating habits and nutrients intake have previously been

conducted on shift workers in different jobs [4,5]. Shift

workers preferred to eat cold and fast foods and tend to

have a nibble rather than a meal and have fewer meals

over 24 hours [5]. These eating habit changes may in-

crease or decrease intake of nutrients. Shift work and

insufficient rest, as both are considered the main obstacle

to healthy eating by respondents. Obesity has been

shown to be more prevalent among shift workers and is

associated with higher BMI, independently of age and

work duration [5,6]. Several mechanisms explain weight

gain in shift workers, such as higher calorie intake,

changes in dietary habits such as eating fewer meals,

more snacks and in the circadian distribution of food

*Corresponding author.

Dietary, Anthropometric, Biochemical and Psychiatric Indices in Shift Work Nurses

1240

intake and lower physical exercise [5]. Modifying exter-

nal factors such as food and beverage intake patterns can

help to reduce the destructive health effects of shift work

[1]. Compared to the number of studies that evaluated

intra-individual differences in nutrient intake by shift,

there have been few studies that have examined the dif-

ference in micronutrient intakes between shift workers

and day time workers [5].

Findings highlight that night and early morning work-

ing is associated with an adverse profile of cardiovascu-

lar risk factors, which are partly explained by socioeco-

nomic, other occupational factors, and health behaviors

[7]. Moreover, shift work leads to change in lifestyle, for

instance in relation to diet, smoking, alcohol and exercise,

all being risk factors of ischemic heart disease [8]. We

measured the high-sensitivity C-reactive protein (hs-

CRP) which is being increasingly used as a marker for

cardiac risk assessment and as a prognostic tool in heart

disease [9].

Studies have demonstrated that daylight exposure may

be effective on job burnout in nurses. Daylight at least 3

h a day was found to cause less stress and higher satis-

faction at work in them [10]. A more relaxed and less tense

mood has been reported after UV exposure compared

with after non UV exposure [11]. In addition, decreased

25-hydroxyvitamin D is associated with Depression [12,

13]. Since the shift workers presumably have a poor sun

exposure and a higher risk of vitamin D deficiency, we

have also measured vitamin D status in nurses.

To our best knowledge, there is no other study pub-

lished concerning the effect of shift work on daily nutria-

ents intake, anthropometric, biochemical and psychiatric

indices of nurses. This study was aimed to compare these

indices between shift work and daytime nurses in Uni-

versity hospitals.

2. Material and Methods

2.1. Study Design and Sample

In this analytical cross-sectional comparative study,

healthy female clinical nurses with the mean age of 37

years old (range from of 23 years to 52 years old) em-

ployed in educational University hospitals in Ahvaz city,

Iran, participated in April to September 2009. Sample

size was calculated from a formula



12 1111 2

nZ Z



 





 









[14]. α is

type 1 statistical error and β is type 2 statistical error.

where n is the sample size, 12



 is the 12



 criti-

cal value of the standard normal distribution which is

found in the table of the standard normal distribution, δ is

the known sample standard deviation, and μ is the sample

mean. A three-stage sampling design was used. At each

stage, simple random sampling was applied. In the first

stage of sampling, the sampling unit was educational

University hospitals (administrative units). A total of six

hospitals were randomly selected from eight hospitals. In

the second stage, on average, from a total of 1350 nurses,

20 volunteers were selected randomly from each sample

hospital. A total of 120 volunteers were selected. A self-

reported questionnaire assessed demographic characteris-

tics, disease history (chronic and psychiatric), medication

and supplement usage, pregnancy, smoking status and

physical activity, were completed by volunteers. Subjects

with the history of anemia, thyroid disorders, renal fail-

ure, heart failure, diabetes mellitus, malabsorption, chro-

nic and psychiatric disease, pregnancy, history of using

medicines and other substances that could affect appetite

were excluded from this study. 22 individuals who were

not eligible were excluded. In the third stage, 98 volun-

teers who met inclusion criteria were categorized in day

time and shift workers groups (55 day time workers and

43 shift workers).

Shift work was defined as work at times out of normal

daylight hours 8:00 am to 2:00 pm or work during the

weekends [15]. An additional question representing the

shift work period was asked. In this study, nurses were

divided into two groups: shift-work and day-time nurses.

Participants completed a questionnaire included demo-

graphic characteristics, physical activity during the week,

duration of exposure to sunlight and use of tobacco over

a three-month period.

The study protocol was approved by the research eth-

ics committee of Ahvaz Jondi-Shapour University of Me-

dical Sciences (AJUMS). Written consents were obtained

from all participants.

2.2. Assessment of Depression and Anxiety

Depression status was assessed using the short 13-items

version Beck Depression Inventory (BDI) and total

scores (BDI score) were calculated. The BDI cut-off

values ≥ 5 is defined as depression [16]. The BDI in-

cluded questions to assess nine characteristic attitudes

and symptoms listed in the DSM-IV criteria for a major

depressive episode. Anxiety was evaluated by the Hospi-

tal Anxiety and Depression Scale (HADS). HADS anxi-

ety score between 8 - 10 and 11 - 21 were considered as

mild and clinical anxiety, respectively [17].

2.3. Dietary Assessment

We assessed dietary intake using a 3-day 24-hour recall

(including 2 working days and one off-day). Quantities

were expressed in household measures. The inventories

were double checked by a nutritionist, who verified the

quantities and type of recalled foods. Daily dietary in-

takes of energy and micronutrients (thiamin, riboflavin,

niacin, pyridoxine, cobalamin, folate, ascorbate, toco-

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Dietary, Anthropometric, Biochemical and Psychiatric Indices in Shift Work Nurses 1241

pherol, retinol, cholecalciferol, magnesium, zinc, iron

and calcium) were analyzed using Iranian Food Proces-

sor software, which has been developed by the Iranian

Institute of Nutrition Research and Food Industry and

comprises Iranian meals dataset.

2.4. Biochemical Measurements

Fasting blood samples were obtained into potassium

EDTA—containing tubes for determination of hemoglo-

bin and hematocrite and tubes with no anticoagulants for

serum hs-CRP and 25(OH)D3 levels evaluation. Deter-

mination of Hemoglobin was done by Cyanmethemoglo-

bin Method and Hematocrit by calculating the percentage

of blood that is comprised of red blood cell (RBC) [18].

Serum hs-CRP level were measured by a particle-en-

hanced turbidimetric immunoassay (quantitative diag-

nosis kit for serum or plasma hs-CRP by immunotur-

bidimetric method; Pars Azmoon, Tehran, Iran) with a

limit of detection of 0.10 mg/l [19]. In this study, the

Risk Evaluation Guidelines proposed by American Heart

Association and Center for Disease Control and preven-

tion (AHA/CDC) was used for categorizing hs-CRP lev-

els [9].

Serum 25(OH)D level were measured during summer

months using Electrochemiluminescent immunoassay

[20] (Serum 25(OH)D kit; Roche, Britain). Lips [21]

cut-offs were used for vitamin D deficiency evaluation

which has categorized vitamin D deficiency based on

increasing serum parathormon (PTH) levels and bone

histology. In this method, values 25 - 50, 12.5 - 25 and <

12.5 nmol/l indicate mild (insufficiency), moderate and

severe vitamin D deficiency, respectively.

2.5. Anthropometric Indices

Anthropometric indices including weight and height in-

dices were measured according to WHO (World health

organization) standard protocol [22]. Body Mass Index

(BMI), Body Fat Percent (% BF) and Fat to Weight Ratio

(F/W) were assessed by bioelectric impedance methods

(Omron, BF 302, Japan).

2.6. Statistical Analysis

Independent sample t and chi-square tests were carried

out for analyzing the quantitative and categorized vari-

ables, respectively. p values less than 0.05 were regarded

as significant. SPSS software version 13 was used for

statistical analysis.

3. Results

Table 1 shows the basic demographic characteristics of

participations in both groups. Results show that there is

no significant difference between shift and day-time

Table 1. The basic demographic characteristics of partici-

pations.

Study groups

Basic demographic

characteristics Shift workers

(N = 43)

Day time workers

(N = 55) p value

Age (Year)a 33 ± 5.3 33.7 ± 3.3 0.963

Married statusb: Married74.4 (32) 73.6 (39) 0.865

Work experiencea 14.7 ± 5.1 15.8 ± 5.3 0.753

Overtime workb yes 44.2 (19) 32.7 (18) 0.112

aQuantitative data presented as mean ± SD. Independent sample t-test was

conducted; bQualitative data presented as percent (number). Chi square test

was conducted.

worker nurses in terms of obtained demographic vari-

ables.

3.1. Comparison of Nutrients Intakes

Table 2 compares total energy and dietary micronutrient

intakes between shift workers and day time workers.

Lower dietary intakes of thiamin, riboflavin, niacin,

folate, magnesium and iron were seen in shift workers

compared with the day-time nurses. There were no sig-

nificant differences in other micronutrient and energy

intakes between these two groups.

3.2. Comparison of Biochemical Variables

Table 3 shows values for biochemical variables in both

shift work and day time nurses. No significant differ-

ences were found in serum hs-CRP concentrations and

percentage of risk measurements between shift work and

daytime nurses. Serum 25(OH)D3 levels (nmol/l), vita-

min D deficiency severity percent and hematologic indi-

ces were not significantly different between two groups.

3.3. Comparison of Anthropometric, Lifestyle

and Psychiatric Indices

Table 4 indicates that there is no significant difference in

anthropometric variables between two groups. Nor BDI

neither HADS anxiety scores revealed any statistically

significant differences between two groups. Duration of

daily exposure to sunlight was significantly higher in

shift workers (p = 0.013) compared with day time nurses.

Duration of weekly physical exercise was more than

eleven times higher in daytime nurses compared with the

shift workers (p = 0.001).

4. Discussion

According to our search, this was the first study carried

out to assess the dietary intake, anthropometric, bio-

chemical, lifestyle and psychiatric parameters in hospital

hift working nurses. s

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Dietary, Anthropometric, Biochemical and Psychiatric Indices in Shift Work Nurses

Open Access FNS

1242

Table 2. The comparison of dietary nutrients intakes (Mean ± SD) between shift work and day-time nursesa.

Study groups

Dietary intakes

Shift workers (N = 43) Day time workers (N = 55) p value

Thiamin (mg/day) 1.2 ± 0.55 1.6 ± 1.2 0.01b

Riboflavin (mg/day) 1.6 ± 0.72 2.1 ± 1.1 0.003b

Niacin (mg/day) 16 ± 7.7 21.1 ± 13.1 0.01b

Pyridoxine (mg/day) 1.6 ± 0.82 1.1 ± 1 0.71

Cobalamin (µg/day) 3.6 ± 2.3 5.2 ± 6 0.1

Folate (µg/day) 284.7 ± 157.4 386 ± 236.8 0.007b

Ascorbate (mg/day) 117.6 ± 76 160.9 ± 204.7 0.18

Tocopherol (mg/day) 7.9 ± 4.6 12.8 ± 33.38 0.16

Retinol (µg/ day) 947.3 ± 663.9 1319.6 ± 906.3 0.11

Cholecalciferol (µg/day) 2.4 ± 4.4 2.42 ± 2.1 0.56

Magnesium (mg/day) 251.7 ± 76.3 317.4 ± 208.75 0.049b

Zinc (mg/day) 8 ± 2.6 10.1 ± 4.7 0.09

Iron (mg/day) 11.8 ± 4.8 15.3 ± 9.5 0.03b

Calcium (mg/day) 862.9 ± 313.5 940.7 ± 488.3 0.18

Energy intake (kcal/day) 1637.1 ± 542.6 1859.7 ± 539.8 0.43

cIndependent sample t-test was conducted; dLower dietary intakes of thiamin, riboflavin, niacin, folate, magnesium and iron were seen in shift works compared

with the day-time nurses (p < 0.05).

Table 3. The comparison of biochemical indices between shift work and day-time nur sesa.

Study groups

Biochemical variables

Shift workers (N = 43) Day-time workers (N = 55) p value

hs-CRP serum levels (mg/l)b 2.1 ± 2.3 2.21 ± 2.6 0.89

percent of risk measurementsc

<1 mg/l (low risk) 46.5 (20) 42.3 (22) 0.72

1 - 3 mg/l (medium risk) 32.6 (14) 40.4 (21)

>3 mg/l (high risk) 20.9 (9) 17.3 (9)

Serum 25(OH)D3 levels (nmol/l)b 26.3 ± 20.5 27.4 ± 22.7 0.39

Vitamin D deficiency severityc

Severe 39.5 (17) 39.6 (21) 0.88

Moderate 18.6 (8) 13.2 (7)

Mild 30.2 (13) 35.8 (19)

Normal 11.6 (5) 11.3 (6)

Hemoglobin (g/l)b 11.5 ± 0.92 11.16 ± 1 0.97

Hematocrite (%)b 37.3 ± 4.3 36.1 ± 2.8 0.67

aThere was no significant difference between shift works and day-time nurses in biochemical indices; bQuantitative data presented as mean ± SD. Independent

sample t-test was conducted to analyze data; cQualitative data presented as percent (number). Chi square test was conducted.

Dietary, Anthropometric, Biochemical and Psychiatric Indices in Shift Work Nurses 1243

Table 4. The comparison of anthropometric, lifestyle and psychiatric indices between shift wo r k and day-time nurses.

Study groups

Indices

Shift workers (N = 43) Day-time workers (N = 55) p value

Anthropometric va riables

Weight (kg) a 64 ± 11.8 66.6 ± 11.1 0.55

Body fat percent (% BF)a 29.8 ± 6.5 32.27 ± 6.3 0.84

Fat to Weight Ratio (F/W) 20.7 ± 8 23.1 ± 88.1 0.72

Body Mass Index (BMI) (kg/m2)a 25.4 ± 4.6 26.2 ± 4.4 0.95

Underweight 10.8 (4) 2.1 (1) 0.19

Normal weightb 51.4 (19) 46.8 (22)

Over weightb 32.4 (12) 48.9 (23)

Obesityb 5.4 (2) 2.1 (1)

Life style variables

Duration of weekly physical exercise (min/wk)ac 6.2 ± 21.7 68.7 ± 208.36 0.001d

Duration of daily exposure to sunlight (min/day)ad 27.3 ± 33.1 16.39 ± 19.1 0.013e

<30 (min/wk)b 61 (25) 71.2 (37) 0.23

30 - 60 (min/wk)b 19.5 (8) 21.2 (11)

>60 (min/wk)b 19.5 (8) 7.7 (4)

Psychiatric variables

BDI scorea 4.79 ± 3.35 3.65 ± 3.64 0.32

Depression severityb

Mild 37.2 (16) 21.8 (12) 0.17

Moderate 18.6 (8) 16.4 (9)

Severe 0 (0) 0 (0)

Normal 44.2 (19) 61.8 (34)

HADS anxiety scorea 4.88 ± 3.24 3.82 ± 3.26 0.58

Anxiety severityb

Normal 78.6 (33) 87.3 (48) 0.48

Moderate 14.3 (6) 7.3 (4)

Clinical 7.1 (3) 5.5 (3)

aQuantitative data presented as mean±SD. Independent sample t-test was conducted; bQualitative data presented as percent (number). Chi square test was con-

ducted; cDuration of weekly physical exercise was more than eleven times higher in daytime nurses compared with the shift works; dDuration of daily exposure

to sunlight was significantly higher in shift workers compared with daytime nurses.

This study showed that shift working nurses had lower

dietary intakes of some B vitamins (including thiamin,

riboflavin, niacin and folate), two trace elements magne-

sium and iron compared with daytime nurses. Higher

duration of daily exposure to sunlight and lower duration

of weekly physical exercise were also observed in the

shift working group.

There are few studies investigating the effect of shift

working on dietary nutrients intake mostly focused on

dietary habits. Some authors did not find any difference

between shift workers and day time employees with re-

spect to their total energy intake and dominant macronu-

trient intakes [5]. Morikawa have reported that Japanese

shift workers, particularly the late-shift workers, took

smaller amounts of energy and nutrients than the daytime

workers. Their inadequate nutrient intake was due to

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Dietary, Anthropometric, Biochemical and Psychiatric Indices in Shift Work Nurses

1244

lower meal frequency and poor meal quality, both of

which were conditioned by shift work. One study on the

impact of work hours on eating habits and dietary intake

of male industrial workers in day workers and two- and

three-shift workers, showed no changes in intake of en-

ergy, nutrients and coffee/tea between 8 hour morning

and afternoon shifts, but a reduction in intake of nutrients

and coffee/tea during 8 hours night shifts. On the whole,

the energy-intake and the quality of food intake (per-

centages of energy from macronutrients and density of

micronutrients) were not affected by shift work [5].

In recent study on nurses in Hong Kong [4], shift du-

ties were positively associated with abnormal eating be-

havior among nurses working in hospitals. It has been

reported that the total energy and nutrient intakes in-

crease when individuals eat with others [23]. However

shift workers have fewer opportunities to take meals with

their families and friends. These effects appeared to be

most prominent among workers with midnight shifts,

who decreased their micronutrients intakes [5].

In Morikawa et al. study [5], the energy density value

of thiamin, vitamin A and potassium in shift workers

with mid night shifts were significantly lower than those

with fixed day workers. Also, in this study, energy intake

of dairy products (one of the good sources of riboflavin),

meat (good sources of niacin, folate and iron) and vege-

tables (rich in riboflavin, folate and magnesium) were the

lowest in shift workers with mid night shift than fixed

day workers. These results are comparable with our

findings on nutrients intake of shift nurses. Several stud-

ies agree that shift work affects the distribution of food

intake and the selection of food items over 24 hour

[24,25].

In this study, it is suggested that subjects had undesir-

able food items selection of that can result in long term

complications of micronutrients deficiencies. Such defi-

ciencies can lead to impaired energy and macronutrients

metabolism and synthesis, immune system dysfunction,

anorexia, neurologic and cardiac signs, depression, con-

fusion, sleeplessness, fatigue, general weakness, indiges-

tion, osteoporosis and anomies [26].

There was no significant difference between shift and

day-time nurses in terms of anthropometric variables.

The effect of shift work on body weight has been inves-

tigated in previous studies, several of which demon-

strated a significant tendency to become overweight [6,

27,28]. In contrast, some studies failed to show such as-

sociations [15,29].

According to studies, body fat distribution indices that

are body fat percent (% BF) and Fat to Weight Ratio

(F/W) variables in our study were not different between

two shift workers. Weight gain in shift workers has been

explained by several mechanisms, such as higher calorie

intake, changes in dietary habits (such as eating fewer

meals and more snacks) and the circadian distribution of

food intake [5,6], as well as lower physical exercise and

changes in sleeping habits [5].

In this study, there was no significant difference in to-

tal energy intake between shift workers and day time

workers whereas, in most of the other studies mentioned

above, no clear-cut conclusion in this respect was pre-

sented.

According to our results, duration of daily exposure to

sunlight was significantly higher in shift workers. Night

shift workers can improve nocturnal alertness and day-

time sleep by bright light exposure in their work place.

These improvements can be maximized by attenuating

morning light on the way home. Melatonin exerted mod-

est benefit in improving the adaptation of workers to

nightshift, and its effect was not enhanced by attenuation

of morning sunlight exposure [30]. This result may, in

part, explain the nonsignificant findings of psychiatric

variables due to higher duration of exposure time to sun

light.

In our study, duration of weekly physical exercise was

significantly lower in shift nurses compared with day

time nurses. In an interventional study on shift workers,

overall “disengagement” coping scores from the SSI

(Standard Shift-work Index) were positively related to

leisure-time energy expenditure [31]. In another study

lack of exercise was the lifestyle factor which strongly

contributed to chronic fatigue in shift working nurses

[32]. Time spent in shift work was found to be predictors

of energy expenditure. It is recommended that physical

activity interventions for shift workers should be de-

signed with careful consideration of individual domestic

responsibilities and perceived disruption to sleep [32].

Concerning the rhythm desynchronization of transfering

from shift work to day work, it has been suggested that

while examining tolerance/in tolerance of a shift worker

to rotational shift work, the levels of anxiety and mental

health status of the individual under careful and thorough

examination should be taken into consideration. In this

study, there was no significant difference in serum hs-

CRP concentrations and percentage of risk measurements

between shift working and daytime workers. Serum

25(OH)D 3 levels (nmol/litr), vitamin D deficiency se-

verity percent, hemoglobin and hematocrite concentra-

tions were not different between two groups. It is sug-

gested that these insignificant findings are resulted from

limited numbers of subjects in each group. In this study,

one of the Limitations was the descriptive comparative

nature of its design. The other limitation was that labora-

tory measurements of micronutrients were not used to

assess nutritional status. There for, it is suggested that in

future studies evaluation of micronutrients status by

proper biochemical methods would confirm our results.

In summary, shift duties were associated with unhealthy

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Dietary, Anthropometric, Biochemical and Psychiatric Indices in Shift Work Nurses 1245

lifestyle and nutritional imbalances accompanied by de-

ficiencies of some B vitamin, magnesium and iron in-

takes among hospital shift nurses. More health promo-

tional initiatives and education should be targeted to-

wards hospital nurses whose duties require frequent

shifts to enhance healthier eating and lifestyle patterns. In

this study, it is recommended that in every work place

where shift work is mandatory, trained health care per-

sonnel should monitor intermittently (preferably every

alternate year) the state of the psychological and nutri-

tional status of each shift nurse to minimize the occupa-

tional health hazards and enhance their performance.

5. Conclusions

As a conclusion, shift work is associated with unhealthy

lifestyle and nutritional imbalances accompanied by de-

ficiencies of some B vitamin, magnesium and iron in-

takes among hospital clinical nurses. Moreover, engage-

ment in planned physical activities was lower in shift

nurses.

More health promotional initiatives and education

programs should be targeted towards nurses whose duties

require frequent shifts in order to enhance their eating

and lifestyle patterns. It is suggested that in every work

place where shift work is mandatory, trained health care

personnel should frequently monitor nutritional status of

the staff to minimize the occupational health hazards and

enhance their performance.

6. Acknowledgements

This study was supported by Vice-Chancellor for Re-

search Affairs, Jondi-Shapour University of Medical Sci-

ences as a Grant for the Master of Science Thesis. We

wish to thank Dr. Ahmad Zaree Javid (Ph.D) for his kind

grammatical edition and Mr. Ahmad Hemadi (MSc.) for

his kind laboratory assistance.

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