Journal Reading

THE ASSOCIATION OF WORK -RELATED STRESSORS AND

THEIR CHANGES OVER
TIME WITH THE DEVELOPMENT OF METABOLIC SYNDROME:
THE FURUKAWA NUTRITION AND HEALTH STUDY

Dipresentasikan oleh : Agustiany

 INTRODUCTION

• Work-related stress is the response people may have when presented with work
demands and pressures that are not matched to their knowledge and abilities and
which challenge their ability to cope.
• A systematic meta-analysis suggested that job strain is a risk factor for
hypertension, and a prospective study also found a dose-response relationship
between job strain and the risk of obesity.
• Metabolic syndrome (MetS) is an important underlying condition of CVD events.
• Only three longitudinal studies and one cross-sectional study have investigated the
association between job strain and MetS, and all reported significant associations
 INTRODUCTION

• The effect of work-related stressors on the development of MetS may differ

between Japan and western countries. Thus, there is a need for studies of
work-related stressors and MetS development in Asian countries, including
Japan.
• existing studies have only measured workrelated stressors at baseline or as the
total amount of exposure during follow-up. Currently, workers are exposed to
a work environment that can rapidly change due to new technologies,
organizational changes, or other challenges; and work-related stressors can
change over time.
• it is important to assess the effect of changes in work stressors over time on
the risk of MetS.
 AIM

• To investigate the association of job strain and each component of the JCQ
scale (i.e., job demands, job control, and worksite social support) at baseline
and over time with the onset of MetS among Japanese employees.
 METHODS

• Study design : Prospective design using validated JCQ scale,

• A baseline health survey was conducted during a periodic health checkup in
2012 and 2013 among workers of a manufacturing company and its affiliated
companies.
• Three years later, the second survey was conducted. In both surveys, we
assessed work-related stressors and lifestyle factors, and obtained health
examination data including anthropometric and biochemical data and medical
history. The research staff checked the questionnaires for completeness, and if
necessary, asked participants to clarify their responses.
 METHODS

Participants :
• Incusion: men and women, aged 18-70 years who agreed to participate in the
study in baseline and second survey
• Exclusion: people who lacked information on any component of MetS in
baseline and second survey, people who had a history of cancer, cardiovascular
disease, chronic hepatitis, chronic pancreatitis, or kidney disease at baseline,
those who had missing data on the JCQ scales and covariates in baseline and
second survey.
• The study protocol was approved by the Ethics Committee of the National
Center for Global Health and Medicine, Japan. Written informed consent was
obtained from each participant.
 METHODS

Definition of metabolic syndrome

• Definotion of MetS according to the Joint Interim Statement of the International Diabetes
Federation and the American Heart Association/National Heart, Lung, and Blood Institute as
those who had any three or more of the following criteria:
1. large waist circumference for Asians: 90 cm in men and 80 cm in women;
2. high triacylglycerol: 150 mg/dl;
3. low high-density lipoprotein (HDL)-cholesterol: <40 mg/dl in men and <50 mg/dl in women;
4. high blood pressure: systolic blood pressure 130 mmHg and/or a diastolic blood pressure 85
mmHg; and
5. high fasting blood glucose:100 mg/dl.
• Participants currently receiving antihypertensive medication, those currently receiving a lipid-
lowering drug, and those with a history of diabetes were also considered to meet the criteria
for high blood pressure, high triacylglycerol, and high fasting glucose, respectively.
 METHODS

Definition of work related stressors

• They used the 22-item Japanese version of the JCQ, which has confirmed reliability and validity.
• Levels of job strain, job demands, job control, and worksite social support were classified into
high and low levels by the median value in each survey.
Other covariates
• The baseline covariates included in the analyses were age (years), sex (men or women), site
(workplace A or workplace B), family structure (living alone, or living with family/other), marital
status (married or other), occupational category (blue collar or white collar), work status
(standard or non-standard/part time), night and rotating shift work (yes or no), work-related
physical activity (<3, 3-6, 7-19, or20 METs-h/d), leisure-time physical activities (not engaged, 1-2,
3-9, or 10 METs-h/week), smoking (never-smoker, former smoker, or current smoker), alcohol
drinking (never, occasionally, <23 g ethanol/day, or 23 g ethanol/day), sleep duration (<6, 6-6.9,
or 7 h/d), and quality of sleep (good or poor).
 METHODS

Statistical analysis
• We first examined the association between JCQ scales at baseline and the risk
of MetS by multiple logistic regression analysis, and calculated the adjusted
odds ratios (ORs) and 95% confidence intervals (CIs) of MetS for the JCQ
scales at baseline, using the lower level of the JCQ scales as a reference.
• Then, we performed the main analysis to investigate the association between
changes in each of the JCQ items and the onset of MetS, using the “stable low
stressor” group as a reference.
• Model 1 was adjusted for age, sex, and site.
 METHODS

• Model 2 was further adjusted for family structure, marital status, occupational
category, work status, night and rotating shift work, work-related physical
activity, leisure-time physical activities, smoking, alcohol drinking, sleep duration,
quality of sleep, waist circumference ( cm ) , triacylglycerol ( logtransformed
mg/dl), high-density lipoprotein cholesterol (mg/dl), systolic blood pressure
(mmHg) , and fasting blood glucose (mg/dl) at baseline.
• If there was a significant association of the change of each stressor with the
onset of MetS in the main analysis, we further investigated the association
between stressor changes and components of MetS risk (i. e., high waist
circumference, high blood pressure, high triacylglycerol, low HDL cholesterol,
and high fasting blood glucose), with adjustment for covariates and the same
MetS-component value (continuous) at baseline.
 METHODS

• Two-sided p-values <.05 were regarded as statistically significant. All analyses

were performed using statistical software Stata version 15.0 (StataCorp,
College Station, Texas, USA).
RESULT
RESULT
RESULT
RESULT
 DISCUSSION

• This study among Japanese employees showed that job strain, job control, and
worksite social support at baseline and changes in these stressors over time
were not significantly associated with the onset of MetS.
• Higher job demands at baseline were associated with a lower risk of MetS, but
increases in job demands over time were associated with a higher risk of MetS.
• An increase in job demands over time was associated with a higher risk of
MetS and high fasting blood glucose.
 DISCUSSION

Strengths:
• The strengths of this study include a prospective design using the validated JCQ
scale, and controlling for a number of confounders.
• In addition, the present study used 3 year follow-up data, which may reduce the risk
of reverse causality.
Limitation:
• could not assess what type of change in the work environment increased job
demands ( e. g. , a change in the work place or the workload) due to the limited
information in this study.
• this study did not adjust for potentially important confounding factors including
work- or finance-related stressful life events which may predict poor metabolic
health
 CRITICAL APPRAISAL

P : Employees of manufacturing company in Japan

I : No intervention but observing exposure of work-related stressor
C : stable low stressor as reference (or control group)
O:
• increase of job demands over time associated with higher risk of MetS.
• Increase job demands over time associated with high fasting blood glucose.
 VALIDITY

1. Were patients similar for prognostic factors that are known to be associated
with the outcome? (Yes) The choice of comparison groups significantly
influence the credibility of study results  the control population as a
comparison group had a stable low stressor have similar prognostic factors
2. Were the circumstances and methods for detecting the outcome similar? Yes,
determination of baseline and outcome were similar (using JCQ scale, health
examination data and medical history
 VALIDITY

3. Was follow-up sufficiently complete? Yes, the participants complete the follow
up survey (follow up rate 64,8%)
 IMPORTANCE

• How strong is the association between exposure and outcome?

* those who experienced increased job demands (change into high stressor)
showed a significantly higher risk of MetS (OR 3.27, 95% CI: 1.46, 7.34)
compared with those who reported low job demands in both surveys
• * Is there a dose-response relationship between exposure and outcome? no
• How precise was the estimate of the risk?
* 95% CI: 1.46,-7.34)
 APPLICABILITY

1. Were the study subjects similar to your patients or population?

Yes, they are Asian
2. Was the follow-up sufficiently long?
a 3-year follow-up study is sufficient to determine changes in work stressors
3. Is the exposure similar to what might occur in your patient?
Yes, similar exposure might occur where I work, but there may be differences in the types of
job demand that occur in my patients
4. What is the magnitude of the risk?
The level of baseline risk for the harm is amplified by the exposure studied (by the changes of
stressor the risk of MetS is higher
5. Are there any benefits known to be associated with the exposure?
with the knowledge that there is a relationship between changes in stress levels and the risk
of MetS can be useful for controlling stress in the workplace