Shift Work and Serum Vitamin D Levels: A Systematic Review and Meta-Analysis

Margherita Martelli, Gianmaria Salvio, Lory Santarelli, Massimo Bracci, Margherita Martelli, Gianmaria Salvio, Lory Santarelli, Massimo Bracci

Abstract

Vitamin D deficiency and insufficiency are highly prevalent conditions worldwide due to several factors, including poor sun exposure. Shift workers may be exposed to the risk of hypovitaminosis D due to fewer opportunities for sunlight exposure compared to day workers. A systematic review of the PubMed, SCOPUS, and EMBASE databases was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) statement to investigate the effect of shift work on vitamin D levels. Mean differences (MD) and 95% confidence intervals (CI) of serum 25-OH-D levels in shift workers and non-shift workers were calculated. A total of 13 cross-sectional studies were included in the meta-analysis. We found significantly lower levels of serum 25-OH-D in shift workers compared with non-shift workers (MD: −1.85, 95% CI [−2.49 to −1.21]). Heterogeneity among included studies was high (I2 = 89%, p < 0.0001), and neither subgroup analysis nor meta-regression were able to identify specific sources of the heterogeneity that may be related to the different characteristics of shift work among studies. The monitoring of serum vitamin D levels and prompt correction of any deficiencies should be considered in shift workers. Notably, since a large part of the observations are derived from Koreans, larger epidemiological studies are needed in other populations.

Keywords: circadian rhythm; job; night work; shift work; vitamin D; workers.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) flowchart.
Figure 2
Figure 2
Forest plot showing mean differences in serum 25-hydroxyvitamin D (25-OH-D) levels (ng/mL) in shift workers and non-shift workers [12,24,25,26,27,28,29,30,31,32,33,34,35].
Figure 3
Figure 3
Funnel plot of the included studies showing no significant asymmetry.
Figure 4
Figure 4
Forest plots showing mean differences in serum 25-hydroxyvitamin D (25-OH-D) levels (ng/mL) in shift workers and non-shift workers (subgroup 1: methods of vitamin D measurement) [12,24,25,26,27,28,29,30,31,32,33,34,35].
Figure 5
Figure 5
Forest plots showing mean differences in serum 25-hydroxyvitamin D (25-OH-D) levels (ng/mL) in shift workers and non-shift workers (omitting unspecified methods of vitamin D measurement) [12,24,25,27,29,31,32,33,34,35].
Figure 6
Figure 6
Forest plots showing mean differences in serum 25-hydroxyvitamin D (25-OH-D) levels (ng/mL) in shift workers and non-shift workers (subgroup 2: gender prevalence) [12,24,25,26,27,28,29,30,31,32,33,34,35].
Figure 7
Figure 7
Meta-regression analysis performed for mean differences in serum vitamin D levels between shift and non-shift workers, with age (A) and BMI (B) as covariates.

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