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Munteanu C, Turti S, Achim L, Muresan R, Souca M, Prifti E, Mârza SM, Papuc I. The Relationship between Circadian Rhythm and Cancer Disease. Int J Mol Sci 2024; 25:5846. [PMID: 38892035 PMCID: PMC11172077 DOI: 10.3390/ijms25115846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/25/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
The circadian clock regulates biological cycles across species and is crucial for physiological activities and biochemical reactions, including cancer onset and development. The interplay between the circadian rhythm and cancer involves regulating cell division, DNA repair, immune function, hormonal balance, and the potential for chronotherapy. This highlights the importance of maintaining a healthy circadian rhythm for cancer prevention and treatment. This article investigates the complex relationship between the circadian rhythm and cancer, exploring how disruptions to the internal clock may contribute to tumorigenesis and influence cancer progression. Numerous databases are utilized to conduct searches for articles, such as NCBI, MEDLINE, and Scopus. The keywords used throughout the academic archives are "circadian rhythm", "cancer", and "circadian clock". Maintaining a healthy circadian cycle involves prioritizing healthy sleep habits and minimizing disruptions, such as consistent sleep schedules, reduced artificial light exposure, and meal timing adjustments. Dysregulation of the circadian clock gene and cell cycle can cause tumor growth, leading to the need to regulate the circadian cycle for better treatment outcomes. The circadian clock components significantly impact cellular responses to DNA damage, influencing cancer development. Understanding the circadian rhythm's role in tumor diseases and their therapeutic targets is essential for treating and preventing cancer. Disruptions to the circadian rhythm can promote abnormal cell development and tumor metastasis, potentially due to immune system imbalances and hormonal fluctuations.
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Affiliation(s)
- Camelia Munteanu
- Department of Plant Culture, Faculty of Agriculture, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Calea Mănăştur 3-5, 400372 Cluj-Napoca, Romania; (C.M.); (S.T.); (L.A.); (R.M.); (M.S.); (E.P.)
| | - Sabina Turti
- Department of Plant Culture, Faculty of Agriculture, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Calea Mănăştur 3-5, 400372 Cluj-Napoca, Romania; (C.M.); (S.T.); (L.A.); (R.M.); (M.S.); (E.P.)
| | - Larisa Achim
- Department of Plant Culture, Faculty of Agriculture, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Calea Mănăştur 3-5, 400372 Cluj-Napoca, Romania; (C.M.); (S.T.); (L.A.); (R.M.); (M.S.); (E.P.)
| | - Raluca Muresan
- Department of Plant Culture, Faculty of Agriculture, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Calea Mănăştur 3-5, 400372 Cluj-Napoca, Romania; (C.M.); (S.T.); (L.A.); (R.M.); (M.S.); (E.P.)
| | - Marius Souca
- Department of Plant Culture, Faculty of Agriculture, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Calea Mănăştur 3-5, 400372 Cluj-Napoca, Romania; (C.M.); (S.T.); (L.A.); (R.M.); (M.S.); (E.P.)
| | - Eftimia Prifti
- Department of Plant Culture, Faculty of Agriculture, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Calea Mănăştur 3-5, 400372 Cluj-Napoca, Romania; (C.M.); (S.T.); (L.A.); (R.M.); (M.S.); (E.P.)
| | - Sorin Marian Mârza
- Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Calea Mănăştur 3-5, 400372 Cluj-Napoca, Romania;
| | - Ionel Papuc
- Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Calea Mănăştur 3-5, 400372 Cluj-Napoca, Romania;
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Wu X, Yang C, Zou Y, Jones SE, Zhao X, Zhang L, Han Z, Hao Y, Xiao J, Xiao C, Zhang W, Yan P, Cui H, Tang M, Wang Y, Chen L, Zhang L, Yao Y, Liu Z, Li J, Jiang X, Zhang B. Using human genetics to understand the phenotypic association between chronotype and breast cancer. J Sleep Res 2024; 33:e13973. [PMID: 37380357 DOI: 10.1111/jsr.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/23/2023] [Accepted: 06/11/2023] [Indexed: 06/30/2023]
Abstract
Little is known regarding the shared genetic influences underlying the observed phenotypic association between chronotype and breast cancer in women. Leveraging summary statistics from the hitherto largest genome-wide association study conducted in each trait, we investigated the genetic correlation, pleiotropic loci, and causal relationship of chronotype with overall breast cancer, and with its subtypes defined by the status of oestrogen receptor. We identified a negative genomic correlation between chronotype and overall breast cancer (r g = -0.06, p = 3.00 × 10-4), consistent across oestrogen receptor-positive (r g = -0.05, p = 3.30 × 10-3) and oestrogen receptor-negative subtypes (r g = -0.05, p = 1.11 × 10-2). Five specific genomic regions were further identified as contributing a significant local genetic correlation. Cross-trait meta-analysis identified 78 loci shared between chronotype and breast cancer, of which 23 were novel. Transcriptome-wide association study revealed 13 shared genes, targeting tissues of the nervous, cardiovascular, digestive, and exocrine/endocrine systems. Mendelian randomisation demonstrated a significantly reduced risk of overall breast cancer (odds ratio 0.89, 95% confidence interval 0.83-0.94; p = 1.30 × 10-4) for genetically predicted morning chronotype. No reverse causality was found. Our work demonstrates an intrinsic link underlying chronotype and breast cancer, which may provide clues to inform management of sleep habits to improve female health.
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Affiliation(s)
- Xueyao Wu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chao Yang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Department of Epidemiology and Health Statistics, School of Public Health, Southwest Medical University, Luzhou, China
| | - Yanqiu Zou
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Samuel E Jones
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Xunying Zhao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Li Zhang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zhitong Han
- School of Life Sciences, Sichuan University, Chengdu, China
| | - Yu Hao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jinyu Xiao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chenghan Xiao
- Department of Maternal, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Wenqiang Zhang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peijing Yan
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Huijie Cui
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Mingshuang Tang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yutong Wang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Lin Chen
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ling Zhang
- Department of Iatrical Polymer Material and Artificial Apparatus, School of Polymer Science and Engineering, Sichuan University, Chengdu, China
| | - Yuqin Yao
- Department of Occupational and Environmental Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zhenmi Liu
- Department of Maternal, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jiayuan Li
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xia Jiang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Department of Nutrition and Food Hygiene, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ben Zhang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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Kendzerska T, Murray BJ, Colelli DR, Dela Cruz GR, Gershon AS, Povitz M, Talarico R, Boulos MI. The relationship between the morningness-eveningness questionnaire and incident cancer: A historical clinical cohort study. Sleep Med 2024; 117:139-145. [PMID: 38537521 DOI: 10.1016/j.sleep.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/20/2023] [Accepted: 03/14/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE We conducted a retrospective cohort study to explore the relationship between chronotype measured by the total Morningness-Eveningness Questionnaire (MEQ) score and incident cancer. METHODS We used clinical and provincial health administrative data on consecutive adults who underwent a Level 1 Polysomnography (PSG) and completed the MEQ between 2010 and 2015 in an academic hospital (Ontario, Canada) and were cancer-free at baseline. Cancer status was derived from the Ontario Cancer Registry. Individuals were followed until death or March 31, 2020. We used multivariable Cox cause-specific regressions to address the research objective. RESULTS Of 3,004 individuals, 1,781 were analyzed: a median age of 54 years (IQR: 40-64) and 838 (47.1%) men. The median total MEQ score was 63 (IQR: 55-69); 61 (3.4%) were classified as evening (≤41), 536 (30.1%) as intermediate (42-58), and 1,184 (66.5%) as morning chronotypes (≥59). Over a median of 7 years (IQR: 5-8), 120 (6.7%) developed cancer. A U-shape relationship was found between the total MEQ score and an increased hazard of incident cancer, controlling for PSG measures of sleep apnea severity and sleep architecture, demographics, and comorbidities. Compared to the median of 63.0, a total MEQ score greater or less than the median was associated with an increased hazard of incident cancer, with the largest effect for those with a total score ≥76 (e.g., HR of a MEQ total score of 78 vs. 63: 2.01, 95% CI: 1.09-3.71). CONCLUSION The U-shaped curve may reflect deviations from a standard circadian tendency, which may stress biological systems and influence malignancy risk.
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Affiliation(s)
- Tetyana Kendzerska
- Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada; ICES, Ottawa, Toronto, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Brian J Murray
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David R Colelli
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gio R Dela Cruz
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrea S Gershon
- ICES, Ottawa, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Marcus Povitz
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario, Canada
| | | | - Mark I Boulos
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Von Behren J, Goldberg D, Hurley S, Clague DeHart J, Wang SS, Reynolds P. Prospective analysis of sleep characteristics, chronotype, and risk of breast cancer in the california teachers study. Cancer Causes Control 2024; 35:597-604. [PMID: 37940783 PMCID: PMC10960753 DOI: 10.1007/s10552-023-01817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Poor sleep quality and evening chronotype were associated with increased risk of breast cancer in a previous retrospective study in the California Teachers Study (CTS). The present analysis examines these sleep factors prospectively in the same cohort of women. METHODS From the CTS, we included 1,085 incident breast cancer cases and 38,470 cancer-free participants from 2012 through 2019. We calculated time at risk and used Cox proportional hazards regression models to estimate the hazard ratios (HRs) and control for risk factors such as age, race, body mass index, family history of breast cancer, and reproductive history. The sleep factors examined were quality, latency, duration, disturbance, and sleep medication use, based on a shortened version of the Pittsburgh Sleep Quality Index, as well as chronotype (preference for morning or evening activity). This analysis was limited to women who were post-menopausal at the time they answered these sleep-related questions. RESULTS Measures of sleep quality did not appear to be associated with subsequent breast cancer risk. The HR for evening chronotypes compared to morning chronotypes was somewhat elevated (HR 1.19, 95% CI 1.04, 1.36). CONCLUSION While the measures of sleep quality and duration were not associated with post-menopausal breast cancer risk in this prospective analysis, the modestly elevated risk observed for evening chronotypes was consistent with the prior retrospective analysis.
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Affiliation(s)
- Julie Von Behren
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
| | - Debbie Goldberg
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Susan Hurley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Jessica Clague DeHart
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, USA
| | - Sophia S Wang
- Division of Health Analytics, Department of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Peggy Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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Jung HN, Suh D, Jeong WC, Ryu J, Kim YM, Yoon S, Kim H. Associations of chronotype and insomnia with menstrual problems in newly employed nurses at university hospitals in the Republic of Korea. Ann Occup Environ Med 2023; 35:e30. [PMID: 37701482 PMCID: PMC10493377 DOI: 10.35371/aoem.2023.35.e30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/06/2023] [Accepted: 06/30/2023] [Indexed: 09/14/2023] Open
Abstract
Background Dysmenorrhea and menstrual cycle changes occur in women working shifts. Circadian rhythm disruption and sleep disturbances associated with shift work leads to health problems. We identified chronotypes and the occurrence of insomnia among newly employed university hospital nurses and investigated the association of these factors with menstrual problems. Methods We conducted pre-placement health examinations for shift workers using self-reported questionnaires between 2018 and 2020. A total of 463 nurses were included in the study. Sociodemographic data, shift work experience, and information on insomnia were collected from health examination data. In addition, details regarding chronotype, dysmenorrhea, irregular and abnormal menstrual cycles, amenorrhea, and contraceptive use were obtained from the questionnaire. Multiple logistic regression analysis was performed to study the association between chronotype, insomnia, and menstrual problems after controlling for age, body mass index, contraceptive use, amenorrhea, and prior shift work. Results The prevalence rates of dysmenorrhea, irregular menstrual cycles, and longer menstrual cycles were 23.8%, 14.9%, and 4.1%, respectively. The risk of dysmenorrhea increased in the evening-type (odds ratio [OR]: 3.209; 95% confidence interval [CI]: 1.685-6.113) and those with insomnia (OR: 1.871; 95% CI: 1.074-3.261). Additionally, the risk of an irregular menstrual cycle (OR: 2.698; 95% CI: 1.167-6.237) increased in the evening-type, and the risk of a longer menstrual cycle (OR: 4.008; 95% CI: 1.354-11.864) increased in individuals with insomnia. Conclusions Our findings suggest that dysmenorrhea is promoted in the evening-type and insomnia individuals. There may be an increased risk of irregular menstrual cycles among evening-type nurses and an increased risk of longer menstrual cycles among those with insomnia. Therefore, factors such as evening-type and insomnia should be considered for the prevention of menstrual problems in women performing shift work.
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Affiliation(s)
- Han-Na Jung
- Department of Occupational and Environmental Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Dongwhan Suh
- Department of Occupational and Environmental Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Woo Chul Jeong
- Department of Occupational and Environmental Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Jia Ryu
- Department of Occupational and Environmental Medicine, Catholic Kwandong University International St. Mary’s Hospital, Incheon, Korea
| | - Yu-Mi Kim
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, Korea
- School of Public Health, Hanyang University, Seoul, Korea
| | - Seohyun Yoon
- Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyunjoo Kim
- Department of Occupational and Environmental Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
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Lotti S, Dinu M, Colombini B, Amedei A, Sofi F. Circadian rhythms, gut microbiota, and diet: Possible implications for health. Nutr Metab Cardiovasc Dis 2023; 33:1490-1500. [PMID: 37246076 DOI: 10.1016/j.numecd.2023.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 05/30/2023]
Abstract
AIMS Over the past years, interest in chrono-nutrition has grown enormously as the fundamental role of circadian rhythms in regulating most physiological and metabolic processes has become clearer. Recently, the influence of circadian rhythms on the gut microbiota (GM) composition has also emerged, as more than half of the total microbial composition fluctuates rhythmically throughout the day. At the same time, other studies have observed that the GM itself synchronises the host's circadian biological clock through signals of a different nature. Therefore, it has been hypothesised that there is a two-way communication between the circadian rhythms of the host and the GM, but researchers have only just begun to identify some of its action mechanisms. The manuscript aim is, therefore, to gather and combine the latest evidence in the field of chrono-nutrition with the more recent research on the GM, in order to investigate their relationship and their potential impact on human health. DATA SYNTHESIS Considering current evidence, a desynchronization of circadian rhythms is closely associated with an alteration in the abundance and functionality of the gut microbiota with consequent deleterious effects on health, such as increased risk of numerous pathologies, including cardiovascular disease, cancer, irritable bowel disease, and depression. A key role in maintaining the balance between circadian rhythms and GM seems to be attributed to meal-timing and diet quality, as well as to certain microbial metabolites, in particular short-chain fatty acids. CONCLUSIONS Future studies are needed to decipher the link between the circadian rhythms and specific microbial patterns in relation to different disease frameworks.
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Affiliation(s)
- Sofia Lotti
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Italy.
| | - Barbara Colombini
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Unit of Clinical Nutrition, Careggi University Hospital, Florence, Italy.
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Barber LE, VoPham T, White LF, Roy HK, Palmer JR, Bertrand KA. Circadian Disruption and Colorectal Cancer Incidence in Black Women. Cancer Epidemiol Biomarkers Prev 2023; 32:927-935. [PMID: 36409509 PMCID: PMC10199956 DOI: 10.1158/1055-9965.epi-22-0808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/11/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Animal and experimental studies suggest circadian disruption increases colorectal cancer risk, but evidence in humans is limited. We examined night shift work, chronotype, and residential position within a time zone, proxies for circadian disruption, in relation to colorectal cancer risk. METHODS Participants in the Black Women's Health Study, a prospective cohort of 59,000 Black American women established in 1995, reported history of night shift work and chronotype on follow-up questionnaires. Residential position within a time zone was estimated using participant addresses at each questionnaire cycle. Number of colorectal cancer cases and follow-up duration varied by analysis depending on timing of exposure assessment, ranging from 204 over the 2005 to 2018 night shift work study period to 452 over the 1995 to 2018 residential position study period. Cox proportional hazards regression was used to estimate multivariable-adjusted HRs and 95% confidence intervals (CI). RESULTS Compared with never having worked a night shift, working a night shift for ≥10 years was associated with increased colorectal cancer risk (HR = 1.64; 95% CI, 1.01-2.66). However, shorter duration was not. The HR for evening versus morning chronotype was 0.96 (95% CI, 0.73-1.27). Westward position of residence within a time zone was not associated with colorectal cancer risk (HR per 5-degree longitude increase: 0.92; 95% CI, 0.82-1.03). CONCLUSIONS Our findings suggest a possible increased risk of colorectal cancer associated with long duration night shift work; however, results require confirmation in larger studies. IMPACT Circadian disruption from long-term night shift work may contribute to colorectal cancer development in Black women.
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Affiliation(s)
- Lauren E. Barber
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
- Slone Epidemiology Center at Boston University, Boston, MA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Trang VoPham
- Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Laura F. White
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Hemant K. Roy
- Department of Medicine, Baylor College of Medicine, Houston, TX
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Muscogiuri G. The EASO New Investigator Award in Clinical Research 2021: Role of Chronotype in Obesity. Obes Facts 2023; 16:131-140. [PMID: 36349806 PMCID: PMC10028370 DOI: 10.1159/000527691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Chronotype is the expression of the timing of circadian rhythmicity of a subject, and three categories of chronotype have been identified: morning, evening, and intermediate chronotype. Subjects with morning chronotype prefer to carry out most of their daily activities in the morning, while subjects with evening chronotype perform most of their daily activities in the second half of the day. Intermediate chronotype is in an intermediate position between the above reported categories. Recently, evening chronotype has been associated with an increased risk of developing chronic diseases. Thus, the aim of this manuscript was to review the current evidence on the role of chronotype categories on the risk of developing obesity and the most common obesity-related comorbidities (cardiometabolic and neoplastic complications). SUMMARY Subjects with evening chronotype have been reported to be at high risk of developing obesity, and this was mostly due to the tendency of these subjects to follow unhealthy lifestyle mostly characterized by sedentary behavior and high intake of unhealthy food. In addition, sleep disturbances are a common finding in subjects with evening chronotype that in turn could further contribute to the risk of obesity. The impairment of insulin sensitivity, melatonin, adiponectin, and clock genes function along with increase of leptin secretion detected in subjects with evening chronotype could also represent a favorable milieu for the onset of obesity-related cancer. The current evidence is limited to breast, prostate, and endometrial cancer. KEY MESSAGES The chronotype categories could be easy assessed in subjects with obesity and at the same time provide an important information on an additional risk factor predisposing to the onset of obesity-related comorbidities. Since chronotype could be potentially modified through a behavioral-driven approach thus potentiating the efficacy of anti-obesity treatment, the assessment of chronotype categories should be included in the management of obesity.
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Affiliation(s)
- Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia ed Andrologia, Università Federico II di Napoli, Naples, Italy
- Centro Italiano per La Cura e Il Benessere Del Paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy
- Cattedra Unesco “Educazione Alla Salute e Allo Sviluppo Sostenibile”, Università Federico II di Napoli, Naples, Italy
- *Giovanna Muscogiuri,
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Muscogiuri G, Zanata I, Barrea L, Cozzolino A, Filice E, Messina E, Colao A, Faggiano A. A practical nutritional guideline to manage neuroendocrine neoplasms through chronotype and sleep. Crit Rev Food Sci Nutr 2022; 63:7546-7563. [PMID: 35285728 DOI: 10.1080/10408398.2022.2047882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Chronotype is the attitude of subjects to carry out their daily activities mainly in the morning ("lark") or in the evening ("owl"). The intermediate chronotype is located between these two categories. It has been demonstrated that chronotype can influence the incidence, course and response to treatments of tumors. In particular patients diagnosed with gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) and evening chronotype are characterized by unhealthy lifestyle, obesity, metabolic syndrome, a worsen cardiometabolic profile, a poor prognosis with a progressive disease and the development of metastasis. In addition, evening chronotype has been associated with sleep disturbances, which in turn have been related to tumor development and progression of tumors. There is a strict connection between sleep disturbances and NENs because of the hyperactivation of proangiogenic factors that caused aberrant neoangiogenesis. A nutritional tailored approach could represent a tool to align subjects with evening chronotype to physiological biological rhythms based on the properties of some macro and micronutrients of being substrate for melatonin synthesis. Thus, we aimed to provide an overview on the association of chronotype categories and sleep disturbances with NENs and to provide nutritional advices to manage subjects with NENs and these disturbances of circadian rhythm.
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Affiliation(s)
- Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
- Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile,", Università Federico II di Napoli, Naples, Italy
| | - Isabella Zanata
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Luigi Barrea
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Naples, Italy
| | - Alessia Cozzolino
- Section of Medical Pathophysiology and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Emanuele Filice
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Erika Messina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
- Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile,", Università Federico II di Napoli, Naples, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Associating sleep problems with advanced cancer diagnosis, and immune checkpoint treatment outcomes: a pilot study. Support Care Cancer 2022; 30:3829-3838. [PMID: 35034197 PMCID: PMC8761099 DOI: 10.1007/s00520-022-06825-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/10/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sleep problems (SP) are common in cancer patients but have not been previously assessed in patients receiving immune checkpoint inhibitors (ICI). METHODS We collected questionnaire data on sleep apnea risk, insomnia, and general sleep patterns. We used an adjusted multivariate Poisson regression to calculate prevalence ratios (PRs) and associated 95% confidence intervals (CIs) for associations between these SP and metastatic versus localized cancer stage (M1 vs. M0), and adjusted logistic regression models to calculate ORs for associations between SP with the number of ICI infusions completed (6 + vs. < 6). RESULTS Among 32 patients who received ICI treatment, the prevalence of low, intermediate, and high-risk OSA risk was 36%, 42%, and 21%, respectively. Overall, 58% of participants reported clinically significant insomnia. We did not find a significant association between intermediate or high risk OSA (vs. low risk) and metastatic cancer status (PR = 1.01 (95% CI: 0.28, 3.67)). Patients in the cohort who reported taking > 15 min to fall asleep were 3.6 times more likely to be diagnosed with metastatic cancer compared to those reporting shorter sleep latency (95% CI (1.74, 7.35)). We did not find a significant association between SP and number of ICI infusions completed. CONCLUSION Our data associating sleep apnea risk, insomnia, and sleep patterns with more advanced cancer encourages further exploration in larger-scale observational studies and suggests interventional clinical trials focused on sleep quality improvement that could result in better outcomes for these patients.
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11
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Kant AK, Graubard BI. Clock Time of First Eating Episode and Prospective Risk of All-Cause Mortality in US Adults. J Nutr 2021; 152:217-226. [PMID: 34718676 PMCID: PMC8754512 DOI: 10.1093/jn/nxab327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/07/2021] [Accepted: 09/10/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is increasing recognition that a morning or evening preference is associated with time of eating, metabolic health, and morbidity. However, few studies have examined the association of time of eating with mortality. OBJECTIVES To examine the association of time of first recalled ingestive episode with the prospective risk of all-cause mortality. METHODS We used mortality-linked data from the NHANES conducted in 1988-1994 and 1999-2014 (n = 34,609; age ≥ 40 years). The exposure was quartiles (Q1-Q4) of clock time of first eating episode self-reported in the baseline 24-hour dietary recall. The outcome was follow-up time from the date of NHANES examination to the date of death or end of the follow-up period (31 December 2015). We used proportional hazards regression methods to determine the independent association of time of first eating episode with relative hazard of all-cause mortality, with adjustments for multiple covariates and the complex survey design. Multiple linear regression methods were used to examine the associations of time of first eating episode with baseline cardiometabolic biomarkers and dietary attributes. RESULTS In this national cohort, with a median age of ∼55 years (95% CI: 54.6-55.4 years) at baseline and a median follow-up of 8.3 years (IQR, 8.75 years), there were 10,303 deaths. The median times of first eating episodes in Q1-Q4 were 05:45, 07:00, 08:00, and 10:00, respectively. Covariate-adjusted relative hazards of mortality in Q1 to Q3 of the time of the first eating episode were 0.88 (95% CI: 0.81-0.96), 0.88 (95% CI: 0.81-0.95), 0.94 (95% CI: 0.87-1.02), with Q4 as the referent (P = 0.0008). Qualitative dietary attributes were inversely related with the time of the first eating episode; however, BMI and serum concentrations of glycemic biomarkers increased with later times of first eating episode (P ≤ 0.0001). CONCLUSIONS Recall of an earlier time of the first eating episode by ≥40-year-old US participants was suggestive of a small relative survival advantage in this observational study.
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Affiliation(s)
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, Biostatistics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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12
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Lotti S, Pagliai G, Colombini B, Sofi F, Dinu M. Chronotype Differences in Energy Intake, Cardiometabolic Risk Parameters, Cancer, and Depression: A Systematic Review with Meta-Analysis of Observational Studies. Adv Nutr 2021; 13:269-281. [PMID: 34549270 PMCID: PMC8803479 DOI: 10.1093/advances/nmab115] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/11/2021] [Accepted: 09/13/2021] [Indexed: 01/31/2023] Open
Abstract
Chronotype is a behavioral manifestation of the internal circadian clock system. It refers to the specific activity-rest preference of an individual over a 24-h period and can be assessed using different methodologies that classify individuals into morning or evening chronotype. In recent years, several studies have suggested a relation between individual chronotype, eating habits, and the risk of developing obesity and other conditions. Our aim was to evaluate the association between chronotype, energy intake, and health status through a meta-analytic approach. A comprehensive search of MEDLINE, Embase, Scopus, Web of Science, and Cochrane Database was conducted. Observational studies that reported a measure of association between chronotype, energy intake, and health indicators were considered eligible. Overall, 39 observational studies (37 cross-sectional studies, 2 prospective cohort studies) were included in the systematic review, with a total of 377,797 subjects. By comparing morning and evening subjects, pooled analyses of cross-sectional studies showed significantly (P < 0.001) higher concentrations of blood glucose [mean difference (MD): 7.82; 95% CI: 3.18, 12.45], glycated hemoglobin (MD: 7.64; 95% CI: 3.08, 12.21), LDL cholesterol (MD: 13.69; 95% CI: 6.84, 20.54), and triglycerides (MD: 12.62; 95% CI: 0.90, 24.35) in evening subjects. Furthermore, an association between evening type and the risk of diabetes (OR: 1.30; 95% CI: 1.20, 1.41), cancer (OR: 1.18; 95% CI: 1.08, 1.30), and depression (OR: 1.86; 95% CI: 1.20, 2.88) was reported. Regarding the other outcomes examined, no significant differences were observed between the groups in terms of energy intake, anthropometric parameters, blood pressure, insulin, total and HDL cholesterol, and hypertension risk. In conclusion, evening chronotype was associated with a worse cardiometabolic risk profile and higher risk of diabetes, cancer, and depression. Further studies are needed to confirm these results and to better elucidate the interplay between chronotype, nutrition, and health status. This systematic review was registered at www.crd.york.ac.uk/prospero/ as CRD42021231044.
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Affiliation(s)
| | - Giuditta Pagliai
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Barbara Colombini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy,Unit of Clinical Nutrition, Careggi University Hospital, Florence, Italy
| | - Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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13
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Relationship of Circadian Rhythm and Psychological Health in Adolescents and Young Adults With Cancer. Cancer Nurs 2021; 44:E659-E669. [PMID: 34387235 DOI: 10.1097/ncc.0000000000000971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence shows that adolescent and young adult (AYA) cancer patients have an increasing survival rate but experience psychological distress and circadian rhythm dysregulation. Little is known about the effect of circadian rhythm on psychological distress. OBJECTIVE To investigate the type of circadian rhythm in Chinese AYA cancer survivors and examine the associations among chronotype, demographic characteristics, psychological distress, anxiety and depression, character strengths, and medical coping in this group. METHODS This cross-sectional study enrolled 800 AYA cancer participants, 728 of whom completed the Chinese version of the Morningness-Eveningness Questionnaire, the Distress Thermometer, the Hospital Anxiety and Depression Scale, the Three-Dimensional Inventory of Character Strengths, and the Medical Coping Modes Questionnaire. RESULTS Evening- and morning-type participants accounted for 35.0% and 19.1%, respectively, among participants, which was significantly higher than those found in the general population. The prevalence of psychological distress was 84.9% among AYA cancer participants. Exercise, Distress Thermometer, and depression were important predictive factors for the circadian rhythm. CONCLUSIONS Circadian rhythm disorder and psychological distress were common among AYA cancer survivors. Evening-type participants performed worse on character strength, confrontation, and avoidance of medical coping. IMPLICATIONS FOR PRACTICE Healthcare professionals need to understand the circadian rhythm and psychological health of AYA cancer survivors. Psychological rehabilitation guidance, especially within the 6 months after diagnosis, may benefit AYA survivors according to their chronotype. Character strengths can also be used during rehabilitation to properly guide AYA survivors.
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14
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Von Behren J, Hurley S, Goldberg D, Clague DeHart J, Wang S, Reynolds P. Chronotype and risk of post-menopausal endometrial cancer in the California Teachers Study. Chronobiol Int 2021; 38:1151-1161. [PMID: 33902365 PMCID: PMC9172273 DOI: 10.1080/07420528.2021.1912073] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/09/2021] [Accepted: 03/27/2021] [Indexed: 12/12/2022]
Abstract
Working at night causes circadian disruption and it has been classified as a probable carcinogen. An evening chronotype, or preference for late day activity, has been shown to increase risk for several adverse health effects, such as metabolic disorders and recently, breast cancer. To further explore this emerging area of interest, we examined the association between endometrial cancer (EC) risk, another common cancer in women, and chronotype. The women in this study were members of the California Teachers Study cohort, which was established in 1995. Chronotype was reported on a subsequent questionnaire (Q5), administered in 2012-2013. The women included in this analysis were under age 90 years, were post-menopausal at Q5, and had no hysterectomy. The cancer cases, identified through linkages to the California Cancer Registry, were diagnosed between 1996 and 2014. We used unconditional logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the associations between chronotype and EC diagnosis. There were 437 EC cases and 26,753 cancer-free controls included in this analysis. Controls were more likely to classify themselves as current morning chronotypes than were cases (39% and 34%, respectively). Compared to morning types, women who were definite evening types had a statistically significantly elevated OR of 1.44 (95% CI 1.09-1.91). This association was more pronounced among obese women as compared to non-obese women. For evening type compared to morning type, the OR among obese women was 2.01 (95% CI 1.23, 3.29) while the OR for non-obese women was 1.12 (95% CI 0.77, 1.63). To our knowledge, the association between EC risk and evening chronotype has not been previously reported, but is consistent with the small body of literature which suggests increased breast cancer risks among evening chronotypes. Because this study was based on a retrospective analysis in a cohort of mostly white female teachers in California, further analysis of chronotype as a potential EC risk factor should be considered in other cohorts and in prospective analyses in order to further explore this relationship.
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Affiliation(s)
- J Von Behren
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - S Hurley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - D Goldberg
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - J Clague DeHart
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, USA
| | - S Wang
- Division of Health Analytics, Department of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - P Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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15
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Barrea L, Muscogiuri G, Pugliese G, Modica R, Laudisio D, Aprano S, Faggiano A, Colao A, Savastano S. Chronotype: what role in the context of gastroenteropancreatic neuroendocrine tumors? J Transl Med 2021; 19:324. [PMID: 34330303 PMCID: PMC8325322 DOI: 10.1186/s12967-021-03010-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/23/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Chronotype is defined as a trait determining the subject circadian preference in behavioral and biological rhythms relative to external light-dark cycle. Although individual differences in chronotype have been associated with an increased risk of developing some types of cancer, no studies have been carried out in gastroenteropancreatic neuroendocrine tumors (GEP-NET). MATERIALS We investigate the differences in chronotype between 109 GEP-NET and 109 healthy subjects, gender-, age-, and BMI-matched; and its correlation with tumor aggressiveness. RESULTS GEP-NET patients have a lower chronotype score (p = 0.035) and a higher percentage of evening chronotype (p = 0.003) than controls. GEP-NET patients with morning chronotype had lower BMI, waist circumference, and higher percentage of MetS (p < 0.001) than evening type. Interestingly, considering the clinical pathological characteristics, patients with the presence of metastasis, grading G2, and in progressive disease presented the lower chronotype score (p = 0.004, p < 0.001, and p = 0.002; respectively) compared to other categories. Chronotype score was negatively associated with anthropometric measurements, metabolic profile, percentage of MetS, and Ki67 index (p < 0.001 for all). CONCLUSIONS GEP-NET patients have an unhealthy metabolic profile and present more commonly an evening chronotype. These results support the importance of including the assessment of chronotype in an adjunctive tool for the prevention of metabolic alterations and tumor aggressiveness of GEP-NET.
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Affiliation(s)
- Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Via Porzio, Centro Direzionale, isola F2, 80143, Naples, Italy.
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy
| | - Gabriella Pugliese
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Roberta Modica
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Daniela Laudisio
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Sara Aprano
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, 00189, Rome, Italy
| | - Annamaria Colao
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy
| | - Silvia Savastano
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
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Siudej K, Malinowska-Borowska J. Relationship between chronotype and consumption of stimulants. Chronobiol Int 2021; 38:1549-1556. [PMID: 34080490 DOI: 10.1080/07420528.2021.1935989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Consumption of some stimulants may lead to health problems. The aim of the study was to identify a potential correlation between extreme chronotypes and the tendency to use various stimulants. The preferred time of consumption was also checked, both on working and nonworking days. The study was conducted in January 2020 using the CAWI method. 306 people took part in the survey. To determine the chronotype of the surveyed people, the polish version of MEQ questionnaire (Morningness - Eveningness Questionnaire) was used. Because 178 respondents were intermediate types, 128 people participated in the second part of the study, including 68 owls and 60 larks. Activity preferences during the day of respondents were checked and compared with data about the quantity and frequency of using stimulants like coffee, energy drinks, alcohol and cigarettes. Chi-square test was used for testing relationships. The time periods for taking stimulants differed between groups and were associated with activity during the day. It has been shown that people with evening chronotype use more energy drinks (p = .009), alcohol drinks (p = .013) and cigarettes or e-cigarettes (p = .021), especially in the group of respondents aged ≥30. Social jet lag was statistically higher in the group of owls and larks; however, consumption of stimulants depended on age and chronotype, not social jet lag. People with the morning chronotype are less likely to use stimulants. Owls showed a greater and more frequent use of energy drinks, alcohol and cigarettes, especially those older than 30 years. Assessing eveningness among people aged more than 30 may be helpful in characterizing an overall risk profile.
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Affiliation(s)
- Katarzyna Siudej
- Scientific Circle at Department of Toxicology and Health Protection, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Bytom, Poland
| | - Jolanta Malinowska-Borowska
- Department of Toxicology and Health Protection, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Bytom, Poland
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Szkiela M, Kusideł E, Makowiec-Dąbrowska T, Kaleta D. How the Intensity of Night Shift Work Affects Breast Cancer Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4570. [PMID: 33925799 PMCID: PMC8123502 DOI: 10.3390/ijerph18094570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/09/2022]
Abstract
Background-In 2019, the IARC concluded that "night shift work is probably carcinogenic to humans (Group 2A), based on limited evidence from human epidemiological studies and sufficient evidence of cancer and strong mechanistic evidence in experimental Animals." The negative health consequences of night shift work may depend on how the night shifts are scheduled. The aim of this study was to investigate how the characteristics of night work affect the risk of developing breast cancer. Methods-A case-control study was conducted in 2015-2019 in the Lodz region. The case group included 494 women with breast cancer, while the control group included 515 healthy women. Results-Night work was found to be the third most important factor regarding breast cancer after a high BMI and a short or no breastfeeding period and before factors such as early menstruation, late menopause, no pregnancy, and smoking. The harmful effects of night work were influenced by its intensity, frequency, rotation, and the number of night shift years worked. Night work increases the breast cancer risk by 2.34 times, and high-intensity night work increases the breast cancer risk by 2.66 times. Conclusions-Appropriate ergonomic recommendations for night shift work for employers should be considered.
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Affiliation(s)
- Marta Szkiela
- Department of Hygiene and Epidemiology, Faculty of Health Sciences, Medical University of Lodz, 90-752 Lodz, Poland;
- Department of Hygiene and Health Promotion, Faculty of Health Sciences, Medical University of Lodz, 90-752 Lodz, Poland
| | - Ewa Kusideł
- Department of Spatial Econometrics, Faculty of Economics and Sociology, University of Lodz, 90-255 Lodz, Poland;
| | - Teresa Makowiec-Dąbrowska
- Nofer Institute of Occupational Medicine in Łódź, Department of Environmental and Occupational Health Hazards, 91-348 Lodz, Poland;
| | - Dorota Kaleta
- Department of Hygiene and Epidemiology, Faculty of Health Sciences, Medical University of Lodz, 90-752 Lodz, Poland;
- Department of Hygiene and Health Promotion, Faculty of Health Sciences, Medical University of Lodz, 90-752 Lodz, Poland
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Montaruli A, Castelli L, Mulè A, Scurati R, Esposito F, Galasso L, Roveda E. Biological Rhythm and Chronotype: New Perspectives in Health. Biomolecules 2021; 11:biom11040487. [PMID: 33804974 PMCID: PMC8063933 DOI: 10.3390/biom11040487] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
The circadian rhythm plays a fundamental role in regulating biological functions, including sleep–wake preference, body temperature, hormonal secretion, food intake, and cognitive and physical performance. Alterations in circadian rhythm can lead to chronic disease and impaired sleep. The circadian rhythmicity in human beings is represented by a complex phenotype. Indeed, over a 24-h period, a person’s preferred time to be more active or to sleep can be expressed in the concept of morningness–eveningness. Three chronotypes are distinguished: Morning, Neither, and Evening-types. Interindividual differences in chronotypes need to be considered to reduce the negative effects of circadian disruptions on health. In the present review, we examine the bi-directional influences of the rest–activity circadian rhythm and sleep–wake cycle in chronic pathologies and disorders. We analyze the concept and the main characteristics of the three chronotypes.
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Affiliation(s)
- Angela Montaruli
- Department of Biomedical Sciences for Health, University of Milan, Via G. Colombo 71, 20133 Milan, Italy; (A.M.); (L.C.); (A.M.); (R.S.); (F.E.); (E.R.)
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
| | - Lucia Castelli
- Department of Biomedical Sciences for Health, University of Milan, Via G. Colombo 71, 20133 Milan, Italy; (A.M.); (L.C.); (A.M.); (R.S.); (F.E.); (E.R.)
| | - Antonino Mulè
- Department of Biomedical Sciences for Health, University of Milan, Via G. Colombo 71, 20133 Milan, Italy; (A.M.); (L.C.); (A.M.); (R.S.); (F.E.); (E.R.)
| | - Raffaele Scurati
- Department of Biomedical Sciences for Health, University of Milan, Via G. Colombo 71, 20133 Milan, Italy; (A.M.); (L.C.); (A.M.); (R.S.); (F.E.); (E.R.)
| | - Fabio Esposito
- Department of Biomedical Sciences for Health, University of Milan, Via G. Colombo 71, 20133 Milan, Italy; (A.M.); (L.C.); (A.M.); (R.S.); (F.E.); (E.R.)
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
| | - Letizia Galasso
- Department of Biomedical Sciences for Health, University of Milan, Via G. Colombo 71, 20133 Milan, Italy; (A.M.); (L.C.); (A.M.); (R.S.); (F.E.); (E.R.)
- Correspondence: ; Tel.: +2-5031-4656
| | - Eliana Roveda
- Department of Biomedical Sciences for Health, University of Milan, Via G. Colombo 71, 20133 Milan, Italy; (A.M.); (L.C.); (A.M.); (R.S.); (F.E.); (E.R.)
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
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19
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Hurley S, Goldberg D, Von Behren J, Clague DeHart J, Wang S, Reynolds P. Sleep deficiency and breast cancer risk among postmenopausal women in the California teachers study (CTS). Cancer Causes Control 2020; 31:1115-1128. [PMID: 32981009 PMCID: PMC8519507 DOI: 10.1007/s10552-020-01349-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 09/16/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE There is provocative, yet inconsistent, evidence that sleep deficiency may influence the development of breast cancer. The purpose of this study was to evaluate the risk of breast cancer associated with sleep deficiency among postmenopausal women in the California Teachers Study (CTS). METHODS We conducted a case-control study of 2,856 invasive breast cancer cases and 38,649 cancer-free controls, nested within the CTS. Self-administered questionnaires were used to ascertain several components of sleep deficiency, including quality, latency, duration, disturbance and use of sleep medications. Additionally, a Global Sleep Index (GSI) was created by summing the individual sleep components and categorizing into quartiles. Multivariable logistic regression analyses were used to estimate odds ratios and 95% confidence intervals (OR, 95% CI). RESULTS Increased breast cancer risks were associated with sleep deficiency. With the exception of duration, linear increases in risk were associated with all the other individual components of sleep deficiency (p-trend ≤ 0.002). The OR for the highest GSI quartile vs. lowest was 1.24, 95% CI 1.12-1.38; p-trend < 0.001). CONCLUSIONS Sleep deficiency may be a risk factor for breast cancer. Additional prospective studies and those aimed at elucidating underlying mechanism are warranted.
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Affiliation(s)
- S Hurley
- Department of Epidemiology and Biostatistics, University of California San Francisco, Berkeley, CA, USA.
| | - D Goldberg
- Department of Epidemiology and Biostatistics, University of California San Francisco, Berkeley, CA, USA
| | - J Von Behren
- Department of Epidemiology and Biostatistics, University of California San Francisco, Berkeley, CA, USA
| | - J Clague DeHart
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, USA
| | - S Wang
- Division of Health Analytics, Department of Computational and Quantitative Medicine, City of Hope Comprehensive Cancer Center, Beckman Research Institute, Duarte, CA, USA
| | - P Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, Berkeley, CA, USA
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20
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Kiyotoki S, Nishikawa J, Nagata N, Niikura R, Doyama H, Imagawa A, Hasatani K, Hatta W, Sumiyoshi T, Nebiki H, Nagami Y, Nishida T, Kakushima N, Iguchi M, Tomida H, Inoue T, Kuribayashi S, Narasaka T, Hikichi T, Yada T, Ochiai Y, Furuhashi H, Yoshio T, Mori H, Yamauchi K, Kitamura K, Fujita T, Mabe K, Mikami T, Goto A, Akashi M, Hamamoto Y, Fujishiro M, Sakaida I. Exploration of the characteristics of chronotypes in upper gastrointestinal tract diseases: a multicenter study in Japan. Chronobiol Int 2020; 38:534-542. [PMID: 33059467 DOI: 10.1080/07420528.2020.1830791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Characteristics of the chronotypes of patients with gastrointestinal disease are unknown. We evaluated chronotypes of patients with upper gastrointestinal diseases with the Munich ChronoType Questionnaire (MCTQ). A total of 2027 subjects from 29 institutions in Japan who had undergone esophagogastroduodenoscopy were asked to answer the MCTQ. The subjects' chronotypes were divided into three groups (early, intermediate, and late chronotype) using the sleep-corrected mid-point of sleep on free days (MSFSC) values. According to their endoscopic diagnosis and abdominal symptoms, the subjects were divided into the reflux esophagitis (RE) group, gastroduodenal ulcer (GDU) group, upper gastrointestinal carcinoma (CA) group, functional dyspepsia (FD) group, non-FD group, and control group. In total, 1128 subjects were eligible for the analysis. The MSFSC (average ± standard deviation, clock hours, h) of each disease group was as follows: control group: 02.51 ± 1.22, non-FD group: 02.69 ± 1.14, FD group: 02.91 ± 1.19, RE group: 02.58 ± 1.05, GDU group: 02.47 ± 1.31, and CA group: 02.11 ± 1.08 h. Compared to the control group, the rate of late chronotype of the FD group significantly increased to 33.3%, whereas that of early chronotype of the CA group significantly increased to 38.3% (P = .0177 and 0.0036, respectively). In both the FD and CA groups, chronotype was the independent factor related to the diseases. The adjusted odds ratio of late chronotype to early chronotype was 3.01 [95% CI, 1.23-7.35] in the FD group and 0.44 [95% CI, 0.23-0.85] in the CA group. In conclusion, late chronotype was common in patients with FD, and early chronotype was common in patients with upper gastrointestinal carcinoma.
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Affiliation(s)
- Shu Kiyotoki
- Faculty of Laboratory Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Jun Nishikawa
- Department of Gastroenterology, Shuto General Hospital, Yanai, Japan
| | - Naoyoshi Nagata
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan.,Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ryota Niikura
- Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | | | - Kenkei Hasatani
- Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Hiroko Nebiki
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Naomi Kakushima
- Division of Endoscopy, Shizuoka Cancer Center, Suntougun, Japan
| | - Mikitaka Iguchi
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hideomi Tomida
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Takuya Inoue
- Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan
| | - Shiko Kuribayashi
- Department of Gastroenterology and Hepatology, Gunma University Hospital, Maebashi, Japan
| | - Toshiaki Narasaka
- Department of Gastroenterology, University of Tsukuba, Tsukuba, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Tomoyuki Yada
- Department of Gastroenterology & Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan
| | - Yorinari Ochiai
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Hiroto Furuhashi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Hideki Mori
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kenji Yamauchi
- Department of Gastroenterology, Mitoyo General Hospital, Kannonji, Japan
| | - Kazuya Kitamura
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Tomoki Fujita
- Department of Medical Gastroenterology, Otaru-Ekisaikai Hospital, Otaru, Japan
| | - Katsuhiro Mabe
- Junpukai Health Maintenance Center Kurashiki, Kurashiki, Japan
| | - Tatsuya Mikami
- Division of Endoscopy, Hirosaki University Hospital, Hirosaki, Japan
| | - Atsushi Goto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Makoto Akashi
- The Research Institute for Time Studies, Yamaguchi University, Yamaguchi, Japan
| | - Yoshihiko Hamamoto
- Department of Information Science and Engineering, Yamaguchi University Graduate School of Sciences and Technology for Innovation, Ube, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Isao Sakaida
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
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21
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Lozano-Lorca M, Olmedo-Requena R, Vega-Galindo MV, Vázquez-Alonso F, Jiménez-Pacheco A, Salcedo-Bellido I, Sánchez MJ, Jiménez-Moleón JJ. Night Shift Work, Chronotype, Sleep Duration, and Prostate Cancer Risk: CAPLIFE Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6300. [PMID: 32872503 PMCID: PMC7503878 DOI: 10.3390/ijerph17176300] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/25/2022]
Abstract
To analyze the association between prostate cancer (PCa) risk and night shift work, chronotype, and sleep duration in the context of a population-based case-control study of incident prostate cancer in Spain, a total of 465 PCa cases and 410 controls were analyzed. Selection criteria were: (i) age 40-80 years, and (ii) residence in the coverage area of the reference hospitals for ≥6 months before recruitment. Exposure variables were: (i) night shift work (permanent or rotating); (ii) chronotype: morning, neither, or evening (Munich ChronoType Questionnaire) and (iii) sleep duration according to the recommendations of the American National Sleep Foundation. PCa aggressiveness was determined according to the International Society of Urology Pathology classification. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were estimated using logistic regression models. Night shift work was associated with PCa, aOR = 1.47 (95% CI 1.02-2.11), especially for rotating night shifts, aOR = 1.73 (95% CI 1.09-2.75). The magnitude of the association between ever night work and PCa was higher in evening subjects with aOR = 3.14 (95% CI 0.91-10.76) than in morning chronotypes with an aOR = 1.25 (95% CI 0.78-2.00). Working night shifts, especially rotating night shifts, could increase PCa risk. This risk may be higher in people with an evening chronotype.
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Affiliation(s)
- Macarena Lozano-Lorca
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, 18016 Granada, Spain; (M.L.-L.); (I.S.-B.); (M.-J.S.); (J.-J.J.-M.)
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
| | - Rocío Olmedo-Requena
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, 18016 Granada, Spain; (M.L.-L.); (I.S.-B.); (M.-J.S.); (J.-J.J.-M.)
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | | | | | | | - Inmaculada Salcedo-Bellido
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, 18016 Granada, Spain; (M.L.-L.); (I.S.-B.); (M.-J.S.); (J.-J.J.-M.)
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - María-José Sánchez
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, 18016 Granada, Spain; (M.L.-L.); (I.S.-B.); (M.-J.S.); (J.-J.J.-M.)
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Andalusian School of Public Health (EASP), 18011 Granada, Spain
| | - José-Juan Jiménez-Moleón
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, 18016 Granada, Spain; (M.L.-L.); (I.S.-B.); (M.-J.S.); (J.-J.J.-M.)
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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22
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Gordon HW. Sleep Researchers are Studying Addiction but Don't Know It. ACTA ACUST UNITED AC 2019; 5. [PMID: 31886464 DOI: 10.33552/ann.2019.05.000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Harold W Gordon
- Epidemiology Research Branch, Division of Epidemiology, Services and Prevention Research (DESPR), National Institute on Drug Abuse, The Neuroscience Center, Room 5151, 6001 Executive Boulevard, Bethesda, MD 20892, USA
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