Gece Vardiyasında Çalışan Hemşirelerde Melatonin, Leptin ve Grelin Düzeyleri

Öz

Amaç: Melatonin, leptin ve grelin dahil olmak üzere birçok hormonun seviyeleri sirkadiyen ritim tarafından düzenlenir. Sirkadiyen ritim bozulmasına bağlı düzensiz hormon düzeyleri metabolik sendrom (MetS) gibi sorunlara neden olabilir. Bu kesitsel çalışmada, en az 3 aydır gece ve en az 3 aydır gündüz vardiyasında çalışan sağlıklı hemşirelerin melatonin düzeylerini belirleyerek, melatonin, sirkadien ritim, leptin, grelin ve metabolik sendrom ilişkisinin araştırılması amaçlanmıştır. 

Yöntemler: 20-40 yaş aralığında, Vücut Kitle İndeksi (BMI) > 25 olan 50 hemşirenin sabah 8 saatlik açlıkla venöz kanları alınmıştır. Gece nöbet tutan grup gece grubu olarak, gündüz çalışan kontrol grubu ise gündüz grubu olarak adlandırılmıştır. Alınan kanlarda melatonin, leptin ve grelin düzeyleri ELISA metodu ile, metabolik sendrom kriterlerinden olan insülin immünokimyasal olarak, açlık kan şekeri, kolesterol, trigliserid, yüksek yoğunluklu lipoprotein (HDL) ve düşük yoğunluklu lipoprotein (LDL) düzeyleri ise spektrofotometrik olarak incelenmiştir.

Bulgular: Melatonin düzeyleri gece grubunda, gündüz grubuna göre anlamlı derecede düşük bulunmuştur (p=0,003). Leptin düzeyleri gece grubunda düşük bulunmuştur ancak istatistiksel olarak anlamlı değildir (p=0,097). Aksine grelin düzeyleri ve diğer biyokimyasal parametreler olan trigliserit, açlık kan şekeri, insülin, insülin direnci ve kolesterol gece grubunda artmıştır, ancak bu artışlar istatistiksel olarak anlamlı değildir. 

Sonuç: Bulgularımız gece vardiyasında çalışmanın sırkadiyen ritmin bozularak, MetS eğiliminin artabileceğini göstermektedir.

Anahtar Kelimeler

• Gece vardiyası,Metabolik sendrom,Melatonin,Leptin,Grelin

Melatonin, leptin, and ghrelin levels in nurses working night shifts

Abstract

Aim: The levels of several hormones including melatonin, leptin, and ghrelin are regulated by circadian rhythm. Deregulated hormone levels due to disruption of circadian rhythm may result in medical conditions like metabolic syndrome (MetS). The aim of this cross-sectional study was to investigate the associations among circadian rhythm, melatonin, leptin, ghrelin and metabolic syndrome by determining melatonin levels of healthy nurses who were working on night-shift for at least 3 months and of those on day-shift for at least 3 months.

Methods: Venous bloods following 8-hour fasting of 50 nurses, who were aged at 20-40 age range and whose Body Mass Index (BMI) were >25, were collected. Those working on night-shift were named as night group and the control group of the study was named as day group. From the bloods collected; melatonin, leptin and ghrelin levels were evaluated by ELISA method, insulin was evaluated by immunochemically, whereas fasting blood glucose, cholesterol, triglyceride, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were evaluated spectrophotometrically.

Results: Melatonin level was significantly lower in the night-shift group compared to the day-shift group (p=0.003). Leptin level was slightly but not significantly lower in the night-shift group (p=0.097). In contrast, ghrelin level and other biochemical parameters including triglyceride, fasting blood sugar (FBS), insulin, insulin resistance index (HOMA-IR) and cholesterol were increased in the night-shift group but these increments were not statistically significant.

Conclusion: Our results suggest that night-shift work might exhibit tendency towards MetS by disrupting circadian rhythm. 

Keywords

• Night shift
• Metabolic syndrome
• Melatonin
• Leptin
• Ghrelin

Kaynakça

1. 1. Boivin DB, Boudreau P. Impacts of shift work on sleep and circadian rhythms. Pathol Biol (Paris). 2014;62(5):292-301.
2. 2. Caruso CC. Negative impacts of shiftwork and long work hours. Rehabil Nurs. 2014;39(1):16-25.
3. 3. Kim TW, Jeong JH, Hong SC. The impact of sleep and circadian disturbance on hormones and metabolism. Int J Endocrinol. 2015;2015:591729.
4. 4. Claustrat B, Leston J. Melatonin: Physiological effects in humans. Neurochirurgie. 2015;61(2-3):77-84.
5. 5. Hardeland R, Cardinali DP, Srinivasan V, Spence DW, Brown GM, Pandi-Perumal SR. Melatonin--a pleiotropic, orchestrating regulator molecule. Prog Neurobiol. 2011;93(3):350-84.
6. 6. Kaur J. A comprehensive review on metabolic syndrome. Cardiol Res Pract. 2014;2014:943162.
7. 7. Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol. 2008;28(4):629-36.
8. 8. Dominguez LJ, Barbagallo M. The biology of the metabolic syndrome and aging. Curr Opin Clin Nutr Metab Care. 2016;19(1):5-11.

9. 9. Booth A, Magnuson A, Fouts J, Foster MT. Adipose tissue: an endocrine organ playing a role in metabolic regulation. Horm Mol Biol Clin Investig. 2016;26(1):25-42.
10. 10. Zhang Y, Proenca R, Maffei M, Barone M, Leopold L, Friedman JM. Positional cloning of the mouse obese gene and its human homologue. Nature. 1994;372(6505):425-32.
11. 11. Oswal A, Yeo G. Leptin and the control of body weight: a review of its diverse central targets, signaling mechanisms, and role in the pathogenesis of obesity. Obesity (Silver Spring) 2010;18(2):221-9.
12. 12. Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402(6762):656-60.
13. 13. Collden G, Tschop MH, Muller TD. Therapeutic Potential of Targeting the Ghrelin Pathway. Int J Mol Sci. 2017;18(4).
14. 14. Turker Y, Bas FY, Yavuz E, Arslan B. Knowledge, Attitude and Behavior of Midwives and Nurses Working Primary Health Services on Family Planning. Prusias Medical Journal. 2016;1(1):1-5.
15. 15. Ulas T, Buyukhatipoglu H, Kirhan I, Dal MS, Eren MA, Hazar A, et al. The effect of day and night shifts on oxidative stress and anxiety symptoms of the nurses. Eur Rev Med Pharmacol Sci. 2012;16(5):594-9.
16. 16. Pietroiusti A, Neri A, Somma G, Coppeta L, Iavicoli I, Bergamaschi A, et al. Incidence of metabolic syndrome among night-shift healthcare workers. Occup Environ Med. 2010;67(1):54-7.
17. 17. Jaworek J, Konturek SJ. Hormonal protection in acute pancreatitis by ghrelin, leptin and melatonin. World J Gastroenterol. 2014;20(45):16902-12.
18. 18. Reiter RJ, Tan DX, Erren TC, Fuentes-Broto L, Paredes SD. Light-mediated perturbations of circadian timing and cancer risk: a mechanistic analysis. Integr Cancer Ther. 2009;8(4):354-60.
19. 19. Davis S, Mirick DK, Chen C, Stanczyk FZ. Night shift work and hormone levels in women. Cancer Epidemiol Biomarkers Prev. 2012;21(4):609-18.
20. 20. Nduhirabandi F, du Toit EF, Lochner A. Melatonin and the metabolic syndrome: a tool for effective therapy in obesity-associated abnormalities? Acta Physiol (Oxf). 2012;205(2):209-23.
21. 21. Konturek SJ, Konturek PC, Brzozowska I, Pawlik M, Sliwowski Z, Czesnikiewicz-Guzik M, et al. Localization and biological activities of melatonin in intact and diseased gastrointestinal tract (GIT). J Physiol Pharmacol. 2007;58(3):381-405.
22. 22. Karlsson BH, Knutsson AK, Lindahl BO, Alfredsson LS. Metabolic disturbances in male workers with rotating three-shift work. Results of the WOLF study. Int Arch Occup Environ Health. 2003;76 (6):424-30.
23. 23. Cardinali DP, Bernasconi PA, Reynoso R, Toso CF, Scacchi P. Melatonin may curtail the metabolic syndrome: studies on initial and fully established fructose-induced metabolic syndrome in rats. Int J Mol Sci. 2013;14(2):2502-14.
24. 24. Sheu WH, Shieh SM, Fuh MM, Shen DD, Jeng CY, Chen YD, et al. Insulin resistance, glucose intolerance, and hyperinsulinemia. Hypertriglyceridemia versus hypercholesterolemia. Arterioscler Thromb. 1993;13(3):367-70.
25. 25. Cipolla-Neto J, Amaral FG, Afeche SC, Tan DX, Reiter RJ. Melatonin, energy metabolism, and obesity: a review. J Pineal Res. 2014;56(4):371-81.
26. 26. Solak A, Tuncel P. Leptin, Adiponectin, Oxidized LDL Levels and Paraoxonase Activity in Metabolic Syndrome. Journal of Turkish Clinical Biochemistry. 2009;7(1):23-9.
27. 27. Kassi E, Pervanidou P, Kaltsas G, Chrousos G. Metabolic syndrome: definitions and controversies. BMC Med. 2011;9:48.
28. 28. Itani O, Kaneita Y, Murata A, Yokoyama E, Ohida T. Association of onset of obesity with sleep duration and shift work among Japanese adults. Sleep Med. 2011;12(4):341-5.
29. 29. Lasfargues G, Vol S, Caces E, Le Clesiau H, Lecomte P, Tichet J. Relations among night work, dietary habits, biological measure, and health status. Int J Behav Med. 1996;3(2):123-34.
30. 30. Ha M, Park J. Shiftwork and metabolic risk factors of cardiovascular disease. J Occup Health. 2005;47(2):89-95.
31. 31. Shea SA, Hilton MF, Orlova C, Ayers RT, Mantzoros CS. Independent circadian and sleep/wake regulation of adipokines and glucose in humans. J Clin Endocrinol Metab. 2005;90(5):2537-44.
32. 32. Klok MD, Jakobsdottir S, Drent ML. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obes Rev. 2007;8(1):21-34.
33. 33. Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLOS Med. 2004;1(3):e62.
34. 34. Brondel L, Romer MA, Nougues PM, Touyarou P, Davenne D. Acute partial sleep deprivation increases food intake in healthy men. Am J Clin Nutr. 2010;91(6):1550-9.
35. 35. Baker RG, Hayden MS, Ghosh S. NF-kappaB, inflammation, and metabolic disease. Cell Metab. 2011;13(1):11-22.
36. 36. Cardinali DP, Hardeland R. Inflammaging, Metabolic Syndrome and Melatonin: A Call for Treatment Studies. Neuroendocrinology. 2017;104(4):382-97.
37. 37. Engin A. The Pathogenesis of Obesity-Associated Adipose Tissue Inflammation. Adv Exp Med Biol. 2017;960:221-45.
38. 38. De Bacquer D, Van Risseghem M, Clays E, Kittel F, De Backer G, Braeckman L. Rotating shift work and the metabolic syndrome: a prospective study. Int J Epidemiol. 2009;38(3):848-54.
39. 39. Perez-Perez A, Vilarino-Garcia T, Fernandez-Riejos P, Martin-Gonzalez J, Segura-Egea JJ, Sanchez-Margalet V. Role of leptin as a link between metabolism and the immune system. Cytokine and Growth Factor Rev. 2017;(35):71-84.
40. 40. Kozirog M, Poliwczak AR, Duchnowicz P, Koter-Michalak M, Sikora J, Broncel M. Melatonin treatment improves blood pressure, lipid profile, and parameters of oxidative stress in patients with metabolic syndrome. J Pineal Res. 2011;50(3):261-6.