Glucose Intolerance in an Employed Population

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1 Tohoku J. exp. Med., 1983, 141, Suppl., Glucose Intolerance in an Employed Population EIICHI MIKUNI, TAKASHI OHOSHI, KOJI HAYASHI* and KEI MIYAMURA õ Wakayama Rosai Hospital, Wakayama 640,* National Osaka South Hospital, Osaka 586 and õ Wakayama Medical School, Wakayma 640, Japan MIKUNI, E., OHOSHI, T., HAYASHI, K. and MIYAMURA, K. Glucose Intolerance in an Employed Population. Tohoku J. exp. Med., 1983, 141, Suppl., Differences in glucose intolerance within various occupational groups, i.e. laborers, clerks, and managers, and the related environmental factors were studied in ca male workers of a certain factory. Age-and weight-adjusted prevalence rates of glucose intolerance were 3.2% in the laborers, 5.8% in the clerks, and 9.3% in the managers. In the managers, the total intake of calories was excessive for the amount of exercise expended ; food intake was relatively low in complex carbohy drates and high in animal fats. The clerks were characterized by a high sugar intake. The low prevalence of glucose intolerance in the laborers was ascribed to the greater amount of exercise. Assigned work hours, however, probably affected the prevalence of diabetes in the laborers, which was 2.1% in subjects who worked all three shifts, but 0.9% in subjects working only day shifts. Thirty laborers from all 3 shifts consented to give urine specimens during their working time (8 hr), after the same amount of food and exercise in all of them. Urinary excretionn of HGH and VMA during the midnight shift was significantly higher (p <0.05) than that during the day shift although urinary 170HCS was significantly low (p <0.01) at midnight. There were no significant changes in urinary CPR excretion between day and night shifts. These data indicate the importance of environmental factors, such as exercise, nutrition and stress, in glucose intolerance. occupation ; diabtes mellitus ; shift workers ; stress ; urinary human growth hormone There are many reports suggesting the importance of environmental factors in the development of diabetes mellitus1-3). The findings reported here deal with the prevalence of glucose intolerance in a factory and related environmental factors such as diet, physical activity and stress. SUBJECTS AND METHODS The survey was conducted in The subjects of this study were male factory workers, made up of laborers, clerks and managers. The diabetic type was defined by the criteria of the Diagnostic Criteria Committee of Address requests for reprints to : Dr. Mikuni, Clinic of Preventive Medicine, Wakayama Rosai Hospital, Wakayama 640, Japan. 251

2 252 E. Mikuni et al. the Japanese Diabetic Society4) ; i.e. as venous plasma glucose levels above 185mg/100ml at 1 hr and above 150mg/100ml at 2 hr after oral 50 g glucose challenge. Plasma glucose was determined by the Autoanalyzer. The dietary histories in this survey were intended to determine average dietary intake over a long period. Daily physical activity was calculated by the Calorie Counter (Kenz, USA). In shift workers, disrupted social life is a cause of stress. Since HGH (human growth hormone) and catecholamine are considered to be good indicators of stress, their urinary metabolites were measured at each shift time in 30 laborers. Urinary HGH was assayed by the method of Hanssen et al.5) and urinary CPR was assayed by the double antibody method. Urinary CPR is an excellent indicator of B-cell secretion under different metabolic conditions'). Statistical comparisons were performed using the chi-squared test and Wilcoxon matched pair signed-rank test. RESULTS The distribution of age in a certain factory is shown in Fig. 1. The mean age of the clerks was 34.7 years, of the laborers 38.6 years, and of the managers 42.0 years. The mean age of the whole was 38.1 years. Fig. 2 shows the distribution of weight. The obesity index is shown as the percentage in excess of ideal body weight. The obesity index of the clerks was +6.1%, of the laborers +9.9%, and of the managers, +8.1%. The overall obesity index was +9.3, and did not differ greatly between each group. Age-and weight-adjusted prevalence rates of glucose intolerance at each job level are shown in Table 1. Glucose intolerance (right column) denotes types other than the normal type ; i.e. diabetic type or borderline type. The managers had a significantly higher rate of glycosuria than the laborers (p<0.001), as well as of diabetes (p<0.02), and of glucose intolerance (p<0.001). The managers also had significantly higher rates of glycosuria (p < 0.01) and glucose intolerance (p <0.05) than the clerks. On the other hand, the clerks had significantly higher rates of glycosuria (p <0.001) and glucose intoler- Fig. 1. Distribution of Age.

3 Glucose Intolerance in an Employed Population 253 Fig. 2. Distribution of Weight. TABLE 1. Age and weight adjusted prevalence rate of glucose intolerance, by job level ance (p <0.001) than the laborers. Ca. 20% of diabetic type glucose intolerance was definite diabetes (fasting plasma glucose level above 140mg/100ml) in each group. Family history of diabetes mellitus did not differ between the groups. Mean nutrient intake and physical activity is shown in Table 2. The total daily intake of calories was highest among the laborers, and daily physical activity was correspondingly high in that group. The food intake of the mana gers was high in animal fat and relatively low in complex carbohydrates in spite of an average total intake as large as that of the laborers. In addition, total intake of calories in the managers was excessive for the amount of energy expen ded. In the clerks, the intake of simple carbohydrates, mainly sugar, was high. Among the laborers, the percentages of diabetic subjects were compared between the group made up of who worked all three shifts alternately, and the group of day workers (as shown in Table 3). The chi-squared test showed that there was a significantly higher number of diabetics among the three-shift workers than among the day workers (p <0.05). Table 4 shows the means and standard deviations of 8-hour urinary hormone excretion among the three-shift workers. Urinary excretion of HGH and VMA during the midnight shift was significantly higher (p <0.05) than that in the day-shift although urinary 170HCS was signifi cantly low (p<0.01) at midnight. There were no significant changes in urinary

4 254 E. Mikuni et al. TABLE 2. Mean nutrient intake and physical activity TABLE 3. Prevalence rate of diabetes mellitus in laborers TABLE 4. Means and standard deviations for 8-hr urinary hormone excretion among three-shift workers with weekly changes of shifts CPR excretion between the day and night shifts. Our data showed that managerial DISCUSSION staff had the highest rate of glucose intoler ance. Food intake among the managers was high in animal fat and relatively low in complex carbohydrates in spite of a total intake as large as that in the laborers. In the clerks, the intake of simple carbohydrates, particularly of sugar, was relatively high. A lack of exercise and the changeover to a western diet may account for some of the differences in diabetes prevalence.

5 Glucose Intolerance in an Employed Population 255 Changes in diet were related to diabetes prevalence during World Wars I & II1,7). The Investigators concluded that low carbohydrate and high fat diets were risk factors for diabetes. Kawate et al.2) reported that the high prevalence of diabetes in Hawaiian Japanese was due to the intake of animal fats, simple carbohydrates, and the low intake of complex carbohydrates as well as low physical activity levels. Campbell8) emphasized the risk of excessive sugar intake for diabetes. The low prevalence of glucose intolerance in the laborers seemed to be ascribed to a greater amount of exercise. In fact, there is evidence to suggest that exercise reduces the risk of the development of diabetes9). Physical and mental stress cannot be ignored as a diabetogenic factor. We attempted to estimate the degree of stress by measuring urinary HGH and VMA, as the level of these hormones serves as a good indicator of stress. Comparison of urinary hormone excretion between 8-hour day-and night-shifts after the same amount of food and exercise in each, showed lower values of cortisol series (with this degree of shifting, nornal circadian rhythm seems to be maintained) and higher values of HGH and VMA in the night shift. One would expect to see a low level of urinary HGH in subjects awake at night10) and urinary VMA should also be low at night. Urinary CPR excretion, which is an excellent noninvasive measure of B-cell secretion in various pathological circumstances6) showed no difference between the two shifts. In the night shift, urinary CPR excretion should be lower than that in the day shift, because the cortisol series was low11). The data for urinary CPR suggest elevation of all insulin antagonists except glucocorticoid. It is possible that the level of hormones (HGH and catechola mine) which are considered easily reactive to stress increase in the blood during the night shift and contribute to glucose intolerance. In conclusion, our data showed that managerial staff have the highest inci dence of glucose intolerance. A lack of exercise and changes in diet to more western foods seem to be partly responsible. The laborers have the lowest incidence of glucose intolerance. However, such factors as mental stress, which accompany changes in working conditions, do not seem unrelated to the glucose inotlerance, in the laborers. References 1) Goto, Y., Nakayama, Y. & Yagi, T. (1958) Influence of World War II food shortage on the incidence of diabetes mellitus in Japan. Diabetes, 7, ) Kawate, R., Yamakido, M., Nishimoto, Y., Bennett, P.H., Hamman, R.F. & Knowler, W.C. (1979) Diabetes mellitus and its vascular complications in Japanese migrants on the Island of Hawaii. Diabetes Care, 2, ) Cohen, A.M., Chen, B., Eisenberg, S., Fidel, J. & Furst, A. (1979) Diabetes, blood lipids, lipoproteins and change of environment. Restudy of the enew immigrant Yemenites' in Israel. Metabolism, 28, ) Kuzuya, N., Abe, M., Ueda, H., Kuzuya, K., Kuzuya, T. et al. (1970) Report of diagnostic criteria for diabetes mellitus in glucose tolerance test. (Recommendation for the criteria for glucose tolerance test in the diagnosis of diabtes mellitus). J. Jap.

6 256 E. Mikuni et al. diab. Soc., 13, ) Hanssen, K.F., Aaby Svendsen, P. & Evrin, P.E. (1974) Immunoreactive growth hormone in plasma and urine in long-term insulin treated diabetics with clinical diabetic neuropathy. Acta endocri., 75, ) Blix, P.M., Boddie-Willis, C., Landau, R.L., Rochman, H. & Rubenstein, A.H. (1982) Urinary C-peptide : An indicator of Ĉ-cell secretion under different metabolic condi tions. J. din Endoer. Metab., 54, ) Himsworth, H.P. ( ) Diet and incidence of diabetes mellitus. Clin Sci., 2, ) Campbell, G.D. (1967) Diabetes in Asians and Africans in and around Durban. S. Afr. med. J., 37, ) West, K.M. (1978) Epidemiology of Diabetes and Its Vascular Complications. Elsevier, New York. 1 0) Sassin, J.F., Parker, J.W., Mace, J.W., Gotlin, Johnson, J.C. & Rossman, L.G. (1969) Human growth hormone release : Relation to slow-wave sleep and sleep-waking cycles. Science, 165, ) Hoogwerf, B. & Goetz, F.C. (1981) Urinary c-peptide : a simple measure of integra ted insulin production with emphasis on the effects of body size, diet and corticoste roids. Endocrinology, Suppl. 108, 143. (Abstract 207)

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