Iran Journal of Nursing

Introduction
Metabolic Syndrome include a cluster of risk factors such as abdominal obesity, high blood pressure, high fasting blood glucose, high triglyceride level, and low high-density lipoprotein (HDL) level, which increase the risk of diabetes, heart diseases, and strokes. Some studies have reported a higher prevalence of metabolic syndrome in women and night shift workers. Night shift refers to shifts starts at 6 p.m. and ends at 7 a.m., during which working hours can negatively affect the body’s secretion rhythm and thus alter the secretion cycle of hormones such as growth hormone, melatonin, cortisol, leptin, and ghrelin. Another issue in healthcare workers, particularly nurses, is thyroid problems. Considering that nurses play a crucial role as primary members of the healthcare team in promoting community health, their health can significantly affect the quality of patient care. This study aims to investigate the metabolic syndrome status and thyroid function in Iranian nurses.

Methods 
This descriptive cross-sectional study was conducted at Rajaie Cardiovascular, Medical, & Research Center (RCMRC), Tehran, Iran, in 2020-2021. Health records of nurses working in Rajaie Hospital in Tehran, Iran, were examined, and those with incomplete information were excluded. The sampling was done using a census method. A form surveying demographic information such as age, gender, marital status, and work experience was used to collect data. The data related to thyroid function tests and laboratory tests of metabolic syndrome were collected from nurses’ health records. To determine the status of the laboratory indicators for metabolic syndrome (including fasting blood glucose, triglyceride, and HDL), the criteria proposed by the American Heart Association (AHA), the National Heart, Lung, and Blood Institute (NHLBI), and the National Cholesterol Education Program III (NCEP-III) were employed based on the diagnosis of physician. Since normal values for laboratory indicators of metabolic syndrome are considered separately for men and women according to the criteria, we also considered separate criteria for men and women. According to the NCEP-III criteria, individuals who had all three following criteria: Fasting blood glucose ≥110 mg/dL, triglyceride levels ≥150 mg/dL, and HDL <40 mg/dL (in men) and <50 mg/dL (in women), were considered to have metabolic syndrome. According to the AHA and NHLBI criteria, individuals who had all three following criteria: Fasting blood glucose ≥100 mg/dL, triglyceride levels ≥150 mg/dL, and HDL <40 mg/dL (in men) and <50 mg/dL (in women) were considered to have metabolic syndrome. Normal values for thyroid hormones were considered as following: Total triiodothyronine (T3) = 0.58-1.59 ng/dL, total thyroxine (T4) = 4.84-11.72 mcg/dL, and thyroid-stimulating hormone (TSH) = 0.32-5.06 mIU/L. Finally, data analysis was performed in SPSS software, version 26.

Results 
Out of 401 examined files, 339 cases (84.5%) were for females and 62 (15.5%) for male. The mean age of nurses was 37.47±8.68 years, and their mean work experience was 13.17±8.07 years. The number of nurses with fasting blood glucose <100 mg/dL was 71.3%; between 100-126 mg/dL, 25.2%; and >126 mg/dL, 3.5%. According to the NCEP-III criteria, 12% of nurses had fasting blood glucose >110 mg/dL and 24.4% had triglyceride levels ≥150 mg/dL. Moreover, the level of HDL <40 mg/dL was reported in 28.5% of male nurses and the level of HDL <50 mg/dL was found in 53.1% of female nurses. According to the AHA and NHLBI criteria, 28.7% of nurses had fasting blood glucose level ≥100 mg/dL and 24.4% had triglyceride levels ≥150 mg/dL. Additionally, the HDL level was <40 mg/dL in 28.5% of male nurses and <50 mg/dL in 53.1% of female nurses. The prevalence of abnormalities in laboratory findings for metabolic syndrome in nurses was 5.21% according to the AHA and NHLBI criteria and 2.99% according to the NCEP-III criteria. The prevalence of clinical hypothyroidism was 0.2%, subclinical hypothyroidism was 12%, and subclinical hyperthyroidism was 1.5%. None of nurses were diagnosed with clinical hyperthyroidism.

Conclusion 
The prevalence of metabolic syndrome and thyroid disorders among nurses working in RCMRC is not considerable. Further studies are recommended in other hospitals.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethics Committee of Shaheed Rajaie Cardiovascular, Medical & Research Center (Code: IR.RHC.REC.1399.103). 

Funding
This article is extracted from the master's thesis of Mohammad Mahdi Khani, approved by Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences.

Authors' contributions
Conceptualization and Supervision: Zahra Ghaem- Maghami, Mohammad Mahdi Khani and Shiva Khaleghparast; Methodology: Yasaman Khalili and Mohammad Mahdi Khani; Investigation, Writing original draft, and Writing, Review & Editing: All authors; Data collection: Mohammad Mahdi Khani; Data analysis: Yasaman Khalili and Mohammad Mahdi Khani.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
We acknowledge the nurses of Rajaie Cardiovascular Medical and Research Institute for their valuable support and contribution to this study.




References

1. Baveicy K, Mostafaei S, Darbandi M, Hamzeh B, Najafi F, Pasdar Y. Predicting Metabolic syndrome by Visceral Adiposity Index, Body Roundness Index and a Body Shape Index in adults: A cross-sectional study from the Iranian RaNCD Cohort Data. Diabetes Metab Syndr Obes. 2020; 13:879-87. [DOI:10.2147/DMSO.S238153] [PMID]
2. Saklayen MG. The global epidemic of the Metabolic syndrome. Curr Hypertens Rep. 2018; 20(2):12-20. [DOI:10.1007/s11906-018-0812-z] [PMID]
3. Alizade Z, Azadbakht L. [Review of epidemiology of Metabolic syndrome in Iran (Persian)]. Iranian J Diabetes Metab. 2016; 15(3):143-57. [Link]
4. Fatahi A, Doosti-Irani A, Cheraghi Z. Prevalence and incidence of Metabolic syndrome in Iran: A systematic review and meta-analysis. Int J Prev Med. 2020; 11:64. [DOI:10.4103/ijpvm.IJPVM_489_18] [PMID]
5. Tabatabaei-Malazy O, Saeedi Moghaddam S, Rezaei N, Sheidaei A, Hajipour MJ, Mahmoudi N, et al. A nationwide study of Metabolic syndrome prevalence in Iran; A comparative analysis of six definitions. PLoS One. 2021; 16(3):e0241926. [DOI:10.1371/journal.pone.0241926] [PMID]
6. Amiri A, Hakimi A. [The study of prevalence of Metabolic syndrome among nurses of Shahid Mohammadi Hospital of Bandar Abbas city, Iran (Persian)]. J Multidiscip Care. 2017; 6(1):1-8. [Link]
7. Ribeiro RP, Marziale MH, Martins JT, Ribeiro PH, Robazzi ML, Dalmas JC. Prevalence of Metabolic syndrome among nursing personnel and its association with occupational stress, anxiety and depression. Rev Lat-Am. 2015; 23(3):435-40. [DOI:10.1590/0104-1169.0383.2573] [PMID]
8. das Merces MC, Santana AIC, Lua I, da Silva DAR, E Silva DS, Gomes AMT, et al. Metabolic syndrome among primary health care nursing professionals: A cross-sectional population-based study. Int J Environ Res. 2019; 16(15):2686. [DOI:10.3390/ijerph16152686] [PMID]
9. Bartosiewicz A, Łuszczki E, Nagórska M, Oleksy Ł, Stolarczyk A, Dereń K. Risk factors of Metabolic syndrome among Polish nurses. Metabolites. 2021; 11(5):267. [DOI:10.3390/metabo11050267] [PMID]
10. Sooriyaarachchi P, Jayawardena R, Pavey T, King NA. Shift work and the risk for Metabolic syndrome among healthcare workers: A systematic review and meta-analysis. Obes Rev. 2022; 23(10):e13489. [DOI:10.1111/obr.13489] [PMID]
11. Mousavi A, Biglari A, Reyhanian M. [Prevalence of Metabolic syndrome and its related criteria in health network personnel in Babolsar, 2012 (Persian)]. J Mazandaran Univ Med Sci. 2015; 24(122):377-81. [Link]
12. Saberi HR, Moravveji AR, Fakharian E, Kashani MM, Dehdashti AR. Prevalence of Metabolic syndrome in bus and truck drivers in Kashan, Iran. Diabetol Metab Syndr. 2011; 3(1):8. [DOI:10.1186/1758-5996-3-8] [PMID]
13. Cai H, Huang J, Xu G, Yang Z, Liu M, Mi Y, et al. Prevalence and determinants of Metabolic syndrome among women in Chinese rural areas. PloS One. 2012; 7(5):e36936. [DOI:10.1371/journal.pone.0036936] [PMID]
14. Lye MS, Ahmadi N, Khor GL, Hassan STBS, Hanachi P, Agajani Delavar M. Parity and Metabolic syndrome in middle-aged Iranian women: A cross-sectional study. Caspian J Reprod Med 2015; 1(1):19-24. [Link]
15. Jung H, Dan H, Pang Y, Kim B, Jeong H, Lee JE, et al. Association between dietary habits, shift work, and the Metabolic syndrome: The Korea nurses’ health study. Int J Environ Res Public Health. 2020; 17(20):7697. [PMID]
16. Kim TW, Jeong JH, Hong SC. The impact of sleep and circadian disturbance on hormones and metabolism. Int J Endocrinol. 2015; 2015:591729. [DOI:10.1155/2015/591729] [PMID]
17. Chico-Barba G, Jiménez-Limas K, Sánchez-Jiménez B, Sámano R, Rodríguez-Ventura AL, Castillo-Pérez R, et al. Burnout and Metabolic syndrome in female nurses: An observational study. Int J Environ Res Public Health. 2019; 16(11):1993. [DOI:10.3390/ijerph16111993] [PMID]
18. Nikpour M, Tirgar A, Hajiahmadi M, Hosseini A, Heidari B, Ghaffari F, et al. Shift work and Metabolic syndrome: A multi-center cross-sectional study on females of reproductive age. Biomed Rep. 2019; 10(5):311-7. [PMID] [DOI:10.3892/br.2019.1205]
19. Boivin DB, Boudreau P. Impacts of shift work on sleep and circadian rhythms. Pathol Biol (Paris). 2014; 62(5):292-301. [DOI:10.1016/j.patbio.2014.08.001] [PMID]
20. Morris CJ, Purvis TE, Hu K, Scheer FA. Circadian misalignment increases cardiovascular disease risk factors in humans. Proc Natl Acad Sci USA. 2016; 113(10):E1402-11. [DOI:10.1073/pnas.1516953113] [PMID]
21. Oh JI, Yim HW. Association between rotating night shift work and Metabolic syndrome in Korean workers: Differences between 8-hour and 12-hour rotating shift work. Ind Health. 2018; 56(1):40-8. [DOI:10.2486/indhealth.2017-0072] [PMID]
22. Shakeri HS, Akaberi A, Ahadi M, Soleimanpour M, Seyed Sharifi SH. [Evaluation of thyroid dysfunction in the operating room staff in Bojnurd, Iran, 2014 (Persian)]. J North Khorasan Univ Med Sci. 2018; 9(4):27-33. [DOI:10.29252/nkjmd-09045]
23. Sahu MT, Das V, Mittal S, Agarwal A, Sahu M. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome. Arch Gynecol Obstet. 2010; 281(2):215-25. [DOI:10.1007/s00404-009-1105-1] [PMID]
24. De Escobar GM, Obregón MJ, Del Rey FE. Iodine deficiency and brain development in the first half of pregnancy. Public Health Nutr. 2007; 10(12A):1554-70. [DOI:10.1017/S1368980007360928] [PMID]
25. Maghsoodi S, Hesabi M, Emami sigaroudi A, Kazemnejad leili E, Monfared A. [General health and related factors in employed nurses in Medical-Educational Centers in Rasht (Persian)]. J Holist Nurs Midwifery. 2015; 25(1):63-72. [Link]
26. Maleki F, Sayehmiri K, Sayehmiri F, Kiani F, Nasiri S, Mohamadi HR, et al. [Metabolic syndrome prevalence in Iran: A systematic review and meta-analysis (Persian)]. J Kermanshah Univ Med. 2014; 18(4):242-50. [Link]
27. Mordouei Z, Sheikh Fathollahi M, Besharat F, Salem Z, Saeidi Fard S, Molaei Hosn F, et al. [The survey of metabolic syndrome frequency and its factors in employees of Rafsanjan University of Medical Sciences Faculties in 2016: A short report (Persian)]. J Rafsanjan Univ Med Sci. 2017; 16(8):789-96. [Link]
28. Dalvand S, Niksima SH, Meshkani R, Gheshlagh RG, Sadegh-Nejadi S, Kooti W, et al. Prevalence of metabolic syndrome among Iranian population: A systematic review and meta-analysis. Iran J Public Health. 2017; 46(4):456. [PMCID]
29. Rochlani Y, Pothineni NV, Kovelamudi S, Mehta JL. Metabolic syndrome: Pathophysiology, management, and modulation by natural compounds. Ther Adv Cardiovasc Dis. 2017; 11(8):215-25. [DOI:10.1177/1753944717711379] [PMID]
30. Oğuz A, Sağun G, Uzunlulu M, Alpaslan B, Yorulmaz E, Tekiner E, et al. Frequency of abdominal obesity and Metabolic syndrome in healthcare workers and their awareness levels about these entities. Turk Kardiyol Dern Ars. 2008; 36(5):302-9. [Link]
31. de Carvalho Vidigal F, Ribeiro AQ, Babio N, Salas-Salvadó J, Bressan J. Prevalence of metabolic syndrome and pre-metabolic syndrome in health professionals: LATINMETS Brazil study. Diabetol Metab Syndr. 2015; 7(1):1-9. [PMID]
32. Tsou MT, Chen JY. Burnout and metabolic syndrome among healthcare workers: Is subclinical hypothyroidism a mediator? J Occup Health. 2021; 63(1):e12252. [DOI:10.1002/1348-9585.12252] [PMID]
33. Tsai HJ, Tsou MT. Age, Sex, and Profession Difference Among Health Care Workers With Burnout and Metabolic Syndrome in Taiwan Tertiary Hospital-A cross-section study. Front Med (Lausanne) 2022; 9:854403. [DOI:10.3389/fmed.2022.854403] [PMID]
34. González-Zapata LI, Deossa GC, Monsalve-Álvarez J, Díaz-García J, Babio N, Salas-Salvadó J. Metabolic syndrome in healthcare personnel of the university of Antioquia-Colombia; LATINMETS study. Nutr Hosp. 2013; 28(2):522-31. [DOI:10.3305/nh.2013.28.2.6315]
35. Shokouhi F, Amiripour A, Ahmadi A, Imani S. Evaluation of the prevalence and modeling of social determinants of metabolic syndrome in Shahrekord, Iran. Sci J Nurs, Midwifery Paramed Fac. 2020; 6(2):43-53. [Link]
36. Assadi M, Delshad H, Tohidi M, Azizi F. [The incidence of subclinical thyroid dysfunction and it’s natural course in The Tehranian Adults (Persian)]. Iran J Endocrinol Metab. 2009; 11(6):673-9. [Link]
37. Aminorroaya A, Meamar R, Amini M, Feizi A, Tabatabae A, Faghih Imani E. Incidence of thyroid dysfunction in an Iranian adult population: The predictor role of thyroid autoantibodies: Results from a prospective population-based cohort study. Eur J Med Res. 2017; 22(1):21-5. [DOI:10.1186/s40001-017-0260-2] [PMID]