{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:09:37Z","timestamp":1789711777673,"version":"4.0.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100032579","name":"Beijing Medical Award Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100032579","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Night-shift work is highly prevalent among healthcare workers and has been associated with various adverse health outcomes, including metabolic syndrome (MetS). However, the psychosocial factors potentially involved in this association remain unclear. This study aimed to examine the association between night-shift frequency and MetS among healthcare workers and to explore the potential statistical indirect association through occupational stress, as well as whether the association between night-shift frequency and occupational stress varied according to sleep quality, providing scientific evidence for workplace health promotion and MetS prevention in healthcare settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A hospital-based cross-sectional study involving 719 healthcare workers from a tertiary Grade A hospital in Shanxi Province, China, was conducted from January to March 2026. Participants were selected using stratified cluster sampling. Night-shift frequency, occupational stress, sleep quality, and relevant covariates were assessed using questionnaires, with occupational stress measured using the Effort-Reward Imbalance Questionnaire. MetS was determined based on physical examination and laboratory criteria. Multivariable logistic regression was used to evaluate the associations of night-shift frequency and occupational stress with MetS. Exploratory mediation analysis was performed to assess the statistical indirect association through occupational stress, and moderated mediation analysis was used to examine whether the association between night-shift frequency and occupational stress varied according to sleep quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 719 healthcare workers, 124 (17.2%) had MetS. Compared with participants reporting 0 night shifts per month, those reporting 1\u20133 night shifts per month did not have significantly higher odds of MetS, whereas those reporting \u22654 night shifts per month had substantially higher adjusted odds (OR = 6.65, 95% CI 2.56\u201317.28). Exploratory mediation analysis showed a statistically significant indirect association through occupational stress in the \u22654 night shifts per month group (indirect effect 0.725, 95% CI 0.424\u20131.173), accounting for approximately 27.7% of the total association. The association between night-shift frequency and occupational stress was stronger at poorer sleep quality levels. In the \u22654-night-shift group, the conditional indirect effect increased from 0.350 (95% CI 0.149\u20130.647) at better sleep quality to 1.187 (95% CI 0.699\u20131.921) at poorer sleep quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher night-shift frequency was associated with higher odds of MetS among healthcare workers. Exploratory analyses suggested a potential statistical indirect association through occupational stress, and this indirect association varied according to sleep quality. These findings may help inform future workplace health strategies focusing on night-shift scheduling, occupational stress management, metabolic health monitoring, and sleep health support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1940688","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:36:49Z","timestamp":1789709809000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between night-shift frequency and metabolic syndrome among healthcare workers: a moderated mediation analysis of occupational stress and sleep quality"],"prefix":"10.3389","volume":"14","author":[{"given":"Yin","family":"Yang","sequence":"first","affiliation":[{"name":"Yuncheng Hospital Affiliated to Shanxi Medical University, Yuncheng","place":["Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xida","family":"Wang","sequence":"additional","affiliation":[{"name":"Yuncheng Hospital Affiliated to Shanxi Medical University, Yuncheng","place":["Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Dong","sequence":"additional","affiliation":[{"name":"Yuncheng Hospital Affiliated to Shanxi Medical University, Yuncheng","place":["Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodong","family":"Guan","sequence":"additional","affiliation":[{"name":"Yuncheng Hospital Affiliated to Shanxi Medical University, Yuncheng","place":["Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"9548","DOI":"10.1038\/s41598-025-87400-1","article-title":"Current situation and related factors of fatigue among doctors and nurses in tertiary general hospitals in northeast china","volume":"15","author":"Wang","year":"2025","journal-title":"Sci Rep."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1723567","DOI":"10.3389\/fpubh.2025.1723567","article-title":"The impact of night shift workload on nurses' depressive symptoms: a chain mediation analysis of sleep disturbances, social avoidance and fear of missing out","volume":"13","author":"Jiang","year":"2025","journal-title":"Front Public Health."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e13489","DOI":"10.1111\/obr.13489","article-title":"Shift work and the risk for metabolic syndrome among healthcare workers: a systematic review and meta-analysis","volume":"23","author":"Sooriyaarachchi","year":"2022","journal-title":"Obes Rev."},{"key":"B4","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1007\/s00424-024-03051-7","article-title":"Epidemiology of metabolic syndrome","volume":"477","author":"Pigeot","year":"2025","journal-title":"Pflugers Arch."},{"key":"B5","doi-asserted-by":"publisher","first-page":"114103","DOI":"10.1016\/j.physbeh.2023.114103","article-title":"Controlled light exposure and intermittent fasting as treatment strategies for metabolic syndrome and gut microbiome dysregulation in night shift workers","volume":"263","author":"Bijnens","year":"2023","journal-title":"Physiol Behav."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1539679","DOI":"10.3389\/fpubh.2025.1539679","article-title":"Unraveling the complex relationship between night shift work and diabetes: exploring mechanisms and potential interventions","volume":"13","author":"Zhu","year":"2025","journal-title":"Front Public Health."},{"key":"B7","doi-asserted-by":"publisher","first-page":"20036","DOI":"10.1038\/s41598-025-05533-9","article-title":"The effect of effort-reward imbalance on job performance among primary healthcare professionals: the mediating roles of social support and resilience","volume":"15","author":"Fan","year":"2025","journal-title":"Sci Rep."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.11836\/JEOM25279","article-title":"Interaction between shift work and occupational stress on occupational burnout among employees in power companies","volume":"42","author":"Liu","year":"2025","journal-title":"J Environ Occup Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00420-024-02078-8","article-title":"Does mindfulness-based stress reduction training have an impact on the occupational burnout and stress experienced by nurses? 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