Introduction

Prevalence of obesity is rising in Latin America, is increasingly affecting socially disadvantaged groups, particularly women. Conditional cash transfers are recently established welfare interventions in the region. One, Familias en Accion, transfers ~20% of average monthly income to women in Colombia’s poorest families. Previous work has found that families buy more food as a result.

We tested the hypothesis that participation in Familias would be associated with increasing body mass index (BMI) in participating women

Methods

Women from participating areas and control areas (matched on environmental and socioeconomic criteria) were surveyed in 2002 and 2006. Pregnant, breast-feeding or women aged<18 or with BMI<18.5kg/m2 were excluded. The sample comprises 835 women from control and 1238 from treatment areas. Because some treatment areas started Familias shortly before baseline data collection, a dummy variable was created that identified exposure independent of time-point or area. Follow-up was 61.5%.

BMI was measured by trained personnel using standardized techniques. Overweight was defined as BMI>25kg/m2 and obesity as >30kg/m2. The effect of Familias was estimated using linear regression (or logistic regression for dichotomous outcomes) in a double-difference technique, controlling for several individual, household and area characteristics, including parity and baseline BMI, using robust standard-errors clustered at area-level in an intention-to-treat analysis.

Results

At baseline, women’s mean age was 33.3 years and mean BMI 25.3kg/m2; 12.3% women were obese. After adjustment, exposure to Familias was significantly associated with increased BMI (β=0.25, 95% CI 0.03, 0.47; p=0.03). Age (β=0.09; 95%CI 0.06, 0.13; p<0.001) and household wealth (β=0.78; 95%CI 0.41, 1.15; p<0.001) were also positively associated with BMI. Familias was also associated with increased odds of obesity (O.R.=1.27 95%CI 1.03, 1.57; p=0.03), as was age (O.R.=1.04; 95%CI 1.02, 1.06; p=0.001).

Conclusion

Conditional cash transfers to poor women in Colombia are independently associated with increasing BMI and obesity risk. Although conditional cash transfers are generally regarded as popular and successful schemes, parallel interventions at individual, household and community level are needed to avoid unanticipated adverse outcomes.

Unfavorable work characteristics, such as low job control and too high or too low job demands, have been suggested to increase the likelihood of physical inactivity during leisure time, but this has not been verified in large-scale studies. The authors combined individual-level data from 14 European cohort studies (baseline years from 1985–1988 to 2006–2008) to examine the association between unfavorable work characteristics and leisure-time physical inactivity in a total of 170,162 employees (50% women; mean age, 43.5 years). Of these employees, 56,735 were reexamined after 2–9 years. In cross-sectional analyses, the odds for physical inactivity were 26% higher (odds ratio = 1.26, 95% confidence interval: 1.15, 1.38) for employees with high-strain jobs (low control/high demands) and 21% higher (odds ratio = 1.21, 95% confidence interval: 1.11, 1.31) for those with passive jobs (low control/low demands) compared with employees in low-strain jobs (high control/low demands). In prospective analyses restricted to physically active participants, the odds of becoming physically inactive during follow-up were 21% and 20% higher for those with high-strain (odds ratio = 1.21, 95% confidence interval: 1.11, 1.32) and passive (odds ratio = 1.20, 95% confidence interval: 1.11, 1.30) jobs at baseline. These data suggest that unfavorable work characteristics may have a spillover effect on leisure-time physical activity.

Objective

To examine the combined effects of depressive symptoms and resting heart rate (RHR) on mortality.

Methods

Data come from 5936 participants, aged 61 ± 6 years, from the Whitehall II study. Depressive symptoms were assessed in 2002–2004 using the center-for-epidemiologic-studies-depression-scale (score ≥ 16). RHR was measured at the same study phase via electrocardiogram. Participants were assigned to 1 of 6 risk-factor-groups based on depression status (yes/no) and RHR categories (<60, 60 – 80, >80 bpm). Mean follow-up for mortality was 5.6 years.

Results

In mutually adjusted Cox regression models, depression (hazard ratio = 1.93 p<0.001) and RHR>80 bpm (hazard ratio = 1.67, p<0.001) were independent predictors of mortality. After adjustment for potential confounding and mediating variables, participants with both depression and high RHR had a 3.0-fold higher (p<0.001) risk of death compared to depression-free participants with RHR ranging from 60 to 80 bpm. This risk is particularly marked in participants with prevalent CHD.

Conclusions

This study provides evidence that the coexistence of depressive symptoms and elevated RHR is associated with substantially increased risk of death compared to those without these two factors. This finding raises the possibility that treatments that improve both depression and RHR might improve survival.

Background: Childhood and current economic difficulties are associated with physical health. However, evidence concerning the factors underlying these associations is sparse. This study examines the contribution of a range of social and behavioural factors to associations between economic difficulties and physical functioning. Methods: We used comparable data on middle-aged white-collar employees from the Finnish Helsinki Health Study cohort (n = 3843) and the British Whitehall II Study cohort (n = 3052). Our health outcome was physical functioning measured by the SF-36 Physical Component Summary. Relative indices of inequality (RII), calculated using logistic regression analysis, were used to examine associations between economic difficulties and physical functioning, and the contribution of further socio-economic circumstances, health behaviours, living arrangements and work–family conflicts to these associations. Results: In age-adjusted models, childhood (RII = 1.76−3.06) and current (RII = 1.79−3.03) economic difficulties were associated with poor physical functioning in both cohorts. Further adjusting for work–family conflicts attenuated the associations of current economic difficulties with physical functioning in both cohorts, and also those of childhood economic difficulties in the Helsinki cohort. Adjustments for other socio-economic circumstances also caused some attenuation, while health behaviours and living arrangements had small or negligible effects. Conclusions: Conflicts between work and family contribute to the associations of economic difficulties with physical functioning among employees from Finland and Britain. This suggests that supporting people to cope with economic difficulties, and efforts to improve the balance between paid work and family may help employees maintain good physical functioning.

Objectives

Cognitive reserve is associated with a lower risk of dementia but the extent to which it shapes cognitive aging trajectories remains unclear. Our objective is to examine the impact of three markers of reserve from different points in the lifecourse on cognitive function and decline in late adulthood.

Methods

Data are from 5234 men and 2220 women, mean age 56 years (standard deviation=6) at baseline, from the Whitehall II cohort study. Memory, reasoning, vocabulary, phonemic and semantic fluency were assessed three times over 10 years. Linear mixed models were used to assess the association between markers of reserve (height, education, and occupation) and cognitive decline, using the 5 cognitive tests and a global cognitive score composed of these tests.

Results

All three reserve measures were associated with baseline cognitive function, with strongest associations with occupation and the weakest with height. All cognitive functions except vocabulary declined over the 10 year follow-up period. On the global cognitive test, there was greater decline in the high occupation group (−0.27; 95% confidence interval (CI): −0.28, −0.26) compared to the intermediate (−0.23; 95% CI: −0.25, −0.22) and low groups (−0.21; 95% CI: −0.24, −0.19); p=0.001. The decline in reserve groups defined by education (p=0.82) and height (p=0.55) was similar.

Interpretation

Cognitive performance over the adult lifecourse was remarkably higher in the high reserve groups. However, rate of cognitive decline did not differ between reserve groups except occupation where there was some evidence of greater decline in the high occupation group.

Background

Obesity is a growing problem in lower income countries particularly among women. There are few studies exploring individual socioeconomic status indicators in depth. This study examines the interaction of education and wealth in relation to obesity, hypothesising that education protects against the obesogenic effect of wealth.

Methods

Four datasets of women of reproductive age from the Egyptian Demographic and Health Surveys spanning the period 1992–2008 are used to examine two distinct time periods: 1992/95 (N = 11097) and 2005/08 (N = 23178). The association in the two time periods between education level and household wealth in relation to the odds of being obese is examined, and the interaction between the two socioeconomic indicators investigated. Estimates are adjusted for age group and area of residence.

Results

An interaction was found between the association of education and wealth with obesity in both time periods (P-value for interaction <0.001). For women with the lowest education level, moving up one wealth quintile was associated with a 78% increase in the odds of obesity in 1992/95 (OR; 95%CI: 1.78; 1.65,1.91) and a 33% increase in 2005/08 (OR; 95%CI: 1.33; 1.26,1.39). For women with the highest level of education, there was little evidence of an association between wealth and obesity (OR; 95%CI: 0.82; 0.57,1.16 in 1992/95 and 0.95; 0.84,1.08 in 2005/08). Obesity levels increased most in women who were in the no/primary education, poorest wealth quintile and rural groups (absolute difference in prevalence percentage points between the two time periods: 20.2, 20.1, and 21.3 respectively).

Conclusion

In the present study, wealth appears to be a risk factor for obesity in women with lower education levels, while women with higher education are protected. The findings also suggest that a reversal in the social distribution of obesity risk is occurring which can be explained by the large increase in obesity levels in lower socioeconomic groups between the two time periods.

Aim

The objectives of this study were to examine the relationship between social network, social support and periodontal disease among older American adults and to test whether social network and support mediates socioeconomic inequality in periodontal disease.

Materials and Methods

Data pertaining to participants aged 60 years and over from the National Health and Nutrition Examination Survey 2001-2004 was used. Periodontal disease variables were extent loss of periodontal attachment ≥ 3mm, and moderate periodontitis. Social support and networks were indicated by need for emotional support, number of close friends and marital status.

Results

Widowed and those with lowest number of friends had higher rates of the extent of loss of periodontal attachment (1.27,95%CI:1.03,1.58) and (1.22,95%CI:1.03,1.45), respectively. Marital status and number of friends were not significantly associated with moderate periodontitis after adjusting for behavioural factors. The need for more emotional support was not related to periodontal disease in this analysis. Social networks and support had no impact on socioeconomic inequality in periodontal disease.

Conclusion

Certain aspects of social network, namely being widowed and having fewer friends were linked to the extent of loss of periodontal attachment but not to the definition of moderate periodontitis, in older adults.

Background

Prospective data on the association between common mental disorders and obesity are scarce, and the impact of ageing on this association is poorly understood.

Aims

To examine the association between common mental disorders and obesity (BMI≥30 kg/m2) across the adult life course.

Methods

6832 men and 3348 women aged 35-55 were screened 4 times during a 19-year follow-up (the Whitehall II study). Each screening included measurements of mental disorders (the General Health Questionnaire), weight, and height.

Results

The excess risk of obesity in the presence of mental disorders increased with age (p=0.004). The estimated proportion of obese people was 5.7% at age 40 both in the presence and absence of mental disorders, but the corresponding figures were 34.6% and 27.1% at age 70. The excess risk did not vary by sex or according to ethnic group or socioeconomic position.

Conclusion

The association between common mental disorders and obesity becomes stronger at older ages.

Conflict of interest

No conflict of interest declared (MK, GDB, ASM, HN, SS, AGT, TNA, JV, MGM, MJ)

Objective

To examine the effects of unfairness on incident coronary events and health functioning.

Design

Prospective cohort study. Unfairness, sociodemographics, established coronary risk factors (high serum cholesterol, hypertension, obesity, exercise, smoking and alcohol consumption) and other psychosocial work characteristics (job strain, effort–reward imbalance and organisational justice) were measured at baseline. Associations between unfairness and incident coronary events and health functioning were determined over an average follow‐up of 10.9 years.

Participants

5726 men and 2572 women from 20 civil service departments in London (the Whitehall II Study).

Main outcome measures

Incident fatal coronary heart disease, non‐fatal myocardial infarction and angina (528 events) and health functioning.

Results

Low employment grade is strongly associated with unfairness. Participants reporting higher levels of unfairness are more likely to experience an incident coronary event (HR 1.55, 95% CI 1.11 to 2.17), after adjustment for age, gender, employment grade, established coronary risk factors and other work‐related psychosocial characteristics. Unfairness is also associated with poor physical (OR 1.46, 95% CI 1.20 to 1.77) and mental (OR 1.54, 95% CI 1.19 to 1.99) functioning at follow‐up, controlling for all other factors and health functioning at baseline.

Conclusions

Unfairness is an independent predictor of increased coronary events and impaired health functioning. Further research is needed to disentangle the effects of unfairness from other psychosocial constructs and to investigate the societal, relational and biological mechanisms that may underlie its associations with health and heart disease.

Background

The course of major depressive disorder is often characterized by progressing chronicity, but whether this applies to the course of self-reported psychological distress remains unclear. We examined whether the risk of self-reported psychological distress becomes progressively higher the longer the history of distress and whether prolonged history of distress modifies associations between risk markers and future distress.

Methods

Participants were British civil servants from the prospective Whitehall II cohort study (n=7934; 31.5% women, mean age 44.5 years at baseline) followed from 1985 to 2006 with repeat data collected in 7 study phases. Psychological distress was assessed with the 30-item General Health Questionnaire (GHQ). Sex, socioeconomic status, marital status, ethnicity, physical activity, alcohol consumption, smoking, and obesity were assessed as risk markers.

Results

Recurrent history of psychological distress was associated with a progressively increasing risk of future distress in a dose-response manner. Common risk markers, such as low socioeconomic status, non-White ethnicity, being single, and alcohol abstinence were stronger predictors of subsequent distress in participants with a longer history of psychological distress. Sex differences in psychological distress attenuated with prolonged distress history.

Limitations

The participants were already adults in the beginning of the study, so we could not assess the progressive chronicity of psychological distress from adolescence onwards.

Conclusions

These data suggest that self-reported psychological distress becomes more persistent over time and that a longer prior exposure to psychological distress increases sensitivity to the stressful effects of certain risk markers.

Background

While several plausible biological mechanisms have been advanced for the association between greater physical stature and lower coronary heart disease (CHD) risk in prospective cohort studies, the importance of one of the principal artifactua explanations – reverse causality due to shrinkage – remains unresolved. To explore this issue, studies with repeat measurements of height are required, however, to date, such data have been lacking.

Methods

We analysed data from the Whitehall II prospective cohort study of 3802 men and 1615 women who participated in a physical examination in 1985/88, had their height re-measured in 1997/99, and were then followed for fatal and non-fatal CHD.

Results

A mean follow-up of 7.4 years after the second height measurement gave rise to 69 CHD events in men (18 in women). After adjustment for baseline CHD risk factors, greater loss of physical stature between survey and resurvey was associated with an increased risk of CHD in men (hazard ratio; 95% CI for a one SD increase: 1.24; 1.00, 1.53) but not women (0.93; 0.58, 1.50).

Conclusions

It is possible that reverse causality due to shrinkage may contribute to the inverse association between a single measurement of height and later CHD in other studies.

Background

Evidence on the association between obesity and suicide is mixed. However, the strength of obesity as a predictor of suicide may be reduced, because of the role of weight changes associated with mental disorders. We tested the hypothesis that both obesity and unexplained weight loss are related to elevated suicide risk.

Methods

A clinical examination with measurements of height, weight and self-reported unexplained weight loss was conducted at baseline for 18,784 men aged 40 to 69. Based on national mortality register, 61 suicides were identified during the 38-year follow-up.

Results

The age-adjusted hazard ratio for suicide among obese versus normal weight men was 2.22 (95% CI 0.94 to 5.28). Additional adjustment for unexplained weight loss raised this ratio to 2.48 (95% CI 1.04 to 5.92). Unexplained weight loss was associated with a substantial excess risk of suicide irrespective of obesity (age-adjusted hazard ratio 5.38, 95% CI 2.31 to 12.50; age- and obesity-adjusted hazard ratio 5.58, 95% CI 2.37 to 13.13).

Limitations

Inability to take into account the effect of depression as a potential mediating mechanism.

Conclusions

This study provides evidence that both obesity and unexplained weight loss may be important predictors of suicide. Lack of adjustment for weight loss may suppress the observed association between obesity and suicide.

Prospective data on depressive symptoms and blood pressure (BP) are scarce, and the impact of age on this association is poorly understood. The present study examines longitudinal trajectories of depressive episodes and the probability of hypertension associated with these trajectories over time. Participants were 6,889 men and 3,413 women London based civil servants, aged 35–55 years at baseline, followed for 24 years between 1985 and 2009. Depressive episode (defined as scoring 4 or more on the General Health Questionnaire-Depression subscale or using prescribed antidepressant medication) and hypertension (systolic/diastolic blood pressure ≥ 140/90 mm Hg or use of antihypertensive medication) were assessed concurrently at five medical examinations. In the fully adjusted longitudinal logistic regression analyses based on Generalized-Estimating-Equations using age as the time scale, participants in the “increasing depression” group had a 24% (p<0.05) lower risk of hypertension at ages 35–39, compared to those in the “low/transient depression” group. However, there was a faster age-related increase in hypertension in the “increasing depression” group, corresponding to a 7% (p<0.01) greater increase in the odds of hypertension for every each five-year increase in age. A higher risk of hypertension in the first group of participants was not evident before age 55. A similar pattern of association was observed in men and women although it was stronger in men. This study suggests that the risk of hypertension increases with repeated experience of depressive episodes over time and becomes evident in later adulthood.

Objective

To examine the combined effects of depressive symptoms and resting heart rate (RHR) on mortality.

Methods

Data come from 5936 participants, aged 61 ±6 years, from the Whitehall II study. Depressive symptoms were assessed in 2002–2004 using the center-for-epidemiologic-studies-depression-scale (score ≥16). RHR was measured at the same study phase via electrocardiogram. Participants were assigned to 1 of 6 risk-factor-groups based on depression status (yes/no) and RHR categories (<60, 60–80, >80 bpm). Mean follow-up for mortality was 5.6 years.

Results

In mutually adjusted Cox regression models, depression (hazard ratio = 1.93 p<0.001) and RHR>80 bpm (hazard ratio = 1.67, p<0.001) were independent predictors of mortality. After adjustment for potential confounding and mediating variables, participants with both depression and high RHR had a 3.0-fold higher (p<0.001) risk of death compared to depression-free participants with RHR ranging from 60 to 80 bpm. This risk is particularly marked in participants with prevalent CHD.

Conclusions

This study provides evidence that the coexistence of depressive symptoms and elevated RHR is associated with substantially increased risk of death compared to those without these two factors. This finding raises the possibility that treatments that improve both depression and RHR might improve survival.

Background

We examined socioeconomic and ethnic differences in use of lipid-lowering drugs after deregulation of simvastatin in the UK for adults with moderate or high risk of coronary heart disease.

Methods

3631 participants in the Whitehall II cohort study (mean age 62.7 years, 91% white) were informed of their risk of coronary heart disease, based on Framingham score, before deregulation (2002–2004). Use of prescribed lipid-lowering drugs and use of over-the-counter simvastatin were analysed as outcome variables, after deregulation (2005–2007).

Results

2451 participants were at high risk and 1180 at moderate risk. 20% moderate-risk and 44% high-risk participants reported using prescribed lipid-lowering drugs although no over-the-counter simvastatin was used. Prescribing rates did not differ between employment grades (an index of socioeconomic position), but was higher among South Asian high-risk compared with White high-risk participants (odds ratio 1.64, 95% CI 1.21 to 2.23). Of the high-risk participants, 44% recalled their increased coronary heart disease risk. South Asian high-risk participants were less likely to recall than White high-risk participants (odds ratio 0.65, 95% CI 0.46–0.93). Furthermore, high risk participants with middle (odds ratio 0.74, 95% CI. 0.61–0.89) and low (odds ratio 0.52, 95% CI 0.37–0.74) employment grades were less likely to recall than those with high grades.

Conclusion

Socioeconomic and ethnic differences in reported use of lipid-lowering drugs were small, but the use of these drugs in general was much lower than recommended and the participants did not utilise over-the-counter statins. Ethnic minorities and lower socioeconomic position groups were less likely to be aware of their increased coronary risk.

Background

Although long working hours are common in working populations, little is known about the effect of long working hours on mental health.

Method

We examined the association between long working hours and onset of depressive and anxiety symptoms in middle-aged employees. Participants were 2960 full-time employees aged 44 to 66 (2248 men, 712 women) from the prospective Whitehall II cohort study of British civil servants. Working hours, anxiety and depressive symptoms, and covariates were measured at baseline (1997–1999) followed by two subsequent measurements of depressive and anxiety symptoms (2001 and 2002–2004).

Results

In prospective analysis of participants with no depressive symptoms (n=2549) or anxiety symptoms (n=2618) at baseline, Cox proportional hazard analysis adjusted for baseline covariates showed a 1.66-fold (95% CI 1.06–2.61) risk of depressive symptoms and a 1.74-fold (1.15–2.61) risk of anxiety symptoms among employees working more than 55 hours a week compared with employees working 35–40 hours a week. Sex-stratified analysis showed an excess risk of depression and anxiety associated with long working hours among women [hazard ratios 2.67 (1.07–6.68) and 2.84 (1.27–6.34)] but not men [1.30 (0.77–2.19) and 1.43 (0.89–2.30)].

Conclusions

Working long hours is a risk factor for development of depressive and anxiety symptoms in women.

The use of anti-depressant medication has been linked to cardiovascular disease (CVD). We examined the association between anti-depressant medication use and a marker of low grade systemic inflammation as a potential pathway linking anti-depressant use and CVD in two population based studies. Data were collected in a representative sample of 8,131 community dwelling adults (aged 47.4 ± 15.9 yrs, 46.7% male) from the Scottish Health Surveys (SHS). The use of anti-depressant medication was coded according to the British National Formulary and blood was drawn for the measurement of C-reactive protein (CRP). In a second study, we attempted to replicate our findings using longitudinal data from the Whitehall II study (n=4584, aged 55.5 ± 5.9 yrs, mean follow-up 5.5 years). Antidepressants were used in 5.6% of the SHS sample, with selective serotonin reuptake inhibitors (SSRIs) being the most common. There was a higher risk of elevated CRP (>3 mg/L) in users of tricyclic antidepressant (TCA) medication (multivariate adjusted odds ratio (OR) = 1.52, 95% CI, 1.07 – 2.15), but not in SSRI users (multivariate adjusted OR = 1.07, 95% CI, 0.81 – 1.42). A longitudinal association between any antidepressant use and subsequent CRP was confirmed in the Whitehall cohort. In summary, the use of anti-depressants was associated with elevated levels of systemic inflammation independently from the symptoms of mental illness and cardiovascular co-morbidity. This might be a potential mechanism through which antidepressant medication increases CVD risk. Further data are required to explore the effects of dosage and duration of antidepressant treatment.

Given the well-established links between diabetes and elevated rates of pancreatic cancer, there are reasons to anticipate that other markers of metabolic abnormality (raised body mass index, plasma cholesterol, and blood pressure) and their correlates (physical activity and socio-economic status) may also confer increased risk of pancreatic cancer. However, to date, the results of a series of population-based cohort studies are inconclusive. We examined these associations in the original Whitehall cohort study of 17,898 men. A maximum of thirty-eight years of follow-up gave rise to 163 deaths due to carcinoma of the pancreas. While Poisson regression analyses confirmed established risk factor disease associations for increasing age, smoking and type II diabetes, there was essentially no evidence that body mass index (rate ratio; 95% confidence interval per one SD increase: 1.01; 0.86, 1.18), plasma cholesterol (per one SD increase: 0.91; 0.78, 1.07), diastolic blood pressure (per one SD increase: 0.93; 0.78, 1.09), systolic blood pressure (per one SD increase: 0.98; 0.83, 1.15), physical activity (sedentary vs. high: 1.37; 0.89, 2.12), or socio-economic status (clerical[low] vs. professional/executive: 0.95; 0.59, 1.51) offered any predictive value for pancreatic cancer mortality. These results were unchanged following control for a range of covariates.

Background

There is mixed evidence on the association between psychosocial work exposures (i.e., passive jobs) and physical activity, but previous studies did not take into account the effect of cumulative exposures nor did they examine different trajectories in exposure. We investigated whether exposure to passive jobs, measured three times over an average of five years, is associated with leisure-time physical activity (LTPA).

Methods

Data were from working men (n=4291) and women (n=1794) aged 35 to 55 who participated in the first three phases of the Whitehall II prospective cohort. Exposure to passive jobs was measured at each phase and LTPA at phases 1 and 3. Participants were categorized according to whether or not they worked in a passive job at each phase, leading to a scale ranging from 0 (non-passive job at all three phases) to 3 (passive job at all three phases). Poisson regression with robust variance estimates were used to assess the prevalence ratios of low LTPA.

Results

An association was found in men between exposure to passive jobs over 5 years and low LTPA at follow-up, independently of other relevant risk factors. The prevalence ratio for low LTPA in men was 1.16 (95% confidence interval 1.01 to 1.33) times greater for employees with three reports of passive job than for those who had never worked in passive jobs. No association was observed in women.

Conclusion

This study provides evidence that working in passive jobs may encourage a passive lifestyle in men.

Objectives

Growing evidence shows that high levels of justice are beneficial for employee health, although biological mechanisms underlying this association are yet to be clarified. We aim to test whether high justice at work protects against metabolic syndrome.

Methods

A prospective cohort study of 20 civil service departments in London (the Whitehall II study) including 6123 male and female British civil servants aged 35 to 55 years without prevalent CHD at baseline (1985-1990). Perceived justice at work was determined by means of questionnaire on two occasions between 1985 and 1990. Follow-up for metabolic syndrome and its components occurring from 1990 through 2004 was based on clinical assessments on three occasions over more than 18 years.

Results

Cox proportional hazard models adjusted for age, ethnicity and employment grade showed that men who experienced a high level of justice at work had a lower risk of incident metabolic syndrome than employees with a low level of justice (hazard ratio 0.75; 95% confidence interval: 0.63-0.89). There was little evidence of an association between organizational justice and metabolic syndrome or its components in women (hazard ratio 0.88; 95%CI: 0.67-1.17).

Conclusions

Our prospective findings provide evidence of an association between high levels of justice at work and the development of metabolic syndrome in men.

Sleep deprivation (≤5h per night) was associated with a higher risk of hypertension in middle-aged American adults but not among older individuals. However, the outcome was based on self-reported diagnosis of incident hypertension and no gender-specific analyses were included. We examined cross-sectional and prospective associations of sleep duration with prevalent and incident hypertension in a cohort of 10,308 British civil servants aged 35-55 at baseline (Phase 1, 1985-88). Data were gathered from phase 5 (1997-1999) and phase 7 (2003-2004). Sleep duration and other covariates were assessed at phase 5. At both examinations, hypertension was defined as blood pressure ≥140/90 mmHg or regular use of antihypertensive medications. In cross-sectional analyses at phase 5 (n=5,766), short duration of sleep (≤5h per night) was associated with higher risk of hypertension compared to the group sleeping 7h, among women (OR 2.01; 95%CI 1.13 to 3.58), independent of confounders, with an inverse linear trend across decreasing hours of sleep (p=0.003). No association was detected in men. In prospective analyses (mean follow-up 5 years), the cumulative incidence of hypertension was 20.0% (n=740) among 3,691 normotensive individuals at phase 5. In women, short duration of sleep was associated with higher risk of hypertension in a reduced model (age, employment) [6h per night: 1.56 (1.07 to 2.27), ≤5h per night: 1.94 (1.08 to 3.50) vs 7h]. The associations were attenuated after accounting for cardiovascular risk factors and psychiatric co-morbidities [1.42 (0.94 to 2.16); 1.31 (0.65 to 2.63), respectively]. Sleep deprivation may produce detrimental cardiovascular effects among women.

A cross-sectional relation between short sleep and obesity has not been confirmed prospectively. We examined the relationship between sleep duration and changes in body mass index (BMI) and waist circumference using the Whitehall II study, a prospective cohort of 10,308 white-collar British civil servants aged 35–55 in 1985–88. Data were gathered in 1997–9 and 2003–4. Sleep duration and other covariates were assessed. Changes in BMI and waist circumference were assessed between the two phases. The incidence of obesity (BMI ≥30 kg/m2) was assessed among non-obese participants at baseline. In cross-sectional analyses (n=5,021), there were significant, inverse associations (p<0.001) between duration of sleep and both BMI and waist circumference. Compared to 7h sleep short duration of sleep (≤5h) was associated with higher BMI (β=+0.82 units; 95% CI 0.38 to 1.26) and waist circumference (β=+1.88 cm; 0.64 to 3.12), and with an increased risk of obesity (ORadj 1.65; 1.22 to 2.24). In prospective analyses, short duration of sleep was not associated with significant changes in BMI (β=−0.06; −0.26 to 0.14) or waist circumference (β=+0.44; −0.23 to 1.12), nor with the incidence of obesity (ORadj 1.05; 0.60 to 1.82). There is no temporal relationship between short duration of sleep and future changes in measures of body weight and central adiposity.