Self-reported “night owls” more likely to have unhealthy lifestyle behaviors, significantly increased diabetes risk

Embargoed for release until 5:00 p.m. ET on Monday 11 September 2023
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1. Self-reported “night owls” more likely to have unhealthy lifestyle behaviors, significantly increased diabetes risk  

Large study of middle-aged nurses found those with an evening chronotype were more likely to engage in an overall unhealthy lifestyle particularly smoking, poor sleep and physical inactivity and had a 72 percent higher risk of developing diabetes

Abstract: https://www.acpjournals.org/doi/10.7326/M23-0728 
URL goes live when the embargo lifts
A study of more than 60,000 middle-aged nurses found that people with an evening chronotype, or a circadian preference to feel energetic later in the day, experienced an increased risk for diabetes and were more likely to report unhealthy lifestyle behaviors, such as smoking, poor sleep and physical inactivity, compared with persons with a morning chronotype. The authors caution that profession, education, and socioeconomic status of study participants may affect results. The findings are published in Annals of Internal Medicine.

Chronotype, also known as circadian preference, is a partly genetically determined construct and refers to one’s inclination for earlier or later sleeping times. An estimated 8% of the population has an evening chronotype, which has been linked to poor metabolic regulation, disrupted glycemic control, metabolic disorders, and higher incidence and prevalence of type 2 diabetes. However, the reasons for the observed association between evening chronotype and increased diabetes risk are not well understood.

Researchers from Brigham and Women’s Hospital and Harvard Medical School conducted a prospective cohort study of 63,676 nurses aged 45 to 62 years with no history of cancer, cardiovascular disease, or diabetes from 2009 to 2017. The authors found that participants with a “definite evening” chronotype were 54 percent more likely to have an unhealthy lifestyle than participants reporting a “definite morning” chronotype. Persons with evening chronotype also had a 72 percent higher risk of developing diabetes during the follow-up period. The authors report that this associated weakened but persisted even after adjusting for all measured lifestyle and sociodemographic factors. They emphasize that these results are restricted to persons who did not work recent night shifts. Future investigation in other populations leveraging genetic determinants for chronotype is needed to determine whether their findings are applicable to men, non-White racial or ethnic groups, or other socioeconomic classes. Moreover, generational differences in diet, exercise, and body weight may limit the applicability of their findings to younger or older generations or current times.

An accompanying editorial by authors from the Harvard T.H. Chan School of Public Health and Harvard Medical School highlight that several factors, including psychological factors, type of work, and possible lifetime changes to chronotype could confound the results of this study. They add that the results suggest that circadian misalignment due to a mismatch between chronotype and work timing, rather than the chronotype, may be a potential mechanism for these results. The authors suggest that this study adds to the growing evidence that reassigning evening chronotype workers to night shifts may improve sleep among shift workers and improve their metabolic health. Finally, they note that these results point to the potential benefit of developing standardized tools to assess chronotype regularly throughout a person’s life.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Tianyi Huang, ScD, please email Cassandra Falone at cfalone@partners.org.

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2. Only about a quarter of adults overdue for colorectal cancer screening report receiving a clinician recommendation for screening during wellness visit  

Prevalence lowest among marginalized racial/ethnic and socioeconomic groups

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1341
URL goes live when the embargo lifts

Most adults overdue for colorectal cancer (CRC) screening report that they did not receive a screening recommendation from their clinician during a wellness visit in the past year, especially among historically marginalized populations. Even if some adults underreported receiving a recommendation due to low recall (e.g. not remembering or understanding what was discussed with their clinician during a past appointment), the findings highlight a major communication gap about CRC prevention in the clinical setting. The findings are published in Annals of Internal Medicine.

More than 1 in 3 U.S. adults is overdue for CRC screening. Receiving a clinician recommendation is the strongest and most consistent determinant of CRC screening participation. Lack of clinician recommendation may contribute to low uptake of CRC screening, but the magnitude of this problem is unknown.

Researchers from the American Cancer Society, Surveillance and Health Equity Science pooled nationally representative data from the 2019 and 2021 National Health Interview Survey to estimate, the prevalence of receiving a clinician recommendation for CRC screening among underscreened U.S. adults, overall and by demographic, socioeconomic, and health care access characteristics. The analysis included 5,022 adults who were eligible and overdue for CRC screening and had a wellness visit in the past year. Overall, only about a quarter of respondents reported receiving a clinician recommendation for CRC screening and the rate of recommendation was lowest among marginalized racial/ethnic and socioeconomic groups. The authors suggest that interventions are needed to remove barriers that prevent effective counseling on CRC prevention.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Jordan Baeker Bispo, PhD, MPH, please email Anne Reynolds-Doerr at anne.doerr@cancer.org.

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3. Commentary: Newest vaccination recommendations provide more protection against RSV

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2196 

URL goes live when the embargo lifts

Earlier this summer, the Advisory Committee on Immunization Practices (ACIP) at the U.S. Centers for Disease Control and Prevention (CDC) voted in favor of a recommendation that adults 60 years and older receive a single dose of respiratory syncytial virus (RSV) vaccine, using shared clinical decision-making. Two new vaccines - RSVpreF (ABRYSVO) by Pfizer and RSVPreF3 (Arexvy) by GSK - are approved for use in this population and show robust protection against RSV. As several vaccines emerge offering protection to both the old and the very young, ACIP member Camille Nelson Kotton, MD, says this is an exciting time for RSV prevention.

In her commentary, Dr. Kotton shares key highlights from the vaccine trials including efficacy and safety data and offers insight into the discussion surrounding the shared decision-making recommendation. The editorial is published in Annals of Internal Medicine.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Camille Nelson Kotton, MD, please email Noah Brown at Nbrown9@mgb.org.

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Also in this issue:
Travel Medicine

Robert J. Rolfe, MD; Edward T. Ryan, MD; Regina C. LaRocque, MD, MPH

In The Clinic

Abstract: https://www.acpjournals.org/doi/10.7326/M23-0801