title: The Association of Work Stress and Glycemic Status Is Partially Mediated by Autonomic Nervous System Function: Cross-Sectional Results from the Mannheim Industrial Cohort Study (MICS).
abstract: BACKGROUND
  Work stress is associated with an increased risk of pre-diabetes, Type 2 diabetes, and inflammation, as well as decreased autonomic nervous system function as measured, for example, via heart rate variability. We investigated the extent to which the association between work stress and glycemic status is mediated by vagally-mediated heart rate variability (vmHRV) and/or inflammation.
  
  
  METHODS
  Cross-sectional data from the Mannheim Industrial Cohort Study (MICS) with 9,937 participants were analyzed. The root mean squared successive differences (RMSSD) from long-term heart rate monitoring during work and night time periods was used to index vmHRV. Fasting plasma glucose and glycosylated hemoglobin were assessed to determine glycemic status. High sensitive C-reactive protein levels were observed as a measure of systemic inflammation and the Effort-Reward-Imbalance scale was used to evaluate work stress. Mediation models were adjusted for age, sex, and occupational status, and estimations were bootstrapped (5,000 replications).
  
  
  RESULTS
  Effort-Reward-Imbalance was significantly negatively associated with RMSSD and both glycosylated hemoglobin and fasting plasma glucose during both work and night time periods. Effort-Reward-Imbalance was observed to have a significant direct effect on glycosylated hemoglobin and significant indirect effects, through RMSSD, on both glycemic measures during both time periods. Introducing C-reactive protein as a further mediator to the model did not alter the indirect effects observed. C-reactive protein, as an exclusive mediator, was observed to have smaller direct and indirect effects on the glycemic measures as compared to when Effort-Reward-Imbalance was included in the model.
  
  
  CONCLUSIONS
  Our results suggest that the association between work stress and glycemic status is partially mediated through vmHRV independent of systemic inflammation as measured by C-reactive protein. We conclude that work stress may be an additional factor that promotes development of hyperglycemic-metabolic states. If supported by prospective evidence, these results may lead to new approaches for primary prevention of hyperglycemia in the workplace.
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf-Krehl-Strasse 7-11, 68167, Mannheim, Germany.|Institute of Medical Psychology, Center for Psychosocial Medicine, UniversityHospital Heidelberg, Heidelberg, Germany, Bergheimer Strasse 20, 69115, Heidelberg, Germany.
authors.forename: Marc N
authors.identifier: http://orcid.org/0000-0002-6055-385X
authors.initials: MN
authors.lastname: Jarczok
authors.affiliation: The Ohio State University, Department of Psychology, 1835 Neil Avenue, 43210, Columbus, Ohio, United States of America.
authors.forename: Julian
authors.initials: J
authors.lastname: Koenig
authors.affiliation: Institute of Occupational, Social, and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany.
authors.forename: Jian
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Occupational Medicine Allianz SE, Königinstrasse 28 80802, Munich, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Mauss
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf-Krehl-Strasse 7-11, 68167, Mannheim, Germany.
authors.forename: Kristina
authors.initials: K
authors.lastname: Hoffmann
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf-Krehl-Strasse 7-11, 68167, Mannheim, Germany.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Schmidt
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf-Krehl-Strasse 7-11, 68167, Mannheim, Germany.
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Fischer
authors.affiliation: The Ohio State University, Department of Psychology, 1835 Neil Avenue, 43210, Columbus, Ohio, United States of America.
authors.forename: Julian F
authors.initials: JF
authors.lastname: Thayer
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology; D005260:Female; D005858:Germany; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007249:Inflammation / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000209:etiology; D016272:Occupational Health; D011236:Prediabetic State / Q000209:etiology; D013315:Stress, Psychological
chemical_list: D001786:Blood Glucose