Study finds daytime meals may reduce health risks linked to night shift work

Study finds daytime meals may reduce health risks linked to night shift work

A small clinical trial supported by the National Institutes of Health has found that eating during the nighttime—like many shift workers do—can increase glucose levels, while eating only during the daytime might prevent the higher glucose levels now linked with a nocturnal work life.

The findings, the study authors said, could lead to novel behavioral interventions aimed at improving the health of shift workers – grocery stockers, hotel workers, truck drivers, first responders, and others – who past studies show may be at an increased risk for diabetes, heart disease, and obesity.

The new study, which the researchers noted is the first to demonstrate the beneficial effect of this type of meal timing intervention in humans, appears online in the journal Science Advances. It was funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), part of NIH.

“This is a rigorous and highly controlled laboratory study that demonstrates a potential intervention for the adverse metabolic effects associated with shift work, which is a known public health concern,” said Marishka Brown, Ph.D., director of the NHLBI’s National Center on Sleep Disorders Research. “We look forward to additional studies that confirm the results and begin to untangle the biological underpinnings of these findings.”

For the study, the researchers enrolled 19 healthy young participants (seven women and 12 men). After a preconditioning routine, the participants were randomly assigned to a 14-day controlled laboratory protocol involving simulated night work conditions with one of two meal schedules. One group ate during the nighttime to mimic a meal schedule typical among night workers, and one group ate during the daytime.

The researchers then evaluated the effects of these meal schedules on their internal circadian rhythms. That’s the internal process that regulates not just the sleep-wake cycle, but also the 24-hour cycle of virtually all aspects of your bodily functions, including metabolism.

The researchers found that nighttime eating boosted glucose levels – a risk factor for diabetes – while restricting meals to the daytime prevented this effect. Specifically, average glucose levels for those who ate at night increased by 6.4% during the simulated night work, while those who ate during the daytime showed no significant increases.

“This is the first study in humans to demonstrate the use of meal timing as a countermeasure against the combined negative effects of impaired glucose tolerance and disrupted alignment of circadian rhythms resulting from simulated night work,” said study leader Frank A.J.L. Scheer, Ph.D., professor of medicine at Harvard Medical School and director of the Medical Chronobiology Program at Brigham & Women’s Hospital in Boston.

The researchers said that the mechanisms behind the observed effects are complex. They believe that the nighttime eating effects on glucose levels during simulated night work are caused by circadian misalignment. That corresponds to the mistiming between the central circadian “clock” (located in the brain’s hypothalamus) and behavioral sleep/wake, light/dark, and fasting/eating cycles, which can influence peripheral “clocks” throughout the body. The current study shows that, in particular, mistiming of the central circadian clock with the fasting/eating cycles plays a key role in boosting glucose levels. The work further suggests the beneficial effects of daytime eating on glucose levels during simulated night work may be driven by better alignment between these central and peripheral “clocks.”

“This study reinforces the notion that when you eat matters for determining health outcomes such as blood sugar levels, which are relevant for night workers as they typically eat at night while on shift,” said the study co-leader Sarah L. Chellappa, M.D., Ph.D., a researcher in the nuclear medicine department at the University of Cologne, Germany. Chellappa formerly worked with Scheer in Brigham & Women’s Medical Chronobiology Program.

To translate these findings into practical and effective meal timing interventions, the researchers said more study is needed, including with real-life shift workers in their typical work environment.

So Far, Over 140k Children Have Lost Primary or Secondary Caregivers to Covid-19

So Far, Over 140k Children Have Lost Primary or Secondary Caregivers to Covid-19

One U.S. child loses a parent or caregiver for every four COVID-19 deaths, a new modeling study published today in Pediatrics reveals.  The findings illustrate orphanhood as a hidden and ongoing secondary tragedy caused by the COVID-19 pandemic and emphasizes that identifying and caring for these children throughout their development is a necessary and urgent part of the pandemic response – both for as long as the pandemic continues, as well as in the post-pandemic era.

From April 1, 2020 through June 30, 2021, data suggest that more than 140,000 children under age 18 in the United States lost a parent, custodial grandparent, or grandparent caregiver who provided the child’s home and basic needs, including love, security, and daily care. Overall, the study shows that approximately 1 out of 500 children in the United States has experienced COVID-19-associated orphanhood or death of a grandparent caregiver. There were racial, ethnic, and geographic disparities in COVID-19-associated death of caregivers: children of racial and ethnic minorities accounted for 65% of those who lost a primary caregiver due to the pandemic.

Children’s lives are permanently changed by the loss of a mother, father, or grandparent who provided their homes, basic needs, and care. Loss of a parent is among the adverse childhood experiences (ACEs) linked to mental health problems; shorter schooling; lower self-esteem; sexual risk behaviors; and increased risk of substance abuse, suicide, violence, sexual abuse, and exploitation.

“Children facing orphanhood as a result of COVID is a hidden, global pandemic that has sadly not spared the United States,” said Susan Hillis, CDC researcher and lead author of the study. “All of us – especially our children – will feel the serious immediate and long-term impact of this problem for generations to come. Addressing the loss that these children have experienced – and continue to experience – must be one of our top priorities, and it must be woven into all aspects of our emergency response, both now and in the post-pandemic future.”

The study was a collaboration between the Centers for Disease Control and Prevention (CDC), Imperial College London, Harvard University, Oxford University, and the University of Cape Town, South Africa. Published in the Oct. 7 issue of the journal Pediatrics, it was jointly led by CDC’s COVID Response and Imperial College London, and partly funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), as well as Imperial College London.

“The magnitude of young people affected is a sobering reminder of the devastating impact of the past 18 months,” said Dr Alexandra Blenkinsop, co-lead researcher, Imperial College London. “These findings really highlight those children who have been left most vulnerable by the pandemic, and where additional resources should be directed.”

The analysis used mortality, fertility, and census data to estimate COVID-19-associated orphanhood (death of one or both parents) and deaths of custodial and co-residing grandparents between April 1, 2020, and June 30, 2021, for the U.S. broadly, and for every state. “COVID-19-associated deaths” refers to the combination of deaths caused directly by COVID-19 and those caused indirectly by associated causes, such as lockdowns, restrictions on gatherings and movement, decreased access or quality of health care and of treatment for chronic diseases. The data were also separated and analyzed by race and ethnicity, including White, Black, Asian, and American Indian/Alaska Native populations, and Hispanic and non-Hispanic populations.

The study authors estimate that 120,630 children in the U.S. lost a primary caregiver, (a parent or grandparent responsible for providing housing, basic needs and care) due to COVID-19-associated death.  In addition, 22,007 children experienced the death of a secondary caregiver (grandparents providing housing but not most basic needs). Overall, 142,637 children are estimated to have experienced the death of at least one parent, or a custodial or other co-residing grandparent caregiver.

“The death of a parental figure is an enormous loss that can reshape a child’s life. We must work to ensure that all children have access to evidence-based prevention interventions that can help them navigate this trauma, to support their future mental health and wellbeing,” said NIDA Director Nora D. Volkow, MD. “At the same time, we must address the many underlying inequities and health disparities that put people of color at greater risk of getting COVID-19 and dying from COVID-19, which puts children of color at a greater risk of losing a parent or caregiver and related adverse effects on their development.”

Racial and ethnic disparities in COVID-related caregiver loss

There were significant racial and ethnic disparities in caregiver deaths due to COVID-19. White people represent 61% of the total U.S. population and people of racial and ethnic minorities represent 39%  of the total population. Yet, study results indicate that non-Hispanic White children account for 35% of those who lost a primary caregiver (51,381 children), while children of racial and ethnic minorities account for 65% of those who lost a primary caregiver (91,256 children).

When looking at both primary and secondary caregivers, the study found that findings varied greatly by race/ethnicity: 1 of every 168 American Indian/Alaska Native children, 1 of every 310 Black children, 1 of every 412 Hispanic children, 1 of every 612 Asian children, and 1 of every 753 White children experienced orphanhood or death of caregivers. Compared to white children, American Indian/Alaska Native children were 4.5 times more likely to lose a parent or grandparent caregiver, Black children were 2.4 times more likely, and Hispanic children were nearly 2 times (1.8) more likely.

Overall, the states with large populations – California, Texas, and New York – had the highest number of children facing COVID-19 associated death of primary caregivers. However, when analyzed by geography and race/ethnicity, the authors were able to map how these deaths and disparities varied at the state level.

In southern states along the U.S.-Mexico border, including New Mexico, Texas, and California , between 49% and 67% of children who lost a primary caregiver were of Hispanic ethnicity. In the southeast, across Alabama, Louisiana, and Mississippi, between 45% to 57% of children who lost a primary caregiver were Black. And American Indian/Alaska Native children who lost a primary caregiver were more frequently represented in South Dakota (55%), New Mexico (39%), Montana (38%), Oklahoma (23%), and Arizona (18%).

The current study follows closely in line with a similar study published in The Lancet in July 2021, which found more than 1.5 million children around the world lost a primary or secondary caregiver during the first 14 months of the COVID-19 pandemic.  In both the global and US studies, researchers used the UNICEF definition of orphanhood, as including the death of one or both parents6. The definition includes children losing one parent, because they have increased risks of mental health problems, abuse, unstable housing, and household poverty. For children raised by single parents, the COVID-19-associated death of that parent may represent loss of the person primarily responsible for providing love, security, and daily care.

“We often think of the impact of COVID-19 in terms of the number of lives claimed by the disease, but as this study shows, it is critical to also address the broader impact – both in terms of those who have died, and those who have been left behind,” said study co-author Charles A. Nelson III, PhD. who studies the effects of adversity on brain and behavioral development at Boston Children’s Hospital. “We must ensure children who have lost a parent or caregiver have access to the support services they need, and that this additional impact of the COVID-19 pandemic is comprehensively addressed in both our rapid response and our overall public health response.”

There are evidence-based responses that can improve outcomes for children who experience the COVID-associated death of their caregivers:

  • Maintaining children in their families is a priority. This means families bereaved by the pandemic must be supported, and those needing kinship or foster care must rapidly receive services.
  • Child resilience can be bolstered via programs and policies that promote stable, nurturing relationships and address childhood adversity. Key strategies include:
    • Strengthening economic supports to families.
    • Quality childcare and educational support.
    • Evidence-based programs to improve parenting skills and family relationships.
  • All strategies must be age specific for children and must be sensitive to racial disparities and structural inequalities. They must reach the children who need them most.

In the closing words of the paper, “Effective action to reduce health disparities and protect children from direct and secondary harms from COVID-19 is a public health and moral imperative.”

U.S. Department of Health and Human Services(link is external)

CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Methamphetamine-involved overdose deaths nearly tripled between 2015 to 2019, NIH study finds

Methamphetamine-involved overdose deaths nearly tripled between 2015 to 2019, NIH study finds

Overdose deaths involving methamphetamine nearly tripled from 2015 to 2019 among people ages 18-64 in the United States, according to a study by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. The number of people who reported using methamphetamine during this time did not increase as steeply, but the analysis found that populations with methamphetamine use disorder have become more diverse. Published today in JAMA Psychiatry, the study suggests that increases in higher-risk patterns of methamphetamine use, such as increases in methamphetamine use disorder, frequent use, and use of other drugs at the same time, may be contributing to the rise in overdose deaths.

“We are in the midst of an overdose crisis in the United States, and this tragic trajectory goes far beyond an opioid epidemic. In addition to heroin, methamphetamine and cocaine are becoming more dangerous due to contamination with highly potent fentanyl, and increases in higher risk use patterns such as multiple substance use and regular use,” said NIDA Director Nora D. Volkow, M.D., one of the authors of the study. “Public health approaches must be tailored to address methamphetamine use across the diverse communities at risk, and particularly for American Indian and Alaska Native communities, who have the highest risk for methamphetamine misuse and are too often underserved.”

In 2020, more than 93,000 Americans died from drug overdoses, marking the largest one-year increase in overdose deaths ever recorded, according to provisional data from the U.S. Centers for Disease Control and Prevention. This increase has largely been driven by rising overdoses involving synthetic opioids, primarily fentanyl. Overdose deaths involving psychostimulants, and particularly methamphetamine, have also risen steeply in recent years, and many of these deaths involved use of an opioid at the same time. However, questions remain on how trends in methamphetamine use  contribute to greater risk for overdose deaths.

To address this gap, the study authors analyzed data on overdose deaths involving psychostimulants other than cocaine from cause of death files in the National Vital Statistics System(link is external) from 2015 to 2019. They also assessed the methamphetamine use patterns of U.S. adults ages 18 to 64 – the age group at highest risk of substance use and overdose deaths – from the National Survey on Drug Use and Health(link is external) (NSDUH), which provides annual information on tobacco, alcohol, and other drug use, mental health, and other health-related issues in the United States.

The researchers found that from 2015 to 2019, the number of overdose deaths involving psychostimulant drugs other than cocaine, (largely methamphetamine), rose from 5,526 to 15,489, a 180% increase. However, the number of people who reported using methamphetamine only increased by 43% over the same period.

In addition, the data show that people reporting frequent methamphetamine use (100 days or more per year) rose by 66% between 2015 and 2019, and people reporting the use of methamphetamine and cocaine together increased by 60% during this period. The researchers also found that since 2017, more people who reported using methamphetamine in the past year also reported higher-risk use patterns (i.e., had methamphetamine use disorder and/or injected methamphetamine) than reported lower-risk use patterns (i.e., did not meet criteria for methamphetamine use disorder and/or inject methamphetamine). These findings indicate that riskier use patterns may have contributed to the increased numbers of methamphetamine-involved overdose deaths during this time period.

The researchers also noted shifts in the populations using methamphetamine between 2015 and 2019. Whereas, historically, methamphetamine has been most commonly used by middle-aged white persons, this analysis found that American Indians/Alaska Natives had the highest prevalence of methamphetamine use, as well as methamphetamine use disorder and methamphetamine injection. Previous studies have found that American Indians/Alaska Natives also had the greatest increases in methamphetamine overdose deaths in recent years.

This analysis also found that prevalence of methamphetamine use disorder among those who did not inject the drug increased 10-fold among Black people from 2015 to 2019, a much steeper increase than among white or Hispanic people. Like frequency of use, methamphetamine use disorder is a measure used to capture escalating methamphetamine use. Methamphetamine use disorder without injection quadrupled in young adults ages 18 to 23, a substantially greater increase than in older age groups. This is of particular concern, as young adulthood is a critical period of continued brain, social, and academic maturation, and having methamphetamine use disorder during this vulnerable period could have long-lasting consequences.

Methamphetamine use has also been linked to HIV transmission, as infectious diseases can spread by sharing injection equipment and through heightened unprotected sexual activity that is often associated with methamphetamine use. Previous studies have reported high rates of methamphetamine use among men who have sex with men, who also face higher rates of HIV transmission. This study found that the prevalence of methamphetamine injection was the highest among homosexual men. Moreover, methamphetamine use disorder without injection more than doubled among homosexual or bisexual men. It also more than tripled among heterosexual women and lesbian or bisexual women, and more than doubled among heterosexual men, further emphasizing the expansion of use across different groups.

“What makes these data even more devastating is that currently, there are no approved medications to treat methamphetamine use disorder,” said Emily Einstein, Ph.D., chief of NIDA’s Science Policy Branch and a co-author of the study. “NIDA is working to develop new treatment approaches, including safe and effective medications urgently needed to slow the increase in methamphetamine use, overdoses, and related deaths.”

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH Awards Nearly $470 Million to Fund Nationwide Long Covid (PASC) Study

NIH Awards Nearly $470 Million to Fund Nationwide Long Covid (PASC) Study

The National Institutes of Health awarded nearly $470 million to build a national study population of diverse research volunteers and support large-scale studies on the long-term effects of COVID-19. The NIH REsearching COVID to Enhance Recovery (RECOVER) Initiative  made the parent award to New York University (NYU) Langone Health, New York City, which will make multiple sub-awards to more than 100 researchers at more than 30 institutions and serves as the RECOVER Clinical Science Core. This major new award to NYU Langone supports new studies of COVID-19 survivors and leverages existing long-running large cohort studies with an expansion of their research focus. This combined population of research participants from new and existing cohorts, called a meta-cohort, will comprise the RECOVER Cohort. This funding was supported by the American Rescue Plan.

NIH launched the RECOVER Initiative to learn why some people have prolonged symptoms (referred to as long COVID) or develop new or returning symptoms after the acute phase of infection from SARS-CoV-2, the virus that causes COVID-19. The most common symptoms include pain, headaches, fatigue, “brain fog,” shortness of breath, anxiety, depression, fever, chronic cough, and sleep problems.

“We know some people have had their lives completely upended by the major long-term effects of COVID-19,” said NIH Director Francis S. Collins, M.D., Ph.D. “These studies will aim to determine the cause and find much-needed answers to prevent this often-debilitating condition and help those who suffer move toward recovery.”

Data from the RECOVER Cohort will include clinical information, laboratory tests, and analyses of participants in various stages of recovery following SARS-CoV-2 infection. With immediate access to data from existing, diverse study populations, it is anticipated researchers will be able to accelerate the timeline for this important research.

“This scientifically rigorous approach puts into place a collaborative and multidisciplinary research community inclusive of diverse research participants that are critical to informing the treatment and prevention of the long-term effects of COVID-19,” said Gary H. Gibbons, M.D., director of NIH’s National Heart, Lung, and Blood Institute and one of the co-chairs of the RECOVER Initiative.

Researchers, people affected by long COVID, and representatives from advocacy organizations worked together to develop the RECOVER master protocols that use standardized trial designs and research methods to enable uniform evaluation of study populations across studies and the ability to quickly pivot the research focus depending on what findings show. This approach allows for data harmonization across research studies and study populations.  Data harmonization allows data to be compared and analyzed, which will facilitate the research process and provide more robust findings.

Studies will include adult, pregnant, and pediatric populations; enroll patients during the acute as well as post-acute phases of the SARS-CoV-2 infection; evaluate tissue pathology; analyze data from millions of electronic health records; and use mobile health technologies, such as smartphone apps and wearable devices, which will gather real-world data in real time. Together, these studies are expected to provide insights over the coming months into many important questions including the incidence and prevalence of long-term effects from SARS-CoV-2 infection, the range of symptoms, underlying causes, risk factors, outcomes, and potential strategies for treatment and prevention.

“Given the range of symptoms that have been reported, intensive research using all available tools is necessary to understand what happens to stall recovery from this terrible virus. Importantly, the tissue pathology studies in RECOVER will enable in depth studies of the virus’s effects on all body systems” said Walter J. Koroshetz, M.D., director of NIH’s National Institute of Neurological Disorders and Stroke and one of the RECOVER co-chairs.

Research opportunity announcements were issued in February 2021 and awards to launch the RECOVER Clinical Science Core and Data Resource Core were announced in June. An award in support of a RECOVER Biorepository Core has also been made to the Mayo Clinic for approximately $40 million to collect, curate, and distribute comprehensive sources of clinical samples for additional research studies. The Cores provide coordination and infrastructure for the RECOVER Initiative, including supporting the activities of the investigator consortium and ensuring that all data are harmonized and shared among researchers. In May and June, short-term awards were provided to more than 30 institutions to develop the master protocols.

These awards pave the path to gaining greater understanding of the long-term effects of SARS-CoV-2 infection and enabling researchers to identify potential interventions and preventive strategies.


About the National Institute of Neurological Disorders and Stroke (NINDS): NINDS is the nation’s leading funder of research on the brain and nervous system. The mission of NINDS is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. For more information, visit www.ninds.nih.gov.

About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit www.nhlbi.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH Awards 5-Year Grant to Advanced Practice Genetics Nurse

NIH Awards 5-Year Grant to Advanced Practice Genetics Nurse

Vanderbilt University School of Nursing Associate Professor Laurie Connors, DNP, FAANP, has received a grant from the National Institutes of Health National Human Genome Research Institute to train doctoral nurses—doctors of nursing practice and Ph.D. nurses—in the translation and integration of genomics into academics, research, and clinical practice. The five-year grant, called Translation and Integration of Genomics is Essential to Doctoral Nursing, aims to facilitate personalized health care through this national educational effort. 

Genomics, the study of all of a person’s genes, is a growing field within health care and the burgeoning health technology space. Genomics is a complex competency and has been identified as a core trend shaping health care’s future. With the vast amount of information made available by genetic testing, data science, and advanced sequencing technologies, there is an increased need for nurses trained in genomics, who can interpret the information and translate it in a way that patients can understand. 

The largest patient-facing workforce in health care, nurses play an integral role in the effective delivery of genomic health care for patients, their families, communities, and populations. Research over the past decade has shown that many nurses have knowledge gaps in the basics of human genetics, Connors said. Totaling nearly $700,000, the TIGER grant will enable Connors and her collaborators at Clemson University and Loyola University Chicago to increase the capacity and capability of doctoral nurses in genomics over the course of the grant’s timeline. 

“We will deploy a ‘train the trainer’ model,” Connors said. “Our participants will take their skills back to their universities to serve as champions to incorporate genomics into curriculum, research, scholarship and clinical practice. 

“Genomics impacts nursing practice across the lifespan from before birth to end of life. Nursing is one of the oldest and largest health care professions, and we must continue to ask ourselves if we have the necessary knowledge and workforce skilling to participate in genomic health care.”

—Laurie Connors, DNP, FAANP

An advanced practice nurse in genetics, Connors aims to close the space between students with higher levels of proficiency in genomics and their educators. In her four years at Vanderbilt University School of Nursing, she has developed and implemented multiple genomic and oncology clinical-focused courses. Her specialty in genomics was sparked by looking deeper into hereditary predispositions to breast cancer during her time as an oncology nurse. 

“Nursing is a profession where you are a lifelong learner,” Connors said. “Genomics has allowed me the opportunity to pursue new knowledge and to assist individuals and families in understanding their genetic risk assessment and risk of disease and what they can do about it.” 

The training Connors is developing will begin with a half-day genomics course provided at the American Association of Colleges of Nursing annual doctoral conference in January, followed by monthly webinars posted to a learning management system from February to December 2022. To find out more information about this educational project, contact Connors at [email protected].