Guest blog by Lisa Davies, Registered Nutritionist & Postgraduate Dietetic student, KCL
Shift work is a significant public health concern, affecting 14% of the UK working population (over 4 million people). It is associated with long-term health risks, with evidence showing that night-shift or irregular-hour workers are at increased risk of cardiovascular disease, obesity, T2D (1), gastrointestinal problems, sleep disturbances and poor mental health along with increased risk of cancer. The World Health Organization has concluded that shift work is a probable carcinogen (2) due to circadian disruption.
A 2018 meta-analysis reported that the risk of any cardiovascular disease event was 17% higher among shift workers than day workers, and coronary heart disease morbidity was 26% higher. After the first five years of shift work, the risk of CVD events rose by 7.1% for every additional five years of exposure (3). Beyond physical health, shift work disrupts social and family life, leading to stress and reduced wellbeing. From a public health perspective, this links to health improvement (reducing chronic disease, supporting mental wellbeing) and wider determinants of health (employment conditions shaping health outcomes). It also carries economic implications through sickness absence, presenteeism, and reduced productivity.
Dietary Impacts
Diet is a key pathway linking shift work with poor health outcomes. Qualitative evidence from UK healthcare shift workers with type 2 diabetes highlights that environmental and social factors, including limited access to healthy food at night, inadequate storage/preparation facilities, time pressures, and fatigue-driven eating, strongly influence dietary behaviours. The study concluded that workplace interventions must go beyond education to include environmental restructuring and practical support for meal planning and self-management, ensuring healthier choices are both accessible and affordable during night shifts (4).
Observational studies show poorer diet quality in shift workers, including higher intakes of sugar-sweetened beverages, alcohol, and saturated fats, and lower intakes of vegetables (5).
Furthermore, emergency healthcare workers consume significantly fewer calories, macronutrients and fluid on night shifts compared with day shifts. Prolonged fasting periods and reduced meal frequency suggest that altered eating patterns, rather than total energy intake alone, contribute to adverse metabolic outcomes (6). A recent UK study of police officers found diet quality significantly worse on shift days, particularly nights, with over 65% of participants overweight or obese. Shift workers reported altered meal timing, increased reliance on convenience foods, and barriers such as lack of time, motivation, and cost (7).
Additionally, observational evidence also indicates circadian misalignment in night-shift workers with more frequent meals, shorter fasting periods, higher fat intake, and reduced daylight exposure, all of which may increase risks of obesity, cardiometabolic disease and poor overall health (8).
Existing UK Guidance on Shift Work
Existing UK guidance on shift work, including the British Nutrition Foundation (BNF) health and lifestyle recommendations (9), NHS (2020) guidance on the health, safety, and well-being of shift workers in healthcare (10), and the HSE (2006) “Managing Shift Work” guidance (11), collectively emphasises the importance of protecting the health and well-being of shift-working populations.
Commonly agreed strategies include forward-rotating shift schedules (day → evening → night), limiting consecutive night shifts and overly long shifts, ensuring adequate breaks and recovery periods, and providing supportive environmental conditions such as appropriate lighting, temperature, safe travel, and facilities for rest. Guidance also highlights the importance of nutrition, recommending access to healthy and affordable food and drink throughout shifts, promotion of meal planning, and attention to meal timing to support metabolic health. In addition, NHS guidance specifically treats shift work as a workplace hazard, recommending formal risk assessments, equal access to occupational health services, training, and wellbeing support, provision of break and rest areas including opportunities for short naps, support for mental health and fatigue management, and compliance with Working Time Regulations, including minimum rest periods, maximum weekly hours, and limits on night shift duration. Collectively, these measures provide a framework to mitigate the physical, metabolic, and psychosocial risks associated with shift work.
CIPD and other organisational wellbeing guidance note that workers often report negative effects from unpredictable schedules, poor control, and low work-life balance, emphasising mental health, exhaustion, and stress.
Gaps in Guidance and Research
Despite clear recommendations from HSE, NHS Employers, CIPD, and NICE, several gaps remain. Many workplace health initiatives are designed for a 9–5 workforce, leaving night-shift workers with limited access to occupational health services, healthy food options, and wellbeing activities. Guidance often lacks specificity on meal timing, circadian-aligned nutrition, and individualised adjustments for factors such as age, pregnancy, chronic conditions, or long-term vulnerability. Mental health and fatigue management are recognised as important, but practical, evidence-based strategies are limited. Research is also limited, with few long-term studies or multi-component interventions, and most evidence comes from healthcare workers, leaving other industries such as manufacturing and hospitality underrepresented. Addressing these gaps is essential to ensure workplace health solutions are effective and equitable for all shift workers. Supporting shift workers requires coordinated action between employers, occupational health teams, and workplace wellbeing services.
What Can Employers Do to Support Shift Workers?
Legal Compliance
- Follow Working Time Regulations: 11-hour rest in 24 hours, max 48-hour average week, max 8-hour night shifts, paid annual leave (5.6 weeks), 20-minute break for shifts over 6 hours.
- Provide health assessments before assigning night work.
Shift Scheduling & Fatigue Management
- Use forward-rotating shifts (day → evening → night) and limit consecutive night shifts.
- Ensure protected breaks, adequate recovery, and predictable schedules.
- Supervisors trained to recognise fatigue and safety-critical periods.
Workplace Environment & Nutrition
- Maintain safe travel, lighting, temperature, and rest areas for breaks or naps.
- Provide healthy food and drink 24/7, with facilities for storage and preparation.
- Support meal planning and hydration, considering timing to reduce metabolic risk.
Health, Wellbeing & Training
- Offer occupational health, mental health support, and fatigue/sleep education.
- Make reasonable adjustments for vulnerable staff (pregnancy, chronic conditions).
- Promote physical activity and wellbeing initiatives accessible to all shifts.
References:
1. Jung C-h, Jung SH, Lee B, Choi D, Kim B-y, Kim C-h, et al. Differential impact of sleep duration on fasting plasma glucose level according to work timing. Archives of Medical Research. 2018;49(1):51-7.
2. Wegrzyn LR, Tamimi RM, Rosner BA, Brown SB, Stevens RG, Eliassen AH, et al. Rotating night-shift work and the risk of breast cancer in the nurses' health studies. American journal of epidemiology. 2017;186(5):532-40.
3. Torquati L, Mielke GI, Brown WJ, Kolbe-Alexander T. Shift work and the risk of cardiovascular disease. A systematic review and meta-analysis including dose–response relationship. Scandinavian journal of work, environment & health. 2018;44(3):229-38.
4. Gibson R, D'Annibale M, Oliver N, McGowan B, Forbes G, Crayton E, et al. Exploration of the individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes working in UK healthcare—The Shift-Diabetes Study: A qualitative study using the theoretical domains framework. Diabetic Medicine. 2024;41(2):e15179.
5. Tada Y, Kawano Y, Maeda I, Yoshizaki T, Sunami A, Yokoyama Y, et al. Association of body mass index with lifestyle and rotating shift work in Japanese female nurses. Obesity (Silver Spring). 2014;22(12):2489-93.
6. Bouillon-Minois JB, Thivel D, Croizier C, Ajebo É, Cambier S, Boudet G, et al. The Negative Impact of Night Shifts on Diet in Emergency Healthcare Workers. Nutrients. 2022;14(4).
7. Allen K, Safi A, Deb SK. An exploration into the impact that shift work has on the nutritional behaviours of UK police officers. British Journal of Nutrition. 2023;130(2):284-93.
8. van de Langenberg D, Vlaanderen JJ, Dollé MET, Rookus MA, van Kerkhof LWM, Vermeulen RCH. Diet, Physical Activity, and Daylight Exposure Patterns in Night-Shift Workers and Day Workers. Ann Work Expo Health. 2019;63(1):9-21.
9. Foundation BN. Healthy diet and lifestyle tips for shift workers. 2021.
10. Employers N. The health, safety and wellbeing of shift workers in healthcare environments. 2024.
11. Executive HaS. Managing shift work: Health and safety guidance. 2006.
Lisa Davies is a Registered Nutritionist & Postgraduate Dietetic student at King's College London.