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Chronic stress at work and the metabolic syndrome: prospective study

BMJ 2006; 332 doi: (Published 02 March 2006) Cite this as: BMJ 2006;332:521
  1. Tarani Chandola, senior lecturer (t.chandola{at},
  2. Eric Brunner, reader1,
  3. Michael Marmot, head of group and department1
  1. 1 Department of Epidemiology and Public Health, University College London, London WC1E 6BT
  1. Correspondence to: T Chandola
  • Accepted 17 November 2005


Objectives To investigate the association between stress at work and the metabolic syndrome.

Table 4

Risk of having the metabolic syndrome by relative index of inequality of employment grade. Multivariate multiple imputation logistic regression models: non-retired men and women in the Whitehall II cohort at phase 5

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Design Prospective cohort study investigating the association between work stress and the metabolic syndrome.

Participants 10 308 men and women, aged 35-55, employed in 20 London civil service departments at baseline (the Whitehall II study); follow-up was an average of 14 years.

Main outcome measures Work stress based on the iso-strain model, measured on four occasions (1985-99). Biological measures of the metabolic syndrome, based on the National Cholesterol Education Program definition, measured in 1997-9.

Results A dose-response relation was found between exposure to work stressors over 14 years and risk of the metabolic syndrome, independent of other relevant risk factors. Employees with chronic work stress (three or more exposures) were more than twice as likely to have the syndrome than those without work stress (odds ratio adjusted for age and employment grade 2.25, 95% confidence interval 1.31 to 3.85).

Conclusions Stress at work is an important risk factor for the metabolic syndrome. The study provides evidence for the biological plausibility of the link between psychosocial stressors from everyday life and heart disease.


  • We thank all participating civil service departments and their welfare, personnel, and establishment officers; the Occupational Health and Safety Agency; the Council of Civil Service Unions; all participating civil servants in the Whitehall II study; and all members of the Whitehall II study team. We also thank the referees of this paper for their useful comments.

  • Contributors TC wrote the first draft of the paper and did all the analyses. EB and MM wrote subsequent drafts and guided the analyses. TC is the guarantor.

  • Funding The Whitehall II study was supported by grants from the Medical Research Council; Economic and Social Research Council; British Heart Foundation; Health and Safety Executive; Department of Health; National Heart Lung and Blood Institute (HL36310), US, NIH; National Institute on Aging (AG13196), US, NIH; Agency for Health Care Policy Research (HS06516); and the John D and Catherine T MacArthur Foundation Research Nes on Successful Midlife Development and Socioeconomic Status and Health. MM is supported by an MRC research professorship.

  • Competing interests None declared.

  • Ethical approval University College London Medical School committee on the ethics of human research.

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