Day Nurses Snack More Than Night Nurses, Italian Study of Eating Habits Finds

Night shift work has long been cast as one of the chief dietary villains of modern medicine, blamed for everything from midnight vending-machine raids to creeping weight gain among the clinicians who keep hospitals running around the clock. But a new cross-sectional study of more than 400 Italian nurses, published in Nursing Open, is challenging that narrative in an unexpected way. When researchers compared the eating behaviours of nurses who worked only during the day with those who also worked through the night, it was the daytime-only group—not the night workers—who reported snacking between meals more often. The finding, drawn from an online survey conducted in May 2022, adds a counterintuitive twist to a scientific debate that has grown increasingly contentious as evidence about shift work, metabolism and health has accumulated.

The stakes of this question extend well beyond the nursing profession itself. Nurses form the largest professional group in the global healthcare workforce, and their wellbeing is tightly linked to patient outcomes, perceived quality of care and organizational performance. A growing body of research has associated night shift work with elevated risks of chronic conditions including type 2 diabetes, metabolic syndrome, cardiovascular disease and certain cancers, along with higher rates of sleep disorders and obesity compared with daytime colleagues. Much of that elevated risk has been attributed to circadian rhythm disruption—the misalignment that occurs when the body’s internal clock is forced to reconcile wakefulness at night with sleep during daylight hours. Because meal timing, digestion and metabolism are all governed by circadian regulation, understanding precisely how shift schedules reshape eating behaviour has become a central question in occupational health research.

Previous studies have generally painted a consistent picture: night shift workers tend to consume more total energy, favour energy-dense foods and sugar-sweetened beverages, snack more frequently, and eat more carbohydrates and saturated fats than their day-working peers. Reviews have described night nurses skipping breakfast and lunch, eating dinner late, and grazing on high-fat, sugar-rich snacks during overnight shifts. Meal skipping itself has been linked to metabolic dysfunction, and the American Heart Association has issued a scientific statement emphasizing that meal timing and frequency matter for cardiovascular disease prevention. Yet the evidence has not been unanimous. Some studies have failed to confirm the link between night work and overweight or obesity, and much of the existing data rely on self-reported dietary information, which researchers urge should be interpreted cautiously.

To probe these questions, the Italian research team recruited 408 nurses through dedicated nursing communities on Facebook and Instagram, using a Google Forms questionnaire. Participants reported their sex, age, years of professional experience, educational level, smoking habits, height and weight, and the nature of their shift work—whether they worked only between 8 a.m. and 8 p.m. or also covered the night window from 8 p.m. to 8 a.m. The survey also asked about the number of meals consumed per day, whether snacks were eaten between main meals, and whether meals were taken at regular times, with reference to Italian dietary recommendations. Body mass index was calculated and classified into standard categories ranging from underweight to obese.

The study’s most distinctive feature, however, was its use of the Eating Disorder Flexibility Index, or EDFLIX, a 36-item questionnaire measuring cognitive and behavioural flexibility around food, exercise, weight and body shape. Higher scores indicate a greater capacity to adapt eating-related attitudes and behaviours flexibly rather than rigidly—a trait previously associated with healthier responses to food intake, whereas inflexibility has been linked to disordered eating patterns. Because no validated Italian version existed, the researchers translated the instrument and asked 30 nurses to rate the clarity and relevance of every item on a structured validation checklist; all rated the items strongly agreeable, and the translated questionnaire showed good internal consistency, with a Cronbach’s alpha of 0.752 for the total score in the main sample.

The results defied several expectations. Of the 408 participants, 109 nurses (26.7 percent) worked exclusively daytime shifts while 299 (73.3 percent) also worked nights. The two groups differed significantly in work characteristics: night shift nurses were markedly younger in professional experience, with 27.9 percent reporting fewer than five years of employment compared with 8.1 percent of daytime-only nurses, and they were more likely to hold full-time positions. Yet when the researchers turned to eating patterns, the anticipated differences largely failed to materialize. The number of meals consumed per day did not differ significantly between groups, nor did the regularity of meal timing, though the latter came close to the significance threshold. Body mass index categories and smoking habits were also statistically indistinguishable between the two shift groups.

The single significant difference concerned snacking between main meals, and it ran in the opposite direction from much of the prior literature. Fully 83 percent of daytime-only nurses reported eating snacks between their principal meals, compared with 68 percent of nurses who worked night shifts—a difference the authors deemed statistically significant. This finding directly contradicts evidence from Lebanese nurses, where night shift work was associated with less healthy eating, irregular meal timing and greater consumption of high-fat, sugar-rich snacks during overnight hours. It also sits awkwardly with the physiological model that has dominated the field, in which circadian disruption alters appetite-regulating hormones—suppressing leptin, the satiety signal, and elevating ghrelin, the hunger signal—thereby driving increased snacking and meal skipping among night workers.

Equally striking was the absence of any difference in eating behaviour flexibility. Analyses of the EDFLIX total score and its three sub-dimensions—general flexibility, food and exercise flexibility, and weight and shape flexibility—revealed no statistically significant differences between daytime and night shift nurses. The authors suggest this indicates that flexibility in eating, exercise and body-shape-related behaviours is independent of nursing shift work, a conclusion at odds with earlier reports of reduced physical activity among night shift nurses due to fatigue. The lack of association between night work and body mass index in this sample echoes some previous studies that failed to confirm the shift work–obesity link, even as systematic reviews and meta-analyses have generally supported it, pointing to weight gain and increased waist circumference likely driven by excess caloric intake during night work.

The researchers are candid about the limitations that temper these conclusions. Recruitment through social media introduced substantial selection bias and limits generalizability, and the two comparison groups were markedly unbalanced in size. The night shift group was not subdivided into fixed and rotating schedules, even though schedule predictability could plausibly influence eating behaviour. The questionnaire captured only a limited set of dietary variables, online self-report may have affected data quality, and the cross-sectional design means no causal inferences can be drawn about the relationship between shift work, diet, body weight or physical activity. Non-significant findings, the authors caution, should be interpreted with appropriate care.

Even so, the study offers a useful corrective to a field prone to simple narratives, and the authors frame it as a preliminary contribution to a complex and multifaceted topic. Night shift nurses do appear to experience alterations in their relationship with food and physical activity, but the key underlying factors remain highly controversial. The team plans to examine the nutritional composition of snacks and explore meal patterns in greater depth, moving beyond simple counts of meals per day. In the meantime, they argue that targeted health promotion strategies to foster healthy eating behaviours among nurses—regardless of shift—could be essential to protect a workforce whose health underpins the performance of entire healthcare systems, and to prevent the long-term adverse outcomes that decades of shift work research have made all too familiar.

Subject of Research: The impact of day versus night shift work on eating behaviours, snacking patterns and eating flexibility among nurses

Article Title: How Shift Work Impacts on Eating Behaviours Among Nurses: A Cross‐Sectional Study

Article References: Chang, Y.-C., Mea, R., & Vitale, E. (2026). How Shift Work Impacts on Eating Behaviours Among Nurses: A Cross‐Sectional Study. Nursing Open, 13(10), Article e70884. https://doi.org/10.1002/nop2.70884

Image Credits: AI Generated

DOI: 10.1002/nop2.70884

Keywords: shift work, nurses, eating behaviours, snacking, circadian rhythm, body mass index, EDFLIX, occupational health, cross-sectional study, meal patterns, metabolism, healthcare workforce