Water, hydration, and health

Hydration: Knowledge, Attitudes, and Practices of UK Dietitians

Aim. The aim of this study was to investigate dietitians’ knowledge, attitudes, and practices (KAP) regarding hydration and patient care. Methods. A cross-sectional online survey was administered to UK dietitians via the British Dietetic Association monthly newsletter and included 18 items on hydration knowledge (n=8), attitudes (n=4), and practices (n=6). KAP scores were calculated by adding the total number of correct knowledge responses and by ranking attitude and practice responses on a Likert scale. Results. 97 dietitians completed the online survey and displayed varying levels of KAP regarding hydration and patient care. The mean unweighted scores were knowledge 5.0 (±1.3) out of 8; attitude 13.9 (±1.3) out of 16; practice 14.9 (±2.6) out of 24. Dietitians appeared to be guided by clinical reasoning and priorities for nutrition care. Conclusions. There may be scope to further assess and potentially enhance the KAP of dietitians regarding hydration and patient care. Innovative approaches to hydration promotion are warranted and may include focusing on dietitians’ personal hydration status, increasing communication with other healthcare professionals, and partnering with patients to take a proactive role in hydration monitoring.

Dietary water affects human skin hydration and biomechanics

It is generally assumed that dietary water might be beneficial for the health, especially in dermatological (age preventing) terms. The present study was designed to quantify the impact of dietary water on major indicators of skin physiology. A total of 49 healthy females (mean 24.5±4.3 years) were selected and characterized in terms of their dietary daily habits, especially focused in water consumption, by a Food Frequency Questionnaire. This allowed two groups to be set - Group 1 consuming less than 3,200 mL/day (n=38), and Group 2 consuming more than 3,200 mL/day (n=11). Approximately 2 L of water were added to the daily diet of Group 2 individuals for 1 month to quantify the impact of this surplus in their skin physiology. Measurements involving epidermal superficial and deep hydration, transepidermal water loss, and several biomechanical descriptors were taken at day 0 (T0), 15 (T1), and 30 (T2) in several anatomical sites (face, upper limb, and leg). This stress test (2 L/day for 30 days) significantly modified superficial and deep skin hydration, especially in Group 1. The same impact was registered with the most relevant biomechanical descriptors. Thus, in this study, it is clear that higher water inputs in regular diet might positively impact normal skin physiology, in particular in those individuals with lower daily water consumptions.

Grab a Cup, Fill It Up! An Intervention to Promote the Convenience of Drinking Water and Increase Student Water Consumption During School Lunch

OBJECTIVES

We evaluated a low-cost strategy for schools to improve the convenience and appeal of drinking water.

METHODS

We conducted a group-randomized, controlled trial in 10 Boston, Massachusetts, schools in April through June 2013 to test a cafeteria-based intervention. Signage promoting water and disposable cups were installed near water sources. Mixed linear regression models adjusting for clustering evaluated the intervention impact on average student water consumption over 359 lunch periods.

RESULTS

The percentage of students in intervention schools observed drinking water during lunch nearly doubled from baseline to follow-up compared with controls (+ 9.4%; P < .001). The intervention was associated with a 0.58-ounce increase in water intake across all students (P < .001). Without cups, children were observed drinking 2.4 (SE = 0.08) ounces of water from fountains; with cups, 5.2 (SE = 0.2) ounces. The percentage of intervention students observed with sugar-sweetened beverages declined (-3.3%; P < .005).

CONCLUSIONS

The current default of providing water through drinking fountains in cafeterias results in low water consumption. This study shows that an inexpensive intervention to improve drinking water's convenience by providing cups can increase student water consumption.

The Healthy Beverage Index Is Associated with Reduced Cardiometabolic Risk in US Adults: A Preliminary Analysis

BACKGROUND AND OBJECTIVE

Beverage recommendations exist, but few evaluate overall beverage intake quality. Our objective was to develop a scoring algorithm for assessing beverage intake quality among US adults (aged ≥19 years), and to examine the association between overall beverage quality and cardiometabolic risk.

DESIGN

We developed a scoring algorithm, similar to the Healthy Eating Index-2010, using recommendations for total beverage energy, meeting fluid requirements, and consuming within recommended limits for beverage subgroups (eg, low-fat milk, fruit juice). Multiple scoring systems were evaluated. The final scoring system, which consisted of 10 components, was applied to the average of 2 days of 24-hour dietary intake data for adults (aged ≥19 years) from the National Health and Nutrition Examination Survey (NHANES), 2005-2010.

STATISTICAL ANALYSES PERFORMED

Poisson regression models stratified by sex and body mass index multivariables were used to examine the cross-sectional association between the Healthy Beverage Index (HBI) score and cardiometabolic outcomes.

RESULTS

The 10-item index had a mean±standard deviation score of 63±16 from a possible 100 points. Each 10-point higher HBI score was associated with lower odds ratios for hypertension (men and women); high fasting insulin level, high fasting glucose level, and high low-density lipoprotein cholesterol level (women and overweight/obese men), low high-density lipoprotein cholesterol level (women), and high C-reactive protein level (men).

CONCLUSIONS

We found positive associations between higher HBI scores and more favorable lipid profiles; hypertension risk; and, among men, C-reactive protein levels. These preliminary results suggest that the HBI could be a valuable tool to evaluate overall beverage intake quality in adults. More research is needed to understand whether improvements in beverage quality and, thus, HBI score, are associated with beneficial changes in health.

What do Indian children drink when they do not receive water? Statistical analysis of water and alternative beverage consumption from the 2005-2006 Indian National Family Health Survey

Background

Over 1.2 billion people lack access to clean water. However, little is known about what children drink when there is no clean water. We investigated the prevalence of receiving no water and what Indian children drink instead.

Methods

We analysed children’s beverage consumption using representative data from India’s National Family and Health Survey (NFHS-3, 2005–2006). Consumption was based on mothers’ reports (n = 22,668) for children aged 6–59 months (n = 30,656).

Results

About 10 % of Indian children had no water in the last 24 h, corresponding to 12,700,000 children nationally, (95 % CI: 12,260,000 to 13,200,000). Among children who received no water, 23 % received breast or fresh milk and 24 % consumed formula, “other liquid”, juice, or two or more beverages. Children over 2 were more likely to consume non-milk beverages, including tea, coffee, and juice than those under 2 years. Those in the lowest two wealth quintiles were 16 % less likely to have received water (OR = 0.84; 95 % CI: 0.74 to 0.96). Compared to those living in households with bottled, piped, or tanker water, children were significantly less likely to receive water in households using well water (OR = 0.75; 95 % CI: 0.64 to 0.89) or river, spring, or rain water (OR = 0.70; 95 % CI: 0.53 to 0.92) in the last 24 h.

Conclusions

About 13 million Indian children aged 6–59 months received no water in the last 24 h. Further research is needed to assess the risks potentially arising from insufficient water, caffeinated beverages, and high sugar drinks at early stages of life.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1946-4) contains supplementary material, which is available to authorized users.

Higher plain water intake is associated with lower type 2 diabetes risk: a cross-sectional study in humans

The aim of this study was to investigate the relationship between plain water intake and type 2 diabetes (T2D) risk. It was hypothesized that higher plain water intake would be associated with a lower T2D risk score. One hundred thirty-eight adults from Southwest and Southeast England answered a cross-sectional online survey assessing T2D risk (using the Diabetes UK risk assessment); physical activity (using the short International Physical Activity Questionnaire); and consumption of fruits, vegetables, and beverages (using an adapted version of the Cambridge European Prospective Investigation into Cancer and Nutrition Food Frequency Questionnaire). There was a trend for differences in mean plain water intake between those stratified as having low, increased, moderate, or high risk of T2D; but these did not achieve significance (P = .084). However, plain water intake was significantly negatively correlated with T2D risk score (τ = -0°180, P = .005); and for every 240-mL cup of water consumed per day, T2D risk score was reduced by 0.72 point (range, 0-47) (B = -0.03, 95% confidence interval = -0.06 to -0.01, P = .014). The current study has provided preliminary results that are supported by theory; mechanisms need to be explored further to determine the true effect of plain water intake on disease risk. As increasing plain water intake is a simple and cost-effective dietary modification, its impact on T2D risk is important to investigate further in a randomized controlled trial. Overall, this study found that plain water intake had a significant negative correlation with T2D risk score; and regression analysis suggested that water may have a role in reducing T2D risk.

Prevalence of Inadequate Hydration Among US Children and Disparities by Gender and Race/Ethnicity: National Health and Nutrition Examination Survey, 2009-2012

OBJECTIVES

We evaluated the hydration status of US children and adolescents.

METHODS

The sample included 4134 participants aged 6 to 19 years in the National Health and Nutrition Examination Survey from 2009 to 2012. We calculated mean urine osmolality and the proportion with inadequate hydration (urine osmolality > 800 mOsm/kg). We calculated multivariable regression models to estimate the associations between demographic factors, beverage intake, and hydration status.

RESULTS

The prevalence of inadequate hydration was 54.5%. Significantly higher urine osmolality was observed among boys (+92.0 mOsm/kg; 95% confidence interval [CI] = 69.5, 114.6), non-Hispanic Blacks (+67.6 mOsm/kg; 95% CI = 31.5, 103.6), and younger children (+28.5 mOsm/kg; 95% CI = 8.1, 48.9) compared with girls, Whites, and older children, respectively. Boys (OR = 1.76; 95% CI = 1.49, 2.07) and non-Hispanic Blacks (odds ratio [OR] = 1.34; 95% CI = 1.04, 1.74) were also at significantly higher risk for inadequate hydration. An 8-fluid-ounce daily increase in water intake was associated with a significantly lower risk of inadequate hydration (OR = 0.96; 95% CI = 0.93, 0.98).

CONCLUSIONS

Future research should explore drivers of gender and racial/ethnic disparities and solutions for improving hydration status.

Positive impact of dietary water on in vivo epidermal water physiology

BACKGROUND/PURPOSE

The importance of water in human physiology is well known, also for skin functionality. This study was conducted to assess the effects of dietary water on epidermal skin hydration in healthy females.

METHODS

Thirty-four healthy females (mean 24.5 ± 6.34 years old) were selected and characterized according to their dietary daily habits, by a previously validated Food Frequency Questionnaire. For 1 month, these subjects were asked to add 2 L/day of water to their regular dietary habits. Measurements took place at day D0, D15, and D30, and involved general variables (body weight, blood pressure, Body Mass Index) and specific skin physiological variables in five anatomical sites (ventral forearm, anterior leg, dorsal hand, zygomatic area, and forehead) involving epidermal superficial and deep hydration, by capacitance and transepidermal water loss (TEWL).

RESULTS

This water overload (2 L/day/30 days) did not change the blood volume or weight of the individuals. However, both superficial and deep skin hydration were clearly in those individuals that regularly consumed lees water per day. No significant effect was observed in the TEWL.

CONCLUSIONS

This study clearly suggests that dietary water intake seems to influence skin water content. Nevertheless further in vivo investigations involving other variables, such as biomechanical descriptors, should follow to look deeper into this aspect of skin physiology.

Water intake: validity of population assessment and recommendations

Good hydration is vital for good health and well-being. Until recently, there was little interest in collecting data on water and drink and beverage intake. However, there is increasing evidence that a low water intake or mild dehydration may be linked with the risk of chronic diseases. Accurate estimates of intake in populations are essential to explore these relationships. This will enable the identification of specific populations at the risk of low water intake and allow exposure assessment of potential contaminates and specific nutrients present in drinks and beverages. In addition, data from these population studies are used as the basis of national and international recommendations on water intake and to set and evaluate national health policies. For example, EFSA based their recommendations on data from population studies from 13 European countries. The range of intakes varied from 720 to 2621 mL/day; this diversity cannot be explained by environmental differences alone. However, this variability may, at least partially, be explained by the inconsistency in methodologies used as none of surveys used a dietary assessment tool validated for total water intake or beverage and drink intake. It is reasonable to suggest that this may result in incomplete data collection and it raises questions on the validity of the recommendations. The relationship between water consumption and health warrants further investigation, and robust methodologies are essential to ensure that these data are accurate and useful for setting public health priorities and policies.

Total fluid intake and its determinants: cross-sectional surveys among adults in 13 countries worldwide

PURPOSE

To evaluate the total fluid intake from drinking water and beverages in adult populations from different countries and assess the percentage of individuals complying with the European Food Safety Agency (EFSA) adequate intake (AI) of water from fluids.

METHODS

A total of 16,276 adults (7580 men and 8696 women) aged between 18 and 70 years (mean age 39.8 years) were randomly recruited from 13 different countries from three continents. Information about the total daily fluid intake (sum of drinking water and beverages) was collected using a 24-h fluid-specific record over seven consecutive days.

RESULTS

Important differences in total fluid intake between countries were found; however, few differences between men and women were reported in most of the countries. Less than 50 % of the women and approximately 60 % of the men do not comply with the EFSA AI of water from fluids. Women were more than twice as likely as men to meet these AI (OR 2.15; 95 % CI 2.02-2.29). The odds of meeting the AI of water from fluids were lower in individuals over 50 years (OR 0.88; 95 % CI 0.80-0.96). Nine percent of the total population consumed less than half of the AI, 40.5 % between 50 and 100 %, and 50.5 % more than the AI.

CONCLUSIONS

There were considerable differences in total fluid intake between countries but not between genders. Only 40 % of men and 60 % of women comply with the EFSA AI of water from fluids. Men and elderly individuals had an increased risk of not complying with this reference value.

Total fluid intake of children and adolescents: cross-sectional surveys in 13 countries worldwide

PURPOSE

To describe total fluid intake (TFI) according to socio-demographic characteristics in children and adolescents worldwide.

METHODS

Data of 3611 children (4-9 years) and 8109 adolescents (10-18 years) were retrieved from 13 cross-sectional surveys (47 % males). In three countries, school classes were randomly recruited with stratified cluster sampling design. In the other countries, participants were randomly recruited based on a quota method. TFI (drinking water and beverages of all kinds) was obtained with a fluid-specific record over 7 consecutive days. Adequacy was assessed by comparing TFI to 80 % of adequate intake (AI) for total water intake set by European Food Safety Authority. Data on height, weight and socio-economic level were collected in most countries.

RESULTS

The mean (SD) TFI ranged from [1.32 (0.68)] to [1.35 (0.71)] L/day. Non-adherence to AIs for fluids ranged from 10 % (Uruguay) to >90 % (Belgium). Females were more likely to meet the AIs for fluids than males (4-9 years: 28 %, OR 0.72, p = 0.002; 10-18 years: 20 %, OR 0.80, p = 0.001), while adolescents were less likely to meet the AI than children (OR 1.645, p < 0.001 in males and OR 1.625, p < 0.001 in females).

CONCLUSIONS

A high proportion of children and adolescents are at risk of an inadequate fluid intake. This risk is especially high in males and adolescents when compared with females or children categories. This highlights water intake among young populations as an issue of global concern.

Student perceptions of a healthy university

As complex environments within which individuals and populations operate, universities present important contexts for understanding and addressing health issues. The healthy university is an example of the settings approach, which adopts a whole system perspective, aiming to make places within which people, learn, live, work and play supportive to health and well-being. The UK Healthy Universities Network has formulated an online toolkit, which includes a Self-Review Tool, intended to enable universities to assess what actions they need to take to develop as a healthy university. This paper presents findings from consultative research undertaken with students from universities in England, Scotland and Wales, which explored what they believe, represents a healthy university.

METHODS

Student surveys and focus groups were used to collect data across eleven universities in England, Scotland and Wales. A priori themes were used to develop our own model for a healthy university, and for the thematic coding phase of analysis.

FINDINGS

A healthy university would promote student health and well-being in every aspect of its business from its facilities and environment through to its curriculum. Access to reasonably priced healthy food and exercise facilities were key features of a healthy university for students in this study. The Self-Review Tool has provided a crucial start for universities undertaking the journey towards becoming a healthy university. In looking to the future both universities and the UK Healthy Universities Network will now need to look at what students want from their whole university experience, and consider how the Self-Review Tool can help universities embrace a more explicit conceptual framework.

CONCLUSION

The concept of a healthy university that can tailor its facilities and supportive environments to the needs of its students will go some way to developing students who are active global citizens and who are more likely to value and prioritise health and well-being, in the short and long term through to their adult lives.

Associations among chronic disease status, participation in federal nutrition programs, food insecurity, and sugar-sweetened beverage and water intake among residents of a health-disparate region

OBJECTIVE

To determine whether sociodemographic characteristics, food security status, participation in federal nutrition programs (Supplemental Nutrition Assistance Program [SNAP] or Special Supplemental Nutrition Program for Women, Infants, and Children [WIC]), and chronic disease status were associated with adherence to water and sugar-sweetened beverage (SSB) intake recommendations.

DESIGN

Cross-sectional, random-digit phone survey with questions from the Behavioral Risk Factor Surveillance System and beverage intake questionnaire.

PARTICIPANTS

Residents of a medically underserved, rural area.

MAIN OUTCOME MEASURES

Water and SSB intake.

ANALYSIS

Descriptive statistics, chi-square and 1-way ANOVA, and linear and logistic regression.

RESULTS

The sample consisted of 930 respondents (aged 56 ± 17 years; 35% non-white); reported food insecurity and SNAP and WIC participation were 37%, 29%, and 8%, respectively. Prevalent health conditions included overweight/obesity (69%), diabetes (19%), and hypertension (45%). Water recommendations were more likely to be met (72%; mean intake, 31 ± 19 fluid oz) than SSB (41%; mean intake, 246 ± 297 kcal). Food insecurity and SNAP/WIC participation were not associated with meeting recommendations, but those reporting ≥ 1 chronic disease were more likely to meet SSB recommendations (odds ratio, 2.42; P = .02).

CONCLUSIONS AND IMPLICATIONS

Odds of achieving SSB but not water recommendations were greater among individuals with a chronic disease. Efforts to communicate beverage recommendations to at-risk groups are needed.

Sensory attributes of soft drinks and their influence on consumers' preferences

Soft drinks are beverages composed of water and other ingredients that provide specific sensorial attributes. Soft drink consumption patterns have recently been changed partially influenced by an increased availability of different types of beverages during the last few years. Consumers' preferences to choose one drink over another are influenced, not only by genetic, psychological and environmental factors, but also by the beverage's specific attributes. In fact, beverage consumption is driven by the sensations it gives. Because the main component of soft drinks is water, an increase in the intake of soft drinks might improve fluid intake and the levels of water in the body if it is regarded as an "essential nutrient".

Validation analysis of a geriatric dehydration screening tool in community-dwelling and institutionalized elderly people

Dehydration is common among elderly people. The aim of this study was to perform validation analysis of a geriatric dehydration-screening tool (DST) in the assessment of hydration status in elderly people. This tool was based on the DST proposed by Vivanti et al., which is composed by 11 items (four physical signs of dehydration and seven questions about thirst sensation, pain and mobility), with four questions extra about drinking habits. The resulting questionnaire was evaluated in a convenience sample comprising institutionalized (n = 29) and community-dwelling (n = 74) elderly people. Urinary parameters were assessed (24-h urine osmolality and volume) and free water reserve (FWR) was calculated. Exploratory factor analysis was used to evaluate the scale’s dimensionality and Cronbach’s alpha was used to measure the reliability of each subscale. Construct’s validity was tested using linear regression to estimate the association between scores in each dimension and urinary parameters. Two factors emerged from factor analysis, which were named “Hydration Score” and “Pain Score”, and both subscales showed acceptable reliabilities. The “Hydration Score” was negatively associated with 24-h urine osmolality in community-dwelling; and the “Pain Score” was negatively associated with 24-h urine osmolality, and positively associated with 24-h urine volume and FWR in institutionalized elderly people.

Critical review and rethinking of USEPA secondary standards for maintaining organoleptic quality of drinking water

Consumers assess their tap water primarily by its taste, odor, and appearance. Starting in 1979, USEPA promulgated Secondary Maximum Contaminant Levels (SMCLs) as guidance for contaminants with organoleptic effects and also to maintain consumers’ confidence in tap water. This review assesses the basis for the 15 SMCLs (aluminum, chloride, color, copper, corrosivity, fluoride, foaming agents, iron, manganese, odor, pH, silver, sulfate, total dissolved solids, zinc) and summarizes advances in scientific knowledge since their promulgation. SMCLs for aluminum, color, pH, silver, sulfate, total dissolved solids, and zinc are appropriate at current values and remain consistent with sensory science literature. Recent advances in sensory and health sciences indicate that SMCLs for chloride, copper, fluoride, iron, and manganese are too high to minimize organoleptic effects. The SMCLs for corrosivity and foaming agents may be outdated. The SMCL for odor requires rethinking as the test does not correlate with consumer complaints. Since current stresses on source and treated waters include chemical spills, algal blooms, and increased salinization, organoleptic episodes that negatively impact consumer confidence and perception of tap water still occur and may increase. Thus, adherence to SMCLs can help maintain production of palatable water along with consumers’ confidence in their water providers.

Markers of the hydration process during fluid volume modification in women with habitual high or low daily fluid intakes

PURPOSE

Human daily total water intake (TWI) has a large inter-individual range. Recently, water supplementation has been suggested as a potential preventative and therapeutic modality. Thus, we aimed to measure hydration biomarkers in women with high (HIGH) versus low (LOW) daily TWI to determine baseline differences, and the efficacy of these markers during a systematic alteration in TWI.

METHODS

This cohort study identified 14 HIGH [3.34 (0.56) L day(-1)] and 14 LOW [1.62 (0.48) L day(-1)] from 120 women. Next, fluid intake was decreased in HIGH [2.00 (0.21) L day(-1)] while LOW increased [3.50 (0.13) L day(-1)] across 4 days. Body mass, fluid intake, serum osmolality (S osmo), total plasma protein (TPP), 24 h urine osmolality, and 24 h urine volume, were measured on each day of modified TWI. Estimated plasma volume (E pv) was calculated using measured body mass and hematocrit values.

RESULTS

At baseline, urinary markers and TPP differentiated HIGH from LOW [7.0 (0.3) versus 7.3 (0.3) mg dL(-1), respectively]. Upon TWI intervention, (1) body mass decreased in HIGH [-0.7 (1.1) kg, p = 0.010)] but did not increase in LOW [+0.0 (0.6) kg, p = 0.110], (2) E pv decreased 2.1 (2.4) %, p = 0.004, (3) urine osmolality increased in HIGH [397 (144)-605 (230) mOsm kg(-1), p < 0.001] and decreased in LOW [726 (248)-265 (97) mOsm kg(-1) p < 0.001], and (4) no changes of serum osmolality occurred in either HIGH or LOW (all p > 0.05).

CONCLUSIONS

Urinary markers and TPP are sensitive measures to habitual high and low TWI and to changes in TWI. Both groups through urinary and some hematological responses following TWI manipulation achieved regulation of hemoconcentration.

Optimal composition of fluid-replacement beverages

The objective of this article is to provide a review of the fundamental aspects of body fluid balance and the physiological consequences of water imbalances, as well as discuss considerations for the optimal composition of a fluid replacement beverage across a broad range of applications. Early pioneering research involving fluid replacement in persons suffering from diarrheal disease and in military, occupational, and athlete populations incurring exercise- and/or heat-induced sweat losses has provided much of the insight regarding basic principles on beverage palatability, voluntary fluid intake, fluid absorption, and fluid retention. We review this work and also discuss more recent advances in the understanding of fluid replacement as it applies to various populations (military, athletes, occupational, men, women, children, and older adults) and situations (pathophysiological factors, spaceflight, bed rest, long plane flights, heat stress, altitude/cold exposure, and recreational exercise). We discuss how beverage carbohydrate and electrolytes impact fluid replacement. We also discuss nutrients and compounds that are often included in fluid-replacement beverages to augment physiological functions unrelated to hydration, such as the provision of energy. The optimal composition of a fluid-replacement beverage depends upon the source of the fluid loss, whether from sweat, urine, respiration, or diarrhea/vomiting. It is also apparent that the optimal fluid-replacement beverage is one that is customized according to specific physiological needs, environmental conditions, desired benefits, and individual characteristics and taste preferences.

Assessment of hydration status in a large population

Both acute and chronic dehydration can have important implications for human behaviour and health. Young children, non-autonomous individuals and the elderly are at a greater risk of dehydration. Mild hypertonic dehydration could be related to less efficient cognitive and physical performance and has been reported to be associated with frequently occurring pathological conditions, especially nephrolithiasis. The assessment of hydration status in a large sample appears to be of interest for conducting epidemiological and large clinical studies aimed at improving preventive and curative care. Especially in large-population studies, methods that are used have to be accurate, cheap, quick and require no technical expertise. Body weight change is widely used to determine acute hydration changes, but seems to be insufficiently accurate in longitudinal studies. Bioimpedance analysis methods enable the assessment of total body water content, but their use is still under debate. Because plasma osmolality directly reflects intracellular osmolality, it constitutes a good marker to assess acute hydration changes, but not chronic hydration status because it changes constantly. Moreover, venepuncture is considered to be invasive and is not suitable for a large-sample study, especially in children. Urinary markers appear to be good alternatives for assessing hydration status in large populations. Collection of urine samples is non-invasive and cheap. High technical expertise is not required to perform urinary marker measurements and these measurements can be carried out quickly. Thus, methods based on urinary markers are very well suited for field studies. Urine colour is probably the least sensitive marker despite its high specificity. Urine osmolality and especially urine specific gravity could be easily used for determining hydration status in large-sample studies.

Assessment of toxic effects of the methanol extract of Citrus macroptera Montr. Fruit via biochemical and hematological evaluation in female Sprague-Dawley rats

Citrus macroptera Montr. (C. macroptera) is locally known as Satkara. The fruit of this plant is used as appetite stimulant and in the treatment of fever. This study therefore aimed to evaluate the toxic effects of the fruit extract using some biochemical and hematological parameters in rat model. The effects of methanol extract of Citrus macroptera Montr. fruit administered at 250, 500 and 1000 mg/kg body weight were investigated on hematological and biochemical parameters in Sprague-Dawley female rats. Moreover, histopathological study was performed to observe the presence of pathological lesions in primary body organs. The extract presented no significant effect on body weight, percent water content, relative organ weight and hematological parameters in rat. Significant decrease from control group was observed in the levels of triglyceride, total cholesterol, low density lipoprotein and very low density lipoprotein; thus leading to significant decrease of cardiac risk ratio, castelli's risk index-2, atherogenic coefficient and atherogenic index of plasma at all doses. 500 mg/kg dose significantly decreased alkaline phosphatase (P<0.05), 1000 mg/kg dose significantly increased high density lipoprotein cholesterol (P<0.05) and 250 mg/kg dose significantly decreased the level of glycated hemoglobin (P<0.05) from the control group. There were no significant alterations observed with other serum biochemical parameters. Histopathological study confirmed the absence of inflammatory and necrotic features in the primary body organs. Study results indicate that methanolic fruit extract is unlikely to have significant toxicity. Moreover, these findings justified the cardio-protective, moderate hepato-protective and glucose controlling activities of the fruit extract.

Snacking is prevalent in Mexico

BACKGROUND

Snacking has increased globally, but little is known about how Mexicans consume foods outside meals.

OBJECTIVE

The aim of this study was to examine the prevalence and patterns of snacking behavior among Mexicans.

METHODS

We used data from children and adults (aged ≥ 2 y; n = 9937) from the Mexican National Nutrition Survey 1999 and the Mexican National Health and Nutrition Survey (NHNS) 2012 to examine the prevalence of snacking as well as amount (kcal) and contribution of snacks to total energy intake per day. Snacking was defined as eating outside of the 3 main meals. We calculated per capita (among the total population) and per consumer ("snackers") estimates of the number of snacks per day, kilocalories per snack, kilocalories per day from snacks, and the percentage of energy from snacks. Top foods consumed during snack occasions were also examined for the NHNS 2012. All results were weighted to account for survey design and to be nationally representative.

RESULTS

In 2012, an estimated 73% of the population consumed snacks on a given day, with estimates ranging from 70% among ≥ 59 y olds to 77% among 2-11 y olds. An average of 1.6 snacks/d were consumed by the population. This value was slightly higher (2.1 snacks/d) among snackers. Snacks provided an average of 343 kcal/d per snacker (17% of total energy/d). Fruit was the most commonly consumed snack food by all ages except for 12-18 y olds. Salty snacks, sweet snacks, sugar-sweetened beverages, and milk were frequently in the top 5 categories across age groups. Differences were observed between age groups.

CONCLUSIONS

Snacking is prevalent in the Mexican population. Many, but not all, of the foods consumed during snack occasions are foods considered "foods to limit" in the United States.

Physical and dosimetric optimization of laser equipment in dermatology: a preliminary study

The aim of this preliminary study is to investigate the correlation between clinical set-up at present used in the treatment of specific skin conditions and laser beam absorbed power in the tissue. This study focused on the CO2 and Nd-Yag laser equipment used in the daily clinical practice in the Department of Dermatology of San Gallicano Institute in Rome. Different types of tissue-equivalent material with various water and haemoglobin concentrations were tested to evaluate laser beam attenuation power. In particular, thinly sliced pork loin, of uniform consistency and without fat, was selected for its high content of haemoglobin to mimic human tissues. An optical power meter was used to measure the power or energy of a laser beam. During measurements, the tissue equivalent phantoms were positioned on the detector head and the laser beam was orthogonally oriented. The results of two experimental set-ups are reported here. The dependence of residual power (W) as a function of ex vivo tissue thickness (mm) for different laser output powers was studied. Data were fitted by a parametric logistic equation. These preliminary data allow for more accurately determining the energy fraction released from lasers to the tissues in order to improve clinical outcomes.

Water from fruit or the river? Examining hydration strategies and gastrointestinal illness among Tsimane’ adults in the Bolivian Amazon

Objective

Water is an essential nutrient overlooked in many cross-cultural studies of human nutrition. The present article describes dietary water intake patterns among forager-horticulturalist adults in lowland Bolivia, compares daily intake with international references and examines if variation in how people acquire water relates to gastrointestinal illness.

Design

Cross-sectional observational study used survey, anthropometric and qualitative methods with Tsimane’ adults selected by age and sex stratification sampling in one community.

Setting

Research occurred in one Tsimane’ village in the Beni department, Bolivia with limited access to clean water. The 24 h diet and health recalls were conducted in July–August 2012 and qualitative interviews/ethnographic observation in September–October 2013.

Subjects

Forty-five Tsimane’ household heads (49 % men) took part in the first data collection and twenty-two Tsimane’ (55 % men) were included in the follow-up interviews.

Results

Men and women reported consuming 4·9 litres and 4·4 litres of water daily from all dietary sources, respectively. On average, water from foods represented 50 % of total water intake. Thirteen per cent of participants reported symptoms of gastrointestinal illness. In a logistic regression model adjusted for age, BMI, sex and raw water consumed, each percentage increase in water obtained from foods was associated with a reduced risk of gastrointestinal illness (OR=0·92; 95 % CI 0·85, 0·99).

Conclusions

Both total water intake and percentage of water from foods were higher than averages in industrialized countries. These findings suggest that people without access to clean water may rely on water-rich foods as a dietary adaptation to reduce pathogen exposures.

Current patterns of water and beverage consumption among Mexican children and adolescents aged 1-18 years: analysis of the Mexican National Health and Nutrition Survey 2012

OBJECTIVE

To evaluate patterns of water consumption from plain water, beverages and foods among Mexican children and adolescents and to compare actual patterns of total daily water intake with the Dietary Reference Intakes (DRI).

DESIGN

We analysed one 24 h dietary recall from Mexican children and adolescents. We calculated intakes of total daily water and water from foods and from beverages. Actual total water intake per capita was subtracted from the DRI for water to calculate the shortfall.

SETTING

Mexican National Health and Nutrition Survey in 2012.

SUBJECTS

Mexican children and adolescents (n 6867) aged 1-18 years.

RESULTS

Approximately 73% of children and adolescents aged 1-18 years reported drinking plain water. Beverages and plain water represented 65·5% and 26·5% of total daily water intake, respectively. Among 1-3-year-olds, the top three main sources of water were from foods, plain water and water from plain milk. Among 4-8- and 9-13-year-olds, the main sources were from foods, plain water and agua fresca (fruit water). Among 14-18-year-olds, the main sources of water were plain water, water from foods and soda. A higher proportion of 1-3-year-olds and 4-8-year-olds met the DRI for water (38% and 29%, respectively). Among 9-13-year-olds and 14-18-year-olds, 13-19% of children met the DRI for water.

CONCLUSIONS

Total daily water intakes remain below DRI levels in all age groups. Although plain water still contributes the greatest proportion to daily water intake among fluids, caloric beverages are currently major sources of water especially among older children and adolescents.

Evidence-informed physical therapy management of performance-related musculoskeletal disorders in musicians

Playing a musical instrument at an elite level is a highly complex motor skill. The regular daily training loads resulting from practice, rehearsals and performances place great demands on the neuromusculoskeletal systems of the body. As a consequence, performance-related musculoskeletal disorders (PRMDs) are globally recognized as common phenomena amongst professional orchestral musicians. These disorders create a significant financial burden to individuals and orchestras as well as lead to serious consequences to the musicians’ performance and ultimately their career. Physical therapists are experts in treating musculoskeletal injuries and are ideally placed to apply their skills to manage PRMDs in this hyper-functioning population, but there is little available evidence to guide specific injury management approaches. An Australia-wide survey of professional orchestral musicians revealed that the musicians attributed excessively high or sudden increase in playing-load as major contributors to their PRMDs. Therefore, facilitating musicians to better manage these loads should be a cornerstone of physical therapy management. The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favorable outcomes. After these methodologies were employed, the intervention studies were conducted with a national cohort of professional musicians including: health education, onsite injury management, cross-training exercise regimes, performance postural analysis, and music performance biomechanics feedback. The outcomes of all these interventions will be discussed alongside a focussed review on the existing literature of these management strategies. Finally, a framework for best-practice physical therapy management of PRMDs in musicians will be provided.

Tapping into water: key considerations for achieving excellence in school drinking water access

OBJECTIVES

We examined free drinking water access in schools.

METHODS

We conducted cross-sectional interviews with administrators from 240 California public schools from May to November 2011 to examine the proportion of schools that met excellent water access criteria (i.e., location, density, type, maintenance, and appeal of water sources), school-level characteristics associated with excellent water access, and barriers to improvements.

RESULTS

No schools met all criteria for excellent water access. High schools and middle schools had lower fountain:student ratios than elementary schools (odds ratio [OR] = 0.06; 95% confidence interval [CI] = 0.02, 0.20; OR = 0.30, 95% CI = 0.12, 0.70). Rural schools were more likely to offer a nonfountain water source than city schools (OR = 5.0; 95% CI = 1.74, 14.70). Newer schools were more likely to maintain water sources than older schools (OR = 0.98; 95% CI = 0.97, 1.00). Schools that offered free water in food service areas increased from pre- to postimplementation of California's school water policy (72%-83%; P < .048). Barriers to improving school water included cost of programs and other pressing concerns.

CONCLUSIONS

Awareness of the benefits related to school drinking water provision and funding may help communities achieve excellence in drinking water access.

Fluid intake survey among schoolchildren in Belgium

Background

In childhood, inadequate fluid intakes can lead on the short term, to reduced physical and cognitive performances. However, few data are available on the fluid intake among schoolchildren in Belgium. The main aim of this study is to evaluate total fluid intake provided by different types of beverages in a sample of Belgian schoolchildren, in order to assess the percentage of individuals complying with the European Food Safety Authority recommendations for total fluid intake. A secondary aim was to characterize the study population in terms of determinants of the total fluid intake requirements.

Methods

A child friendly “fluids and liquid food” diary was used to prospectively record the volume and frequency of beverage consumption over 7 days from 1045 schoolchildren. This diary also recorded the practice of physical activity. An adequate fluid intake was defined as an intake ≥ 75% of the age-specific adequate intake recommended by the EFSA.

Results

The median (P25-P75) of habitual daily fluid intake was 864 (608–1104) ml/day, with 355 (194–579) coming from drinking water. This habitual daily fluid intake varied significantly among the three investigated EFSA groups (girls and boys aged from 8 years, girls from 9 to 13 and boys from 9 to 13), except for the drinking water (P = 0.906). The highest medians of fruit juice, sugar-sweetened beverages and milk and derivatives were found among boys of 9–13. Only 9.5% of the children had an adequate fluid intake, with a value of 19.2% among the 8 years old girls and boys, 7.0% among girls of 9–13 and 8.4% among boys of 9–13. In the whole sample, 27.7% of the children declared to drink less than 3-4x/day, 56% drunk water less than 2x/day and 7.7% drunk no water at all. Every day, 27.1% and 34.1% of the children drank respectively one fruit juice and one sugar-sweetened beverage.

Conclusion

Belgian schoolchildren have an inadequate total fluid intake. Given the potential health consequences, interventions involving parents and school environment to promote water consumption seem pertinent.

Fluid intake from beverages across age groups: a systematic review

BACKGROUND

Fluid intake, especially water, is essential for human life and also necessary for physical and mental function. The present study aimed to assess beverage consumption across age groups.

METHODS

A systematic review was conducted. Original research in English language publications and available studies (or abstracts in English) from 2000 to 2013 was searched for by using the medical subheading (MeSH) terms: ('beverage' OR 'fluid' [Major]) AND ('consumption' [Mesh] OR 'drinking' [Mesh] OR 'intake' [Mesh]) AND ('child' [Mesh] OR 'adolescent' [Mesh] OR 'adult' [Mesh]). Article selection was restricted to those papers covering healthy populations of all age groups in a nationwide sample, or from a representative sample of the population of a city or cities, which examined the trends or patterns of beverage intake and the determinants of beverage intake. Sixty-five studies were identified with respect to beverage consumption across age groups. The papers were screened by thoroughly reading titles or abstracts. Full-text articles were assessed by three investigators.

RESULTS

Total beverage intake varied between 0.6 and 3.5 L day(-1) among all age groups (males more than females). Plain water contributed up to 58%, 75% and 80% of the total beverage intake in children, adolescents and adults, respectively. Milk consumption was higher among children; consumption of soft drinks was higher among adolescents; and the consumption of tea, coffee and alcoholic beverages was higher among adults.

CONCLUSIONS

Plain water is the main water source for all age groups and the consumption of other beverages varies according to age.

Systemic hydration: relating science to clinical practice in vocal health

OBJECTIVES

To examine the current state of the science regarding the role of systemic hydration in vocal function and health.

STUDY DESIGN

Literature review.

METHODS

Literature search spanning multiple disciplines, including speech-language pathology, nutrition and dietetics, medicine, sports and exercise science, physiology, and biomechanics.

RESULTS

The relationship between hydration and physical function is an area of common interest among multiple professions. Each discipline provides valuable insight into the connection between performance and water balance, as well as complimentary methods of investigation. Existing voice literature suggests a relationship between hydration and voice production; however, the underlying mechanisms are not yet defined and a treatment effect for systemic hydration remains to be demonstrated. Literature from other disciplines sheds light on methodological shortcomings and, in some cases, offers an alternative explanation for observed phenomena.

CONCLUSIONS

A growing body of literature in the field of voice science is documenting a relationship between hydration and vocal function; however, greater understanding is required to guide best practice in the maintenance of vocal health and management of voice disorders. Integration of knowledge and technical expertise from multiple disciplines facilitates analysis of existing literature and provides guidance as to future research.

Availability of drinking water in US public school cafeterias

This study examined the availability of free drinking water during lunchtime in US public schools, as required by federal legislation beginning in the 2011-2012 school year. Data were collected by mail-back surveys in nationally representative samples of US public elementary, middle, and high schools from 2009-2010 to 2011-2012. Overall, 86.4%, 87.4%, and 89.4% of students attended elementary, middle, and high schools, respectively, that met the drinking water requirement. Most students attended schools with existing cafeteria drinking fountains and about one fourth attended schools with water dispensers. In middle and high schools, respondents were asked to indicate whether drinking fountains were clean, and whether they were aware of any water-quality problems at the school. The vast majority of middle and high school students (92.6% and 90.4%, respectively) attended schools where the respondent perceived drinking fountains to be clean or very clean. Approximately one in four middle and high school students attended a school where the survey respondent indicated that there were water-quality issues affecting drinking fountains. Although most schools have implemented the requirement to provide free drinking water at lunchtime, additional work is needed to promote implementation at all schools. School nutrition staff at the district and school levels can play an important role in ensuring that schools implement the drinking water requirement, as well as promote education and behavior-change strategies to increase student consumption of water at school.

Consumptions of plain water, moisture in foods and beverages, and total water in relation to dietary micronutrient intakes and serum nutrient profiles among US adults

OBJECTIVE

To investigate water contributors in relation to dietary and serum micronutrient profiles.

DESIGN

A cross-sectional study. The main exposures were water contributors. Selected dietary and serum micronutrient levels were outcome measures. Settings The US population and its subgroups.

SUBJECTS

US adults (n 2691) aged ≥20 years from the National Health and Nutrition Examination Survey 2005-2006.

RESULTS

The daily mean total water intake was 3.1 (se 0.047) litres, with 68 % of adults consuming below the Adequate Intake level. Total water intake was higher in adults with higher BMI and physical activity, those taking dietary supplements and alcohol consumers (P < 0.05). Plain water intake was positively associated with food moisture and negatively with beverage moisture (P < 0.001). Beverage moisture was negatively associated with food moisture (P < 0.001). In multivariate regression analyses, plain water and food moisture intakes were positively associated with Fe, Ca, vitamins A, B, C, E and K and carotenoid intakes (P < 0.05). However, beverage moisture was unrelated to Ca, niacin and vitamin B6 intakes, and negatively associated with Fe, vitamin A, folate, vitamins C, E and K and carotenoid intakes (P < 0.05). Concentrations of serum vitamins A and C and carotenoids increased with plain water and food moisture intakes (P < 0.05) but decreased (P < 0.01) or were unrelated to beverage moisture intake.

CONCLUSIONS

Various contributors of total water intake differed in their associations with dietary and serum micronutrient profiles in US adults. The study provides evidence of plain water benefits on micronutrient adequacy over beverages.

Effects of hydration status on cognitive performance and mood

Although it is well known that water is essential for human homeostasis and survival, only recently have we begun to understand its role in the maintenance of brain function. Herein, we integrate emerging evidence regarding the effects of both dehydration and additional acute water consumption on cognition and mood. Current findings in the field suggest that particular cognitive abilities and mood states are positively influenced by water consumption. The impact of dehydration on cognition and mood is particularly relevant for those with poor fluid regulation, such as the elderly and children. We critically review the most recent advances in both behavioural and neuroimaging studies of dehydration and link the findings to the known effects of water on hormonal, neurochemical and vascular functions in an attempt to suggest plausible mechanisms of action. We identify some methodological weaknesses, including inconsistent measurements in cognitive assessment and the lack of objective hydration state measurements as well as gaps in knowledge concerning mediating factors that may influence water intervention effects. Finally, we discuss how future research can best elucidate the role of water in the optimal maintenance of brain health and function.

Adapting a database of text messages to a mobile-based weight loss program: the case of the middle East

Obesity has become a worldwide epidemic. Qatar, a rapidly developing country in the Middle East, has seen a sharp increase in the prevalence of obesity. The increase can be attributed to several reasons, including sedentary lifestyles imposed by a harsh climate and the introduction of Western fast food. Mobile technologies have been used and studied as a technology to support individuals' weight loss. The authors have developed a mobile application that implements three strategies drawn from proven theories of behavioral change. The application is localized to the cultural context of its proposed users. The objective of this paper is to present a method through which we adapted the messaging content of a weight loss application to the context of its users while retaining an effective degree of automation. The adaptation addressed body image, eating and physical exercise habits, and regional/cultural needs. The paper discusses how surveying potential users can be used to build a profile of a target population, find common patterns, and then develop a database of text messages. The text messages are automated and sent to the users at specific times of day, as suggested by the survey results.

Middle school student attitudes about school drinking fountains and water intake

OBJECTIVE

To describe middle school student attitudes about school drinking fountains, investigate whether such attitudes are associated with intentions to drink water at school, and determine how intentions relate to overall water intake.

METHODS

Students (n = 3211) in 9 California middle schools completed surveys between 2009 and 2011. We used multivariate linear regression, adjusting for school sociodemographic characteristics, to examine how attitudes about fountains (5-point scale; higher scores indicating more positive attitudes) were associated with intentions to drink water at school and how intentions to drink water at school were related to overall water intake.

RESULTS

Mean age of students was 12.3 (SD = 0.7) years; 75% were Latino, 89% low income, and 39% foreign born. Fifty-two percent reported lower than recommended overall water intake (<3 glasses/day), and 30% reported that they were unlikely or extremely unlikely to drink water at school. Fifty-nine percent reported that school fountains were unclean, 48% that fountain water does not taste good, 33% that fountains could make them sick, 31% that it was not okay to drink from fountains, and 24% that fountain water is contaminated. In adjusted analyses, attitudes about school drinking fountains were related to intentions to drink water at school (β = 0.41; P < .001); intentions to drink water at school were also associated with overall water intake (β = 0.20; P < .001).

CONCLUSIONS

Students have negative attitudes about school fountains. To increase overall water intake, it may be important to promote and improve drinking water sources not only at school but also at home and in other community environments.

Impact of fluid intake in the prevention of urinary system diseases: a brief review

We are often told that we should be drinking more water, but the rationale for this remains unclear and no recommendations currently exist for a healthy fluid intake supported by rigorous scientific evidence. Crucially, the same lack of evidence precludes the claim that a high fluid intake has no clinical benefit. The aim of this study is to describe the mechanisms by which chronic low fluid intake may play a crucial role in the pathologies of four key diseases of the urinary system: urolithiasis, urinary tract infection, chronic kidney disease and bladder cancer. Although primary and secondary intervention studies evaluating the impact of fluid intake are lacking, published data from observational studies appears to suggest that chronic low fluid intake may be an important factor in the pathogenesis of these diseases.

The Hydration Equation: Update on Water Balance and Cognitive Performance

To become aware of the most practical measures of hydration status.To describe sources of water input and output and the basics of water balance.To understand how hydration status may impact daily cognitive performance.

CONDENSED VERSION AND BOTTOM LINE

Water is a crucial nutrient and euhydration is necessary for optimal daily functioning. Water balance is precisely regulated within the body and many methods exist for assessing hydration status. Cognitive performance measures an individual's attentiveness, critical thinking skills, and memory. Traditionally a 2% or more body water deficit was thought to produce cognitive performance decrements; however, recent literature suggests that even mild dehydration - a body water loss of 1-2% - can impair cognitive performance. Counseling clients about their health and wellbeing should include conveying the importance of water for normal body functioning, as well as its effects on physical and cognitive performance.

Season, temperature and blood pressure: a complex interaction

An increase in blood pressure values measured during winter either in the office, at home, or at ambulatory blood pressure monitoring was consistently observed. Besides potentially contributing to increase the risk for cardiovascular events during the cold season, long term blood pressure variations can influence results of clinical trials, epidemiological surveys, and require personalized management of antihypertensive medications in the single patient. Those variations are often considered as an effect of climate, due to the close correlation observed in various countries and in different settings between temperature and blood pressure among children, adults, and specially the elderly. However, obtaining true measurements of exposition is a main problem when investigating the effects of climate on human health especially when the aim is to disentangle the effects of climate from those of seasonality. The aim of the present note is not to provide a complete review of the literature demonstrating the implications of seasonal blood pressure changes in the clinical and experimental setting; rather it is to consider methodological aspects useful to investigate the interaction between seasonality and temperature on blood pressure and to make health care providers aware of the implications of environmental factors on blood pressure in clinical and research settings.

Contribution of fruit and vegetable intake to hydration status in schoolchildren

BACKGROUND

The specific effects of fruit and vegetable (F&V) intake on water balance and consequently on 24-h hydration status (HS) are unknown.

OBJECTIVES

In a large observational cohort of German children, we examined whether a higher F&V intake per se is associated with improved HS and attempted to quantify the influence of greater consumption of F&Vs on HS.

DESIGN

A total of 1286 complete 3-d weighed dietary records and 24-h urine samples for 442 children (4- to 10-y-olds) collected in 2000-2010 in the Dortmund Nutritional and Anthropometric Longitudinally Designed Study were analyzed. Free water reserve [FWR; urine volume (mL/24 h) minus obligatory urine volume (mL/24 h)] served as an HS biomarker. Median FWR and water balance variables were analyzed in different categories of solid-F&V intakes. Repeated-measures regression models (PROC MIXED; SAS Institute), adjusted for all other dietary water sources, were used to quantify the separate effects of solid-F&V and F&V-juice consumption on FWR.

RESULTS

Negative FWR values, which indicated risk of hypohydration, were observed in 22% of children. FWR was significantly higher in solid-F&V consumers with high intakes than in those with low intakes (P < 0.0001). PROC MIXED models predicted an increase of 46 mL in FWR (average in boys and girls) when increasing solid-F&V intake by 100 g. Similar results were observed for F&V juice (β = 43, P < 0.0001). Drinking water and milk were the other significant dietary predictors of FWR. Solid F&Vs and F&V juices contributed 12% and 10%, respectively, to total water intake.

CONCLUSIONS

These data confirm that regular intake of F&Vs may relevantly improve HS in children. Dietary interventions to increase F&V intake may be a promising strategy to achieve positive water balance in this population.

Decreased hydration status of emergency department physicians and nurses by the end of their shift

BACKGROUND

Typical emergency department (ED) shifts are physically demanding. The aim of this study was to assess the hydration status of ED physicians and nurses by the end of their shifts.

METHODS

A prospective cross-sectional clinical study of ED physicians and nurses assessing fluid intake, activities, vital signs, weight, urine specific gravity and ketones at the end of the shift. Forty-three participants were tested over 172 shifts distributed over 48% in the morning, 20% in the evening and 32% at night. Fifty-eight percent were females, and 51% were physicians.

RESULTS

Overall, participants lost 0.3% of their body weight by the end of the shift. While physicians lost a mean of 0.57 kg (± SD 0.28; P < 0.0001, 95% CI 0.16-0.28), nurses lost 0.12 kg (± SD 0.25; P < 0.0001, 95% CI 0.07-1.7). While nurses drank more fluid (P < 0.0001), physicians had a higher specific gravity of 1.025 (P < 0.01), visited the washroom less often (P < 0.0001) and reported less workload and stress (P = 0.01 and 0.008, respectively). There were no major changes in vital signs or urinary ketones (OR.0.41, 95% CI 0.1-2.1). In a multivariate analysis, being male (OR 13.5, 95% CI 1.6-112.5), being of younger age (OR 4.1, 95% CI 1.7-10.2), being Middle Eastern (OR 5.3, 95% CI 1.1-26.2), working the morning shift (OR 2.7, 95% CI 0.7-10.5) and having less fluid intake (OR 5.7, 95% CI 1.2-26.6) were significant predictors of decreased hydration.

CONCLUSIONS

The majority of physicians and to a lesser extent nurses working in a tertiary care emergency department have decreased hydration status at the end of the shift. Therefore, awareness of the hydration status by emergency department staff is needed. A further study in a similar setting with more subjects and a better balance among the variables is recommended.

Behaviors and attitudes associated with low drinking water intake among US adults, Food Attitudes and Behaviors Survey, 2007

INTRODUCTION

Water is vital for life, and plain water is a calorie-free option for hydration. Increasing consumption of drinking water is a strategy to reduce energy intake and lose or maintain weight; however, information on the characteristics of consumers who drink water is limited. Our objective was to describe the characteristics of people who have a low intake of drinking water and to determine associations between their behaviors and attitudes and their intake of water.

METHODS

We analyzed data from a nationally representative sample of 3,397 US adults who participated in the National Cancer Institute's 2007 Food Attitudes and Behaviors Survey. Multivariable logistic regression was used to identify sociodemographic characteristics and health-related behaviors and attitudes associated with self-reported drinking water intake of less than 4 cups per day.

RESULTS

Overall, 7% of adults reported no daily consumption of drinking water, 36% reported drinking 1 to 3 cups, 35% reported drinking 4 to 7 cups, and 22% reported drinking 8 cups or more. The likelihood of drinking less than 4 cups of water daily was significantly higher among participants aged 55 years or older than among those aged 18 to 34 (adjusted odds ratio [AOR], 1.3), among residents of the Northeast than among residents of the South (AOR, 1.4), among participants who consumed 1 cup or less of fruits or vegetables per day than among those who consumed 4.5 cups or more (AOR, 3.0), among participants who did not exercise than among those who exercised 150 minutes or more per week (AOR, 1.7), and among participants who were neither trying to gain nor lose weight than among those trying to lose weight (AOR, 1.3).

CONCLUSION

Low drinking water intake was associated with age, region of residence, and several unhealthful behaviors and attitudes. Understanding characteristics associated with low drinking water intake may help to identify populations that could benefit from interventions to help adults drink more water.

Seasonal blood pressure changes: an independent relationship with temperature and daylight hours

Seasonal blood pressure (BP) changes have been found to be related to either outdoor or indoor temperature. No information regarding the independent effects of temperature measured proximally to the patient, the personal-level environmental temperature (PET), is available. Inclusion of daylight hours in multivariate analysis might allow exploring the independent interaction of BP with seasonality. To investigate whether ambulatory BP monitoring is affected by PET or by seasonality, 1897 patients referred to our hypertension units underwent ambulatory BP monitoring with a battery-powered temperature data logger fitted to the carrying pouch of the monitor. Predictors of 24-hour daytime and nighttime BP and of morning BP surge were investigated with a multivariate stepwise regression model, including age, sex, body mass index, antihypertensive treatment, office BP, ambulatory heart rate, PET, relative humidity, atmospheric pressure, and daylight hours as independent variables. At adjusted regression analysis, daytime systolic BP was negatively related to PET (-0.14; 95% confidence interval, -0.25 to -0.02); nighttime BP was positively related to daylight hours (0.63; 0.37-0.90); and morning BP surge was negatively related to daylight hours (-0.54; -0.87 to -0.21). These results provide new evidence that PET and seasonality (daylight hours) are 2 independent predictors of ambulatory BP monitoring.

Influence of progressive fluid restriction on mood and physiological markers of dehydration in women

The present study evaluated, using a well-controlled dehydration protocol, the effects of 24 h fluid deprivation (FD) on selected mood and physiological parameters. In the present cross-over study, twenty healthy women (age 25 (SE 0.78) years) participated in two randomised sessions: FD-induced dehydration v. a fully hydrated control condition. In the FD period, the last water intake was between 18.00 and 19.00 hours and no beverages were allowed until 18.00 hours on the next day (23-24 h). Water intake was only permitted at fixed periods during the control condition. Physiological parameters in the urine, blood and saliva (osmolality) as well as mood and sensations (headache and thirst) were compared across the experimental conditions. Safety was monitored throughout the study. The FD protocol was effective as indicated by a significant reduction in urine output. No clinical abnormalities of biological parameters or vital signs were observed, although heart rate was increased by FD. Increased urine specific gravity, darker urine colour and increased thirst were early markers of dehydration. Interestingly, dehydration also induced a significant increase in saliva osmolality at the end of the 24 h FD period but plasma osmolality remained unchanged. The significant effects of FD on mood included decreased alertness and increased sleepiness, fatigue and confusion. The most consistent effects of mild dehydration on mood are on sleep/wake parameters. Urine specific gravity appears to be the best physiological measure of hydration status in subjects with a normal level of activity; saliva osmolality is another reliable and non-invasive method for assessing hydration status.

Beverage consumption habits "24/7" among British adults: association with total water intake and energy intake

BACKGROUND

Various recommendations exist for total water intake (TWI), yet it is seldom reported in dietary surveys. Few studies have examined how real-life consumption patterns, including beverage type, variety and timing relate to TWI and energy intake (EI).

METHODS

We analysed weighed dietary records from the National Diet and Nutrition Survey of 1724 British adults aged 19-64 years (2000/2001) to investigate beverage consumption patterns over 24 hrs and 7 days and associations with TWI and EI. TWI was calculated from the nutrient composition of each item of food and drink and compared with reference values.

RESULTS

Mean TWI was 2.53 L (SD 0.86) for men and 2.03 L (SD 0.71) for women, close to the European Food Safety Authority "adequate Intake" (AI) of 2.5 L and 2 L, respectively. However, for 33% of men and 23% of women TWI was below AI and TWI:EI ratio was <1 g/kcal. Beverages accounted for 75% of TWI. Beverage variety was correlated with TWI (r 0.34) and more weakly with EI (r 0.16). Beverage consumption peaked at 0800 hrs (mainly hot beverages/ milk) and 2100 hrs (mainly alcohol). Total beverage consumption was higher at weekends, especially among men. Overall, beverages supplied 16% of EI (men 17%, women 14%), alcoholic drinks contributed 9% (men) and 5% (women), milk 5-6%, caloric soft drinks 2%, and fruit juice 1%.In multi-variable regression (adjusted for sex, age, body weight, smoking, dieting, activity level and mis-reporting), replacing 100 g of caloric beverages (milk, fruit juice, caloric soft drinks and alcohol) with 100 g non-caloric drinks (diet soft drinks, hot beverages and water) was associated with a reduction in EI of 15 kcal, or 34 kcal if food energy were unchanged. Using within-person data (deviations from 7-day mean) each 100 g change in caloric beverages was associated with 29 kcal change in EI or 35 kcal if food energy were constant. By comparison the calculated energy content of caloric drinks consumed was 47 kcal/100 g.

CONCLUSIONS

TWI and beverage consumption are closely related, and some individuals appeared to have low TWI. Compensation for energy from beverages may occur but is partial. A better understanding of interactions between drinking and eating habits and their impact on water and energy balance would give a firmer basis to dietary recommendations.

Beverage consumption habits "24/7" among British adults: association with total water intake and energy intake

Background

Various recommendations exist for total water intake (TWI), yet it is seldom reported in dietary surveys. Few studies have examined how real-life consumption patterns, including beverage type, variety and timing relate to TWI and energy intake (EI).

Methods

We analysed weighed dietary records from the National Diet and Nutrition Survey of 1724 British adults aged 19–64 years (2000/2001) to investigate beverage consumption patterns over 24 hrs and 7 days and associations with TWI and EI. TWI was calculated from the nutrient composition of each item of food and drink and compared with reference values.

Results

Mean TWI was 2.53 L (SD 0.86) for men and 2.03 L (SD 0.71) for women, close to the European Food Safety Authority “adequate Intake” (AI) of 2.5 L and 2 L, respectively. However, for 33% of men and 23% of women TWI was below AI and TWI:EI ratio was <1 g/kcal. Beverages accounted for 75% of TWI. Beverage variety was correlated with TWI (r 0.34) and more weakly with EI (r 0.16). Beverage consumption peaked at 0800 hrs (mainly hot beverages/ milk) and 2100 hrs (mainly alcohol). Total beverage consumption was higher at weekends, especially among men. Overall, beverages supplied 16% of EI (men 17%, women 14%), alcoholic drinks contributed 9% (men) and 5% (women), milk 5-6%, caloric soft drinks 2%, and fruit juice 1%.

In multi-variable regression (adjusted for sex, age, body weight, smoking, dieting, activity level and mis-reporting), replacing 100 g of caloric beverages (milk, fruit juice, caloric soft drinks and alcohol) with 100 g non-caloric drinks (diet soft drinks, hot beverages and water) was associated with a reduction in EI of 15 kcal, or 34 kcal if food energy were unchanged. Using within-person data (deviations from 7-day mean) each 100 g change in caloric beverages was associated with 29 kcal change in EI or 35 kcal if food energy were constant. By comparison the calculated energy content of caloric drinks consumed was 47 kcal/100 g.

Conclusions

TWI and beverage consumption are closely related, and some individuals appeared to have low TWI. Energy from beverages may be partly compensated. A better understanding of interactions between drinking and eating habits and their impact on water and energy balance would give a firmer basis to dietary recommendations.

Sugary beverages represent a threat to global health

Sugary beverages represent a major global threat to the health of all populations. The shifts in distribution, marketing, and sales have made them the plague of the globe in terms of obesity, diabetes, and a host of other chronic health problems. The fructose-laden beverages have unique properties that lead to lack of dietary compensation and direct adverse effects on our health. Global efforts to limit marketing and sales are necessary to protect the health of the planet.