Water, hydration, and health

Neurogenic Bowel and Management after Spinal Cord Injury: A Narrative Review

People with spinal cord injury (SCI) suffer from the sequela of neurogenic bowel and its disabling complications primarily constipation, fecal incontinence, and gastrointestinal (GI) symptoms. Neurogenic bowel is a functional bowel disorder with a spectrum of defecatory disorders as well as colonic and gastrointestinal motility dysfunction. This manuscript will review the anatomy and physiology of gastrointestinal innervation, as well as the pathophysiology associated with SCI. It will provide essential information on the recent guidelines for neurogenic bowel assessment and medical management. This will allow medical providers to partner with their patients to develop an individualized bowel plan utilizing a combination of various pharmacological, mechanical and surgical interventions that prevent complications and ensure successful management and compliance. For people with SCI and neurogenic bowel dysfunction, the fundamental goal is to maintain health and well-being, promote a good quality of life and support active, fulfilled lives in their homes and communities.

Landscaping the Behavioural Ecology of Primate Stone Tool Use

Ecology is fundamental in the development, transmission, and perpetuity of primate technology. Previous studies on tool site selection have addressed the relevance of targeted resources and raw materials for tools, but few have considered the broader foraging landscape. In this landscape-scale study of the ecological contexts of wild chimpanzee (Pan troglodytes verus) tool use, we investigated the conditions required for nut-cracking to occur and persist in discrete locations at the long-term field site of Bossou, Guinea. We examined this at three levels: selection, frequency of use, and inactivity. We collected data on plant foods, nut trees, and raw materials using transect and quadrat methods, and conducted forest-wide surveys to map the location of nests and watercourses. We analysed data at the quadrat level (n = 82) using generalised linear models and descriptive statistics. We found that, further to the presence of a nut tree and availability of raw materials, abundance of food-providing trees as well as proximity to nest sites were significant predictors of nut-cracking occurrence. This suggests that the spatial distribution of nut-cracking sites is mediated by the broader behavioural landscape and is influenced by non-extractive foraging of perennial resources and non-foraging activities. Additionally, the number of functional tools was greater at sites with higher nut-cracking frequency, and was negatively correlated with site inactivity. Our research indicates that the technological landscape of Bossou chimpanzees shares affinities with the ‘favoured places’ model of hominin site formation, providing a comparative framework for reconstructing landscape-scale patterns of ancient human behaviour. A French translation of this abstract is provided in theelectronic supplementary information: EMS 2.

Dealing with dehydration in hospitalized oldest persons: accuracy of the calculated serum osmolarity

BACKGROUND

 Assessment of hydration status is complex and difficult to detect in older persons. Different methods have been developed to determine hydration status in clinical settings, but their diagnostic accuracy remains questionable.

AIMS

The aim of this study was to determine and compare the diagnostic accuracy of all methods routinely used in acute settings to detect dehydration in a cohort of hospitalized oldest-old persons, using as primary reference standard blood urea nitrogen (BUN) to creatinine ratio.

METHODS

 This retrospective study was conducted on 59 oldest-old subjects at hospital admission in an acute setting, with complete physical, biochemical, bioelectrical impedance analysis (BIA) and ultrasound assessment, including inferior vena cava diameters.

RESULTS

Fifty-nine (45 women/14 men) subjects, with a mean age of 87.4 ± 5.9 years, were studied. Based on the value of the BUN/creatinine ratio, the whole population was divided into hyperhydrated (n = 10), normohydrated (n = 42), and dehydrated (n = 7) groups. Among parameters indicating the hydration status, serum sodium levels (p < 0.0001), serum chloride levels (p = 0.010), calculated plasma osmolarity (p < 0.0001), and fat mass (FM) (p = 0.030) differed significantly among groups. A ROC analysis showed that the highest and most significant value for dehydration detection was the calculated plasma osmolarity (AUC: 0.820, p = 0.013), which significantly correlated with clinical parameters including heart rate (r = 0.300; p = 0.021), capillary refill (r = 0.379; p = 0.013) and systolic blood pressure (r = - 0.261; p = 0.046).

DISCUSSION

The measurement of calculated serum osmolarity is simple and inexpensive and may quickly provide high sensitivity and specificity indication of dehydration in hospitalized oldest-old persons.

Drinking Gesture Detection Using Wrist-Worn IMU Sensors with Multi-Stage Temporal Convolutional Network in Free-Living Environments

Maintaining adequate hydration is important for health. Inadequate liquid intake can cause dehydration problems. Despite the increasing development of liquid intake monitoring, there are still open challenges in drinking detection under free-living conditions. This paper proposes an automatic liquid intake monitoring system comprised of wrist-worn Inertial Measurement Units (IMU s) to recognize drinking gesture in free-living environments. We build an end-to-end approach for drinking gesture detection by employing a novel multi-stage temporal convolutional network (MS-TCN). Two datasets are collected in this research, one contains 8.9 hours data from 13 participants in semi-controlled environments, the other one contains 45.2 hours data from 7 participants in free-living environments. The Leave-One-Subject-Out (LOSO) evaluation shows that this method achieves a segmental F1-score of 0.943 and 0.900 in the semi-controlled and free-living datasets, respectively. The results also indicate that our approach outperforms the convolutional neural network and long-short-term-memory network combined model (CNN-LSTM) on our datasets. The dataset used in this paper is available at https://github.com/Pituohai/drinking-gesture-dataset/. Clinical Relevance- This automatic liquid intake monitoring system can detect drinking gesture in daily life. It has the potential to be used to record the frequency of drinking water for at-risk elderly or patients in the hospital.

COVID-19 and Nutrition: Summary of Official Recommendations

Medical nutrition therapy may have a key role in the COVID-19 pandemic. Given the spread of misinformation, the present review organizes and summarizes nutrition recommendations regarding COVID-19, serving as a reference guide for health professionals. Nineteen official recommendations were included of international, US, Asian, European, Canadian, and Australian origin on (i) lactation, (ii) nutrition during quarantine, (iii) nutrition in high-risk groups, (iv) nutrition for recovery at home, and (v) nutrition in hospital. Breastfeeding is encouraged, and the role of hydration and the adoption of a healthy diet during quarantine are emphasized. Older people and/or people with comorbidities should be checked for malnutrition and follow a healthy diet. For patients recovering at home, hydration, protein, and energy intake should be ensured. For hospitalized patients, early feeding with a priority on enteral route is recommended.

Renal transcriptome profiles in mice reveal the need for sufficient water intake irrespective of the drinking water type

This study sought to characterize the impact of long-term dehydration in terms of physiological and biochemical parameters, as well as renal transcriptomes. Furthermore, we assessed whether consumption of specific types of water elicit more beneficial effects on these health parameters. To this end, C57BL/6 mice were either provided water for 15 min/day over 2 and 4 weeks (water restricted; RES), or ad libitum access to distilled (CON), tap, spring, or purified water. Results show that water restriction decreases urine output and hematocrit levels while increasing brain vasopressin mRNA levels in RES mice compared to control mice (CON). Meanwhile, blood urea nitrogen and creatinine levels were higher in the RES group compared to the CON group. Kidney transcriptome analysis further identified kidney damage as the most significant biological process modulated by dehydration. Mechanistically, prolonged dehydration induces kidney damage by suppressing the NRF2-signaling pathway, which targets the cytoprotective defense system. However, type of drinking water does not appear to impact physiological or blood biochemical parameters, nor the renal transcriptome profile, suggesting that sufficient water consumption is critical, irrespective of the water type. Importantly, these findings also inform practical action for environmental sustainability by providing a theoretical basis for reducing bottled water consumption.

International society of sports nutrition position stand: tactical athlete nutrition

This position stand aims to provide an evidence-based summary of the energy and nutritional demands of tactical athletes to promote optimal health and performance while keeping in mind the unique challenges faced due to work schedules, job demands, and austere environments. After a critical analysis of the literature, the following nutritional guidelines represent the position of the International Society of Sports Nutrition (ISSN).

General Recommendations

Nutritional considerations should include the provision and timing of adequate calories, macronutrients, and fluid to meet daily needs as well as strategic nutritional supplementation to improve physical, cognitive, and occupational performance outcomes; reduce risk of injury, obesity, and cardiometabolic disease; reduce the potential for a fatal mistake; and promote occupational readiness.

Military Recommendations

Energy demands should be met by utilizing the Military Dietary Reference Intakes (MDRIs) established and codified in Army Regulation 40-25. Although research is somewhat limited, military personnel may also benefit from caffeine, creatine monohydrate, essential amino acids, protein, omega-3-fatty acids, beta-alanine, and L-tyrosine supplementation, especially during high-stress conditions.

First Responder Recommendations

Specific energy needs are unknown and may vary depending on occupation-specific tasks. It is likely the general caloric intake and macronutrient guidelines for recreational athletes or the Acceptable Macronutrient Distribution Ranges for the general healthy adult population may benefit first responders. Strategies such as implementing wellness policies, setting up supportive food environments, encouraging healthier food systems, and using community resources to offer evidence-based nutrition classes are inexpensive and potentially meaningful ways to improve physical activity and diet habits. The following provides a more detailed overview of the literature and recommendations for these populations.

Acute Water Supplementation Improved the Body Composition of Young Female Adults After Water Restriction of 12 h in Baoding, China: A Randomized Controlled Trial (RCT)

Insufficient intake of water may influence the balance of water in the human body. In this study, we explore the impacts of water supplementation on body composition indices among young adults after 12 h of water restriction, with the aim to determine the optimum volume of water for improving body water composition. A randomized controlled trial study was conducted among 64 young men and women in Baoding, China. After fasting overnight for 12 h, anthropometric measurements and urine and blood samples were collected as a baseline test at 8:00 a.m. of Day 2. Body composition was determined by measuring the ECW (extracellular water), ICW (intracellular water), and TBW (total body water) through bioelectrical impedance analysis (BIA). The participants were randomly divided into four groups, including water supplementation (WS) groups 1, 2, and 3, with 500, 200, and 100 mL of water, respectively, and a no water supplementation (NW) group. After 90 min, they were reassessed in a rehydration test (at 10:00 a.m. of Day 2). Repeated measurement ANOVA was used to assess the impact of water supplementation on body composition. Comparing the baseline and rehydration tests, interactions between time and volume were not significant among the men (all p > 0.05). Among women, a significant interaction was only found in ECW (p = 0.043), with TBW tending toward being significant (p = 0.055). Comparing the baseline and rehydration tests, the ECW in WS group 1, WS group 3, and the NW group all decreased (p = 0.028, p = 0.001, and p = 0.029), with reductions of 0.1, 0.3, and 0.2 kg, respectively; however, no significant decrease was observed in WS group 2 (p = 0.329). Furthermore, comparing the WS groups with the NW group in the rehydration test, the differences were not significant (p = 1.000, p = 1.000, and p = 0.288, respectively). Between men and women within groups, all of the body composition indices differed significantly, both at baseline and rehydration tests (all p < 0.05). Water supplementation led to changes in the distribution of the water content in young female adults in this study-but not men-after 12 h of water restriction, with no decrease in ECW. Finally, we found that 200 mL was the minimum volume capable of improving the water content distribution in participants in this study.

Trial Registration

[www.chictr.org.cn], identifier [ChiCTR-IOR-17011568].

Automated Urinal-Based Specific Gravity Measurement Device for Real-Time Hydration Monitoring in Male Athletes

Acute and chronic hydration status is important for athlete safety and performance and is frequently measured by sports scientists and performance staff in team environments via urinalysis. However, the time required for urine collection, staff testing, and reporting often delays immediate reporting and personalized nutrition insight in situations of acute hydration management before training or competition. Furthermore, the burdensome urine collection and testing process often renders chronic hydration monitoring sporadic or non-existent in real-world settings. An automated urinalysis device (InFlow) was developed to measure specific gravity, an index of hydration status, in real-time during urination. The device was strongly correlated to optical refractometry with a mean absolute error of 0.0029 (±0.0021). Our results show this device provides a novel and useful approach for real-time hydration status via urinalysis for male athletes in team environments with high testing frequency demands.

Non-alcoholic beverages intake and risk of CVD among Japanese men and women: the Japan Public Health Center study

The association between the intake of non-alcoholic beverages and CVD in Asians is uncertain. The intake of non-alcoholic beverages was estimated in 77 407 participants of the Japan Public Health Centre-based cohort study aged 45-74 years. The Cox regression calculated the hazard ratios (HR) and 95 % CI for incident CVD according to sex-specific quintiles of intake of non-alcoholic beverages. A total of 4578 incident CVD (3751 strokes and 827 CHD) were diagnosed during a 13·6-year median follow-up. The risks of stroke and total CVD were lower for the highest v. lowest intake quintiles of non-alcoholic beverages in men and women: the multivariable HRs (95 % CIs) were 0·82 (0·71, 0·93, P_trend = 0·005) and 0·86 (0·76, 0·97, P_trend = 0·02), respectively, in men and were 0·73 (0·63, 0·86, P_trend = 0·003) and 0·75 (0·65, 0·87, P_trend = 0·005), respectively, in women. The reduced risk was evident for both ischaemic and haemorrhagic strokes and was mainly attributable to green tea consumption. The intake of non-alcoholic beverages from coffee and other beverages was not associated with the risk of CVD in both men and women. Also, there was no association between the intake of non-alcoholic beverages and the risk of CHD in either sex. In conclusion, the risks of stroke and total CVD were lower with a higher intake of non-alcoholic beverages in Japanese men and women.

Effective food hygiene principles and dietary intakes to reinforce the immune system for prevention of COVID-19: a systematic review

Background

This study aimed at reviewing effective food hygiene principles and dietary intakes to reinforce the immune system for prevention of corona virus disease 2019 (COVID-19).

Methods

The systematic literature search was performed in three databases from Jan. 2020 up to 10^th July 2020. English articles that focused on nutrition, food, immunity and corona virus were searched. Systematic and narrative reviews were included.

Results

After evaluation of search papers, 27 relevant articles were used in this review. The importance of nutrients, phytochemicals, probiotics and some spices were highlighted for enhancing immunity during the COVID-19 pandemic. A healthy dietary pattern with proper energy intake provides sufficient nutrients. The unhealthy dietary pattern is linked with inflammation and risk factors related to high mortality in patients with severe COVID-19 infection. Different thermal procedures have been used for the inactivation of viruses. It is recommended not to consume raw or undercooked animal products.

Conclusions

It is critical to ensure that the nutritional needs of the population are met and sustained based on standards during a COVID-19 pandemic. Clear advice on adequate calorie intake and an optimal healthy diet to support the immune function should be provided. Good hygiene practices must be performed by everyone and done in the food industry.

Nutritional Wellness for the Busy Health Care Provider: Small Everyday Wins

When describing health care provider wellness, diet and nutrition are typically not addressed. This, in combination with the lack of decent food and diet resources typically available to the typically busy health care provider, exposes a significant gap in the road to advancing clinician wellness. This article aims to describe the relationship between nutrition and well-being, and potential barriers to optimal nutrition encountered by health care providers in the workplace. Readily available and practical strategies to improve physician diet and nutrition include: mindful eating practices, home meal preparation, food journaling, and mobile applications. From an organizational level, once physicians are making more informed food choices it is the hospital's responsibility to make nutritional options available in the workplace.

Factors Related to Water Filter Use for Drinking Tap Water at Home and Its Association With Consuming Plain Water and Sugar-Sweetened Beverages Among U.S. Adults

OBJECTIVE

To examine factors associated with water filter use (WFU) for drinking tap water at home and its association with consuming plain water and sugar-sweetened beverages (SSBs).

DESIGN

Quantitative, cross-sectional study.

SETTING

The 2018 SummerStyles survey data.

SUBJECTS

U.S. adults (≥18 years; N=4042).

MEASURES

Outcomes were intake of plain water (tap/bottled water) and SSBs. Exposure was WFU (yes, no, not drinking tap water at home). Covariates included sociodemographics, weight status, Census regions, and home ownership status.

ANALYSIS

We used multivariable logistic regressions to estimate adjusted odds ratios (AOR) and 95% confidence interval (CI) for consuming tap water, bottled water, or total plain water >3 cups/day (vs. ≤3 cups) and SSBs ≥1 time/day (vs. <1 time) by WFU.

RESULTS

Overall, 36% of adults reported using a filter for drinking tap water at home; 14% did not drink tap water at home. Hispanics had significantly higher odds of using a water filter (AOR=1.50, 95% CI=1.14-1.98) vs non-Hispanic White. Factors significantly associated with lower odds of WFU were lower education (AOR=.69, 95% CI=.55-.86 for ≤high school; AOR=.78, 95% CI=.64-.95 for some college, vs college graduate), not being married (AOR=.81, 95% CI=.66-.98, vs married/domestic partnership), and lower household income (AOR=.68, 95% CI=.68-.90 for <$35,000, vs ≥$100,000). Using a water filter was associated with higher odds of drinking >3 cups/day of tap water (AOR=1.33, 95% CI=1.13-1.56) and lower odds of SSBs ≥1 time/day (AOR=.76, 95% CI=.62-.92). Not drinking tap water at home was associated with higher odds of drinking >3 cups/day bottled water (AOR=3.46, 95% CI=2.70-4.44).

CONCLUSIONS

WFU was associated with higher tap water intake and lower SSB intake among U.S. adults. WFU was higher among Hispanics, but lower among those with lower education and income and not married adults. Although WFU was associated with healthful beverage habits, additional considerations for WFU may include source water quality, oral health, cost, and proper use.

Is Inadequate Water Intake a Risk Factor for Vestibular Disorders?

BACKGROUND

Water is a vital nutrient for the human body system and failing to consume enough water could cause health problems. The purpose of this study is to investigate the relationship between water intake and vestibular system disorders.

METHODS

Data from 93 patients (aged between 20 and 76 years) with vestibular disorders were analyzed in the study. The mean age of the patients was 46.96 ±13.94 years (female: 45.68 ±13.45, male: 49.96 ±14.85), and 69.9% (n=65) were female. Participants were sub-categorized into diagnostic groups as follows: benign paroxysmal positional vertigo, Meniere's disease, vestibular neuritis, vestibular migraine, and persistent postural perceptual dizziness. The water intake information was analyzed for total water, plain water, and caffeinated beverages separately and compared between groups.

RESULTS

There was a significant difference between vestibular neuritis and benign paroxysmal positional vertigo (P < .001) and also between vestibular neuritis and Meniere's disease (P = .021) in terms of the intake values of plain water and total water. No significant difference was found between groups in caffeinated beverages intake (P = .151), and it was found that there is no statistically significant difference in plain water and total water intake in terms of gender (P > .05).

CONCLUSION

The most significant result of this study is that inadequate water intake can be a risk factor for some forms of peripheral vestibular disorders. People should be informed about the importance of drinking water and be encouraged to increase their water intake.

Response to a Water Bolus in Long Term Oral Contraceptive Users

The purpose of our study was to determine the responses to an acute water bolus in long-term oral contraception (OCP) users. Seventeen female volunteers (27 ± 5 y, 64.1 ± 13.7 kg, 39.6 ± 5.9 kg/LBM) provided consent and enrolled in our study. All were long-term OCP users and participated in two trials, one during the active pill (High Hormone, HH) dose of their prescribed OCP and one during the sham pill (Low Hormone, LH) dose. Participants reported to the laboratory euhydrated, were fed breakfast, remained seated for 60 min and were provided a bolus of room temperature water in the amount of 12 mL/kg/LBM. Urine output over 180 min was measured. Nude body mass was measured pre- and post-trial. Urine specific gravity (USG) and urine osmolality were analyzed. Between trials, there were no differences in 3-h total urine volume (P = 0.296), 3-h USG (P = 0.225), 3-h urine osmolality (P = 0.088), or 3-h urine frequency (P = 0.367). Heart rate was not different between trials (P = 0.792) nor over time (P = 0.731). Mean arterial pressure was not different between trials (P = 0.099) nor over time (P = 0.262). Perceived thirst demonstrated a significant main effect for increasing over time regardless of trial (P &lt; 0.001) but there was no difference between trials (P = 0.731). The urgency to void was not different between trials (P = 0.149) nor over time (P = 0.615). Plasma volume change was not different between trials (P = 0.847) (HH: −3.4 ± 5.0, LH post: −3.8 ± 4.5%) and plasma osmolality did not differ between trials (P = 0.290) nor over time (P = 0.967) (HH pre: 290 ± 4, HH post: 289 ± 4, LH pre: 291 ± 4, LH post: 291 ± 4 mosm/L). Blood glucose significantly decreased over time (P &lt; 0.001) but there was no difference between trials (P = 0.780) (HH pre: 95.9 ± 113.9, HH post: 86.8 ± 6.5, LH pre: 95.9 ± 13.5, LH post: 84.6 ± 9.4 mmol/L). Copeptin concentration did not differ between phases of OCP use (P = 0.645) nor from pre- to post-trial (P = 0.787) Despite fluctuations in hormone concentrations, responses to a water bolus seem to be unaffected in OCP users in euhydrated, resting conditions.

Effect of School Water, Sanitation, and Hygiene on Health Status Among Basic Level Students' in Nepal

Background

Access to drinking Water, Sanitation, and Hygiene (WASH) at schools are the basic determinants of a child's right to healthy and quality education. In Nepal, most of the schools had limited WASH facilities, including separate sanitation facilities for girls. The limited WASH facilities, unsafe drinking water, poor sanitation, and hygiene practices result in irresponsible behaviors that directly impede on students' health. This study examines the association between WASH services and health status of basic level students', ranging sixth to eighth grades. In Nepal, basic level education consists up to eighth standards from grade 1.

Methods

The study applies causal-comparative research design within 2 groups; 1 having improved WASH and another without improved WASH services at the schools in Dhanusha and Chitwan districts of Nepal. Each group consists 2 schools, so altogether 4 schools were included in this study. Total 768, equal 384 respondents were selected from each improved and without improved WASH facilities. The study was conducted in between January and March 2021 at a single-phase time. The sample size was calculated using the standard statistical formula for the infinite population. The study applied quantitative research method, including 3 sorts of analysis; univariate, bivariate, and the multivariate. The univariate was applied to analyze the frequency and percentages of the respondents. Bivariate analysis was made applying chi2 test in order to show the association between 2 variables, whereas the multivariate logistic regression was performed through multilevel modeling to show the effects of school WASH facilities on students' health status.

Results

Out of 768 students', 384 (50%) were from improved and 384 (50%) were from unimproved WASH facilities at schools. More than two third (64%) of respondents from the unimproved and higher than two fifth (41%) from the improved schools got sickness (P <.001). Further, three fifth (59%) of respondents aged 15 to 19 and higher than half (51%) of respondents ages of 10 to 14 years got sickness (P <.05). Most (57%) of the female respondents had sickness compared to males (47%), (P <.05). More than two-thirds (67%) of respondents from Dalit and nearly two-thirds (62%) of respondents from Brahmin/Chhetri-Terai more often found being sick in unimproved schools compared to other castes (55%), Janajati (43%), and Brahmin/Chhetri-Hill (39%) (P <.001). The school WASH services has significant effect (cOR = 0.388, CI; 290-0.519, P <.001) on students health status, even adjusting other socio-covariates (aOR = .442, CI; 0.302-0.646, P <.001). The female respondents were more likely to fall sick (aOR = 678, CI; 0.502-0.915, P <.01) compared to the male respondents keeping all other variables constant in the model.

Conclusion

The study recommends to extend WASH awareness program to school families, particularly to the students as there is an evident need to increase preventive as well as the therapeutic efficacy of the potential infections.

Public Knowledge and Perception of Drinking Water Quality and Its Health Implications: An Example from the Makueni County, South-Eastern Kenya

Due to the semi-arid nature of Makueni County in South-Eastern Kenya, there is a high dependence on groundwater resources for domestic use. Reliance on this source of potable water may have health implications for the population, given the presence of several naturally occurring and potentially harmful elements reported from aquifer source rocks, soil, and water in the area. A survey involving questionnaires and focus group discussions (FGDs) was conducted with 115 individuals to determine the local population’s knowledge, attitude, and perceptions of their drinking water quality and its health impacts. The results show that most respondents (67%) preferred piped water because it was pre-treated and not saline. Only 29% of the respondents were very satisfied with the taste of their drinking water, while the rest complained about varying salinity levels, ranging from slightly salty to very salty. This low satisfaction might have influenced the low daily drinking water consumption (1–2 L) by most respondents. Health issues reported by many (43%) respondents in the area include diarrhoea and gastrointestinal upsets, which may be associated with the saline nature of the drinking water. Elevated fluoride (F−) in the local groundwater was reported, and the health effects remain a concern. Although 91% knew someone with dental fluorosis, 53% did not know the deleterious effects of high F− in drinking water. Most respondents (59%) associated the salty nature of the water with dental fluorosis, and as a result, 48% avoided drinking the salty water to prevent the condition. Despite the high prevalence and known psycho-social effects, most people did not perceive dental fluorosis as a severe health threat. The increased health risks associated with high salinity and high F− in drinking water in Makueni County are poorly understood by most residents, regardless of their education, gender, or age. This warrants an immediate public health education programme and detailed epidemiological studies to determine all the health effects associated with naturally occurring, potentially harmful elements in groundwater in the area.

Time to drink: Activating lateral hypothalamic area neurotensin neurons promotes intake of fluid over food in a time-dependent manner

The lateral hypothalamic area (LHA) is essential for ingestive behavior but has primarily been studied in modulating feeding, with comparatively scant attention on drinking. This is partly because most LHA neurons simultaneously promote feeding and drinking, suggesting that ingestive behaviors track together. A notable exception are LHA neurons expressing neurotensin (LHANts neurons): activating these neurons promotes water intake but modestly restrains feeding. Here we investigated the connectivity of LHANts neurons, their necessity and sufficiency for drinking and feeding, and how timing and resource availability influence their modulation of these behaviors. LHANts neurons project broadly throughout the brain, including to the lateral preoptic area (LPO), a brain region implicated in modulating drinking behavior. LHANts neurons also receive inputs from brain regions implicated in sensing hydration and energy status. While activation of LHANts neurons is not required to maintain homeostatic water or food intake, it selectively promotes drinking during the light cycle, when ingestive drive is low. Activating LHANts neurons during this period also increases willingness to work for water or palatable fluids, regardless of their caloric content. By contrast, LHANts neuronal activation during the dark cycle does not promote drinking, but suppresses feeding during this time. Finally, we demonstrate that the activation of the LHANts → LPO projection is sufficient to mediate drinking behavior, but does not suppress feeding as observed after generally activating all LHANts neurons. Overall, our work suggests how and when LHANts neurons oppositely modulate ingestive behaviors.

Water and Beverages Intake Among Workers Amid the COVID-19 Pandemic in Indonesia

As the COVID-19 pandemic hit worldwide in the early 2020, people were urged to alter their behavior to prevent disease spread, thus, led to change water intake. This study aimed to analyze water and beverage intake among health workers and general workers during COVID-19 pandemic in Indonesia. This study was a comparative descriptive study where the participants were 20–45-year-old health workers and general workers in Indonesia. Data collected included demographic, water and beverage intake, physical activity, nutrient intake, and body weight and height. All data collection was obtained online using self-reported questionnaire. Water intake data was collected for 7 days consecutively using a 7-day fluid record. There were 246 participants comprised of 102 (41.5%) general workers and 144 (58.5%) health workers who were analyzed in this study. All participants showed barely adequate intake of daily total fluid 1,882 (1,473–2,433) ml/day. Total fluid intake among general workers was 1,759 (1,447–2,396) ml/day, whereas in health workers it was slightly higher 1,939 (1,516–2,446) ml/day (p-value = 0.378). Among health workers who were highly exposed to patients with COVID-19 showed the highest percentage in drinking water adequately (20 participants, 60.6%) compared to health workers who worked under moderate (29 participants, 48.3%) and low (24 participants, 47.2%) level of exposure to patients with COVID-19. In conclusion, workers need to improve their daily fluid intake. This study also showed better behavior of water consumption among health workers compared to general workers despite of their strict personal protection equipment during working hour.

Osmotic Stress Interferes with DNA Damage Response and H2AX Phosphorylation in Human Keratinocytes

The human skin and in particular its outermost layer, the epidermis, protects the body from potentially harmful substances, radiation as well as excessive water loss. However, the interference between the various stress responses of the epidermal keratinocytes, which often occur simultaneously, is largely unknown. The focus of this study was to investigate the interference between osmotic stress and DNA damage response. In addition to revealing the already well-described regulation of diverse gene sets, for example, cellular processes such as transcription, translation, and metabolic pathways (e.g., the KEGG citrate cycle and Reactome G2/M checkpoints), gene expression analysis of osmotically stressed keratinocytes revealed an influence on the transcription of genes also related to UV-induced DNA damage response. A gene network regulating the H2AX phosphorylation was identified to be regulated by osmotic stress. To analyze and test the interference between osmotic stress and DNA damage response, which can be triggered by UV stress on the one hand and oxidative stress on the other, in more detail, primary human keratinocytes were cultured under osmotic stress conditions and subsequently exposed to UV light and H2O2, respectively. γH2AX measurements revealed lower γH2AX levels in cells previously cultured under osmotic stress conditions.

Exposure to microcystin-LR in tropical reservoirs for water supply poses high risks for children and adults

While the presence of microcystin-LR (MC-LR) in raw water from eutrophic reservoirs poses human health concerns, the risks associated with the ingestion of MC-LR in drinking water are not fully elucidated. We used a time series of MC-LR in raw water from tropical urban reservoirs in Brazil to estimate the hazard quotients (HQs) for non-carcinogenic health effects and the potential ingestion of MC-LR through drinking water. We considered scenarios of MC-LR removal in the drinking water treatment plants (DWTPs) of two supply systems (Cascata and Guarapiranga). The former uses coagulation/flocculation/sedimentation/filtration/disinfection, while the latter has an additional step of membrane ultrafiltration, with contrasting expected MC-LR removal efficiencies. We considered reference values for infants (0.30 μg L^-1), children/adults (1.60 μg L^-1), or the population in general (1.0 μg L^-1). For most scenarios for Cascata, the 95% upper confidence level of the HQ indicated high risks of exposure for the population (HQ > 1), particularly for infants (HQ = 30.910). The water treatment in Cascata was associated to the potential exposure to MC-LR due to its limited removal capacity, with up to 263 days/year with MC-LR above threshold values. The Guarapiranga system had the lowest MC-LR in the raw water as well as higher expected removal efficiencies in the DWTP, resulting in negligible risks. We reinforce the importance of integrating raw water quality characteristics and treatment technologies to reduce the risks of exposure to MC-LR, especially for vulnerable population groups. Our results can serve as a starting point for risk management strategies to minimize cases of MC-LR intoxication in Brazil and other developing countries.

Cleaning of Wastewater Using Crosslinked Poly(Acrylamide-co-Acrylic Acid) Hydrogels: Analysis of Rotatable Bonds, Binding Energy and Hydrogen Bonding

The discharge of untreated wastewater, often contaminated by harmful substances, such as industrially used dyes, can provoke environmental and health risks. Among various techniques, the adsorption of dyes, using three-dimensional (3D) networks consisting of hydrophilic polymers (hydrogels), represents a low-cost, clean, and efficient remediation method. Three industrially used dyes, Methylene Blue, Eosin, and Rose Bengal, were selected as models of pollutants. Poly(acrylamide) (poly(AM)) and poly(acrylamide-co-acrylic acid) (poly(AM-co-AA)) networks were chosen as adsorbent materials (hydrogels). These polymers were synthesized by crosslinking the photopolymerization of their respective monomer(s) in an aqueous medium under exposure to UV light. Experimental adsorption measurements revealed substantially higher dye uptakes for poly(AM-co-AA) compared to poly(AM) hydrogels. In this report, a theoretical model based on docking simulations was applied to analyze the conformation of polymers and pollutants in order to investigate some aspects of the adsorption process. In particular, hydrogen and halogen interactions were studied. The presence of strong hydrogen bonding plays a crucial role in the retention of dyes, whereas halogen bonding has a small or negligible effect on adsorption. An evaluation of binding energies allowed us to obtain information about the degree of affinity between polymers and dyes. The number of rotatable bonds in the copolymer exceeds those of poly(AM),meaning that poly(AM-co-AA) is revealed to be more suitable for obtaining a high retention rate for pollutants.

Water - A life-giving toxin - A nephrological oxymoron. Health consequences of water and sodium balance disorders. A review article

BACKGROUND

This article aims to reveal misconceptions about methods of assessment of hydration status and impact of the water disorders on the progression of kidney disease or renal dysfunction.

MATERIALS AND METHODS

The PubMed database was searched for reviews, meta-analyses and original articles on hydration, volume depletion, fluid overload and diagnostic methods of hydration status, which were published in English.

RESULTS

Based on the results of available literature the relationship between the amount of fluid consumed, and the rate of progression of chronic kidney disease, autosomal dominant polycystic kidney disease, and kidney stones disease was discussed. Selected aspects of the assessment of the hydration level in clinical practice based on physical examination, laboratory tests, and imaging are presented. The subject of in-hospital fluid therapy is discussed. Based on available randomized studies, an attempt was made to assess, which fluids should be selected for intravenous treatment.

CONCLUSIONS

There is some evidence for the beneficial effect of increased water intake in preventing recurrent cystitis and kidney stones, but there are still no convincing data for chronic kidney disease and autosomal dominant polycystic kidney disease. Further studies are needed to clarify the aforementioned issues and establish a reliable way to assess the volemia and perform suitable fluid therapy.

Obesity history, physical exam, laboratory, body composition, and energy expenditure: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on History, Physical Exam, Body Composition and Energy Expenditure is intended to provide clinicians an overview of the clinical and diagnostic evaluation of patients with pre-obesity/obesity.

Methods

The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results

This CPS outlines important components of medical, dietary, and physical activity history as well as physical exams, with a focus on specific aspects unique to managing patients with pre-obesity or obesity. Patients with pre-obesity/obesity benefit from the same preventive care and general laboratory testing as those without an increase in body fat. In addition, patients with pre-obesity/obesity may benefit from adiposity-specific diagnostic testing - both generally and individually - according to patient presentation and clinical judgment. Body composition testing, such as dual energy x-ray absorptiometry, bioelectrical impedance, and other measures, each have their own advantages and disadvantages. Some patients in clinical research, and perhaps even clinical practice, may benefit from an assessment of energy expenditure. This can be achieved by several methods including direct calorimetry, indirect calorimetry, doubly labeled water, or estimated by equations. Finally, a unifying theme regarding the etiology of pre-obesity/obesity and effectiveness of treatments of obesity centers on the role of biologic and behavior efficiencies and inefficiencies, with efficiencies more often associated with increases in fat mass and inefficiencies more often associated with decreases in fat mass.

Conclusion

The Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on History, Physical Exam, Body Composition and Energy Expenditure is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of pre-obesity/obesity.

Healthy Aging and Dietary Patterns

A number of factors contribute to the complex process of aging, which finally define whether someone will or not develop age-associated chronic diseases in late life. These determinants comprise genetic susceptibility as well as various behavioral, environmental, and dietary factors, all of which have been shown to influence specific pathways regulating the aging process and the extension of life, which makes longevity a multidimensional phenomenon. Although a "miraculous elixir" or a "nutrition pill" are not plausible, researchers agree on the notion that nutritional factors have major impact on the risk of age-associated chronic non-communicable diseases and mortality. In recent years nutrition research in relation to health outcomes has considerably changed from focusing exclusively on single nutrients to considering combinations of foods rather than nutrients in isolation. Although research on specific nutrients is scientifically valid providing crucial evidence on the mechanisms by which nutrition impacts health, the recent switch targeting the multifaceted synergistic interplay among nutrients, other dietary constituents, and whole foods, has promoted emerging interest on the actions of total dietary patterns. This narrative review aims to describe some specific dietary patterns with evidence of associations with reduction in the incidence of chronic diseases allowing older adults to live a long-lasting and healthier life, and confirming the powerful impact nutrition can exert on healthy aging.

Furosemide-induced systemic dehydration alters the proteome of rabbit vocal folds

Whole-body dehydration (i.e., systemic dehydration) leads to vocal fold tissue dehydration. Furosemide, a common diuretic prescribed to treat hypertension and edema-associated conditions, induces systemic dehydration. Furosemide also causes voice changes in human speakers, making this method of systemic dehydration particularly interesting for vocal fold dehydration studies. Our objective was to obtain a comprehensive proteome of vocal folds following furosemide-induced systemic dehydration. New Zealand White rabbits were used as the animal model and randomly assigned to euhydrated (control) or furosemide-dehydrated groups. Systemic dehydration, induced by injectable furosemide, was verified by an average body weight loss of -5.5% and significant percentage changes in blood analytes in the dehydrated rabbits compared to controls. Vocal fold specimens, including mucosa and muscle, were processed for proteomic analysis using label-free quantitation LC-MS/MS. Over 1600 proteins were successfully identified across all vocal fold samples; and associated with a variety of cellular components and ubiquitous cell functions. Protein levels were compared between groups showing 32 proteins differentially regulated (p ≤ 0.05) in the dehydrated vocal folds. These are mainly involved with mitochondrial translation and metabolism. The downregulation of proteins involved in mitochondrial metabolism in the vocal folds suggests a mechanism to prevent oxidative stress associated with systemic dehydration. SIGNIFICANCE: Voice disorders affect different population demographics worldwide with one in 13 adults in the United States reporting voice problems annually. Vocal fold systemic hydration is clinically recognized for preventing and treating voice problems and depends on optimal body hydration primarily achieved by water intake. Herein, we use the rabbit as a translatable animal model, and furosemide as a translatable method of systemic dehydration, to reveal a comprehensive proteomic profile of vocal fold mucosa and muscle in response to systemic dehydration. The significant subset of proteins differentially regulated due to furosemide-induced dehydration offer novel insights into the molecular mechanisms of systemic dehydration in the vocal folds. These findings also deepen our understanding of changes to tissue biology after diuretic administration.

Effect of the multicomponent healthy high school intervention on meal frequency and eating habits among high school students in Denmark: a cluster randomized controlled trial

BACKGROUND

Previous studies have shown that multicomponent interventions may improve meal frequency and eating habits in children, but evidence among young people is limited. This study evaluated the effect of the Healthy High School (HHS) intervention on daily intake of breakfast, lunch, water, fruit, and vegetables at 9-month follow-up.

METHODS

The study included first-year students (≈16 years) attending high school in Denmark. Participating schools were randomized into the HHS intervention (N = 15) or control group (operating as usual) (N = 15). The intervention was designed to promote well-being (primary outcome) by focusing on healthy habits including meals, stress prevention, and strong peer relations. It included a curriculum, structural and organisational initiatives, a workshop, and a smartphone application. Students completed self-administered online questionnaires at the beginning of the school year and nine months later. To account for clustering of data, we used multilevel logistic regression analyses to estimate odds ratios (OR). We applied an intention-to-treat approach with multiple imputations of missing data.

RESULTS

At baseline 4577 of 5201 students answered the questionnaire and 4512 at follow-up. In both groups the proportion of students eating breakfast decreased from approximately 50% to 40% from baseline to follow-up, and lunch frequency decreased from approximately 50% to 47%. Daily water intake, intake of fresh fruit and intake of vegetables remained unchanged from baseline to follow-up. There were no significant between group differences on any of the outcomes at first follow-up: breakfast: OR = 0.85 (95% CI: 0.65;1.10), lunch: OR = 0.96 (95% CI: 0.75;1.22), water intake: OR = 1.14 (95% CI: 0.92;1.40), intake of fresh fruit: (OR = 1.07, 95% CI: 0.84;1.37), vegetables: (OR = 1.01, 95% CI: 0.77;1.33).

CONCLUSION

No evidence of an effect of the HHS intervention was found for any of the outcomes. Future studies are warranted to explore how health promoting interventions can be integrated in further education to support educational goals. Moreover, how to fit interventions to the lives and wishes of young people, by also including systems outside of the school setting.

TRIAL REGISTRATION

ISRCTN, ISRCTN43284296 . Registered 28 April 2017 - retrospectively registered.

Projecting Temperature-Attributable Mortality and Hospital Admissions due to Enteric Infections in the Philippines

BACKGROUND

Enteric infections cause significant deaths, and global projection studies suggest that mortality from enteric infections will increase in the future with warmer climate. However, a major limitation of these projection studies is the use of risk estimates derived from nonmortality data to project excess enteric infection mortality associated with temperature because of the lack of studies that used actual deaths.

OBJECTIVE

We quantified the associations of daily temperature with both mortality and hospital admissions due to enteric infections in the Philippines. These associations were applied to projections under various climate and population change scenarios.

METHODS

We modeled nonlinear temperature associations of mortality and hospital admissions due to enteric infections in 17 administrative regions of the Philippines using a two-stage time-series approach. First, we quantified nonlinear temperature associations of enteric infections by fitting generalized linear models with distributed lag nonlinear models. Second, we combined regional estimates using a meta-regression model. We projected the excess future enteric infections due to nonoptimal temperatures using regional temperature-enteric infection associations under various combinations of climate change scenarios according to representative concentration pathways (RCPs) and population change scenarios according to shared socioeconomic pathways (SSPs) for 2010-2099.

RESULTS

Regional estimates for mortality and hospital admissions were significantly heterogeneous and had varying shapes in association with temperature. Generally, mortality risks were greater in high temperatures, whereas hospital admission risks were greater in low temperatures. Temperature-attributable excess deaths in 2090-2099 were projected to increase over 2010-2019 by as little as 1.3% [95% empirical confidence intervals (eCI): -3.1%, 6.5%] under a low greenhouse gas emission scenario (RCP 2.6) or as much as 25.5% (95% eCI: -3.5%, 48.2%) under a high greenhouse gas emission scenario (RCP 8.5). A moderate increase was projected for temperature-attributable excess hospital admissions, from 0.02% (95% eCI: -2.0%, 1.9%) under RCP 2.6 to 5.2% (95% eCI: -12.7%, 21.8%) under RCP 8.5 in the same period. High temperature-attributable deaths and hospital admissions due to enteric infections may occur under scenarios with high population growth in 2090-2099.

DISCUSSION

In the Philippines, futures with hotter temperatures and high population growth may lead to a greater increase in temperature-related excess deaths than hospital admissions due to enteric infections. Our results highlight the need to strengthen existing primary health care interventions for diarrhea and support health adaptation policies to help reduce future enteric infections. https://doi.org/10.1289/EHP9324.

Recent Advances in Multiresponsive Flexible Sensors towards E-skin: A Delicate Design for Versatile Sensing

Multiresponsive flexile sensors with strain, temperature, humidity, and other sensing abilities serving as real electronic skin (e-skin) have manifested great application potential in flexible electronics, artificial intelligence (AI), and Internet of Things (IoT). Although numerous flexible sensors with sole sensing function have already been reported since the concept of e-skin, that mimics the sensing features of human skin, was proposed about a decade ago, the ones with more sensing capacities as new emergences are urgently demanded. However, highly integrated and highly sensitive flexible sensors with multiresponsive functions are becoming a big thrust for the detection of human body motions, physiological signals (e.g., skin temperature, blood pressure, electrocardiograms (ECG), electromyograms (EMG), sweat, etc.) and environmental stimuli (e.g., light, magnetic field, volatile organic compounds (VOCs)), which are vital to real-time and all-round human health monitoring and management. Herein, this review summarizes the design, manufacturing, and application of multiresponsive flexible sensors and presents the future challenges of fabricating these sensors for the next-generation e-skin and wearable electronics.

Quality of Beverage Intake and Cardiometabolic and Kidney Outcomes: Insights From the STANISLAS Cohort

Background and Aims: Beverages are an important aspect of diet, and their quality can possibly affect health. The Healthy Beverage Index (HBI) has been developed to take into account these effects. This study aimed to highlight the relationships between health and beverage quality by assessing the association of the HBI and its components with kidney and cardiometabolic (CM) outcomes in an initially healthy population-based familial cohort.

Methods: This study included 1,271 participants from the STANISLAS cohort. The HBI, which includes 10 components of habitual beverage consumption, was calculated. Associations of the HBI and its components with estimated glomerular filtration rate (eGFR), albuminuria, hypertriglyceridemic waist (HTG waist), metabolic syndrome (MetS), carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT), and left ventricular mass (LV mass) were analyzed using multivariable linear or logistic regression models.

Results: The median HBI score was 89.7 (78.6–95) out of 100 points. While the overall HBI score was not significantly associated with any of the studied outcomes, individual HBI components were found differently associated with the outcomes. cfPWV and cIMT were lower in participants who did not meet the full-fat milk criteria (p = 0.03 and 0.001, respectively). In men, higher cfPWV was observed for the “low Fat milk” (p = 0.06) and “alcohol” (p = 0.03) non-adherence criteria. Odds of HTG waist were higher with the non-adherence to sugar-sweetened beverages criteria (p < 0.001). eGFR was marginally higher with non-adherence to the coffee/tea criteria (p = 0.047).

Conclusions: In this initially healthy population, HBI components were differently associated with kidney and cardiometabolic outcomes, despite a good overall HBI score. Our results highlight specific impacts of different beverage types and suggest that beverages could have an impact on kidney and cardiometabolic health.

Correction of Temperature Variation with Independent Water Samples to Predict Soluble Solids Content of Kiwifruit Juice Using NIR Spectroscopy

Using the framework of aquaphotomics, we have sought to understand the changes within the water structure of kiwifruit juice occurring with changes in temperature. The study focuses on the first (1300-1600 nm) and second (870-1100 nm) overtone regions of the OH stretch of water and examines temperature differences between 20, 25, and 30 °C. Spectral data were collected using a Fourier transform-near-infrared spectrometer with 1 mm and 10 mm transmission cells for measurements in the first and second overtone region, respectively. Water wavelengths affected by temperature variation were identified. Aquagrams (water spectral patterns) highlight slightly different responses in the first and second overtone regions. The influence of increasing temperature on the peak absorbance of the juice was largely a lateral wavelength shift in the first overtone region and a vertical amplitude shift in the second overtone region of water. With the same data set, we investigated the use of external parameter orthogonalisation (EPO) and extended multiple scatter correction (EMSC) pre-processing to assist in building temperature-independent partial least square regression models for predicting soluble solids concentration (SSC) of kiwifruit juice. The interference component selected for correction was the first principal component loading measured using pure water samples taken at the same three temperatures (20, 25, and 30 °C). The results show that the EMSC method reduced SSC prediction bias from 0.77 to 0.1 °Brix in the first overtone region of water. Using the EPO method significantly reduced the prediction bias from 0.51 to 0.04 °Brix, when applying a model made at one temperature (30 °C) to measurements made at another temperature (20 °C) in the second overtone region of water.

Evaluation of the safety of ethanolic extract from Piper amalago L. (Piperaceae) leaves in vivo: Subacute toxicity and genotoxicity studies

Piper amalago L. (Piperaceae) is traditionally used due to its anti-inflammatory, analgesic, diuretic, and antiparasitic properties. However, few studies have focused on its adverse effects, compromising its safe use. This study evaluated the toxicological safety of ethanolic extract from Piper amalago leaves (EEPA), through subacute toxicity and genotoxicity assays in rodents. In subacute toxicity, 100, 200 or 300 mg/kg of EEPA were tested in female Wistar rats, by gavage, for 28 days. For genotoxicity test, female Swiss mice were orally treated with 17.5, 175 or 1750 mg/kg of EEPA and the comet, micronucleus, and splenic phagocytic assays were evaluated. In subacute toxicity, the extract induced an increase in the food and water intakes, as well as in the liver absolute weight, and in the heart and kidney relative weights. EEPA also provoked alterations in histopathological analysis of liver and in hemato-biochemical parameters, evidenced by a decrease in hematocrit levels and albumin levels, and an increase in the number of platelets and in alkaline phosphatase and cholesterol levels. However, EEPA did not presented genotoxic nor mutagenic properties. EEPA showed hemato-biochemical toxicity profile in rats and should be used with caution, especially when for prolonged period.

Evaluation of the 'H2NOE Water Schools' programme to promote water consumption in elementary schoolchildren: a non-randomised controlled cluster trial

OBJECTIVE

This study evaluated a simple environmental intervention called 'Water Schools' in Lower Austria providing free refillable water bottles and educational material.

DESIGN

Non-randomised controlled cluster trial with three measurements: at baseline (T0), after the intervention at 9 months (T1) and after 1-year follow-up (T2).

SETTING

Half-day elementary schools in Lower Austria (Austria).

PARTICIPANTS

Third-grade pupils from twenty-two schools in the intervention group (IG) and thirty-two schools in the control group (CG) participated in the study. Data were analysed for 569 to 598 pupils in the IG and for 545 to 613 in the CG, depending on the time of measurement.

RESULTS

The consumption of tap water increased in the IG from baseline to T1 and then decreased again at T2, but this was similar in the CG (no statistically significant difference in the time trend between the IG and CG). Similar results were seen for tap water consumption in the mornings. The proportion of children who only drank tap water on school mornings increased significantly from baseline to T1 in the IG compared to the CG (P = 0·020). No difference in the changes over time occurred between the groups for the proportion of pupils drinking approximately one bottle of tap water during school mornings.

CONCLUSIONS

Not only the children in the IG but also those in the CG drank more tap water after 1 school year than at the beginning. The measurement of drinking habits in the CG may have been intervention enough to bring about changes or to initiate projects.

Stress amelioration potential of vitamin C in ruminants: a review

Ruminants, as well as other livestock, can synthesize vitamin C (VC) in their liver, and therefore, dietary requirements from exogenous supplementation are often ignored. However, metabolic demand may be exceeded, leading to a decreased endogenous synthetic capacity of VC following exposure to stressful conditions. Such conditions include high thermal load, limited water intake (induced by water scarcity), physiological status and infectious diseases. The obvious consequences are decreased performance, susceptibility to infections and increased mortality. This review discusses the potential role of vitamin C in ruminants' stress management and summarizes the in vitro and in vivo research to date. The different administration routes, comparative advantages and supplementation outcomes on growth, production parameters and physiological status were also identified. Also, areas where there was a lack of evidence or controversy, including critical literature research gaps, were identified, while the mechanism of VC's actions on significant outcomes was explained.

Gender-Specific Differences of Renal Heat Tolerance in Older Adults during Heat Waves

BACKGROUND

Heat waves are known to cause increased morbidity and mortality in susceptible populations like old and functionally impaired people. The objective of the study was to assess renal tubular stress, a predictor for development of acute kidney injury, during heat waves in Central Europe. As a marker of renal tubular stress tissue inhibitor of metalloproteinases-2 [TIMP-2]·insulin-like growth factor binding protein-7 [IGFBP7], a new FDA-cleared renal tubular stress biomarker, was used.

MATERIALS AND METHODS

68 residents from facilities of sheltered housing with urine samples collected at heat waves in 2015 and at control visits were included. Urinary [TIMP-2]·[IGFBP7] was compared between the heat waves and the control visits. Multivariate linear models were adjusted for age, frailty index, and functional comorbidity index.

RESULTS

The median age was 82.0 years, 82.3% were women. The percentage of elevated levels of urinary [TIMP-2]·[IGFBP7] (>0.3 [ng/mL]2/1,000) in the total study population was higher at the heat waves than at the control visits (25.0% vs. 17.7%). The effect of the heat waves on urinary [TIMP-2]·[IGFBP7] was stronger in men than in women: The percentage of elevated levels was 75.0% in men and 14.3% in women. In the multivariate analysis, the mean urinary [TIMP-2]·[IGFBP7] was 0.48 (95% CI 0.25; 0.70) (ng/mL)2/1,000 higher in men than in women. Except gender, a number of additional variables did not show an association with urinary [TIMP-2]·[IGFBP7] at the heat waves or the control visits.

CONCLUSIONS

At heat waves, urinary [TIMP-2]·[IGFBP7] was elevated and higher in men than in women. This suggests gender-specific differences in renal heat tolerance in older people.

Water Security and Nutrition: Current Knowledge and Research Opportunities

Water is an essential nutrient that has primarily been considered in terms of its physiological necessity. But reliable access to water in sufficient quantities and quality is also critical for many nutrition-related behaviors and activities, including growing and cooking diverse foods. Given growing challenges to water availability and safety, including climate change, pollution, and infrastructure degradation, a broader conceptualization of water and its diverse uses is needed to sustainably achieve global nutrition targets. Therefore, we review empirical and qualitative evidence describing the linkages between water security (the reliable availability, accessibility, and quality of water for all household uses) and nutrition. Primary linkages include water security for drinking, food production and preparation, infant and young child feeding, and limiting exposure to pathogens and environmental toxins. We then identify knowledge gaps within each linkage and propose a research agenda for studying water security and nutrition going forward, including the concurrent quantification of both food and water availability, accessibility, use, and stability. By making explicit the connections between water security and nutritional well-being, we aim to promote greater collaboration between the nutrition and water, sanitation, and hygiene sectors. Interdisciplinary policies and programs that holistically address the water-nutrition nexus, versus those that focus on water and nutrition independently, are likely to significantly advance our ability to ensure equitable access to healthy foods and safe water for all.

Palatable Flavoured Fluids without Carbohydrates and Electrolytes Do Not Enhance Voluntary Fluid Consumption in Male Collegiate Basketball Players in the Heat

Using palatable fluids to enhance drinking in athletes who display insufficient compensatory hydration behaviour may mitigate the risks of hypohydration and performance deficits. However, it is unclear whether flavour can independently enhance fluid consumption. This study examined the effects of a colourless, artificially sweetened flavoured water (FW), without carbohydrates and with negligible amounts of sodium, compared to plain water (W) on fluid consumption in male collegiate basketball players in a practical game setting. Eighteen male basketball players (age 23.1 ± 1.3 years) played a 3v3 basketball small-sided game. The players were randomly assigned to consume either FW or W. Pre-game urine-specific gravity, fluid consumption, body mass, and hedonic taste perceptions were assessed. Basketball performance was analysed through notational analysis. Ratings of perceived exertion and thirst were recorded at pre-, post-game, and at each rest period. Heart rate was recorded throughout the gameplay. Despite significantly higher hedonic ratings for FW than W (6.78 ± 0.83 vs. 5.56 ± 1.33, p = 0.033, d = 1.36), there were no significant differences in fluid consumption (1083 ± 32 mL vs. 1421 ± 403 mL, p = 0.068, d = 0.92). Our result highlighted that using palatable fluids as a strategy to increase fluid consumption during high-intensity gameplay in the heat may not be effective if used without carbohydrates and electrolytes. Practitioners could consider both fluid palatability and composition in establishing a hydration plan for athletes.

Microfluidics and materials for smart water monitoring: A review

Water quality monitoring of drinking, waste, fresh and seawaters is of great importance to ensure safety and wellbeing for humans, fauna and flora. Researchers are developing robust water monitoring microfluidic devices but, the delivery of a cost-effective, commercially available platform has not yet been achieved. Conventional water monitoring is mainly based on laboratory instruments or sophisticated and expensive handheld probes for on-site analysis, both requiring trained personnel and being time-consuming. As an alternative, microfluidics has emerged as a powerful tool with the capacity to replace conventional analytical systems. Nevertheless, microfluidic devices largely use conventional pumps and valves for operation and electronics for sensing, that increment the dimensions and cost of the final platforms, reducing their commercialization perspectives. In this review, we critically analyze the characteristics of conventional microfluidic devices for water monitoring, focusing on different water sources (drinking, waste, fresh and seawaters), and their application in commercial products. Moreover, we introduce the revolutionary concept of using functional materials such as hydrogels, poly(ionic liquid) hydrogels and ionogels as alternatives to conventional fluidic handling and sensing tools, for water monitoring in microfluidic devices.

Current Knowledge Base of Beverage Health Impacts, Trends, and Intake Recommendations for Children and Adolescents: Implications for Public Health

PURPOSE OF REVIEW

Improving beverage patterns is important for promoting the health of children and adolescents. Food preferences can begin developing at a young age; thus, children and adolescents should be provided healthy beverages in accordance with current recommendations. The purpose of this review is to identify and summarize existing beverage recommendations for children and adolescents. This review also discusses the health impacts of beverages and how beverage consumption has changed among children and adolescents over time.

RECENT FINDINGS

The mean number of calories that children and adolescents are consuming from beverages on a given day has declined in recent years. However, sugar-sweetened beverages (SSB) are the primary source of added sugars in this population. Therefore, SSB consumption remains a concern, and reducing the intake of SSB is still considered a top priority for helping to improve dietary quality. This review uniquely compiles recommendations into one convenient table for the entire age range of 0-19 years and includes recommendations that can be more adequately individualized. Beverage categories where beverage recommendations from authoritative sources are lacking have also been identified. Potential methods that can be implemented to improve beverage patterns and current public policy recommendations have been discussed to provide actionable steps that public health professionals can utilize in practice. The comprehensive table of beverage recommendations could be useful for professionals promoting the health of children and adolescents in research, clinical, and public health settings.

Nutrition and Water

Water has numerous functions necessary for survival including cellular homeostasis, solvent properties for dissolving ions and solutes, thermoregulation, and transport of waste and nutrients. Despite the established beneficial role of water in skin physiology, the optimal methods for skin hydration and requirements for daily water consumption remain elusive. This review summarizes the cellular and molecular biology of skin hydration, the debate and current recommendations of daily water requirements, and the latest research on interventions to improve skin hydration by both internal and external means of water exposure. We also explore the chemical properties of water, such as the concept of water "hardness" and environmental pollutants, and their impact on skin physiology.

Food Myths or Food Facts? Study about Perceptions and Knowledge in a Portuguese Sample

Food myths are nutritional concepts poorly justified or even contradict existing scientific evidence that individuals take as the truth. Knowledge in nutrition is an important tool in tackling misinformation and in the promotion of adequate food choices. This study aimed to investigate the beliefs and perceptions of a sample of the Portuguese population regarding a series of food myths and facts, evaluating, consequently, the level of knowledge and the main sources of information. The research was conducted on a sample of 503 participants, using a questionnaire disclosed online, by email, and social networks, between May and June of 2021. Thirty statements, some true and others false, were analyzed to assess people's perceptions. Based on the respondents' answers, a score was calculated for each statement, allowing to differentiate the correct (positive score) from incorrect (negative score) perceptions. The results showed that most statements obtained positive scores, corresponding to correct perceptions. Moreover, the level of knowledge was measured, being very high for 21.7% of the participants and high for 42.1%. The main sources where the participants acquire nutritional information are scientific journals (43.3%), website of the Portuguese General Health Office (DGS) (31.4%), and technical books (31.0%), which is concordant with the level of trust in these sources. Hence, it was concluded that, despite the levels of nutritional knowledge, there are still several food myths that need to be debunked, through the proper channels, in order to promote healthy, balanced, and adequate eating behaviors.

An Overview on Food Applications of the Instant Controlled Pressure-Drop Technology, an Innovative High Pressure-Short Time Process

Food processing systematically aims at meeting the needs of consumers who are looking for total high quality and perfect food safety. As the various thermal and non-thermal food preservation technologies often affect the natural properties in terms of sensation, flavor, texture, etc., instant controlled pressure drop (DIC) has been conceived as a relevant, innovative process in this field. DIC uses high saturated steam pressure and short duration to provide a new way to expand biological matrices, improve drying, decontaminate, and extract biologically active compounds, among other attributes. Therefore, this review focuses on describing the applications of DIC technology on a wide range of products such as foods and by-products that have been processed both in the laboratory and on an industrial scale. The application of DIC has shown the possibility of a significant leap in quality improvement and cost reduction in the food industry. DIC reduces the drying time of fruits and vegetables, and improves the extraction of essential oils, vegetable oils, and antioxidant components. It also provides strong decontamination, eliminates vegetative microorganisms and spores, and reduces non-nutritional and allergenic components. Over the past 33 years, this technology has continued to expand its food applications and improve its characteristics on an industrial scale. But there are still many food unit operations that can be taken to the next level with DIC.

The Relationships between Water Intake and Hydration Biomarkers and the Applications for Assessing Adequate Total Water Intake among Young Adults in Hebei, China

Water is an essential nutrient for humans. A cross-sectional study was conducted among 159 young adults aged 18–23 years in Hebei, China. The total drinking fluids and water from food were obtained by 7-day 24 h fluid intake questionnaires and the duplicate portion method, respectively. Pearson’s correlation coefficients were performed to determine the relationship between fluid intake and 24 h urinary biomarkers and plasma biomarkers. A multivariable partial least squares (PLS) model was used to identify the key predictors in modeling the total water intake (TWI) with 24 h urine biomarkers. Logistic regressions of the TWI against binary variables were performed, and the receiver operating characteristic curve (ROC) was analyzed to determine the cutoff value of the TWI for the optimal hydration status and dehydration without adjustments to favor either the sensitivity or specificity. In total, 156 participants (80 males and 76 females) completed the study. Strong relationships were found between the total drinking fluids, TWI, and 24 h urine biomarkers among young adults, especially for the 24 h urine volume (r = 0.784, p < 0.001; r = 0.747, p < 0.001) and osmolality (r = −0.589, p < 0.001; r = −0.477, p < 0.001), respectively. As for the FMU and plasma biomarkers, no strong relationships were found. The percentages of the variance in TWI explained by the PLS model with 13 urinary biomarkers were 66.9%. The optimal TWI values for assessing the optimal hydration and dehydration were 2892 mL and 2482 mL for young males, respectively, and 2139 mL and 1507 mL for young females, respectively. Strong relationships were found between the TWI, total drinking fluids, and 24 h urine biomarkers, but not with the FMU and plasma biomarkers, among young adults, including males and females. The 24 h urine biomarkers were more sensitive than the first morning urinary biomarkers in reflecting the fluid intake. The TWI was a reliable index for assessing the hydration statuses for young adults in free-living conditions.

Interventions to Improve Hydration in Older Adults: A Systematic Review and Meta-Analysis

Dehydration is common in the elderly, especially when hospitalised. This study investigated the impact of interventions to improve hydration in acutely unwell or institutionalised older adults for hydration and hydration linked events (constipation, falls, urinary tract infections) as well as patient satisfaction. Four databases were searched from inception to 13 May 2020 for studies of interventions to improve hydration. Nineteen studies (978 participants) were included and two studies (165 participants) were meta-analysed. Behavioural interventions were associated with a significant improvement in hydration. Environmental, multifaceted and nutritional interventions had mixed success. Meta-analysis indicated that groups receiving interventions to improve hydration consumed 300.93 mL more fluid per day than those in the usual care groups (95% CI: 289.27 mL, 312.59 mL; I² = 0%, p < 0.00001). Overall, there is limited evidence describing interventions to improve hydration in acutely unwell or institutionalised older adults. Behavioural interventions appear promising. High-quality studies using validated rather than subjective methods of assessing hydration are needed to determine effective interventions.

Effects of Water Restriction and Supplementation on Cognitive Performances and Mood among Young Adults in Baoding, China: A Randomized Controlled Trial (RCT)

The brain is approximately 75% water. Therefore, insufficient water intake may affect the cognitive performance of humans. The present study aimed to investigate the effects of water restriction and supplementation on cognitive performances and mood, and the optimum amount of water to alleviate the detrimental effects of dehydration, among young adults. A randomized controlled trial was conducted with 76 young, healthy adults aged 18–23 years old from Baoding, China. After fasting overnight for 12 h, at 8:00 a.m. of day 2, the osmolality of the first morning urine and blood, cognitive performance, and mood were measured as a baseline test. After water restriction for 24 h, at 8:00 a.m. of day 3, the same indexes were measured as a dehydration test. Participants were randomly assigned into four groups: water supplementation group (WS group) 1, 2, or 3 (given 1000, 500, or 200 mL purified water), and the no water supplementation group (NW group). Furthermore, participants were instructed to drink all the water within 10 min. Ninety minutes later, the same measurements were performed as a rehydration test. Compared with the baseline test, participants were all in dehydration and their scores on the portrait memory test, vigor, and self-esteem decreased (34 vs. 27, p < 0.001; 11.8 vs. 9.2, p < 0.001; 7.8 vs. 6.4, p < 0.001). Fatigue and TMD (total mood disturbance) increased (3.6 vs. 4.8, p = 0.004; 95.7 vs. 101.8, p < 0.001) in the dehydration test. Significant interactions between time and volume were found in hydration status, fatigue, vigor, TMD, symbol search test, and operation span test (F = 6.302, p = 0.001; F = 3.118, p = 0.029; F = 2.849, p = 0.043; F = 2.859, p = 0.043; F = 3.463, p = 0.021) when comparing the rehydration and dehydration test. Furthermore, the hydration status was better in WS group 1 compared to WS group 2; the fatigue and TMD scores decreased, and the symbol search test and operation span test scores increased, only in WS group 1 and WS group 2 (p < 0.05). There was no significant difference between them (p > 0.05). Dehydration impaired episodic memory and mood. Water supplementation improved processing speed, working memory, and mood, and 1000 mL was the optimum volume.

Awareness of dehydration state and fluid intake practice among adults population in the Jazan Region of Saudi Arabia, 2019

Despite the hot climate and high humidity in the Jazan Region of Saudi Arabia, which increases risk for dehydration, no previous studies have assessed awareness of dehydration and fluid intake practice among adults in this region. Therefore, the aim of this cross-sectional study was to determine awareness of the dehydration state and fluid intake practices among 440 adults in the Jazan Region of Saudi Arabia. Out of the total, 51⋅8 % were male and 48⋅2 % were females. Good knowledge of dehydration definition and prevention and recommended minimum water intake was observed in 98, 95 and 75 % of the participants, respectively. Fifty-nine percent of the participants met the minimum daily requirement of 3 l or more per day. The age (95 % CI 1⋅003, 1⋅017, P value = 0⋅006), diabetes (95 % CI 1⋅028, 1⋅459, P value = 0⋅023) and prior hospitalisation due to dehydration (95 % CI 1⋅010, 1⋅378, P value = 0⋅037) were associated with higher water intake. Additional glasses of coffee (95 % CI 1⋅02, 1⋅115, P value = 0⋅004) and juice (95 % CI 1⋅039, 1⋅098, P value < 0⋅001) were associated with more water intake. The participants exhibited good knowledge of dehydration definition, symptoms and consequences. Intake of fluids such as 'juice and coffee' enhances more water intake. Although two-thirds of the participants met the recommended daily water intake, still one-third of them did not meet this level. Innovative approaches to enhance healthy drinking are warranted and may include partnering with patients to take an active role in hydration monitoring and increasing communication with the different healthcare providers.