Water, hydration, and health

Physician Well-Being in Practice

Despite a recent surge of interest in physician well-being, the discussion remains diffuse and often scattered. Lingering questions of what wellness entails, how it is personally applicable, and what can be done, remain pervasive. In this review, we focus on policy-level, institutional and personal factors that are both obstacles to wellness and interventions for potential remedy. We outline clear obstacles to physician wellness that include dehumanization in medicine, environments and cultures of negativity, barriers to wellness resources, and the effect of second victim syndrome. This is followed by proven and proposed interventions to support physicians in need and foster cultures of sustained well-being from policy, institutional, and personal levels. These include medical liability and licensure policy, peer support constructs, electronic health record optimization, and personal wellness strategies. Where sufficient data exists, we highlight areas specific to anesthesiology. Overall, we offer a pragmatic framework for addressing this critical concern at every level.

Investigation of the Association between Drinking Water Habits and the Occurrence of Women Breast Cancer

Risk and protective factors for breast cancer (BC) include lifestyle, diet, reproduction, and others. Increased risk for colon cancer was linked with low water intake. The link between water consumption and BC was scarcely studied. We investigated the association between water and fluid consumption and the occurrence of BC in a retrospective case-control study in the Shaare Zedek Medical Center, Jerusalem, in 206 women aged 25-65 years (106 with newly diagnosed BC, and 100 controls). A food frequency questionnaire (FFQ), consumption of water, foods, and beverages, lifestyle, and other risk and protective factors were recorded. The age of women in both groups was comparable ((M ± SD) 52.7 ± 9.8 and 50.6 ± 11.4 years, respectively (p = 0.29)). Women with BC consumed 20.2% less water (M ± SD = 5.28 ± 4.2 and 6.62 ± 4.5 cups/day, respectively, p = 0.02) and 14% less total fluids than controls (M ± SD = 2095 ± 937 mL/day and 2431 ± 1087 mL/day, respectively, p = 0.018). Multiple stepwise logistic regression showed that the differences remained significant both for daily water consumption (p = 0.031, CI = 0.462-0.964) and for total daily liquid intake (p = 0.029, CI = 0.938-0.997). Low water and liquids intake as a risk factor for BC may be related to the younger age of our subjects. The effect of age on the potential role of water intake in decreasing BC risk should be investigated.

[The importance of water consumption in health and disease prevention: the current situation]

Water is an essential nutrient for life and the most abundant component in the human body. However, its dietary recommendations or clinical management guidelines do not receive as much attention as they deserve. In addition, there are some obstacles to establishing optimal values, both for the amount of water the body must contain and for water ingestion. Water intake and elimination depend on unsteady factors that are difficult to measure and, at the same time, compensated by the body's ability to regulate homeostasis. Since scientific evidence is lacking for establishing recommendations, "adequate intakes" (to maintain an adequate hydration state) have been estimated using data on water intake from groups of healthy people. The European Food Safety Authority (EFSA) also considers desirable the use of urine osmolarity to estimate the adequacy of water intake in adults. Clinical studies have generally shown the benefits of adequate hydration and the damage caused by water imbalance, whether quantitative (dehydration and overhydration) or qualitative (extracellular and intracellular water). Unfortunately, these studies are few and often have poor cross-sectional, case-control, or prospective designs, and use small samples or indirect methods to assess hydration status. This article presents up-to-date information on subjects such as: 1) compliance with water consumption recommendations and suggestions for improvement; 2) techniques available to measure hydration status and their clinical applications; 3) effects of hydration/dehydration on physical or cognitive activities and chronic diseases; and 4) existing Spanish regulations on the quality and salubrity of water.

Impact of Nuun Electrolyte Tablets on Fluid Balance in Active Men and Women

Background: Maintaining adequate hydration is important for overall health and has major implications for athletes involved in physically demanding tasks. While water is viewed as an effective means to rehydrate, and is inexpensive and readily available, electrolyte beverages appear to be more beneficial, in particular for athletes who routinely lose electrolytes through sweating. Nuun tablets contain a mix of electrolytes and are quickly dissolved in water to create an electrolyte-rich beverage. We determined the impact of Nuun tablets on the fluid balance of healthy, exercise-trained men and women at rest. Methods: Eight men (25.9 ± 4.5 yrs) and 10 women (28.2 ± 9.4 yrs) ingested either water only or water with Nuun electrolyte tablets, at both a single and double strength concentration, in random order, on three occasions separated by approximately one week, in a fasted and euhydrated state. A total of 1 L of fluid was ingested at each visit over a 30 min period. Urine was collected from each subject at 0, 1, 2, 3, and 4 h post-ingestion. Urine mass values were used to calculate fluid balance and the beverage hydration index (BHI; i.e., the volume of urine produced after drinking the Nuun beverages, relative to that of water only—control condition). Heart rate and blood pressure were measured throughout the four-hour period, while body weight was measured at the start and end of the experiment. Results: Neither heart rate nor blood pressure were impacted by beverage consumption. Nuun tablets resulted in a lower urine output compared to water, with fluid balances for both concentrations more favorable compared to water (p < 0.05), beginning at 2 h post-ingestion and continuing at the 3 h and 4 h times. Body weight loss was less with Nuun at the single dose (0.38 kg; p = 0.02) and double dose (0.43 kg; p = 0.08), compared to water (0.57 kg). The BHI was higher for Nuun (single dose in particular) compared to water at both 2 h (p = 0.05) and 4 h (p = 0.02). Conclusion: The addition of Nuun electrolyte tablets to water improves the fluid balance and BHI in healthy men and women. Results were similar for both concentrations, suggesting that additional electrolytes are not necessary when in a rested state. Future studies should determine the impact of various concentrations of the Nuun beverage during physical exercise—in particular, exercise in the heat, when sweat loss may be highest.

Body Composition and a School Day Hydration State among Polish Children-A Cross-Sectional Study

Background: Little is known on the relationship between obesity and hydration level in children. To explore the possible association between children’s hydration status and body composition, we conducted this cross-sectional study. Methods: The survey was carried out in 2018 in Preliminary and High Schools from the Malopolska Province, Poland. The study group consisted of 264 children aged 7–15 years. The level of hydration was assessed based on urine osmolality during a school day. The examined had anthropometric tests and body composition assessment (FM, BF%, FFM, TBW, TBW%). Odds ratio (OR) and 95% confidence interval (CI) were calculated using a logistic regression analysis. Results: In the study group, 9.5% of the examined were overweight, 7.2% obese, and it referred more to the country than towns (p < 0.05). Improper hydration was found in 53% of children, and 16.3% of them were severely dehydrated during a school day (urine osmolality > 1000 mOsm/kgH₂O). The level of dehydration was higher in children with excessive body fat (BF%) than in children with normal BF% [903.00 vs. 775 mOsm/kgH₂O]. Older age (>10 y) showed inverse association with dehydration [OR 0.52 (95% CI; 0.28–0.99)] and excessed BF% showed 2.3-fold increase in odds of dehydration during a school day [OR 2.39 (95% CI; 1.15–4.94)]. Improper hydration was a risk factor of difficulties with concentration declared by students during a school day OR 2.85 (95% CI; 1.16–6.99). Conclusions: Attention should be paid to appropriate hydration especially in children with excessive body fat content who feature a higher risk of dehydration and fluid demand.

Drinking Water in the United States: Implications of Water Safety, Access, and Consumption

Recent water quality crises in the United States, and recognition of the health importance of drinking water in lieu of sugar-sweetened beverages, have raised interest in water safety, access, and consumption. This review uses a socioecological lens to examine these topics across the life course. We review water intakes in the United States relative to requirements, including variation by age and race/ethnicity. We describe US regulations that seek to ensure that drinking water is safe to consume for most Americans and discuss strategies to reduce drinking water exposure to lead, a high-profile regulated drinking water contaminant. We discuss programs, policies, and environmental interventions that foster effective drinking water access, a concept that encompasses key elements needed to improve water intake. We conclude with recommendations for research, policies, regulations, and practices needed to ensure optimal water intake by all in the United States and elsewhere.

Nutrition, Bioenergetics, and Metabolic Syndrome

According to the World Health Organization (WHO), the global nutrition report shows that whilst part of the world's population starves, the other part suffers from obesity and associated complications. A balanced diet counterparts these extreme conditions with the proper proportion, composition, quantity, and presence of macronutrients, micronutrients, and bioactive compounds. However, little is known on the way these components exert any influence on our health. These nutrients aiming to feed our bodies, our tissues, and our cells, first need to reach mitochondria, where they are decomposed into CO2 and H2O to obtain energy. Mitochondria are the powerhouse of the cell and mainly responsible for nutrients metabolism, but they are also the main source of oxidative stress and cell death by apoptosis. Unappropriated nutrients may support mitochondrial to become the Trojan horse in the cell. This review aims to provide an approach to the role that some nutrients exert on mitochondria as a major contributor to high prevalent Western conditions including metabolic syndrome (MetS), a constellation of pathologic conditions which promotes type II diabetes and cardiovascular risk. Clinical and experimental data extracted from in vitro animal and cell models further demonstrated in patients, support the idea that a balanced diet, in a healthy lifestyle context, promotes proper bioenergetic and mitochondrial function, becoming the best medicine to prevent the onset and progression of MetS. Any advance in the prevention and management of these prevalent complications help to face these challenging global health problems, by ameliorating the quality of life of patients and reducing the associated sociosanitary burden.

Why women may live longer than men do? A telomere-length regulated and diet-based entropic assessment

BACKGROUND & AIMS

Empirical analyses of the data available around the word concluded that women have longer life span now, when compared to the men. Available literature unfortunately could not offer full answers to this observation. The "entropic age" concept suggests that ageing related changes in the body, such as loss of molecular functions and overwhelming of the maintenance systems, may be explained in terms of entropy generation.

METHODS

Telomere-length regulated entropic assessment based on metabolic activity with four different diets carried out.

RESULTS

Estimates of the life expectancy of the women on all of these diets is longer than those of the men. Faster shortening of the telomere lengths in men was the major reason of the shorter life expectancy. The highest and the lowest life expectancy for women were estimated with Mediterranean and the vegetarian diets, respectively; men were estimated to have the longest life span with the vegetarian diet and the shortest life span with the ketogenic diet.

CONCLUSIONS

A higher rate of metabolism causes higher entropy generation and hints correlations that can be helpful in future ageing research. Faster shortening of the telomere lengths in men was the major reason of the estimation of the shorter life span for men.

A Mobile-Based Tailored Recommendation System for Parents of Children with Overweight or Obesity: A New Tool for Health Care Centers

Childhood obesity is associated with unbalanced lifestyle patterns, and new strategies are needed to support parents in the compliance with the guidelines for children's age. Tailored automatic recommendations mimic interpersonal counseling and are promising strategies to be considered for health promotion programs. This study aimed to develop and test a mobile recommendation system for parents of preschool children identified with overweight/obesity at health care centers. Evidence-based recommendations related to children's eating, drinking, moving, and sleeping habits were developed and tested using a questionnaire. A pilot study was conducted in a health care center to test how using an app with those tailored recommendations, in video format, influenced parents' perceptions of the child's weight status and their knowledge about the guidelines, compared to a control group. The chi-squared test was used for categorical variables and the Mann-Whitney U test for continuous variables (p < 0.05). A high proportion of parents were already informed about the guidelines, but their children were not meeting them. After watching the tailored recommendations, there was an increased knowledge of the guideline on water intake, but there was no improvement in the perception of the child's excessive weight. Parents may benefit from a mobile-based tailored recommendation system to improve their knowledge about the guidelines. However, there is a need to work with parents on motivation to manage the child's weight with additional strategies.

Unraveling the molecular pathobiology of vocal fold systemic dehydration using an in vivo rabbit model

Vocal folds are a viscoelastic multilayered structure responsible for voice production. Vocal fold epithelial damage may weaken the protection of deeper layers of lamina propria and thyroarytenoid muscle and impair voice production. Systemic dehydration can adversely affect vocal function by creating suboptimal biomechanical conditions for vocal fold vibration. However, the molecular pathobiology of systemically dehydrated vocal folds is poorly understood. We used an in vivo rabbit model to investigate the complete gene expression profile of systemically dehydrated vocal folds. The RNA-Seq based transcriptome revealed 203 differentially expressed (DE) vocal fold genes due to systemic dehydration. Interestingly, function enrichment analysis showed downregulation of genes involved in cell adhesion, cell junction, inflammation, and upregulation of genes involved in cell proliferation. RT-qPCR validation was performed for a subset of DE genes and confirmed the downregulation of DSG1, CDH3, NECTIN1, SDC1, S100A9, SPINK5, ECM1, IL1A, and IL36A genes. In addition, the upregulation of the transcription factor NR4A3 gene involved in epithelial cell proliferation was validated. Taken together, these results suggest an alteration of the vocal fold epithelial barrier independent of inflammation, which could indicate a disruption and remodeling of the epithelial barrier integrity. This transcriptome provides a first global picture of the molecular changes in vocal fold tissue in response to systemic dehydration. The alterations observed at the transcriptional level help to understand the pathobiology of dehydration in voice function and highlight the benefits of hydration in voice therapy.

Neural Control and Modulation of Thirst, Sodium Appetite, and Hunger

The function of central appetite neurons is instructing animals to ingest specific nutrient factors that the body needs. Emerging evidence suggests that individual appetite circuits for major nutrients-water, sodium, and food-operate on unique driving and quenching mechanisms. This review focuses on two aspects of appetite regulation. First, we describe the temporal relationship between appetite neuron activity and consumption behaviors. Second, we summarize ingestion-related satiation signals that differentially quench individual appetite circuits. We further discuss how distinct appetite and satiation systems for each factor may contribute to nutrient homeostasis from the functional and evolutional perspectives.

Effect of Post-Stroke Rehabilitation on Body Mass Composition in Relation to Socio-Demographic and Clinical Factors

Background and objectives: Stroke is one of the leading causes of morbidity, mortality and long-term adult disability. The aim of this study was to assess the changes in body mass composition in patients after stroke in connection with selected socio-demographic and clinical factors (sex, age, type of stroke and time from the first symptoms) following the rehabilitation process. Materials and Methods: The study group consisted of 100 post-stroke subjects who participated in a comprehensive rehabilitation program for a duration of five weeks. The measurements of body composition by a Tanita MC 780 MA analyser were performed on the day of admission to hospital, on the day of discharge (after 5 weeks) and 12 weeks after discharge from hospital. Results: It was shown that before rehabilitation (Exam I) in the study group there were significant differences in body composition relative to sex, age and time from stroke. The rates of fat mass % and visceral fat level decreased after rehabilitation (Exam II) in both males and females. Exam II, at the end hospital rehabilitation, showed lower levels of fat mass %, visceral fat level, as well as fat-free mass % and higher values of total body water % and muscle mass %. In Exam III, i.e., 12 weeks after discharge, all of the parameters retained their values. Conclusions: The study shows an association between stroke risk factors (primarily age, sex and time from the onset of the first symptoms of stroke) and body mass composition resulting from rehabilitation. The type of stroke and the effects of rehabilitation on body mass components showed no differences. Comprehensive rehabilitation had a positive effect on the body mass components.

Extinguish Burnout in Critical Care Nursing

Burnout is reaching epidemic levels among health care providers. It negatively impacts individual providers, the care team, facility, and patients. Increased employee turnover, job dissatisfaction, and conflict are found whenever staff becomes burned out. Patient outcomes and satisfaction are negatively impacted. Although burnout is increasing in health care, much can be done to change the level of burnout and improve employee satisfaction. Individuals can learn the factors that lead to burnout and specific actions that can help prevent and recover from burnout. This information can be used to transform health care and decrease burnout and its effects.

What is Needed for Evidence-Based Dietary Recommendations for Migraine: A Call to Action for Nutrition and Microbiome Research

BACKGROUND

The gastrointestinal symptoms of migraine attacks have invited numerous dietary hypotheses for migraine etiology through the centuries. Substantial efforts have been dedicated to identifying dietary interventions for migraine attack prevention, with limited success. Meanwhile, mounting evidence suggests that the reverse relationship may also exist - that the biological mechanisms of migraine may influence dietary intake. More likely, the truth involves some combination of both, where the disease influences food intake, and the foods eaten impact the manifestations of the disease. In addition, the gut's microbiota is increasingly suspected to influence the migraine brain via the gut-brain axis, though these hypotheses remain largely unsubstantiated.

OBJECTIVE

This paper presents an overview of the strength of existing evidence for food-based dietary interventions for migraine, noting that there is frequently evidence to suggest that a dietary risk factor for migraine exists but no evidence for how to best intervene; in fact, our intuitive assumptions on interventions are being challenged with new evidence. We then look to the future for promising avenues of research, notably the gut microbiome.

CONCLUSION

The evidence supports a call to action for high-quality dietary and microbiome research in migraine, both to substantiate hypothesized relationships and build the evidence base regarding nutrition's potential impact on migraine attack prevention and treatment.

Risk Assessment of Lead and Cadmium in Drinking Water for School use in Nakhon Si Thammarat Province, Thailand

This research aimed to evaluate children’s health risk based on the concentration of lead (Pb) and cadmium (Cd) in the drinking water used by 44 primary schools. Samples were collected from bottled water, tap water, filtered tap water and raw water, for a total of 146 samples, between 1 September 2018 and 31 January 2019. The concentrations of Pb and Cd in drinking water samples were determined by graphite furnace atomic absorption spectrometry. The results showed that the concentration of Pb and Cd in bottled water samples were in the range of non-detected (ND)–0.0180 mg/L and ND–0.0013 mg/L, respectively. The concentration of Pb and Cd in tap water samples ranged from ND-0.0250 mg/L and ND-0.0042 mg/L, respectively, from ND–0.005 mg/L and ND–0.0021 mg/L, respectively, in filtered tap water samples and from ND–0.0400 mg/L and ND–0.0049 mg/L, respectively, in raw water samples. The summation of the total hazardous index (HI)-values of bottled water samples, tap water samples, filtered tap water, and raw water samples were less than 1, was considered health-protective. The results will provide the direct evidence needed by school managers to warn learners about the health risk of ingestion exposure among children.

Drinking water access in California schools: Room for improvement following implementation of school water policies

This study aims to investigate how access to free drinking water in California public schools changed after implementation of 2010 federal and state school water policies. Repeated cross-sectional surveys were conducted with administrators in a random sample of California public schools, stratified by school type and urban-centric geography, from 2010 to 2011 (n = 240) and from 2016 to 2018 (n = 240). Surveys assessed excellence in drinking water access, defined as 1) providing water in 4 of 5 key school locations, 2) having a high density of free water available, 3) providing water via a non-fountain source, 4) providing water that is perceived as safe, and 5) offering water sources that are reported as clean and functioning. Multivariate logistic regression was used to examine changes in excellence in drinking water access after implementation of school drinking water policies. Analysis was completed in 2019. In 2010-2011, 5% of schools met all water excellence criteria; in 2016-2018, 18% of schools met all excellence criteria. In adjusted models, post-legislation schools had 4 times the odds of meeting all drinking water excellence criteria compared to pre-legislation schools (OR: 4.34; 95% confidence interval = 2.07, 9.10). There were significant increases in public schools meeting the criteria for excellence in free drinking water access after school water policies were implemented; however, a majority of schools still lacked excellent water access. Findings suggest that policies mandating free water access in schools may help to improve excellence in access, and more work is needed to help all schools excel in this area.

Teachers' Perceptions and Understanding of Children's Fluid Intake

No public health data exists on elementary teachers’ perceptions of both their own fluid intake and of their elementary school aged children’s fluid intake. A total of 271 (20 males, 251 females) teachers in developed areas of Australia, Belgium, England, Ireland, United Arab Emirates, and the United States of America completed an online questionnaire (Feb–Mar 2019) on: (i) their fluid intake, (ii) their perception and understanding of children’s fluid intake and (iii) barriers in the school day that they felt prevented school children consuming fluids. Overall, the data indicated that teachers consume considerably lower amounts than recommended themselves, but have a good awareness of children’s fluid intake and estimate children drink approximately half (1 litre (34% n = 93)) of what is recommended per day. The results were also similar to those reported by children previously. Yet, the data highlighted a lack of active encouragement of drinking water throughout the school day by teachers, with only 11% (n = 29) suggesting they actively encourage children to drink and 45% (n = 123) reporting no active encouragement at all. It is recommended as a public health measure that all school children consume an extra cup of water during lunch times in those schools where water intake was recognized as sub optimal. Furthermore, depending on weather conditions, a cup of water before, during and after Physical Education lessons should be encouraged by teachers. Water coolers or bottles may be used as a supplementary resource, provided that hygiene is maintained. From an educational perspective, more professional development needs to be provided to teachers on the importance of regular water consumption, and more time dedicated across the elementary curriculum to educational understanding of fluid consumption.

A systematic review of the effectiveness of promoting water intake to reduce sugar-sweetened beverage consumption

OBJECTIVE

To examine whether the promotion of water intake could reduce sugar-sweetened beverage (SSB) consumption or purchases independent of interventions that target SSBs.

METHODS

Seven databases were systematically searched. Included studies used water promotion as the primary intervention; used a controlled trial, single group pre-post, or prospective cohort study design; included a measure of SSB consumption or purchase; enrolled human participants of any age who lived in high-income or middle-income countries; contained original data; and appeared in a peer-reviewed English-language article published from 1 January 2000 to January 4, 2019. The search yielded 7068 publications, from which 108 were chosen for full-text review. Seventeen were included in this review.

RESULTS

Nine of the 17 studies were randomized controlled trials, six were nonrandomized controlled trials, and 2 were single-group pre-post studies. Participants were primarily children and adolescents. Interventions included water provision, education or promotion activities. Ten of 17 studies were at low or some/moderate risk of bias. Seven studies showed a statistically significant decrease in SSB consumption of which only 2 were at low or some/moderate risk of bias.

CONCLUSIONS

This review found limited evidence that interventions aimed solely at increasing water consumption reduce SSB intake. Further research is needed to investigate whether interventions that combine water promotion and SSB reduction strategies could be synergistic for reducing SSB intake.

Biocompatible modified water as a non-pharmaceutical approach to prevent metabolic syndrome features in obesogenic diet-fed mice

The prevalence of metabolic syndrome (MetS), elevating cardiovascular risks, is increasing worldwide, with no available global therapeutic options. The intake of plain, mineral or biocompatible modified waters was shown to prevent some MetS features. This study was designed to analyze, in mice fed a high fat and sucrose diet (HFSD), the effects on MetS features of the daily intake of a reverse osmosed, weakly remineralized, water (OW) and of an OW dynamized by a physical processing (ODW), compared to tap water (TW). The HFSD was effective at inducing major features of MetS such as obesity, hepatic steatosis and inflammation, blood dyslipidemia, systemic glucose intolerance and muscle insulin resistance. Compared to TW, OW intake decreased hepatic fibrosis and inflammation, and mitigated hepatic steatosis and dyslipidemia. ODW intake further improved skeletal muscle insulin sensitivity and systemic glucose tolerance. This study highlights the deleterious metabolic impacts of the daily intake of TW, in combination with a high energy diet, and its possible involvement in MetS prevalence increase. In addition, it demonstrates that biocompatible modified water may be promising non-pharmaceutical, cost-effective tools for nutritional approaches in the treatment of MetS.

The Validity of Urine Color as a Hydration Biomarker within the General Adult Population and Athletes: A Systematic Review

Frequent monitoring of hydration status may help to avoid the adverse effects of dehydration. Other than urine color assessment, hydration assessment methods are largely impractical for the general population and athletes to implement on a routine basis. Despite its widespread use, the validity of urine color as an indicator of hydration status has not been systematically evaluated. The objective of this systematic review is to determine the validity of urine color evaluation as a hydration status assessment method in the general adult population, older adults, and athletes. Using the PRISMA guidelines, electronic databases were searched to identify original research articles of all study design types for inclusion. Of the 424 articles screened, 10 met inclusion criteria. Most studies compared urine color to either urinary specific gravity or urine osmolality, and reported significant associations (r) ranging from 0.40 to 0.93. Lower correlations were noted in studies of adults aged >60 years. Studies generally reported a high sensitivity of urine color as a diagnostic tool for detecting dehydration and supported the ability of this method to distinguish across categories of hydration status. Research is needed to determine if clinicians, patients, and clients can accurately utilize this method in clinical and real-world settings. Future research is also needed to extend these findings to other populations, such as children.Key teaching pointsInadequate hydration can lead to impairments in physical performance and cognitive function.Methods used to assess hydration status include plasma/serum osmolality, urinary specific gravity (USG), urine osmolality (Uosm), change in body weight, urine volume, and urine color.Urine color assessment is a practical method that is routinely used in clinical, athletic, and other settings. The validity of this method has not been systemically evaluated.Available research was limited to 10 articles.Validity of this method was generally supported; however, research has not investigated the validity of this method by clinicians, patients and clients.

Drinking patterns and hydration biomarkers among young adults with different levels of habitual total drinking fluids intake in Baoding, Hebei Province, China: a cross-sectional study

BACKGROUND

The purposes were to investigate the drinking patterns and hydration biomarkers among young adults with different levels of habitual total drinking fluids intake.

METHODS

A cross-sectional study was conducted among 159 young adults aged 18-23 years in Baoding, China. Total drinking fluids and water from food were assessed by 7-day 24-h fluid intake questionnaire and duplicate portion method, respectively. The osmolality and electrolyte concentrations of the 24 h urine and fasting blood samples were tested. Differences in LD1 (low drinker), LD2, LD3 and HD (high drinker) groups, stratified according to the quartiles of total drinking fluids, were compared using one-way ANOVA, Kruskal-Wallis H test and chi-square test.

RESULTS

A total of 156 participants (80 males and 76 females) completed the study. HD group had greater amounts of TWI (Total Water Intake), water from food, higher and lower contributions of total drinking fluids and water from food to TWI, respectively, than LD1, LD2 and LD3 groups (p < 0.05). Participants in HD group had higher amounts of water and water from dishes than participants in LD1, LD2 and LD3 groups (p < 0.05). No significant differences were found in the contributions of different fluids to total drinking fluids within the four groups (p > 0.05). The osmolality of urine was 59-143 mOsm/kg higher in LD1 than that in LD2, LD3 and HD group (p < 0.05). The percentage of participants in optimal hydration status increased from 12.8% in LD1 group to 56.4% in HD group (p < 0.05). HD and LD3 groups had 386~793 higher volumes of urine than that of LD1 and LD2 groups (p < 0.05). Differences were found in the concentrations of electrolytes among the four groups (p < 0.05). No significant differences were found in the plasma biomarkers (p > 0.05), with the exception of higher concentration of Mg in LD3 and HD groups than that in LD1 and LD2 groups (p < 0.05).

CONCLUSIONS

Participants with higher total drinking fluids had better drinking pattern and hydration status. Interventions should be undertaken to advise adults to have adequate total drinking fluids, in order to keep in optimal hydration status.

TRIAL REGISTRATION

The registration number was ChiCTR-ROC-17010320, which was registered on the Chinese clinical trial registry.

Antibiotic resistance in urinary tract infections: A re-visit after five years and experience over two sites

OBJECTIVE

The aim of this study was to repeat a previous audit, performed from 2009 to 2013, for the cohort of 2018 to determine how the resistance rates in urinary pathogens in women over 18 years of age have changed. A secondary aim of the study was to use resistance data from a different UK hospital in the same year to compare differences in resistance rates across different geographic locations.

STUDY DESIGN

This was a retrospective study of all positive urine cultures grown from female patients attending two different hospitals in the year 2018. Resistance patterns were analysed.

RESULTS

The resistance rate to co-amoxiclav continues to increase with amoxicillin retaining high resistance patterns. There are some significant differences in resistance patterns between the different locations.

CONCLUSION

Antimicrobial resistance is a significant problem in the UK particularly in antibiotics used to treat UTI. These patterns can vary across different geographical locations and over time; therefore, up-to-date knowledge of local anti-biotic resistance is essential when making an appropriate prescription choice.

Short sleep duration is associated with inadequate hydration: cross-cultural evidence from US and Chinese adults

Study Objectives

Short and long sleep durations are linked to reduced kidney function, but little research has examined how sleep is associated with hydration status. Our aim was to assess the relationship between sleep duration and urinary hydration biomarkers among adults in a cross-cultural context.

Methods

Three samples of adults aged ≥20 years were analyzed: 2007-2008 National Health and Nutrition Examination Survey (NHANES; n = 4680), 2009-2012 NHANES (n = 9559), and 2012 cross-sectional wave of the Chinese Kailuan Study (n = 11903), excluding pregnant women and adults with failing kidneys. We estimated multiple linear regression models between self-reported usual night-time sleep duration (<6, 6, 7, 8 (reference), and ≥9 hr/day) and urine specific gravity (Usg) and urine osmolality (Uosm) as continuous variables and logistic regression models dichotomized as inadequate hydration (>1.020 g/mL; >831 mOsm/kg). In primary analyses, we estimated models excluding diabetes and diuretic medications for healthier subpopulations (NHANES, n = 11353; Kailuan, n = 8766).

Results

In the healthier NHANES subset, 6 hr was associated with significantly higher Usg and odds of inadequate hydration (adjusted OR: 1.59, 95% CI: 1.25, 2.03) compared with 8 hr. Regression results were mixed using Uosm, but in the same direction as Usg. Among Chinese adults, short sleep duration (<6 and 6 hr) was associated with Usg and higher likelihood of inadequate hydration (6 hr adjusted OR: 1.42, 95% CI: 1.26, 1.60). No consistent association was found with sleeping ≥9 hr.

Conclusions

Short sleep duration was associated with higher odds of inadequate hydration in US and Chinese adults relative to sleeping 8 hr.

Diet and Skin Aging-From the Perspective of Food Nutrition

We regularly face primary challenges in deciding what to eat to maintain young and healthy skin, defining a healthy diet and the role of diet in aging. The topic that currently attracts maximum attention is ways to maintain healthy skin and delay skin aging. Skin is the primary barrier that protects the body from external aggressions. Skin aging is a complex biological process, categorized as chronological aging and photo-aging, and is affected by internal factors and external factors. With the rapid breakthrough of medicine in prolonging human life and the rapid deterioration of environmental conditions, it has become urgent to find safe and effective methods to treat skin aging. For diet, as the main way for the body to obtain energy and nutrients, people have gradually realized its importance to the skin. Therefore, in this review, we discuss the skin structure, aging manifestations, and possible mechanisms, summarize the research progress, challenges, possible directions of diet management, and effects of foodborne antioxidants on skin aging from the perspective of food and nutrition.

Correlates of Infrequent Plain Water Intake Among US High School Students: National Youth Risk Behavior Survey, 2017

PURPOSE

To examine factors associated with frequency of plain water (ie, tap, bottled, and unflavored sparkling water) intake among US high school students.

DESIGN

Quantitative, cross-sectional study.

SETTING

The 2017 national Youth Risk Behavior Survey data.

SUBJECTS

US high school students with plain water intake data (N = 10 698).

MEASURES

The outcome was plain water intake. Exposure variables were demographics, academic grades, and behavioral characteristics.

ANALYSIS

We used logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CIs) for factors associated with infrequent plain water intake (<3 vs ≥3 times/day).

RESULTS

Overall, 48.7% of high school students reported drinking plain water <3 times/day. Factors associated with infrequent plain water intake were younger age (≤15 years; aOR = 1.20, CI = 1.05-1.37); earning mostly D/F grades (aOR = 1.37, CI = 1.07-1.77); consuming regular soda 1 to 6 times/week (aOR = 1.92, CI = 1.67-2.20) or ≥1 time/day (aOR = 3.23, CI = 2.65-3.94), sports drinks 1 to 6 times/week (aOR = 1.30, CI = 1.14-1.49), milk <2 glasses/day (aOR = 1.51, CI = 1.31-1.73), fruits <2 times/day (aOR = 1.92, CI = 1.66-2.22), and vegetables <3 times/day (aOR = 2.42, CI = 2.04-2.89); and being physically active ≥60 minutes/day on <5 days/week (aOR = 1.83, CI = 1.60-2.08). Students with obesity were less likely to have infrequent water intake (aOR = 0.63, CI = 0.53-0.74).

CONCLUSIONS

Infrequent plain water intake was associated with younger age, poor academic grades, poor dietary behaviors, and physical inactivity. These findings can inform intervention efforts to increase water intake to promote healthy lifestyles among adolescents.

Risk factor analysis of insufficient fluid intake among urban adults in Wuxi, China: a classification and regression tree analysis

Background

Dehydration due to insufficient fluid intake (IFI) is detrimental to health. This cross-sectional study aimed to assess the fluid intake of urban adults in Wuxi, China, and to identify potential risk factors contributing to IFI.

Methods

Adults were selected from the urban area of Wuxi, China, using a multiple-stage random sampling method. The fluid intake information was obtained with a 24-h self-reported diary over seven consecutive days in both summer and winter of 2015. A classification and regression tree (CART) analysis was conducted to detect the potential risk factors associated with IFI. CART is a machine-learning algorithm that portions the data into subsets by threshold.

Results

A total of 584 adults aged 18–87 years were included. The results showed that the median (P25–P75) values of daily fluid intake of the participants were 1100 (800–1550) mL in summer and 1000 (750–1300) mL in winter. Women had a higher prevalence of IFI than men in both summer (odds ratio (OR) = 2.683, 95% confidence interval (CI): 1.830–3.934) and winter (OR = 2.636, 95% CI: 1.677–4.142). The results of CART analysis showed that, in summer, BMI < 25 kg/m² (probability: 64.2%) and age < 64 years (probability: 67.4%) were main risk factors of IFI for men, and BMI < 29 kg/m² (probability: 81.6%) and living in C Community (probability: 86.7%) were main risk factors for women. In winter, age < 40 years (probability: 81.8%) and BMI < 20 kg/m² (probability: 94.5%) were identified as main risk factors of IFI for men and women, respectively.

Conclusions

Most of the participants living in the study site had IFI. The fluid consumption varied by gender, age, location, and BMI. The findings could be useful for the implementation and optimization of intervention programs by identifying the individuals who may at greater risk of dehydration.

Dehydration Impairs Physical Growth and Cognitive Development in Young Mice

Infancy and childhood are periods of physical and cognitive development that are vulnerable to disruption by dehydration; however, the effects of dehydration on cognitive development during the periods have not yet been fully elucidated. Thus, the present study used a murine model to examine the effects of sustained dehydration on physical growth and cognitive development. Three-week-old C57BL/6J mice were provided either ad libitum (control group) or time-limited (15 min/day; dehydration group) access to water for 4 weeks. Physical growth was examined via a dual-energy X-ray absorptiometry whole-body scan, and cognitive development was assessed using the Barnes maze test. RNA-sequencing and qPCR analyses were carried out to assess the hippocampal transcriptome and the expression of key neurotrophic factors, respectively. These analyses showed that dehydrated mice exhibited a reduced body mass and tail length, and they spent four times longer completing the Barnes maze test than control mice. Moreover, dehydration significantly dysregulated long-term potentiation signaling and specifically decreased hippocampal brain-derived neurotrophic factor (Bdnf) expression. Collectively, these data confirm dehydration inhibits physical growth and suggest that it impairs cognitive development by altering the hippocampal transcriptional network in young mice; thus, they highlight the importance of water as a vital nutrient for optimal growth and development during infancy and childhood.

Stories of success: a qualitative examination of contributors to excellence in school drinking water access

Objective:

Drinking water instead of beverages with added sugar can help prevent obesity and cavities and promote overall health. Children spend much of their day in school, where they have variable access to drinking water. In 2010, federal and state law required California public schools to provide free potable water to students in areas where meals are served and/or eaten. The current study aims to identify factors associated with an excellent drinking water culture in schools.

Design:

A qualitative assessment of barriers and facilitators to providing excellent water quality and access in a purposive sample of California schools. In-depth interviews with key informants were conducted using a snowball sampling approach, after which data were analysed using both inductive and deductive methods.

Setting:

California public elementary, middle/junior and high schools.

Participants:

Knowledgeable individuals involved in initiatives related to school drinking water accessibility, quality or education at each selected school.

Results:

Thirty-four interviewees participated across fifteen schools. Six themes emerged as prominent facilitators to a school’s success in providing excellent water access to students: active and engaged champions, school culture and policy, coordination between groups, community influences, available resources and environmentalism.

Conclusions:

While policy is an important step for achieving minimum standards, resources and interest in promoting excellence in drinking water access and quality can vary among schools. Ensuring that schools have dedicated staff committed to advancing student health and promoting the benefits of water programs that are more salient to schools could help reduce disparities in drinking water excellence across schools.

Advanced Sensing and Human Activity Recognition in Early Intervention and Rehabilitation of Elderly People

Ageing is associated with a decline in physical activity and a decrease in the ability to perform activities of daily living, affecting physical and mental health. Elderly people or patients could be supported by a human activity recognition (HAR) system that monitors their activity patterns and intervenes in case of change in behavior or a critical event has occurred. A HAR system could enable these people to have a more independent life.

In our approach, we apply machine learning methods from the field of human activity recognition (HAR) to detect human activities. These algorithmic methods need a large database with structured datasets that contain human activities. Compared to existing data recording procedures for creating HAR datasets, we present a novel approach, since our target group comprises of elderly and diseased people, who do not possess the same physical condition as young and healthy persons.

Since our targeted HAR system aims at supporting elderly and diseased people, we focus on daily activities, especially those to which clinical relevance in attributed, like hygiene activities, nutritional activities or lying positions. Therefore, we propose a methodology for capturing data with elderly and diseased people within a hospital under realistic conditions using wearable and ambient sensors. We describe how this approach is first tested with healthy people in a laboratory environment and then transferred to elderly people and patients in a hospital environment.

We also describe the implementation of an activity recognition chain (ARC) that is commonly used to analyse human activity data by means of machine learning methods and aims to detect activity patterns. Finally, the results obtained so far are presented and discussed as well as remaining problems that should be addressed in future research.

Hydrate Philly: An Intervention to Increase Water Access and Appeal in Recreation Centers

INTRODUCTION

Previous interventions to increase water access and consumption have focused on school settings, have shown mixed results on sugar-sweetened beverage (SSB) consumption, and have rarely addressed tap water safety. Our randomized controlled trial examined how improving access and appeal of water in recreation centers in low-income neighborhoods affected counts of SSBs carried by youth attending summer camp.

METHODS

Recreation centers (N = 28) matched on their characteristics were randomly assigned to control or intervention groups. Intervention centers received a new water fountain with a bottle filler (hydration station), water testing services, reusable water bottles, and water promotion and education training and materials. Primary outcomes were 1-year changes in center-level average daily gallons of water from fountains and hydration stations (flowmeter readings). Secondary outcomes were counts of SSBs observed, use of bottled water and reusable water bottles, staff SSB consumption, and hydration station maintenance.

RESULTS

Results showed increased water use (b = 8.6, 95% CI, 4.2-13.0) and reusable bottle counts (b = 10.2, 95% CI, 4.2-16.1) in intervention centers compared with control centers. No change occurred in youth carrying SSBs at camp, but center staff's past 30-day SSB consumption frequency decreased (b = -34.8, 95% CI, -67.7 to -1.9). Intervention sites had marginally lower odds of maintenance problems (OR = 0.09; 95% CI, 0.004-0.76, P = .06) than control sites.

CONCLUSION

Although providing hydration stations along with water testing, reusable water bottles, education, and promotion increased water consumption among youth at recreation centers, it had no effect on the number of SSBs observed during camp. Future strategies to increase water consumption should also address reducing SSB intake.

Fruits

Fruits come in a wide variety of colors, shapes, and flavors. This chapter will cover selected fruits that are known to be healthy and highly nutritious. These fruits were chosen due to their common usage and availability. Since it is not possible to cover all health benefits or essential nutrients and important phytochemicals of the fruit composition, this chapter will focus on the key valuable constituents and their potential health effects.

Substitution of sugar-sweetened beverages for other beverages and the risk of developing coronary heart disease: Results from the Harvard Pooling Project of Diet and Coronary Disease

Sugar-sweetened beverage (SSB) intake is associated with metabolic disorders. The reduction of SSB intake has been promoted to prevent death and disability from chronic diseases. We investigated the association between SSB intake and the risk of coronary events and death, and assessed if substitution of coffee, tea, milk, fruit juice and artificially-sweetened beverages (ASB) for SSBs was associated with a reduced risk of coronary events and death. This was a follow-up study in which data from six studies were pooled and standard observational analyses were performed. Diet intake was assessed at baseline by food-frequency questionnaires. Hazard ratios (HRs) with 95% confidence intervals for the incidence of coronary events and deaths were calculated by Cox proportional hazards regression. The effect of substituting another beverage for SSBs was calculated by taking the difference in the individual effect estimates. During the median 8.2-year follow-up, 4248 coronary events and 1630 coronary deaths were documented among 284,345 individuals. 355 ml daily increase of SSB intake was associated with an increased risk of coronary events (HR: 1.08; 95%CI: 1.02, 1.14) and possibly coronary death (HR: 1.05; 95%CI: 0.96, 1.16). Substitution analyses suggested that replacing SSBs with coffee (HR: 0.93; 95%CI: 0.87, 1.00) or ASB (HR: 0.89; 95%CI: 0.83, 0.97), might be associated with a lower risk of developing coronary events. We found that SSB intake was associated with an increased risk of coronary events and possibly coronary death. Our findings also suggest that replacing SSB's with ASBs or coffee may lower the risk of developing CHD.

Association Between Daily Water Intake and 24-hour Urine Volume Among Adolescents With Kidney Stones

OBJECTIVE

To determine the association between daily water intake and 24-hour urine volume among adolescents with nephrolithiasis in order to estimate a "fluid prescription," the additional water intake needed to increase urine volume to a target goal.

METHODS

We conducted a secondary analysis of an ecological momentary assessment study that prospectively measured daily water intake of 25 adolescents with nephrolithiasis over 7 days. We identified 24-hour urine volumes obtained for clinical care within 12 months of water intake assessment. A linear regression model was fit to estimate the magnitude of the association between daily water intake and 24-hour urine volume, adjusting for age, sex, race, and daily temperature.

RESULTS

Twenty-two participants completed fifty-seven 24-hour urine collections within 12 months of the study period. Median daily water intake was 1.4 L (IQR 0.67-1.94). Median 24-hour urine volume was 2.01 L (IQR 1.20-2.73). A 1 L increase in daily water intake was associated with a 710 mL increase in 24-hour urine output (95%CI 0.55-0.87). Using the model output, the equation was generated to estimate the additional fluid intake needed fluid prescription (FP) to produce the desired increase in urine output (dUOP): FP = dUOP/0.71.

CONCLUSION

The FP equation (FP = dUOP)/0.71), which reflects the relationship between water intake and urine volume, could be used to help adolescents with nephrolithiasis achieve urine output goals to decrease stone recurrence.

Defining a Healthy Diet: Evidence for The Role of Contemporary Dietary Patterns in Health and Disease

The definition of what constitutes a healthy diet is continually shifting to reflect the evolving understanding of the roles that different foods, essential nutrients, and other food components play in health and disease. A large and growing body of evidence supports that intake of certain types of nutrients, specific food groups, or overarching dietary patterns positively influences health and promotes the prevention of common non-communicable diseases (NCDs). Greater consumption of health-promoting foods and limited intake of unhealthier options are intrinsic to the eating habits of certain regional diets such as the Mediterranean diet or have been constructed as part of dietary patterns designed to reduce disease risk, such as the Dietary Approaches to Stop Hypertension (DASH) or Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets. In comparison with a more traditional Western diet, these healthier alternatives are higher in plant-based foods, including fresh fruits and vegetables, whole grains, legumes, seeds, and nuts and lower in animal-based foods, particularly fatty and processed meats. To better understand the current concept of a “healthy diet,” this review describes the features and supporting clinical and epidemiologic data for diets that have been shown to prevent disease and/or positively influence health. In total, evidence from epidemiological studies and clinical trials indicates that these types of dietary patterns reduce risks of NCDs including cardiovascular disease and cancer.

Understanding the principles and aims of intravenous fluid therapy

A balance between the volume of fluid taken in by the human body, and the volume of fluid excreted, is essential for life. Body fluid balance, which is maintained via various homeostatic mechanisms, can be disrupted by injury or disease. Prompt action is usually required to replenish fluid volumes and restore homeostasis, which is achieved via intravenous (IV) fluid therapy. Nurses will often encounter patients with a disrupted fluid balance, particularly in critical care. They will be involved in assessing patients' fluid status and administering and monitoring therapy. Therefore, nurses have an important role in ensuring the safety and effectiveness of IV fluid therapy. This article provides an overview of the principles and aims of IV fluid therapy. It also explains the physiology of body fluid and mechanisms of fluid balance regulation, outlines the principles of patient assessment and indications for IV fluid therapy, and details its potential risks and complications.

A multicentre prospective audit of bedside hydration in hospital

INTRODUCTION

access to water at the bedside is a cornerstone of patient care. Among bedbound inpatients, water within reach at the bedside is a basic human dignity and one that ought not to be neglected.

AIM

the authors sought to identify the extent to which accessible hydration facilities were provided to a bedbound inpatient population.

METHODS

a cross-sectional, point-prevalent audit of hospitalised medical inpatients across five centres was conducted. Data were collected between meal times and noted baseline demographics and admission details, adequacy of oral hydration provision at the bedside and, where provision was inadequate, factors associated with this.

RESULTS

across a total surveyed patient population of 559 we identified 138 patients who were bedbound. Among these bedbound patients, 6% (n=8) had no water provided at the bedside. However, 7 of these were deemed to be unable to swallow safely. In total, 44 (32%) of the 138 bedbound patients were unable to reach the water at their bedside; 18 of these patients would have been able to drink for themselves had the water been in reach.

CONCLUSION

there is significant room for improvement in ensuring patients who are immobile are able to reach drinking apparatus at the bedside. In the five centres surveyed, approximately one in five bedbound patients with no contraindication are unable to reach an essential means of hydration.

Lessons learned from a blended telephone/e-health platform for caregivers in promoting physical activity and nutrition in children with a mobility disability

BACKGROUND

Children with physical disabilities report higher rates of sedentary lifestyle and unhealthy dietary patterns than non-disabled peers. These behaviors can increase comorbidities, caregiver burden, and healthcare costs. Innovative interventions are needed to assist caregivers of children with physical disabilities improve health behaviors.

OBJECTIVE

/Hypothesis: The purpose of this pilot study was to test the usability and preliminary efficacy of an e-health and telecoaching intervention compared to telecoaching alone.

METHODS

Parent/child dyads (n = 65) were randomized into either the e-health and telephone group (e-HT) or the telephone only group (TO). All participants received regular calls from a telecoach, and the e-HT group received access to a website with personalized weekly goals for diet and physical activity, and access to resources to meet these goals. At the conclusion of the intervention, participants in the e-HT group were asked to complete a semi-structured interview to discuss the usability of the e-health platform.

RESULTS

Fifty of the 65 randomized dyads (77%) completed all baseline measures and had at least one intervention call. Forty families (80% of those that started the intervention) completed the study (50% spina bifida, 24% mobility limitation, diagnosis not reported). Age of the children ranged from 6 to 17 years old. Both groups had high adherence to scheduled phone calls (e-HT (n = 17): 81%, TO (n = 23): 86%); however no significant differences in dietary intake or physical activity were seen within or between groups. Primary themes to emerge from qualitative interviewers were: the platform should target children rather than parents, parents valued the calls more than the website, and schools need to be involved in interventions.

CONCLUSIONS

E-health interventions are a promising way to promote healthy behaviors in children with physical disability, but technology must be balanced with ease of use for parents while also engaging the child.

Analysis of human brain by magnetic resonance imaging using content-based image retrieval

OBJECTIVE

Content-based image retrieval (CBIR) is the most suitable and alternative method for older text searches that use keywords. This article aims to improve feature extraction as well as matching techniques designed for more accurate and precise CBIR systems, especially for brain scan images associated with various brain diseases and abnormalities. Tests should be described at an appropriate success rate.

METHODS

Various methods of producing medical images are discussed, and examples of biological applications are given. The discussion emphasizes as an introduction to CBIR the new method of echo-planar imaging, which is fully described. We have done here many methods related to digital image processing and we had developed a code for retrieving everything automatically. This application has been developed in Matlab software.

RESULTS

Testing the correctness and effectiveness of the system evolved becomes more important when the system is going to be used in real-time and more when it is for humankind, i.e., medical diagnosis. Nowadays, our science and technology areas as develop as we can say that we have such advanced medical equipment so that our thought and program can be capable that it is giving us useful results. Determining if whether the two images are identical or not, it depends on the point of view of the person.

CONCLUSIONS

In this paper, the outcome of feature extraction and matching by setting cutoff limit and threshold is pretty promising. Further studies can be done apart from computed tomography scans for a more generalized CBIR system.

Providing Students with Adequate School Drinking Water Access in an Era of Aging Infrastructure: A Mixed Methods Investigation

Ensuring students’ access to safe drinking water at school is essential. However, many schools struggle with aging infrastructure and subsequent water safety problems and have turned to bottled water delivery systems. Little is known about whether such systems are feasible and effective in providing adequate student water access. This study was a mixed-methods investigation among six schools in an urban district in the U.S. with two types of water delivery systems: (1) tap water infrastructure, with updated water fountains and bottle fillers, and (2) bottled water coolers. We measured students’ water consumption and collected qualitative data from students and teachers about their perceptions of school drinking water. Student water consumption was low—between 2.0 (SD: 1.4) ounces per student and 2.4 (SD: 1.1) ounces per student during lunch. Students and teachers reported substantial operational hurdles for relying on bottled water as a school’s primary source of drinking water, including difficulties in stocking, cleaning, and maintaining the units. While students and teachers perceived newer bottle filler units positively, they also reported a distrust of tap water. Bottled water delivery systems may not be effective long-term solutions for providing adequate school drinking water access and robust efforts are needed to restore trust in tap water.

Evaluation of a Novel Tool for Screening Inadequate Food Intake in Age-Related Macular Degeneration Patients

Diet assessment tools provide valuable nutrition information in research and clinical settings. With growing evidence supporting dietary modification to delay development and progression of age-related macular degeneration (AMD), an AMD-specific diet assessment tool could encourage eye-care practitioners to refer patients in need of further dietary behavioural support to a dietitian and/or support network. Therefore, the aim of this study was to evaluate clinical use of a novel, short dietary questionnaire (SDQ-AMD) to screen for inadequate food intake in AMD patients by comparing it against a validated food frequency questionnaire (FFQ). Recruitment sources included Sydney-based private eye clinics and research databases (N = 155; 57% female; 78 ± 8 years). Scoring criteria based on the Australian Dietary Guidelines and dietary recommendations for AMD in literature were developed and applied to dietary data from the FFQ and SDQ-AMD. Bland-Altman plot of difference suggests agreement between the FFQ and SDQ-AMD as most mean difference scores were within the 95% CI (6.91, -9.94), and no significant bias between the scores as the mean score increased ((regression equation: y = 0.11x - 2.60) (95% CI: -0.058, 0.275, p-value = 0.20)). Scores were also significantly correlated (0.57, p ≤ 0.0001). The SDQ-AMD shows potential as a diet screening tool for clinical use, however, additional studies are warranted to validate the SDQ-AMD.

Single-Cell RNA Sequencing Reveals Renal Endothelium Heterogeneity and Metabolic Adaptation to Water Deprivation

BACKGROUND

Renal endothelial cells from glomerular, cortical, and medullary kidney compartments are exposed to different microenvironmental conditions and support specific kidney processes. However, the heterogeneous phenotypes of these cells remain incompletely inventoried. Osmotic homeostasis is vitally important for regulating cell volume and function, and in mammals, osmotic equilibrium is regulated through the countercurrent system in the renal medulla, where water exchange through endothelium occurs against an osmotic pressure gradient. Dehydration exposes medullary renal endothelial cells to extreme hyperosmolarity, and how these cells adapt to and survive in this hypertonic milieu is unknown.

METHODS

We inventoried renal endothelial cell heterogeneity by single-cell RNA sequencing >40,000 mouse renal endothelial cells, and studied transcriptome changes during osmotic adaptation upon water deprivation. We validated our findings by immunostaining and functionally by targeting oxidative phosphorylation in a hyperosmolarity model in vitro and in dehydrated mice in vivo.

RESULTS

We identified 24 renal endothelial cell phenotypes (of which eight were novel), highlighting extensive heterogeneity of these cells between and within the cortex, glomeruli, and medulla. In response to dehydration and hypertonicity, medullary renal endothelial cells upregulated the expression of genes involved in the hypoxia response, glycolysis, and-surprisingly-oxidative phosphorylation. Endothelial cells increased oxygen consumption when exposed to hyperosmolarity, whereas blocking oxidative phosphorylation compromised endothelial cell viability during hyperosmotic stress and impaired urine concentration during dehydration.

CONCLUSIONS

This study provides a high-resolution atlas of the renal endothelium and highlights extensive renal endothelial cell phenotypic heterogeneity, as well as a previously unrecognized role of oxidative phosphorylation in the metabolic adaptation of medullary renal endothelial cells to water deprivation.

Water turnover among human populations: Effects of environment and lifestyle

OBJECTIVES

To discuss the environmental and lifestyle determinants of water balance in humans and identify the gaps in current research regarding water use across populations.

METHODS

We investigated intraspecific variation in water turnover by comparing data derived from a large number of human populations measured using either dietary survey or isotope tracking. We also used published data from a broad sample of mammalian species to identify the interspecific relationship between body mass and water turnover.

RESULTS

Water facilitates nearly all physiological tasks and water turnover is strongly related to body size among mammals (r2=0.90). Within humans, however, the effect of body size is small. Instead, water intake and turnover vary with lifestyle and environmental conditions. Notably, despite living physically active lives in conditions that should increase water demands, the available measures of water intake and turnover among small-scale farming and pastoralist communities are broadly similar to those in less active, industrialized populations.

CONCLUSIONS

More work is required to better understand the environmental, behavioral, and cultural determinants of water turnover in humans living across a variety of ecosystems and lifestyles. The results of such work are made more vital by the climate crisis, which threatens the water security of millions around the globe.

Measuring Human Water Needs

Water connects the environment, culture, and biology, yet only recently has it emerged as a major focus for research in human biology. To facilitate such research, we describe methods to measure biological, environmental, and perceptual indicators of human water needs. This toolkit provides an overview of methods for assessing different dimensions of human water need, both well‐established and newly‐developed. These include: (a) markers of hydration (eg, urine specific gravity, doubly labeled water) important for measuring the impacts of water need on human biological functioning; (b) methods for measuring water quality (eg, digital colorimeter, membrane filtration) essential for understanding the health risks associated with exposure to microbiological, organic, metal, inorganic nonmental, and other contaminants; and (c) assessments of household water insecurity status that track aspects of unmet water needs (eg, inadequate water service, unaffordability, and experiences of water insecurity) that are directly relevant to human health and biology. Together, these methods can advance new research about the role of water in human biology and health, including the ways that insufficient, unsafe, or insecure water produces negative biological and health outcomes.

Association between Hydration Status and Body Composition in Healthy Adolescents from Spain

At present, obesity and overweight are major public health concerns. Their classical determinants do not sufficiently explain the current situation and it is urgent to investigate other possible causes. In recent years, it has been suggested that water intake could have important implications for weight management. Thus, the aim of this study was to examine the effect of hydration status on body weight and composition in healthy adolescents from Spain. The study involved 372 subjects, aged 12-18 years. Water intake was assessed through the validated "hydration status questionnaire adolescent young". Anthropometric measurements were performed according to the recommendations of the International Standards for Anthropometric Assessment (ISAK) and body composition was estimated by bioelectrical impedance analysis. Water intake normalized by body weight was positively correlated with body water content (boys (B): r = 0.316, p = 0.000; girls (G): r = 0.245, p = 0.000) and inversely with body mass index (BMI) (B: r = -0.515, p = 0.000; G: r = -0.385, p =0.000) and fat body mass (B: r = -0.306, p = 0.000; G: r = -0.250, p = 0.001). Moreover, according to BMI, overweight/obese individuals consumed less water than normal weight ones. In conclusion, higher water balance and intake seems to be related with a healthier body composition. In conclusion, higher water balance and intake is associated with a healthier body composition.

Estimated Substitution of Tea or Coffee for Sugar-Sweetened Beverages Was Associated with Lower Type 2 Diabetes Incidence in Case-Cohort Analysis across 8 European Countries in the EPIC-InterAct Study

INTRODUCTION

Beverage consumption is a modifiable risk factor for type 2 diabetes (T2D), but there is insufficient evidence to inform the suitability of substituting 1 type of beverage for another.

OBJECTIVE

The aim of this study was to estimate the risk of T2D when consumption of sugar-sweetened beverages (SSBs) was replaced with consumption of fruit juice, milk, coffee, or tea.

METHODS

In the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study of 8 European countries (n = 27,662, with 12,333 cases of incident T2D, 1992-2007), beverage consumption was estimated at baseline by dietary questionnaires. Using Prentice-weighted Cox regression adjusting for other beverages and potential confounders, we estimated associations of substituting 1 type of beverage for another on incident T2D.

RESULTS

Mean ± SD of estimated consumption of SSB was 55 ± 105 g/d. Means ± SDs for the other beverages were as follows: fruit juice, 59 ± 101 g/d; milk, 209 ± 203 g/d; coffee, 381 ± 372 g/d; and tea, 152 ± 282 g/d. Substituting coffee for SSBs by 250 g/d was associated with a 21% lower incidence of T2D (95% CI: 12%, 29%). The rate difference was -12.0 (95% CI: -20.0, -5.0) per 10,000 person-years among adults consuming SSBs ≥250 g/d (absolute rate = 48.3/10,000). Substituting tea for SSBs was estimated to lower T2D incidence by 22% (95% CI: 15%, 28%) or -11.0 (95% CI: -20.0, -2.6) per 10,000 person-years, whereas substituting fruit juice or milk was estimated not to alter T2D risk significantly.

CONCLUSIONS

These findings indicate a potential benefit of substituting coffee or tea for SSBs for the primary prevention of T2D and may help formulate public health recommendations on beverage consumption in different populations.

Biobehavioral variation in human water needs: How adaptations, early life environments, and the life course affect body water homeostasis

Body water homeostasis is critical for optimal physiological and cognitive function for humans. The majority of research has illustrated the negative biological consequences of failing to meet water needs. The human body has several mechanisms for detecting, regulating, and correcting body water deficits and excesses. However, variation exists in total water intake and how people meet those water needs as well as thirst thresholds and how well people tolerate water restriction. An evolutionary and developmental framework provides an underexplored perspective into human water needs by examining how adaptations, early life experiences and environments, as well as life course changes in health states and behaviors may shape these critical factors in body water homeostasis. This article first reviews biological and behavioral adaptations to water scarcity among animals and humans. It then examines human variation in water intake in a mostly water secure environment through the analysis of National Health and Nutrition Examination Survey dietary data and the link between water intake patterns and hydration biomarkers. Next, it reviews existing evidence of how maternal water restriction in utero and during lactation shape vasopressin release, thirst thresholds, drinking patterns, and body water homeostasis for the infant. Early life water restriction appears to have implications for hydration status, body size, and cardiovascular health. Finally, it examines how life course changes in health states and behaviors, including obesity, sleep, and parasitic infection, affect body water homeostasis. This article poses new questions about the plasticity and shaping of human water needs, thirst, and hydration behaviors.

Beverage consumption and energy intake among Canadians: analyses of 2004 and 2015 national dietary intake data

Background

Among adults and children consuming Western diets, beverages are significant sources of free sugars, saturated fats, excess calories, and alcohol, with relevance to chronic disease risk. The impact of recent healthy eating policies and beverage market evolutions on population-level consumption patterns in Canada is unknown. The current study examined trends in intake of a range of beverage types among a nationally-representative sample of Canadians, with stratification by socio-demographic characteristics.

Methods

The 2004 (n = 34,775) and 2015 (n = 20,176) nutrition-focused cycles of the Canadian Community Health Surveys are cross-sectional surveys representative of the population of the 10 Canadian provinces. Based on a single multiple-pass 24-h dietary recall for each participant, fluids consumed as beverages were grouped into seven categories. Using linear regression, reported intake (volume, ml and energy, kcal) of each category was characterized over time and in relation to sex, age, ethnicity, income, body mass index (BMI), and province of residence.

Results

In 2015, Canadians reported consuming an average of 1806 ml (275 kcal) fluids as beverages per day, including: plain water 867 ml (0 kcal); other unsweetened beverages, e.g. coffee, 364 ml (6 kcal); sugar-sweetened beverages (SSBs) 204 ml (99 kcal); plain milk 132 ml (64 kcal); alcoholic drinks 120 ml (71 kcal); 100% juice 74 ml (34 kcal); and diet or low calorie beverages 44 ml (2 kcal). Differential consumption was observed across socio-demographic groups, with high consumption of sugary drinks (i.e., SSBs and 100% juice) and alcohol across groups. From 2004 to 2015, the reported volumes of beverages consumed decreased by 10% (energy: − 24%). With adjustment for socio-demographic characteristics, there were significant changes (p < 0.001) over time in intake of: 100% juice − 40% (− 38%); plain milk − 37% (− 35%); SSBs − 26% (− 20%); diet or low calorie beverages (− 46%); and other unsweetened beverages − 11% (− 42%). The volume of plain water consumed increased by 10% (p < 0.0001). Intake of alcoholic (volume and energy) and diet or light beverages did not change significantly.

Conclusions

Lower intake of beverages was reported by Canadians in 2015 versus 2004, with a shift towards plain water. Consumption of sugary drinks decreased, but these beverages continue to contribute substantially to Canadians' overall energy intake. The findings underscore the need for policies to further reduce the consumption of sugary and alcoholic beverages, as well as calories from beverages.