Water, hydration, and health

Efficacy of Arogya Rakshak Panchatantra (Five Lifestyle Principles) on Heart Rate Variability and Menstrual Symptoms in Primary Dysmenorrhea: A Randomized Controlled Trial

Introduction: Primary dysmenorrhea (PD) is associated with decreased performance and reduced quality of life in young adults. This study aims to evaluate the effectiveness of implementing Arogya Rakshak Panchatantra (ARP), a naturopathic lifestyle practice, among young female adults with PD. Method: This open-label, parallel-arm, randomized controlled trial included 52 young female adults with PD aged between 16 and 25 years. They were randomly assigned to the ARP group practicing the ARP module for 2 months or the control group maintaining their routine lifestyle. The primary outcome was changes in heart rate variability (HRV), while secondary outcomes included menstrual distress, quality of life, pain, and daytime sleepiness, all evaluated at baseline and during the first three menstrual cycles in both groups. To evaluate the feasibility, the study also monitored self-reported symptoms, emotions, adverse events, calorie intake, and adherence to the intervention. The effectiveness of ARP was evaluated using repeated measures analysis of variance and a generalized linear model. Results: In the intervention group, we observed significant improvements in the high frequency component of HRV (p = 0.007), as well as reductions in weight (p = 0.017), visual analog scale pain (p = 0.000), and retrospective symptom scale score (p < 0.011). There were no significant changes in other HRV metrics, quality of life, or daytime sleepiness. Participants reported mild symptoms such as headaches, colds, body pain, diarrhea, constipation, fever, and weakness, with no serious adverse events. Discussion: This trial is the first to examine the long-term impact of ARP on young females with PD, suggesting it could be an effective and feasible management option. Further research with larger sample sizes is needed to confirm these findings.

Molecular changes, histopathology, and ultrasonic vocalization acoustic profiles of systemically dehydrated rats

Systemic hydration is known to promote optimal functioning of bodily systems-including the vocal folds. The impact of systemic dehydration on the biology of the vocal folds and the downstream effects of dehydration on voice output are not well understood. An in vivo rat model of systemic dehydration was employed to investigate vocal fold gene expression, histological changes, and acoustic changes in vocalization. Ultrasonic vocalizations (USVs) were recorded every day for 5 days (baseline), in male and female Long-Evans rats (N = 36, ages: 3-4 months) using an anticipatory reward paradigm. Next, rats were dehydrated (N = 18) using a published water-restriction model for 5 days or euhydrated (N = 18) and provided ad libitum access to water for 5 days. USVs were recorded daily during the dehydration/euhydration period. The USV variables were averaged at baseline and following dehydration/euhydration for individual animals, and the difference between these time periods was used for statistical analysis. USV analysis included total USV count, complexity ratio, duration (s), frequency range (kHz), and maximum intensity (dB). At the end of dehydration/euhydration, animals were euthanized, and kidney and vocal fold tissue samples were dissected and processed for histology and gene expression analysis. Compared to euhydrated rats, dehydrated male and female rats had significantly up-regulated gene expression of kidney renin (male p = 0.047; female p = 0.018), indicating physiologic dehydration. There were no statistically significant differences in the USV acoustic profile or histopathology between the two groups. Differential expression (p < 0.05) of several genes related to extracellular matrix remodeling, inflammatory responses, and water ion transport in the vocal folds was present. Our results indicate that mild systemic dehydration impacts gene expression in the vocal fold mucosa; however, these gene expression changes are not evident in the acoustic profile of vocalizations.

Determinants of Multimorbidity in a Low-Resource Setting: A Population-Based Cross-Sectional Study in Bangladesh

Multimorbidity is a complex and highly prevalent health condition characterised by the coexistence of two or more chronic diseases within an individual. It is a growing public health issue worldwide, predominantly in low-resource countries like Bangladesh. Therefore, this study aimed to determine the prevalence and associated factors of multimorbidity among the adult population in Bangladesh. A cross-sectional study was carried out among 504 respondents who were 18 years or older. The generalised linear mixed model was used to identify the risk factors. Among the respondents, 65.3% (95% confidence interval [CI]: 61.0 to 69.3) had multimorbidity. The most common chronic conditions were allergic disorder (34%, 95% CI: 30 to 39), gastritis (31%, 95% CI: 27 to 35), low back pain (28.4%, 95% CI: 24.6 to 32.5), oral diseases (27%, 95% CI: 23 to 29) and arthritis (21%, 95% CI: 18 to 25). Middle-aged adults (adjusted odds ratio [AOR] = 7.97; 95% CI: 3.35 to 18.92) and older adults (AOR = 8.44; 95% CI: 1.90 to 36.64) had significantly higher odds of multimorbidity than young adults. Employed respondents had an 86% (AOR = 0.14; 95% CI: 0.07 to 0.36) lower odds of multimorbidity than non-working individuals. Higher sleeping duration (6 to 8 h: AOR = 0.44; 95% CI: 0.25 to 0.80; 8 to 10 h: AOR = 0.26; 95% CI: 0.11 to 0.60), regular vegetable consumption (AOR = 0.42; 95% CI: 0.22 to 0.80) and adequate water intake (AOR = 0.48; 95% CI: 0.29 to 0.79) were protective factors against multimorbidity, whereas obesity increased the odds (AOR = 3.32; 95% CI: 1.06 to 10.43). These findings emphasise the need to promote healthy lifestyle habits, such as maintaining a balanced diet, staying hydrated and engaging in regular physical exercise, to reduce the burden of multimorbidity in low-resource settings.

Association between plain water intake and the risk of osteoporosis among middle-aged and elderly people in the United States: a cross-sectional study

Background

The connection between plain water intake (PWI) and osteoporosis risk is still unclear. The investigation aimed to identify the relationship between PWI and osteoporosis risk in middle-aged and elderly individuals in the United States (US).

Methods

This cross-sectional study was conducted among participants aged 50 years and older in the following waves of the National Health and Nutrition Examination Survey (NHANES): 2007-2008, 2009-2010, 2013-2014, and 2017-2018. The relationship between PWI and osteoporosis risk was examined by multivariable logistic regression models, accompanied by subgroup analyses and interaction tests. Smooth curve fitting and threshold effect analysis were utilized.

Results

The present investigation included 6,686 participants. In accordance with the fully adjusted model, individuals in the highest PWI tertile had a significantly reduced risk of osteoporosis in contrast to those in the lowest tertile [odds ratio (OR) = 0.62; 95% confidence interval (CI): 0.49-0.77; P for trend<0.001]. After adjusting for all covariates, a higher PWI was linked to a decreased risk of osteoporosis (OR = 0.92; 95% CI: 0.86-0.98; p = 0.008). No significant interactions were detected in the subgroup analyses for age, gender, race, body mass index, diabetic history, hypertension status, smoking history, consumption of prednisone or cortisone, or moderate or strenuous activity (all P for interaction>0.05). Smooth curve fitting and threshold effect analysis revealed that when PWI was less than 1,220 mL/day, there was a significant negative connection between PWI and osteoporosis risk (OR = 0.79; 95% CI: 0.70-0.89; p < 0.001); nevertheless that association was not significant when PWI was greater than 1,220 mL/day (OR = 1.06; 95% CI: 0.95-1.17; p = 0.288).

Conclusion

The outcomes of our investigation indicated that among middle-aged and older US adults, a higher PWI was connected with a moderately reduced osteoporosis risk. Managing PWI might reduce the osteoporosis risk.

Natural radionuclides in drinking water and annual effective dose to infant, child, and adult

This study assessed the annual effective dose from drinking water across different age categories, considering various sources of water. The water samples were collected from different locations, with the samples categorized into public drinking water systems, private wells, and bottled water. In the drinking water samples, no radionuclides other than Ra-226, Th-232, K-40, and H-3 were detected. The average tritium concentration in drinking water was measured at 1.84 Bq L-1, significantly below the permissible safety standards. The study indicated that infants received the highest annual effective dose from drinking water, averaging 0.88 mSv year-1, compared to 0.11 mSv*year-1 for children and 0.08 mSv*year-1 for adults. Among the different water sources, well water from Stublla village showed significantly elevated levels at 0.49 mSv*year-1. The highest contribution to the annual effective dose from the ingestion of drinking water comes from Ra-226, Th-232, and K-40, with average values of 1.72, 0.42, and 0.161 mSv*year-1, respectively. Despite these variations, the average annual effective doses from drinking water for infants, children, and adults were 0.81, 0.098, and 0.076 mSv year-1, respectively. Based on drinking water sources, the Stublla region had the highest yearly effective dosage, with an average value of 0.49 mSv year-1.

Disaster emergency meal plans for Korean patients who require hemodialysis

Proactive planning and preparation are critical to the safety of patients on dialysis during emergencies, such as natural disasters, and pandemics, such as coronavirus disease 2019. Patients with end-stage kidney disease are particularly vulnerable to disruptions such as power outages, water shortages, transportation issues, and dialysis center closures because they can result in missed dialysis sessions and severe health deterioration. This study aimed to develop tailored dietary guidelines for Korean patients on hemodialysis by applying the U.S. Centers for Disease Control and Prevention guidelines and considering the dietary limitations of these patients. The proposed guidelines impose strict potassium, phosphorus, sodium, and fluid restrictions and include two 3-day emergency meal plans: one for scenarios involving disruptions of electricity and water supply and another for situations in which these utilities are available. The use of a food exchange list enhances the dietary flexibility of these patients. Although these guidelines cannot replace dialysis, they could mitigate the impact of emergencies on patient health by providing essential support during critical periods.

Water Intake in Drinks and Food: How Should We Advise Patients With Lower Urinary Tract Dysfunction on Their Water Intake and/or Urine Output, as a Cornerstone of Lifestyle Interventions? ICI-RS 2024

CONTEXT

Water intake in drinks and food is essential for life. Multiple guidelines exist to help give recommendations for healthy water intake and urine output, but few of these are specific to patients with lower urinary tract symptoms.

METHODS

A debate held at the International Consultation on Incontinence-Research Society meeting, held in Bristol in June 2024, considered ways to improve this situation.

RESULTS AND CONCLUSION

There are challenges in measuring both total water intake and also urine output, but we suggest that urine output may be the most helpful measure to focus on for future guidelines for patients.

Electrolyte Imbalances and Metabolic Emergencies in Obesity: Mechanisms and Clinical Implications

Electrolyte imbalances are a frequently overlooked yet critical component of obesity-related metabolic dysfunction, contributing to an increased risk of cardiovascular disease, kidney impairment, and metabolic emergencies such as diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), and acute kidney injury (AKI). These disturbances arise from insulin resistance, chronic inflammation, hormonal dysregulation, and renal dysfunction, leading to sodium retention, potassium depletion, and deficiencies in calcium and magnesium homeostasis. Managing electrolyte imbalances is essential in obesity management, as imbalances exacerbate hypertension, metabolic acidosis, neuromuscular complications, and insulin resistance. This review explores the pathophysiology of electrolyte disturbances in obesity and their impact on fluid balance, acid-base status, and metabolic health. Effective management strategies include individualized electrolyte monitoring, dietary sodium restriction, potassium supplementation, vitamin D and magnesium correction, and pharmacologic interventions targeting renin-angiotensin-aldosterone system (RAAS) activity and insulin resistance. Additionally, lifestyle interventions, including dietary modification, weight loss strategies, and hydration optimization, play a key role in preventing metabolic complications. Future research should investigate the long-term impact of electrolyte imbalances in obesity, the role of emerging therapies, and how lifestyle interventions can optimize electrolyte homeostasis and metabolic outcomes. A personalized, multidisciplinary approach integrating endocrinology, nephrology, and clinical nutrition is essential to improving the prevention and management of electrolyte imbalances in obese individuals.

The Power of Environment: A Comprehensive Review of the Exposome's Role in Healthy Aging, Longevity, and Preventive Medicine-Lessons from Blue Zones and Cilento

Aging and longevity are shaped by the exposome, a dynamic network of environmental, social, and biological factors. Understanding how these exposures interact with biological mechanisms can inform strategies for healthier aging. Background/Objectives: This review explores the exposome as a dynamic system encompassing both protective and risk factors, with a specific focus on how beneficial environmental exposures, microbiome diversity, lifestyle behaviors, and resilience mechanisms contribute to successful aging. By analyzing high-longevity populations, such as the Blue Zones and Cilento, it aims to identify common determinants of successful aging. Methods: A mixed-method study was conducted, combining a systematic review of the English literature (2003-2024) with a comparative analysis of longevity regions. A structured search was performed in PubMed, Scopus, and Google Scholar using keywords such as "longevity", "Blue Zones", "Cilento", "microbiome", "environmental factors", and related terms. Additionally, qualitative and quantitative analysis were applied to assess key protective factors across different aging models. Results: This study identified key factors contributing to successful aging in longevity hotspots, including sustained exposure to biodiverse natural environments, adherence to Mediterranean or plant-based diet rich in polyphenols and probiotics, regular physical activity, strong social networks, and psychological resilience. A novel aspect of this review is the role of the gut microbiome as a mediator between environmental exposures and immune-metabolic health, influencing inflammation modulation and cellular aging. Despite geographic and cultural differences, case studies reveal a shared pattern of protective factors that collectively enhance lifespan and healthspan. Conclusions: The exposome is a critical determinant of aging trajectories, acting through complex interactions between environmental and biological mechanisms. By integrating insights from high-longevity populations, this mixed-method study proposes a comprehensive framework for optimizing microbiome health, enhancing resilience, and promoting protective environmental exposures. These findings provide a translational perspective to guide future interventions in aging research and global health initiatives.

Association of dietary water intake with body composition and the potential mechanism based on urinary metabolic signatures in Chinese elderly individuals aged 75 years and above

With the rising global aging rate, elderly nutrition and health issues are major concerns. Current research focuses on nutrients such as protein and vitamins, while there are limited studies on water intake in the elderly. The aim of this study was to assess whether Chinese people aged over 75 years are meeting the recommended adequate intake (AI) for total water intake and its relationship with body composition. This was done by exploring potential mechanisms through the analysis of urinary metabolites. Water intake and dietary status were collected from 456 community seniors aged over 75 years using a 24-hour water intake and dietary record form. Body composition was determined by bioelectrical impedance analysis (BIA). We found that 16.01% of community seniors reached the AI. The protein, fat-free mass (FFM) and skeletal muscle mass (SMM) levels were all increased in the AI group compared to the Collapse

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MESH Headings

• Humans
• Aged
• Body Composition
• Male
• Female
• Aged, 80 and over
• China
• Drinking
• Diet
• East Asian People

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Affiliation(s)

Sai Yao Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, 266000, China.
Tianlin Gao Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, 266000, China.
Yajun Liu Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, 266000, China.
Ying Zhou Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, 266000, China.
Zhixuan Zhao Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, 266000, China.
Yinkun Wang Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, 266000, China.
Xincen Wang Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, 266000, China.
Aiguo Ma Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, 266000, China.
Feng Zhong Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, 266000, China.

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Unveiling the Potential of Three Endemic Gypsophila L. (Caryophyllaceae) Taxa as Promising Carbonic Anhydrase Inhibitors-Bio-Metabolic Profiles and In Vitro Evaluation of Enzyme Inhibition and Antioxidant Capacity

The Caryophyllaceae family, commonly utilized in traditional medicine, exhibits various effects revealed by ethnopharmacological studies. Thus, the diuretic effect of the leaf and stem of three Gypsophila taxa endemic to Türkiye was evaluated for the first time by comparing their bio-metabolic profiles, antioxidant capacities, carbonic anhydrase inhibition, and infrared spectra. The leaf and stem of Gypsophila taxa were macerated in 50% ethanol and 50% water, bio-metabolic profiles were performed by a new validated ultra-performance liquid chromatographic (UPLC) method and spectrophotometric methods, the antioxidant capacity was determined by DPPH and ABTS assays, and the in vitro diuretic activity was evaluated by carbonic anhydrase inhibition. The results show that the G. simonii leaf exhibited the highest quantity of rutin and total polyphenols content (TPC). On the other hand, the G. germanicopolitana leaf showed the highest quantity of rosmarinic acid, and the G. eriocalyx leaf contained the maximum total flavonoids content (TFC). The antioxidant results indicated that G. eriocalyx has the highest capacity. The G. germanicopolitana leaf strongly inhibited the enzyme activity. The ATR-FTIR spectra showed that the general chemical composition in the leaf and stem parts was preserved after the extraction process. Band intensity changes may be due to the extraction process and the amount of substances. In conclusion, the species of Gypsophila taxa show considerable potential for utilization in the pharmaceutical area.

L-Arginine and Nitric Oxide in Vascular Regulation-Experimental Findings in the Context of Blood Donation

This narrative review provides an analysis of the role of nitric oxide (NO) and its precursors, particularly L-arginine, in vascular regulation and health, with an emphasis on findings from our experimental research in animal models. NO serves as a critical mediator of vascular function, contributing to vasodilation, the regulation of blood flow, and the prevention of thrombosis. As a primary precursor of NO, L-arginine is essential for maintaining endothelial integrity, modulating mitochondrial function, and reducing oxidative damage. This review synthesises the data and contextualises these findings within the physiological challenges faced by blood donors, such as repeated blood donation and associated oxidative stress. It examines the effects of L-arginine supplementation on mitochondrial respiration, lipid peroxidation, and microsomal oxidation in different conditions, including differences in age, gender, and dietary interventions. The mechanisms by which L-arginine enhances NO production, improves vascular elasticity, and alleviates endothelial dysfunction caused by reduced NO bioavailability are also investigated. By integrating experimental findings with insights from the existing literature, this review provides a perspective on the potential of L-arginine supplementation to address the specific physiological needs of blood donors. It highlights the importance of personalised nutritional approaches in enhancing donor recovery and vascular resilience. In addition, this review assesses the wider implications of L-arginine supplementation in mitigating oxidative stress and preserving vascular function. The interplay between NO bioavailability, dietary factors, and physiological adaptation in blood donors is highlighted, along with the identification of current knowledge gaps and recommendations for future research. By presenting both original experimental evidence and a critical synthesis of the literature, this article highlights the therapeutic potential of NO precursors, particularly L-arginine, in promoting vascular health in the context of blood donation.

The Impact of a Commercial Electrolyte Beverage on the Hydration Status of Active Men and Women

BACKGROUND/OBJECTIVES

Hypo-hydration is a major health concern that affects performance and is associated with increasing morbidity and growing health care costs. There is an emerging interest in optimizing hydration and identifying how factors such as ingestion rate and beverage composition affect hydration. This study examined three beverages with varying ingestion rates and measured markers of hydration.

METHODS

Thirty healthy, active participants between the ages of 18 and 45 years were given three different beverages on three separate days. The beverages were of identical volumes (1 L), but differed in the rate of ingestion, carbohydrate content and electrolyte content. Beverage 1 and water alone were both consumed at a metered rate of one liter over four hours, whereas Beverage 2 was used as a positive control and was consumed at a bolus rate of one liter in 30 min.

RESULTS

After six hours, Beverage 1 significantly improved markers of hydration compared to water alone or Beverage 2. Beverage 1 decreased cumulative urine output vs. water alone by 32% (absolute difference -0.33 L; CI ± -0.16 to -0.51) and vs. Beverage 2 by 26% (absolute difference -0.26 L; CI ± -0.13 to -0.38). Beverage 1 increased the beverage hydration index vs. water alone by 64% (absolute difference +0.64 L; CI ± 0.36 to 0.92) and vs. Beverage 2 by 48% (absolute difference +0.53 L; CI ± 0.30 to 0.76).

CONCLUSIONS

Beverage 1 is superior to water alone at improving hydration when it is ingested at similar rates. Moreover, metered ingestion of Beverage 1 improved hydration compared to a bolus ingestion of Beverage 2, this could be due to the dissimilar ingestion rates and/or beverage composition.

Physical activity and heat stress shape water needs in pregnant endurance athletes

Background and objectives

Pregnancy, heat stress, and physical activity (PA) are all known to independently increase human water requirements. We hypothesize that climate conditions and behavioral strategies interact to shape water needs in highly active pregnancies.

Methodology

We recruited 20 female endurance runners who were pregnant (8-16 weeks gestational age; n = 13) or planning to be pregnant (n = 7) for an observational, prospective cohort study. At three timepoints in the study (preconception, 8-16 weeks, and 32-35 weeks), we measured water turnover (WT) using the deuterium dilution and elimination technique, PA using ActiGraph wGT3X-BT accelerometers, and heat index (HI) using historical temperature and humidity data. We also compared athletes to nonathletes from a previously published study.

Results

Athletes maintained high WT from preconception through the end of pregnancy. PA was positively associated with WT among athletes for preconception and early pregnancy time periods but not for the third trimester. HI weakly moderated the relationship between PA and WT in predicting a more positive slope in hotter and more humid weather conditions. WT in athletes was higher than in nonathletes, but this difference attenuated during the third trimester, as nonathletes increased their WT.

Conclusions and implications

Athletes experience higher WT with greater levels of PA, and this relationship is somewhat stronger in higher HI conditions. With the threat of climate change expected to exacerbate extreme heat conditions, evidence-based, global policies are required for particularly vulnerable populations.

Heatwaves and its impact on the depressive symptoms among Chinese community-dwelling older adults: Examining the role of social participation

OBJECTIVES

Based on the Environment-Person Fit Perspective, this study explores the relationship between heatwaves and subsequent depressive symptoms among older Chinese community dwellers. Additionally, the study investigates if this association varies among older adults with different levels of social participation.

METHODS

Heatwaves were defined as the frequency of occurrences where daily maximum temperature exceeded 35 °C for 3 consecutive days. A sample including 7124 older adults aged 55 and above was selected from the 2018 China Health and Retirement Longitudinal Study. Depressive symptoms were measured by the 10-item Centre for Epidemiological Studies Depression Scale. Social participation was measured by volunteer participation and leisure participation. Multilevel fixed effect model was employed to investigate the temporal association between heatwaves and depressive symptoms, as well as the moderating effect of social participation.

RESULTS

This study found that older adults who had experienced a greater number of heatwaves presented more severe depressive symptoms (b = 0.66, p < 0.001). However, a high level of leisure participation buffered the effect of heatwaves on depressive symptoms (b = ̶ 0.52, p < 0.05).

CONCLUSIONS

This study highlighted the differential impact of heatwaves on mental health outcomes among older adults depending on their levels of social participation. Our findings provide valuable insights into designing an integrative heatwave adaption scheme that simultaneously focuses on temperature adjustment and social participation enhancement.

Exploring the metabolic patterns and response mechanisms of bile acids during fasting: A study with poultry as an example

Fasting is beneficial to alleviate fatty liver, lose weight and improve reproductive function. However, previous studies have shown that, during fasting, disorders of bile acid metabolism were strongly associated with intestinal inflammation. The physiological and biochemical parameters and gene expression of multiple tissues of chickens at every critical time node were measured by ELISA and qPCR. In addition, association analysis was performed based on liver transcriptome sequencing and cecum metabolome data. At the cellular level, the regulatory effects of cecal metabolites on host bile acid metabolism were verified. During fasting, hepatic FXR-SHP-CYP7A1 and ileum-hepatic FXR-SHP-FGF15/19-FGFR4-CYP7A1 negative feedback pathways were activated to inhibit hepatic bile acid synthesis. The ileum FXR-SHP-ASBT pathways are activated, hindered the ileal bile reflux. At the same time, it promotes the secretion of bile acids and cholesterol in the liver, accelerates the utilization of H2O and CO2, to maintain liver homeostasis during fasting. In addition, enhanced gallbladder contraction and increased hunger were observed in laying hens during fasting. At the cellular level, the correlation between CYP7A1 and L-valine was verified, revealing that cecal metabolites of laying hens was enabled to regulate host bile acid metabolism. This study explored the metabolic patterns of bile acids during fasting and identified the main reasons for the accumulation of bile acids in the cecum, which provides a basis for fasting research and offers a reference for the formulation of fasting protocols.

The Association of moisture intake and constipation among us adults: evidence from NHANES 2005-2010

BACKGROUND

Constipation is a common gastrointestinal disorder that affects the quality of life of millions of adults worldwide. Dietary moisture intake is considered to have a significant impact on intestinal health, yet its specific role in constipation has not been thoroughly investigated in large-scale population studies. This study aims to explore the correlation between adult dietary moisture intake and constipation by analyzing the NHANES database, filling a knowledge gap in the literature.

METHODS

Data from NHANES participants aged 20 years and older from 2005 to 2010 were analyzed. Moisture intake was assessed using dietary recall data, which included moisture from all food and beverages consumed. A weighted logistic regression model was used to assess the relationship between moisture intake and the risk of constipation, calculating the odds ratios (ORs) and their 95% confidence intervals (CIs), while controlling for potential confounders. Additionally, restricted cubic splines (RCS) were applied to further explore potential non-linear patterns in the relationship between moisture intake and constipation, along with subgroup analysis.

RESULTS

The study included 14,492 participants, of whom 1,514 reported constipation issues. After adequately adjusting for confounders, a significant negative correlation was observed between moisture intake and constipation risk (OR 0.81; 95% CI: 0.74-0.89). Quartile analysis of moisture intake demonstrated that, compared to the first quartile Q1 (0.06 to 1.90 kg), the constipation risk for the second quartile Q2 (1.91 to 2.53 kg), third quartile Q3 (2.54 to 3.36 kg), and fourth quartile Q4 (3.37 to 16.97 kg) were OR 0.80 (95% CI: 0.64-0.72), OR 0.57 (95% CI: 0.45-0.72), and OR 0.54 (95% CI: 0.44-0.67) respectively, with a trend test P-value ofless than 0.001. RCS regression revealed a significant non-linear negative relationship between moisture intake and constipation prevalence (P < 0.001). Depression may modulate the relationship between moisture and constipation (interaction effect P = 0.014).

CONCLUSION

The findings of this study indicate that appropriate dietary moisture intake is significantly associated with a lower risk of constipation, demonstrating a dose-response relationship. This emphasizes the importance of considering adequate moisture intake in the prevention and management of constipation. Future studies should adopt a prospective design to further verify the causal relationship between dietary moisture intake and constipation progression.

Children, Adolescents and Urine Hydration Indices-A Systematic Literature Review on Athletes and Non-Athletes

BACKGROUND/OBJECTIVES

The importance of adequate hydration in children and adolescents has raised significant attention, both for its health benefits and for its role in supporting cognitive and physical performance. This is particularly important for young athletes who have increased dehydration risk due to high sweat loss and often inadequate water intake. The aim of this review is to systematically assess the hydration status of children and adolescents, including athletes, and to identify notable differences in hydration levels between these groups.

METHODS

A systematic literature search was conducted following PRISMA guidelines. PubMed, Scopus, and Scholar were searched for articles published between 2004 and 2024 on hydration in children and adolescents, focusing on urinary biomarkers such as urine osmolality, urine specific gravity, and urine color. Two independent reviewers screened the studies, and clinical studies or those involving chronic diseases, disabilities, or missing data were excluded.

RESULTS

Fifty-one articles met the inclusion criteria and were categorized into competitive athletes (n = 26) and non-athletes (n = 25). The review revealed that both athletes and non-athletes were frequently dehydrated. Among athletes, 81% of studies reported dehydration, while 69% of studies observed dehydration in non-athlete children. Biomarkers consistently indicated failure to meet recommended hydration guidelines in both groups.

CONCLUSIONS

Despite existing hydration guidelines, dehydration is prevalent among children and adolescents, irrespective of athletic involvement. This underscores the urgent need for targeted interventions to improve hydration education and practices in schools, homes, and extracurricular settings.

Optical Based Methods for Water Monitoring in Biological Tissue

Skin homeostasis is strongly dependent on its hydration levels, making skin water content measurement vital across various fields, including medicine, cosmetology, and sports science. Noninvasive diagnostic techniques are particularly relevant for clinical applications due to their minimal risk of side effects. A range of optical methods have been developed for this purpose, each with unique physical principles, advantages, and limitations. This review provides an in-depth examination of optical techniques such as diffuse reflectance spectroscopy, optoacoustic spectroscopy, optoacoustic tomography, hyperspectral imaging, and Raman spectroscopy. We explore their efficacy in noninvasive monitoring of skin hydration and edema, which is characterized by an increase in interstitial fluid. By comparing the parameters, sensitivity, and clinical applications of these techniques, this review offers a comprehensive understanding of their potential to enhance diagnostic precision and improve patient care.

Overweight and Obese Children Aged 6-17 Years in China Had Lower Level of Hydration Status: A Cross-Sectional Study

PURPOSE

The aims of this study were to explore the differences in total body water and hydration status among Chinese children aged 6-17 years.

METHODS

A cross-sectional study was implemented among children aged 6-17 years in China. The total body water (TBW), intracellular water (ICW), and extracellular water (ECW) were determined by bioelectrical impedance analysis (BIA). The participants were divided according to age-age 6-8 years, age 9-11 years, age 12-14 years, age 15-17 years-and body mass index (BMI) of China-underweight, normal weight, overweight, and obese groups. The differences of variables of groups were compared using analysis of variance, Student's t-test, and Kruskal-Wallis test. Significance levels were set at 0.05 (p < 0.05).

RESULTS

A total of 59,643 participants (30,103 males and 29,540 females) completed the study. As children became older, the TBW, ICW, ECW, ICW/TBW, and TBW/FFM (TBW to fat free mass ratio) increased simultaneously (all p < 0.05); concurrently, the ECW/TBW decreased with age (all p < 0.05). Boys had higher TBW, ICW, ECW, ICW/TBW, TBW/BW, and TBW/FFM than those of girls at each age (all p < 0.05). For all BMI groups, increases in TBW, ICW, ECW were observed from the underweight group to the obese group, both in boys and girls (all p < 0.001). For the increase in BMI in all age groups, the values of TBW made a significantly lower percentage compared to BW. The higher BMI groups showed higher levels of TBW/FFM, both in girls and boys (all p < 0.001).

CONCLUSIONS

The body water contents of children aged 6-17 years varied according to their age, sex, and BMI. Overweight and obese individuals may have inferior hydration status compared to those with normal weight.

Household water security is a mediator of household food security in a nationally representative sample of Mexico

OBJECTIVE

Explore the relationship between water insecurity (WI) and food security and their covariates in Mexican households.

DESIGN

A cross-sectional study with nationally representative data from the National Health and Nutrition Survey-Continuous 2021 (in Spanish, ENSANUT-Continua 2021), collected data from 12 619 households.

SETTING

WI was measured using the Household Water Insecurity Experiences (HWISE) Scale in Spanish and adapted to the Mexican context. Food security was measured using the Latin American and Caribbean Food Security Scale. A generalised path model was used to produce two simultaneous logistical regression equations - WI (HWISE ≥ 12) and moderate-to-severe food insecurity (FI) - to understand key covariates as well as the contribution of WI to FI.

PARTICIPANTS

The head of the household, an adult of >18 years of age, consented to participate in the survey.

RESULTS

Households experiencing WI were more likely to experience moderate-to-severe FI (OR = 2·35; 95 % CI: 2·02, 2·72). The odds of WI were lower in households with medium (OR = 0·74; 95 % CI: 0·61, 0·9) to high (OR = 0·45; 95 % CI: 0·37, 0·55) asset scores. WI also depended on the region of Mexico. FI is more prevalent in indigenous people (OR = 1·29; 95 % CI: 1·05, 1·59) and rural households (OR = 0·42; 95 % CI: 1·16, 1·73). Notably, wealth and household size did not contribute directly to FI but did so indirectly through the mediating factor of WI.

CONCLUSIONS

Our study shows that there are structural factors that form part of the varied determinants of WI, which in turn is closely linked to FI.

Comparative Analysis of Hydration Status and Microbial Quality of Tap Water Between Urban and Rural Settings in the Ashanti Region of Ghana

Maintaining proper hydration is crucial for human health, physiological functions, and cognitive performance. This study sought to determine the hydration status and the microbial safety of tap water in an urban setting (Kwame Nkrumah University of Science and Technology Campus) and a rural community (Adjamesu) in the Ashanti Region of Ghana. The water safety perception and hydration status of 171 study participants aged 10-61 years were assessed. Six taps were randomly selected at each site in triplicates, resulting in 36 water samples. The microbial quality of the water was assessed by testing for heterotrophic bacteria, coliforms, Staphylococcus aureus, and Salmonella. The physicochemical quality of the water samples was assessed with a pH meter. About 68.9%, 20%, and 11.1% of participants were minimally dehydrated, significantly dehydrated, and well hydrated, respectively. Furthermore, 86.7% of the urban participants did not depend on tap water (p < 0.001) compared to 46.9% of the rural participants (p = 0.579). Moreover, 78.9% of the urban participants did not trust the quality of tap water (p < 0.001), compared to 38.3% of rural dwellers (p = 0.035). The water microbial quality assessment of both the rural and urban water samples indicated the presence of some heterotrophic bacteria at similar levels (p = 0.0649) between 7.0 × 100 ± 1.15 and 5.93 × 103 ± 5.51 cfu/mL. Some coliforms in the samples exceeded safe limits with those of the rural communities recording higher levels of contamination. Further assessment revealed the absence of pathogenic bacteria such as Escherichia coli, Salmonella, or Staphylococcus aureus. However, regular monitoring and evaluation of tap water quality are crucial, given its significance as a primary hydration source for the general population. Additionally, it would be advisable for consumers to treat their water further when using it for cooking and drinking to prevent any adverse health effects.

Designing LTC Physical Work Environments to Support Worker Well-being: A Review and Recommendations

OBJECTIVES

Well-designed, health-promoting physical work environments have the potential to reduce burnout and attrition for employees who work in long-term care (LTC) facilities. Unfortunately, there is limited existing guidance for LTC facility owners and operators related to specific health-promoting design strategies for LTC work environments. This narrative review aims to fill this knowledge gap.

METHODS

Information was synthesized from healthy-building certification standards for health care and non-health care buildings, LTC design guidelines, academic studies, and expert commentaries. The review was conducted in 3 phases to (1) identify specific space types and design characteristics generally considered to be health-supportive, (2) gather existing research on the identified strategies to critically analyze their supportive value, and (3) communicate the findings to a broad audience of stakeholders.

RESULTS

Five specific space types and 21 design characteristics were identified as both supportive of employee health and well-being, and relevant to LTC physical work environments.

CONCLUSIONS

When health care organizations construct new facilities or renovate existing facilities, using these health-promoting design strategies should be considered. Benefits of health-promoting physical work environments include better employee mental and physical health, less burnout, and less turnover. Reducing burnout and increasing employee retention is essential to mitigate the ongoing staffing crisis in the LTC industry.

Water deprivation induces a systemic procatabolic state that differentially affects oxidative and glycolytic skeletal muscles in male mice

Dehydration, characterized by the loss of total body water and/or electrolytes due to diseases or inadequate fluid intake, is prevalent globally but often underestimated. Its contribution to long-term chronic diseases and sarcopenia is recognized, yet the mechanisms involved in systemic and muscle protein metabolism during dehydration remain unclear. This study investigated metabolic adaptations in a 36-h water deprivation (WD) model of mice. Male C57BL/6 mice underwent 36-h WD or pair-feeding at rest, with assessments of motor skills along with biochemical and metabolic parameters. Dehydration was confirmed by hypernatremia, body mass loss, hyporexia, and increased activity of vasopressinergic and oxytocinergic neurons compared with controls. These results were associated with liver mass loss, decreased glycemia, and increased cholesterolemia. In addition, increased V̇o2 and a decreased respiratory exchange ratio indicated reduced carbohydrate consumption and potentially increased protein use during dehydration. Thus, skeletal muscle protein metabolism was evaluated due to its high protein content. In the oxidative muscles of the WD group, total and proteasomal proteolysis increased, which was associated with decreased Akt-mediated intracellular signaling. Interestingly, there was an increase in fiber cross-sectional area, likely due to higher muscle water content caused by increased intracellular osmolality induced by protein catabolism products. Conversely, no changes were observed in protein turnover or water content in glycolytic muscles. These findings suggest that short-term WD imposes a procatabolic state, depleting protein content in skeletal muscle. However, skeletal muscle may respond differently to dehydration based on its phenotype and might adapt for a limited time.NEW & NOTEWORTHY This study investigated the effects of WD on mouse homeostasis, focusing on energy substrates and skeletal muscle protein metabolism. Our findings revealed a shift toward reduced dependence on carbohydrate degradation and increased reliance on lipid oxidation, or even protein oxidation, as energy sources, since we observed increased proteolysis in one muscle phenotype. Despite body mass loss, soleus and EDL muscle masses were differently affected. These results indicate the procatabolic potential of short-term WD in mice.

Urinary health indicators in folivorous-frugivorous primates with and without food supplementation

Food supplementation by humans in peri-urban and urban landscapes can lead to excessive intake of energy and certain macronutrients, and affect animal health. In this study, we evaluated the influence of food supplementation on urinary health indicators in brown howler monkeys (Alouatta guariba) by comparing supplemented and non-supplemented free-ranging peri-urban groups. We also evaluated the effect of sex, day shift, and season of sampling. Between August 2021 and August 2022, we non-invasively collected 61 samples (43 from females and 18 from males) from adult individuals (N = 10) in three supplemented groups and 56 samples (25 from females and 31 from males) from adults (N = 7) in three non-supplemented groups. The supplements, mostly raw foods (e.g., fruits, vegetables, and tubers) and bread, represented 18% of the total fresh mass ingested by the supplemented groups. We assessed pH, density, and the presence of eight urine components (glucose, bilirubin, ketones, protein, urobilinogen, nitrite, blood, and leukocytes) using reagent urine strips. Season of sampling predicted urine density (mean = 1.022), while both season and day shift predicted pH (mean = 6.5). The occurrence of supplementation was a weak predictor of these parameters. Finally, we detected leukocytes in 21% of the 117 samples. We did not identify any visible signs of disease in any individual throughout the study and found no clinical changes in urine under the conditions studied. We urge validation of the results with urine strips to facilitate monitoring of the health of howler monkeys living in anthropogenic landscapes in the presence or absence of dietary supplementation.

Medical and Surgical Emergencies in Occupational Medicine: A Comprehensive Review

This review aims to provide a general resource for occupational health stakeholders. It also serves as a clinical guide for frontline providers and a policy framework for employers and regulators. Medical and surgical emergencies in occupational settings can cause serious harm if not identified and managed early. This review covers trauma, chemical exposures, thermal injuries, respiratory distress, and infectious hazards. We outline clinical signs, diagnostic steps, initial care, and follow-up plans. We also discuss preventive strategies such as hazard assessments and safety protocols. Evidence-based guidelines and practical methods can lower injury and death rates. Our objective is to help stakeholders recognize risks, respond fast, and improve outcomes. Future studies should monitor and examine new threats, such as novel industrial processes and evolving pathogens, to optimize workplace safety.

Dietary phytochemicals alleviate the premature skin aging: A comprehensive review

Skin aging, often called as premature skin aging, is the hastened deterioration of the skin resulting from multiple factors, including UV radiation, environmental contaminants, inadequate nutrition, stress, etc. Dietary phytochemicals, present in fruits, vegetables, and other plant-derived meals, have gained interest due to their efficiency to eradicate free radicals and lowering the release of inflammatory mediators which accounts for premature skin aging. Several dietary phytochemicals, i.e., carotenoids, polyphenols, flavonoids, terpenes, alkaloids, phytosterols, etc., exhibited potential anti-oxidant, anti-inflammatory, suppression of UV damage, and promote collagen synthesis. In addition, dietary phytochemicals include sulfur, present in various foods safeguard the skin against oxidative stress and inflammation. Thus, this article delves into the comprehension of various dietary phytochemicals investigated to alleviate the premature skin aging. The article further highlights specific phytochemicals and their sources, bioavailability, mechanisms, etc., in the context of safeguarding the skin against oxidative stress and inflammation. The present manuscript is a systematic comprehension of the available literature on dietary phytochemicals and skin aging in various database, i.e., PubMed, ScienceDirect, Google Scholar using the keywords, i.e., "dietary phytochemicals", "nutraceuticals", "skin aging" etc., via Boolean operator, i.e., "AND". The dietary guidelines presented in the manuscript is a unique summarization for a broad reader to understand the inclusion of various functional foods, nutrients, supplements, etc., to prevent premature skin aging. Thus, the utilization of dietary phytochemicals has shown a promising avenue in preventing skin aging, however, the future perspectives and challenges of such phytochemicals should be comprehended via clinical investigations.

Assessment of Exercise-Induced Dehydration Status Based on Oral Mucosal Moisture in a Field Survey

Background/Objective: Conventional techniques for evaluating hydration status include the analysis of blood, urine, and body weight. Recently, advancements in dentistry have introduced capacitance sensor-based oral epithelial moisture meters as promising avenues for assessment. This study aimed to examine the correlation between oral mucosal moisture content, as determined using a capacitance sensor, and exercise-induced dehydration. Methods: A total of 21 participants engaged in a 120 min slow distance exercise session. A series of measurements were taken before and after the exercise session, including body weight, sweat rate, secretory immunoglobulin A (s-IgA) concentration in saliva samples, saliva flow rate, and oral mucosal moisture content, which were assessed using a capacitance sensor. The relationship between physical dehydration and oral mucosal moisture content was investigated using statistical analysis. Receiver operating characteristic curves were constructed to ascertain whether variations in oral mucosal moisture content could discern body mass losses (BMLs) of 1.5% and 2%. Results: A significant correlation was observed between the sweat rate during exercise and the change in oral mucosal moisture content before and after exercise (Spearman's rank correlation coefficient: ρ = -0.58, p < 0.001). The salivary flow and s-IgA secretion rates were lower after the exercise period than before, whereas the s-IgA concentration was higher. Oral mucosal moisture decreased during the exercise period. Receiver operating characteristic curve analysis revealed that differences in oral mucosal moisture content exhibited discriminative capabilities, with area under the curve values of 0.79 at 1.5% BML and 0.72 at 2% BML. Conclusions: The measurement of oral mucosal moisture using capacitance sensors represents a promising noninvasive approach for the assessment of exercise-induced dehydration.

Hydration profile of the Latin American population and the contribution of total daily pure water. The ELANS study

Introduction

Introduction: water is a crucial component of human health useful for various bodily functions. Despite its importance, previous research has largely overlooked hydration in Latin America, focusing instead on regions with greater access to a variety of food sources. Objective: hence, this study provides comprehensive data on water consumption patterns in this region and analyses the hydration profiles of urban Latin American populations, emphasizing the role of pure water in daily intake. Materials and methods: involving 5977 participants from Argentina, Brazil, Costa Rica, Ecuador, and Peru, the study utilized a cross-sectional approach, examining total water intake (TWI) through two nonconsecutive 24-hour dietary recalls. This study focused on understanding the contribution of pure water to daily hydration and identifying disparities in water consumption patterns across different demographic conditions by measuring the TWI from beverages. Results: the findings indicated significant variations in hydration profiles based on country, sex, and socioeconomic status. The median TWI was 3245.6 g/day, with a median water intake from beverages of 1982.9 g/d kcal, which represented 61 % of the participants' total water intake. A total of 63.8 % of the overall sample met the TWI recommendations. Our data indicate that 38.4 % of the water intake came from plain water, followed by coffee and tea (16.9 %), commercial sugar-sweetened beverages (13.7 %), and homemade SSB (11.7 %). Conclusion: these findings contribute to a deeper understanding of nutritional behaviors and may serve as a basis for future studies and health interventions focused on improving hydration habits, with emphasis on pure water consumption, especially in urban areas in developing regions.

Association between predicted level of water turnover deficit and all-cause and cause-specific mortalities among Japanese adults: The Japan Collaborative Cohort Study

BACKGROUND

Although water is essential for maintaining health and life, the association between water turnover as an indicator of daily water requirement and water deficit and mortality is unclear.

OBJECTIVES

We aimed to investigate this association in Japanese adults.

METHODS

A total of 63,488 (36,739 females and 26,749 males) Japanese aged 40-79 y in the Japan Collaborative Cohort Study in 1988-1990 were followed up their mortality through 2009. Water turnover was calculated considering lifestyle and environmental factors using an equation previously developed by the International Doubly Labeled Water Database Group. Participants were classified into sex-specific quintiles based on their water turnover. Water deficit levels were calculated from water turnover and dietary water consumption, which were estimated using a validated questionnaire.

RESULTS

The mean daily water turnovers were 2950 and 3466 mL in females and males, respectively. During 19.4 years of median follow-up (1,039,914 person-years), 12,551 deaths were recorded. After adjusting for lifestyle and medical history, the bottom quintile was associated with higher hazard ratios (HRs) of mortality from all causes (females-HR: 1.26; 95% CI: 1.12, 1.41; males-HR: 1.18; 95% CI: 1.07, 1.29) and cardiovascular disease (CVD). In spline analyses, the water turnover range with the lowest HR for all-cause mortality was 3000-3300 mL/d in females and the water turnover at which the HR for all-cause mortality plateaued was ∼3500-3700 mL/d in males. Water deficiency levels were associated with all-cause and CVD-related mortality in both sexes.

CONCLUSIONS

The association between water turnover and deficit and all-cause and CVD-related mortalities (especially coronary artery disease and ischemic stroke) in adults is L-shaped. These findings may be useful for setting the target values of water requirement, and differences between dietary requirements and actual intake may bridge the knowledge gap in water-mortality associations.

A review of nutritional recommendations for scuba divers

BACKGROUND

Scuba diving is an increasingly popular activity that involves the use of specialized equipment and compressed air to breathe underwater. Scuba divers are subject to the physiological consequences of being immersed in a high-pressure environment, including, but not limited to, increased work of breathing and kinetic energy expenditure, decreased fluid absorption, and alteration of metabolism. Individual response to these environmental stressors may result in a differential risk of decompression sickness, a condition thought to result from excess nitrogen bubbles forming in a diver's tissues. While the mechanisms of decompression sickness are still largely unknown, it has been postulated that this response may further be influenced by the diver's health status. Nutritional intake has direct relevancy to inflammation status and oxidative stress resistance, both of which have been associated with increased decompression stress. While nutritional recommendations have been determined for saturation divers, these recommendations are likely overly robust for recreational divers, considering that the differences in time spent under pressure and the maximum depth could result nonequivalent energetic demands. Specific recommendations for recreational divers remain largely undefined.

METHODS

This narrative review will summarize existing nutritional recommendations and their justification for recreational divers, as well as identify gaps in research regarding connections between nutritional intake and the health and safety of divers.

RESULTS

Following recommendations made by the Institute of Medicine and the Naval Medical Research Institute of Bethesda, recreational divers are advised to consume ~170-210 kJ·kg-1 (40-50 kcal·kg-1) body mass, depending on their workload underwater, in a day consisting of 3 hours' worth of diving above 46 msw. Recommendations for macronutrient distribution for divers are to derive 50% of joules from carbohydrates and less than 30% of joules from fat. Protein consumption is recommended to reach a minimum of 1 g of protein·kg-1 of body mass a day to mitigate loss of appetite while meeting energetic requirements. All divers should take special care to hydrate themselves with an absolute minimum of 500 ml of fluid per hour for any dive longer than 3 hours, with more recent studies finding 0.69 liters of water two hours prior to diving is most effective to minimize bubble loads. While there is evidence that specialized diets may have specific applications in commercial or military diving, they are not advisable for the general recreational diving population considering the often extreme nature of these diets, and the lack of research on their effectiveness on a recreational diving population.

CONCLUSIONS

Established recommendations do not account for changes in temperature, scuba equipment, depth, dive time, work of breathing, breathing gas mix, or individual variation in metabolism. Individual recommendations may be more accurate when accounting for basal metabolic rate and physical activity outside of diving. However, more research is needed to validate these estimates against variation in dive profile and diver demographics.

Water First School Water Promotion and Access Intervention: A Cost Analysis Study

BACKGROUND

Adequate water intake is associated with improved cognitive and physical performance, prevention of dental caries, and overweight and obesity. However, access to free drinking water in schools remains inadequate. Water First, a school-based intervention promoting water consumption, was shown effective in preventing overweight, yet its costs have not been quantified.

OBJECTIVE

To evaluate the costs of Water First from the school's perspective over 1 academic year.

DESIGN

Secondary analysis of a cluster-randomized clinical trial assessing the cost of Water First.

PARTICIPANTS AND SETTING

Six public schools in the San Francisco Bay Area during the 2018-2019 academic year, with an average of 578 ± 69 students per school and 110 ± 2 fourth-grade students in intervention schools, and 508 ± 190 students per school and 101 ± 5 fourth-grade students in control schools.

INTERVENTION

Schools were randomized to receive water dispensers and stations in cafeterias and high-traffic areas and a schoolwide water promotion campaign (school-level intervention). Fourth-grade students and teachers received reusable water bottles, lessons, and materials for school and home (class-level intervention).

MAIN OUTCOME MEASURES

Activities, resources, and the value needed to implement the school-level and classroom-level intervention were systematically captured over 1 academic year, including labor, materials, and utilities costs.

STATISTICAL ANALYSIS

The intervention costs per school and per student were estimated by summing the component-specific costs. Results are presented for both school-level and classroom-level interventions in 2023 US dollars.

RESULTS

The Water First intervention costs $20 per student for the school-level and $131 per student for the classroom-level intervention over 1 academic year. Accounting for the useful life of the installed water stations and dispensers beyond 1 year, the annualized cost of the school-level intervention was $11 per student.

CONCLUSIONS

These cost estimates provide useful insights for schools and stakeholders to plan and implement effective school-based interventions that promote access to drinking water.

Multiple recommended health behaviors among medical students in Western Canada: a descriptive study of self-reported knowledge, adherence, barriers, and time use

Background

General medical practitioners are responsible for promoting and prescribing lifestyle modification and serve as role models for healthy behaviors. We aimed to assess self-reported knowledge, adherence, barriers and time spent on all recommended health behaviors among medical students.

Methods

A cross-sectional online survey of eight behavioral domains among undergraduate medical students in The University of British Columbia, Canada, was analysed using descriptive statistics and visual display.

Results

Between March and April 2023, 137 medical students participated in the survey (74% female). Over 80% had knowledge of five health behavior recommendations, but lacked knowledge of specific dietary recommendations in particular. Over 60% reported meeting guideline-recommended levels for tobacco, weekly alcohol, daily alcohol (females only), and physical activity (males only). Large gaps existed between knowledge and adherence for physical activity, sleep, sedentariness, screen time, and dietary recommendations. Sex differences in knowledge and adherence to recommended health behaviors were identified. Time spent on wellness focused on sleep (47-49 h/week), diet (9.6 h/week), exercise (5.8 h/week), and hobbies (6.1 h/week). Forgetting recommendations (69% of females, 71% of males), and lack of time (72% of females, 52% of males) were principal barriers to knowledge and adherence.

Conclusion

Most medical students in Western Canada reported not meeting multiple recommended health behaviors. Time was the largest barrier to adherence and free time was spent on sleep. Medical education may require protected time and dedicated content for health behaviors to ensure future physicians can be role models of health promotion for patients.

Association of Ultra-processed Food and Unprocessed or Minimally Processed Food Consumption With Bowel Habits Among U.S. Adults

BACKGROUND & AIMS

Ultra-processed foods (UPFs) may have a negative impact on bowel habits. We aimed to assess the association between UPF and unprocessed or minimally processed food (MPF) intake and bowel habits among adults in the United States (U.S.).

METHODS

We performed a cross-sectional study using data from the National Health and Nutrition Examination Survey (2005-2010). We used two 24-hour dietary recalls and, based on the Nova classification, calculated intakes of UPFs and MPFs. Constipation and diarrhea were defined using the Bristol Stool Form Scale and stool frequency. We performed survey-weighted logistic regression and substitution analysis to estimate the odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Among 12,716 U.S. adults, there were 1290 cases of constipation and 1067 cases of diarrhea. Median UPF and MPF intakes were 26.5% and 66.2% of total grams per day, respectively. Greater UPF consumption (in % gram/d) was associated with higher odds of constipation (adjusted OR [aORQ4 vs Q1], 2.20; 95% CI, 1.76-2.74) (Ptrend < .001) but not diarrhea (aORQ4 vs Q1, 0.82; 95% CI, 0.62-1.09) (Ptrend = .12). Increased MPF consumption was associated with lower odds of constipation (aORQ4 vs Q1, 0.46; 95% CI, 0.370-0.57) (Ptrend < .001). Associations with constipation were attenuated after adjusting for diet quality (aORQ4 vs Q1, UPF, 1.53; MPF, 0.69). Substituting 10% of UPF intake with an equivalent proportion of MPFs was associated with lower odds of constipation (aOR, 0.90; 95% CI, 0.87-0.93).

CONCLUSIONS

UPF intake was associated with higher odds of constipation, whereas the odds were lower with greater MPF consumption. The effect of food processing on bowel habits was independent of diet quality.

Blood pressure alteration associated with abnormal body electrolyte and water balance in colitis mice

Previous studies reported that there is an association between abnormal body fluid balance and prognosis in colitis patients. However, it remains to be clarified the effects of colitis on characteristics of body electrolytes or water content, including alternation in blood pressure. In this study, we examined the effects of colon injury on body water balance and blood pressure in the dextran sodium sulfate (DSS)-induced colitis mouse model. We evaluated body electrolytes and water content, blood pressure, and urea-associated water conservation in DSS mice. By 5 days after the treatment, DSS mice exhibited diarrhea but relatively maintained body weight and total body sodium, potassium, and water content by increases in water intake and hepatic ureagenesis. On 7 days after DSS treatment, when colitis becomes severe, DSS mice significantly decreased food and water intake, and body weight but significantly increased relative total body sodium, potassium, and water content per dry mass. Notably, DSS induced more total body dry mass loss relative to water loss. These body electrolytes and water accumulation on day 7 were associated with a reduction in urinary osmole excretion and urine volume accompanied by renal urea accumulation. DSS mice significantly increased blood pressure by day 5 and then decreased on day 7. These findings suggest that body electrolyte and fluid imbalance and alternations in blood pressure in colitis vary with the stage and severity of the condition. Assessment and correction of electrolyte and water content at the tissue level would be important to improve the prognosis of colitis.

Water Versus Electrolyte Rehydration on Vocal Fold Osmotic and Oxidative Stress Gene Expression

OBJECTIVES

Systemic dehydration may induce osmotic and oxidative stress in the vocal folds, but our knowledge of the biology and mitigation with rehydration is limited. The purpose of this experiment was to evaluate whether systemic dehydration induces vocal fold oxidative and osmotic stress and to compare the impact of rehydration by water intake versus electrolyte intake on osmotic and oxidative stress-related gene expression.

METHODS

Four-month-old male Sprague-Dawley rats (N = 32) underwent water restriction. Rehydration was achieved with ad libitum access to water or electrolytes for 24 hours. Rats were divided into four groups: euhydration control, dehydration-only, dehydration followed by either water or electrolyte rehydration (n = 8/group). Gene expression was assessed via RT2 Gene Expression Profiler arrays.

RESULTS

With respect to oxidative stress, 10 genes were upregulated and 2 were downregulated after vocal fold dehydration compared with the euhydrated control. Concerning osmotic stress, six genes were upregulated with dehydration only, six genes were upregulated following rehydration with water, whereas a single gene was upregulated with electrolyte rehydration. All genes with significantly different expression between the rehydration groups showed lower expression with electrolytes compared with water.

CONCLUSIONS

The results support a potential role of oxidative and osmotic stresses in vocal folds related to systemic dehydration. The differences in stress-related gene expression in vocal fold tissue between rehydration with electrolytes or water, albeit modest, suggest that both rehydration options offer clinical utility to subjects experiencing vocal fold dehydration with preliminary evidence that electrolytes may be more effective than water in resolving osmotic stress.

LEVEL OF EVIDENCE

NA (prospective animal study) Laryngoscope, 134:4636-4641, 2024.

Association of plain water intake with risk of all-cause and cause-specific mortality in individuals with non-alcoholic fatty liver disease or metabolic dysfunction-associated steatotic liver disease

Non-alcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD)-related mortality have increased dramatically in past decades. Our study aims to investigate the association between plain water and this prevalent metabolic disease, as water plays a crucial role in regulating metabolic processes. A total of 3,543/3,428 individuals with NAFLD/MASLD were included in this study from National Health and Nutrition Examination Survey (NHANES). Daily plain water intake was recorded, and mortality status was tracked until December 31, 2019. Multivariate Cox regression models and restricted cubic spline (RCS) regression models were used to assess the association between plain water intake and long-term all-cause as well as cause-specific mortality among participants with NAFLD/MASLD. Furthermore, we investigated the relationship between substituting other beverages with plain water intake and the risk of mortality. The multivariate Cox regression analyses revealed a significant association between higher plain water intake and lower all-cause mortality, cerebrovascular diseases mortality, and cancer mortality in both NAFLD or MASLD patients. Dose-response analyses revealed a non-linear trend between plain water intake and mortality among NAFLD/MASLD patients. Additionally, replacing sugar or artificial beverages with plain water was linked to reduced all-cause mortality, cerebrovascular diseases mortality, and cancer mortality in patients with NAFLD/MASLD. Higher plain water intake is independently linked to lower risk of all-cause, cerebrovascular diseases mortality, and cancer mortality in NAFLD/MASLD patients. Increasing plain water intake may be an effective way for these patients to reduce their risk of mortality.

Weight loss, changes in body composition and inflammatory status after a very low-energy ketogenic therapy (VLEKT): does gender matter?

BACKGROUND

Considering differences in body composition and inflammatory status between sexes, as well as recent recommendations advocating for personalized dietary approaches, this study aimed to explore how sex influences weight loss, changes in body composition, and inflammatory status in subjects with grade I and II obesity undergoing a 45-day of the Very Low-Energy Ketogenic Therapy (VLEKT).

METHODS

Participants (21 premenopausal females and 21 males), included in the study adhered to the 45-day of the VLEKT and underwent assessments of anthropometric parameters (weight, height, body mass index-BMI -, and waist circumference), body composition via bioelectrical impedance analysis, and inflammatory status measured by high sensitivity C-reactive protein (hs-CRP) levels at baseline and post-intervention.

RESULTS

At baseline, premenopausal females and males did not differ in BMI (p = 0.100) and hs-CRP levels (p = 0.948). Males demonstrated overall larger benefits than premenopausal females from the VLEKT in terms of weight loss (Δ% = - 11.63 ± 1.76 vs - 8.95 ± 1.65 kg, p < 0.001), fat mass (Δ% = - 30.84 ± 12.00 vs -21.36 ± 4.65 kg, p = 0.002), and hs-CRP levels (Δ% = - 41.42 ± 21.35 vs - 22.38 ± 17.30 mg/L, p = 0.003). Of interest, in males phase angle values are statistically improved compared to female (Δ% = 17.11 ± 9.00 vs 7.05 ± 3.30°, p < 0.001).

CONCLUSION

These findings underscore the importance of considering sex-specific responses in personalized obesity treatment strategies, particularly dietary interventions like VLEKTs.

Seasonal changes in hydration in free-living Japanese children and adolescents

Changes in hydration status occur throughout the day affecting physiological and behavioural functions. However, little is known about the hydration status of free-living Japanese children and the seasonality of this response. We evaluated hydration status estimated by urine osmolality (Uosm) in 349 children (189 boys and 160 girls, 9.5 ± 2.6 years, range: 6-15 years) upon waking at home and during a single school day in spring (April) and summer (July). Further, we assessed the efficacy of employing self-assessment of urine colour (UC; based on an 8-point scale) by children to monitor their hydration status. Early morning Uosm was greater in the spring (903 ± 220 mOsm L-1; n = 326) as compared to summer (800 ± 244 mOsm L-1; n = 125) (P = 0.003, paired t test, n = 104). No differences, however, were observed in Uosm during the school day (P = 0.417, paired t test, n = 32). While 66% and 50% of children were considered underhydrated (Uosm ≥ 800 mOsm L-1) upon waking in the spring and summer periods, respectively, more children were underhydrated (∼12%) during the school day. Self-reported UC was similar between seasons as assessed in the morning and school day (P ≥ 0.101, paired t test), which differed from the pattern of responses observed with Uosm. We showed that a significant number of Japanese children are likely underhydrated especially in the spring period. Children do not detect seasonal changes in hydration from self-assessed UC, limiting its utility to manage hydration status in children.

Determinant of factors associated with water requirement measured using the doubly labelled water method among older Japanese adults

OBJECTIVE

Water is an essential nutrient for all organisms and is important for maintaining life and health. We aimed to develop a biomarker-calibrated equation for predicting water turnover (WT) and pre-formed water (PW) using the doubly labelled water (DLW) method.

DESIGN

Cross-sectional study.

SETTING

General older population from the Kyoto-Kameoka Study, Japan.

PARTICIPANTS

The 141 participants aged ≥ 65 years were divided into a model developing (n 71) and a validation cohort group (n 70) using a random number generation. WT and PW was measured using the DLW method in May-June of 2012. In developing the cohort, equations for predicting WT and PW were developed by multivariate stepwise regression using all data from the questionnaires in the Kyoto-Kameoka study (including factors such as dietary intake and personal characteristics). WT and PW measured using the DLW method were compared with the estimates from the regression equations developed using the Wilcoxon signed-rank test and correlation analysis in validation cohort.

RESULTS

The median WT and PW for 141 participants were 2·81 and 2·28 l/d, respectively. In the multivariate model, WT (R2 = 0·652) and PW (R2 = 0·623) were moderately predicted using variables, such as height, weight and fluid intake from beverages based on questionnaire data. WT (r = 0·527) and PW (r = 0·477) predicted that using this model was positively correlated with the values measured by the DLW method.

CONCLUSIONS

Our results showed factors associated with water requirement and indicated a methodological approach of calibrating the self-reported dietary intake data using biomarkers of water consumption.

Bioinspired, Carbohydrate-Containing Polymers Efficiently and Reversibly Sequester Heavy Metals

Water scarcity and heavy metal pollution are significant challenges in today's industrialized world. Conventional heavy metal remediation methods are often inefficient and energy-intensive, and produce chemical sludge. To address these issues, we developed a bioinspired, carbohydrate-containing polymer system for efficient and selective heavy metal removal. Using ring opening metathesis polymerization, we synthesized polymers bearing amphiphilic glucuronate side chains capable of selectively binding heavy metal cations in mixed media. In samples containing high concentrations of heavy metals (>550 ppb), these polymers rapidly form a filterable precipitate upon metal capture, reducing the concentration of cation to <1.5 ppb within 3 min, as measured by inductively coupled plasma mass spectrometry. This system effectively removes cadmium ions from highly contaminated solutions to levels below the Agency for Toxic Substances and Disease Registry limit for Cd2+ in drinking water and selectively removes both Cd2+ and Pb2+ from lake water spiked with trace amounts of metal. Acidification triggers protonation of the glucuronate groups, releasing the heavy metals and resolubilizing the polymer. This capture-and-release process can be repeated over multiple cycles without loss of binding capacity. As such, this study introduces a novel class of recyclable materials with pH-responsive properties, offering potential for applications in water remediation and beyond.

Low daily water intake profile-is it a contributor to disease?

Few previous review articles have focused on the associations between inadequate daily water intake (LOW) or urinary biomarkers of dehydration (UD; low urine volume or high urine osmolality) and multiple diseases. Accordingly, we conducted manual online searches (47 key words) of the PubMed, Embase, and Google Scholar databases with these inclusion criteria: English language, full-text, peer reviewed, no restriction on research design, and three publications minimum. Initially, 3,903 articles were identified based on their titles and abstracts. Evaluations of full length .pdf versions identified 96 studies that were acceptable for inclusion. We concluded that the evidence is insufficient or conflicting for seven disorders or diseases (i.e. suggesting the need for additional clarifying research) and it is lacking for all-cause mortality. Differential characterizations among women and men have been reported in the results of nine studies involving five diseases. Finally, the evidence for associations of LOW or UD is strong for both kidney stones and type 2 diabetes with hyperglycemia. This suggests that great public health value (i.e. reduced disease risk) may result from increased daily water intake-a simple and cost-effective dietary modification.

The multi-tissue gene expression and physiological responses of water deprived Peromyscus eremicus

The harsh and dry conditions of desert environments have resulted in genomic adaptations, allowing for desert organisms to withstand prolonged drought, extreme temperatures, and limited food resources. Here, we present a comprehensive exploration of gene expression across five tissues (kidney, liver, lung, gastrointestinal tract, and hypothalamus) and 19 phenotypic measurements to explore the whole-organism physiological and genomic response to water deprivation in the desert-adapted cactus mouse (Peromyscus eremicus). The findings encompass the identification of differentially expressed genes and correlative analysis between phenotypes and gene expression patterns across multiple tissues. Specifically, we found robust activation of the vasopressin renin-angiotensin-aldosterone system (RAAS) pathways, whose primary function is to manage water and solute balance. Animals reduced food intake during water deprivation, and upregulation of PCK1 highlights the adaptive response to reduced oral intake via its actions aimed at maintained serum glucose levels. Even with such responses to maintain water balance, hemoconcentration still occurred, prompting a protective downregulation of genes responsible for the production of clotting factors while simultaneously enhancing angiogenesis which is thought to maintain tissue perfusion. In this study, we elucidate the complex mechanisms involved in water balance in the desert-adapted cactus mouse, P. eremicus. By prioritizing a comprehensive analysis of whole-organism physiology and multi-tissue gene expression in a simulated desert environment, we describe the complex response of regulatory processes.

Personalized metabolic whole-body models for newborns and infants predict growth and biomarkers of inherited metabolic diseases

Comprehensive whole-body models (WBMs) accounting for organ-specific dynamics have been developed to simulate adult metabolism, but such models do not exist for infants. Here, we present a resource of 360 organ-resolved, sex-specific models of newborn and infant metabolism (infant-WBMs) spanning the first 180 days of life. These infant-WBMs were parameterized to represent the distinct metabolic characteristics of newborns and infants, including nutrition, energy requirements, and thermoregulation. We demonstrate that the predicted infant growth was consistent with the recommendation by the World Health Organization. We assessed the infant-WBMs' reliability and capabilities for personalization by simulating 10,000 newborns based on their blood metabolome and birth weight. Furthermore, the infant-WBMs accurately predicted changes in known biomarkers over time and metabolic responses to treatment strategies for inherited metabolic diseases. The infant-WBM resource holds promise for personalized medicine, as the infant-WBMs could be a first step to digital metabolic twins for newborn and infant metabolism.

Nurses' perception of thirst in patients within palliative home care: a qualitative study

BACKGROUND

Thirst is the body's natural urge to replenish fluids in response to a deficiency in hydration. Patients at the end of life gradually lose their independence and reach a point where they become unable to express their needs and can no longer drink on their own. In palliative care, the main advice is to provide regular oral care to relieve symptoms such as dry mouth and thirst. However, according to previous studies the prevalence of thirst and dry mouth remains.

AIM

The aim of this study was to describe palliative care, nurses' views and experiences of thirst in end-of-life care in specialist palliative care units.

METHODS

A qualitative interview study with an inductive approach was conducted. Eighteen nurses working in six different specialist palliative care units in different hospitals in Sweden were interviewed. The interviews were transcribed and analysed with a content analysis approach according to Graneheim and Lundman.

RESULTS

When nurses discuss thirst, they perceive thirst as a problem for the patient. This is attributable to various factors, including the patient breathing with an open mouth, a reduced level of awareness, and negligence on the part of the nursing staff. Signs of thirst are dry mouth, and frequently and intense sucking on the oral care stick during oral care. It also emerged that not all nurses perceived that dying patients experienced thirst. They believe that thirst is something that is reduced in the dying patient in the same way as hunger. The most important thing to them is to relieve the dry mouth by providing good oral care. Several issues, such as a lack of guidelines paired with the patient's reduced consciousness and hence his/her lack of communication, make assessing thirst problematic.

CONCLUSION

Nurses have different thoughts and experiences about thirst, where some perceive patients as thirsty while others perceive them as having a dry mouth. Nurses expressed that both evidence and guidelines are lacking.

A New Method for Detecting Dehydration of the Human Body Using Non-Contact Millimeter Wave Radiometry

Dehydration is a common problem in the aging population. Medical professionals can detect dehydration using either blood or urine tests. This requires experimental tests in the lab as well as urine and blood samples to be obtained from the patients. This paper proposed 100 GHz millimeter wave radiometry for early detection of dehydration. Reflectance measurements were performed on healthy and dehydrated patients of both genders (120 males and 80 females) in the aging population. Based on the cause of dehydration, the patient groups were divided into three categories: (1) patients dehydrated due to less thirst sensation, (2) patients dehydrated due to illnesses (vomiting and diarrhea), and (3) patients dehydrated due to diabetes. Reflectance measurements were performed on eight locations: (1) the palm, (2) the back of the hand, (3) the fingers, (4) the inner wrist, (5) the outer wrist, (6) the volar side of the arm, (7) the dorsal surface of the arm, and (8) the elbow. Skin dehydrated due to vomiting and diarrhea was found to have lower reflectance at all the measurement locations compared with healthy and other types of dehydrated skin. The elbow region showed the highest difference in reflectance between healthy and dehydrated skin. This indicates that radiometric sensitivity is sufficient to detect dehydration in a few seconds. This will reduce the patient's waiting time and the healthcare professional's intervention time as well as allow early treatment of dehydration, thus avoiding admission to hospitals.

Omnivore and vegetarians show similar body composition and skin physiology across body regions-A comparative analysis

BACKGROUND

Skin physiology seems to be influenced by dietary choices and body composition, although links between these factors remain poorly characterised. In the present manuscript, we elaborate on the potential relationships among food groups, body composition and skin physiology in omnivores and vegetarians.

MATERIAL AND METHODS

This cross-sectional observational study involved 181 participants, 129 omnivores and 52 vegetarians. The main functions of the skin measured in our laboratory were transepidermal water loss, deep and superficial epidermal hydration, skin elasticity, and carotenoid content. Skin variables obtained from different body regions were made comparable by a new Proportional Skin Index calculated to respect their relative representativity.

RESULTS

No statistical differences were found when comparing both groups' body composition and skin variables from different body regions, with the exception of the skin carotenoid content significantly higher in the vegetarian group (p < 0.001).

CONCLUSION

Although dietary patterns significantly differed between groups, with vegetarians consuming fewer animal-derived products and more plant-based foods, multiple linear regression analysis revealed no differences or association between the dietary pattern and the skin physiology. These findings highlight the need for further research to elucidate the specific impact of diet and food groups and body composition on skin physiology.

Assessment of Water Intake among Chinese Toddlers: The Report of a Survey

Toddlerhood (aged 13~36 months) is a period of dietary transition, with water intake being significantly influenced by parental feeding patterns, cultural traditions, and the availability of beverages and food. Nevertheless, given the lack of applicable data, it is challenging to guide and evaluate the water intake of toddlers in China. In this study, our objectives were to assess the daily total water intake (TWI), evaluate the consumption patterns of various beverages and food sources contributing to the TWI, determine the conformity of participants to the adequate intake (AI) recommendation of water released by the Chinese Nutrition Society, and analyze the various contributors to the daily total energy intake (TEI). The data for the assessment of water and dietary intake were obtained from the cross-sectional dietary intake survey of infants and young children (DSIYC, 2018-2019). A total of 1360 eligible toddlers were recruited in the analysis. The differences in related variables between two age groups were compared by Mann-Whitney U test and Chi-Square test. The potential correlation between water and energy intake was examined utilizing age-adjusted partial correlation. Toddlers consumed a median daily TWI of 1079 mL, with 670 mL (62.3%, r = 0.752) derived from beverages and 393 mL (37.7%, r = 0.716) from foods. Plain water was the primary beverage source, contributing 300 mL (52.2%, r = 0.823), followed by milk and milk derivatives (MMDs) at 291 mL (45.6%, r = 0.595). Notably, only 28.4% of toddlers managed to reach the recommended AI value. Among these, toddlers obtain more water from beverages than from foods. The median daily TEI of toddlers was 762 kcal, including 272 kcal from beverages (36.4%, r = 0.534) and 492 kcal from foods (63.6%, r = 0.894). Among these, the median daily energy intake from MMDs was 260 kcal, making up 94.6% of the energy intake from beverages (r = 0.959). As the pioneer survey on TWI of toddlers in China based on nationally representative data, attention to the quality and quantity of water intake and actions to better guide parents by both individuals and authorities are eagerly anticipated. Additionally, the revision of the reference value of TWI for Chinese toddlers is urgently required.

Knowledge, Attitudes, and Practices Regarding Air Pollution among Medical Students

Background: Air pollution has emerged as a global public health concern. Specifically, in Medellín, Colombia, episodes of elevated air pollution have been documented. Medical students' knowledge of air pollution is paramount for implementing future interventions directed toward patients. The aim of this research was to delineate the knowledge, attitudes, and practices regarding air pollution among medical students at a private university in Medellín. Methods: A cross-sectional study involving 352 medical students was conducted. A questionnaire was administered, generating scores ranging from 0 to 100, where a higher score signified better knowledge, attitudes, and practices. Data were analyzed using frequencies, summary measures, non-parametric tests, and linear regression. Results: In total, 31% rated the education received at the university on the relationship between health and air quality as fair to poor, and 81% perceived the air quality in the city as poor. The knowledge score was 77.8 (IQR 71.1-85.6), with 90% acknowledging that exposure to air pollution increases the risk of various diseases. The attitudes score was 82.1 (IQR 71.8-87.2), and 25.9% believed that air pollution is a multifactorial problem, rendering their actions ineffective. In terms of practices, the score was 50 (IQR 42.9-57.1), indicating that students either did not employ protective measures against pollution or used inappropriate practices such as masks or air purifiers. Regression analysis revealed no association between knowledge and practices. Conclusion: The findings of this study underscore that medical students possess commendable knowledge regarding the health effects of air pollution. However, their adoption of inappropriate practices for self-protection is evident. The lack of correlation between knowledge and practices highlights the necessity of educational initiatives to be complemented by regulatory and cultural interventions.