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Hydration and Health: Scientific Evidence and Recommendations

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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (31 March 2019) | Viewed by 73315

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Prof. Dr. Lluis Serra-Majem

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1. Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
2. Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35001 Las Palmas, Spain
3. Preventive Medicine Service, Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, 35016 Las Palmas, Spain
Interests: mediterranean diet; public health; nutrition; obesity; epidemiology; diet; macro and micronutrients; hydration
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Prof. Dr. Javier Aranceta-Bartrina

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Latin America Director of the International Chair for Advanced Studies on Hydration. University of Las Palmas de Gran Canaria, Las Palmas, SpainProfessor of Community Nutrition. University of Navarra. Pamplona, SpainPresident of the Scientific Committee of the Spanish Society for Community Nutrition (SENC). Spain
Interests: hydration; sustainability; Mediterranean diet; public health; nutrition; obesity; epidemiology; diet; macro and micronutrients

Prof. Dr. Adriana Ortiz-Andrellucchi

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International Chair for Advanced Studies on Hydration. University of Las Palmasde Gran Canaria. Spain.Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, SpainCIBER OBN, Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition, Carlos III Health Institute, Madrid, Spain
Interests: hydration; sustainability; Mediterranean diet; public health; nutrition; obesity; epidemiology; diet; macro and micronutrients

Special Issue Information

Dear Colleagues,

Water is physiologically necessary for human survival. The total amount of water in the body and the balance between intake and loss of water are controlled homeostatically by mechanisms that modify the routes of excretion and stimulate consumption (thirst). Every cell of the human body needs water, therefore adequate hydration is essential for health and well-being. Hydration is the fundamental pillar of the most basic physiological functions, such as the regulation of blood pressure and body temperature and digestion.

The ingestion of the water of each individual varies in relation to the weight and the body surface, the temperature and humidity of the environment, the diet, the activities carried out (for example, work, sports, etc.), culture, dress and the health status. Adequate water intake is linked to survival, improved health, physical and mental performance and safety and productivity at work. Given the rapid growth of the world's population, it is expected that water demand increases by almost a third by the year 2050. A pattern of accelerated consumption, the growing deterioration of the environment and the multifaceted impacts of climate change, current challenges of water management in all sectors are revealed, which demands new forms of management of this valuable natural resource.

In the same way that evidence-based nutrition (NUBE) was developed based on the pillars of evidence-based medicine (MBE), CIEAH aims to promote the development of evidence-based hydration (HIBE) with the objective of provide the best scientific evidence available to support the binomial hydration and health. The HIBE is an emerging discipline in the field of MBE that aims to offer the best scientific evidence considering a diversity of approaches ranging from the clinical, epidemiological, physiological, dietary-nutritiona and community from all sources of hydration and its adaptation to the different needs of the human organism. The interest created around the MBE in general and the HIBE in particular, driven by the CIEAH and the Spanish Society of Community Nutrition (SENC), aims to address this diversity of approaches, contributing to improve the quality of research on hydration , in order to support health professionals, vulnerable populations and the general population by promoting an adequate level of hydration in a context of a healthy lifestyle, without forgetting the social challenges that must be faced in terms of efficient use of water.

The objective of this proposed Special Issue is to publish papers detailing multidisciplinary aspects of hydration with regard to health, functionality, quality of life and sustainability. The key idea is to achieve, through this special issue, a picture of all the topics presented to the III INTERNATIONAL AND V SPANISH HYDRATION CONGRESS, held in Bilbao, Spain, in 2018.

Prof. Dr. Lluís Serra-Majem
Prof. Dr. Javier Aranceta-Bartrina
Prof. Dr. Adriana Ortiz-Andrellucchi
Guest Editors

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Keywords

Water intake
Adults, Infants, Elderly, Pregnant women (population)
Adequate hydration
Hydration status
Behavioural aspects
Water quality
Sustainability
Beverages consumption

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Published Papers (10 papers)

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8 pages, 1415 KiB

Open AccessArticle

Fluid Restriction Decreases Solid Food Consumption Post-Exercise

by Cristian Pérez-Luco, Francisco Díaz-Castro, Carlos Jorquera, Rodrigo Troncoso, Hermann Zbinden-Foncea, Neil M Johannsen and Mauricio Castro-Sepulveda

Nutrients 2019, 11(6), 1209; https://doi.org/10.3390/nu11061209 - 28 May 2019

Cited by 5 | Viewed by 4081

Abstract

Dehydration in rodents induces anorexia. In humans however, the role of dehydration in energy intake is controversial. This study investigated the effect of extreme fluid restriction on acute energy intake during and after exercise-induced dehydration. Eight physically active participants performed two exercise sessions to induce dehydration. After the exercise, the men were allowed to either rehydrate for 2 h or were maintained in a hypohydrated state, in a randomized manner. After 2 h, they were given cereal bars ad libitum for 1 h. Blood and saliva samples of the participants were collected before the exercise session, after the exercise session, after rehydration, and after the meal. Post-exercise energy intake differed between hypohydrated (1430 ± 210 kcal) and rehydrated (2190 ± 780 kcal) trials (p = 0.01). For the concentrations of ghrelin and leptin, there were no significant effects of time (p = 0.94, p = 0.21), between trials (p = 0.09, p = 0.99), or due to a trial–time interaction (p = 0.64, p = 0.68), respectively. The concentrations of peptide YY (PYY) were not different between trials (p = 0.94) but there was a significant effect of time (p = 0.0001) and a trial–time interaction (p = 0.01), with higher levels in the rehydration trial after eating in response to a higher energy intake. For saliva production, there was a significant effect of time (p = 0.02) and a trial–time interaction (p = 0.04), but no between-trial effect (p = 0.08). In conclusion, extreme fluid restriction decreased acute food intake after exercise, which may be explained by a lower flow of saliva. Full article

(This article belongs to the Special Issue Hydration and Health: Scientific Evidence and Recommendations)

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12 pages, 1195 KiB

Open AccessArticle

Fluctuation of Water Intake and of Hydration Indices during the Day in a Sample of Healthy Greek Adults

by Adelais Athanasatou, Aikaterini Kandyliari, Olga Malisova and Maria Kapsokefalou

Nutrients 2019, 11(4), 793; https://doi.org/10.3390/nu11040793 - 6 Apr 2019

Cited by 8 | Viewed by 4770

Abstract

Mild dehydration may occur during specific periods of the day because of poor hydration habits and/or limited access to a variety of beverages or foods, for example, in work environments. Measurement of hydration indices in spot or in 24 h urine samples may mask mild dehydration in specific periods of the day. Healthy subjects (n = 164; 74 females; age 38 ± 12 years) living in Athens, Greece were enrolled in the study. Subjects recorded their solid food and drink intakes and recorded and collected all urinations for three consecutive days. Water intake was analyzed in 24 h and 6 h periods from wake-up time and scored for variety. Urine hydration indices (osmolality, volume, color, specific gravity) were analyzed in 24 h samples, in morning urine samples and in samples collected in 6 h periods from wake-up time. Fluctuations during the day were significant for the intake of drinking water, hot beverages, milk, fruit and vegetable juices, and alcoholic drinks and for urine osmolality, volume, color, and specific gravity. The urine volume of the first 6 h period after wake-up time (557 ± 231 mL/day) reflects by 76% the 24 h urine collection (1331 ± 144 mL/day). Water intake from all beverages, with the exception of alcoholic beverages, was greater in the first 6h period (morning period) and decreased throughout the day. Hydration indices changed accordingly. The 6 h timed urine sample collected reflects indices in samples collected over 24 h better than any spot urine sample. Full article

(This article belongs to the Special Issue Hydration and Health: Scientific Evidence and Recommendations)

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13 pages, 817 KiB

Open AccessArticle

Differing Water Intake and Hydration Status in Three European Countries—A Day-to-Day Analysis

by Hans Braun, Judith von Andrian-Werburg, Olga Malisova, Adelais Athanasatou, Maria Kapsokefalou, Juan F. Ortega, Ricardo Mora-Rodriguez and Mario Thevis

Nutrients 2019, 11(4), 773; https://doi.org/10.3390/nu11040773 - 3 Apr 2019

Cited by 13 | Viewed by 7636

Abstract

Adequate hydration is essential for maintaining health and functionality of the human body. Studies assessing both daily water intake and hydration status are lacking. This study explored data from the European Hydration Research Study (EHRS) and focused on total water intake (TWI), 24 h hydration status, and day-to-day variations in a sample of 573 healthy adults. TWI was assessed by food records and hydration status (urine osmolality and urine volume) was measured from 24 urine samples collected over seven consecutive days. On all weekdays, mean TWI was higher (p < 0.001 for all days) for the German subjects compared to the Greek and Spanish participants. In 37% of the male and 22% of the female subjects, the individual mean TWI was below the European Food Safety Authority (EFSA) recommendation, with 16% men (4% women) being below the EFSA recommendation on every testing day. Twenty-four hour urine osmolality was lower in women compared to men (595 ± 261 vs. 681 ± 237 mOsmol/kg; p < 0.001). More men (40%) showed a urine osmolality ≥800 mOsmol/kg at least on four days of the study period compared to women (26%) and more participants from Spain (46%) compared to Greece (29%) and Germany (11%). A large number of individuals showed an inadequate hydration status on several days per week, which may have a negative health and cognitive impact on daily life. Full article

(This article belongs to the Special Issue Hydration and Health: Scientific Evidence and Recommendations)

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9 pages, 274 KiB

Open AccessArticle

Intracellular Water Content in Lean Mass is Associated with Muscle Strength, Functional Capacity, and Frailty in Community-Dwelling Elderly Individuals. A Cross-Sectional Study

by Mateu Serra-Prat, Isabel Lorenzo, Elisabet Palomera, Juan Carlos Yébenes, Lluís Campins and Mateu Cabré

Nutrients 2019, 11(3), 661; https://doi.org/10.3390/nu11030661 - 19 Mar 2019

Cited by 32 | Viewed by 4857

Abstract

High intracellular water (ICW) content has been associated with better functional performance and a lower frailty risk in elderly people. However, it is not clear if the protective effect of high ICW is due to greater muscle mass or better muscle quality and cell hydration. We aimed to assess the relationship between ICW content in lean mass (LM) and muscle strength, functional performance, frailty, and other clinical characteristics in elderly people. In an observational cross-sectional study of community-dwelling subjects aged ≥75 years, ICW and LM were estimated by bioelectrical impedance, and the ICW/LM ratio (mL/kg) calculated. Muscle strength was measured as hand grip, frailty status was assessed according to Fried criteria, and functional status was assessed by Barthel score. For 324 recruited subjects (mean age 80 years), mean (SD) ICW/LM ratio was 408 (29.3) mL/kg. The ICW/LM ratio was negatively correlated with age (r_s = −0.249; p < 0.001). A higher ICW/LM ratio was associated with greater muscle strength, better functional capacity, and a lower frailty risk, even when adjusted by age, sex, nº of co-morbidities, and LM. ICW content in LM (including the muscle) may influence muscle strength, functional capacity and frailty. However, further studies are needed to confirm this hypothesis. Full article

(This article belongs to the Special Issue Hydration and Health: Scientific Evidence and Recommendations)

44 pages, 1630 KiB

Open AccessArticle

Analysis of 2009–2012 Nutrition Health and Examination Survey (NHANES) Data to Estimate the Median Water Intake Associated with Meeting Hydration Criteria for Individuals Aged 12–80 Years in the US Population

by Jodi Dunmeyer Stookey

Nutrients 2019, 11(3), 657; https://doi.org/10.3390/nu11030657 - 18 Mar 2019

Cited by 27 | Viewed by 7816

Abstract

In 2005, US water intake recommendations were based on analyses of Nutrition Health and Examination Surveys (NHANES) III data that examined if hydration classification varied by water intake and estimated the median water intake associated with hydration in persons aged 19–30. Given the upcoming 2020–2025 Dietary Guidelines review, this analysis addressed the same two aims with 2009–2012 NHANES data. Methods were updated by defining hydration criteria in terms of multiple measures (serum sodium 135–144 mmol/L and urine osmolality < 500 mmol/kg), expressing water intake as ml/kg, distinguishing plain water intake (PWI) from total water intake (TWI), using weighted age- and sex-specific multivariable models to control for determinants of water intake requirements, and selecting two study samples (the non-acutely ill US population and a sub-group without selected chronic disease risk factors). In the US population and sub-group, the relative risk (RR) of meeting the hydration criteria was significantly greater for individuals with TWI ≥ 45 mL/kg or PWI ≥ 20 mL/kg (for the US population 19–50 years of age: adjusted RR = 1.36, 95% CI: 1.10–1.68 for males; adjusted RR = 1.70, 95% CI: 1.49–1.95 for females. For the sub-group 51–70 years of age: adjusted RR = 2.20, 95% CI: 1.15–4.18 for males; adjusted RR = 2.00, 95% CI: 1.18–3.40 for females). The median (SE) TWI and PWI associated with meeting the hydration criteria for males and females 19–50 years of age were 42 (2) mL/kg and 14 (1) mL/kg and 43 (2) mL/kg and 16 (1) mL/kg, respectively. The significant association between water intake and hydration classification differs from the null association underlying the 2005 water intake recommendations and may lead to different reasoning and inferences for the 2020–2025 Dietary Guidelines. Full article

(This article belongs to the Special Issue Hydration and Health: Scientific Evidence and Recommendations)

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14 pages, 1411 KiB

Open AccessArticle

Adaptation and Validation of the Hydration Status Questionnaire in a Spanish Adolescent-Young Population: A Cross Sectional Study

by Ana Isabel Laja García, Maria de Lourdes Samaniego-Vaesken, Teresa Partearroyo and Gregorio Varela-Moreiras

Nutrients 2019, 11(3), 565; https://doi.org/10.3390/nu11030565 - 6 Mar 2019

Cited by 3 | Viewed by 4702

Abstract

The achievement of adequate hydration status is essential for mental and physical performance and for health in general, especially in children and adolescents. Nevertheless, little is known about hydration status of this population, mainly due to the limited availability of research tools; thus, the objective of the current study was to adapt and validate our hydration status questionnaire in a Spanish adolescent-young population. The questionnaire was validated against important hydration markers: urine colour, urine specific gravity, haemoglobin, haematocrit and total body water and involved 128 subjects aged between 12–17 years. Water intake was also estimated through a three-day dietary record and physical activity was assessed through accelerometers. Participants completed the questionnaire twice. Water balance and water intake were correlated with urine specific gravity and with total body water content. Water intake obtained by the questionnaire was correlated with results from the three-day dietary record. The intraclass correlation coefficient indicated moderate concordance between both recordings and the Cronbach’s alpha revealed high consistency. The Bland and Altman method indicated that the limits of agreement were acceptable to reveal the reliability of the estimated measures. In conclusion, this is the first time that a questionnaire is valid and reliable to estimate hydration status of adolescent-young populations. Full article

(This article belongs to the Special Issue Hydration and Health: Scientific Evidence and Recommendations)

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14 pages, 2657 KiB

Open AccessArticle

Beverage Intake and Drinking Patterns—Clues to Support Older People Living in Long-Term Care to Drink Well: DRIE and FISE Studies

by Oluseyi F. Jimoh, Tracey J. Brown, Diane Bunn and Lee Hooper

Nutrients 2019, 11(2), 447; https://doi.org/10.3390/nu11020447 - 21 Feb 2019

Cited by 27 | Viewed by 7476

Abstract

Low-intake dehydration, due to insufficient beverage intake, is common in older people and associated with increased mortality and morbidity. We aimed to document the drinking patterns of older adults living in long-term care and compared patterns in those drinking well with those not drinking enough. One-hundred-and-eighty-eight people aged ≥ 65 years living in 56 UK long-term care homes were interviewed and hydration status was assessed in the Dehydration Recognition In our Elders (DRIE) study. In 22 DRIE residents, the Fluid Intake Study in our Elders (FISE) directly observed, weighed and recorded all drinks intake over 24 h. Twenty percent of DRIE participants and 18% of FISE participants had low-intake dehydration (serum osmolality > 300 mOsm/kg). Mean total drinks intake was 1787 mL/day (SD 693) in FISE participants (2033 ± 842 mL/day in men; 1748 ± 684 mL/day in women). Most drinks intake was between meals (59%, including 10% with medications). Twelve (55%) FISE participants achieved European Food Safety Authority drinks goals (3/6 men drank ≥ 2.0 L/day, 9/16 women drank ≥ 1.6 L/day). Those drinking well were offered beverages more frequently and drank more with medications and before breakfast (beverage variety did not differ). Promising strategies to support healthy drinking include offering drinks more frequently, particularly before and during breakfast and with medication. Full article

(This article belongs to the Special Issue Hydration and Health: Scientific Evidence and Recommendations)

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Review

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19 pages, 917 KiB

Open AccessReview

Hydration, Arginine Vasopressin, and Glucoregulatory Health in Humans: A Critical Perspective

by Harriet A. Carroll and Lewis J. James

Nutrients 2019, 11(6), 1201; https://doi.org/10.3390/nu11061201 - 28 May 2019

Cited by 12 | Viewed by 6739

Abstract

Glucoregulatory diseases, such as type 2 diabetes are currently a key public health priority. Public health messages have started to include the addition of water in their dietary guidelines. Such guidelines however are not based on causal evidence pertaining to the health effects of increased water intake, but rather more heavily based upon non-causal or mechanistic data. One line of thinking linking fluid intake and health is that hypohydration induces elevated blood concentrations of arginine vasopressin (AVP). Research in the 1970s and 1980s implicated AVP in glucoregulation, supported by observational evidence. This important area of research subsequently appeared to stop until the 21st century during which interest in hypertonic saline infusion studies, animal AVP receptor knockout models, dietary and genetic associations, and human interventions manipulating hydration status have resurged. This narrative review briefly describes and critically evaluates the usefulness of the current AVP-glucoregulatory research. We offer suggestions on how to test the independent glucoregulatory effects of body water changes compared to elevated circulating AVP concentrations, such as investigating hydration manipulations using 3,4-Methylenedioxymethamphetamine. Whilst much research is still needed before making firm conclusions, the current evidence suggests that although AVP may be partially implicated in glucoregulation, more ecologically valid models using human participants suggests this effect might be independent of the hydration status. The key implication of this hypothesis if confirmed in future research is that manipulating the hydration status to reduce circulating AVP concentrations may not be an effective method to improve glucoregulatory health. Full article

(This article belongs to the Special Issue Hydration and Health: Scientific Evidence and Recommendations)

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22 pages, 1683 KiB

Open AccessReview

Classification of Hydration in Clinical Conditions: Indirect and Direct Approaches Using Bioimpedance

by Henry C. Lukaski, Nicanor Vega Diaz, Antonio Talluri and Lexa Nescolarde

Nutrients 2019, 11(4), 809; https://doi.org/10.3390/nu11040809 - 10 Apr 2019

Cited by 113 | Viewed by 9707

Abstract

Although the need to assess hydration is well recognized, laboratory tests and clinical impressions are impractical and lack sensitivity, respectively, to be clinically meaningful. Different approaches use bioelectrical impedance measurements to overcome some of these limitations and aid in the classification of hydration status. One indirect approach utilizes single or multiple frequency bioimpedance in regression equations and theoretical models, respectively, with anthropometric measurements to predict fluid volumes (bioelectrical impedance spectroscopy—BIS) and estimate fluid overload based on the deviation of calculated to reference extracellular fluid volume. Alternatively, bioimpedance vector analysis (BIVA) uses direct phase-sensitive measurements of resistance and reactance, measured at 50 kHz, normalized for standing height, then plotted on a bivariate graph, resulting in a vector with length related to fluid content, and direction with phase angle that indexes hydration status. Comparison with healthy population norms enables BIVA to classify (normal, under-, and over-) and rank (change relative to pre-treatment) hydration independent of body weight. Each approach has wide-ranging uses in evaluation and management of clinical groups with over-hydration with an evolving emphasis on prognosis. This review discusses the advantages and limitations of BIS and BIVA for hydration assessment with comments on future applications. Full article

(This article belongs to the Special Issue Hydration and Health: Scientific Evidence and Recommendations)

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25 pages, 339 KiB

Open AccessReview

Effects of Drugs and Excipients on Hydration Status

by Ana M. Puga, Sara Lopez-Oliva, Carmen Trives, Teresa Partearroyo and Gregorio Varela-Moreiras

Nutrients 2019, 11(3), 669; https://doi.org/10.3390/nu11030669 - 20 Mar 2019

Cited by 26 | Viewed by 10995

Abstract

Despite being the most essential nutrient, water is commonly forgotten in the fields of pharmacy and nutrition. Hydration status is determined by water balance (the difference between water input and output). Hypohydration or negative water balance is affected by numerous factors, either internal (i.e., a lack of thirst sensation) or external (e.g., polypharmacy or chronic consumption of certain drugs). However, to date, research on the interaction between hydration status and drugs/excipients has been scarce. Drugs may trigger the appearance of hypohydration by means of the increase of water elimination through either diarrhea, urine or sweat; a decrease in thirst sensation or appetite; or the alteration of central thermoregulation. On the other hand, pharmaceutical excipients induce alterations in hydration status by decreasing the gastrointestinal transit time or increasing the gastrointestinal tract rate or intestinal permeability. In the present review, we evaluate studies that focus on the effects of drugs/excipients on hydration status. These studies support the aim of monitoring the hydration status in patients, mainly in those population segments with a higher risk, to avoid complications and associated pathologies, which are key axes in both pharmaceutical care and the field of nutrition. Full article

(This article belongs to the Special Issue Hydration and Health: Scientific Evidence and Recommendations)

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