Water turnover of healthy children measured by deuterated water elimination

Children's water intake and hydration: a public health issue

Optimal hydration is required for all physiologic functions and cognition. Children, especially younger ones, are particularly susceptible to dehydration, given their physiological specificities, in particular, their renal immaturity and relatively large skin surface in early life, but also their dependence on adults and their greater propensity to develop digestive diseases leading to fluid losses. Mild dehydration consequences are dominated by their impact on cognitive functions, whereas more severe dehydration may endanger the health outcome. Studies on this subject in children are scarce; in particular, the long-term consequence on renal function remains questionable. This review considers how children's water intake including fluid intake and water content of food, are worrying. The findings show that, worldwide, most children do not meet adequate water intake recommendations. The main problems likely to explain insufficient water intake are access to safe water, availability of drinking water at school, and healthy-hydration education, which are all points that need to be improved within health policy.

Recent Updates on the Development of Deuterium-Containing Drugs for the Treatment of Cancer

Cancer is one of the deadliest diseases in the world. In 2020, 19.3 million cancer cases and 10 million deaths were reported in the world. It is supposed that the prevalence of cancer cases will rise to 28.4 million by 2040. Chemotherapy-based regimens have a narrow therapeutic index, severe adverse drug reactions, and lack metabolic stability. Besides, the metabolism of anticancer produces several non-active and toxic metabolites that reduce exposure of the target site to the parent drug. Therefore, developing better-tolerated and effective new anticancer drugs and modification of the existing anticancer drugs to minimize toxicity and increase efficacy has become a very urgent need. Deuterium incorporation reduces the metabolism of certain drugs that are breakdown by pathways involving hydrogen-carbon bond scission. For example, CYP450 mediated oxidative metabolism of drugs that involves the breakdown of a hydrogen-carbon bond affected by deuteration. Deuterium incorporation into the drug increases the half-life and reduces the dose, which provides better safety and efficacy. Deutetrabenazine is the first deuterated form of tetrabenazine approved to treat chorea associated with Huntington’s disease and tardive dyskinesia. The study revealed that Deutetrabenazine has fewer neuropsychiatric side effects with favorable safety than tetrabenazine. The current review highlights the deuterium kinetic isotope effect on drug metabolism, deuterated compound pharmacokinetic property, and safety profile. Besides, this review explains the deuterated anticancer drug development update status.

Total water intake and its contributors in infants and young children

Hydration is a particular concern for infants and young children due to their greater risk of dehydration. However, studies on their water intakes are scarce. The current survey aimed to analyse total water intake (TWI) in non-breastfed children aged 0·5-35 months compared with the adequate intake (AI) for the same age group set by the European Food Safety Authority and to examine the different contributors to TWI as well as beverage consumption patterns. Nationally representative data from the Nutri-Bébé cross-sectional survey were used to assess food, beverage and plain water consumption by age group over three non-consecutive days. With age, median TWI in 1035 children increased from 732 to 1010 ml/d, without differences between sexes, but with a great inter-individual variation, and the percentage of children who did not meet the AI increased from 10 to 88 %. Median weight-related TWI decreased from 136·6 to 69·0 ml/kg per d. Among infants, 90 % had a ratio of water:energy below the AI, similarly for about 75 % of toddlers. Milk and milk products were the main contributors to TWI, while the part of plain water increased gradually to be 25 % in the older toddlers, half of which was tap water. The beverage consumption pattern varied in types and timing, with little consumption of juices and sweetened beverages. Vegetables and fruits accounted for 20 % of TWI after the age of 6 months. These initial results, showing strong discrepancies between actual and recommended water intakes in young children, should help identify ways to increase children's water consumption.

Association between Water and Energy Requirements with Physical Activity and Fat-Free Mass in Preschool Children in Japan

Water and energy are essential for the human body. The doubly labeled water (DLW) method measures water turnover (WT) and total energy expenditure (TEE), which serves as a benchmark for the adequate intake (AI) of water and estimated energy requirements (EER). The objective of the current study was to examine the association of WT and TEE with physical activity and body composition in Japanese preschool children. We included 41 preschool children (22 girls, 19 boys) aged 3–6 in this study. WT, TEE, and fat-free mass (FFM) were obtained using DLW. Physical activity was measured using a triaxial accelerometer and categorized as light (LPA; 1.5–2.9 Metabolic equivalents, METs) and of moderate-to-vigorous intensity (MVPA; ≥3.0 METs). Exercise duration (Ex) was defined as ≥4.0 METs of physical activity. WT and TEE moderately positively correlated with Ex, but not with LPA. WT moderately positively correlated with BW and FFM while TEE strongly. We established predictive equations for WT and TEE using body weight (BW), FFM, step count, and Ex to guide the AI of water and EER in Japanese preschool children. We found that FFM and step count are the determinants of TEE, and that BW and Ex are the determinants of WT in preschool children.

Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children's Continence Society

BACKGROUND

We present a consensus view from the International Children's Continence Society (ICCS) on the evaluation and management of bladder bowel dysfunction (BBD) in children with urinary tract infection (UTI). The statement aims to highlight the importance of BBD in the development and recurrence of childhood UTI and its management to reduce its associated morbidity and sequelae.

METHODS

A systematic literature search was done on PubMed, Embase, and Scopus databases until August 15, 2016. Relevant publications concerning BBD and its relationship with UTI among children were reviewed and aggregated for statements of recommendation. Discussion by the ICCS Board and a multi-disciplinary core group of authors resulted in a document available on its website for all ICCS members to review. Insights and feedback were considered with consensus and agreement reached to finalize this position statement.

RESULTS

BBD in children with UTI is summarized. Details regarding epidemiology, pathophysiology, and recommendations for general and family practitioners and pediatricians relating to the evaluation and management of this condition are presented.

CONCLUSIONS

This document serves as the position statement from ICCS, based on literature review and expert opinion providing our current understanding of BBD in children with UTI.

Water turnover assessment in overweight adolescents

Adequate intake (AI) standards for water in adolescents range between 2.4-3.3 l/day for males and 2.1-2.3 l/day for females, independent of obesity status. Water intakes and excretions of this population are not well documented. The purposes of this study were to assess water turnover, inputs, and outputs in overweight adolescents, compare these parameters between males and females, and evaluate the reproducibility of water turnover. Eighteen girls (BMI 31.7 ± 4 kg/m(2); mean ± s.d.) and nine boys (BMI 26.3 ± 3 kg/m(2)) aged 12-15 years completed two 3-week metabolic balance trials. Rate of water turnover (rH(2)O) was measured by tracking the decline of deuterated water from the body over 14 days. Water inputs (diet*, ad libitum(#), metabolic(#)) and outputs (urine*, feces*, insensible(#)) were assessed (*measured, #estimated). rH(2)O was lower (P = 0.002) in girls vs. boys (3,742 ± 536 vs. 4,537 ± 623 g/day). Per kg body weight, rH(2)O was 28% lower in girls vs. boys (46 ± 7 vs. 64 ± 9 g·kg(-1)·day(-1)). Water input from food and beverages provided and metabolic production were 44 and 28% lower, respectively, in girls vs. boys. Urine and insensible water losses were 21 and 17% lower in girls vs. boys. BMI was positively associated with water turnover in both sexes (girls P = 0.037; boys P = 0.014). The intraclass correlation of rH(2)O between trials was 0.981 (P < 0.001). In conclusion, these overweight adolescents consumed water well in excess of sex-specific AI standards. The lower rH(2)O in girls compared to boys is consistent with adult females and males.

Retention of tritium in reference persons: a metabolic model. Derivation of parameters and application of the model to the general public and to workers

Tritium ((3)H) is a radioactive isotope of hydrogen that is ubiquitous in environmental and biological systems. Following debate on the human health risk from exposure to tritium, there have been claims that the current biokinetic model recommended by the International Commission on Radiological Protection (ICRP) may underestimate tritium doses. A new generic model for tritium in mammals, based on energy metabolism and body composition, together with all its input data, has been described in a recent paper and successfully tested for farm and laboratory mammals. That model considers only dietary intake of tritium and was extended to humans. This paper presents the latest development of the human model with explicit consideration of brain energy metabolism. Model testing with human experimental data on organically bound tritium (OBT) in urine after tritiated water (HTO) or OBT intakes is presented. Predicted absorbed doses show a moderate increase for OBT intakes compared with doses recommended by the ICRP. Infants have higher tritium retention-a factor of 2 longer than the ICRP estimate. The highest tritium concentration is in adipose tissue, which has a very low radiobiological sensitivity. The ranges of uncertainty in retention and doses are investigated. The advantage of the new model is its ability to be applied to the interpretation of bioassay data.

Water turnover in children and young adults

Water homeostasis is essential for life and optimal function and considerable interest surrounds the issue of recommendations for water consumption in healthy individuals. Objective data on water turnover in free-living individuals are limited, however. The aim of the present work was to measure water turnover in children and young adults using isotopically labeled water to provide objective data on magnitude and variability in relation to body weight, fat-free mass and physical activity level. Water turnover was measured by deuterated water dilution in 91 healthy children (40 boys, 51 girls; age 5-14 years) and 109 healthy young adults (80 women, 29 men; age 18-27 years) with a wide range of body mass index (13.3-51.8 kg/m(2)) and percent body fat (6.1-59.3%). Total energy expenditure (TEE) and resting metabolic rate were measured by the doubly labeled water technique and indirect calorimetry, respectively. Water turnover was 1.77 ± 0.57 (SD), 1.79 ± 0.44, 2.85 ± 0.82, and 3.90 ± 0.81 L/day in girls, boys, women, and men, respectively. Water turnover indexed to body surface area did not differ significantly between girls and women but was higher in men than boys. Water turnover indexed to TEE was 0.8 mL/kcal in girls and boys and 1.0 mL/kcal in women and men. This study provides objective data on water turnover for children and young adults in a temperate climate and shows that anthropometric parameters can account for the variation between girls, boys and women but not between these groups and the more active men.

Neonatology/Paediatrics - Guidelines on Parenteral Nutrition, Chapter 13

There are special challenges in implementing parenteral nutrition (PN) in paediatric patients, which arises from the wide range of patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. Age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN-practice in adult patients, e.g. the fluid, nutrient and energy needs of premature infants and newborns per kg body weight are markedly higher than of older paediatric and adult patients. Premature infants <35 weeks of pregnancy and most sick term infants usually require full or partial PN. In neonates the actual amount of PN administered must be calculated (not estimated). Enteral nutrition should be gradually introduced and should replace PN as quickly as possible in order to minimise any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. If energy and nutrient demands in children and adolescents cannot be met through enteral nutrition, partial or total PN should be considered within 7 days or less depending on the nutritional state and clinical conditions.

Comparison of Body Water Turnover in Endurance Runners and Age-matched Sedentary Men

This study compared the body water turnover in endurance athletes and age-matched sedentary men. Eight competitive endurance athletes (20.8+/-1.9 yr) and age-matched eight sedentary men (21.6+/-2.5 yr) participated in this study. Total body water and body water turnover were measured using the deuterium (D(2)O) dilution technique. Urine samples were obtained every day for 10 days after oral administration of D(2)O. The day-by-day concentrations were used to calculate the biological half-life of D(2)O and body water turnover. Maximal oxygen uptake (VO(2max)) and oxygen uptake corresponding to ventilatory threshold (VO(2VT)) as an index of aerobic capacity were determined during a graded exercise test. Both VO(2max) and VO(2VT) were higher in the exercise group than in the sedentary group (P<0.05). The biological half-life of D(2)O was significantly shorter in the exercise group than in the sedentary group (5.89+/-0.81 days vs. 7.52+/-0.77 days, P<0.05), and the percentage of the body water turnover was significantly higher in the exercise group than in the sedentary group (11.99+/-1.96% vs. 9.39+/-1.21%, P<0.05). The body water turnover was correlated with VO(2max) and VO(2VT), respectively (P<0.05). Based on these findings, this study speculates that a level of physical activity may induce a body water turnover higher in the healthy state, since the better trained subjects have a higher body water turnover.

The turnover of body water as an indicator of health

Water homeostasis is essential for healthy living. Body water turnover, meaning the replacement of body water that is lost in a given period of time, has been examined in a number of previous studies, and a review of their results has yielded the following findings. Children up to 15 years of age show higher body water turnover than adults, although it is not clear how the aging process influences body water. Among people of similar age, the rate of body water turnover seems to be higher in those who exercise than in those who are sedentary. Therefore we hypothesized that healthy individuals have a higher body water turnover than unhealthy individuals whose metabolic balance, as indicated by water turnover, has broken down, and that a prolonged condition of excessively slow body water turnover may be associated with a lower level of metabolism. If so, body water turnover can be an indicator of human health. However, there is a paucity of information regarding water turnover rates in individuals with various physical characteristics. This study indicates the need for further investigation of body water turnover levels associated with significant changes in physiological condition and metabolic state.

Physical fitness influences water turnover and body water changes during trekking

PURPOSE

This study was performed to assess water turnover and changes of body water during a trekking tour at moderate altitude.

METHODS

Fifteen healthy normally trained adults participated in a 7-d backpack trek tour in the Swiss Alps (total walking distance: 120.5 km; cumulated altitude difference: 6990 m (uphill) and 7550 m downhill; lowest point: 1285 m; highest point: 3317 m). Total body water and water turnover were measured using deuterium dilution and elimination (oral load of 0.33 g 99.8% D2O per kg body weight, overnight equilibration period, pre- and postdose saliva samples immediately before and after sleep, analysis of D2O concentrations in saliva using Fourier-transform infrared spectroscopy, CV < 1%). Physical training state was assessed after the tour using the lactate-exercise intensity relationship obtained by performing 50-W increments every 3 min on a cycle ergometer.

RESULTS

Body water decreased from the evening of day 0 to the evening of day 4 (from 45.3 +/- 7.3 L to 43.4 +/- 7.6 L, P < 0.05), and did not significantly decrease (43.5 +/- 7.9 L) until the evening of day 5 (maximum of trekking exercise intensity). Mean daily water turnover was 5.7 +/- 1.8 L x d(-1) corresponding to 78.7 +/- 17.5 mL x kg(-1) x d(-1). Body water changes and water turnover were significantly related to the exercise intensity obtained at the lactate threshold as well as at the level of 4 mM lactate.

CONCLUSIONS

This correlation may be in part explained by differing glycogen content of muscle tissue.

Fourier transform infrared spectroscopy measures 1H/2H ratios of native water with a precision comparable to that of isotope ratio mass spectrometry

A fast and easy method is described which uses Fourier transform infrared spectroscopy (FT-IR) to measure the 1H/2H ratio of aqueous samples of less than 100 microliters with high precision (+/- 0.2-0.5% in the range of 89 to 2680 microliters/l). Using a thermostat-controlled CaF2 cell, low resolution absorption specta (8 cm-1) are measured. The integral of absorption in the range of 2600 and 2460 cm-1 (O2H vibration) is used to analyse the 2H content of the sample. For measurements at low enrichment five standards are used (SLAP: 89.00 microliters/l, GISP: 126.3 microliters/l, V-SMOW: 156.0 microliters/l, all from the International Atomic Energy Agency, Vienna, Austria, standard 1: 183.3 microliters/l, standard 2: 222.5 microliters/l, both prepared by weighing and controlled by isotope ratio mass spectrometry (IR-MS)). For measurements at high enrichment three standards are used (standard 2: 222.5 microliters/l, standard 3: 1323 microliters/l, standard 4: 2680 microliters/l, all prepared by weighing and controlled by IR-MS). Measured and reported 2H concentrations coincide very well, two samples for quality control (145 and 1612 microliters/l) were measured with a precision of 0.3 and 0.4% corresponding to +/- 0.5 and 5.9 microliters/l.