Estimates of fluid intake, urine output and hydration-levels in women from Somaliland: a cross-sectional study

Investigating Water Balance as a Nutritional Determinant in Breastfeeding: A Comparative Study of Water Consumption Patterns and Influencing Factors

BACKGROUND

Ensuring adequate hydration is critical for breastfeeding women, yet their water consumption patterns and hydration status is poorly understood. This study investigates the water consumption patterns and estimated water balance among women, practicing exclusive, mixed, and no breastfeeding methods.

METHODS

529 healthy women completed the Nursing Water Balanced Questionnaire (N-WBQ). Participants were distributed across breastfeeding groups as follows: exclusive (39.7%), mixed (31.9%), and no breastfeeding (28.4%).

RESULTS

Significant differences were noted in water consumption patterns among breastfeeding groups regarding intake from beverages (p < 0.001), juices (p = 0.019), coffee (p < 0.001), and milk (p = 0.015). Water intake from liquids, except for drinking water (p < 0.001), juices (p = 0.024) and coffee (p < 0.001) differed significantly among groups in women with adequate total water intake based on recommendation, with exclusive breastfeeding mothers prioritizing plain water over other beverages. Total water loss (p < 0.001) and estimated water balance (p < 0.001) significantly varied among breastfeeding groups, with exclusive breastfeeding mothers to exhibit the lowest water balance (-475.36 mL/day), indicating potential dehydration risk. Apart from plain water, water from foods, coffee and milk significantly contributed to positive water balance.

CONCLUSIONS

Our findings highlight a risk of dehydration in this population, while water consumption patterns are influenced by breastfeeding method, likely affected by varying lactational demands and lifestyle factors. Further research to develop more accurate and individualized methods for assessing water balance in breastfeeding women is needed.

Dental caries status and related factors among 12-year-old Somali school children in Hargeisa

OBJECTIVES

There is little data on the oral health conditions of Somali children. The aim was to assess the dental caries status and related risk factors of 12-aged children in primary schools in Hargeisa, Somaliland.

METHODS

A school-based survey was conducted in Hargeisa in December 2022. Using 2-stage cluster sampling, 405 children (12-aged) were randomly selected from 16 primary schools. Data collection involved WHO structured interviewer-administered questionnaire and clinical examinations. The DMFT index was measured according to WHO criteria, and accordingly, the mean for the significant caries index (SiC) was calculated. The association between the DMFT and the relevant variables was analysed using negative binomial regression in STATA.

RESULTS

The overall prevalence of dental caries was found to be 62.7%, with a mean DMFT of 1.7 and a SiC score of 3.7. Non-public school pupils showed significantly higher prevalence of dental caries and mean DMFT compared to public school counterparts (68.5% vs. 58.6%) and (1.91 vs. 1.48), respectively. Merely 14.7% of the participants utilized dental care services in the previous year. The multivariable analysis showed a significant positive association of the DMFT outcome with attending a non-public school (95% CI 1.16-2.12) and having many previous dental visits (95% CI 1.22-2.83). In the adjusted model, fathers of low education had children with better dental caries status (lower mean DMFT) than their well-educated counterparts. The mean DMFT was not significantly influenced by the factors sex, location, educational attainment (school class of the participants) and frequency of teeth cleaning.

CONCLUSION

Although the overall mean DMFT of school children in Hargeisa could be regarded low, the high levels of untreated caries especially in the one-third most affected are a cause for concern. Children enrolled in non-public schools formed the high-risk group. Preventive oral public health programs targeting Somali school children are recommended.

A Study of the Fluid Intake, Hydration Status, and Health Effects among Pregnant Women in Their Second Trimester in China: A Cross-Sectional Study

The fluid intake and hydration status during pregnancy may influence the health outcomes of both the mother and the fetus. However, there are few studies related to this. The aim of the present study was to investigate fluid intake behaviors among pregnant women in their second trimester, to evaluate their hydration status and pregnancy complications, and to further explore the association of fluid intake and the amniotic fluid index (AFI). Participants’ total fluid intake (TFI) levels were determined using a 7-day 24 h fluid intake questionnaire. The levels of water intake from food were not recorded or measured. Morning urine samples were collected, and both urine osmolality levels and urine specific gravity (USG) were tested to evaluate their hydration status. Fasting blood samples were also collected and measured for osmolality and complete blood count (CBC). A total of 324 participants completed the study. They were divided into four groups based on quartiles of TFI, including participants with lower (LFI1 and LFI2) and higher (HFI1 and HFI2) fluid intake levels. The median TFI was 1485 mL, and the median values of the four groups with different TFI levels were 1348, 1449, 1530, and 1609 mL, respectively. Only 3.4% of the participants attained the recommended value following an adequate water intake (1.7 L) level for pregnant women in China. Plain water was the main TFI resource (78.8~100.00%), and differences in the plain water intake levels among the four groups were evident (χ2 = 222.027, p < 0.05). The urine osmolality decreased sequentially with increasing TFI values from the LFI1 to HFI2 group, and significant differences in the urine osmolality levels among the four groups were evident (p < 0.05). Meanwhile, the percentage of dehydrated participants decreased from 26.8% in the LFI1 group to 0.0% in the HFI2 group (χ2 = 131.241, p < 0.05). Participants with higher TFI values had higher AFI values (χ2 = 58.386, all p < 0.05), and moderate-intensity correlations were found between TFI and urine osmolality, hydration status, and AFI (all p < 0.05). A large proportion of the participants had insufficient TFIs during the second trimester of pregnancy, and a proportion of the participants were dehydrated. The preliminary analysis showed that the AFI was correlated with the TFI during the second trimester of pregnancy. A sufficient TFI is necessary for pregnant women to improve their hydration status and may have effects on their health. The results can provide appropriate scientific references for the development of beneficial recommendations concerning adequate water intake levels for pregnant women in China.

Middle-age high normal serum sodium as a risk factor for accelerated biological aging, chronic diseases, and premature mortality

BACKGROUND

It is known that some people age faster than others, some people live into old age disease-free, while others develop age-related chronic diseases. With a rapidly aging population and an emerging chronic diseases epidemic, finding mechanisms and implementing preventive measures that could slow down the aging process has become a new challenge for biomedical research and public health. In mice, lifelong water restriction shortens the lifespan and promotes degenerative changes. Here, we test the hypothesis that optimal hydration may slow down the aging process in humans.

METHODS

We performed a cohort analysis of data from the Atherosclerosis Risk in Communities study with middle-age enrollment (45-66 years, n = 15,752) and 25 years follow-up. We used serum sodium, as a proxy for hydration habits. To estimate the relative speed of aging, we calculated the biological age (BA) from age-dependent biomarkers and assessed risks of chronic diseases and premature mortality.

FINDINGS

The analysis showed that middle age serum sodium >142 mmol/l is associated with a 39% increased risk to develop chronic diseases (hazard ratio [HR] = 1.39, 95% confidence interval [CI]:1.18-1.63) and >144 mmol/l with 21% elevated risk of premature mortality (HR = 1.21, 95% CI:1.02-1.45). People with serum sodium >142 mmol/l had up to 50% higher odds to be older than their chronological age (OR = 1.50, 95% CI:1.14-1.96). A higher BA was associated with an increased risk of chronic diseases (HR = 1.70, 95% CI:1.50-1.93) and premature mortality (HR = 1.59, 95% CI 1.39-1.83).

INTERPRETATION

People whose middle-age serum sodium exceeds 142 mmol/l have increased risk to be biologically older, develop chronic diseases and die at younger age. Intervention studies are needed to confirm the link between hydration and aging.

FUNDING

This work was funded by Intramural Research program of the National Heart, Lung, and Blood Institute (NHLBI). The ARIC study has been funded in whole or in part with federal funds from the NHLBI; the National Institutes of Health (NIH); and the Department of Health and Human Services.

Multiple Indicators of Undernutrition, Infection, and Inflammation in Lactating Women Are Associated with Maternal Iron Status and Infant Anthropometry in Panama: The MINDI Cohort

Maternal infections, nutrient deficiencies, and inflammation (MINDI) co-exist in lactating indigenous women in Panama, but their impact on maternal iron status and infant growth is unknown. For this secondary analysis of cross-sectional data of lactating mothers from our MINDI cohort, we investigated associations of MINDI variables with maternal anemia, elevated serum transferrin receptor (sTfR), low serum iron, hepcidin, ferritin, and infant weight-for-age (WAZ), length-for-age (LAZ), and head-circumference-for-age (HCAZ) Z-scores in 99 mother-infant dyads. A bootstrapping resampling procedure preselected covariates for inclusion in multivariable regressions models from chronic maternal infections and nutritional status [folate, vitamins A, D, retinol-binding protein (RBP), insulin-growth factor-1 (IGF-1)] and inflammation [C-reactive protein (CRP), cytokines, platelet indices] indicators. Anemia was prevalent (53.5%) but underestimated due to widespread low plasma volume (<2.2 L, 79.9%) and was associated with indicators of malnutrition [lower IGF-1, body mass index (BMI), vitamin D, and intake of green/leafy vegetables], but not inflammation. Higher CRP was associated with lower serum iron, and higher hepcidin and ferritin, whereas maternal platelets were associated with lower HCAZ (β = −0.22), WAZ (β = −0.17), and LAZ (β = −0.17). Higher LAZ was also associated with maternal serum vitamin D (β = 0.23), whereas maternal iron supplementation lowered LAZ (β = −0.22). Assessment of iron status in this MINDI cohort is complex and supplementation strategies must consider consequences for both the mother and the infant.

Household Water Is the Main Source of Iodine Consumption among Women in Hargeisa, Somaliland: A Cross-Sectional Study

BACKGROUND

Iodine status surveys of women in Somaliland present widely conflicting results. Previous research indicates elevated concentrations of iodine (IQR 18-72 μg/L) in groundwater used for drinking and cooking, but the relation with iodine intake is not well characterized.

OBJECTIVES

We aimed to investigate the contributions of household water iodine concentration (WIC), breastfeeding, total fluid intake, hydration levels, and urine volume on urinary iodine concentration (UIC) and excretion (UIE) over a 24-h period and to define iodine status from iodine intake estimates and median UIC, normalized to a mean urine volume of 1.38 L/d (hydration adjusted).

METHODS

The study sample comprised 118 nonpregnant, healthy women aged 15-69 y. All participants resided in Hargeisa, and 27 were breastfeeding. Data collection consisted of a 24-h urine collection, a 24-h fluid intake diary, a beverage frequency questionnaire, and a structured recall interview. We measured UIC and WIC in all urine and in 49 household water samples using the Sandell-Kolthoff reaction.

RESULTS

WIC ranged between 3 and 188 μg/L, with significant median differences across the water sources and city districts (P < 0.003). Nonbreastfeeding women were borderline iodine sufficient [hydration-adjusted median urinary iodine concentration (mUIC) 109 μg/L; 95% CI: 97, 121 μg/L], whereas breastfeeding women showed a mild iodine deficiency (73 μg/L; 95% CI: 54, 90 μg/L). There were strong correlations (ρ: 0.50-0.69, P = 0.001) between WIC and UIC, with iodine from household water contributing more than one-half of the total iodine intake. Multivariate regression showed hydration and breastfeeding status to be the main predictors of UIC.

CONCLUSIONS

Iodine from household water is the main contributor to total iodine intake among women in Hargeisa, Somaliland. Variation in female hydration and spatial and temporal WIC may explain diverging mUIC between studies. Water sources at the extremes of low and high iodine concentrations increase the risk of subpopulations with insufficient or more than adequate iodine intake.