A study of fluid intake from beverages in a sample of healthy French children, adolescents and adults

Water and beverage consumption habits of adults in Turkey by gender and BMI: a cross-sectional survey

The study aims to determine water and beverage consumption status and related factors in daily nutrition of adults living in Turkey. This study was conducted with 6332 adults aged 18-65 years across Turkey. Demographics and anthropometric data of subjects, their daily water and beverage consumption habits were explored using the retrospective 24-hour recall method. Water and black tea were the most consumed beverages (1801.38 ± 11.06 mL/day, 455 ± 6.10 mL/day, respectively). Increased BMI was associated with a significantly decreased rate of insufficient fluid intake among the participants. Underweight individuals were found to be consuming less (by 0.558 times) fluid compared to those with normal BMI, while obese individuals appeared to have greater energy intake from daily fluid consumption (by 1.111 times). This study showed a relationship between water and beverage intake and anthropometric measurements, suggesting that further research on personalized water intake strategies is beneficial in weight management.

Quality of Beverage Intake and Cardiometabolic and Kidney Outcomes: Insights From the STANISLAS Cohort

Background and Aims: Beverages are an important aspect of diet, and their quality can possibly affect health. The Healthy Beverage Index (HBI) has been developed to take into account these effects. This study aimed to highlight the relationships between health and beverage quality by assessing the association of the HBI and its components with kidney and cardiometabolic (CM) outcomes in an initially healthy population-based familial cohort.

Methods: This study included 1,271 participants from the STANISLAS cohort. The HBI, which includes 10 components of habitual beverage consumption, was calculated. Associations of the HBI and its components with estimated glomerular filtration rate (eGFR), albuminuria, hypertriglyceridemic waist (HTG waist), metabolic syndrome (MetS), carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT), and left ventricular mass (LV mass) were analyzed using multivariable linear or logistic regression models.

Results: The median HBI score was 89.7 (78.6–95) out of 100 points. While the overall HBI score was not significantly associated with any of the studied outcomes, individual HBI components were found differently associated with the outcomes. cfPWV and cIMT were lower in participants who did not meet the full-fat milk criteria (p = 0.03 and 0.001, respectively). In men, higher cfPWV was observed for the “low Fat milk” (p = 0.06) and “alcohol” (p = 0.03) non-adherence criteria. Odds of HTG waist were higher with the non-adherence to sugar-sweetened beverages criteria (p < 0.001). eGFR was marginally higher with non-adherence to the coffee/tea criteria (p = 0.047).

Conclusions: In this initially healthy population, HBI components were differently associated with kidney and cardiometabolic outcomes, despite a good overall HBI score. Our results highlight specific impacts of different beverage types and suggest that beverages could have an impact on kidney and cardiometabolic health.

Maternal Factors and Their Association with Patterns of Beverage Intake in Mexican Children and Adolescents

Childhood and adolescence represent critical periods where beverage and food consumption behaviors are learned and developed. Mexican mothers' presence and influence are instrumental in shaping such behaviors. The aim of this study was to estimate the prevalence and risk associations of maternal factors for unhealthy patterns of beverage intake. This study analyzed data from a population-based cross-sectional study of healthy children and adolescents from Mexico City. Data of subject's total water intake (TWI) and its' sources were collected using two 24-h recall surveys. Patterns of beverage intake were constructed based on the guidance system of beverage consumption in the US. Maternal factors of interest included age, body mass index (BMI), mother's educational level (MEL), socioeconomic status (SES), and belongingness to the paid workforce (BPW). Data of 1532 subject-mother dyads informed that 47% of subjects did not meet the Institute of Medicine (IOM) recommendations for TWI, and 94.6% showed an unhealthy beverage intake pattern, mainly consisting in a lower intake of water and a higher intake of caloric beverages with some nutrients; and calorically sweetened beverages. The major sources of hydration were caloric beverages with some nutrients (i.e., whole milk, fruit water, and flavored milk). The highest risk association for an unhealthy beverage intake pattern was seen in those subjects with mothers in the cluster with lower SES, lower MEL, lower proportion of BPW, higher BMI, and younger age (OR = 9.3, 95% CI 1.2-72.8, P = 0.03). Thus, there is a remarkably high prevalence of an unhealthy pattern of beverage intake, and specific maternal factors may be implicated as enablers of such behaviors, which is also addressable for future interventions.

Evaluation of daily hydration in pediatric outpatients over 3 years old

The topic of hydration of children over 3 years of age is often neglected in general pediatric consultations, even though proper hydration is essential for optimal physical and intellectual functions.

OBJECTIVE

To evaluate the daily water and beverage consumption of 3- to 8-year-old patients in a private pediatric practice through a retrospective observational study.

METHOD

This single-centre study was conducted in a French private practice with five pediatricians and included 200 healthy children, aged 3-8 years.

RESULTS

Recommended intake of beverages was reached in 62% of 54 children in the 3- to 4-year-old group and 43% of the 146 children in the 4- to 8-year-old group. Recommended beverages intake of±20% was found in 55% of the 3- to 4-year-old group and 45% of the 4- to 8-year-old group. The potential risk factors of inadequate hydration could not be demonstrated in this study. Water alone was the predominant intake in 63% of the 200 children; milk accounted for 19%, and sweetened drinks for 17%.

CONCLUSIONS

These results show a persistent gap between recommended and observed total beverage intake. Although our results are more robust than previous French and international published data, they remain insufficient. In the future, a systematic approach to hydration with parents and children is needed including personalised advice, while maintaining other public health interventions in schools and canteens.

Hydration status, total water intake and subjective feelings of adolescents living in a hot environment, during a typical school day

AIM

Individuals living in a hot environment appear to face increased risk of dehydration. Currently there is not extensive literature on the adolescent population in relation to hydration. The aim of the present study was to assess hydration status and total water intake (TWI) at school, of adolescents living in a hot environment, and to investigate the association of hydration and TWI with various subjective feelings.

METHODS

The hydration status of 141 adolescents (boys n = 102), age 15-17 years, was assessed via urine specific gravity (USG), at the beginning (07:30 am) and at the end (1:30 pm) of one school day. TWI from fluids and solid food was assessed via detailed food and fluid records. Subjective feelings (i.e. thirst, alertness, ability to concentrate) were recorded by specific scales.

RESULTS

Ninety percent of the students arrived dehydrated at school (USG >1.020). Thirteen students were hydrated (USG <1.020), 67 students were slightly dehydrated (USG 1.021-1.029), and 50 students were seriously dehydrated (USG >1.030). There was no difference in TWI between the three groups (765 ± 451 mL). TWI correlated with alertness (p = 0.005) and the ability to concentrate (p = 0.015), and inversely correlated with fatigue (p = 0.015). Seriously dehydrated students felt less alert in the morning (p < 0.035) whereas the feeling of thirst was similar between all groups.

CONCLUSIONS

The prevalence of the dehydration of the adolescents during school time appeared to be extremely high, and thirst was not driving those adolescents to drink enough. Apart from health concerns, school performance could be affected by dehydration and inadequate water intake.

Physical activity and sedentary behavior impacts on dietary water intake and hydration status in Spanish schoolchildren: A cross-sectional study

BACKGROUND

The importance of maintaining an adequate hydration status and the complexity of the water balance make it necessary to study the lifestyle factors that can influence or modify these variables. The aim of this study was to evaluate the hydration status and dietary water intake for a sample of Spanish schoolchildren from 7 to 12 years old and their associations with physical activity (PA) and sedentary behaviors.

METHODS

A total of 242 schoolchildren was studied (49.17% females). A 24-hour urine sample was collected from each child, and the urine volume and osmolality were measured to estimate the hydration status (adequate hydration ≤800 mOsm/kg). In addition, a 3-day dietary record was completed to evaluate their water intake according to EFSA parameters. Dietary information was processed with DIAL software, and a statistical analysis was performed using SPSS. Student's t-test was used to study the normal variables, and the Mann-Whitney U test was used for those that were not normal. In the case of the categorical variables, the Z and Chi-Square proportions tests were used. The Bonferroni test was used to adjust the values in multiple comparisons. To evaluate the influence of these lifestyles on the urine osmolality, a 2-way ANOVA and an odds ratio were used.

RESULTS

A total of 48.3% of the sample presented an adequate hydration status, and the percentage was significantly higher in females (p = 0.003). Only 20.9% showed an adequate intake of dietary water. The lifestyle influence reveals that more inactive and non-sedentary schoolchildren were adequately hydrated (p = 0.008). PA (practice ≥1 h/day) was associated with a higher risk of having an inadequate hydration status, even when accounting for sex and other lifestyle factors (OR = 1.753(1.006-3.054), p = 0.048).

CONCLUSIONS

Approximately half of the participants presented an inadequate hydration status (which was higher in males than in females). PA (practice ≥1 h/day) was associated with a higher risk of inadequate hydration. This fact highlighted the importance of raising awareness about hydration in children, especially in ones who are more active.

Beverage Consumption among Adults in the Balearic Islands: Association with Total Water and Energy Intake

The paper seeks to describe beverage consumption and examine the association between beverage consumption and total water intake and total energy intake of the adult population in the Balearic Islands. Beverage consumption, total water intake, and total energy intake were obtained by using two 24-h diet recalls from a cross-sectional nutritional survey carried out in the Balearic Islands (n = 1386). The contribution of beverages to total water intake and total energy intake were also assessed. Beverages accounted for 65–71% of total water intake and 29–35% of it provided by drinking water. Food moisture contributed 31–37% of total water intake. The mean daily total water intake from all sources was around 2.2 L for men and 1.9 L for women and slightly lower than the proposed adequate intake (AI) recommendations of the European Food Safety Authority (EFSA). The mean total energy intake was 2222 kcal/day and beverages contributed 10.3% of total energy intake for men and 9.5% for women. Energy intake from beverages varied with age. In both sexes, milk was the main beverage contributed to total energy intake. The energy contribution of caloric soft drinks was 1.8% for men and 1.2% for women and energy intake from these beverages was significantly higher among younger adults. Water was the main beverage in the diet, followed by milk and hot beverages. Beverages were mainly consumed in the main meal times (breakfast, lunch, and dinner) in both sexes. The main findings of this study indicate that consumption of sugar-sweetened beverages (caloric soft drinks and commercial fruit juice) is higher among young adults, consumption of alcoholic beverages is higher among males aged 26 and older, and TWI (total water intake) is lower than the EFSA recommendations. These findings may be used to develop effective, healthy eating and drinking policies and campaigns.

Biopharmaceutical considerations in paediatrics with a view to the evaluation of orally administered drug products - a PEARRL review

OBJECTIVES

In this review, the current biopharmaceutical approaches for evaluation of oral formulation performance in paediatrics are discussed.

KEY FINDINGS

The paediatric gastrointestinal (GI) tract undergoes numerous morphological and physiological changes throughout its development and growth. Some physiological parameters are yet to be investigated, limiting the use of the existing in vitro biopharmaceutical tools to predict the in vivo performance of paediatric formulations. Meals and frequencies of their administration evolve during childhood and affect oral drug absorption. Furthermore, the establishment of a paediatric Biopharmaceutics Classification System (pBCS), based on the adult Biopharmaceutics Classification System (BCS), requires criteria adjustments. The usefulness of computational simulation and modeling for extrapolation of adult data to paediatrics has been confirmed as a tool for predicting drug formulation performance. Despite the great number of successful physiologically based pharmacokinetic models to simulate drug disposition, the simulation of drug absorption from the GI tract is a complicating issue in paediatric populations.

SUMMARY

The biopharmaceutics tools for investigation of oral drug absorption in paediatrics need further development, refinement and validation. A combination of in vitro and in silico methods could compensate for the uncertainties accompanying each method on its own.

Challenges in the assessment of total fluid intake in children and adolescents: a discussion paper

Purpose

In recent years, evidence has emerged about the importance of healthy fluid intake in children for physical and mental performance and health, and in the prevention of obesity. Accurate data on water intake are needed to inform researchers and policymakers and for setting dietary reference values. However, to date, there are few published data on fluid or water intakes in children. This is due partly to the fact that drinking water is not always reported in dietary surveys. The aim of this paper is to review the current status of the literature and highlight the challenges of assessing total fluid intake in children and adolescents.

Results

From the dietary assessment literature it is apparent that children present unique challenges to assessing intake due to ongoing cognitive capacity development, limited literacy skills, difficulties in estimating portion sizes and multiple caregivers during any 1 day making it difficult to track intakes. As such, many issues should be considered when assessing total fluid intakes in children or adolescents. Various methods to assess fluid intakes exist, each with its own strengths and weaknesses; the ultimate choice of method depends on the research question and resources available. Based on the literature review, it is apparent that if the research focus is to assess only fluid intake, a fluid-specific method, such as a diary or record, appears to be a feasible approach to provide an accurate estimate of intakes.

A comparison of drinking behavior using a harmonized methodology (Liq.In 7 ) in six countries

PURPOSE

To assess drinking occasions (volume and type) according to consumption with food in or outside meals, and location, for six countries.

METHODS

A total of 10,521 participants aged 4-65 years from Argentina, Brazil, China, Indonesia, Mexico and Uruguay completed a validated 7-day fluid intake record. For each drinking event, the volume consumed, the fluid type, the location of intake, and whether the drink was accompanied by food (meal or snack) or not, was recorded.

RESULTS

Similar drinking behaviors were found in Mexico and Argentina; fluid intake during meals was 48 and 45% of total fluid intake (TFI), respectively. In Brazil (55%), Indonesia (58%) and China (66%) most fluid was consumed without food. In Uruguay, 34% of TFI was with a main meal, 31% with food between meals and 35% without food. Indonesia had the highest median (25-75th percentile) TFI; 2520 (1750-3347) mL/day, and China the lowest 1138 (818-3347) mL/day. Water was consumed with meals for 37% of Chinese and 87% of Indonesian participants, while the four Latin-American American countries showed a preference for sweet drinks; 54% in Mexico, 67% in Brazil, 55% in Argentina and 59% in Uruguay. Diversity in fluid type was noted when drinking with food between meals. Apart from China, most drinking occasions (> 75%) occurred at home.

CONCLUSIONS

Three distinct drinking behaviors were identified, namely, drinking with meals, drinking as a stand-alone activity, and a type of 'grazing' (i.e., frequent drinks throughout the day) behavior. Most drinking occasions occurred at home.

Water and beverage consumption patterns among 4 to 13-year-old children in the United Kingdom

Background

The UK government has announced a tax on sugar-sweetened beverages. The aim of this study was to assess consumption patterns for plain drinking water relative to sugary beverages among UK children.

Methods

Dietary intake data for 845 children aged 4–13 years came from the nationally representative cross-sectional National Diet and Nutrition Survey, 2008–2011. Beverage categories were drinking water (tap or bottled), milk, 100% fruit juices, soda, fruit drinks, tea, coffee, sports drinks, flavored waters, and liquid supplements. Consumption patterns were examined by age group, gender, household incomes, time and location of consumption, region and seasonality. Total water consumption from drinking water, beverages, and foods, and the water-to-calorie ratios (L/kcal) were compared to the EFSA (European Food Safety Authority) adequate intake standards.

Results

Total water intake (1338 ml/d) came from plain water (19%), beverages (48%), and food moisture (33%). Plain drinking water provided 258 g/d (241 g/d for children aged 4–8 years; 274 g/d for 9–13 years), mostly (83.8%) from tap. Water and beverages supplied 901 g /d of water. Tap water consumption increased with income and was highest in the South of England. The consumption of bottled water, soda, tea and coffee increased with age, whereas milk consumption declined. About 88.7% of children did not meet EFSA adequate intake standards. The daily water shortfall ranged from 322 ml/d to 659 ml/d. Water-to-calorie ratio was 0.845 L/1000 kcal short of desirable levels of 1.0–1.5 L/1000 kcal.

Conclusion

Total water intake were at 74.8% of EFSA reference values. Drinking water consumption among children in the UK was well below US and French estimates.

Drinking Water Intake Is Associated with Higher Diet Quality among French Adults

This study aimed to examine the association between drinking water intake and diet quality, and to analyse the adherence of French men and women to the European Food Safety Authority 2010 Adequate Intake (EFSA AI). A representative sample of French adults (≥18) from the Individual and National Survey on Food Consumption (INCA2) was classified, by sex, into small, medium, and large drinking water consumers. Diet quality was assessed with several nutritional indices (mean adequacy ratio (MAR), mean excess ratio (MER), probability of adequate intakes (PANDiet), and solid energy density (SED)). Of the total sample, 72% of men and 46% of women were below the EFSA AI. This percentage of non-adherence decreased from the small to the large drinking water consumers (from 95% to 34% in men and from 81% to 9% in women). For both sexes, drinking water intake was associated with higher diet quality (greater MAR and PANDiet). This association remained significant independently of socio-economic status for women only. Low drinking water consumers did not compensate with other sources (beverages and food moisture) and a high drinking water intake was not a guarantee for reaching the EFSA AI, meaning that increasing consumption of water should be encouraged in France.

Beverage Consumption Habits in Italian Population: Association with Total Water Intake and Energy Intake

Background: The aim of this study was to investigate total water intake (TWI) from water, beverages and foods among Italian adults and the elderly. Methods: Data of 2607 adults and the elderly, aged 18–75 years from the last national food consumption survey, INRAN-SCAI 2005-06, were used to evaluate the TWI. The INRAN-SCAI 2005-06 survey was conducted on a representative sample of 3323 individuals aged 0.1 to 97.7 years. A 3-day semi-structured diary was used for participants to record the consumption of all foods, beverages and nutritional supplements. Results: On average, TWI was 1.8 L for men and 1.7 L for women. More than 75% of women and 90% of men did not comply with the European Food Safety Authority (EFSA) Adequate Intake. The contribution of beverages to the total energy intake (EI) was 6% for the total sample. Water was the most consumed beverage, followed by alcoholic beverages for men and hot beverages for women. Conclusion: According to the present results, adults and elderly Italians do not reach the adequate intake for water as suggested by the EFSA and by the national reference level of nutrient and energy intake. Data on water consumption should also be analyzed in single socio-demographic groups in order to identify sub-groups of the population that need more attention and to plan more targeted interventions.

Contribution of Water from Food and Fluids to Total Water Intake: Analysis of a French and UK Population Surveys

Little has been published on the contribution of food moisture (FM) to total water intake (TWI); therefore, the European Food Safety Authority assumed FM to contribute 20%-30% to TWI. The aim of the present analysis was to estimate and compare TWI, the percentage of water from FM and from fluids in population samples of France and UK. Data from 2 national nutrition surveys (Enquête Comportements et Consommations Alimentaires en France (CCAF) 2013 and the National Diet and Nutrition Survey (NDNS) 2008/2009-2011/2012) were analyzed for TWI and the contribution of water from FM and fluids. Children and adults TWI were significantly lower in France than in the UK. The contribution of water from foods was lower in the UK than in France (27% vs. 36%). As TWI increased, the proportion of water from fluids increased, suggesting that low drinkers did not compensate by increasing intake of water-rich foods. In addition, 80%-90% of the variance in TWI was explained by differences in water intake from fluids. More data on the contribution of FM to TWI is needed to develop more robust dietary recommendations on TWI and guidance on fluid intake for the general public.

Characteristics of Beverage Consumption Habits among a Large Sample of French Adults: Associations with Total Water and Energy Intakes

BACKGROUND

Adequate hydration is a key factor for correct functioning of both cognitive and physical processes. In France, public health recommendations about adequate total water intake (TWI) only state that fluid intake should be sufficient, with particular attention paid to hydration for seniors, especially during heatwave periods. The objective of this study was to calculate the total amount of water coming from food and beverages and to analyse characteristics of consumption in participants from a large French national cohort.

METHODS

TWI, as well as contribution of food and beverages to TWI was assessed among 94,939 adult participants in the Nutrinet-Santé cohort (78% women, mean age 42.9 (SE 0.04)) using three 24-h dietary records at baseline. Statistical differences in water intakes across age groups, seasons and day of the week were assessed.

RESULTS

The mean TWI was 2.3 L (Standard Error SE 4.7) for men and 2.1 L (SE 2.4) for women. A majority of the sample did comply with the European Food Safety Authority (EFSA) adequate intake recommendation, especially women. Mean total energy intake (EI) was 1884 kcal/day (SE 1.5) (2250 kcal/day (SE 3.6) for men and 1783 kcal/day (SE 1.5) for women). The contribution to the total EI from beverages was 8.3%. Water was the most consumed beverage, followed by hot beverages. The variety score, defined as the number of different categories of beverages consumed during the three 24-h records out of a maximum of 8, was positively correlated with TWI (r = 0.4); and with EI (r = 0.2), suggesting that beverage variety is an indicator of higher consumption of food and drinks. We found differences in beverage consumptions and water intakes according to age and seasonality.

CONCLUSIONS

The present study gives an overview of the water intake characteristics in a large population of French adults. TWI was found to be globally in line with public health recommendations.

Beverage Consumption Patterns among Norwegian Adults

Beverages may be important contributors for energy intake and dietary quality. The purpose of the study was to investigate how beverage consumption varies between different meals (breakfast, lunch, dinner, supper/evening meal, snacks) and between weekdays and weekend-days in Norwegian adults. A cross-sectional dietary survey was conducted among Norwegian adults (n = 1787) in 2010-2011. Two telephone-administered 24 h recalls were used for dietary data collection. Breakfast was the most important meal for milk and juice consumption, dinner for sugar-sweetened beverages and wine, and snacks for water, coffee, artificially sweetened beverages, and beer. Consumption of sugar-sweetened and artificially sweetened beverages did not differ between weekdays and weekend-days among consumers. The average intake of wine and beer (men only) was higher on weekend-days. Higher age was positively associated with wine consumption and negatively associated with consumption of water, sugar-sweetened, and artificially sweetened beverages. Higher education was associated with consumption of water, beer, and wine, whereas lower education was associated with sugar-sweetened beverage consumption. Beverage consumption patterns among Norwegian adults vary between different meal types and in subgroups of the population. Alcohol consumption was higher on weekend-days. Knowledge regarding beverage consumption patterns in the population should be considered when revising dietary guidelines in the future.

Water Intake in a Sample of Greek Adults Evaluated with the Water Balance Questionnaire (WBQ) and a Seven-Day Diary

Awareness on the importance of hydration in health has created an unequivocal need to enrich knowledge on water intake of the general population and on the contribution of beverages to total water intake. We evaluated in the past water intake in a sample of Greek adults using two approaches. In study A, volunteers completed the Water Balance Questionnaire (WBQ), a food frequency questionnaire, designed to evaluate water intake (n = 1092; 48.1% males; 43 ± 18 years). In study B, a different population of volunteers recorded water, beverage, and food intake in seven-day diaries (n = 178; 51.1% males; 37 ± 12 years). Herein, data were reanalyzed with the objective to reveal the contribution of beverages in total water intake with these different methodologies. Beverage recording was grouped in the following categories: Hot beverages; milk; fruit and vegetable juices; caloric soft drinks; diet soft drinks; alcoholic drinks; other beverages; and water. Total water intake and water intake from beverages was 3254 (SE 43) mL/day and 2551 (SE 39) mL/day in study A; and 2349 (SE 59) mL/day and 1832 (SE 56) mL/day in study B. In both studies water had the highest contribution to total water intake, approximately 50% of total water intake, followed by hot beverages (10% of total water intake) and milk (5% of total water intake). These two approaches contribute information on water intake in Greece and highlight the contribution of different beverages; moreover, they point out differences in results obtained from different methodologies attributed to limitations in their use.

Increased Hydration Can Be Associated with Weight Loss

This mini-review develops the hypothesis that increased hydration leads to body weight loss, mainly through a decrease in feeding, and a loss of fat, through increased lipolysis. The publications cited come from animal, mainly rodent, studies where manipulations of the central and/or the peripheral renin–angiotensin system lead to an increased drinking response and a decrease in body weight. This hypothesis derives from a broader association between chronic hypohydration (extracellular dehydration) and raised levels of the hormone angiotensin II (AngII) associated with many chronic diseases, such as obesity, diabetes, cancer, and cardiovascular disease. Proposed mechanisms to explain these effects involve an increase in metabolism due to hydration expanding cell volume. The results of these animal studies often can be applied to the humans. Human studies are consistent with this hypothesis for weight loss and for reducing the risk factors in the development of obesity and type 2 diabetes.

Effect and Process Evaluation of a Cluster Randomized Control Trial on Water Intake and Beverage Consumption in Preschoolers from Six European Countries: The ToyBox-Study

Background

Within the ToyBox-study, a kindergarten-based, family-involved intervention was developed to prevent overweight and obesity in European preschoolers, targeting four key behaviours related to early childhood obesity, including water consumption. The present study aimed to examine the effect of the ToyBox-intervention (cluster randomized controlled trial) on water intake and beverage consumption in European preschoolers and to investigate if the intervention effects differed by implementation score of kindergartens and parents/caregivers.

Method

A sample of 4964 preschoolers (4.7±0.4 years; 51.5% boys) from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, Spain) was included in the data analyses. A standardized protocol was used and parents/caregivers filled in socio-demographic data and a food-frequency questionnaire. To assess intervention effects, multilevel repeated measures analyses were conducted for the total sample and for the six country-specific samples. Based on the process evaluation questionnaire of teachers and parents/caregivers, an implementation score was constructed. To assess differences in water intake and beverage consumption by implementation score in the total sample, multilevel repeated measures analyses were performed.

Results

Limited intervention effects on water intake from beverages and overall beverage consumption were found. However, important results were found on prepacked fruit juice consumption, with a larger decrease in the intervention group compared to the control group. However, also a decline in plain milk consumption was found. Implementation scores were rather low in both kindergartens and parents/caregivers. Nevertheless, more favorable effects on beverage choices were found in preschoolers whose parents/caregivers and kindergarten teachers had higher implementation scores compared to those with lower implementation scores.

Conclusion

The ToyBox-intervention can provide the basis for the development of more tailor-made interventions. However, new strategies to improve implementation of interventions should be created.

Water and beverage consumption among children aged 4-13 years in France: analyses of INCA 2 (Étude Individuelle Nationale des Consommations Alimentaires 2006-2007) data

OBJECTIVE

To examine the consumption of plain water among children in France and compare total water intakes with guidelines issued by the European Food Safety Authority (EFSA).

DESIGN

Nationally representative data were used to assess food, beverage and water consumption by sex, age group (4-8 years, 9-13 years), income-to-poverty ratio, eating occasion and location. Beverages were classified into nine groups: water (tap or bottled), milk, 100 % fruit juice, sodas, fruit drinks, hot beverages, sports drinks and flavoured waters. Total water volume in relation to energy intake (litres/kcal) was also examined.

SETTING

INCA 2 study (Étude Individuelle Nationale des Consommations Alimentaires 2006-2007).

SUBJECTS

French children (n 835) aged 4-13 years.

RESULTS

Total water intakes were accounted for by plain water (34 %), beverages (26 %) and food moisture (40 %). Plain water could be tap (18 %) or bottled (16 %). Older children drank more plain water than did younger children and boys drank more plain water than did girls. No socio-economic gradient for plain water consumption was observed. About 90 % of children did not meet the EFSA water intake recommendations. The daily water shortfall ranged from 367 to 594 ml/d. Water-to-energy ratio was 0·75-0·77 litres/1000 kcal (4184 kJ). Children drank milk at breakfast and plain water during lunch and dinner. Caloric beverages provided 10 % of dietary energy; consumption patterns varied by eating location.

CONCLUSIONS

Total water intakes among young children in France were below EFSA-recommended levels. Analyses of beverage consumption patterns by eating occasion and location can help identify ways to increase water consumption among children.

Water intake and beverage consumption of pre-schoolers from six European countries and associations with socio-economic status: the ToyBox-study

OBJECTIVE

To study the quantity and quality of water intake from beverages among pre-schoolers and investigate associations with gender and socio-economic status (SES).

DESIGN

Kindergarten-based cross-sectional survey within the large-scale European ToyBox-study. A standardized protocol was used and parents/caregivers filled in sociodemographic data and a semi-quantitative FFQ.

SETTING

Kindergartens in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain).

SUBJECTS

European pre-schoolers (aged 3·5-5·5 years) and their parents/caregivers (n 7051).

RESULTS

Mean water intake was 1051 ml/d; plain water, 547 ml/d; plain milk, 241 ml/d; other fruit juice, 104 ml/d; pure fruit juice, 59 ml/d; soft drinks, 55 ml/d; tea, 45 ml/d; sugared and chocolate milk, 37 ml/d; smoothies, 15 ml/d; and light soft drinks, 6 ml/d. Boys had a higher water intake than girls due to a higher consumption of plain water, but more importantly to the consumption of beverages of less quality. Lower-SES pre-schoolers scored better on quantity than high-SES pre-schoolers, but as a consequence of consumption of sugared beverages. Nevertheless, the associations differed by country.

CONCLUSIONS

The water intake from beverages did not meet the European Food Safety Authority standard of 1280 ml/d; especially in Western European countries water intake from beverages was low. The most important water sources were plain water, milk and fruit juices. Interventions aiming at a proper and sufficient water intake should focus on both quantity and quality. Messages about water and water sources should be clear for everyone and interventions should be sufficiently tailored.

Belgian primary school children's hydration status at school and its personal determinants

PURPOSE

Dehydration has been related to several health aspects, and children are especially vulnerable. Since children spend a large time at school, we aim to examine children's hydration status at school-start and its change during the school-day by objective measures. To identify subpopulations at risk, determinants of hydration were tested.

METHODS

In 371 Belgian 7-13-year-old children, hydration was measured by (1) urinary osmolality at school-start and by a pooled school-day sample; (2) body water% by impedance; (3) parental reported beverage consumption; (4) urination frequency. Linear regression analyses were used to test putative predictors of hydration status: age, sex, parental education, region (Dutch-speaking versus French-speaking part of Belgium), diet quality and adiposity.

RESULTS

A mean osmolality of 888 mosmol/kg was found in the school-start sample and 767 mosmol/kg in the school-day sample. This resulted in, respectively, 76 and 54 % of the children being dehydrated (>800 mosmol/kg). In 45 % of the children, the hydration level decreased over the school-day. Also the body water% as derived from bio-impedance (57 % ±4), the reported average daily beverage intake (911 ml) and the lower urination frequency during weekdays versus weekend days confirmed the low hydration status in our school population. Boys, Walloon children and those with higher adiposity were at increased risk of low hydration level. Diet quality was not the predictor of hydration status.

CONCLUSIONS

Hydration status at school appeared problematic in this population. This emphasizes the need for more resources and attention by school management and governmental organizations. Herein, especially Walloon schools and boys should be reached.

Fluid consumption, total water intake and first morning urine osmolality in Spanish adolescents from Zaragoza: data from the HELENA study

BACKGROUND/OBJECTIVES

The objective of the study is to describe the hydration status and to assess the main food- and/or fluid intake-associated factors in healthy adolescents.

SUBJECTS/METHODS

A total of 194 adolescents from the city of Zaragoza aged 12.5-17.5 years (99 males) participating in the 'Healthy Lifestyle in Europe by Nutrition in Adolescence' (HELENA) cross-sectional study were included. First morning urine was collected, and osmolality was determined by freezing point depression osmometer. A self-reported computer-based 24-h dietary recall was applied the same day of the urine collection. Analysis of variance, Kruskal-Wallis procedure or Pearson's χ(2) analyses was used to examine the group associations.

RESULTS

Seventy-one percent of adolescents did not meet the European Food Safety Agency (EFSA) recommendations for average total water intake (TWI), and 68% had high first morning urine osmolality values. TWI and the proportion of those meeting EFSA reference values significantly (P<0.05) decreased with increased osmolality. Males who met the EFSA recommendations consumed significantly (P<0.05) more plain water (1035.13 vs 582.68 ml) and dairy drinks (368.13 vs 226.68 ml) than those who did not. In females, the consumption of water (1359.41 vs 620.44 ml) and sugar-sweetened beverages (214.61 vs 127.42 ml) was significantly higher in those meeting the EFSA recommendations than in those who did not. First morning urine osmolality was associated with vegetables (unstandardized β: -0.6; 95% confidence interval (CI): -1.02 and -0.18) and fruits intake (β: -0.41; 95% CI: -0.63 and -0.19) in males and with dairy drinks (β: -0.39; 95% CI: -0.76 and -0.02) and fruits (β: -0.41; 95% CI: -0.73 and -0.10) in females.

CONCLUSIONS

There was a high prevalence of inadequate TWI and high urine osmolality among these Spanish adolescents. Lower urine osmolality was associated with higher consumption of vegetables in males, dairy drinks in females and fruits in both males and females.

Fluid intake and hydration status in obese vs normal weight children

BACKGROUND/OBJECTIVES

Little is known on the relationship between obesity and hydration levels in children. This study assessed whether and by which mechanisms hydration status differs between obese and non-obese children.

SUBJECTS/METHODS

Hydration levels of 86 obese and 89 normal weight children (age: 7-11 years) were compared. Hydration was measured as the average free water reserve (FWR=urine output/24 h minus the obligatory urine output [total 24 h excreted solutes/97th percentile of urine osmolality of children with adequate water intake, that is, 830 mOsm/kg]) over 2 days. Three days of weighed dietary and fluid intakes were recorded. Non-parametric tests were used to compare variables that were skewed and to assess which variables correlated with hydration. Variables mediating the different hydration levels of obese and normal weight children were assessed by co-variance analysis.

RESULTS

Obese children were less hydrated than normal weight peers [FWR=median (IQR): 0.80 (-0.80-2.80) hg/day vs 2.10 (0.10-4.45) hg/day, P<0.02; 32% of obese children vs 20% of non-obese peers had negative FWR, P<0.001]. Body mass index (BMI) z-score (z-BMI) and water intake from fluids correlated with FWR (ρ=-0.18 and 0.45, respectively, both P<0.05). Water intake from fluids completely explained the different hydration between obese and normal weight children [FWR adjusted for water from fluids and z-BMI=2.44 (0.44) hg vs 2.10 (0.50) hg, P=NS; B coefficient of co-variation between FWR (hg/day) and water intake from fluids (hg/day)=0.47, P<0.001].

CONCLUSIONS

Obese children were less hydrated than normal weight ones because, taking into account their z-BMI, they drank less. Future prospective studies are needed to explore possible causal relationships between hydration and obesity.

Total fluid intake of children and adolescents: cross-sectional surveys in 13 countries worldwide

Purpose

To describe total fluid intake (TFI) according to socio-demographic characteristics in children and adolescents worldwide.

Methods

Data of 3611 children (4–9 years) and 8109 adolescents (10–18 years) were retrieved from 13 cross-sectional surveys (47 % males). In three countries, school classes were randomly recruited with stratified cluster sampling design. In the other countries, participants were randomly recruited based on a quota method. TFI (drinking water and beverages of all kinds) was obtained with a fluid-specific record over 7 consecutive days. Adequacy was assessed by comparing TFI to 80 % of adequate intake (AI) for total water intake set by European Food Safety Authority. Data on height, weight and socio-economic level were collected in most countries.

Results

The mean (SD) TFI ranged from [1.32 (0.68)] to [1.35 (0.71)] L/day. Non-adherence to AIs for fluids ranged from 10 % (Uruguay) to >90 % (Belgium). Females were more likely to meet the AIs for fluids than males (4–9 years: 28 %, OR 0.72, p = 0.002; 10–18 years: 20 %, OR 0.80, p = 0.001), while adolescents were less likely to meet the AI than children (OR 1.645, p < 0.001 in males and OR 1.625, p < 0.001 in females).

Conclusions

A high proportion of children and adolescents are at risk of an inadequate fluid intake. This risk is especially high in males and adolescents when compared with females or children categories. This highlights water intake among young populations as an issue of global concern.

Electronic supplementary material

The online version of this article (doi:10.1007/s00394-015-0946-6) contains supplementary material, which is available to authorized users.

Intake of water and beverages of children and adolescents in 13 countries

Purpose

To describe the intake of water and all other beverages in children and adolescents in 13 countries of three continents.

Methods

Data of 3611 children (4–9 years) and 8109 adolescents (10–17 years) were retrieved from 13 cross-sectional surveys (47 % males). In three countries, stratified cluster sampling design was applied to randomly recruit schools classes. A quota method was applied in the other countries to randomly recruit participants. Details on the intake of all fluid types were obtained with a fluid-specific record over 7 consecutive days.

Results

In the total sample, the highest mean intakes were observed for water (738 ± 567 mL/day), followed by milk (212 ± 209 mL/day), regular soft beverages (RSB) (168 ± 290 mL/day) and juices (128 ± 228 mL/day). Patterns characterized by a high contribution of water, RSB or hot beverages to total fluid intake were identified among the countries with close geographical location. Adolescents had a significantly lower milk intake and higher intake of RSB and hot beverages than children in most countries. The most consistent gender difference observed was that in both age groups males reported a significantly higher RSB consumption than females.

Conclusion

On average, water was the fluid consumed in the largest volume by children and adolescents, but the intake of the different fluid types varied substantially between countries. Since the RSB intake was as large, or even larger, than water intake in some countries, undertaking actions to improve fluid intake habits of children and adolescents are warranted.

Electronic supplementary material

The online version of this article (doi:10.1007/s00394-015-0955-5) contains supplementary material, which is available to authorized users.

Intake of water and different beverages in adults across 13 countries

Purpose

To describe the intake of water and all other fluids and to evaluate the proportion of adults exceeding the World Health Organisation (WHO) recommendations on energy intake from free sugar, solely from fluids.

Methods

A total of 16,276 adults (46 % men, mean age 39.8 years) were recruited in 13 countries from 3 continents. A 24-h fluid-specific record over 7 days was used for fluid assessment.

Results

In Spain, France, Turkey, Iran, Indonesia and China, fluid intake was characterised by a high contribution of water (47–78 %) to total fluid intake (TFI), with a mean water intake between 0.76 and 1.78 L/day, and a mean energy intake from fluids from 182 to 428 kcal/day. Between 11 and 49 % of adults exceeded the free sugar WHO recommendations, considering solely fluids. In Germany, UK, Poland and Japan, the largest contributors to TFI were hot beverages (28–50 %) and water (18–32 %). Mean energy intake from fluids ranged from 415 to 817 kcal/day, and 48–62 % of adults exceeded free sugar WHO recommendations. In Mexico, Brazil and Argentina, the contribution of juices and regular sugar beverages (28–41 %) was as important as the water contribution to TFI (17–39 %). Mean energy intake from fluids ranged 565–694 kcal/day, and 60–66 % of the adults exceeded the free sugar WHO recommendation.

Conclusions

The highest volumes recorded in most of the countries were for water, mean energy intake from fluids was up to 694 kcal/day, and 66 % of adults exceeded the free sugar WHO recommendation solely by fluids. Actions to create an environment in favour of water consumption and reduce sugar intake from fluids therefore are warranted.

Electronic supplementary material

The online version of this article (doi:10.1007/s00394-015-0952-8) contains supplementary material, which is available to authorized users.

A cross-over study comparing an online versus a paper 7-day food record: focus on total water intake data and participant's perception of the records

PURPOSE

To compare (1) fluid, food and nutrient intake obtained with a paper versus an online version of a 7-day food record and (2) user's acceptability of both versions of the food record.

METHODS

A cross-over study was carried out in 2010 in France. A total of 246 participants aged 18-60 years reported their food and fluid intake using both versions of the 7-day food record, separated by a 7- to 14-day washout period. To help participants in estimating consumed portions, both versions of the food record were supported by a photographic booklet of standard portions and containers. At the end of the study protocol, participants completed a questionnaire designed to assess the acceptability of the two questionnaires.

RESULTS

The reported water intake of fluids was significantly higher with the online version compared with the paper version (respectively 1348 ± 36 and 1219 ± 34 mL/day, p < 0.0001). No difference was found between methods in terms of energy intake and the consumption of most food categories, macro- and micronutrients. Furthermore, 77 % of the participants preferred the online method to the paper version.

CONCLUSIONS

Fluid intake, but not food intake, reported with the online 7-day food record was higher in comparison with the paper version. In addition, the online version was preferred by users. In population surveys, the online record is therefore a relevant alternative, and even a preferred alternative in the case of fluid intake, to the paper record.

Total fluid intake and its determinants: cross-sectional surveys among adults in 13 countries worldwide

Purpose

To evaluate the total fluid intake from drinking water and beverages in adult populations from different countries and assess the percentage of individuals complying with the European Food Safety Agency (EFSA) adequate intake (AI) of water from fluids.

Methods

A total of 16,276 adults (7580 men and 8696 women) aged between 18 and 70 years (mean age 39.8 years) were randomly recruited from 13 different countries from three continents. Information about the total daily fluid intake (sum of drinking water and beverages) was collected using a 24-h fluid-specific record over seven consecutive days.

Results

Important differences in total fluid intake between countries were found; however, few differences between men and women were reported in most of the countries. Less than 50 % of the women and approximately 60 % of the men do not comply with the EFSA AI of water from fluids. Women were more than twice as likely as men to meet these AI (OR 2.15; 95 % CI 2.02–2.29). The odds of meeting the AI of water from fluids were lower in individuals over 50 years (OR 0.88; 95 % CI 0.80–0.96). Nine percent of the total population consumed less than half of the AI, 40.5 % between 50 and 100 %, and 50.5 % more than the AI.

Conclusions

There were considerable differences in total fluid intake between countries but not between genders. Only 40 % of men and 60 % of women comply with the EFSA AI of water from fluids. Men and elderly individuals had an increased risk of not complying with this reference value.

Hydration Status over 24-H Is Not Affected by Ingested Beverage Composition

OBJECTIVE

To investigate the 24-h hydration status of healthy, free-living, adult males when given various combinations of different beverage types.

METHODS

Thirty-four healthy adult males participated in a randomized, repeated-measures design in which they consumed: water only (treatment A), water+cola (treatment B), water+diet cola (treatment C), or water+cola+diet cola+orange juice (treatment D) over a sedentary 24-h period across four weeks of testing. Volumes of fluid were split evenly between beverages within each treatment, and when accounting for food moisture content and metabolic water production, total fluid intake from all sources was equal to 35 ± 1 ml/kg body mass. Urine was collected over the 24-h intervention period and analyzed for osmolality (Uosm), volume (Uvol) and specific gravity (USG). Serum osmolality (Sosm) and total body water (TBW) via bioelectrical impedance were measured after the 24-h intervention.

RESULTS

24-h hydration status was not different between treatments A, B, C, and D when assessed via Uosm (590 ± 179; 616 ± 242; 559 ± 196; 633 ± 222 mOsm/kg, respectively) and Uvol (1549 ± 594; 1443 ± 576; 1690 ± 668; 1440 ± 566 ml) (all p > 0.05). A -difference in 24-h USG was observed between treatments A vs. D (1.016 ± 0.005 vs. 1.018 ± 0.007; p = 0.049). There were no differences between treatments at the end of the 24-h with regard to Sosm (291 ± 4; 293 ± 5; 292 ± 5; 293 ± 5 mOsm/kg, respectively) and TBW (43.9 ± 5.9; 43.8 ± 6.0; 43.7 ± 6.1; 43.8 ± 6.0 kg) (all p > 0.05).

CONCLUSIONS

Regardless of the beverage combination consumed, there were no differences in providing adequate hydration over a 24-h period in free-living, healthy adult males. This confirms that beverages of varying composition are equally effective in hydrating the body.

Fluid intake from beverages across age groups: a systematic review

BACKGROUND

Fluid intake, especially water, is essential for human life and also necessary for physical and mental function. The present study aimed to assess beverage consumption across age groups.

METHODS

A systematic review was conducted. Original research in English language publications and available studies (or abstracts in English) from 2000 to 2013 was searched for by using the medical subheading (MeSH) terms: ('beverage' OR 'fluid' [Major]) AND ('consumption' [Mesh] OR 'drinking' [Mesh] OR 'intake' [Mesh]) AND ('child' [Mesh] OR 'adolescent' [Mesh] OR 'adult' [Mesh]). Article selection was restricted to those papers covering healthy populations of all age groups in a nationwide sample, or from a representative sample of the population of a city or cities, which examined the trends or patterns of beverage intake and the determinants of beverage intake. Sixty-five studies were identified with respect to beverage consumption across age groups. The papers were screened by thoroughly reading titles or abstracts. Full-text articles were assessed by three investigators.

RESULTS

Total beverage intake varied between 0.6 and 3.5 L day(-1) among all age groups (males more than females). Plain water contributed up to 58%, 75% and 80% of the total beverage intake in children, adolescents and adults, respectively. Milk consumption was higher among children; consumption of soft drinks was higher among adolescents; and the consumption of tea, coffee and alcoholic beverages was higher among adults.

CONCLUSIONS

Plain water is the main water source for all age groups and the consumption of other beverages varies according to age.

No evidence of dehydration with moderate daily coffee intake: a counterbalanced cross-over study in a free-living population

It is often suggested that coffee causes dehydration and its consumption should be avoided or significantly reduced to maintain fluid balance. The aim of this study was to directly compare the effects of coffee consumption against water ingestion across a range of validated hydration assessment techniques. In a counterbalanced cross-over design, 50 male coffee drinkers (habitually consuming 3–6 cups per day) participated in two trials, each lasting three consecutive days. In addition to controlled physical activity, food and fluid intake, participants consumed either 4×200 mL of coffee containing 4 mg/kg caffeine (C) or water (W). Total body water (TBW) was calculated pre- and post-trial via ingestion of Deuterium Oxide. Urinary and haematological hydration markers were recorded daily in addition to nude body mass measurement (BM). Plasma was analysed for caffeine to confirm compliance. There were no significant changes in TBW from beginning to end of either trial and no differences between trials (51.5±1.4 vs. 51.4±1.3 kg, for C and W, respectively). No differences were observed between trials across any haematological markers or in 24 h urine volume (2409±660 vs. 2428±669 mL, for C and W, respectively), USG, osmolality or creatinine. Mean urinary Na⁺ excretion was higher in C than W (p = 0.02). No significant differences in BM were found between conditions, although a small progressive daily fall was observed within both trials (0.4±0.5 kg; p<0.05). Our data show that there were no significant differences across a wide range of haematological and urinary markers of hydration status between trials. These data suggest that coffee, when consumed in moderation by caffeine habituated males provides similar hydrating qualities to water.

Water-loss dehydration and aging

This review defines water-loss and salt-loss dehydration. For older people serum osmolality appears the most appropriate gold standard for diagnosis of water-loss dehydration, but clear signs of early dehydration have not been developed. In older adults, lower muscle mass, reduced kidney function, physical and cognitive disabilities, blunted thirst, and polypharmacy all increase dehydration risk. Cross-sectional studies suggest a water-loss dehydration prevalence of 20-30% in this population. Water-loss dehydration is associated with higher mortality, morbidity and disability in older people, but evidence is still needed that this relationship is causal. There are a variety of ways we may be able to help older people reduce their risk of dehydration by recognising that they are not drinking enough, and being helped to drink more. Strategies to increase fluid intake in residential care homes include identifying and overcoming individual and institutional barriers to drinking, such as being worried about not reaching the toilet in time, physical inability to make or to reach drinks, and reduced social drinking and drinking pleasure. Research needs are discussed, some of which will be addressed by the FP7-funded NU-AGE (New dietary strategies addressing the specific needs of elderly population for a healthy ageing in Europe) trial.

Hydration biomarkers in free-living adults with different levels of habitual fluid consumption

Little is known about the impact of habitual fluid intake on physiology. Specifically, biomarkers of hydration status and body water regulation have not been adequately explored in adults who consume different fluid volumes in everyday conditions, without prolonged exercise or environmental exposure. The purpose of the present study was to compare adults with habitually different fluid intakes with respect to biomarkers implicated in the assessment of hydration status, the regulation of total body water and the risk of kidney pathologies. In the present cross-sectional study, seventy-one adults (thirty-two men, thirty-nine women, age 25–40 years) were classified according to daily fluid intake: thirty-nine low drinkers (LD; ≤ 1·2 litres/d) and thirty-two high drinkers (HD; 2–4 litres/d). During four consecutive days, urinary parameters (first morning urine (FMU) on day 1 and subsequent 24 h urine (24hU) collections), blood parameters, and food and beverage intake were assessed. ANOVA and non-parametric comparisons revealed significant differences between the LD and HD groups in 24hU volume (1·0 (se 0·1) v. 2·4 (se 0·1) litres), specific gravity (median 1·023 v. 1·010), osmolality (767 (se 27) v. 371 (se 33) mOsm/kg) and colour (3·1 (se 0·2) v. 1·8 (se 0·2)). Similarly, in the FMU, the LD group produced a smaller amount of more concentrated urine. Plasma cortisol, creatinine and arginine vasopressin concentrations were significantly higher among the LD. Plasma osmolality was similar between the groups, suggesting physiological adaptations to preserve plasma osmolality despite low fluid intake. The long-term impact of adaptations to preserve plasma osmolality must be examined, particularly in the context of renal health.

Beverage consumption among European adolescents in the HELENA study

BACKGROUND/OBJECTIVES

Our objective was to describe the fluid and energy consumption of beverages in a large sample of European adolescents.

SUBJECTS/METHODS

We used data from 2741 European adolescents residing in 8 countries participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS). We averaged two 24-h recalls, collected using the HELENA-dietary assessment tool. By gender and age subgroup (12.5-14.9 years and 15-17.5 years), we examined per capita and per consumer fluid (milliliters (ml)) and energy (kilojoules (kJ)) intake from beverages and percentage consuming 10 different beverage groups.

RESULTS

Mean beverage consumption was 1611 ml/day in boys and 1316 ml/day in girls. Energy intake from beverages was about 1966 kJ/day and 1289 kJ/day in European boys and girls, respectively, with sugar-sweetened beverages (SSBs) (carbonated and non-carbonated beverages, including soft drinks, fruit drinks and powders/concentrates) contributing to daily energy intake more than other groups of beverages. Boys and older adolescents consumed the most amount of per capita total energy from beverages. Among all age and gender subgroups, SSBs, sweetened milk (including chocolate milk and flavored yogurt drinks all with added sugar), low-fat milk and fruit juice provided the highest amount of per capita energy. Water was consumed by the largest percentage of adolescents followed by SSBs, fruit juice and sweetened milk. Among consumers, water provided the greatest fluid intake and sweetened milk accounted for the largest amount of energy intake followed by SSBs. Patterns of energy intake from each beverage varied between countries.

CONCLUSIONS

European adolescents consume an average of 1455 ml/day of beverages, with the largest proportion of consumers and the largest fluid amount coming from water. Beverages provide 1609 kJ/day, of which 30.4%, 20.7% and 18.1% comes from SSBs, sweetened milk and fruit juice, respectively.