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Kim HK, Sagayama H, Yoshida T, Oishi K, Nakayama Y, Kimura M, Ono R, Yamada Y. Predictors of Water Turnover in Older Adults: A Doubly Labeled Water- and Triaxial Accelerometer-Based Study. J Nutr 2024; 154:1750-1757. [PMID: 38649093 DOI: 10.1016/j.tjnut.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/01/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Water is one of the most essential nutrients for life. The water turnover (WT), total body water (TBW), and total energy expenditure (TEE) can be measured using the doubly labeled water (DLW) method. WT and TBW are lower in older adults than in young adults, and the former are susceptible to dehydration, necessitating to identify predictors of the WT in older adults. OBJECTIVES The current study aimed to examine the association between WT and physical activity, physical function, and body composition in Japanese adults aged ≥65 y and identify predictors for WT in this population. METHODS This study enrolled 133 older adults (women, n = 61; men, n = 72) aged 65-88 y. WT, TBW, TEE, fat-free mass (FFM), and percent body fat (%Fat) were determined using the DLW method. The fitness age score (FAS) was obtained from 5 physical fitness tests. Physical activity and the step count were assessed using a previously validated triaxial accelerometer. Multiple regression analyses were performed with WT as the dependent variable. RESULTS WT was positively associated with weight, physical activity level (PAL), moderate-vigorous physical activity, and TEE, and negatively associated with sedentary behavior. We examined potential predictors for WT using age, sex, height, weight, FFM, %Fat, TEE, PAL, and FAS in older Japanese adults. CONCLUSIONS Our results confirmed that age, sex, weight, FFM, TEE, and PAL are the potential predictors of WT in older Japanese adults aged ≥65 y.
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Affiliation(s)
- Hyeon-Ki Kim
- National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Hiroyuki Sagayama
- Institute of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Tsukasa Yoshida
- National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Kan Oishi
- National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan; Graduate School of Health and Sports Science, Doshisha University, Kyoto, Japan; Japan Society for the Promotion of Sciences, Tokyo, Japan
| | - Yui Nakayama
- National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Misaka Kimura
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan
| | - Rei Ono
- National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Yosuke Yamada
- National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan.
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Kostelnik SB, Davy KP, Hedrick VE, Thomas DT, Davy BM. The Validity of Urine Color as a Hydration Biomarker within the General Adult Population and Athletes: A Systematic Review. J Am Coll Nutr 2020; 40:172-179. [PMID: 32330109 DOI: 10.1080/07315724.2020.1750073] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Frequent monitoring of hydration status may help to avoid the adverse effects of dehydration. Other than urine color assessment, hydration assessment methods are largely impractical for the general population and athletes to implement on a routine basis. Despite its widespread use, the validity of urine color as an indicator of hydration status has not been systematically evaluated. The objective of this systematic review is to determine the validity of urine color evaluation as a hydration status assessment method in the general adult population, older adults, and athletes. Using the PRISMA guidelines, electronic databases were searched to identify original research articles of all study design types for inclusion. Of the 424 articles screened, 10 met inclusion criteria. Most studies compared urine color to either urinary specific gravity or urine osmolality, and reported significant associations (r) ranging from 0.40 to 0.93. Lower correlations were noted in studies of adults aged >60 years. Studies generally reported a high sensitivity of urine color as a diagnostic tool for detecting dehydration and supported the ability of this method to distinguish across categories of hydration status. Research is needed to determine if clinicians, patients, and clients can accurately utilize this method in clinical and real-world settings. Future research is also needed to extend these findings to other populations, such as children.Key teaching pointsInadequate hydration can lead to impairments in physical performance and cognitive function.Methods used to assess hydration status include plasma/serum osmolality, urinary specific gravity (USG), urine osmolality (Uosm), change in body weight, urine volume, and urine color.Urine color assessment is a practical method that is routinely used in clinical, athletic, and other settings. The validity of this method has not been systemically evaluated.Available research was limited to 10 articles.Validity of this method was generally supported; however, research has not investigated the validity of this method by clinicians, patients and clients.
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Affiliation(s)
- Samantha B Kostelnik
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
| | - Kevin P Davy
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
| | - Valisa E Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
| | - D Travis Thomas
- Department of Athletic Training & Clinical Nutrition, University of Kentucky, Lexington, Kentucky, USA
| | - Brenda M Davy
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
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Volcko KL, Carroll QE, Brakey DJ, Daniels D. High-fat diet alters fluid intake without reducing sensitivity to glucagon-like peptide-1 receptor agonist effects. Physiol Behav 2020; 221:112910. [PMID: 32283107 DOI: 10.1016/j.physbeh.2020.112910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/20/2022]
Abstract
Rats that are maintained on a high-fat diet (HFD) differ from controls in many ways, but how HFD maintenance affects water intake and drinking behavior has not been well studied. This is unfortunate because diet and obesity may influence fluid balance in humans through a mechanism that is poorly understood. We therefore tested the hypothesis that HFD maintenance affects water intake in rats. Water intake and drinking behavior are, in part, controlled by the actions of glucagon-like peptide-1 (GLP-1), a peptide which is well studied for its hypophagic effects. Previous studies have shown that HFD maintenance impairs the ability of GLP-1 receptor agonists to suppress food intake when the drug is administered peripherally, but not centrally. The effects of GLP-1 on fluid intake are thought to rely more on central receptor activation; therefore, a secondary aim of these experiments was to shed additional light on the location of GLP-1 responsive cells that mediate feeding vs drinking behavior. We maintained male Sprague-Dawley rats on HFD or low-fat diet (LFD) for six weeks and measured body weight, food intake, water intake, and drinking behavior. We then tested the relative contributions of diet and body weight on food intake and water intake after peripheral and central injections of GLP-1 receptor agonist Exendin-4 (Ex4). We found that HFD maintenance reduced the amount of water consumed, when intake was corrected for body weight. Consistent with other reports, rats on HFD showed a smaller suppression of food intake when given Ex4 peripherally, but not centrally. Water intake suppression when given Ex4 did not differ by diet or body weight regardless of injection site, however, adding support to the hypothesis that only central GLP-1 receptors are involved in water intake.
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Affiliation(s)
- K Linnea Volcko
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY 14260 USA; Behavioral Neuroscience Program, University at Buffalo, State University of New York, Buffalo, NY 14260 USA
| | - Quinn E Carroll
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY 14260 USA; Behavioral Neuroscience Program, University at Buffalo, State University of New York, Buffalo, NY 14260 USA
| | - Destiny J Brakey
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY 14260 USA; Behavioral Neuroscience Program, University at Buffalo, State University of New York, Buffalo, NY 14260 USA
| | - Derek Daniels
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY 14260 USA; Behavioral Neuroscience Program, University at Buffalo, State University of New York, Buffalo, NY 14260 USA; Center for Ingestive Behavior Research, University at Buffalo, State University of New York, Buffalo, NY 14260 USA.
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Tucker MA, Caldwell AR, Ganio MS. Adequacy of Daily Fluid Intake Volume Can Be Identified From Urinary Frequency and Perceived Thirst in Healthy Adults. J Am Coll Nutr 2019; 39:235-242. [PMID: 31347984 DOI: 10.1080/07315724.2019.1639566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Achieving and maintaining an optimal level of hydration has significant implications for both acute and chronic health, yet many hydration assessments are not feasible for the general public. Urinary frequency (UF) is a reliable method to self-assess hydration status in healthy individuals, and thirst can provide additional sensory information on adequacy of daily fluid intake volume (DFI). However, threshold values for these indices to detect optimal hydration have not been determined. In this study, we sought to determine threshold values for 24-hour UF and perceived thirst that could accurately distinguish between optimal and suboptimal hydration states.Methods: Thirty-two healthy adults (age 22 ± 3 years, body mass index 24.9 ± 4.1 kg/m2) collected urine over 24 hours on four separate occasions, where UF was recorded as well as thirst at each void using a numbered perceptual scale. Using urine osmolality as the criterion standard, all samples were either classified as representing an optimal (≤500 mOsm·kg-1) or suboptimal hydration status (>500 mOsm·kg-1).Results: A 24-hour UF ≤6 was able to detect suboptimal hydration with good accuracy (area under the curve [AUC] 0.815) and a 24-hour average perceived thirst rating > 3 ("a little thirsty") could detect it with reasonable accuracy (AUC 0.725). In addition, a UF ≤4 had a considerably higher positive likelihood ratio to detect suboptimal hydration versus a UF ≤6 (9.03 versus 2.18, respectively).Conclusions: These analyses suggest that individuals with a 24-hour UF ≤6 or perceiving themselves to be, on average, "a little thirsty" throughout the day are likely to be suboptimally hydrated and thus underconsuming an adequate DFI.
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Affiliation(s)
- Matthew A Tucker
- Georgia Prevention Institute, Department of Population Health Sciences, Augusta University, Augusta, Georgia, USA.,Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
| | - Aaron R Caldwell
- Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
| | - Matthew S Ganio
- Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
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Suh H, Kavouras SA. Water intake and hydration state in children. Eur J Nutr 2018; 58:475-496. [PMID: 30506317 DOI: 10.1007/s00394-018-1869-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/21/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Although low water intake has been associated with adverse health outcomes, available literature indicated that the majority of children do not meet the water intake guidelines and they are underhydrated based on elevated hydration biomarkers. This review examined the water intake habits and hydration status in children from 32 observational studies (n = 36813). METHODS PubMed, Web of Science, and CINAHL were used to identify relevant articles. Total water/fluid intake from 25 countries was compared with water intake recommendations and underhydration (urine osmolality greater than 800 mmol kg-1) was assessed. Risk of bias was assessed using customized categories following the review guideline for observational studies. RESULTS From 32 studies, only 11 studies reported both water intake and hydration status. 12 out of 24 studies reported mean/median water/fluid intake below the guidelines, while 4 out of 13 studies that assessed hydration status indicated underhydration based on urine osmolality (greater than 800 mmol kg-1). Among the 19 countries that reported comparison of water/fluid intake with guidelines, 60 ± 24% of children (range 10-98%) failed to meet them. CONCLUSION These findings suggest that children are not consuming enough water to be adequately hydrated.
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Affiliation(s)
- HyunGyu Suh
- Hydration Science Lab, Arizona State University, Arizona Biomedical Collaborate, Suite 133, 425 N 5th St, Phoenix, AZ, 85004, USA
| | - Stavros A Kavouras
- Hydration Science Lab, Arizona State University, Arizona Biomedical Collaborate, Suite 133, 425 N 5th St, Phoenix, AZ, 85004, USA.
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Padrão P, Sousa AS, Guerra RS, Álvares L, Santos A, Borges N, Afonso C, Amaral TF, Moreira P. A Cross-Sectional Study on the Association between 24-h Urine Osmolality and Weight Status in Older Adults. Nutrients 2017; 9:nu9111272. [PMID: 29165353 PMCID: PMC5707744 DOI: 10.3390/nu9111272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 01/17/2023] Open
Abstract
Data on the association between hydration and body weight in the elderly are scarce. The objective of this work was to quantify the association between 24-h urine osmolality and weight status in the elderly. A cross-sectional study was conducted within the Nutrition UP 65 study. A quota sampling was implemented to achieve a nationally representative sample of Portuguese older adults (≥65 years) according to age, sex, education and region. From a sample size of 1500 participants, 1315 were eligible for the present analysis, 57.3% were women and 23.5% were aged ≥80 years. Participants were grouped using tertiles of 24-h urine osmolality by sex. World Health Organization cutoffs were used to classify participants according to weight status. Multinomial multivariable logistic regression models were conducted to evaluate the association of tertiles of osmolality with weight status, adjusting for confounders. Odds Ratios (OR) and respective 95% Confidence Intervals (95% CI) were calculated. Being in the 3rd urine osmolality tertile (highest) was associated with a higher risk of being obese in men, OR = 1.97, 95% CI = 1.06, 3.66. No such association was found in women. These results highlight the need for implementing studies in order to clarify the association between hydration and weight status in the elderly.
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Affiliation(s)
- Patrícia Padrão
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, 4200-465 Porto, Portugal.
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.
- Escola Superior de Saúde de Leiria, Instituto Politécnico de Leiria, 2411-901 Leiria, Portugal.
| | - Ana S Sousa
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, 4200-465 Porto, Portugal.
| | - Rita S Guerra
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, 4200-465 Porto, Portugal.
| | - Luísa Álvares
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, 4200-465 Porto, Portugal.
| | - Alejandro Santos
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, 4200-465 Porto, Portugal.
- I3S-Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal.
| | - Nuno Borges
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, 4200-465 Porto, Portugal.
- CINTESIS-Centre for Health Technology and Services Research, 4200-450 Porto, Portugal.
| | - Cláudia Afonso
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, 4200-465 Porto, Portugal.
| | - Teresa F Amaral
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, 4200-465 Porto, Portugal.
- System Integration and Process Automation Unit (UISPA)-Institute of Mechanical Engineering (IDMEC), Faculdade de Engenharia, Universidade do Porto, 4200-465 Porto, Portugal.
| | - Pedro Moreira
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, 4200-465 Porto, Portugal.
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.
- Centro de Atividade Física, Saúde e Lazer, Universidade do Porto, 4200-450 Porto, Portugal.
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Chang T, Ravi N, Plegue MA, Sonneville KR, Davis MM. Inadequate Hydration, BMI, and Obesity Among US Adults: NHANES 2009-2012. Ann Fam Med 2016; 14:320-4. [PMID: 27401419 PMCID: PMC4940461 DOI: 10.1370/afm.1951] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/10/2016] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Improving hydration is a strategy commonly used by clinicians to prevent overeating with the goal of promoting a healthy weight among patients. The relationship between weight status and hydration, however, is unclear. Our objective was to assess the relationship between inadequate hydration and BMI and inadequate hydration and obesity among adults in the United States. METHODS Our study used a nationally representative sample from the National Health and Nutrition Examination Survey (NHANES) 2009 to 2012, and included adults aged 18 to 64 years. The primary outcome of interest was body mass index (BMI), measured in continuous values and also categorized as obese (BMI ≥30) or not (BMI <30). Individuals with urine osmolality values of 800 mOsm/kg or greater were considered to be inadequately hydrated. Linear and logistic regressions were performed with continuous BMI and obesity status as the outcomes, respectively. Models were adjusted for known confounders including age, race/ethnicity, sex, and income-to-poverty ratio. RESULTS In this nationally representative sample (n = 9,528; weighted n = 193.7 million), 50.8% were women, 64.5% were non-Hispanic white, and the mean age was 41 years. Mean urine osmolality was 631.4 mOsm/kg (SD = 236.2 mOsm/kg); 32.6% of the sample was inadequately hydrated. In adjusted models, adults who were inadequately hydrated had higher BMIs (1.32 kg/m(2); 95% CI, 0.85-1.79; P <.001) and higher odds of being obese (OR = 1.59; 95% CI, 1.35-1.88; P <.001) compared with hydrated adults. CONCLUSION We found a significant association between inadequate hydration and elevated BMI and inadequate hydration and obesity, even after controlling for confounders. This relationship has not previously been shown on a population level and suggests that water, an essential nutrient, may deserve greater focus in weight management research and clinical strategies.
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Affiliation(s)
- Tammy Chang
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan Medical School, University of Michigan, Ann Arbor, Michigan Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Nithin Ravi
- Medical School, University of Michigan, Ann Arbor, Michigan
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kendrin R Sonneville
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Matthew M Davis
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan Departments of Pediatrics and Internal Medicine, University of Michigan Ann Arbor, Michigan Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Keino S, van den Borne B, Plasqui G. Body composition, water turnover and physical activity among women in Narok County, Kenya. BMC Public Health 2014; 14:1212. [PMID: 25420458 PMCID: PMC4252005 DOI: 10.1186/1471-2458-14-1212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 11/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In developing countries where access to water and food is not guaranteed, women may have to travel long distances or engage in intense physical activities to gather food. This may compromise their water requirements and overall nutritional status. The aim of the study was to determine water turnover, physical activity and body composition among women in Kenya and to describe the differences between rural and urban Kenyan women. METHODS Thirty women from Narok County who were not pregnant at the time of the study were recruited. Body mass index (BMI) was calculated by dividing weight in kilograms by height in meters squared. Deuterium dilution was used to determine total body water (TBW) and water turnover was measured from deuterium elimination. Fat-free mass (FFM) was calculated by assuming a constant hydration fraction of 73.2%. Accelerometers (Actigraph GT3X) were used to assess physical activity and expressed as Vector magnitude counts per day (VM/day). Simple and multiple linear regressions were used to define the determinants of water turnover. RESULTS Mean BMI was 23.4 ± 4.1 and 21.5 ± 3.8 among rural and urban women respectively. The prevalence of overweight (BMI > 25 kg/m(2)) was 24.1% and of underweight (BMI < 18.4 kg/m2)) was 25%. The mean total body water (TBW) was 29.3 ± 4.2 liters (L) and water turnover was 3.2 ± 0.8 liters per day (L/day). Water loss was positively associated with BMI (R(2) = .45, p < 0.001, n = 28) and Fat mass index (FMI) (R(2) = .41, p < 0.001, n = 28). Water loss was also positively associated with physical activity (PA) (R(2) = .25, p < 0.05, n = 22). Multiple regression analysis showed that physical activity in addition to BMI in the model explained an additional 15% of the variation in water turnover (r(2) = 0.53, p < 0.05; ∆r(2) = 0.15, p < 0.05, n = 22) compared to BMI alone (r(2) = 0.38, p < 0.005 n = 22). CONCLUSION BMI together with physical activity were the strongest predictors of water loss.
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Affiliation(s)
- Susan Keino
- Department of Health Education & Promotion, Faculty of Medicine & Life Sciences, Maastricht University, P,O BOX 616, 6200 MD Maastricht, The Netherlands.
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