Methodological Aspects of Fluid Intake Records and Surveys

Proteomic analysis reveals that aging rabbit vocal folds are more vulnerable to changes caused by systemic dehydration

BACKGROUND

Older adults are more prone to develop systemic dehydration. Systemic dehydration has implications for vocal fold biology by affecting gene and protein expression. The objective of this study was to quantify vocal fold protein changes between two age groups and hydration status, and to investigate the interaction of age and hydration status on protein expression, which has not been investigated in the context of vocal folds before. Comparative proteomics was used to analyze the vocal fold proteome of 6.5-month-old and > 3-year-old rabbits subjected to water ad libitum or water volume restriction protocol.

RESULTS

Young and older adult rabbits (n = 22) were either euhydrated (water ad libitum) or dehydrated by water volume restriction. Dehydration was confirmed by body weight loss of - 5.4% and - 4.6% in young and older groups, respectively, and a 1.7-fold increase of kidney renin gene expression in the young rabbits. LC-MS/MS identified 2286 proteins in the rabbit vocal folds of young and older adult rabbits combined. Of these, 177, 169, and 81 proteins were significantly (p ≤ 0.05) affected by age, hydration status, or the interaction of both factors, respectively. Analysis of the interaction effect revealed 32 proteins with opposite change patterns after dehydration between older and young rabbit vocal folds, while 31 proteins were differentially regulated only in the older adult rabbits and ten only in the young rabbits in response to systemic dehydration. The magnitude of changes for either up or downregulated proteins was higher in the older rabbits. These proteins are predominantly related to structural components of the extracellular matrix and muscle layer, suggesting a disturbance in the viscoelastic properties of aging vocal fold tissue, especially when subjected to systemic dehydration.

CONCLUSIONS

Water restriction is a laboratory protocol to assess systemic dehydration-related changes in the vocal fold tissue that is translatable to human subjects. Our findings showed a higher number of proteins differentially regulated with a greater magnitude of change in the vocal folds of older adult rabbits in the presence of systemic dehydration compared to younger rabbits. The association of these proteins with vocal fold structure and biomechanical properties suggests that older human subjects may be more vulnerable to the effects of systemic dehydration on vocal function. The clinical implications of these protein changes warrant more investigation, but age should be taken into consideration when evaluating vocal treatment recommendations that interfere with body fluid balance.

Hydration status, body composition, and anxiety status in aeronautical military personnel from Spain: a cross-sectional study

BACKGROUND

An adequate hydration status is critical to ensure efficiency during mental and physical activities. Our goal was to assess the hydration status of a Spanish group of aeronautical military men and to determine the association of hydration status with body composition and anxiety.

METHODS

A total of 188 men were evaluated through a validated hydration questionnaire, anthropometric and biochemical parameters, and an anxiety questionnaire. Based on these methods, the criteria of hydration were established.

RESULTS

Of the total sample, 81% met the hydration criteria (urine color = well hydrated, water balance ≥ 0 ml, and total water intake/weight ≥ 35 ml/kg), and 19% did not meet the hydration criteria (urine color = not sufficiently hydrated or dehydrated, water balance < 0 ml, and total water intake/weight < 35 ml/kg). Subjects not meeting the hydration criteria had lower urine pH, negative water balance, and lower water intake. The latter also had higher anxiety status (score = 4 vs. 3, P = 0.026), weight [(84.7 ± 10.5) vs. (80.5 ± 10.2) kg], body mass index [(26.3 ± 3.1) vs. (25.2 ± 2.8)]kg/m², body fat [(22.3 ± 5.6) vs. (18.3 ± 6.5)] %, urine specific gravity, and urine color. Using a logistic binary regression model, hydration status was related significantly with the percentage of body fat (P = 0.004), but no relation was found with age, comorbidities, or medications. Furthermore, total water intake/weight was positively correlated with percentage of body water (r = 0.357, P = 0.000) and negatively with body fat (kg) (r = - 0.427, P = 0.000), percentage of body fat (r = - 0.405, P = 0.000), and waist/hip ratio (r = - 0.223, P = 0.002). Based on a linear regression model, total water intake/weight was related significantly with percentage of body fat (P = 0.001) and percentage of body water content (P = 0.035). No relation was found, however, with waist/hip ratio, age, comorbidities, or medications.

CONCLUSIONS

These findings all suggest a relationship between hydration status and body composition but also set the bases for future studies that relate hydration status and anxiety status. These results can be used to improve the hydration status and body composition of military personnel.

Urban Water Consumption Patterns in an Adult Population in Wuxi, China: A Regression Tree Analysis

Understanding water intake variation is crucial for assessing human exposure to water pollutants. The correlation between water intake and demographic factors warrants further exploration. A cross-sectional study was conducted to estimate urban water consumption and its associated factors among adults in Wuxi, China, in 2015. The water consumption information was obtained by a 24-h self-report diary over seven consecutive days. A classification and regression tree (CART) analysis was applied to detect how water consumption varied with the demographic variables. Finally, a total of 1188 adults (18–87 years old) were included. The results demonstrated that the median water consumption of the adults was 1525 mL/day in summer and 1217 mL/day in winter. The results of the CART analysis demonstrated that body mass index (BMI) and age were the leading factors that were associated with water consumption in summer and winter, respectively. The water consumption threshold of BMI for men differed from women (23 kg/m² vs. 18 kg/m²) in summer, and the threshold of age for men was also different from women (43 years vs. 21 years) in winter. In conclusion, the findings are useful for accurately assessing human exposure to water pollutants and identifying the high-risk subgroups.

The amounts and contributions of total drinking fluids and water from food to total water intake of young adults in Baoding, China

PURPOSE

To investigate the amounts and contributions of total drinking fluids and water from food to total water intake (TWI), to explore the drinking pattern, and to compare the amount of TWI with the recommendations of China and EFSA among young adults.

METHODS

A cross-sectional study was implemented with 159 young adults aged 18-23 years from Hebei, China. Total drinking fluids and water from food were assessed by 7-day 24-h fluid intake questionnaire and the duplicate portion method, respectively. Differences between groups stratified according to the distribution of TWI were compared using one-way ANOVA and Kruskal-Wallis H test. General linear models were used to identify the variations in TWI due to total drinking fluids and water from food.

RESULTS

In total, 156 subjects (80 males and 76 females) completed the study. Approximately 80.1% of them did not meet the TWI recommended by China, while 50.0% did not meet that recommended by the EFSA. Participants with higher TWI had greater amounts of total drinking fluids, water rom food and water than their counterparts with lower TWI. The regression between total drinking fluids and TWI was R² = 0.8526 (P < 0.05) and that between water from food and TWI was R² = 0.4650 (P < 0.05).

CONCLUSIONS

A large proportion of young adults have insufficient TWI. Participants with lower TWI would not compensate with water from food. The variances in TWI among participants were mainly due to differences in total drinking fluids. There is an urgent need to improve the fluids intake behaviors of young adults.

Validation Testing Demonstrates Efficacy of a 7-Day Fluid Record to Estimate Daily Water Intake in Adult Men and Women When Compared with Total Body Water Turnover Measurement

Background: Mean daily water intake from fluids (WATER-FL) has proven to be difficult to measure because of a range of nonvalidated data collection techniques. Few questionnaires have been validated to estimate WATER-FL against self-reported diaries or urinary hydration markers, which may limit their objectivity.Objectives: The goals of this investigation were 1) to assess the validity of a 7-d fluid record (7dFLR) to measure WATER-FL (WATER-FL-7dFLR) through comparison with WATER-FL as calculated by measuring deuterium oxide (D₂O) disappearance (WATER-FL-D₂O), and 2) to evaluate the reliability of the 7dFLR in measuring WATER-FL.Methods: Participants [n = 96; 51% female; mean ± SD age: 41 ± 14 y; mean ± SD body mass index (in kg/m²): 26.2 ± 5.1] completed body water turnover analysis over 3 consecutive weeks. They completed the 7dFLR and food diaries during weeks 2 and 4 of the observation. The records were entered into nutritional software to determine the water content of all foods and fluids consumed. WATER-FL-D₂O was calculated from water turnover (via the D₂O dilution method), minus water from food and metabolic water. The agreement between the 2 methods of determining WATER-FL were compared according to a Bland-Altman plot at week 2. The test-retest reliability of 7dFLR between weeks 2 and 4 was assessed via intraclass correlation (ICC).Results: The mean ± SD difference between WATER-FL-7dFLR and WATER-FL-D₂O was -131 ± 845 mL/d. In addition, no bias was observed (F_[1,94] = 0.484; R² = 0.006; P = 0.488). When comparing WATER-FL-7dFLR from weeks 2 and 4, no significant difference (mean ± SD difference: 71 ± 75 mL/d; t_[79] = 0.954; P = 0.343) and an ICC of 0.85 (95% CI: 0.77, 0.90) was observed.Conclusions: The main findings of this study were that the use of the 7dFLR is an effective and reliable method to estimate WATER-FL in adults. This style of questionnaire may be extremely helpful for collecting water intake data for large-scale epidemiologic studies.

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.

Recording of fluid, beverage and water intakes at the population level in Europe

The European Food Safety Authority's 2010 scientific opinion on dietary reference values for total water intakes was partly based on observed intakes in population groups. Large variability was observed, and it is unlikely that these differences can be explained by differences in climate, activity level and/or culture. This suggests that there are uncertainties in the methodologies used to assess water intake from food and fluids, including all types of beverages. To determine current methods for recording and reporting total water, beverages and fluid intakes, twenty-one European countries were surveyed using an electronic questionnaire. In total, twelve countries responded and ten completed surveys were summarised. Countries reported that their survey was representative of the population in terms of age and socio-economic status. However, a variety of methods were used - that is, repeated 24-h recalls, estimated food diaries and FFQ. None of the methods were validated to assess water and fluid intakes. The methods used to record liquid foods - for example, soup and diluted drinks - were inconsistent. Clarity and consistency on definitions of categories of beverages to facilitate comparisons between countries are needed. Recommendations for a unified approach to surveying and quantifying intake of water from fluids and foods are proposed.

Water Intake and Hydration Indices in Healthy European Adults: The European Hydration Research Study (EHRS)

Hydration status is linked with health, wellness, and performance. We evaluated hydration status, water intake, and urine output for seven consecutive days in healthy adults. Volunteers living in Spain, Germany, or Greece (n = 573, 39 ± 12 years (51.1% males), 25.0 ± 4.6 kg/m² BMI) participated in an eight-day study protocol. Total water intake was estimated from seven-day food and drink diaries. Hydration status was measured in urine samples collected over 24 h for seven days and in blood samples collected in fasting state on the mornings of days 1 and 8. Total daily water intake was 2.75 ± 1.01 L, water from beverages 2.10 ± 0.91 L, water from foods 0.66 ± 0.29 L. Urine parameters were: 24 h volume 1.65 ± 0.70 L, 24 h osmolality 631 ± 221 mOsmol/kg Η₂Ο, 24 h specific gravity 1.017 ± 0.005, 24 h excretion of sodium 166.9 ± 54.7 mEq, 24 h excretion of potassium 72.4 ± 24.6 mEq, color chart 4.2 ± 1.4. Predictors for urine osmolality were age, country, gender, and BMI. Blood indices were: haemoglobin concentration 14.7 ± 1.7 g/dL, hematocrit 43% ± 4% and serum osmolality 294 ± 9 mOsmol/kg Η₂Ο. Daily water intake was higher in summer (2.8 ± 1.02 L) than in winter (2.6 ± 0.98 L) (p = 0.019). Water intake was associated negatively with urine specific gravity, urine color, and urine sodium and potassium concentrations (p < 0.01). Applying urine osmolality cut-offs, approximately 60% of participants were euhydrated and 20% hyperhydrated or dehydrated. Most participants were euhydrated, but a substantial number of people (40%) deviated from a normal hydration level.

Increasing Water Intake of Children and Parents in the Family Setting: A Randomized, Controlled Intervention Using Installation Theory

On average, children and adults in developed countries consume too little water, which can lead to negative health consequences. In a one-year longitudinal field experiment in Poland, we compared the impact of three home-based interventions on helping children and their parents/caregivers to develop sustainable increased plain water consumption habits. Fluid consumption of 334 children and their caregivers were recorded over one year using an online specific fluid dietary record. They were initially randomly allocated to one of the three following conditions: Control, Information (child and carer received information on the health benefits of water), or Placement (in addition to information, free small bottles of still water for a limited time period were delivered at home). After three months, half of the non-controls were randomly assigned to Community (child and caregiver engaged in an online community forum providing support on water consumption). All conditions significantly increased the water consumption of children (by 21.9-56.7%) and of adults (by 22-89%). Placement + Community generated the largest effects. Community enhanced the impact of Placement for children and parents, as well as the impact of Information for parents but not children. The results suggest that the family setting offers considerable scope for successful installation of interventions encouraging children and caregivers to develop healthier consumption habits, in mutually reinforcing ways. Combining information, affordances, and social influence gives the best, and most sustainable, results.

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.

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.

Water intake: validity of population assessment and recommendations

Good hydration is vital for good health and well-being. Until recently, there was little interest in collecting data on water and drink and beverage intake. However, there is increasing evidence that a low water intake or mild dehydration may be linked with the risk of chronic diseases. Accurate estimates of intake in populations are essential to explore these relationships. This will enable the identification of specific populations at the risk of low water intake and allow exposure assessment of potential contaminates and specific nutrients present in drinks and beverages. In addition, data from these population studies are used as the basis of national and international recommendations on water intake and to set and evaluate national health policies. For example, EFSA based their recommendations on data from population studies from 13 European countries. The range of intakes varied from 720 to 2621 mL/day; this diversity cannot be explained by environmental differences alone. However, this variability may, at least partially, be explained by the inconsistency in methodologies used as none of surveys used a dietary assessment tool validated for total water intake or beverage and drink intake. It is reasonable to suggest that this may result in incomplete data collection and it raises questions on the validity of the recommendations. The relationship between water consumption and health warrants further investigation, and robust methodologies are essential to ensure that these data are accurate and useful for setting public health priorities and policies.

Fluid intake survey among schoolchildren in Belgium

Background

In childhood, inadequate fluid intakes can lead on the short term, to reduced physical and cognitive performances. However, few data are available on the fluid intake among schoolchildren in Belgium. The main aim of this study is to evaluate total fluid intake provided by different types of beverages in a sample of Belgian schoolchildren, in order to assess the percentage of individuals complying with the European Food Safety Authority recommendations for total fluid intake. A secondary aim was to characterize the study population in terms of determinants of the total fluid intake requirements.

Methods

A child friendly “fluids and liquid food” diary was used to prospectively record the volume and frequency of beverage consumption over 7 days from 1045 schoolchildren. This diary also recorded the practice of physical activity. An adequate fluid intake was defined as an intake ≥ 75% of the age-specific adequate intake recommended by the EFSA.

Results

The median (P25-P75) of habitual daily fluid intake was 864 (608–1104) ml/day, with 355 (194–579) coming from drinking water. This habitual daily fluid intake varied significantly among the three investigated EFSA groups (girls and boys aged from 8 years, girls from 9 to 13 and boys from 9 to 13), except for the drinking water (P = 0.906). The highest medians of fruit juice, sugar-sweetened beverages and milk and derivatives were found among boys of 9–13. Only 9.5% of the children had an adequate fluid intake, with a value of 19.2% among the 8 years old girls and boys, 7.0% among girls of 9–13 and 8.4% among boys of 9–13. In the whole sample, 27.7% of the children declared to drink less than 3-4x/day, 56% drunk water less than 2x/day and 7.7% drunk no water at all. Every day, 27.1% and 34.1% of the children drank respectively one fruit juice and one sugar-sweetened beverage.

Conclusion

Belgian schoolchildren have an inadequate total fluid intake. Given the potential health consequences, interventions involving parents and school environment to promote water consumption seem pertinent.

Effects of changes in water intake on mood of high and low drinkers

Objective

To evaluate the effects of a change in water intake on mood and sensation in 22 habitual high-volume (HIGH; 2-4 L/d) and 30 low-volume (LOW; <1.2 L/d) drinkers who were asked to respectively decrease and increase their daily water intake.

Method

During baseline HIGH consumed 2.5 L and LOW 1 L of water/day. During 3 controlled intervention days HIGH's water intake was restricted to 1 L/day whereas LOW's was increased to 2.5 L water/day. Several mood scales (Bond & Lader Visual Analog Scale (VAS), Profile of Mood States, Karolinska Sleepiness Scale, Thirst & Emotional VAS) were administered at different time points during the study. ANOVA including intervention, time point and intervention by time point as fixed effects on mean values (i.e.; baseline data vs. mean of 3 intervention days) for each mood scale was performed.

Results

At baseline HIGH and LOW were comparable in mood state, except for thirst scores (estimate = 17.16, p<0.001) and POMS depression-dejection scores (estimate = 0.55, p<0.05) which were both higher in the HIGH vs. LOW. In HIGH the restricted water intake resulted in a significant increase in thirst (p<0.001) and a decrease in contentedness (p<0.05), calmness (p<0.01), positive emotions (p<0.05) and vigor/activity (p<0.001). In LOW, increased water consumption resulted in a significant decrease in fatigue/inertia (p<0.001), confusion/bewilderment (p = 0.05) and thirst (p<0.001) and a trend to lower sleepiness (p = 0.07) compared to baseline.

Conclusion

Increasing water intake has beneficial effects in LOW, especially sleep/wake feelings, whereas decreasing water intake has detrimental effects on HIGH's mood. These deleterious effects in HIGH were observed in some sleep/wake moods as well as calmness, satisfaction and positive emotions.

Impact of fluid intake in the prevention of urinary system diseases: a brief review

We are often told that we should be drinking more water, but the rationale for this remains unclear and no recommendations currently exist for a healthy fluid intake supported by rigorous scientific evidence. Crucially, the same lack of evidence precludes the claim that a high fluid intake has no clinical benefit. The aim of this study is to describe the mechanisms by which chronic low fluid intake may play a crucial role in the pathologies of four key diseases of the urinary system: urolithiasis, urinary tract infection, chronic kidney disease and bladder cancer. Although primary and secondary intervention studies evaluating the impact of fluid intake are lacking, published data from observational studies appears to suggest that chronic low fluid intake may be an important factor in the pathogenesis of these diseases.

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.