Body Composition and a School Day Hydration State among Polish Children-A Cross-Sectional Study

Beverage Consumption and Factors Influencing the Choice of Beverages among Polish Children Aged 11-13 Years in 2018-2023

Adequate hydration is essential for good health, and an individual's hydration status is determined by the quantity and type of ingested fluids. The aim of the present study was to determine the hydration status of school-age children and evaluate changes in the type and quantity of consumed beverages between 2018 and 2023. The study was conducted in two stages between 2018 and 2023, and a total of 1030 fully completed questionnaires were returned by the children and their parents. A comparison of the parents' responses regarding factors that affect beverage choices revealed that beverage composition was more significant for the parents in 2023 than in 2018, whereas health-promoting properties were significant for only less than 30% of the respondents. Taste preferences were important for both the parents and the children, and they were the main criterion in the choice of beverages in both 2018 and 2023. In turn, advertising was an important factor for children, and the percentage of children who were guided by advertising in their choice of beverages increased from 52.1% in 2018 to 58.5% in 2023 (p < 0.05). Daily fluid intake from beverages in children aged 11-13 years generally does not meet recommended intakes. Low fluid intake can negatively affect children's hydration status and bodily functions. Taste preferences and advertising were correlated with a higher intake of carbonated and non-carbonated sugar-sweetened beverages (SSBs) and dairy beverages. The percentage of children who bought drinks independently and had access to SSBs increased significantly during the analyzed period. Obtain results indicate that nutrition education programs are needed to teach adolescents to make healthy drink choices, limit their consumption of SSBs and EDs, and promote regular intake of natural mineral water and non-sweetened dairy beverages.

Provision of special diets to children in public nurseries and kindergartens in Kraków (Poland)

Background

A specialized diet could be due to an allergy or other medical needs and also religious or cultural reasons. This study aimed to assess the availability and provision of special diets in kindergartens and nurseries financed by the Municipality of Kraków.

Methods

This observational cross-sectional study was based on a diagnostic survey carried out using the Computer-Assisted Web Interview method and addressed to the managers of nurseries (n = 21) and kindergartens (n = 71) and, separately, to the parents of children attending these facilities (n = 1,096). Non-parametric tests were applied for an unadjusted comparison between children at nurseries and those at kindergartens.

Results

Children with particular dietary requirements received special diet meals in 95.2% of nurseries and 60.5% of kindergartens. The availability of special diets was associated with the type of facility (p = 0.001), the number of children who ate in the facility (p = 0.032), and the daily cost of meals served to children (p = 0.009). The cost of meals was higher in kindergartens that offered special diets vs. those that did not offer such diets (p < 0.001). According to parents, 96.4% of the total number of children ate meals served in the facilities. In nurseries, 16.1% of children were on a special diet (as per the doctor's recommendations in 11.7% of cases and according to parents' own choice in 4.4%). In kindergartens, a special diet was served to 12.7% of children (doctor's recommendations, 8.5%; parents' own choice, 4.2%). The most common reason for using a special diet was food allergy (8.2% of children in nurseries and 5.8% of children in kindergartens). It was reported more often by the parents of children attending nurseries than by the parents of children attending kindergartens (8.0% vs. 4.2%, p = 0.007). The requirement for a special diet was found to be associated with the age of children (p < 0.033) and the use of oral treatment for chronic disease (p < 0.001).

Conclusion

Providing special diets for children is better in nurseries than in kindergartens. Legal regulations are urgently needed to ensure equal access to adequate nutrition for all children with special dietary needs in childcare facilities.

Psychosocial and environmental risk factors of obesity and hypertension in children and adolescents-a literature overview

Childhood obesity has become a worldwide epidemic in the 21st century. Its treatment is challenging and often ineffective, among others due to complex, often not obvious causes. Awareness of the existence and meaning of psychosocial and environmental risk factors seems to be an essential element in the prevention and treatment of obesity and its complications, especially arterial hypertension. In this review, we will discuss the role of that risk factors linking obesity and increased cardiovascular disorders including the role of nutritional factors (including the role of unhealthy diet, inadequate hydration), unhealthy behaviors (e.g. smoking, alcohol and drugs, sedentary behavior, low physical activity, disrupted circadian rhythms, sleep disorders, screen exposure), unfavorable social factors (such as dysfunctional family, bullying, chronic stress, mood disorders, depression, urbanization, noise, and environmental pollution), and finally differences in cardiovascular risk in girls and boys.

The association between hydration status and body composition in healthy children and adolescents

OBJECTIVES

Children 10-20 years old in the US are currently obese, showing suboptimal hydration as 60% fail to meet the US Dietary Reference Intakes for water. Studies have shown a significant inverse association between hydration status and body composition in children, although most failed to use the Dual-X-Ray Absorptiometry Scan (DEXA), the gold standard for body composition. Limited studies used an objective marker to measure hydration, such as urine specific gravity (USG) from a 24-h urine collection. Therefore, this study aimed to examine the association between hydration status (measured from USG in a 24-h urine sample and assessed from three 24-h dietary recalls) and body fat % and lean mass (assessed from a DEXA scan) in children (10-13 years, n=34) and adolescents (18-20 years, n=34).

METHODS

Body composition was measured using DEXA, total water intake (mL/d) was assessed from three 24-h dietary recalls and analyzed using the Nutrition Data System for Research (NDSR). Hydration status was objectively measured using USG via 24-h urine collection.

RESULTS

Overall body fat % was 31.7 ± 7.31, total water intake was 1746 ± 762.0 mL/d, and USG score was 1.020 ± 0.011 uG. Linear regressions showed significance between total water intake and lean mass (B=12.2, p<0.05). Logistic regressions showed no significant association between body composition and USG and total water intake.

CONCLUSIONS

Findings showed total water intake was significantly associated with lean mass. Future research should be conducted to explore other objective markers of hydration and with a larger sample.

Fluid Intake and the Occurrence of Erosive Tooth Wear in a Group of Healthy and Disabled Children from the Małopolska Region (Poland)

Background: The aim of this study was to analyse the relationship between the type and amount of fluid intake and the incidence of erosive tooth wear in a group of healthy children and children with disabilities. Methods: This study was conducted among children aged 6-17 years, patients of the Dental Clinic in Kraków. The research included 86 children: 44 healthy children and 42 children with disabilities. The prevalence of erosive tooth wear using the Basic Erosive Wear Examination (BEWE) index was assessed by the dentist, who also determined the prevalence of dry mouth using a mirror test. A qualitative-quantitative questionnaire on the frequency of consumption of specific liquids and foods related to the occurrence of erosive tooth wear, completed by the children's parents, was used to assess dietary habits. Results: The occurrence of erosive tooth wear was determined for 26% of the total number of children studied, and these were mostly lesions of minor severity. The mean value of the sum of the BEWE index was significantly higher (p = 0.0003) in the group of children with disabilities. In contrast, the risk of erosive tooth wear was non-significantly higher in children with disabilities (31.0%) than in healthy children (20.5%). Dry mouth was significantly more frequently identified among children with disabilities (57.1%). Erosive tooth wear was also significantly more common (p = 0.02) in children whose parents declared the presence of eating disorders. Children with disabilities consumed flavoured water or water with added syrup/juice and fruit teas with significantly higher frequency, while there were no differences in quantitative fluid intake between groups. The frequency and quantity of drinking flavoured waters or water with added syrup/juice, sweetened carbonated, and non-carbonated drinks were associated with the occurrence of erosive tooth wear for all children studied. Conclusions: The group of studied children presents inappropriate drinking behaviours regarding the frequency and amount of beverages consumed, which, especially in a group of children with disabilities, may contribute to the formation of erosive cavities.

The Severity of Obesity Promotes Greater Dehydration in Children: Preliminary Results

The state of hydration of the body depends on the balance between the amount of water and salt consumed and excreted (the urinary extraction of excess sodium requires water). Inappropriate nutrition, particularly consuming too much processed food, causes obesity in children and additionally causes excessive sodium consumption, thus increasing the risk of excessive water loss. The aim of this study was to assess the hydration status of children with obesity and the relation between hydration, body composition, urinary sodium extraction, and nutrient intake. The study group consisted of 27 patients with obesity, with a mean age of 12.89 ± SD 2.79. Each patient's height, weight, body composition (electrical bioimpedance (BIA)), diet (7-day record), and biochemical tests were assessed. The hydration status was assessed using 24-hour urine collection, 24-hour urine osmolality, and an ultrasound of the vena cava (IVC/Ao index). Overall, 55% of children (n = 15) had urine osmolality values above 800 mOsm/kgH₂O, which indicates significant dehydration, and 53% (n = 14) were dehydrated, based on the IVC/Ao index. Children with obesity and dehydration had a significantly higher BMI (31.79 vs. 27.32; p = 0.0228), fat mass percentage (37.23% vs. 30.07% p = 0.0051), and fat mass in kg (30.89 vs. 20.55; p = 0.0158), and significantly higher sodium intake from their diet (3390.0 mg vs. 2921.0 mg; p = 0.0230), as well as their sodium/potassium ratio (2.4 vs. 2.0; p = 0.0043). The 24-hour urinary sodium excretion and osmolality values were directly related to fat-mass percentage and fat-mass (in kg) in a simple linear correlation analysis. Our preliminary results confirm that obesity is related to dehydration. The overall high sodium excretion in children with obesity indicates an excessive salt intake along with low potassium intake, which is a significant predictor of dehydration, regardless of the total water intake (TWI).

Acute Water Supplementation Improved the Body Composition of Young Female Adults After Water Restriction of 12 h in Baoding, China: A Randomized Controlled Trial (RCT)

Insufficient intake of water may influence the balance of water in the human body. In this study, we explore the impacts of water supplementation on body composition indices among young adults after 12 h of water restriction, with the aim to determine the optimum volume of water for improving body water composition. A randomized controlled trial study was conducted among 64 young men and women in Baoding, China. After fasting overnight for 12 h, anthropometric measurements and urine and blood samples were collected as a baseline test at 8:00 a.m. of Day 2. Body composition was determined by measuring the ECW (extracellular water), ICW (intracellular water), and TBW (total body water) through bioelectrical impedance analysis (BIA). The participants were randomly divided into four groups, including water supplementation (WS) groups 1, 2, and 3, with 500, 200, and 100 mL of water, respectively, and a no water supplementation (NW) group. After 90 min, they were reassessed in a rehydration test (at 10:00 a.m. of Day 2). Repeated measurement ANOVA was used to assess the impact of water supplementation on body composition. Comparing the baseline and rehydration tests, interactions between time and volume were not significant among the men (all p > 0.05). Among women, a significant interaction was only found in ECW (p = 0.043), with TBW tending toward being significant (p = 0.055). Comparing the baseline and rehydration tests, the ECW in WS group 1, WS group 3, and the NW group all decreased (p = 0.028, p = 0.001, and p = 0.029), with reductions of 0.1, 0.3, and 0.2 kg, respectively; however, no significant decrease was observed in WS group 2 (p = 0.329). Furthermore, comparing the WS groups with the NW group in the rehydration test, the differences were not significant (p = 1.000, p = 1.000, and p = 0.288, respectively). Between men and women within groups, all of the body composition indices differed significantly, both at baseline and rehydration tests (all p < 0.05). Water supplementation led to changes in the distribution of the water content in young female adults in this study-but not men-after 12 h of water restriction, with no decrease in ECW. Finally, we found that 200 mL was the minimum volume capable of improving the water content distribution in participants in this study.

Trial Registration

[www.chictr.org.cn], identifier [ChiCTR-IOR-17011568].

Dehydration Status Aggravates Early Renal Impairment in Children: A Longitudinal Study

Dehydration is common in children for physiological and behavioral reasons. The objective of this study was to assess changes in hydration status and renal impairment across school weekdays. We conducted a longitudinal study of three repeated measures of urinalysis within one week in November 2019 in a child cohort in Beijing, China. We measured urine specific gravity (USG) to determine the dehydration status, and the concentration of β₂-microglobulin (β₂-MG) and microalbumin (MA) to assess renal function impairment among 1885 children with a mean age of 7.7 years old. The prevalence of dehydration was 61.9%, which was significantly higher in boys (64.3%). Using chi-square tests and linear mixed-effects regression models, we documented the trends of the renal indicators’ change over time among different hydration statuses. Compared to Mondays, there were apparent increases of β₂-MG concentrations on Wednesdays (β = 0.029, p < 0.001) and Fridays (β = 0.035, p < 0.001) in the dehydrated group, but not in the euhydrated group. As for the MA concentrations, only the decrease on Fridays (β = −1.822, p = 0.01) was significant in the euhydrated group. An increased trend of elevated β₂-MG concentration was shown in both the euhydrated group (Z = −3.33, p < 0.001) and the dehydrated group (Z = −8.82, p < 0.001). By contrast, there was a decreased trend of elevated MA concentrations in the euhydrated group (Z = 3.59, p < 0.001) but not in the dehydrated group. A new indicator ratio, β₂-MG/MA, validated the consistent trends of renal function impairment in children with dehydration. Renal impairment trends worsened as a function of school days during the week and the dehydration status aggravated renal impairment during childhood across school weekdays, especially tubular abnormalities in children.

Parental Food Choices and Engagement in Raising Children's Awareness of Sustainable Behaviors in Urban Poland

Promoting sustainable food consumption patterns and understanding factors driving environmentally-friendly food choices is one of the challenges of public health nutrition policies in the 2020s and crucial for the future wellbeing of humans, food systems and the planet as a whole. To assess the impact of sustainability issues on the behaviors of parents living with young school-aged children in Poland a CAWI survey of 1035 adults in urban areas was conducted. A clustering procedure revealed that two of the identified clusters (73% of the sample) rated sustainability factors as important when purchasing food for children but only one of these clusters (29% of the sample) was actively engaged in raising their child’s awareness about sustainable behaviors. The third cluster (27% of the sample) had no intentions to teach their children about food sustainability because of lack of time or distrust in these topics. More than 80% of the sample agreed that parents share a responsibility in teaching children about the links between food, health and environment. Principles of healthy and sustainable diets should be incorporated into public health programmes to empower family members to engage in raising their children’s awareness and adopt more healthy and environmentally-friendly food consumption practices.

Effects of Water Restriction and Water Replenishment on the Content of Body Water with Bioelectrical Impedance among Young Adults in Baoding, China: A Randomized Controlled Trial (RCT)

Insufficient water intake may affect body composition. The purpose of this research was to explore the effects of water restriction and replenishment on body composition and to evaluate the optimum amount of water that improves body composition. A total of 76 young adults aged 18-23 years old (40 males and 36 females) in Baoding, China, were recruited in this randomized controlled trial, with a 100% completion rate. After fasting overnight for 12 h, at 8:00 a.m. of day 2, a baseline test, including anthropometric indices and collection of urine and blood samples, was explored. Participants were then subjected to water restriction for 24 h, and three meals with ≤75% water content were provided. At 8:00 AM of day 3, the same indices were determined as a dehydration test. Then, participants were randomly assigned into four groups: three water replenishment groups (WR groups 1, 2, and 3 given 1000, 500, and 200 mL of purified water, respectively) and one non-replenishment group (NR group, with no water). After 90 min, the same measurements were performed as a rehydration test. Compared with the baseline test, during the dehydration test, the intracellular water to total body water ratio (ICW/TBW) increased; and extracellular water (ECW), ECW/TBW (extracellular water to total body water ratio), and TBW decreased (all p < 0.05). For males, significant differences were found in ECW, ECW/ICW (extracellular water to intracellular water ratio), ICW/TBW, and ECW/TBW (all p < 0.05); for females, significant reductions were found in ICW, ECW, TBW, ECW/ICW, ICW/TBW, and ECW/TBW (all p < 0.05). Furthermore, significant differences were found in ICW, ECW, ICW/TBW, ECW/TBW, ECW/ICW, TBW, and TBW/BW between males and females during the baseline and dehydration test (all p < 0.05). Comparing the dehydration test with the rehydration test, there were significant interactions between time × volume in ICW and TBW (F = 3.002, p = 0.036; F = 2.907, p = 0.040); in males, these were only found in ICW (F = 3.061, p = 0.040); in females, they were found in ICW and TBW (F = 3.002, p = 0.036; F = 2.907, p = 0.040). The ICW levels in WR groups 1 and 2 were all higher than in the NR group (all p < 0.05); the TBW was higher in WR group 1 than in the NR group (p < 0.05). No significant differences were found between WR groups 1 and 2, either in males or in females (all p > 0.05). In the rehydration test, significant differences in body composition were found between males and females among the four groups (all p < 0.05). Water restriction had adverse effects on body composition, and females were more susceptible to water restriction than males. Water replenishment improved the water content of body composition, alleviating the adverse effects of water restriction on ICW and TBW. After water restriction for 36 h, the optimum volume of water to improve body composition among young male adults was 1000 mL, but this was not the case for females.

Feasibility Study of an Educational Intervention to Improve Water Intake in Adolescent Soccer Players: A Two-Arm, Non-Randomized Controlled Cluster Trial

This study aimed to assess the feasibility of an educational intervention on hydration behavior in adolescent soccer players. A pilot study of a two-arm, non-randomized controlled cluster trial was conducted. A total of 316 players aged 13-16 agreed to participate. The response variables were the players' participation in the intervention, their perception of the knowledge acquired, the usefulness and the overall assessment of the intervention. Hydration patterns and acquisition of knowledge on hydration behavior were also assessed. The intervention involved two elements: posters and a web app. A total of 259 adolescents completed the study (intervention group (IG) = 131; control group (CG) = 128). 80.6% of the players responded to the survey assessing the feasibility of the intervention. The mean number of correct answers regarding behavior was significantly higher in the IG (3.54; SD = 1.162) than in the CG (2.64; SD = 1.174) (p < 0.001). The water consumption pattern at all the clubs was ad libitum. Of the players, 10% did not drink any water at all during the game. In conclusion, this intervention has been shown to be feasible for implementation with adolescent soccer players. It suggests that hydration guidelines should be informed by personal factors and that ad libitum water consumption should be avoided.