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Abstract

Key findings: Data from the National Health and Nutrition Examination Survey, 2009-2012 •Among U.S. adults, men consumed an average of 3.46 liters (117 ounces) of water per day, and women consumed 2.75 liters (93 ounces) per day. •Men aged 60 and over consumed less water (2.92 liters) than men aged 20-39 (3.61 liters) and 40-59 (3.63 liters). Similarly, women aged 60 and over consumed less water (2.51 liters) than women aged 20-39 (2.78 liters) and 40-59 (2.9 liters). •Non-Hispanic white men and women consumed more water daily than non-Hispanic black and Hispanic men and women. •Water intake increased with physical activity level for both men and women. •Among men, 30% of total water consumed was plain water (with the remainder from other foods and liquids) compared with 34% for women.
NCHS Data Brief No. 242 April 2016
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Daily Water Intake Among U.S. Men and Women, 2009–2012
Asher Rosinger, Ph.D., M.P.H., and Kirsten Herrick, Ph.D., M.Sc.
Key ndings
Data from the National
Health and Nutrition
Examination Survey,
2009–2012
Among U.S. adults, men
consumed an average of 3.46
liters (117 ounces) of water per
day, and women consumed 2.75
liters (93 ounces) per day.
Men aged 60 and over
consumed less water (2.92
liters) than men aged 20–39
(3.61 liters) and 40–59 (3.63
liters). Similarly, women aged
60 and over consumed less
water (2.51 liters) than women
aged 20–39 (2.78 liters) and
40–59 (2.9 liters).
Non-Hispanic white men and
women consumed more water
daily than non-Hispanic black
and Hispanic men and women.
Water intake increased with
physical activity level for both
men and women.
Among men, 30% of total
water consumed was plain
water (with the remainder
from other foods and liquids)
compared with 34% for
women.
Water is an essential nutrient for life (1). Institute of Medicine (IOM)
recommendations from 2004 set adequate levels for total water intake from all
foods and liquids at 3.7 liters (125 ounces) for men and 2.7 liters (91 ounces)
for women (2). Consuming inadequate amounts of water increases the risk of
dehydration, kidney stones, and poorer cognitive performance (3,4). Differences
in water intake have been reported by age, race and Hispanic origin, and
physical activity (5,6). This report provides updated estimates of mean daily
total water intake for U.S. men and women aged 20 and over in 2009–2012.
Keyword: National Health and Nutrition Examination Survey
Did total water intake per day vary by age group for men and
women during 2009–2012?
Men consumed an average of 3.46 liters (L) or 117 ounces of water from all foods and
liquids per day, while women consumed an average of 2.75 L or 93 ounces (Figure 1).
WomenMen
Adequate intake (3.7 liters)
Adequate intake (2.7 liters)
3.46 13.61 13.63
2.92 2.75 12.78 1,22.90 2.51
Figure 1. Mean total water intake per day among adults aged 20 and over, by sex and age group:
United States, 2009–2012
95% confidence interval.
1Significantly different from those aged 60 and over, p < 0.01.
2Significantly different from those aged 20–39, p < 0.05.
NOTE: Access data table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db242_table.pdf#1.
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2009–2012.
Total water intake (liters)
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
60 and over40–5920–39Total
NCHS Data Brief No. 242 April 2016
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Total water intake was lowest among both men and women aged 60 and over compared with
younger age groups. Men aged 20–39 (3.61 L) and 40–59 (3.63 L) consumed signicantly more
water per day than men aged 60 and over (2.92 L). Women aged 20–39 consumed 2.78 L of total
water per day, while those aged 40–59 consumed signicantly more (2.90 L), and those aged 60
and over consumed signicantly less (2.51 L).
On average, men aged 20–39 and 40–59 consumed water at about the recommended adequate
intake level of 3.7 L, while those aged 60 and over consumed 0.78 L less water than the
recommended adequate intake. Women aged 20–39 consumed water at about the adequate intake
level of 2.7 L, while women aged 40–59 consumed 0.2 L more than the adequate intake, and
women aged 60 and over consumed 0.19 L less than the recommended adequate intake.
Were there differences in mean total water intake per day by race and
Hispanic origin among men and women?
Non-Hispanic white men (3.60 L) and women (2.85 L) had the highest water intake, followed by
Hispanic men (3.33 L) and women (2.58 L), and non-Hispanic black men (2.92 L) and women
(2.41 L) (Figure 2).
Compared with adequate intake levels, non-Hispanic black men and women consumed 0.78 L and
0.29 L less than the IOM recommendations. Hispanic men and women had average water intakes
0.37 L and 0.12 L below their respective adequate intake levels. Non-Hispanic white men did not
differ signicantly from the adequate intake, while non-Hispanic white women consumed 0.15 L
more water than the adequate intake.
Figure 2. Mean total water intake per day among adults aged 20 and over, by sex and race and Hispanic origin:
United States, 2009–2012
95% confidence interval.
1Significantly different from non-Hispanic black, p < 0.05.
2Significantly different from Hispanic, p < 0.05.
NOTE: Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db242_table.pdf#2.
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2009–2012.
Total water intake (liters)
HispanicNon-Hispanic blackNon-Hispanic white
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
WomenMen
1,23.60
1,22.85
22.41 2.58
22.92
3.33
Adequate intake (3.7 liters)
Adequate intake (2.7 liters)
NCHS Data Brief No. 242 April 2016
■  3  ■
Were there differences in mean total water intake per day by physical
activity level among men and women?
As physical activity level increased, mean total water intake per day increased for both men
and women. Men with low physical activity had the lowest total water intake per day (3.15 L),
followed by moderately active (3.36 L) and highly active (3.63 L) men (Figure 3). Similarly,
women with low physical activity had the lowest total water intake per day (2.55 L), followed by
moderately active (2.73 L) and highly active (2.98 L) women.
Men with low and moderate physical activity levels consumed an average total water intake
lower than the recommended adequate intake, while highly active men did not differ from the
recommendation. Highly active women consumed more total water than the recommended intake
for women, while women with low activity consumed slightly less than the recommendation, and
moderately active women did not differ from the recommendation.
Figure 3. Mean total water intake per day among adults aged 20 and over, by sex and physical activity level:
United States, 2009–2012
Total water intake (liters)
HighModerateLow
95% confidence interval.
1Linear trend by physical activity status, p < 0.01.
NOTE: Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db242_table.pdf#3.
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2009–2012.
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
WomenMen
Adequate intake (3.7 liters)
Adequate intake (2.7 liters)
13.15
12.55
2.98
2.73
3.36
3.63
NCHS Data Brief No. 242 April 2016
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Were there differences between men and women in how much plain water
contributed to total water intake?
Men and women differed in how much plain water contributed to their total daily water intake.
Plain water contributed 30% of total water intake men consumed per day (Figure 4). The
remaining 70% of their water consumption came from other dietary foods and liquids. For
women, plain water made up 34% of total water intake, with the remaining 66% coming from
other dietary foods and liquids.
Figure 4. Plain water as percentage of total water intake among adults aged 20 and over, by sex: United States,
2009–2012
1Significantly different from women, p < 0.01.
NOTE: Access data table for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db242_table.pdf#4.
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2009–2012.
Men Women
Plain water
130%
Other dietary water
70%
Other dietary water
66%
Plain water
34%
NCHS Data Brief No. 242 April 2016
■  5  ■
Summary
Overall in 2009–2012, the daily average total water intake from all foods and liquids among
U.S. adults aged 20 and over was 3.46 L for men, with 30% coming from plain water, and 2.75
L for women, with 34% coming from plain water. Total water intake was lower among men and
women aged 60 and over than among younger adults. Non-Hispanic black men and women had
the lowest average total water intake, similar to results from previous studies (5). For U.S. adults
aged 20 and over, total water intake increased with physical activity level.
Men’s average total water intake per day was approximately 0.25 L less than the recommended
adequate intake, whereas women’s intake was approximately the same as the adequate intake. On
average, men and women aged 60 and over, non-Hispanic black men and women, Hispanic men
and women, men and women with low physical activity, and men with moderate physical activity
consumed less than the adequate daily intake. Previous studies have shown that adults aged 60
and over are among the most vulnerable to dehydration (4,7). This report found that men aged 60
and over consumed 2.92 L, roughly 0.8 L less than the adequate intake, and women aged 60 and
over consumed 2.51 L, approximately 0.2 L less.
Denitions
Physical activity level: Summary of reported time spent in the previous week in moderate and
vigorous activities from biking or walking, work, and leisure activities. Low physical activity is
dened as less than 150 minutes of moderate or vigorous physical activity per week (8). Moderate
physical activity is dened as between 150 minutes and 300 minutes of moderate or vigorous
physical activity per week. High physical activity is dened as 300 minutes or more of moderate
or vigorous physical activity per week.
Total water intake: Determined by the 24-hour dietary recall interview in which respondents list
all foods and liquids consumed in the previous 24-hour period from midnight to midnight. Plain
water intake and moisture content calculated from foods and beverages is then summed in grams,
the equivalent of milliliters.
Data source and methods
Data from the National Health and Nutrition Examination Surveys (NHANES) for survey
years 2009–2010 and 2011–2012 were used for these analyses. NHANES is a cross-sectional
survey designed to monitor the health and nutritional status of the civilian noninstitutionalized
U.S. population (9). It is conducted by the Centers for Disease Control and Prevention’s (CDC)
National Center for Health Statistics. The survey combines in-home interviews conducted in the
participants’ homes and standardized physical examinations conducted in mobile examination
centers (MEC). For this report, data were collected through an in-person 24-hour dietary recall
interview in the MEC. Dietary recalls cover intake during the day (24 hours, midnight to
midnight) prior to the standardized physical examination in the MEC (10).
The NHANES sample is selected through a complex, multistage probability design. In
2009–2010 and 2011–2012, non-Hispanic black and Hispanic persons, among other groups,
were oversampled to obtain reliable estimates for these population subgroups. Race and Hispanic
NCHS Data Brief No. 242 April 2016
■  6  ■
origin categories reect individuals reporting only one race; those reporting “other” races and
more than one race are included in the total but are not reported separately.
Data were analyzed using the day 1 dietary sample weights to account for the days of the week,
differential probabilities of selection, nonresponse, and noncoverage. The standard errors of
total water intake were estimated using Taylor series linearization, a method that incorporates
the sample design. Ninety-ve percent condence intervals were used to assess whether
each subpopulation’s water intake on a given day included the adequate intake. Pregnant and
breastfeeding women were excluded from the analysis.
Differences between groups were evaluated using a univariate t statistic at the p < 0.05
signicance level. Test for trends by physical activity level was evaluated using linear regression,
and the signicance was set at p < 0.05. All differences reported are statistically signicant
unless otherwise indicated. Statistical analyses were conducted using Stata version 13.1 (College
Station, T.X.).
About the authors
Asher Rosinger is with CDC’s Epidemic Intelligence Service, assigned to the National Center for
Health Statistics (NCHS), Division of Health and Nutrition Examination Surveys. Kirsten Herrick
is also with NCHS’ Division of Health and Nutrition Examination Surveys.
References
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read/10925/chapter/1.
3. Grandjean AC, Grandjean NR. Dehydration and cognitive performance. J Am Coll Nutr
26(5 Suppl):549S–554S. 2007.
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5. Kant AK, Graubard BI, Atchison EA. Intakes of plain water, moisture in foods and beverages,
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8. HHS. Physical activity guidelines for Americans. 2008. Available from: http://www.health.
gov/paguidelines/pdf/paguide.pdf.
NCHS Data Brief No. 242 April 2016
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9. National Center for Health Statistics. National Health and Nutrition Examination Survey.
Questionnaires, datasets, and related documentation. Available from: http://www.cdc.gov/nchs/
nhanes/nhanes_questionnaires.htm.
10. National Center for Health Statistics. National Health and Nutrition Examination Survey:
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Suggested citation
Rosinger A, Herrick K. Daily water intake
among U.S. men and women, 2009–2012.
NCHS data brief, no 242. Hyattsville, MD:
National Center for Health Statistics. 2016.
Copyright information
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source, however, is appreciated.
National Center for Health
Statistics
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Nathaniel Schenker, Ph.D., Deputy Director
Jennifer H. Madans, Ph.D., Associate
Director for Science
Division of Health and Nutrition
Examination Surveys
Kathryn S. Porter, M.D., M.S., Director
Ryne Paulose-Ram, Ph.D., Associate
Director for Science
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There is a surprising paucity of studies that have systematically examined the correlates of water intake in the US population. The objective was to examine the association of contributors of water intake with dietary characteristics, meal consumption, and body weight in the US population. We used 24-h dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 (n = 12,283) and the NHANES 2005-2006 (n = 4112) to examine the independent association of intakes of plain water, beverage moisture, food moisture, and total water with sociodemographic factors, dietary characteristics (energy, nutrients, diet quality, and energy density), and meal patterns (number of eating episodes, mention of breakfast or snack) by using multiple regression methods. In 2005-2006, American adults reported consuming 3.18 L of total water within the previous 24 h (in 1999-2004, estimated total water intake was 3.35 L), with plain water and beverages contributing 33% and 48% of the total, respectively. Plain water intake was unrelated to the intake of energy and body mass index but was positively related to dietary fiber and inversely related to beverages, sugars, and the energy density of foods; these associations were in the opposite direction for beverage moisture intake. Total water intake was inversely related to energy from fat and energy density but positively related to dietary fiber, caffeine, alcohol, and diet quality. The number of eating episodes predicted higher beverage and food moisture and total water intakes. A higher body mass index predicted higher intakes of beverage moisture and total water. Various contributors of total water intake differed in their association with dietary characteristics and body weight in the adult US population.
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This review examines the current knowledge of water intake as it pertains to human health, including overall patterns of intake and some factors linked with intake, the complex mechanisms behind water homeostasis, and the effects of variation in water intake on health and energy intake, weight, and human performance and functioning. Water represents a critical nutrient, the absence of which will be lethal within days. Water's importance for the prevention of nutrition-related noncommunicable diseases has received more attention recently because of the shift toward consumption of large proportions of fluids as caloric beverages. Despite this focus, there are major gaps in knowledge related to the measurement of total fluid intake and hydration status at the population level; there are also few longer-term systematic interventions and no published randomized, controlled longer-term trials. This review provides suggestions for ways to examine water requirements and encourages more dialogue on this important topic.
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Recent data suggest that as many as 50% of older adults may have hypertonic plasma, an indicator of cell dehydration that predicts a range of adverse outcomes. To determine if a prevalence of this magnitude could be real, this study used nationally representative data to estimate the prevalence of hypertonicity, and to test for biologically plausible associations between hypertonicity, older age, glucose dysregulation, hemoconcentration, reduced bioelectrical impedance, and water intake. Cross-sectional. Community-dwelling adults (aged 20 to 90 years) who gave blood as part of the Third National Health and Nutrition Examination Survey (N = 14,855). Plasma tonicity was estimated from glucose, sodium, and potassium values. The weighted prevalences of mild (295 to 300 mmol/L) and overt hypertonicity (> or = 300 mmol/L) were estimated by age, sex, race/ethnicity, fasting, and glycemic status. Hyper- and normotonic (285 to 295 mmol/L) groups were compared with respect to elevated blood chemistry values, bioelectrical impedance analysis parameters, as well as total water intake (grams, % Adequate Intake, and grams per kilogram body weight), using multivariable models that adjusted for age, sex, race/ethnicity, and survey design. Mild and overt hypertonicity were observed in 40% and 20% of the sample, respectively. Hypertonicity was positively associated with older age, Hispanic and African-American race, impaired glucose tolerance, diabetes, and hemoconcentration, and inversely associated with bioelectrical impedance analysis parameters. Hypertonicity was associated with greater total water intake in younger adults, but decreased intake in older adults. Clinicians and researchers should be alert to hypertonicity and its causes in older adults.
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Human neuropsychology investigates brain-behavior relationships, using objective tools (neurological tests) to tie the biological and behavior aspects together. The use of neuropsychological assessment tools in assessing potential effects of dehydration is a natural progression of the scientific pursuit to understand the physical and mental ramifications of dehydration. It has long been known that dehydration negatively affects physical performance. Examining the effects of hydration status on cognitive function is a relatively new area of research, resulting in part from our increased understanding of hydration's impact on physical performance and advances in the discipline of cognitive neuropsychology. The available research in this area, albeit sparse, indicates that decrements in physical, visuomotor, psychomotor, and cognitive performance can occur when 2% or more of body weight is lost due to water restriction, heat, and/or physical exertion. Additional research is needed, especially studies designed to reduce, if not remove, the limitations of studies conducted to date.
Daily water intake among U.S. men and women NCHS data brief, no 242. Hyattsville, MD: National Center for Health Statistics. 2016. Copyright information All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however
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Suggested citation Rosinger A, Herrick K. Daily water intake among U.S. men and women, 2009–2012. NCHS data brief, no 242. Hyattsville, MD: National Center for Health Statistics. 2016. Copyright information All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
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Internet: http://www.cdc.gov/nchs Online request form: http://www.cdc.gov/info/ ISSN 1941–4927 Print ed. ISSN 1941–4935 Online ed.
Dietary reference intakes for water, potassium, sodium, chloride, and sulfate Available from: http://www.nap
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Institute of Medicine. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. Washington, DC: National Academies Press. 2004. Available from: http://www.nap.edu/ read/10925/chapter/1.
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Charles J. Rothwell, M.S., M.B.A., Director Nathaniel Schenker, Ph.D., Deputy Director Jennifer H. Madans, Ph.D., Associate Director for Science Division of Health and Nutrition Examination Surveys Kathryn S. Porter, M.D., M.S., Director Ryne Paulose-Ram, Ph.D., Associate Director for Science For e-mail updates on NCHS publication releases, subscribe online at: http://www.cdc.gov/nchs/govdelivery.htm.