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Water intake and hydration state in children

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Hyungyu Suh at The Coca-Cola Company
Hyungyu Suh
Stavros A Kavouras at Arizona State University
Stavros A Kavouras
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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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Vol.:(0123456789)
1 3
European Journal of Nutrition (2019) 58:475–496
https://doi.org/10.1007/s00394-018-1869-9
REVIEW
Water intake andhydration state inchildren
HyunGyuSuh1· StavrosA.Kavouras1
Received: 13 September 2018 / Accepted: 21 November 2018 / Published online: 30 November 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
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 biomark-
ers. 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 obser-
vational 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 underhydra-
tion 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.
Keywords Dehydration· Hypohydration· Hydration assessment· Inadequate hydration· Underhydration· Fluid intake
Introduction
Water is the main component of cells, tissues, and organs
[1], and plays vital roles in macronutrient hydrolysis [2] and
overall cell function regulation [3]. Total body water (TBW)
represents approximately 75% of infants’ body weight, and
decreases to nearly 55% in older adults [4, 5]. According
to the Institute of Medicine (IOM) in the US, human milk
satisfies the daily water needs in infants [5, 6], and water
intake requirements differ by age due to age-related gradual
decrease in TBW [5, 7]. About 5–10% of TBW turns over
every day to maintain fluid homeostasis [5, 8], but it can
vary between children and adults based on body surface area
and physical activity levels [9, 10].
Body fluid deficit due to low water intake can lead to
hypertonic–hypovolemic dehydration [11, 12], which is
associated with chronic diseases [13] and impaired cognitive
function [14–16]. Underhydration (assessed via elevated
urine hydration biomarkers) in children is also linked to
lower cognitive performance [17, 18], while water consump-
tion may have a positive effect on cognitive function. For
instance, Benton etal. reported that children performed bet-
ter in school after drinking 300mL of water [19]. Another
study in children 9–12years old found that subjects who
drank 750mL of water performed better on a cognitive test,
compared to the control group [20].
Water intake can be advantageous in children, but the
amount of water from solid food and endogenous metabolic
production are not enough to meet the daily water intake
needs [2]. The IOM and the European food safety authority
(EFSA) provide dietary water intake guidelines based on
sex and age [5, 6, 21]. According to data from the National
Health And Nutrition Examination Survey (NHANES), over
75% of children do not meet the water intake recommen-
dation by IOM [22], and 54.5% of children in the US are
underhydrated based on elevated urine osmolality (greater
than 800 mmolkg−1) [23]. Moreover, over 80% of children
in many European countries drink less water than EFSA
guideline [24–26]. Although there are several publications
indicating underhydration in children, limited studies have
* Stavros A. Kavouras
stavros.kavouras@asu.edu
1 Hydration Science Lab, Arizona State University, Arizona
Biomedical Collaborate, Suite 133, 425 N 5th St, Phoenix,
AZ85004, USA
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Concerning their beverage consumption, the children in this study did not meet the guidelines recommended by the Aruban health authorities, which state that children aged 9 to 12 should consume six to eight glasses of water or noncaloric beverages daily (DVG and IDEFRE 2012). This public health issue of inadequate hydration among children has also been found in other countries worldwide (Bottin et al. 2019;Suh and Kavouras 2019). Although water consumption improved after Kies Awa, the amount of water consumed by children, approximately four glasses, was still inadequate. ...
Promoting water consumption among children through a social network intervention: a cluster randomized controlled trial on a Caribbean island
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Aim This study examined the effect of the evidence-based adapted social network intervention named Kies Awa (translation: Choose Water) on children’s water and sugar-sweetened beverages (SSB) consumption. It also examined the moderating role of children’s descriptive and injunctive norms of water and SSB consumption on the intervention’s effect. Subject and methods We conducted a cluster randomized control trial (RCT) where schools were randomized to one of two clusters: the intervention group (IG; Kies Awa intervention; 156 participants; M = 11.08, SD = 1.00; 53.8% girls) or the control group (CG; no intervention; 144 participants; M = 11.32, SD = 0.96; 52.8% girls). The primary outcome measure was water consumption and the secondary outcome was SSB consumption. Results Linear mixed modeling analyses showed that water consumption increased significantly more among IG participants than in the CG (β = 0.141; p = 0.015). The effect on SSB consumption was moderated by perceived injunctive norms, which refer to social disapproval of consuming SSBs. Specifically, the intervention reduced SSB consumption for participants reporting high levels of injunctive norms (β = -0.052; p = 0.037). Conclusion These findings suggest that Kies Awa, an evidence-based adapted intervention, could be implemented in other Caribbean islands to improve children’s water consumption. This approach could be integrated into school health programs, contributing to public health. These findings may help achieve the United Nations’ goal of ensuring healthy lives for all children, even in under-researched world regions. Clinical Trial Registration: Main ID number: NL-OMON26157, preregistration date 2018-12-20. https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON26157.
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... On the other hand, adequate hydration can have additional benefits, such as helping to improve cognitive development in children and adolescents, as well as reducing stress, and improving concentration. Moreover, hydration is an important factor in the practice of physical activity, itself key component when predicting their future academic and nutritional status (7,8). ...
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Introduction: water is a crucial component of human health useful for various bodily functions. Despite its importance, previous research has largely overlooked hydration in Latin America, focusing instead on regions with greater access to a variety of food sources. Objective: hence, this study provides comprehensive data on water consumption patterns in this region and analyses the hydration profiles of urban Latin American populations, emphasizing the role of pure water in daily intake. Materials and methods: involving 5977 participants from Argentina, Brazil, Costa Rica, Ecuador, and Peru, the study utilized a cross-sectional approach, examining total water intake (TWI) through two nonconsecutive 24-hour dietary recalls. This study focused on understanding the contribution of pure water to daily hydration and identifying disparities in water consumption patterns across different demographic conditions by measuring the TWI from beverages. Results: the findings indicated significant variations in hydration profiles based on country, sex, and socioeconomic status. The median TWI was 3245.6 g/day, with a median water intake from beverages of 1982.9 g/d kcal, which represented 61 % of the participants' total water intake. A total of 63.8 % of the overall sample met the TWI recommendations. Our data indicate that 38.4 % of the water intake came from plain water, followed by coffee and tea (16.9 %), commercial sugar-sweetened beverages (13.7 %), and homemade SSB (11.7 %). Conclusion: these findings contribute to a deeper understanding of nutritional behaviors and may serve as a basis for future studies and health interventions focused on improving hydration habits, with emphasis on pure water consumption, especially in urban areas in developing regions.
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... Penelitian sebelumnya (Suh and Kavouras, 2019) mengenai asupan cairan dan status hidrasi pada anak menunjukkan bahwa 60±24% anak tidak memenuhi kebutuhan cairan sehari. Penelitian di Australia juga menunjukkan bahwa 79% pekerja lapangan mengalami kejadian dehidrasi. ...
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Latar Belakang: Dehidrasi adalah suatu kondisi kekurangan cairan dalam tubuh yang disebabkan karena jumlah cairan yang keluar melebihi jumlah cairan yang masuk. Pekerja merupakan orang dengan risiko dehidrasi karena penggantian cairan yang kurang yang disebabkan oleh asupan cairan tidak mencukupi kebutuhan serta adanya peningkatan pengeluaran cairan melalui keringat, pernafasan dan metabolisme. Memastikan pekerja cukup terhidrasi merupakan salah satu cara meningkatkan keselamatan kerja dan produktivitas. Tujuan: Mengetahui hubungan antara asupan cairan dengan status hidrasi pada pekerja. Metode: Penelitian ini menggunakan metode literature review dengan memilih desain cross sectional. Pencarian artikel dilakukan dengan strategi pencarian jurnal internasional maupun jurnal nasional. Ulasan: Berdasarkan 12 artikel, terdapat hubungan yang signifikan antara asupan cairan dengan status hidrasi pekerja. Mayoritas pekerja mengalami dehidrasi akibat asupan cairan yang rendah. Kesimpulan: Kesimpulan yang didapat adalah asupan cairan berpengaruh langsung terhadap status hidrasi, namun terdapat factor lain yang mendukung seperti kondisi lingkungan dan jenis cairan yang dikonsumsi.
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... The elderly, hospitalized patients and children are more likely to become dehydrated than healthy young adults. This may be due to reduced thirst, viral infections, aging of the body, and the use of diuretics and laxatives [6][7][8]. Chronic dehydration causes fluid deficits within cells. Any decrease in the stored body water lowers the plasma volume, which can decrease the stroke volume and force the body to compensate by raising the heart rate. ...
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Introduction Adequate hydration is essential for maintaining the health and functionality of the human body. This study aimed to examine the association between selected socioeconomic, lifestyle, and health factors and the hydration status of adults with metabolic disorders by analyzing their urine osmolality. Methods The study involved 290 adults aged 18–70 years with metabolic disorders. Separate multivariate logistic regression models were conducted to evaluate the factors associated with urine osmolality in tertiles for women and men. Odds Ratios (OR) and 95% Confidence Intervals (95% CI) were calculated. Results In women, the following factors of urine osmolality were identified in 1st tertile: age (OR:1.04), physical activity (moderate/high vs. no/low; OR:0.38), and headaches (no vs. yes; OR:1.55), in 2nd tertile: physical activity (moderate/high vs. no/low; OR:2.46) and fatigue during the day (sometimes vs. never/very rarely; OR:0.45), and in 3rd tertile: age (OR:0.94), professional status (‘I work part-time/I study and I work’ vs. ‘I do not work/I study’; OR:0.27), fatigue during the day (very often vs. never/very rarely; OR:2.55), and headaches (no vs. yes; OR:0.44). In men, the following factors of urine osmolality were identified in 1st tertile: place of residence (city vs. village; OR:2.72) and health assessment (average vs. poor; OR:0.32). Conclusion Different factors affecting urine osmolality have been identified in women and men. These results highlight the need to implement studies to clarify the relationship between socioeconomic, lifestyle and health factors, and hydration status in adults with metabolic disorders.
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Ambient temperature and wet bulb globe temperature outperform heat index in predicting hydration status and heat perception in a semi-arid environment
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Background Climate change is increasing temperatures, frequency of heatwaves, and erratic rainfall, which threatens human biology and health, particularly in already extreme environments. Therefore, it is important to understand how environmental heat stress measures are tied to human water needs and thermoregulation under increasingly hot conditions. Aim To test how ambient temperature, heat index, and wet bulb globe temperature (WBGT) relate to hydration status and thermal heat perception in a hot, semi-arid environment. Subjects and methods Urine samples, perceived heat stress, and anthropometrics were collected among Daasanach semi-nomadic pastoralists (n = 187 children, n = 231 adults) in northern Kenya. Environmental heat stress measures were recorded at sample collection; samples’ urine specific gravity (USG) was measured. Results Multiple linear and logistic regressions indicate that all environmental heat stress measures were associated with USG, odds of dehydration, and heat perception. Ambient temperature performed marginally better than WBGT, and both performed better than heat index. These associations were stronger among children than adults. Conclusion In a hot, semi-arid climate, ambient temperature and WBGT accurately predict human water needs and heat stress, with children more vulnerable to dehydration. To mitigate consequences of extreme heat, local bioculturally-appropriate hydration (e.g. tea) and cooling (e.g. shade) strategies should be encouraged.
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Overweight and Obese Children Aged 6–17 Years in China Had Lower Level of Hydration Status: A Cross-Sectional Study
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Purpose: The aims of this study were to explore the differences in total body water and hydration status among Chinese children aged 6–17 years. Methods: A cross-sectional study was implemented among children aged 6–17 years in China. The total body water (TBW), intracellular water (ICW), and extracellular water (ECW) were determined by bioelectrical impedance analysis (BIA). The participants were divided according to age—age 6–8 years, age 9–11 years, age 12–14 years, age 15–17 years—and body mass index (BMI) of China—underweight, normal weight, overweight, and obese groups. The differences of variables of groups were compared using analysis of variance, Student’s t-test, and Kruskal–Wallis test. Significance levels were set at 0.05 (p < 0.05). Results: A total of 59,643 participants (30,103 males and 29,540 females) completed the study. As children became older, the TBW, ICW, ECW, ICW/TBW, and TBW/FFM (TBW to fat free mass ratio) increased simultaneously (all p < 0.05); concurrently, the ECW/TBW decreased with age (all p < 0.05). Boys had higher TBW, ICW, ECW, ICW/TBW, TBW/BW, and TBW/FFM than those of girls at each age (all p < 0.05). For all BMI groups, increases in TBW, ICW, ECW were observed from the underweight group to the obese group, both in boys and girls (all p < 0.001). For the increase in BMI in all age groups, the values of TBW made a significantly lower percentage compared to BW. The higher BMI groups showed higher levels of TBW/FFM, both in girls and boys (all p < 0.001). Conclusions: The body water contents of children aged 6–17 years varied according to their age, sex, and BMI. Overweight and obese individuals may have inferior hydration status compared to those with normal weight.
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Hydration, mood, and cognition in primary aged school children in the United Kingdom
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  • Dec 2024
  • P NUTR SOC
Children are at increased risk of dehydration (1–3) , which can adversely impact cognition and mood (4–6) . Many children begin their school day dehydrated and fail to replenish fluids adequately throughout the day (7–11) , however, these findings have not been confirmed using objective measures of hydration (12,13) . This study aimed to confirm hydration status of primary school-aged children across the school day using objective hydration assessments and to examine if changes in hydration are associated with cognition and mood. Thirty children (mean age 9.4 ± 0.5 years old, stature 1.4 ± 0.5m, body mass 36.5 ± 4.2kg, and body mass index 18.9 ± 1.7 kg/m ² ) were recruited from a local primary school. Food and fluid intake were tracked via nutritional analysis of photographs. Urine osmolality (Uosm), serum osmolality (Sosm), urine specific gravity (USG) and self-reported urine colour (Ucol) were assessed at first void (Uosm only) or the start (9:00) and end (16:00) of the school day. Children’s self-reported mood were obtained via Visual Analogue Scales(100mm) (9:00, 10:30, 13:30, 16:00). Children completed cognitive assessments using the Computerised Mental Performance Assessment System (15:3016:00). Mean total water intake was 759.9 ± 240.7 mL. Children consumed more fluid at mealtimes than from water bottle (Mean Difference (MD) 154.3mL, t(29) = -5.763, p<0.001). From the start to the end of the day, significant increases in Sosm (MD 3.3mOsm/kg, t(21) = 4.011, p = 0.002), USG (MD 0.0066, t(29) = 8.514, p = 0.005) and Ucol (MD 1.2, t(26) = 15.558, p = <0.001), indicated reduced hydration. The prevalence of dehydration (Sosm >290mOsm/kg USG >1.030) increased from the start (17%) to the end of school (40%). A series of ANOVAs from the start to the end of the day showed feelings of boredom, hunger, tiredness, and thirst increased, and focus, and happiness decreased (p’s <0.05). Hydration measures were significantly associated with long term memory (LTM) (changes in Sosm, r = 0.437, p = 0.042) and working memory (WM) (changes in Sosm r = 0.462, p = 0.031, and USG, r = 0.403, p = 0.033). Children were less hydrated at the end of the school day suggesting inadequate fluid replacement during the school hours. Changes in hydration status across the school day were associated with subjective mood states. Furthermore, a decrease in hydration resulted in decreased performance in the memory tasks which could potentially hold implications on school performance. Children in this study had access to water throughout the day, however, most fluids were consumed at breakfast and lunch, suggesting interventions promoting sustained drinking throughout the day are required. For example, measures could be taken to educate parents and school staff on the importance of adequate hydration, and the need to remind children to drink throughout the day. For this to be effective, action needs to be taken across lesson time, meals, and break times.
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Fluid intake of Latin American children and adolescents: results of four 2016 LIQ.IN7 National Cross-Sectional Surveys
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  • Jun 2018
  • EUR J NUTR
Purpose: The primary aim of this survey was to report total fluid intake (TFI) and different fluid types for children (4-9 years) and adolescents (10-17 years) in Mexico, Brazil, Argentina and Uruguay. The second aim was to compare TFI with the adequate intake (AI) of water from fluids as recommended by the USA Institute of Medicine. Methods: Data were collected using a validated liquid intake 7-day record (Liq.In 7 ). Participants' characteristics, including age, sex and anthropometric measurements were recorded. Results: A total of 733 children and 933 adolescents were recruited. Over 75% of children in Uruguay met the IOM's recommended intake. Fewer children in Argentina (64-72%) and Brazil (41-50%) obtained AI and the lowest values were recorded in Mexico (33-44%), where 16% of boys and 14% girls drank 50% or less of the AI. More adolescents in Argentina (42%) met the AIs than other countries; the lowest was in Mexico (28%). Children and adolescents in Mexico and Argentina drank more sugar sweetened beverages than water. Conclusions: Large numbers of children and adolescents did not meet AI recommendations for TFI, raising concerns about their hydration status and potential effects on mental and physical well-being. Given the negative effects on children's health, the levels of SSB consumption are worrying.
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Fluid consumption pattern and hydration among 8–14 years-old children
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Full-text available
  • Mar 2018
Background/objectives: Children consume various fluids to meet dietary water intake needs. However, the contribution of different fluid types on hydration is unclear. The purpose of this study was to develop fluid intake patterns and examine their association with hydration, as indicated by 24-h urine osmolality. Subjects/methods: Two hundred ten (105 girls) healthy children (height: 1.49 ± 0.13 m, weight: 43.4 ± 12.6 kg, body fat: 25.2 ± 7.8%) recorded their fluid intake for two consecutive days, and collected their urine for 24-h during the 2nd day, while conducting their normal daily activities. Urine samples were analyzed for specific gravity and osmolality. Factor analysis with principal components method was applied to extract dietary patterns from six fluid groups. Linear regression analysis evaluated the associations between the extracted dietary patterns and hydration based on 24-h urine osmolality. Results: The analysis revealed the following six components: 1, characterized by consumption of milk and fresh juice, but not packaged juice; 2, by regular soda and other drinks, but not water; 3, by fresh juice and other drinks; 4, by packaged juice, but not regular soda; 5, by water and milk; and 6, by fresh juice. Component 5 was negatively correlated with urine osmolality (P = 0.001) indicating better hydration, whereas component 2 was positively correlated with urine osmolality (P = 0.001). Conclusions: A drinking pattern based on water and milk was associated with better hydration, as indicated by lower urine osmolality, whereas drinking regular soda and other drinks but not water was associated with inferior hydration.
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Shifting Focus: From Hydration for Performance to Hydration for Health
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  • Jun 2017
  • ANN NUTR METAB
Over the past 10 years, literature on hydration biomarkers has evolved considerably - from (de)hydration assessment towards a more global definition of biomarkers of hydration in daily life. This shift in thinking about hydration markers was largely driven by investigating the differences that existed between otherwise healthy individuals whose habitual, ad-libitum drinking habits differ, and by identifying physiological changes in low-volume drinkers who subsequently increase their water intake. Aside from obvious differences in urinary volume and concentration, a growing body of evidence is emerging that links differences in fluid intake with small, but biologically significant, differences in vasopressin (copeptin), glomerular filtration rate, and markers of metabolic dysfunction or disease. Taken together, these pieces of the puzzle begin to form a picture of how much water intake should be considered adequate for health, and represent a shifting focus from hydration for performance, toward hydration for health outcomes. This narrative review outlines the key areas of research in which the global hydration process - including water intake, urinary hydration markers, and vasopressin - has been associated with health outcomes, focusing on kidney and metabolic endpoints. It will also provide a commentary on how various hydration biomarkers may be used in hydration for health assessment. Finally, if adequate water intake can play a role in maintaining health, how might we tell if we are drinking enough? Urine output is easily measured, and can take into account differences in daily physical activity, climate, dietary solute load, and other factors that influence daily water needs. Today, targets have been proposed for urine osmolality, specific gravity, and color that may be used by researchers, clinicians, and individuals as simple indicators of optimal hydration. However, there remain a large number of incomplete or unanswered research questions regarding the relationships between water intake, hydration, vasopressin, and health outcomes. Thus, this emerging field represents an excellent opportunity, particularly for young researchers, to develop relevant and novel lines of research.
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Under What Conditions do Water-Intervention Studies Significantly Improve Child Body Weight?
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  • Jun 2017
  • ANN NUTR METAB
There are particular conditions that may optimize the effects of drinking-water interventions on body weight change and risk of obesity. Strategic planning to create and sustain conditions for optimal effects of drinking water may maximize the impact of school-based interventions to reduce childhood obesity. This paper proposes questions about the target population, type of diet and activity level that will be maintained during the intervention, and planned intervention message(s). The proposed questions are motivated by conditions associated with significant effects of drinking water in randomized controlled trials. They are discussed in relation to conditions underlying the recently successful school-based drinking-water intervention in New York City. If conditions allow, school-based drinking-water interventions have the potential to efficiently benefit millions of children worldwide, who are at risk of becoming obese.
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Water Consumption in European Children: Associations with Intake of Fruit Juices, Soft Drinks and Related Parenting Practices
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Background: High intake of fruit juices and soft drinks contributes to excessive weight gain and obesity in children. Furthermore, parenting practices play an important role in the development of children’s dietary habits. The way parents play this role in the development of their children’s choices of beverages is still unclear. Objectives: To study the associations: (1) of both fruit juices and soft drinks consumption with water consumption of children and (2) The associations between parenting practices towards fruit juices and soft drinks and water consumption of children. Design: Cross-sectional data from 6 to 8 year old children from seven European communities (n = 1187) were collected. Associations among fruit juices, soft drinks, the respective parenting practices and the child’s water consumption were assessed by parental questionnaires. Results: The consumption of water was inversely associated with that of soft drinks but not with the consumption of fruit juices. The child’s water intake was favorably influenced when stricter parenting practices towards soft drinks were adopted (e.g., less parental allowance, low home availability and high parental self-efficacy in managing intake). There was less influence observed of parenting practices towards fruit juices. Fruit juices were consumed more often than soft drinks. Conclusions: Low consumption of soft drinks—and not of fruit juices—was associated with high water consumption in children in the current study. Moreover, parenting practices towards both fruit juices and soft drinks were associated with the water intake of the children, irrespective of their socio-economic status.
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Water and beverage consumption patterns among 4 to 13-year-old children in the United Kingdom
Article
Full-text available
  • May 2017
  • BMC PUBLIC HEALTH
Background The UK government has announced a tax on sugar-sweetened beverages. The aim of this study was to assess consumption patterns for plain drinking water relative to sugary beverages among UK children. Methods Dietary intake data for 845 children aged 4–13 years came from the nationally representative cross-sectional National Diet and Nutrition Survey, 2008–2011. Beverage categories were drinking water (tap or bottled), milk, 100% fruit juices, soda, fruit drinks, tea, coffee, sports drinks, flavored waters, and liquid supplements. Consumption patterns were examined by age group, gender, household incomes, time and location of consumption, region and seasonality. Total water consumption from drinking water, beverages, and foods, and the water-to-calorie ratios (L/kcal) were compared to the EFSA (European Food Safety Authority) adequate intake standards. Results Total water intake (1338 ml/d) came from plain water (19%), beverages (48%), and food moisture (33%). Plain drinking water provided 258 g/d (241 g/d for children aged 4–8 years; 274 g/d for 9–13 years), mostly (83.8%) from tap. Water and beverages supplied 901 g /d of water. Tap water consumption increased with income and was highest in the South of England. The consumption of bottled water, soda, tea and coffee increased with age, whereas milk consumption declined. About 88.7% of children did not meet EFSA adequate intake standards. The daily water shortfall ranged from 322 ml/d to 659 ml/d. Water-to-calorie ratio was 0.845 L/1000 kcal short of desirable levels of 1.0–1.5 L/1000 kcal. Conclusion Total water intake were at 74.8% of EFSA reference values. Drinking water consumption among children in the UK was well below US and French estimates.
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The influence of parental practices on child promotive and preventive food consumption behaviors: A systematic review and meta-analysis
Article
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  • Apr 2017
  • INT J BEHAV NUTR PHY
Abstract Background The family is an important social context where children learn and adopt eating behaviors. Specifically, parents play the role of health promoters, role models, and educators in the lives of children, influencing their food cognitions and choices. This study attempts to systematically review empirical studies examining the influence of parents on child food consumption behavior in two contexts: one promotive in nature (e.g., healthy food), and the other preventive in nature (e.g., unhealthy food). Methods From a total of 6,448 titles extracted from Web of Science, ERIC, PsycINFO and PubMED, seventy eight studies met the inclusion criteria for a systematic review, while thirty seven articles contained requisite statistical information for meta-analysis. The parental variables extracted include active guidance/education, restrictive guidance/rule-making, availability, accessibility, modeling, pressure to eat, rewarding food consumption, rewarding with verbal praise, and using food as reward. The food consumption behaviors examined include fruits and vegetables consumption, sugar-sweetened beverages, and snack consumption. Results Results indicate that availability (Healthy: r = .24, p
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Association between Plain Water and Sugar-Sweetened Beverages and Total Energy Intake among Mexican School-Age Children
Article
Full-text available
  • Dec 2016
Water consumption promotes a decrease in total diet energy intake, and one explanation for this fact is the replacement of sugar-sweetened beverages (SSBs) by plain water (PW). The objective of this study was to analyze the association between SSB and PW consumption as a part of the total energy intake. Dietary information was obtained by one 24 h recall of 2536 school-age children who participated in the National Nutrition Survey in Mexico. PW and SSB consumption was measured in mL and servings (240 mL), and consumption was stratified into two levels (<2 and ≥2 servings/day). Linear regression models were used to evaluate the association between PW and SSB consumption in relation to total energy intake. Models were adjusted for age, sex, the proportion of energy obtained from non-beverage food, area of residence, and socioeconomic status (based on information regarding housing conditions and ownership of home appliances). PW consumption at the national level was two servings/day, and was not associated with total energy intake. However, the combination of the high consumption of PW and the low consumption of SSB was associated with less total energy intake (p < 0.05). Promoting higher PW and lower SSB consumption provides a useful public health strategy for reducing total energy intake and preventing overconsumption among Mexican school-age children.
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Urinary hydration biomarkers and dietary intake in children
Article
  • Jul 2016
  • NUTR HOSP
Introduction: The importance of hydration is undoubtable but reliable data on hydration status and its relation with diet is lacking. Objectives: We aimed to evaluate the hydration status and its relation to beverages and food intake in children. Methods: A sample of 172 (50% male), 7-11 year-old children was included in this survey. Participants completed a 24 h urine collection; a 24 hours food recall corresponding to the day of urine collection was applied, weight and height were measured and parents/caregivers fi lled a lifestyle and socio-demographic questionnaire. The free water reserve was used to assess the hydration status. The intakes of food and beverages were compared according to hydration status using the t-test, Mann-Whitney test or unconditional regression models as appropriate. Results: More than half of the participants were classifi ed as hypohydrated or at risk of hypohydration (57% in girls and 58% in boys). Compared to hypohydrated children, a signifi cant higher consumption of water (276.2 ± 208.4 vs 188.2 ± 187.4 g/day) and fruit juices (77.6 ± 139.4 vs 14.4 ± 57.2 g/day) was reported by euhydrated boys and girls, respectively. Lower consumers of water and fruit juices showed a higher risk of hypohydration (OR = 2.16, 95% CI: 1.02-4.58, p = 0.045), adjusting for confounders. Conclusions: Most of the children included in this analysis were classifi ed as at risk of hypohydration and those with higher water and fruit juices consumption showed a better hydration status.
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Increasing water intake in pre-school children with unhealthy drinking habits: A year-long controlled longitudinal field experiment assessing the impact of information, water affordance, and social regulation
Article
  • Apr 2017
  • APPETITE
Objective: We investigated the effect of three interventions to increase the plain water consumption of children with unhealthy drinking habits, with an innovative approach combining the three layers of Installation Theory: embodied competences, affordances and social regulation. Methods: 334 preschool children and their carers were allocated to three interventions: Control (control): no intervention, Information (info): online coaching sessions on water health benefits aiming at modifying embodied competences (knowledge), Information + Water Affordance (info + w): the same plus home delivery of small bottles of water. After three months, half of the info and info + w subjects were allocated to Social Regulation (+social) (on-line discussion forum) or no further intervention (-social). Intake of plain water and all other fluid types of the children were recorded by the carers 6 times over a year using an online 7-day fluid-specific dietary record. Results: Over 1 year, all groups significantly increased water consumption by 3.0-7.8 times (+118 to +222 mL). Info + w + social and Info-social generated the highest increase in plain water intake after one year compared to baseline, by 7.8 times (+216 mL) and 6.7 times (+222 mL) respectively; both significantly exceeded the control (3.0 times, +118 mL), whilst the effect of info + w-social (5.0 times, +158 mL) and info + social (5.3 times, +198 mL) did not differ from that of control. All groups saw a decrease of sweetened beverages intake, again with info + w + social generating the largest decrease (-27%; -172 mL). No changes in other fluids or total fluid intake were observed. Conclusions: Sustainable increased water consumption can be achieved in children with unhealthy drinking habits by influencing representations, changing material affordances, and providing social regulation. Combining the three provided the strongest effect as predicted by Installation Theory.
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