Interventions to increase the consumption of water among children: A systematic review and meta-analysis.

The aim of this study was to conduct a systematic review and meta-analysis on the effectiveness of interventions to increase children's water consumption. A systematic literature search was conducted in seven electronic databases. Studies published in English before 18 February 2019 that evaluated any type of intervention that measured change in water consumption among children aged 2 to 12 years by applying any type of design were included. Of the 47 interventions included in the systematic review, 24 reported a statistically significant increase in water consumption. Twenty-four interventions (17 randomized controlled trials and seven studies with other controlled designs) were included in the meta-analysis. On average, children in intervention groups consumed 29 mL/d (confidence interval [CI] = 13-46 mL/d) more water than did children in control groups. This effect was larger in eight interventions focused specifically on diet (MD = 73 mL/d, CI = 20-126 mL/d) than in 16 interventions focused also on other lifestyle factors (MD = 15 mL/d, CI = 1-29 mL/d). Significant subgroup differences were also found by study setting and socioecological level targeted but not by children's age group, intervention strategy, or study design. In conclusion, there is evidence that, on average, lifestyle interventions can lead to small increases in children's daily water consumption. More research is needed to further understand the specific intervention elements that have the greatest effect.

Factors associated with water consumption among children: a systematic review.

BACKGROUND: Water is recommended as the main beverage for daily fluid intake. Previous systematic reviews have studied the consumption of sugar-sweetened beverages (SSBs) among children, but none have focused on water consumption. Insight into factors that are associated with children's water intake is needed to inform the development of interventions aimed at the promotion of water consumption. The objective of this review was therefore to summarize the current evidence on factors associated with water consumption among children aged 2 to 12 years. METHODS: A systematic literature search in seven electronic databases was conducted in May, 2018 and retrieved 17,850 unique records. Two additional studies were identified by hand-searching references of included articles. Studies were selected if they had a cross-sectional or longitudinal study design, focused on children aged 2-12 years and published in an English language peer-reviewed journal. Participants from clinical populations, studies that included data of < 10 participants and non-human studies were excluded. RESULTS: A total of 63 articles met inclusion criteria and were included in the analysis. We identified 76 factors that were investigated in these studies; 17/76 were investigated in a longitudinal study. There was evidence of positive associations between water consumption and child's self-efficacy, parental education level, parental self-efficacy, use of feeding practices such as restriction or encouraging healthy eating and study year. Evidence was inconsistent (< 60% of studies reported an association) for child's age, sex, BMI, consumption of SSBs and ethnic background of the parent. There was no evidence (≤33% of studies reported an association) of associations between consumption of milk or juice, parental emotional-, modelling- or instrumental feeding practices, eating school lunch or outside temperature and water consumption. The remaining 54 factors were investigated in fewer than three studies. CONCLUSIONS: There is some evidence for an association between potentially modifiable parental and child-related factors and water consumption. However, most factors identified in this review were only studied by one or two studies and most studies were cross-sectional. More longitudinal research is necessary to investigate environmental, parental and child-related factors associated with water consumption that are currently under-studied and could further inform intervention strategies. TRIAL REGISTRATION: PROSPERO ID# CRD42018093362 , registered May 22, 2018.

Time to treatment response of a magnesium- and sulphate-rich natural mineral water in functional constipation.

OBJECTIVES: First-line recommendations for the management of functional constipation include nutritional-hygienic measures. We previously showed that a natural mineral water rich in sulphates and magnesium (Hépar) is efficient in the treatment of functional constipation. The aim of this study was to consolidate those first results and determine a precise time to respond to Hépar. METHODS: This multicenter, randomized, double-blind, controlled study of the effect of Hépar on stool consistency and frequency in functional constipation included 226 outpatients. After washout, patients used 1.5 L of water daily, including 1 L of Hépar or of low-mineral water, during 14 d. In addition to a daily reporting of stool consistency by the patient, an expert investigator blindly analyzed stool consistency (Bristol stool scale) based on photographs taken by the patient. RESULTS: The primary endpoint was met. Treatment response was more frequent in the Hépar arm than in the control group at day 14 (50% versus 29%, respectively; P = 0.001). Mean time to treatment response was shorter in the Hépar group (6.4 d) than in the control arm (7.3 d; P = 0.013). Concomitant stool scoring was available for 60% of the patients. Scores given to 79% of the stools were similar between the patient and the expert (differences ≤1). Safety analyses showed excellent results. CONCLUSION: This study confirms the efficacy and safety of Hépar in the treatment of functional constipation and shows that it is associated with a response within 7 d. Hépar could be a safe response to the current absence of first-line medication in the treatment of functional constipation.

Water and beverage consumption patterns among 4 to 13-year-old children in the United Kingdom.

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.

Water and Beverage Consumption among Children Aged 4-13 Years in Lebanon: Findings from a National Cross-Sectional Study.

This study evaluates total water intake (TWI) from plain water, beverages and foods among Lebanese children and compares TWI to dietary reference intakes (DRIs). In a national cross-sectional survey, data on demographic, socioeconomic, anthropometric, and physical activity characteristics were obtained from 4 to 13-year-old children (n = 752). Food and beverage consumption patterns were assessed using a validated food-frequency questionnaire. TWI was estimated at 1651 mL/day, with beverages contributing 72% of the TWI compared to 28% from foods. Beverages with the highest contribution to TWI included plain water, fruit juice and soda. A significantly higher proportion of 9-13-year-old children failed to meet the DRIs compared to 4-8 years old (92%-98% vs. 74%). Gender differentials were observed with a significantly higher proportion of boys meeting the DRIs compared to girls. The water to energy ratio ranged between 0.84 and 0.87, which fell short of meeting the desirable recommendations. In addition, children from higher socioeconomic status had higher intakes of water from milk and bottled water, coupled with lower water intakes from sodas. The study findings show an alarming high proportion of Lebanese children failing to meet TWI recommendations, and call for culture-specific interventions to instill healthy fluid consumption patterns early in life.

Water and beverage consumption among children aged 4-13 years in France: analyses of INCA 2 (Étude Individuelle Nationale des Consommations Alimentaires 2006-2007) data.

OBJECTIVE: To examine the consumption of plain water among children in France and compare total water intakes with guidelines issued by the European Food Safety Authority (EFSA). DESIGN: Nationally representative data were used to assess food, beverage and water consumption by sex, age group (4-8 years, 9-13 years), income-to-poverty ratio, eating occasion and location. Beverages were classified into nine groups: water (tap or bottled), milk, 100 % fruit juice, sodas, fruit drinks, hot beverages, sports drinks and flavoured waters. Total water volume in relation to energy intake (litres/kcal) was also examined. SETTING: INCA 2 study (Étude Individuelle Nationale des Consommations Alimentaires 2006-2007). SUBJECTS: French children (n 835) aged 4-13 years. RESULTS: Total water intakes were accounted for by plain water (34 %), beverages (26 %) and food moisture (40 %). Plain water could be tap (18 %) or bottled (16 %). Older children drank more plain water than did younger children and boys drank more plain water than did girls. No socio-economic gradient for plain water consumption was observed. About 90 % of children did not meet the EFSA water intake recommendations. The daily water shortfall ranged from 367 to 594 ml/d. Water-to-energy ratio was 0·75-0·77 litres/1000 kcal (4184 kJ). Children drank milk at breakfast and plain water during lunch and dinner. Caloric beverages provided 10 % of dietary energy; consumption patterns varied by eating location. CONCLUSIONS: Total water intakes among young children in France were below EFSA-recommended levels. Analyses of beverage consumption patterns by eating occasion and location can help identify ways to increase water consumption among children.

Hydration Deficit in 9- to 11-Year-Old Egyptian Children.

Background. Children who drink too little to meet their daily water requirements are likely to become dehydrated, and even mild dehydration can negatively affect health. This is even more important in Middle-Eastern countries where high temperatures increase the risk of dehydration. We assessed morning hydration status in a sample of 519 Egyptian schoolchildren (9-11 years old). Methods. Children completed a questionnaire on breakfast intakes and collected a urine sample after breakfast. Breakfast food and fluid nutritional composition was analyzed and urine osmolality was measured using osmometry. Results. The mean urine osmolality of children was 814 mOsmol/kg: >800 mOsmol/kg (57%) and >1000 mOsmol/kg (24.7%). Furthermore, the results showed that a total water intake of less than 400 mL was associated with a significant higher risk of dehydration. Surprisingly, 63% of the children skipped breakfast. Conclusions. The results showed that a majority of Egyptian schoolchildren arrive at school with a hydration deficit. These results highlight the fact that there is a need to educate schoolchildren about the importance of having a breakfast and adequate hydration.

Efficacy and safety of a magnesium sulfate-rich natural mineral water for patients with functional constipation.

BACKGROUND & AIMS: Little is known about the effects of natural mineral water on constipation in adults. We assessed the effect of a magnesium sulfate-rich natural mineral water (Hépar; Nestlé Waters, Issy-les-Moulineaux, France) on gastrointestinal transit in constipated women. METHODS: We performed a randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of Hépar in outpatients with functional constipation (based on the Rome III criteria). The study included 244 female patients, age 18 to 60 years, identified by 62 general practitioners throughout France. After a washout period, subjects drank 1.5 L natural low-mineral water daily (control, n = 77), 0.5 L Hépar and 1 L natural low-mineral water daily (Hépar 0.5 group, n = 85), or 1 L Hépar and 0.5 L natural low-mineral water daily (Hépar 1 group, n = 82) for 4 weeks. We collected information on the number and types of stools, abdominal pain, rescue medications, adverse events, and volume of water consumed. RESULTS: We observed no significant effect at week 1. At week 2, constipation was reduced in 21.1% of patients in the control group, in 30.9% in the Hépar 0.5 group (P = .099 vs controls), and in 37.5% in the Hépar 1 group (P = .013 vs controls). The Hépar 1 group also had a decreased number of hard or lumpy stools (Bristol scale, P = .030 vs baseline) and a substantial decrease in the use of rescue medication (P = .034 vs controls). Patient responses correlated with magnesium sulfate concentrations. Safety was very good; there were no serious adverse events among patients who drank Hépar. CONCLUSIONS: In a controlled trial, daily consumption of 1 L Hépar reduced constipation and hard or lumpy stools in a greater percentage of women with functional constipation than natural low-mineral water, as early as the second week of treatment.

Water and beverage consumption among adults in the United States: cross-sectional study using data from NHANES 2005-2010.

BACKGROUND: Few studies have examined plain water consumption among US adults. This study evaluated the consumption of plain water (tap and bottled) and total water among US adults by age group (20-50y, 51-70y, and ≥71y), gender, income-to-poverty ratio, and race/ethnicity. METHODS: Data from up to two non-consecutive 24-hour recalls from the 2005-2006, 2007-2008 and 2009-2010 National Health and Nutrition Examination Survey (NHANES) was used to evaluate usual intake of water and water as a beverage among 15,702 US adults. The contribution of different beverage types (e.g., water as a beverage [tap or bottled], milk [including flavored], 100% fruit juice, soda/soft drinks [regular and diet], fruit drinks, sports/energy drinks, coffee, tea, and alcoholic beverages) to total water and energy intakes was examined. Total water intakes from plain water, beverages, and food were compared to the Adequate Intake (AI) values from the US Dietary Reference Intakes (DRI). Total water volume per 1,000 kcal was also examined. RESULTS: Water and other beverages contributed 75-84% of dietary water, with 17-25% provided by water in foods, depending on age. Plain water, from tap or bottled sources, contributed 30-37% of total dietary water. Overall, 56% of drinking water volume was from tap water while bottled water provided 44%. Older adults (≥71y) consumed much less bottled water than younger adults. Non-Hispanic whites consumed the most tap water, whereas Mexican-Americans consumed the most bottled water. Plain water consumption (bottled and tap) tended to be associated with higher incomes. On average, younger adults exceeded or came close to satisfying the DRIs for water. Older men and women failed to meet the Institute of Medicine (IOM) AI values, with a shortfall in daily water intakes of 1218 mL and 603 mL respectively. Eighty-three percent of women and 95% of men ≥71y failed to meet the IOM AI values for water. However, average water volume per 1,000 kcal was 1.2-1.4 L/1,000 kcal for most population sub-groups, higher than suggested levels of 1.0 L/1.000 kcal. CONCLUSIONS: Water intakes below IOM-recommended levels may be a cause for concern, especially for older adults.

Water and beverage consumption among children age 4-13y in the United States: analyses of 2005-2010 NHANES data.

BACKGROUND: Few studies have examined water consumption patterns among U.S. children. Additionally, recent data on total water consumption as it relates to the Dietary Reference Intakes (DRI) are lacking. This study evaluated the consumption of plain water (tap and bottled) and other beverages among US children by age group, gender, income-to-poverty ratio, and race/ethnicity. Comparisons were made to DRI values for water consumption from all sources. METHODS: Data from two non-consecutive 24-hour recalls from 3 cycles of NHANES (2005-2006, 2007-2008 and 2009-2010) were used to assess water and beverage consumption among 4,766 children age 4-13y. Beverages were classified into 9 groups: water (tap and bottled), plain and flavored milk, 100% fruit juice, soda/soft drinks (regular and diet), fruit drinks, sports drinks, coffee, tea, and energy drinks. Total water intakes from plain water, beverages, and food were compared to DRIs for the U.S. Total water volume per 1,000 kcal was also examined. RESULTS: Water and other beverages contributed 70-75% of dietary water, with 25-30% provided by moisture in foods, depending on age. Plain water, tap and bottled, contributed 25-30% of total dietary water. In general, tap water represented 60% of drinking water volume whereas bottled water represented 40%. Non-Hispanic white children consumed the most tap water, whereas Mexican-American children consumed the most bottled water. Plain water consumption (bottled and tap) tended to be associated with higher incomes. No group of U.S. children came close to satisfying the DRIs for water. At least 75% of children 4-8y, 87% of girls 9-13y, and 85% of boys 9-13y did not meet DRIs for total water intake. Water volume per 1,000 kcal, another criterion of adequate hydration, was 0.85-0.95 L/1,000 kcal, short of the desirable levels of 1.0-1.5 L/1,000 kcal. CONCLUSIONS: Water intakes at below-recommended levels may be a cause for concern. Data on water and beverage intake for the population and by socio-demographic group provides useful information to target interventions for increasing water intake among children.

French children start their school day with a hydration deficit.

BACKGROUND AND AIMS: Fluid requirements of children vary as a function of gender and age. To our knowledge, there is very little literature on the hydration status of French children. We assessed the morning hydration status in a large sample of 529 French schoolchildren aged 9-11 years. METHODS: Recruited children completed a questionnaire on fluid and food intake at breakfast and collected a urine sample the very same day after breakfast. Breakfast food and fluid nutritional composition was analyzed and urine osmolality was measured using a cryoscopic osmometer. RESULTS: More than a third of the children had a urine osmolality between 801 and 1,000 mosm/kg while 22.7% had a urine osmolality over 1,000 mosm/kg. This was more frequent in boys than in girls (p < 0.001). A majority of children (73.5%) drank less than 400 ml at breakfast. Total water intake at breakfast was significantly and inversely correlated with high osmolality values. CONCLUSIONS: Almost two thirds of the children in this large cohort had evidence of a hydration deficit when they went to school in the morning, despite breakfast intake. Children's fluid intake at breakfast does not suffice to maintain an adequate hydration status for the whole morning.

Drinking water is associated with weight loss in overweight dieting women independent of diet and activity.

BACKGROUND: Data from short-term experiments suggest that drinking water may promote weight loss by lowering total energy intake and/or altering metabolism. The long-term effects of drinking water on change in body weight and composition are unknown, however. OBJECTIVE: This study tested for associations between absolute and relative increases in drinking water and weight loss over 12 months. METHODS AND PROCEDURES: Secondary analyses were conducted on data from the Stanford A TO Z weight loss intervention on 173 premenopausal overweight women (aged 25-50 years) who reported <1 l/day drinking water at baseline. Diet, physical activity, body weight, percent body fat (dual-energy X-ray absorptiometry), and waist circumference were assessed at baseline, 2, 6, and 12 months. At each time point, mean daily intakes of drinking water, noncaloric, unsweetened caloric (e.g., 100% fruit juice, milk) and sweetened caloric beverages, and food energy and nutrients were estimated using three unannounced 24-h diet recalls. Beverage intake was expressed in absolute (g) and relative terms (% of beverages). Mixed models were used to test for effects of absolute and relative increases in drinking water on changes in weight and body composition, controlling for baseline status, diet group, and changes in other beverage intake, the amount and composition of foods consumed and physical activity. RESULTS: Absolute and relative increases in drinking water were associated with significant loss of body weight and fat over time, independent of covariates. DISCUSSION: The results suggest that drinking water may promote weight loss in overweight dieting women.

Replacing sweetened caloric beverages with drinking water is associated with lower energy intake.

OBJECTIVE: Reduced intake of sweetened caloric beverages (SCBs) is recommended to lower total energy intake. Replacing SCBs with non-caloric diet beverages does not automatically lower energy intake, however. Compensatory increases in other food or beverages reportedly negate benefits of diet beverages. The purpose of this study was to evaluate drinking water as an alternative to SCBs. RESEARCH METHODS AND PROCEDURES: Secondary analysis of data from the Stanford A TO Z intervention evaluated change in beverage pattern and total energy intake in 118 overweight women (25 to 50 years) who regularly consumed SCBs (>12 ounces/d) at baseline. At baseline and 2, 6, and 12 months, mean daily beverage intake (SCBs, drinking water, non-caloric diet beverages, and nutritious caloric beverages), food composition (macronutrient, water, and fiber content), and total energy intake were estimated using three 24-hour diet recalls. Beverage intake was expressed in relative terms (percentage of beverages). RESULTS: In fixed effects models that controlled for total beverage intake, non-caloric and nutritious caloric beverage intake (percentage of beverages), food composition, and energy expenditure [metabolic equivalent (MET)], replacing SCBs with drinking water was associated with significant decreases in total energy intake that were sustained over time. The caloric deficit attributable to replacing SCBs with water was not negated by compensatory increases in other food or beverages. Replacing all SCBs with drinking water was associated with a predicted mean decrease in total energy of 200 kcal/d over 12 months. DISCUSSION: The results suggest that replacing SCBs with drinking water can help lower total energy intake in overweight consumers of SCBs motivated to diet.

Hydration and cognitive function in children.

Adequate fluid intake is critical for survival. While adults are at liberty to drink fluids as wanted, children and infants are dependent upon caregivers for food and fluid. Children are at greater risk for dehydration than adults due to their higher surface-to-mass ratio. Additionally, children have different thirst sensitivities and body cooling mechanisms than adults. Children differ from adults in total body water content, and boys and girls differ in body water content with maturation. Research in young adults shows that mild dehydration corresponding to only 1% to 2% of body weight loss can lead to significant impairment in cognitive function. Dehydration in infants is associated with confusion, irritability, and lethargy; in children, it may produce decrements in cognitive performance.