Joan Gandy

Total fluid intake and its determinants: cross-sectional surveys among adults in 13 countries worldwide

AbstractPurposenTo evaluate the total fluid intake from drinking water and beverages in adult populations from different countries and assess the percentage of individuals complying with the European Food Safety Agency (EFSA) adequate intake (AI) of water from fluids.MethodsA total of 16,276 adults (7580 men and 8696 women) aged between 18 and 70xa0years (mean age 39.8xa0years) were randomly recruited from 13 different countries from three continents. Information about the total daily fluid intake (sum of drinking water and beverages) was collected using a 24-h fluid-specific record over seven consecutive days.ResultsImportant differences in total fluid intake between countries were found; however, few differences between men and women were reported in most of the countries. Less than 50xa0% of the women and approximately 60xa0% of the men do not comply with the EFSA AI of water from fluids. Women were more than twice as likely as men to meet these AI (OR 2.15; 95xa0%xa0CI 2.02–2.29). The odds of meeting the AI of water from fluids were lower in individuals over 50xa0years (OR 0.88; 95xa0% CI 0.80–0.96). Nine percent of the total population consumed less than half of the AI, 40.5xa0% between 50 and 100xa0%, and 50.5xa0% more than the AI.ConclusionsThere were considerable differences in total fluid intake between countries but not between genders. Only 40xa0% of men and 60xa0% of women comply with the EFSA AI of water from fluids. Men and elderly individuals had an increased risk of not complying with this reference value.

Intake of water and different beverages in adults across 13 countries

PurposeTo describe the intake of water and all other fluids and to evaluate the proportion of adults exceeding the World Health Organisation (WHO) recommendations on energy intake from free sugar, solely from fluids.MethodsA total of 16,276 adults (46xa0% men, mean age 39.8xa0years) were recruited in 13 countries from 3 continents. A 24-h fluid-specific record over 7xa0days was used for fluid assessment.ResultsIn Spain, France, Turkey, Iran, Indonesia and China, fluid intake was characterised by a high contribution of water (47–78xa0%) to total fluid intake (TFI), with a mean water intake between 0.76 and 1.78xa0L/day, and a mean energy intake from fluids from 182 to 428xa0kcal/day. Between 11 and 49xa0% of adults exceeded the free sugar WHO recommendations, considering solely fluids. In Germany, UK, Poland and Japan, the largest contributors to TFI were hot beverages (28–50xa0%) and water (18–32xa0%). Mean energy intake from fluids ranged from 415 to 817xa0kcal/day, and 48–62xa0% of adults exceeded free sugar WHO recommendations. In Mexico, Brazil and Argentina, the contribution of juices and regular sugar beverages (28–41xa0%) was as important as the water contribution to TFI (17–39xa0%). Mean energy intake from fluids ranged 565–694xa0kcal/day, and 60–66xa0% of the adults exceeded the free sugar WHO recommendation.ConclusionsThe highest volumes recorded in most of the countries were for water, mean energy intake from fluids was up to 694xa0kcal/day, and 66xa0% of adults exceeded the free sugar WHO recommendation solely by fluids. Actions to create an environment in favour of water consumption and reduce sugar intake from fluids therefore are warranted.

Intake of water and beverages of children and adolescents in 13 countries.

AbstractPurposeTo describe the intake of water and all other beverages in children and adolescents in 13 countries of three continents.nMethodsData of 3611 children (4–9xa0years) and 8109 adolescents (10–17xa0years) were retrieved from 13 cross-sectional surveys (47xa0% males). In three countries, stratified cluster sampling design was applied to randomly recruit schools classes. A quota method was applied in the other countries to randomly recruit participants. Details on the intake of all fluid types were obtained with a fluid-specific record over 7 consecutive days.nResultsIn the total sample, the highest mean intakes were observed for water (738xa0±xa0567xa0mL/day), followed by milk (212xa0±xa0209xa0mL/day), regular soft beverages (RSB) (168xa0±xa0290xa0mL/day) and juices (128xa0±xa0228xa0mL/day). Patterns characterized by a high contribution of water, RSB or hot beverages to total fluid intake were identified among the countries with close geographical location. Adolescents had a significantly lower milk intake and higher intake of RSB and hot beverages than children in most countries. The most consistent gender difference observed was that in both age groups males reported a significantly higher RSB consumption than females.ConclusionOn average, water was the fluid consumed in the largest volume by children and adolescents, but the intake of the different fluid types varied substantially between countries. Since the RSB intake was as large, or even larger, than water intake in some countries, undertaking actions to improve fluid intake habits of children and adolescents are warranted.

Total fluid intake of children and adolescents: cross‑sectional surveys in 13 countries worldwide

PurposeTo describe total fluid intake (TFI) according to socio-demographic characteristics in children and adolescents worldwide.MethodsData of 3611 children (4–9xa0years) and 8109 adolescents (10–18xa0years) were retrieved from 13 cross-sectional surveys (47xa0% males). In three countries, school classes were randomly recruited with stratified cluster sampling design. In the other countries, participants were randomly recruited based on a quota method. TFI (drinking water and beverages of all kinds) was obtained with a fluid-specific record over 7 consecutive days. Adequacy was assessed by comparing TFI to 80xa0% of adequate intake (AI) for total water intake set by European Food Safety Authority. Data on height, weight and socio-economic level were collected in most countries.ResultsThe mean (SD) TFI ranged from [1.32 (0.68)] to [1.35 (0.71)] L/day. Non-adherence to AIs for fluids ranged from 10xa0% (Uruguay) to >90xa0% (Belgium). Females were more likely to meet the AIs for fluids than males (4–9xa0years: 28xa0%, OR 0.72, pxa0=xa00.002; 10–18xa0years: 20xa0%, OR 0.80, pxa0=xa00.001), while adolescents were less likely to meet the AI than children (OR 1.645, pxa0<xa00.001 in males and OR 1.625, pxa0<xa00.001 in females).ConclusionsA high proportion of children and adolescents are at risk of an inadequate fluid intake. This risk is especially high in males and adolescents when compared with females or children categories. This highlights water intake among young populations as an issue of global concern.

Water intake: validity of population assessment and recommendations

Good hydration is vital for good health and well-being. Until recently, there was little interest in collecting data on water and drink and beverage intake. However, there is increasing evidence that a low water intake or mild dehydration may be linked with the risk of chronic diseases. Accurate estimates of intake in populations are essential to explore these relationships. This will enable the identification of specific populations at the risk of low water intake and allow exposure assessment of potential contaminates and specific nutrients present in drinks and beverages. In addition, data from these population studies are used as the basis of national and international recommendations on water intake and to set and evaluate national health policies. For example, EFSA based their recommendations on data from population studies from 13 European countries. The range of intakes varied from 720 to 2621xa0mL/day; this diversity cannot be explained by environmental differences alone. However, this variability may, at least partially, be explained by the inconsistency in methodologies used as none of surveys used a dietary assessment tool validated for total water intake or beverage and drink intake. It is reasonable to suggest that this may result in incomplete data collection and it raises questions on the validity of the recommendations. The relationship between water consumption and health warrants further investigation, and robust methodologies are essential to ensure that these data are accurate and useful for setting public health priorities and policies.

Contribution of Water from Food and Fluids to Total Water Intake: Analysis of a French and UK Population Surveys

Little has been published on the contribution of food moisture (FM) to total water intake (TWI); therefore, the European Food Safety Authority assumed FM to contribute 20%–30% to TWI. The aim of the present analysis was to estimate and compare TWI, the percentage of water from FM and from fluids in population samples of France and UK. Data from 2 national nutrition surveys (Enquête Comportements et Consommations Alimentaires en France (CCAF) 2013 and the National Diet and Nutrition Survey (NDNS) 2008/2009–2011/2012) were analyzed for TWI and the contribution of water from FM and fluids. Children and adults TWI were significantly lower in France than in the UK. The contribution of water from foods was lower in the UK than in France (27% vs. 36%). As TWI increased, the proportion of water from fluids increased, suggesting that low drinkers did not compensate by increasing intake of water-rich foods. In addition, 80%–90% of the variance in TWI was explained by differences in water intake from fluids. More data on the contribution of FM to TWI is needed to develop more robust dietary recommendations on TWI and guidance on fluid intake for the general public.

Development and Validation of a Questionnaire to Measure Research Involvement among Registered Dietitians

Research involvement among registered dietitians (RDs) is important in advancing dietetics practice and ensuring high-quality and cost-effective health care. There are no standardized approaches to measuring levels of research involvement. The aim of the study was to develop a standardized measure of research involvement and test its validity and reliability among RDs. The Research Involvement Questionnaire (RIQ) was developed and underwent content validation, resulting in a content validity index of 0.92. A postal questionnaire survey of RDs was undertaken at two time points. RDs were purposively selected and, based on their number of publications and grants, were assigned by the authors to one of four levels of research involvement: evidence-based practice, collaborating on research, leading research, and leadership in research. Of 192 questionnaires mailed, 111 RDs (58%) returned the first RIQ, of whom 82 (74%) also returned the second RIQ. Total scores and scores for each level were higher for RDs with higher levels of research involvement (P<0.001). RDs assigned by the RIQ to higher levels of research involvement had higher qualifications; were qualified for longer; and had greater evidence of research output, including journal publications and grants (P<0.001). There was excellent internal consistency as measured using Cronbachs coefficient (α=.98). The level of research involvement assigned by the RIQ and by the purposive selection process agreed on 76% of occasions, indicating substantial agreement beyond chance (κ=0.67; P<0.001). The level of research involvement assigned by the RIQ at two time points agreed on 86% of occasions, indicating almost perfect agreement beyond chance (κ=0.81; P<0.001). A valid and reliable questionnaire has been developed to measure research involvement among RDs, providing a useful tool for evaluating and supporting members of the profession to become more involved in research.

Fluid intake of Latin American children and adolescents: results of four 2016 LIQ.IN 7 National Cross-Sectional Surveys

PurposeThe primary aim of this survey was to report total fluid intake (TFI) and different fluid types for children (4–9xa0years) and adolescents (10–17xa0years) in Mexico, Brazil, Argentina and Uruguay. The second aim wasxa0to compare TFI with the adequate intake (AI) of water from fluids as recommended by the USA Institute of Medicine.MethodsData were collected using a validated liquid intake 7-day record (Liq.In7). Participants’ characteristics, including age, sex and anthropometric measurements were recorded.ResultsA 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.ConclusionsLarge 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.

Relevance of Assessment Methods for Fluid Intake.

Reliable data at population level are essential to firmly establish links between fluid intake, hydration and health, investigate dose-response relationships and develop meaningful public health strategies or reference intake values. However, limited research exists regarding the most appropriate methodology for assessing beverage or total fluid intake (TFI). To date, methodologies have been developed to assess food and nutrient intake without due consideration of water or fluid intake behavior. A recent crossover study showed that a 24-hour food recall significantly underestimated mean TFI by 382 ml (95% CI 299-465) compared with a fluid specific 7-day record. The authors postulated that this average difference was mainly the result of missed drinking acts between meals a 24-hour recall was used. Using a 7-day record administered in paper form or on-line has also been shown to lead to a significantly different mean TFI of 129 ml. Therefore, the choice of methodology might result in measurement errors that limit between-survey or between-country comparisons. Such errors may contribute to variations in estimates of TFI that cannot be explained by differences in climate, physical activity or cultural habits. A recent survey confirmed the variation in methodologies used in European national dietary surveys. Since these surveys form the basis for setting adequate intakes for total water intake, measurement error between surveys should be limited, highlighting the need for the development of a consistent methodology that is validated for water and TFI estimation.

Fluid intake of Latin American adults: results of four 2016 Liq.In7 national cross-sectional surveys

PurposeTo report total fluid intake (TFI) and the intake of different fluid types in adults (≥u200918xa0years old) from Mexico, Argentina, Brazil and Uruguay. To compare intakes between countries and with recommended adequate intake (AI) of water from fluids.MethodsCross-sectional data were collected using a validated liquid intake 7-day record (Liq.In7) in populations from Argentina (nu2009=u20091089), Brazil (nu2009=u2009477), Mexico (nu2009=u20091677) and Uruguay (nu2009=u2009554). Population characteristics, including age, gender, body mass index and socioeconomic level were recorded. Mean TFI was compared with the AI of water from fluids set by the USA Institute of Medicine.ResultsThe lowest TFI was recorded in Mexican women (1748xa0mL/day) and the highest in Argentinean men (2318xa0mL/day). Median daily TFI was significantly different between countries; Uruguay and Argentina had higher values than Mexico and Brazil. In the former, plain water contributed to only 25% of TFI, the remainder being predominantly from hot beverages. Approximately, a third of adults did not drink enough fluid to meet the recommended AI. High SSB consumption was reported, which was significantly different between countries (pu2009<u20090.05), the highest being in Mexico (median 25–75th percentiles): 531 (300–895xa0mL/day.ConclusionsThis survey highlights the need to increase water consumption and reduce SSB intake in this region to avoid potential associated health risks. These findings may be useful information in monitoring public health policy strategies.