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The Importance of Healthy Hydration

The Importance of Healthy Hydration. Slide Kit. The Importance of Water. Water is an essential component of all bodily organs The water content of body parts varies from 10% in adipose tissue to 83% in blood 1

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The Importance of Healthy Hydration

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  1. The Importance ofHealthy Hydration Slide Kit

  2. The Importance of Water

  3. Water is an essential componentof all bodily organs The water content of body parts varies from 10% in adipose tissue to 83% in blood1 Adequate hydration is necessary to ensure healthy organ function, including that of the urinary tract, the heart, the digestive system, and the brain2 Water is an essential physiological requirement and maintaining hydration is essential for normal body function Water composition of tissues and organs(% by weight)1 Brain 74.8 72.0 Skin Lungs 79.0 Blood 83.0 Heart 79.2 Liver 68.3 Spleen 75.8 Kidney 82.7 Intestine 74.5 Adipose tissue 10.0 Muscle 75.6 22.0 Skeleton (bone) 1. Pivarnik, J.M. Ed. Hickson, J.F., and Wolinsky, I. Boca Raton, FL: CRC Press, 245-262. 2. Manz F. J Am Coll Nutr 2007; 26(5 Suppl):535S-541S

  4. Healthy Hydration: Two simple concepts Quantity Quality

  5. Healthy Hydration: Two simple concepts Quantity Quality

  6. On average, at least 2.6 litresof water are lost through respiration, perspiration,faeces and urine every day1 The kidneys have a particular requirement for good hydration and are highly sensitive to fluctuations in fluid levels2 Water is continuously lost from the body – even when sedentary Average daily water loss1 Skin 0.5L Respiratory tract 0.4L Kidneys 1.5L Gastrointestinal tract 0.2L Total 2.6L 1. Shirreffs SM. J Sports Med Phys Fitness 2000; 40:80-4. 2. Groff JL, et al. In: Advanced Nutrition and Human Nutrition, Second Edition. 1995; pp423-439

  7. Dehydration has been linked to increases in risk for several diseases and disorders including1 Urinary-tract infections Dental disease Bronchopulmonary disorders Constipation Kidney stones Impaired cognitive function Not drinking enough fluid is associatedwith a range of physiological disorders Relationship between dehydration and disorders and disease1 1. Manz F. J Am Coll Nutr 2007; 26(5 Suppl):535S-541S.

  8. Fluid deficits of >1% of body weight can lead to reductionsin exercise performance and thermoregulation1 Deficits of ≥4% lead to increases in body temperature and in respiratory rate1 Cardiovascular function is increasingly impaired with increasing dehydration, with a rise in heart rate and difficultiesin maintaining blood pressure2,3 250 200 150 100 50 0 Dehydration also impacts on physical performance Differences in blood pressure after exercise induced dehydration (EX-DEH) and after rehydration (EX-REH)3 EX-DEH EX-REH MSNA (unit/beat) 40 50 60 70 80 90 Diastolic blood pressure (mmHg) 1. Grandjean AC, et al. Nutr Rev 2003; 61: 261-71. 2. Schroeder C, et al. Circulation 2002; 106:2806-11. 3. Charkoudian N, et al. J Physiol 2003; 552:635-44.

  9. How much should we drink? • The amount of fluid (including water obtained from food) to maintain hydration for average adults in average conditions is: • 2.9 litres/day for men • 2.2 litres/day for women1 • The European Food Safety Authority (EFSA) and the Institute of Medicine (IOM) state that the average food diet provides 20% of the recommended total daily fluid intake2 • Based on the EFSA expert opinion for recommended daily consumption,the amount of liquid that should be consumed can be calculated as: • 2.0 litres for men • 1.6 litres for women2 • These figures are calculated on the basis of a normal temperate climate and a sedentary lifestyle. Changes in these and/or other factors (such as pregnancy or lactation) would increase the daily liquid intake requirement 1. Howard G, Bartram J. WHO 2003. Available at http://whqlibdoc.who.int/HQ/2003/ WHO_SDE_WSH_03.02.pdf. Accessed June 2009. 2. EFSA. Scientific Opinion on Dietary Reference Values for water. Available at: http://www.efsa.europa.eu/en/scdocs/scdoc/1459.htm. Accessed April 2010.

  10. Healthy Hydration: Two simple concepts Quantity Quality

  11. There are now more than 1 billion overweight adults in the world – at least 300 million are considered to be obese1 22 million of the world’s children under 5 years old are overweight1 The number of people with type 2 diabetes is increasing alarmingly: 150 million in 2000 246 million in 2007 380 million predicted in 20252 Metabolic syndrome now affects around 25% of the world’s population3 Continuous increase in prevalence of diabetes worldwide2 400 350 300 Number of people with diabetes (Millions) 250 200 150 100 50 1985 2000 2009 2025 Estimated 0 Year Obesity and other metabolic disorders have become 21st century health ‘epidemics’ 1. World Health Organization. Available at http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/. Accessed April 2010 2. International Diabetes Federation, Diabetes Atlas Third Edition (2006). Available at: http://www.eatlas.idf.org/. Accessed April 2010. 3. Riccardi G, et al. Eur J Nutr 2004; 43(Suppl 2):II7-II46.

  12. The optimum population BMI is considered to be approximately ~21 kg/m2 Overweight and obesity: classification Cut-off points for overweight and obesity in European and Asian countries1 • Overweight and obesity are caused by: • A sedentary lifestyle • An excess intake of calories vs. energy burned3 1. WHO Western Pacific Region, 2000. http://www.who.int/nutrition/publications/obesity/09577082_1_1/en/index.html. 2. James WPT. J Intern Med. 2008; 263:336-52. 3. Swinburn BA, et al. Public Health Nutr. 2004; 7:123-46.

  13. Overweight and obesity are important risk factorsfor cardiometabolic disease • Excess weight – especially intra-abdominal fat – is associated with a number of conditions that are known risk factors for cardiovascular disease, including:1-3 • Hypertension • Dyslipidaemia • Insulin resistance • Type 2 diabetes 1. Després JP, et al. J Endocrinol Invest. 2006; 29:77-82. 2. James WPT. J Int Med 2008; 263:335-352. 3. WHO. Available at: http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/ Accessed: April 2010.

  14. The increasing prevalence of obesity is rapidly becoming a global societal problem1 35 USA 30 25 England Finland 20 Obese (BMI ≥ 30 kg/m2) (%) 15 Sweden 10 Australia Cuba 5 Brazil Norway Japan 0 1970 1975 1980 1985 1990 1995 2000 2005 Year • The obesity epidemic is not only restricted to Western or industrialised countries • Some Asian and African countries are showing changes in physical activity and diet associated with rapid increases in obesity and type 2 diabetes1,2 1. James WPT. J Intern Med. 2008; 263:336-52. 2. WHO. http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/

  15. BMI ≥30 BMI 25-29.9 BMI 25-29.9 BMI ≥30 1999-2000 USA 1988-94 2002 Germany 1985 1992-4 Hungary 1985-8 2003 England 1993 1999 Austria 1991 (self report) 1999 Italy (self report) 1994 1993-7 Netherlands 1976-80 1992 Denmark 1982 (self report) 2003 France (self report) 1997 60% 40% 20% 0% 20% 40% 60% The prevalence of overweight and obesityis increasing, particularly in men1 Changes in adult weight and obesity in selected countries 1. International obesity task force. March 2005. Available at: http://ec.europa.eu. Accessed: September 3, 2008.

  16. The prevalence of overweight and obesity in children is also of concern Overweight & obesity in pre-adolescent(7–11 yrs approx) European boys1 Overweight & obesity in pre-adolescent(7–11 yrs) European girls1 Obesity Obesity Overweight (inc obesity) Overweight (inc obesity) Spain 1998-2000 Greece 2003/4 Malta 1992 Portugal 1996 England 2004 England 2004 Italy 1993-2001 Italy 1993-2001 Portugal 2002/3 Spain 1998-2000 Russian Fed 1992 Ireland (Republic of) 2001/2 Cyprus 1999/2000 Cyprus 1999/2000 Ireland (Republic of) 2001/2 Sweden 2001 France 2000 Russian Fed 1992 Sweden 2001 Switzerland 2002 Czech Republic 2001 France 2000 Switzerland 2002 Czech Republic 2001 Poland 2001 Germany 1995 Germany 1995 Poland 1996 Denmark 1996/7 Denmark 1996/7 Slovakia 1995-99 Netherlands 1997 Netherlands 1997 Slovakia 1995-99 5 10 15 20 25 30 35 40 5 10 15 20 25 30 35 40 % % Note: some of the data is self-reported and may underestimate prevalence of overweight and obesity 1. International obesity task force 2007. Available at: http://www.iotf.org/database/Childhoodandadolescentoverweightineurope.htm. Accessed: April 2010.

  17. The prevalence of overweight and obesity in adolescents is also of concern Overweight & obesity in post-adolescent (14–17 yrs approx) European boys1 Overweight & obesity in post-adolescent(14–17 yrs) European girls1 Obesity Obesity Overweight (inc obesity) Overweight (inc obesity) Spain 1998-2000 England 2004 Ireland (Republic of) 2001/2 Malta (self report 2001) Italy 1993-2000 England 2004 Hungary 1993/4 Italy 1993-2001 Malta (self report) 2001 Ireland (Republic of) 2001/2 Denmark 1996/7 Denmark 1996/7 Cyprus 1999-2000 Russian Fed 1992 Russian Fed 1992 Slovenia (self report) 2001/2 Spain 1998-2000 Finland (self report) 1999 Germany 1995 Poland 1996 Netherlands 1997 Hungary 1993-4 Turkey 2001 Germany 1995 Finland (self report) 1999 Turkey 2001 Poland 1996 Czech Republic 2001 Czech Republic 2001 Slovakia 1995-99 Slovenia (self report) 2001/2 Estonia (self report) 2001/2 Slovakia 1995/99 Latvia (self report) 2001/2 Estonia (self report) 2001/2 Netherlands 1997 Latvia (self report) 2001/2 5 10 15 20 25 30 35 40 5 10 15 20 25 30 35 40 % % Note: some of the data is self-reported and may underestimate prevalence of overweight and obesity 1. International obesity task force 2007. Available at: http://www.iotf.org/database/Childhoodandadolescentoverweightineurope.htm. Accessed: April 2010.

  18. The prevalence of overweight among schoolchildren is estimated to be 35% in European regions1 More than 20,000 obese children in the EU alone have type 2 diabetes2 Obesity in childhood is associated with the presence of risk factors for conditions such as diabetes and hypertension and with the early development of these diseases2 1.400.000 1.200.000 1.000.000 800.000 600.000 400.000 200.000 0 Childhood obesity has a profound effect on health Estimated numbers of obese children in the EUwith obesity-related disorders2 Number of children Glucose intolerance CV risk factors Early liver disorder Type of disorder 1. Jackson-Leach R, Lobstein T. Int J Pediatr Obes 2006; 1:26-32. 2. Lobstein T, et al. Int J Pediatr Obes 2006; 1:33-41.

  19. Overweight and obese people have a higher number of adipose cells than individuals of normal weight1,2 The number of fat cells is set during childhood and adolescence1 It is important to note that the consumption of calories during childhood has significant consequences for the amount of fat deposits (e.g. adipocytes) in adult life1-3 90 80 70 60 50 30 40 20 10 0 Overweight and obese children can become overweight and obese adults Higher numbers of adipocytes in obese children and adults (open circles) vs. non-obese children and adults (closed circles)2 (8) (13) (13) Adipose cell number x 109 (5) (14) (13) (12) (12) (8) (11) (8) (12) (11) (11) 0.3 1 2-4 6-8 10-12 14-16 18-20 22-24 Age in years 1. Spalding KL, et al. 2008; 453:783-7. 2. Knittle JL, et al. J Clin Invest 1979; 63:239-46. 3. Häger A, et al. Metabolism 1977; 26:607-14.

  20. The relationship between emerging public health issues such as obesity and beverage consumption

  21. Modern dietary habits are also leading to an increased consumption of liquid calories • In the US, soft drink consumption has increased by 300% in the past 20 years1 • Sugar-sweetened beverage (SSB) consumption has increased by 135%in this time2 • In 1998, added sugars in food accounted for 15.8% of daily energy intake for children in the US3 • To burn off the calories in just onecan of sugar-sweetened soft drink(~150 calories) requires 45 minutes walking or 20 minutes jogging • Consuming an additional 120 kcalper day (about one serving of a SSB) produces a 50 kg (110 pounds) increase in body mass over 10 years1 1. Harrington S. J Sch Nurs 2008; 24:3-12. 2. Nielsen SJ, Popkin BM. Am J Prev Med 2004; 27:205-210. 3. Drewnowski A, Bellisle F Am J Clin Nutr. 2007; 85:651-61.

  22. P<0.001 for trend 2 1.8 1.6 1.4 1.2 1 0.2 0.8 0.4 0.6 <1/month 4-6/month 2-6/week ³1/day 0 Excessive consumption of sugar-sweetened drinks has been linked to a range of modern-day health problems • A habitual intake of SSBs has been associated with metabolic disorders and diseases including • Weight gain in children1,2 • Prevalence of metabolic syndrome3 • Type 2 diabetes4,5 • Excessive consumption of carbonated soft drinks is suspected to increase the risk of other diseases, such as kidney disease and kidney stones6,7 Increasing risk of type 2 diabetes with increasing consumption of sugar-sweetened beverages4 Relative risk Number of sweetened beverages consumed 1. Ludwig DS, et al. Lancet 2001; 357:505-508; 2. Troiano RP, et al. Am J Clin Nutr 2000; 72(Suppl. 5):343S-1353S. 3. Yoo S, et al. Am J Clin Nutr 2004; 80:841-848; 4. Schulze MB, et al. JAMA 2004; 292:927-934. 5. Bazzano LA, et al. Diabetes Care 2008; 31:1311-1317; 6. Shuster J, et al. J Clin Epidemiol 1992; 45:911-6. 7. Saldana TM, et al. Epidemiology 2007; 18:501-506

  23. 16 P=Not significant 14 12 10 8 6 4 2 0 Non SSB consumer SSB consumer Regular consumption was ≥4–6 times per week Excessive consumption of SSBs is positively associated with weight gain, especially in children and adolescents • A prospective observational study conducted in schoolchildren showed that daily consumptionof SSBs increased the risk of obesity by approximately 60%1 • SSBs have a high glycaemic index (GI): high GI foods canlead to increased post-prandial insulin, and energy storage, especially in young people2,3 Effect on weight of regular between-meal consumption of SSBs on children between the ages of 2.5 and 4–5 years old4 Percentage of overweight children 1. Ludwig DS, et al. Lancet 2001; 357:505-8. 2. Harrington S. J Sch Nurs 2008; 24:3-12. 3. Ebbeling CB, et al. Lancet 2002; 360:473-82. 4. Dubois L, et al. J Am Diet Assoc 2007; 107:924-34.

  24. 2.5 2 1.5 1 0.5 0 <1/mo 1/mo-4wk 5-7/wk 2-3/day >4/day Fruit-juice intake (number of cups [8oz]) There is a lack of information and some misunderstanding regarding consumption of SSBs – particularly fruit juices • It is not always recognised that some fruit-juice drinks contain high amounts of sugar andcan lead to disorders related to high-sugar consumption • In one study, women who consume fruit juice every day were shown to be heavierthan women who consumeit less than once a week1 • Another study has shown that excessive consumption of fruit juices has been associatedwith an increased incidenceof type 2 diabetes2 Increasing risk of type 2 diabetes with greater consumption of fruit juices2 Relative Hazard for Type 2 Diabetes 1. Schulze MB, et al. JAMA 2004; 292:927-34. 2. Bazzano LA, et al. Diabetes Care 2008; 31:1311-17.

  25. Healthy Hydration: Two simple concepts Quantity Quality Drinking more water can be a simple and sustainable steptowards a healthier lifestyle

  26. Healthy Hydration: Two simple concepts Quantity Quality Maintaining good hydration ensures optimal physical and cognitive performance Water is the only liquidour bodies need to hydrate. It contains no calories,no additives, no acids

  27. 2.5 3 2 1.5 1 0.5 0 Water (men) Water (women) Other fluids (men) Other fluids (women) Increasing daily water consumption is a simple step towards a healthier lifestyle, and has a number of health benefits • Water contains no calories, no sugar, no additives and is not acidified • Water consumption is not associated with weight gain or metabolic disorders • Water is one of the healthiest beverages for children aged >2 years • Drinking water from an early age helps to maintain healthy dietary practices throughout life This study showed a reduced risk of fatal coronary heart disease for people who drank water rather than other types of fluid1 Relative risk Chan J, et al. Water, Am J Epidemiol 2002; 155:827-33.

  28. 29 28 27 26 25 24 23 22 Promoting good hydration behaviour and consumingmore water can have a significant impact on weight, particularly in children • An initiative aimed at promoting water as the sole beverage in German schools, effectively reduced the prevalence of overweight schoolchildren1 • A similar UK initiative showedthat reducing carbonated-drink consumption in schoolchildren prevented further increases in overweight and obesity2 • Reducing consumption of carbonated drinks leads to increased consumptionof pure water2 Reduction in proportion of overweight children after an initiative aimed at promoting water consumption as the sole beverage in school children1 P=0.04 Percent of overwight and obese children 21 Control group Intervention group 1. Muckelbauer R, et al. Pediatrics 2009; 123:e661-e667. 2. James J, et al. BMJ 2004; 328(7450):1237.

  29. Conclusions • Healthy hydration practices are often either overlooked or lack emphasisin current public-health recommendations and advice given by healthcare professionals • However, current scientific literature suggests that there are a number of benefits • Excessive consumption of SSBs has been linked to a range of modern-day health problems • Good hydration ensures optimal physical and cognitive performance • Water is the only liquid needed for hydration – when you drink water, you are not consuming any calories or additives. Drinking plenty* of water each day is a positive behaviourto promote as it is a simple and sustainablestep towards a healthier lifestyle *National daily intake guidelines vary. For reference, EFSA recommend drinking 2L per day

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