7^th Annual Hydration For Health Scientific Conference, Evian, July 2015

Fluid intake data is hard to come by and hard to get right.  Setting the stage for the session, Dr Isabelle Guelinckx from Danone Nutricia Research unveiled a world wild database on fluid intake, Liq.in7.  In conjunction with this topic of fluid intake, a special supplement to the European Journal of Nutrition was distributed: http://link.springer.com/journal/394/54/2/suppl/page/1

Dr Joanne Gandy (UK) opened the session by exploring EFSA’s scientific opinion on Adequate Water Intake questioning if the wide variability on fluid intake data among European countries has more to do with collection methods vs actual intake.   This was supported by the results of a recent European survey investigating countries’ current methods. A series of recommendations was proposed, such as validated methodology published in peer-reviewed journals, calculation of water content in foods and standard definitions for water and beverage classification.

Prof Homero Martinez (California, USA) delved further into the topic, wading through specifics on the challenges of the currently used fluid intake methods.  Prof Martinez suggested that the 24-hour dietary recall has been found to underestimate total beverage intake, as fluids are often taken outside the meal.  For this reason, there is strong support for a 7-day fluid-specific survey. 

Concluding the session, Prof Luis Moreno (Spain), walked the audience through the specifics of Liq.In7, a comprehensive, 13-country fluid intake database that includes 3611 children, 8109 adolescents and 16,276 adults.  Liq.In1 identified some disheartening statistics:

• 60% of men and 40% of women are NOT meeting EFSA ADIs for water
• 61% of children, 77% of adolescent boys and 72% of adolescent girls are at risk of inadequate fluid intake
• Looking at fluid quality, most countries surpassed the WHO’s recommendation of not more than 10% added sugar from sweetened beverage.

More on this survey reported in the European Journal of Nutrition supplement.

Vasopressin took center stage in the second session of the day.  Dr Guelinckx returned to introduce the idea that vasopressin and/or its –surrogate marker - copeptin may be linked to features of cardiometabolic syndrome such as abdominal obesity, insulin resistance and hypertension, as well as kidney function.   Research has shown that individuals with low water intake may have a higher plasma concentration of vasopressin.  Looking at the literature, Dr Guelinckx “connected the dots” on vasopressin research, seeing that individuals with elevated vasopressin levels may benefit from increasing their water intake to reduce their risk of these cardiometabolic risk factors. 

Delving further into the neurophysiological functionality around vasopressin and dehydration, Prof Daniel Bichet (Canada) presented next.  By linking the functionality of thirst and dehydration to increased vasopressin levels Prof Bichet further connected the dots to vasopressin’s role in increased disease risk from conditions such as hypertension.  

Bringing the vasopressin story into the realm of disease risk prediction, Prof Olle Melander (Sweden), concluded the session.  Prof Melander sought to answer the question:  Is excess vasopressin the “factor X” in cardiometabolic syndrome, type 2 diabetes and cardiovascular disease?  Presenting a combination of animal and human studies, Prof Melander identified data suggesting that elevated levels of -copeptine can predict the development of a phenotype resembling a mild form of Cushing’s Syndrome and that elevated levels of copeptin links to increased abdominal obesity, insulin resistance, hypertension and reduced kidney function.  In conclusion, Prof Melander suggested reduction of vasopressin through increased water intake could be a promising candidate for prevention of cardiometabolic disease. 

A highlight of the Evian conference each year is the awarding of the Young Researcher Award.  Prof Evan Johnson from the University of Wyoming won for his research on water intake and insulin resistance in type 2 diabetes.  We will likely hear more from Prof Johnson in coming years!

Returning for the afternoon sessions, kidney health was on the agenda as we heard more about the new initiative conducted in conjunction with the International Society of Nephrology (ISN), Hydration for Kidney Health.  Prof Louise Moist (Canada), offered details of the program, designed to expand the scientific evidence, integrate awareness and create sustainable momentum in hydration for kidney health research.  To kick off the initiative, Prof Moist announced a new investigators grant.  

Detailing the gravity of acute kidney injury, Prof Guisseppe Remuzzi, past President of the ISN, offered an update on ISN’s human rights initiative ,“0by25,” looking to prevent all deaths by acute kidney injury by 2025.  The goals of the 0by25 initiative include:

• To address the current lack of data on the global burden of AKI, especially in low and middle-income countries.
• To raise awareness of AKI across the global healthcare community including among healthcare professionals, patients and, more widely, among governments and public health institutions and the private sector.
• To contribute to developing a sustainable infrastructure by implementing “need driven” approaches in selected areas for education and training and care delivery.

Documenting the progress made through the initiative, Prof John Feehally (UK) and former ISN President detailed more on the 0by25 initiative by reviewing the results of the “Global Snapshot on AKI”.  A web-based prospective data collection survey carried out in more than 400 patients in at least 80 countries over the course of 8 weeks, the Global Snapshot looks at symptoms, lab results and enrollment in the program.  

Initial results included:

• Dehydration is among the top three causes of AKI, induced from vomiting, diarrhea or lack of access to a safe water source.
• Dehydration is the second most important contributory factor for AKI.

The final session looked at health inequities and offered two perspectives on programs to activate healthy hydration and impact change in local communities.  Leading the session was Dr Jean-Michel Borys, from EPODE, an approach for communities to impact change in local communities to improve and promote healthy lifestyles. Disseminated to 40 programs in 29 countries, EPODE has seen encouraging results with a decrease from 10 to 20% prevalence of overweight and obesity.  EPHE, a program of EPODE, is designed specifically to impact change among both high and low socioeconomic communities in seven European communities.  Addressing healthy hydration with interventions such as bottled water contests and decorating your own water carafes, preliminary findings of the EPHE program saw low socio-economic groups improved their behavior even more than the high groups.  These results confirm that low-cost interventions, conducted with community support, can lead to results no matter what the economic condition of the community. 

Find out more: www.ephestory.eu

Concluding the sessions for the day, Mrs Ellis Koster from JOGG, a “Youth at Healthy Weight” program in the Netherlands, demonstrated how interventions that speak to audiences where they are can make a big impact. DrinkWater, the healthy hydration initiative from JOGG, uses social marketing to position water as the best beverage for youth to drink.  Some school-based initiatives include a pre-school kit with activities, school-based programs offering water bottles and jogs, and a mom-based effort focused on supporting moms to be the best mom they can be by encouraging their children to drink more water.  

The 7th Annual Hydration for Health Annual Conference was brought to a close with Dr Liliana Jimenez from Danone Nutricia Research reminding us how far we have come in the past few years and now that many of our dreams have come true, its time for some new dreams.  Read more on this and previous hydration conferences here and stay tuned for a call for the Young Researcher Award nominations in the next few months.

See you next year!