6^th Annual Hydration For Health Scientific Conference, Evian, July 2014

Session moderator Professor Lawrence E. Armstrong from the University of Connecticut, Department of Human Kinesiology, kicked off the session by reviewing research indicating that some children are performing their daily functions while mildly dehydrated (less than 2% body weight). He went on to introduce several experts who discussed various facets of healthy hydration in children.

Moving into cognitive function and the benefits of specific health behaviors on children’s brain health and development, Professor Charles Hillman from the University of Illinois, Department of Kinesiology and Community Health, discussed the brain-body connection in children.

Pr Hillman’s findings imply that healthy markers in childhood, including greater aerobic fitness, healthy body weight and high diet quality are positively related to brain function, cognition and scholastic achievement. Future research may look at hydration and its effect on brain health in children.

To provide context to the hydration in children story, Dr Isabelle Guelinckx from Danone Nutricia Research reviewed fluid intake data to determine if children worldwide are meeting fluid recommendations. Based on the available research, the definitive answer is no. A 2013 study by Moreno et al found that of 2741 European adolescents surveyed, 69% of boys and 64% of girls had total water intake below the adequate intakes recommended by EFSA. Intake surveys conducted in 12 countries around the world found that while quantity and quality of fluid consumed varied country to country, children were not meeting overall adequate intake requirements.

While we know it is probable that many children are dehydrated, what type of a tool might we use to measure it? In 1994, Pr Armstrong developed the Urine Color Chart, a practical and accurate tool for assessing hydration status in adults (Order the Urine Color Chart here). A logical next question was whether this type of tool would also be useful for children. Professor Starvos Kavouras from the University of Arkansas presented data on a validity study of the use of the Urine Color Chart in children.

Sensitivity analysis showed that the overall accuracy of the urine color assessed in a laboratory setting based on a 24-hour sample compared with urine osmolality was 88.7%, after adjusting for age, gender, BMI and water consumption, showing that the UCC was an accurate tool for assessing children’s hydration status.

Professor Richard Johnson from the University of Colorado, Denver explored rehydration’s impact on CKD and the importance of the source of hydration. Reviewing the case of Nicaraguan sugar cane workerswith disproportionate rates of chronic kidney disease, Pr Johnson hypothesized that on top of chronic dehydration it might have been their source of rehydration, fructose-containing beverages, which gave rise to their condition. Based on animal models, Pr Johnson provides additional evidence of a new mechanism for kidney damage initiated by dehydration and further exasperated by rehydration with sugary beverages. Review more of Pr Johnson’s research.

Dialysis initiation could be delayed with improved hydration as measured by lower urine osmolarity, according to research conducted by Dr Lise Bankir from INSERM, Centre de Recherche des Cordeliers in Paris, France. In a retrospective cohort analysis of 273 patients with CKD stages 1-4, Dr Bankir assessed the association among urine volume, urine osmolarity and the risk of dialysis. After 72 months, the research indicated that the probability of dialysis decreased as the patients’ urine osmolarity decreased at a rate of 15% at 315 mosm/L, 24% at 510mosm/L and 34% at 775mosm/L. More on Dr Bankir’s research is available here.

The results of a study assessing safety of increasing water intake in patients with chronic kidney disease was presented by Professor Bill Clark from Western University of Canada. After reviewing general hydration safety and rare cases of overhydration in the general population, Pr Clark presented the findings on hydration safety in CKD patients. His research found that increasing water intake between 1-1.5L per day was not associated with adverse events and did not impact quality of life in CKD patients.

Professor Barry Popkin from the University of North Carolina at Chapel Hill, Carolina Population Center kept the conversation lively by reviewing the impact of water intervention on total diet and diet-related outcomes. Pr Popkin reviewed the recent history of food retail and consumer packaged goods and its evolution along with consumer preference for sweetness. Furthermore, Pr Popkin conveyed concern that hydration has suffered alongside this penchant for sweetness as consumers reach for sweetened and carbonated beverages instead of water. Pr Popkinsuggested the need for more research around the health impact of interventions comparing water intake to that of sweetened, carbonated beverages.

Taking a deeper look at this topic, Dr Hernández Cordero from the National Institute of Nutrition and Public Health in Mexico explored how an intervention study in which water is substituted for sugar-sweetened beverages (SSBs) could impact health outcomes in overweight and obese women. Mexico has one of the highest rates of obesity and related risk factors as well as the highest consumption rate of SSBs. Dr Hernández Cordero’s study, conducted in Cuernavaca, México, looked at the effect of increasing water to the expense of SSBs intake on metabolic parameters. Analysis of the results suggest positive outcomes, particularly in obese women..

Looking at the impetus for making healthy choices from a different perspective, social psychologist Dr Saadi Lahlou from the London School of Economics discussed how the theory of “installation” may impact health choices. This theory takes into account a three-layered installation that includes the environment, the individual and social influences. Dr Lahlou used this theory in a one-year intervention in Poland to “nudge” children to make the healthy choice of drinking more water. This installation’s three elements were: information on the benefits of drinking water, placement of free bottles of water and access to an online forum on water consumption. Placement of water had the strongest effect, but all treatments increased water consumption, “nudging” the children to keep drinking water even six months beyond the end of the intervention.

Making a public health campaign as compelling as a new product launch from the world’s biggest brands, Drew Nannis, chief marketing officer for Partnership for a Healthier America (PHA) gave a behind-the-scenes look at the Drink Up campaign. The Drink Up campaign brings together private sector marketing strategies, consumer research and star power, including PHA’s honorary chair, First Lady of the United States, Michelle Obama. Drink Up has a simple message: “We are what we drink and when we drink water, we drink up.” More on the DrinkUp campaign here.

Nowadays, still an important part of the world population does not access to safe water in sufficient quantities. The impact of providing safe water to populations that does not normally access to has not been extensively studies. Professor Paul Hunter from Norwich Medical School (UK) posed this question in a quasi-longitudinal study in eight Cambodian schools, four of which received treated water from local entrepreneurs. In Pr Hunter’s research, there was a strong association with provision of free water and reduced absenteeism, but mostly in the dry season when pathways to school were more accessible. The local entrepreneurs supplying the water for Pr Hunter’s study were also mentioned, as their participation was part of an initiative from 1001 Fontaines and Danone Communities.

To end the day, Guiseppe Remuzzi, MD, the President of the International Society of Nephrology (ISN) 2013-2015, introduced the “0 by 25” campaign from ISN, currently in development to eradicate Acute Kidney Failure (AKF) by 2025 in the developing world. Currently, more than 1.7 million people die annually from AKF, as many as from HIV. The objectives of this project are to establish AKF as a contributor to the Global Burden of Disease, raise awareness of AKF amongst health professionals, researchers and governments, and develop sustainable infrastructure to enable “need-driven” approaches for education training, care delivery and measurable outcomes. Find out more about the “0 by 25 Campaign” and how to get involved.