Lafontan M. et al. 2013

Recommendations for healthier hydration: addressing the public health issues of obesity and type 2 diabetes

Introduction

Potentially unhealthy food and beverages promotion is now recognized as a risk factor for child obesity. «Children continue to be exposed to junk food advertising at high levels» claimed Dr. Tim Lobstein in a systematic review of evidence recently published in Obesity Reviews (2013 Jul 12). Given the rapid increase in the prevalence of overweight, obesity and type 2 diabetes across the world, it is an important task for public health authorities and health care providers to tackle the problem in depth. Guidance and advice to the general public could prevent overweight progression, health care costs and societal burdens from escalating. Usually, the importance of fluid intake has been overlooked in campaigns and guidelines in most of countries. The question «what do you drink» is often omitted during nutrition questionnaires.

Rationale of the study

An interdisciplinary Expert Working Group including experts in medicine, nutrition, physiology and public health performed an overview of studies related to hydration-related problems. Attention was focused upon the effects of an over-consumption of sugar sweetened beverages (SSB) and non-nutritive sweeteners (NNS) on weight-related problems. Moreover the metabolic impact, mechanisms of action and effects on health of SSB and NNS were analyzed and summarized.

Relevance for an healthy hydration

The authors believe that the various published findings and results reveal the need for an improved healthy hydration. Thus, the Expert Working Group proposed recommendations for healthy hydration. Providers of healthcare education and public must be aware of the following points: (a) the composition and sugar content (with calorie equivalents) of beverages regularly modified for marketing purposes, (b) the detrimental effects of overconsumption of SSBs and NNS on long-term health and (c) the importance of drinking ample safe water within the context of a healthy, balanced diet. To ensure adoption by the general public, actions are requested both at a local but also national level based on:

1. Revision of current dietary guidelines with inclusion of advices on healthy hydration within the context of the rapid evolution of dietary and lifestyle changes.
2. Revision of national nutrition guidelines to emphasise the importance of water as a macronutrient and to include it within the food pyramid.
3. Facilitation of guidelines which should be simple, effective, and include easy-to-remember targets for each group of individuals. For example, guidelines should advise normal adults to drink approximately 2 litres of water per day. Importantly, recommendations about healthy eating and regular exercise practice must be associated to hydration guidelines.
4. Confirmation for the need and re-emphasise the consumption of safe water intake during the practice of physical activity and sweating and for all those living in hot environments.
5. Extension of new research to identify the daily water needs of specific groups at risk of disturbed hydration (e.g., sedentary and/or active children, pregnant and lactating women and the elderly, etc.).
6. Optimization of the hydration procedures by longitudinal studies extended to different populations (different countries, different environments, different socioeconomic levels and different age groups, patients submitted to medications).