Change in hydration indices associated with an increase in total water intake of more than 0.5 L/day, sustained over 4 weeks, in healthy young men with initial total water intake below 2 L/day

Stookey, Jodi; Hamer, Janice; Killilea, David W.

doi:10.14814/phy2.13356

Cited by 17 publications

(33 citation statements)

References 72 publications

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“…(5) Set a personal water intake goal for each segment of the day. (6) A dietitian can help you to determine a TWI goal based on the number of calories you consume each day (1.0-1.5 mL•kcal −1 of food energy)[100,123].…”

mentioning

confidence: 99%

Distinguishing Low and High Water Consumers—A Paradigm of Disease Risk

Armstrong

Muñoz

Armstrong³

2020

Nutrients

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A long-standing body of clinical observations associates low 24-h total water intake (TWI = water + beverages + food moisture) with acute renal disorders such as kidney stones and urinary tract infections. These findings prompted observational studies and experimental interventions comparing habitual low volume (LOW) and high volume (HIGH) drinkers. Investigators have learned that the TWI of LOW and HIGH differ by 1–2 L·d−1, their hematological values (e.g., plasma osmolality, plasma sodium) are similar and lie within the laboratory reference ranges of healthy adults and both groups appear to successfully maintain water-electrolyte homeostasis. However, LOW differs from HIGH in urinary biomarkers (e.g., reduced urine volume and increased osmolality or specific gravity), as well as higher plasma concentrations of arginine vasopressin (AVP) and cortisol. Further, evidence suggests that both a low daily TWI and/or elevated plasma AVP influence the development and progression of metabolic syndrome, diabetes, obesity, chronic kidney disease, hypertension and cardiovascular disease. Based on these studies, we propose a theory of increased disease risk in LOW that involves chronic release of fluid-electrolyte (i.e., AVP) and stress (i.e., cortisol) hormones. This narrative review describes small but important differences between LOW and HIGH, advises future investigations and provides practical dietary recommendations for LOW that are intended to decrease their risk of chronic diseases.

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confidence: 99%

Distinguishing Low and High Water Consumers—A Paradigm of Disease Risk

Armstrong

Muñoz

Armstrong³

2020

Nutrients

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“…In healthy young men with usual total water intake below 2L/d and urine osmolality above 800 mmol/kg, an acute bolus of 750 ml drinking water reduces urine osmolality by over 700 mmol/kg within 60 min. After 4 weeks of total water intake above 3L/d, the corresponding decrease in urine osmolality induced by an acute 750 ml bolus is approximately halved [32] , [31] .…”

Section: Evidence Motivating the Hypothesesmentioning

confidence: 99%

“…Multiple metabolic and physiologic responses co-occur impacting multiple pathways and organ systems simultaneously [14] , [30] . In free-living individuals, under conditions of daily life, adaptation to chronic hypertonicity may take weeks [31] , [32] .…”

Section: Evidence Motivating the Hypothesesmentioning

confidence: 99%

“…In healthy young men with urine osmolality over 800 mmol/kg under conditions of daily life, chronic hypertonicity and mild (<2%) TBW deficit appear associated with metabolic and physiologic adaptations that result in water retention in response to hypotonic challenge [31] . Four weeks of sustained higher intake of drinking water (>+1L/d) is associated with a mean (SE) decrease in HOMA-IR of 2.2 (0.2) to 1.7 (0.1), a mean (SE) increase in plasma aldosterone from 111 (17) pg/ml to 143 (19) pg/ml and an average (SE) increase in body weight of +1.8 (0.5) percent [32] , [31] . While significant change in body weight is not detected from one week to the next, the cumulative change over 4 weeks is statistically significant and correlated with increases in serum sodium and a muted change in water turnover [31] .…”

Section: Evidence Motivating the Hypothesesmentioning

confidence: 99%

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Hypotheses about sub-optimal hydration in the weeks before coronavirus disease (COVID-19) as a risk factor for dying from COVID-19

Stookey¹,

Allu²,

Chabas³

et al. 2020

Medical Hypotheses

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To address urgent need for strategies to limit mortality from coronavirus disease 2019 (COVID-19), this review describes experimental, clinical and epidemiological evidence that suggests that chronic sub-optimal hydration in the weeks before infection might increase risk of COVID-19 mortality in multiple ways. Sub-optimal hydration is associated with key risk factors for COVID-19 mortality, including older age, male sex, race-ethnicity and chronic disease. Chronic hypertonicity, total body water deficit and/or hypovolemia cause multiple intracellular and/or physiologic adaptations that preferentially retain body water and favor positive total body water balance when challenged by infection. Via effects on serum/glucocorticoid-regulated kinase 1 (SGK1) signaling, aldosterone, tumor necrosis factor-alpha (TNF-alpha), vascular endothelial growth factor (VEGF), aquaporin 5 (AQP5) and/or Na + /K + -ATPase, chronic sub-optimal hydration in the weeks before exposure to COVID-19 may conceivably result in: greater abundance of angiotensin converting enzyme 2 (ACE2) receptors in the lung, which increases likelihood of COVID-19 infection, lung epithelial cells which are pre-set for exaggerated immune response, increased capacity for capillary leakage of fluid into the airway space, and/or reduced capacity for both passive and active transport of fluid out of the airways. The hypothesized hydration effects suggest hypotheses regarding strategies for COVID-19 risk reduction, such as public health recommendations to increase intake of drinking water, hydration screening alongside COVID-19 testing, and treatment tailored to the pre-infection hydration condition. Hydration may link risk factors and pathways in a unified mechanism for COVID-19 mortality. Attention to hydration holds potential to reduce COVID-19 mortality and disparities via at least 5 pathways simultaneously.

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“…The experiments cited in the NAM report, by Adolph [14] and Newburg et al [15], regarding ad-libitum water intake adequate to restore water lost, involve less than one week of follow-up, so do not rule out chronic TBW deficit that may take weeks to detect [16]. Working assumptions for the NAM report [12], furthermore, ignore the potential impact from known metabolic adaptations to chronic stress on long-term health [17].…”

Section: Alternative Assumptionsmentioning

confidence: 99%

Water Researchers Do Not Have a Strategic Plan for Gathering Evidence to Inform Water Intake Recommendations to Prevent Chronic Disease

Stookey

Kavouras

2020

Nutrients

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Confusion has persisted for decades in the United States (U.S.) over how much plain water to drink, despite national water intake recommendations which are based on high quality scientific evidence. This editorial summarizes the definition, alignment and coordination of evidence that informs the current U.S. adequate intake (AI) recommendations for water. It highlights gaps in the evidence that perpetuate confusion and opportunity to address the gaps through strategic planning.

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Change in hydration indices associated with an increase in total water intake of more than 0.5 L/day, sustained over 4 weeks, in healthy young men with initial total water intake below 2 L/day

Cited by 17 publications

References 72 publications

Distinguishing Low and High Water Consumers—A Paradigm of Disease Risk

Distinguishing Low and High Water Consumers—A Paradigm of Disease Risk

Hypotheses about sub-optimal hydration in the weeks before coronavirus disease (COVID-19) as a risk factor for dying from COVID-19

Water Researchers Do Not Have a Strategic Plan for Gathering Evidence to Inform Water Intake Recommendations to Prevent Chronic Disease

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