High water intake and low urine osmolality are associated with favorable metabolic profile at a population level: low vasopressin secretion as a possible explanation

Abstract

Purpose Elevated plasma concentration of the vasopressin marker copeptin and low water intake are associated with elevated blood glucose and diabetes risk at a population level. Moreover, in individuals with low urine volume and high urine osmolality (u-Osm), water supplementation reduced fasting plasma (fp) copeptin and fp-glucose. In this observational study, we investigated if low total water intake or high u-Osm correlated with high fp-copeptin and components of the metabolic syndrome at the population level. Methods In the population-based Malmö Offspring Study (MOS, n = 2599), fp-copeptin and u-Osm from morning urine samples were measured, and diet and total water intake (from beverages and food moisture) was assessed by a 4-day webbased record. Results Increasing water intake by tertile was after adjustment for age and sex associated with low fp-triglycerides (p = 0.002) and high fp-HDL (p = 0.004), whereas there was no association with the other investigated metabolic traits (HbA1c, fpglucose, BMI or waist circumference). Increasing u-Osm by tertile was, after adjustment for age and sex, associated with high fp-glucose (p = 0.007), and borderline significantly associated with high HbA1c (p = 0.053), but no association was observed with fp-HDL, fp-triglycerides, BMI or waist circumference. Fp-copeptin concentration correlated significantly with water intake (r = − 0.13, p < 0.001) and u-Osm (r = 0.27, p < 0.001). High copeptin was associated with all investigated metabolic traits (p < 0.001 for all). Conclusion Low concentrations of the vasopressin marker copeptin is linked to high water intake, low u-Osm, and a favorable metabolic profile, suggesting that vasopressin lowering lifestyle interventions, such as increased water intake, may promote metabolic health.

Associations between urinary hydration markers and metabolic dysfunction: a cross-sectional analysis of NHANES data, 2008–2010

“…The evidence that concentrated urine is associated with a worse glycemic profile is consistent with recent findings from another large population-based sample, the Malmö Offspring Study, in which high urine osmolality was associated with unfavorable glucometabolic profile [38]. Additionally, an observational study which primarily aimed to describe the determinants of urine osmolality (medical condition, socio-demographic and lifestyle factors) using the NHANES 2009-2012 cohort reported lower blood glucose in participants with very diluted urine but did not explore this association in multivariate adjusted models [31].…”

“…While several previous investigations have examined relationships between water, fluid intake [10,11,13] or vasopressin (copeptin), a key hormone in the regulation of body fluids [35][36][37] and metabolic outcomes, urinary biomarkers of hydration have seldom been studied in relation to metabolic outcomes [18,31,38].…”

“…To our knowledge, our study was the first population-based study to specifically explore urine concentration in relation to metabolic endpoints in multivariate adjusted models. In addition to measures of insulinemic and glycemic parameters, evidence of underhydration and challenges to water homeostasis have been associated with several components of metabolic syndrome, including adiposity (higher waist circumference or abdominal obesity) [38,[49][50][51] and dyslipidemia (lower HDL cholesterol, higher triglycerides) [38,49,51] in multivariate adjusted models. Our current study also found positive associations between a marker of adiposity (lower HDL cholesterol) or the risk of metabolic syndrome and U SG .…”

“…This cross-sectional analysis of a representative sample of the US population revealed significant relationships between hydration and some measures of metabolic health. While several previous investigations have examined relationships between water, fluid intake [ 10 , 11 , 13 ] or vasopressin (copeptin), a key hormone in the regulation of body fluids [ 35 – 37 ] and metabolic outcomes, urinary biomarkers of hydration have seldom been studied in relation to metabolic outcomes [ 18 , 31 , 38 ].…”

“…However, the study reported no association between the multivariate adjusted odds ratios for very dilute or very concentrated urine and diabetes, a finding in line with our results. Additionally, elevated blood glucose (hyperglycemia, elevated HbA1c) was recently associated with higher copeptin in recent a cross-sectional study [ 38 ], and the reduction in blood glucose following water supplementation was found to be driven by individuals with higher baseline copeptin and greater copeptin reduction in a recent small intervention study [ 47 ]. However, while many studies have observed links between metabolic health and evidence of underhydration or challenges to water homeostasis, whether it is measured by water intake, urine concentration or copeptin (AVP), the evidence remains inconsistent.…”