Water from fruit or the river? Examining hydration strategies and gastrointestinal illness among Tsimane’ adults in the Bolivian Amazon

Abstract

Objective: Water is an essential nutrient overlooked in many cross-cultural studies of human nutrition. The present article describes dietary water intake patterns among forager-horticulturalist adults in lowland Bolivia, compares daily intake with international references and examines if variation in how people acquire water relates to gastrointestinal illness. Design: Cross-sectional observational study used survey, anthropometric and qualitative methods with Tsimane' adults selected by age and sex stratification sampling in one community. Setting: Research occurred in one Tsimane' village in the Beni department, Bolivia with limited access to clean water. The 24 h diet and health recalls were conducted in July-August 2012 and qualitative interviews/ethnographic observation in September-October 2013. Subjects: Forty-five Tsimane' household heads (49 % men) took part in the first data collection and twenty-two Tsimane' (55 % men) were included in the followup interviews. Results: Men and women reported consuming 4·9 litres and 4·4 litres of water daily from all dietary sources, respectively. On average, water from foods represented 50 % of total water intake. Thirteen per cent of participants reported symptoms of gastrointestinal illness. In a logistic regression model adjusted for age, BMI, sex and raw water consumed, each percentage increase in water obtained from foods was associated with a reduced risk of gastrointestinal illness (OR = 0·92; 95 % CI 0·85, 0·99). Conclusions: Both total water intake and percentage of water from foods were higher than averages in industrialized countries. These findings suggest that people without access to clean water may rely on water-rich foods as a dietary adaptation to reduce pathogen exposures. Keywords Hydration strategiesWater intake Gastrointestinal illness Tsimane' AmazoniaAccess to improved water sources, such as hand-pumps or other technology designed to protect against fecal contamination, continues to be a critical public health problem among rural indigenous populations in lowincome countries (1) . To complement this need, the present study examines how individuals use local environmental resources to acquire water and the resulting health consequences (2) . Dietary flexibility serves as an adaptation to environmental constraints and relates to variation in nutrition, health and disease patterns (3,4) . Human populations have long used behaviours and food processing techniques as culturally integrated buffers that reduce toxicity and increase the digestibility and nutrients of food, such as the 10 d processing of bitter manioc (5) , corn alkali processing to reduce niacin deficiency (6) and fire and cooking (7) . Likewise, researchers hypothesize that people have historically used dietary strategies to flexibly meet their water needs, such as eating fruits when water is unavailable or using beer, gruel or cider fermentation to render dirty water drinkable and potentially medicinal (8,9) . In the present paper we describe hydration strategies, or a perso...

Heat and hydration status: Predictors of repeated measures of urine specific gravity among Tsimane’ adults in the Bolivian Amazon

“…This finding is in line with other research that predicts dehydration for farmers in tropical environments due to high heat and humidity stress (Nag et al, 2007). The propensity to become dehydrated during the day may not be due to low overall water consumption because a recent study found that a sample of Tsimane' adults consume significantly more water than industrialized populations (4.6 vs. 3.0 l in the US; Rosinger and Tanner, 2015). However, this inference must be interpreted with caution because intake information was collected one year before this study.…”

“…Armstrong et al (2010Armstrong et al ( , 2012) examined healthy US young adult men and women to set reference values of hydration status and found that roughly 40% of both samples had values above 1.020. The propensity to become dehydrated during the day may not be due to low overall water consumption because a recent study found that a sample of Tsimane' adults consume significantly more water than industrialized populations (4.6 vs. 3.0 l in the US; Rosinger and Tanner, 2015). The average USG in this sample of Tsimane' adults was 1.020, close to the cutoff for dehydration.…”

“…These lifestyle transitions are described elsewhere (Godoy et al, 2009;Rosinger et al, 2013). A recent study found that Tsimane' adults consume significantly more water (4.6 l per day) than adults in industrialized coun-tries (2.4 -3 l) and that 50% of their water intake comes from food sources (Rosinger and Tanner, 2015). As more water from food was incorporated into their hydration strategies, the risk of diarrhea decreased significantly.…”

Food, Water, and Scarcity

“…This may include the decision to purchase industrialized products such as bottled water or soda or to seek hydration from food. This latter strategy is particularly understudied (Rosinger and Tanner 2013). These are just a few examples of how a focus on utilization is needed for advancing understanding of resource scarcity.…”

Age‐related decline in urine concentration may not be universal: Comparative study from the U.S. and two small‐scale societies

“…In contrast, many Tsimane’ and Hadza live their lives outside and use behavioral adaptations, like napping and seeking shade, to reduce heat exposure (Hanna & Brown, ). Tsimane’ and Hadza have higher water needs given their environmental conditions and significantly higher physical activity levels than U.S. adults (Gurven, Jaeggi, Kaplan, & Cummings, ; Pontzer et al, ; Raichlen et al, ; Rosinger, ; Rosinger & Tanner, ). Seasonality did not affect Usg of Tsimane’ and average levels were similar between Tsimane’ and Hadza.…”