Adequacy and sources of total daily water and liquid drinks by low‐income, urban and rural, pregnant and lactating women in the Western Highlands of Guatemala

Abstract

BackgroundPhysiological indications from urinary osmolality in Guatemala show a mixed picture of hydration adequacy, with professional women and daycare‐attending preschool children having superior hydration status, whereas lactating women had precarious hydration states bordering on – and occasionally extending over into – hypohydration. Dietary intake data on water in schoolchildren has shown evidence of deficits relative to recommended volumes. Data on water intake in pregnant and lactating women are largely unavailable.ObjectivesTo determine and compare and contrast the consumption of total daily water and liquid drinks among low‐income pregnant and lactating women from urban and rural areas of the Western Highlands of Guatemala.MethodsA single previous‐day intake recall was obtained in 234 women [n=116 pregnant and n=118 lactating], of whom 121 were living in Quetzaltenango City and 113 were from 8 hamlets of a nearby, rural municipality. For purpose of comparative evaluation, they were classified into 4 subgroups as: urban pregnant (UP, n=58); rural pregnant (RP, n=58]; urban lactating (UL, n=63]; and rural lactating (RL, n=55]. The Adequate intakes (AI) of the Institute of Medicine of the US (2005) are 3000 mL for TDWA and 2300 mL for LD in pregnancy and, respectively; 3800 mL and 3100 mL for lactation. Water‐orgin data were summed to provide estimates of total daily water acquisition (TDWA), expressed in mL, and then reduced to the 4 components: liquid drinks (LD); water added to dishes (AW); intrinsic water of foods (IW); and metabolic water (MW) for illustration. Median intakes were finally compared and contrasted by subgroups.ResultsThe respective median TDWA [and %AI] were: 2299 mL [77%] (UP); 1964 mL [65%] (RP); 2286 mL [60%] (UL); 2121 mL [56%] (RL); volumes consumed were not significantly different within settings (p=0.922, U; p=0.059, R), but AIs were vastly disparate. The respective median LD were: 1215 mL [53%] (UP); 908 mL [39%] (RP); 1216 mL [39%] (UL); 803 mL [26%] (RL); again, volumes did not differ (p=0.997, U; p=0.127, R) despite disproportionate recommendations. Only 2 women (1%) consumed the AI level for TDWA, and only 16 (7%) consumed adequate volume of LD. Across groups the relative contribution of IW and MW were constant, but AW contributed as little as 2 – 5% of TDWA in the urban groups and as much as 16–18% in the rural groups. Reciprocally, the contribution of LD was less than 43% in rural areas and greater than 52% in the urban zone.ConclusionDeficits with respect to recommended water intakes of up to a liter per day are seen, with lactating women showing the greater shortfall. Concerted public health action is warranted to assure adequate hydration status in these vulnerable periods of the lifespan.