Abstract
The study objective was to measure fluid intake and associations with background characteristics and hydration biomarkers in healthy, free-living, non-pregnant women aged 15-69 years from Hargeisa city. We also wanted to estimate the proportion of euhydrated participants and corresponding biomarker cut-off values. Data from 136 women, collected through diaries and questionnaires, 24h urine samples and anthropometric measurements, were obtained with a cross-sectional, purposeful sampling from fifty-two school and health clusters, representing approximately 2250 women. The mean (95 % CI) 24 h total fluid intake (TFI) for all women was 2⋅04 (1⋅88, 2⋅20) litres. In multivariate regression with weight, age, parity and a chronic health problem, only weight remained a predictor (P 0.034, B 0.0156 (l/kg)). Pure water, Somali tea and juice from powder and syrup represented 49⋅3, 24⋅6 and 11⋅7 % of TFI throughout the year, respectively. Mean (95 % CI) 24 h urine volume (Uvol) was 1⋅28 (1⋅17, 1⋅39) litres. TFI correlated strongly with 24 h urine units (r 0.67) and Uvol (r 0.59). Approximately 40 % of the women showed inadequate hydration, using a threshold of urine specific gravity (Usg) of 1⋅013 and urine colour (Ucol) of 4. Five percent had Usg > 1⋅020 and concomitant Ucol > 6, indicating dehydration. TFI lower cut-offs for euhydrated, non-breast-feeding women were 1⋅77 litres and for breast-feeding, 2⋅13 litres. Euhydration cut-off for Uvol was 0⋅95 litre, equalling 9⋅2 urine units. With the knowledge of adverse health effects of habitual hypohydration, Somaliland women should be encouraged to a higher fluid intake.
Highlights
Adequate hydration is paramount for health and well-being, and bodily fluid balance is a fine-tuning between water loss and total water intake (TWI)
In this mixed population of non-pregnant women, total fluid intake (TFI) and plain water intake (PWI) are comparable to a number of European populations
We estimated 60 % of the women to be above the euhydration lower cut-off when using the total information in the hydration biomarker indices
Summary
Adequate hydration is paramount for health and well-being, and bodily fluid balance is a fine-tuning between water loss and total water intake (TWI). Faeces, perspiration and urine are determined by environment temperature and humidity, as well as the size, activity level and nutrient intake of the individual. TWI is the sum of water content in beverages, including plain water, food moisture and metabolic water Since the latter two are difficult to measure, the sum of beverages as total fluid intake (TFI) might be a good proxy in free-living individuals. Established guidelines from the USA and Europe have described adequate TWI of 2⋅7 and 2⋅0 litres, respectively, and corresponding TFI of 2⋅2 and 1⋅6 litres, as necessary for ensuring adequate hydration in adult females living in temperate climate with sedentary activity level. Through the 13 d of trials, the mean (min.–max.) h temperature was (24– 26°C), and the relative humidity was 58 (52–65%)
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