Dietary Water Intake Research Articles

Synergistic Effects of Nutrients on Musculoskeletal Health in Gerontology: Understanding the Combined Impact of Macronutrients and Micronutrients.

With the global aging population, addressing prevalent age-related conditions such as osteoporosis and sarcopenia is crucial. Traditional nutritional strategies focusing on single nutrients like calcium, vitamin D, or protein have limitations, prompting a nuanced exploration of the relationship between aging, nutrition, and musculoskeletal health. This cross-sectional study examines the complex interplay between dietary intake of macronutrients, common micronutrients, and water, as well as their association with musculoskeletal health in adults aged 50 to 80 years, using U.S. National Health and Nutrition Examination Survey data (NHANES). Employing multiple linear regression, restricted cubic splines, weighted quantile sum (WQS), and quantile-based g-computation (QGC) regression models, our initial analysis using the WQS model revealed that a one-quartile increase in mixed macronutrient intake was associated with a significant 0.009 unit increase in bone mineral density (BMD) and a 0.670 unit increase in grip strength, while a similar increase in mixed micronutrient intake showed a 0.007 unit increase in BMD and a 0.442 unit increase in grip strength. Our findings highlight the importance of a balanced dietary approach in promoting musculoskeletal health in the elderly, offering holistic strategies for overall well-being.

The protective role of water intake in age-related eye diseases: insights from a Mendelian randomization study.

Age-related eye diseases (AREDs), including age-related cataracts (ARCs), age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma, are a leading cause of visual loss globally. This study aimed to explore the effects of dietary water intake on AREDs using Mendelian randomization. In the European population, genome-wide association study (GWAS) summary statistics of water intake and AREDs were obtained from the UK Biobank database and the FinnGen Consortium, respectively. The causal associations between water intake and ARED risks were explored by univariable and multivariable MR analyses, followed by sensitivity analyses to test the robustness of the results and detect potential pleiotropy bias. Water intake was associated with reduced risks of ARCs (odds ratio [OR]: 0.61; 95% confidence interval [CI]: 0.46-0.83; P = 1.44 × 10-3) and DR (OR: 0.52; 95% CI: 0.36-0.76; P = 5.47 × 10-4), and a suggestive reduced risk of AMD (OR: 0.42; 95% CI: 0.20-0.88; P = 2.18 × 10-2). Water intake had no effect on glaucoma (OR: 1.16; 95% CI: 0.72-1.88; P = 0.549). After adjusting confounders, the causal effects of water intake on ARCs and DR persisted. Our study provides evidence of the preventive role of water intake in ARCs and DR from a genetic perspective.

Prey consumption does not restore hydration state but mitigates the energetic costs of water deprivation in an insectivorous lizard.

To cope with limited availability of drinking water in their environment, terrestrial animals have developed numerous behavioral and physiological strategies including maintaining an optimal hydration state through dietary water intake. Recent studies performed in snakes, which are generalist carnivorous reptiles, suggest that the benefits of dietary water intake are negated by hydric costs of digestion. Most lizards are generalist insectivores that can shift their prey types, but firm experimental demonstration of dietary water intake is currently missing in these organisms. Here, we performed an experimental study in the common lizard Zootoca vivipara, a keystone mesopredator from temperate climates exhibiting a great diversity of prey in its mesic habitats, in order to investigate the effects of food consumption and prey type on physiological responses to water deprivation. Our results indicate that common lizards cannot improve their hydration state through prey consumption, irrespective of prey type, suggesting that they are primarily dependent upon drinking water. Yet, high-quality prey consumption reduced the energetic costs of water deprivation, potentially helping lizards to conserve a better body condition during periods of limited water availability. These findings have important implications for understanding the physiological responses of ectotherms to water stress, and highlight the complex interactions between hydration status, energy metabolism and feeding behavior in insectivorous lizards.

Atopic Dermatitis and Water: Is There an Optimum Water Intake Level for Improving Atopic Skin?

Water is a vital nutrient with innumerable functions for every living cell. The functions of human skin include protection against dehydration of the body. Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease that presents with dry skin, erythematous and eczematous lesions, and lichenification. This paper discusses the question of whether extra water intake in children with AD affects skin hydration and the skin barrier function. Among the methods used to treat dry skin, topical leave-on products are the first-line treatment, intended to improve hydration and the skin barrier function. The effectiveness of adequate water intake as a measure to treat dry skin is still under debate. Normal skin hydration increases with dietary water intake, particularly in those with prior lower water consumption. Skin dryness in AD is instrumental to the itch and inflammation cycle, contributing to barrier impairment and aggravating disease severity and flares. Certain emollients provide significant hydration to AD skin, with relief of dryness and reduction in barrier impairment, disease severity, and flares. Further investigations are needed to evaluate the optimum water intake levels in children with AD, as important questions remain unanswered, namely, does oral hydration provide relief of skin dryness and reduce barrier impairment, disease severity, and flares; is there any additional benefit from using mineral or thermal spring water; or is there a need to specifically study the fluid/water intake in children with AD and food allergy (FA) restrictions?

What Is the Optimal Sodium Concentration in the Dialysate?

Based on our experience in our hemodiafiltration unit we would recommend a personalized isonatremic dialysate bath. We currently prescribe 137 meq (isonatremic) or delta dialysate Na/serum Na less than 2 meq. In addition to the sodium prescribed in the dialysate, for the majority of our patients we do not restrict dietary sodium or water intake. The average sodium intake is 2775 mg per day and blood pressure is maintained without hypertensive medications. We acknowledge that part of the success for achieving dry weight may not be attributable only to the dialysate sodium but is likely the result of a combination of multiple factors such as convection therapy, cooling of dialysate, close monitoring of volume status during sessions with relative blood volume, presence of a nephrologist during all sessions and assessing volume status regularly with lung ultrasound and bioimpedance. In our experience, exercising during hemodialysis has additionally been associated with better hemodynamic status and less intradialytic hypotension. Moreover, we acknowledge there is little evidence to support a gradient dialysate to serum sodium of less than 2 meq and that our approach may not be optimal.

Nutritive Value, In Vitro Fermentation, and Methane Production of Cactus Cladodes, Sugarcane Bagasse, and Urea.

Simple SummaryCyclical droughts affecting arid and semiarid regions promote direct negative impacts on agriculture, with deficits of water availability for the maintenance of crops destined for human supply and animal production, with direct and indirect socioeconomic effects. Although livestock rearing is one of the few viable economic activities for these regions, forage production in terms of quantity and quality is a critical obstacle to support the herd over the year. Research was developed to find a forage adapted to these climates. Cactus cladodes have been used as a traditional ingredient in ruminant diets in dry areas as a solution to forage scarcity. Many traditionally used sources of forage, fresh or conserved, can be added to diets with cactus. However, the limiting factor to their inclusion would be market availability and price. This study showed that cactus cladodes associated with sugarcane bagasse (a high available crop residue) present the same nutritive value of conserved crops as silages and hay. Cactus (Opuntia and Nopalea) are essential for ruminant production systems in arid and semiarid regions due to the limitation of forage production caused by the low precipitation.This study evaluated the effect of different roughages fed to sheep on nutrient and water intake, ingestive behavior, nitrogen balance, microbial protein synthesis, fermentation parameters, and methane production using an in vitro gas production system. The treatments consisted of five diets: cactus cladodes Nopalea (NUB) and Opuntia (OUB), both with the addition of sugarcane bagasse (SB) and urea/ammonium sulfate (urea/as); Tifton hay (TH); corn silage (CS); and sorghum silage (SS), also with added urea/as. The NUB provided greater (p ≤ 0.03) intakes of dry matter (1024 g/d), digestible organic matter (670 g/d), and crude protein (161 g/d) than those on the SS. The NUB provided greater (p < 0.01) dietary water intake (3023 g/d) than TH. The time spent on rumination was shorter (p < 0.01), and the idle time was longer in animals fed NUB and OUB than TH and CS. Microbial protein synthesis was not affected (p = 0.27). The final pH (6.4) of the incubation fluid and the concentration of NH3-N (39.05 mg/dL) were greater for NUB and OUB. Ruminal parameters and methane production were little or not affected by tested forages. We recommend using cactus cladodes in combination with sugarcane bagasse and urea/as in sheep diets.

Quantifying water requirements of African ungulates through a combination of functional traits

AbstractClimate and land use change modify surface water availability in African savannas. Surface water is a key resource for both wildlife and livestock and its spatial and temporal distribution is important for understanding the composition of large herbivore assemblages in savannas. Yet, the extent to which ungulate species differ in their water requirements remains poorly quantified. Here, we infer the water requirements of 48 African ungulates by combining six different functional traits related to physiological adaptations to reduce water loss, namely minimum dung moisture, relative dung pellet size, relative surface area of the distal colon, urine osmolality, relative medullary thickness, and evaporation rate. In addition, we investigated how these differences in water requirements relate to differences in dietary water intake. We observed strong correlations between traits related to water loss through dung, urine and evaporation, suggesting that ungulates minimize water loss through multiple pathways simultaneously, which suggests that each trait can thus be used independently to predict water requirements. Furthermore, we found that browsers and grazers had similar water requirements, but browsers are expected to be less dependent on surface water because they acquire more water through their diet. We conclude that these key functional traits are a useful way to determine differences in water requirements and an important tool for predicting changes in herbivore community assembly resulting from changes in surface water availability.

Rattlesnakes Must Drink: Meal Consumption Does Not Improve Hydration State.

Water is critical to survival, yet free-standing water is often rare in deserts and seasonally dry environments. Thus, many dry-adapted species utilize either metabolic (that produced from metabolism) or dietary (that found in food) water to meet their hydric needs. It is suspected that desert reptiles can fulfill their hydric needs solely through dietary water intake. However, food consumption does not improve the hydration state of Gila monsters (Heloderma suspectum), a binge-feeding desert lizard, and meal consumption by snakes leads to increased voluntary drinking. Therefore, we predicted that meal consumption would not improve hydration state in dehydrated western diamondbacked rattlesnakes (Crotalus atrox). We found no significant difference in the change in plasma osmolality between moderately dehydrated snakes that consumed a meal and those that did not. In fact, snakes that received a meal reached severe dehydration more than a week sooner than snakes that did not receive a meal. Additionally, consuming a meal when severely dehydrated did not reduce plasma osmolality, whereas severely dehydrated snakes provided with water ab lib. returned to a normosmotic state. These results provide the most convincing evidence that carnivorous desert reptiles likely rely on free-standing water to fulfill their hydric needs. These species have thus had to adapt to sporadic water availability through minimizing water loss and tolerating considerable variation in plasma osmolality.

Physical activity and sedentary behavior impacts on dietary water intake and hydration status in Spanish schoolchildren: A cross-sectional study.

BackgroundThe importance of maintaining an adequate hydration status and the complexity of the water balance make it necessary to study the lifestyle factors that can influence or modify these variables. The aim of this study was to evaluate the hydration status and dietary water intake for a sample of Spanish schoolchildren from 7 to 12 years old and their associations with physical activity (PA) and sedentary behaviors.MethodsA total of 242 schoolchildren was studied (49.17% females). A 24-hour urine sample was collected from each child, and the urine volume and osmolality were measured to estimate the hydration status (adequate hydration ≤800 mOsm/kg). In addition, a 3-day dietary record was completed to evaluate their water intake according to EFSA parameters. Dietary information was processed with DIAL software, and a statistical analysis was performed using SPSS. Student's t-test was used to study the normal variables, and the Mann-Whitney U test was used for those that were not normal. In the case of the categorical variables, the Z and Chi-Square proportions tests were used. The Bonferroni test was used to adjust the values in multiple comparisons. To evaluate the influence of these lifestyles on the urine osmolality, a 2-way ANOVA and an odds ratio were used.ResultsA total of 48.3% of the sample presented an adequate hydration status, and the percentage was significantly higher in females (p = 0.003). Only 20.9% showed an adequate intake of dietary water. The lifestyle influence reveals that more inactive and non-sedentary schoolchildren were adequately hydrated (p = 0.008). PA (practice ≥1 h/day) was associated with a higher risk of having an inadequate hydration status, even when accounting for sex and other lifestyle factors (OR = 1.753(1.006–3.054), p = 0.048).ConclusionsApproximately half of the participants presented an inadequate hydration status (which was higher in males than in females). PA (practice ≥1 h/day) was associated with a higher risk of inadequate hydration. This fact highlighted the importance of raising awareness about hydration in children, especially in ones who are more active.

Assessment of beverage consumption, dietary water intake and adequacy to the recommendations of a group of Spanish schoolchildren from 7 to 12 years old

the dietary water and the intake of beverages play a relevant role in the dietary and hydration patterns of children and few studies provide an overview of them. Objetives: to assess the dietary intake of water, its adaptation to the recommendations and its distribution throughout the day, and the average consumption of beverages by a group of Spanish schoolchildren. a sample of 262 schoolchildren (139 boys and 123 girls) between seven and 12 years old was studied. A three-day dietary record (one day in weekend) was kept to assess beverage consumption. Dietary water intake obtained was compared to EFSA's adequate intake (AI) and other recommendations, its distribution throughout the day was studied, and personal and anthropometric date were collected too. The data were processed using DIAL and SPSS. the beverages consumed in greatest quantity were water as a beverage, milk and commercial juices and nectars. The average dietary water intake was 1,401 ± 432 ml/day (42% from food and 58% from beverages). Only 20.2% of schoolchildren were above the AIs. Dietary water intake was significantly higher at all intakes in the day in those schoolchildren who were above AIs. based on our results, 79.8% of children do not cover the AIs. For this reason it is important improve their hydration patterns. In this aspect, water as a beverage plays a key role to cover the recommendations.

Relationship between water intake and skeletal muscle mass in elderly Koreans: A nationwide population-based study.

The purposes of this study were to evaluate the correlation between sarcopenia and water intake and investigate lack of daily water intake in the presence of sarcopenia in an elderly population. Data from 3656 participants (1582 men and 2074 women) were analyzed using the Korea National Health and Nutrition Examination Survey. Sarcopenia was defined in accordance with the criteria of the Asia Working Group for Sarcopenia. Water intake was assessed using the dietary water adequacy ratio and was calculated by dividing the daily water intake from fluid by the recommended daily amount of 1000 mL in men and 900 mL in women. Water intake from food (g/d and cup/d) and dietary water adequacy ratio (mL) were significantly lower in the sarcopenia group (757.8 g, 890.1 g, and 0.74 mL in men; 511.9 g, 757.8 g, and 0.70 mL in women, respectively) than in the non-sarcopenia group (878.4 g, 1015.1 g, and 0.81 mL in men; 581.3 g, 790.5 g, 0.74 mL in women, respectively). In elderly men, the odds ratio of sarcopenia in the lowest quartile increased to 1.47 (range, 1.13-1.91) in Model 2 compared with that in the highest quartile. In elderly women, the odds ratio of sarcopenia in the lowest quartile increased to 1.50 (range, 1.08-2.08) in Model 2 compared with that in the highest quartile. The prevalence of sarcopenia in the elderly population was related to inadequate dietary water intake after adjusting for covariates. Adequate water intake in the elderly should be recommended to prevent dehydration-related complications, including sarcopenia.

Does dietary fluid intake affect skin hydration in healthy humans? A systematic literature review.

Associations between daily amounts of drinking water and skin hydration and skin physiology receive increasingly attention in the daily life and in clinical practice. However, there is a lack of evidence of dermatological benefits from drinking increased amounts of water. Pubmed and Web of Science were searched without any restrictions of publication dates. References of included papers and related reviews were checked. Eligibility criteria were primary intervention and observational studies investigating the effects of fluid intake on skin properties in English, German, Spanish or Portuguese language, including subjects being healthy and 18+years. Searches resulted in 216 records, 23 articles were read in full text, and six were included. The mean age of the samples ranged from 24 to 56years. Overall the evidence is weak in terms of quantity and methodological quality. Disregarding the methodological limitations a slight increase in stratum corneum and "deep" skin hydration was observed after additional water intake, particularly in individuals with lower prior water consumption. Reductions of clinical signs of dryness and roughness were observed. The extensibility and elasticity of the skin increased slightly. Unclear associations were shown between water intake and transepidermal water loss, sebum content, and skin surface pH. Additional dietary water intake may increase stratum corneum hydration. The underlying biological mechanism for this possible relationship is unknown. Whether this association also exists in aged subjects is unclear. Research is needed to answer the question whether increased fluid intake decreases signs of dry skin.

Fluid consumption pattern and hydration among 8-14 years-old children.

Children consume various fluids to meet dietary water intake needs. However, the contribution of different fluid types on hydration is unclear. The purpose of this study was to develop fluid intake patterns and examine their association with hydration, as indicated by 24-h urine osmolality. Two hundred ten (105 girls) healthy children (height: 1.49 ± 0.13 m, weight: 43.4 ± 12.6 kg, body fat: 25.2 ± 7.8%) recorded their fluid intake for two consecutive days, and collected their urine for 24-h during the 2nd day, while conducting their normal daily activities. Urine samples were analyzed for specific gravity and osmolality. Factor analysis with principal components method was applied to extract dietary patterns from six fluid groups. Linear regression analysis evaluated the associations between the extracted dietary patterns and hydration based on 24-h urine osmolality. The analysis revealed the following six components: 1, characterized by consumption of milk and fresh juice, but not packaged juice; 2, by regular soda and other drinks, but not water; 3, by fresh juice and other drinks; 4, by packaged juice, but not regular soda; 5, by water and milk; and 6, by fresh juice. Component 5 was negatively correlated with urine osmolality (P = 0.001) indicating better hydration, whereas component 2 was positively correlated with urine osmolality (P = 0.001). A drinking pattern based on water and milk was associated with better hydration, as indicated by lower urine osmolality, whereas drinking regular soda and other drinks but not water was associated with inferior hydration.

Aspects of the home range ecology of the leopard tortoise in the semi-arid central Karoo: An area threatened with fracking

Whilst fracking is used globally, impact studies on wildlife are limited. The semi-arid Karoo, South Africa, a large ecosystem with a high degree of endemism, is targeted for fracking. We investigated how adult leopard tortoises (Stigmochelys pardalis) use their environment by determining individual and seasonal variation in home range and effects of weather factors on these pre-fracking. Data were obtained from Global Positioning System (GPS) transmitters placed on leopard tortoises (n = 11) on private livestock farms near Beaufort West, South Africa for a year. Kernel density estimation (KDE) was used to estimate home range. Individuals had a mean (±SE) home range of 121.86 ± 28.12 ha, (range 40.53–258.52 ha) with a core area of 76.55 ± 17.33 ha (range 21.22–83.89 ha). No difference was found between annual male and female home ranges. Two telemetered individuals were excluded from analysis because they exhibited apparent nomadic behaviour. Several individuals did not visit permanent water sources, possibly suggesting that dietary water intake was sufficient. Generalised Linear Mixed Models were used to explain monthly home range estimates (95% KDEhref) in regards to biologically significant predictor variables. A single top model (ΔAICc < 2) was produced, indicating importance of individual variability (sex, body mass) and weather (temperature, rainfall) variables. Our results provide baseline data pre-fracking in the region, and as such, should be repeated following commencement of fracking.

Dietary water intake and bladder cancer risk: An Italian case–control study

Previous studies on the relationship between fluid intake and risk of bladder cancer have generally focused on beverages, and results have been inconsistent. We investigated the relationship between water intake and bladder cancer risk, considering water from both beverages and foods.Between 2003 and 2014 we conducted a multicenter hospital-based case–control study in Italy on 690 cases and 665 frequency-matched controls. Water intake for beverages and foods was computed using the Italian food composition database. Odds ratios (ORs) and the corresponding 95% confidence intervals (95%CIs) for water intake were estimated by unconditional multiple logistic regression models, adjusting for major risk factors for bladder cancer.In the control group, the 64.7% of water intake derived from beverages and 35.4% from foods. Comparing the highest with the lowest quartile of intake, water from beverages (OR=1.14; 95%CI: 0.82–1.59) and water from foods (OR=0.88; 95%CI: 0.61–1.28) were not significantly associated with bladder cancer risk. Some specific water sources showed significant associations with bladder cancer risk (e.g. water from vegetables, OR=0.58; 95%CI: 0.40–0.86). However, these associations may be due to the effect of other components contained in beverages and foods rather than to the water content itself.Considering the intakes of water from both beverages and foods, total water intake was not associated with bladder cancer risk.

Effect of Fasting on Corneal Biomechanical and Structural Parameters

ABSTRACT Purpose: To evaluate the effects of hunger and thirst on corneal biomechanical and structural parameters during Ramadan fasting. Materials and Methods: Corneal biomechanical properties and intraocular pressures of 29 eyes of 29 healthy subjects were evaluated by Reichert ocular response analyzer; and structural and anatomical properties of cornea and anterior eye chamber of same eyes were scanned with Oculus Pentacam anterior segment analyzer. Each eye has been evaluated at 8 am and 4 pm both during and 1 month after Ramadan. Changes of subjects’ weight were calculated and their relationship with corneal biomechanical and structural parameters was assessed. Results: Intraday changes in horizontal corneal astigmatism (p = 0.02), anterior chamber volume (p = 0.01), intraocular pressure associated with the Goldmann IOPg (p = 0.02) and corneal resistance factor (CRF) (p = 0.04) were significantly different when measured during the fasting period in Ramadan and 1 month thereafter. Moreover, when we compared 8 am measurements taken during and after Ramadan, we observed significant differences for anterior chamber volume (p = 0.04) and anterior chamber angle values (p = 0.03). Similarly, for 4 pm measurements, there were significant differences for IOPg (p = 0.01) and CRF values (p = 0.00). Conclusions: Fasting lasting for more than 12 h during Ramadan creates an important window of opportunity to investigate the response of anterior chamber of eye to hunger and thirst. The current study contributes to the existing literature on the effects of dietary habits and water intake on corneal and anterior chamber properties.

Positive impact of dietary water on in vivo epidermal water physiology.

The importance of water in human physiology is well known, also for skin functionality. This study was conducted to assess the effects of dietary water on epidermal skin hydration in healthy females. Thirty-four healthy females (mean 24.5 ± 6.34 years old) were selected and characterized according to their dietary daily habits, by a previously validated Food Frequency Questionnaire. For 1 month, these subjects were asked to add 2 L/day of water to their regular dietary habits. Measurements took place at day D0, D15, and D30, and involved general variables (body weight, blood pressure, Body Mass Index) and specific skin physiological variables in five anatomical sites (ventral forearm, anterior leg, dorsal hand, zygomatic area, and forehead) involving epidermal superficial and deep hydration, by capacitance and transepidermal water loss (TEWL). This water overload (2 L/day/30 days) did not change the blood volume or weight of the individuals. However, both superficial and deep skin hydration were clearly in those individuals that regularly consumed lees water per day. No significant effect was observed in the TEWL. This study clearly suggests that dietary water intake seems to influence skin water content. Nevertheless further in vivo investigations involving other variables, such as biomechanical descriptors, should follow to look deeper into this aspect of skin physiology.

Food and fluid texture consumption in a population-based cohort of preschool children with cerebral palsy: relationship to dietary intake.

To determine the texture constitution of children's diets and its relationship to oropharyngeal dysphagia (OPD), dietary intake, and gross motor function in young children with cerebral palsy (CP). A cross-sectional, population-based cohort study comprising 99 young children with CP (65 males, 35 females) aged 18 to 36months (mean age 27mo; Gross Motor Function Classification System [GMFCS] level I, n=45; II, n=13; III, n=14; IV, n=10; V, n=17). CP subtypes were classified as spastic unilateral (n=35), spastic bilateral (n=49), dyskinetic (n=5), and other (n=10), in accordance with the criteria of the Surveillance of Cerebral Palsy in Europe. Habitual dietary intake of food textures, energy, and water were determined from parent-completed 3-day weighed food records. Parent-reported feeding ability of food textures was reported on the Pediatric Evaluation of Disability Inventory and a feeding questionnaire. OPD was classified based on clinical feeding assessment using the Dysphagia Disorders Survey (rated by a certified assessor, KAB) and a subjective Swallowing Safety Recommendation (classified by a paediatric speech pathologist, KAB). Food/fluid textures were modified for 39% of children. Children with poorer gross motor function tended to receive a greater proportion of energy from fluids (GMFCS levels IV-V: β=0.9, p=0.002) in their diets and fewer chewable foods (level III: β=-0.7, p=0.03; levels IV-V: β=-1.8, p<0.001) compared to level I to II participants. Fluids represented a texture for which children frequently had OPD and the texture most frequently identified as unsafe (or recommended for instrumental assessment). These findings indicate that swallowing safety, feeding efficiency, and energy/water intake should be considered when providing feeding recommendations for children with CP.

Dietary intake of energy, nutrients and water in elderly people living at home or in nursing home.

There is a lack of detailed information on dietary intake in elderly people at an individual level, which is crucial for improvement of nutritional support. The aim of this study was to investigate the dietary intake in elderly people in two types of living situations. Observational study, analysing prospective data. The dietary intake was studied in elderly people living at home or in nursing home, in different cities of Sweden. A total of 264 elderly people (mean age 84) participated in the observational study. Dietary intake was measured using weighed food records and food diaries, comparing females and males. The observed dietary intake was related to Recommended intake and Lower intake level. All dietary intake and patient characteristic variables showed large individual differences (ranges). We found no significant differences (p>0.05) between those living at home and nursing home residents regarding the average intake of energy, protein and water when expressed as total intake per kg of body weight. A very low daily intake of energy (<20 kcal/kg body weight/day) was observed in 16% of the participants. For vitamin D and iron, 19% and 15%, respectively, had intakes below the Lower intake level. There was no correlation between intake of energy, protein or water and resident characteristics such as age, autonomy, morbidity, nutritional state or cognition. The large individual differences (ranges) in energy, nutrients and water show that the use of mean values when analysing dietary intake data from elderly people is misleading. From a clinical perspective it is more important to consider the individual intake of energy, nutrients and water. Ageism is intrinsic in the realm of 'averageology'.

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

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. Cross-sectional observational study used survey, anthropometric and qualitative methods with Tsimane' adults selected by age and sex stratification sampling in one community. 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. Forty-five Tsimane' household heads (49% men) took part in the first data collection and twenty-two Tsimane' (55% men) were included in the follow-up interviews. 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). 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.