Tuesday, June 6, 2017

Different needs for water at different life stages

Water requirements change at different life stages. So how much water should people drink at each stage of their lives?

1.Hydration for pregnant and breast feeding women.

Because of the particular importance and responsibility of the pregnancy and lactation phases, it is often a time when mothers modify their nutritional habits and lifestyles to ensure the best and healthiest start in life for their new child.

 Most pregnant and lactating women are likely to pay attention to living healthily and eating healthily– it is important that health care practitioners should ensure that hydration is not overlooked.

Indeed, weight increases about 12 kg during pregnancy, and most of this added weight, 6 to 9 L, is water1, because:
  • The plasma volume (which is mainly water) increases
  • 85% of the placenta is water2
  • The fetus itself is 70-90% of water
To ensure adequate water intakes during pregnancy, the EFSA recommends an increase of 300 mL per day compared to the normal intake for non-pregnant women, taking total adequate water intake (from food and fluids) to 2,300 mL, or approximately 1,850 mL/ day from fluids.3

During lactation, water intake needs to compensate for the loss of water through milk production. Milk is made of 88% water, and the EFSA therefore recommends that lactating women increase their water by about 700 mL/day, meaning an adequate intake of 2,700 mL/day (from food and drink), or approximately 2,200 mL/day from fluids.


  1. Institute of Medicine (IOM). Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: National Academies Press,2004.
  2. Beall MH, van den Wijngaard JPHM, van Gemert MJC, Ross MG. Amniotic Fluid Water Dynamics. Placenta 2007;28:816-23.
  3. EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on Dietary reference values for water. EFSA Journal 2010; 8:1459-1507. doi:10.2903/j.efsa.2010.1459. Available online: www.efsa.europa.eu

Hydration in infancy and childhood

At birth, the total body water content is as high as
75%. It decreases during the first year of life in
childhood to reach 60% at adult age.

Compared to adults, infants not only have a higher
body water content, but also a higher surface area-
to-body mass ratio, a higher rate of water turnover,1
a limited ability to excrete solutes, and a lower
ability to express thirst. For these reasons,
dehydration in infants is more quickly life
threatening than for children or for adults.

 However, because of the low potential renal solute

load of human milk, healthy ad libitum breast-fed
infants do not need additional water, even under
conditions of high environmental temperature.2

Water requirements increase with age. Adequate
Intakes for infants and children have been defined
by the EFSA in 20102 and are summarized in the
table below:
little girl drinking a glass of water
table : EFSA recommended adequate fluid intakes in children
EFSA recommended adequate fluid intakes in children2

As part of their nutritional education, children should
be taught how to drink in a healthy way: attention
should be paid to allow children good access to water
throughout the day.
Encouraging children to favour non-caloric beverages
such as water should be a component of broader
advice on lifestyle and nutrition.
  • A study recently conducted in Germany has
  • shown that a simple intervention with the sole
  • focus of promoting water consumption
  • effectively prevented overweight among
  • children in elementary schools.3


  1. Fusch C, Hungerland E, Scharrer B, Moeller H. Water turnover of healthy children measured by deuterated water elimination. Eur J Pediat. 1993;152:110-4.
  2. EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on Dietary reference values for water. EFSA Journal 2010; 8:1459-1507. doi:10.2903/j.efsa.2010.1459. Available online: www.efsa.europa.eu
  3. Muckelbauer R, Libuda L, Clausen K, Toschke AM, Reinehr T, Kersting M. Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial. Pediatrics. 2009;123:e661-7.

Hydration and the elderly

As we get older, body water content decreases, the
risk for dehydration increases, and the consequences
become more serious.
Dehydration has been associated with increased
mortality rates among hospitalized older adults1 and
can precipitate emergency hospitalization and
increase the risk of repeated stays in hospital.2,3
Dehydration is a frequent cause of hospitalization of
older adults and one of the ten most frequent diagno
-ses responsible for hospitalization in the United-
States.3 Evidence suggests high dehydration rates of
elderly patients within hospitals and other health care
Dehydration has also been associated with various
morbidities, such as impaired cognition or acute
confusion, falling or constipation.
The cost associated with dehydration may be very
high: a study conducted in 1999 in the United
States evaluated the avoidable costs of
hospitalizations due to dehydration at $1.14 billion.4
Why are the elderly more susceptible to dehydration?
The amount of body water decreases by
approximately 15% (about 6 L) between the ages of
20 and 80.5 With this decrease, the body becomes
more susceptible to dehydration from the loss of a
small amount of body water.6 Moreover, the elderly
often experience diminished thirst sensation which
leads to a reduced fluid consumption.7,8 Also as a
consequence of ageing, the kidneys have a reduced
ability to concentrate urine and retain water during
water deprivation.9 In addition, ageing kidneys are
less able to conserve or excrete sodium.10
Insufficient fluid intakes can also be the result of
limitations such as reduced swallowing capacity,
decreased mobility, or comprehension and
communication disorders. Disease-related factors,
such as incontinence can increase water losses.
Dehydration may also be caused by warm
temperature, inadequate staffing in institutions, or
use of laxatives or diuretics.1

What steps can be taken to prevent

dehydration in the elderly?

Prevention is primarily based on ensuring adequate
fluid intake. Raising awareness of the elderly, their
families and caregivers on the risks of dehydration
and its consequences is fundamental for dehydration
prevention,1,11and can lead to cost-savings in geriatric
  • Offer fluids regularly during the day
  • Make liquids readily available all day (at bedside
or chairside in geriatric institutions) by placing
containers such as small bottle of water or sippy cups
  • Encourage consumption of fluids with medication
  • Provide preferred beverages
  • Prescribe and safeguard a minimum intake of
1.5 L in periods of increased risk for dehydration


    1. Mentes J. Oral hydration in older adults: greater.
    awareness is needed in preventing, recognizing, and
    treating dehydration. Am J Nurs. 2006;106:40-9;
    quiz 50.

    2.Begum MN, Johnson CS. A review of the literature
    on dehydration in the institutionalized elderly.
    E SpenEur E J ClinNutrMetab. 2010; 5:e47-e53.
    3.Sheehy, CM, Perry PA, Cromwell SL. Dehydration
    : biological considerations, age-related changes, and
     risk factors in older adults. Biol Res Nurs. 1999;
    4.Xiao H, Barber J, Campbell ES. Economic burden
    of dehydration among hospitalized elderly patients.
    Am J Health Syst Pharm. 2004;61:2534-40.
    5.Gille D. Overview of the physiological changes
    and optimal diet in the golden age generation over 50.
    European Review of Aging and Physical Activity
    6.Rikkert MG, MelisRJ, ClaassenJA. Heat waves
    and dehydration in the elderly. BMJ. 2009:339:b2663.
    7.Schols JM, De Groot CP, van der Cammen TJ,
    Olde Rikkert MG.Preventing and treating dehydration
    in the elderly during periods of illness and warm
    weather. J Nutr Health Aging 2009;13:150-7.
    8.Kenney WL, Chiu P. Influence of age on thirst and
    fluid intake. Med Sci Sports Exerc. 2001; 33:1524-32.
    9.Bennett JA. Dehydration: Hazards and Benefits.
    Geriatric Nursing 2000;21:84-8.
    10.Silver AJ. Aging and risks for dehydration. Cleve
    Clin J Med. 1990:574:341-4.
    11.Faes MC, Spigt MG, Olde MGM, Rikkert MD.
    Dehydration in Geriatrics. Geriatrics and Aging
    12.Simmons SF, Alessi C, Schnelle JF. An
    intervention to increase fluid intake in nursing home
    residents: prompting and preference compliance.
    J Am GeriatrSoc 2001;49:926-33.
    13.Robinson SB,Rosher RB. Can a beverage cart
    help improve hydration? GeriatrNurs.

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