Wednesday, June 7, 2017

Hydration and Health

Can dehydration influence mood?
  1. EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on Dietary reference values for water. EFSA Journal. 2010; 8:1459-507. doi:10.2903/j.efsa.2010.1459. Available online:
  2. Gopinathan PM, Pichan G, Sharma VM. Role of dehydration in heat stress-induced variations in mental performance. Arch Env Health. 1998;43:15–7.
  3. Lieberman HR. Hydration and Cognition: A Critical Review and Recommendations for Future Research. J Am CollNutr. 2007;26:S555-61.
  4. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on the substantiation of health claims related to water and maintenance of normal physical and cognitive function (ID 1102, 1209, 1294, 1331), maintenance of normal thermoregulation (ID 1208) and “basic requirement of all living things” (ID 1207) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal. 2011;9:2075-91. doi:10.2903/j.efsa.2011.2075. Available online:
  5. D'Anci KE, Constant F, Rosenberg IH. Hydration and cognitive function in children. Nutr Rev. 2006;64:457-64.
Water intake and kidney stones

Image result for kidneys stones

Image result for kidneys stones

Image result for kidneys stones

Kidney stones, also called urolithiasis, are a common pathology affecting about 10% of the population in developed countries at least once in an individual’s lifetime. Recent trends show an increase in stone prevalence.

The role of dietary habits, including fluid intake, has a great implication in stone development.

Hydration: A well recognized role in recurrence prevention

The role of increased fluid intake as a means of preventing recurrence of kidney stones is well recognized today. In fact, it has been used since the time of Hippocrates.

Adequate fluid intake helps to decrease concentrations of substances involved in stone formation thus reducing their saturation degree in urine (a necessary condition for crystallization, and a first step towards stone formation).

Many studies have shown the beneficial effects of improved fluid intake (and consequently urine volume) on stone recurrence prevention.

The strongest scientific evidence certainly comes from a five-year randomized controlled trial conducted amongst patients recruited directly after their first idiopathic calcium stone episode. This study showed that recommending patients to increase fluid intakes to achieve a urine volume superior to 2L per day resulted in reduced kidney stone recurrence compared to a group without specific advice.1

The European Association of Urology2 recommends increasing fluid intake independent of the type of stones to achieve a urine volume of more than 2L a day, on top of other dietary and lifestyle advice.

Recommendations to lower the risk of kidney stones2

table on general preventive measures

Is there a role of hydration for first stone prevention?

Several studies suggest that chronic dehydration from different causes such as working in a hot environment or physical exertion increases the risk of stone incidence.3-7 Data suggests also that stone diseases occur more frequently in geographic areas with a hot climate. In countries such as Saudi Arabia, over 20% of the population develop renal stones whereas the risk of the disease is only 12 to 13% in North America and 5 to 10 % in Europe.8 There is also a seasonal variation of stone incidence, with higher rates in summer.9-10

In addition, some studies show the relationship between fluid intake and stone risk in the healthy population:

  • In two large observational studies, total fluid intake was significantly and negatively associated with the risk of renal stones.11-12
  • A three-year intervention controlled trial tested the preventive effect of an educational program on adequate fluid intake in a population living in a hot climate compared to a similar population who did not receive any advice. Results showed that the population with the educational program had a higher urine volume and a lower stone incidence than the population who were not advised on fluid intake.13
It has also recently been shown that an additional water intake of 1.3 L could decrease the theoretical risk of crystallization, the first step of stone formation, in the urine of a healthy population as measured by the Tiselius crystallization risk index.14
Nevertheless, further studies are needed to confirm the role of adequate fluid intake for first stone prevention.


  1. Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol. 1996;155:839-43.
  2. Türk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C. Guidelines on Urolithiasis, European Association of Urology 2011. 
  3. Embon OM, Rose GA, Rosenbaum T. Chronic dehydration stone disease. Br J Urol. 1990;66:357-62.
  4. Pin NT, Ling NY, Siang LH. Dehydration from outdoor work and urinary stones in a tropical environment. Occup Med (Lond). 1992;42:30-2.
  5. Borghi L, Meschi T, Amato F, Novarini A, Romanelli A, Cigala F. Hot occupation and nephrolithiasis. J Urol. 1993;150:1757-60.
  6. Chang MA, Goldfarb DS. Occupational risk for nephrolithiasis and bladder dysfunction in a chauffeur. Urol Res. 2004;32:41-3.
  7. Olapade-Olaopa EO, Agunloye A, Ogunlana DI, Owoaje ET, Marinho T. Chronic dehydration and symptomatic upper urinary tract stones in young adults in Ibadan, Nigeria. West Afr J Med. 2004;23:146-50.
  8. Ferrari P, Piazza R, Ghidini N, Bisi M, Galizia G, Ferrari G. Lithiasis and riskfactors. UrolInt. 2007;79:8-15.
  9. Baker PW, Coyle P, Bais R, Rofe AM. Influence of season, age, and sex on renal stone formation in South Australia. Med J Aust. 1993;159:390-2.
  10. Al-Hadramy MS. Seasonal variations of urinary stone colic in Arabia. J Pak Med Assoc. 1997;47:281-4.
  11. Taylor EN, Stampfer MJ, Curhan GC. Dietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up. J AmSocNephrol. 2004;15:3225-32.
  12. Curhan GC, Willett WC, Knight EL, Stampfer MJ. Dietary factors and the risk of incident kidney stones in younger women: Nurses' Health Study II. ArchInternMed. 2004;164:885-91.
  13. Frank M, De Vries A. Prevention of urolithiasis. Education to adequate fluid intake in a new town situated in the Judean Desert Mountains. ArchEnvironHealth. 1966;13:625-30.
  14. De La Guéronnière V, Le Bellego L., Buendia Jimenez I, Dohein O, Tack I, Daudon M. Increasing water intake by 2 liters reduces crystallization risk indexes in healthy subjects. ArchItalUrolAndrol. 2011;83:43-50.
Image result for kidneys stones

Healthy hydration and obesity

According to WHO,16 overweight and obesity are now the fifth leading risk for global deaths: in 2008, over 500 million adults were obese.

Living a healthy lifestyle is key component of the fighting against obesity. Promoting physical activity, healthy nutrition and healthy hydration can contribute to maintaining healthy body weight.
Adopting healthy hydration habits is not only a matter of “how much to drink” but also the quality of what we drink is important.
Excessive and regular intake of beverages containing sugar increases the energy intake compared to drinking water. Studies have shown that excessive and regular sugar-sweetened beverages intake can lead to increased body weight.2-15

Whereas water is calorie free, one glass of sugar-sweetened beverage (250 mL) contains about 100 kcal. Excessive consumption of sugar-sweetened beverages can quickly exceed the World Health Organization recommendation which states that free / added sugar (from all nutrition sources) should not exceed 10% of the total calorie intake.1

There is increasing evidence that the types of the fluids we drink can have a long-term impact on health, influencing the development of overweight, obesity or metabolic diseases.
Studies have suggested that excessive consumption of sugar-sweetened beverages increases the risk of type 2 diabetes 16-19 and it has also been shown that in adults, high consumption of sugar-sweetened beverages is associated with the prevalence of metabolic syndrome.20-22

A sensible advice would be to recommend that the bulk of daily fluid intake should come from plain water.


  1. WHO technical report series. Diet, Nutrition and Prevention of Chronic Diseases; Report of a Joint WHO/FAO Expert Consultation; Geneva 2003.
  2. Barquera S, Hernandez-Barrera L, Tolentino ML, Espinosa J, Ng SW, Rivera JA, Popkin BM. Energy intake from beverages is increasing among Mexican adolescents and adults. J Nutr. 2008;138:2454-61.
  3. Berkey CS, Rockett HR, Field AE, Gillman MW, Colditz GA Sugar-added beverages and adolescent weight change. Obes Res. 2004;12:778-88.
  4. Chen L, Appel LJ, Loria C, Lin PH, Champagne CM, Elmer PJ, Ard JD, Mitchell D, Batch BC, Svetkey LP, Caballero B. Reduction in consumption of sugar-sweetened beverages is associated with weight loss: the PREMIER trial. Am J ClinNutr. 2009;89:1299-306.
  5. DiMeglio DP, Mattes RD. Liquid versus solid carbohydrate: effects on food intake and body weight. Int J ObesRelatMetabDisord. 2000;24:794-800.
  6. Guerrero RT, Paulino YC, Novotny R, Murphy SP. Diet and obesity among Chamorro and Filipino adults on Guam. Asia Pac J ClinNutr.2008;17:216-22.
  7. Harnack L,Stang J, Story M. Soft drink consumption among US children and adolescents: nutritional consequences. J Am Diet Assoc.1999;99:436-41.
  8. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 2001;357:505-8.
  9. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J ClinNutr. 2006;84:274-88.
  10. Mrdjenovic G, Levitsky DA. Nutritional and energetic consequences of sweetened drink consumption in 6- to 13-year-old children. J Pediatr.2003;142:604-10.
  11. Raben A, Vasilaras TH, Moller AC, Astrup A. Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10wk of supplementation in overweight subjects. Am J ClinNutr.2002;76:721-9.
  12. Tordoff MG, Alleva AM. Effect of drinking soda sweetened with aspartameor high-fructose corn syrup on food intake and body weight. Am J ClinNutr. 1990;51:963-9.
  13. Troiano RP, Briefel RR, CarrollMD, Bialostosky K. Energy and fatintakes of children and adolescents in the United States: data from the national health and nutrition examination surveys. Am J ClinNutr2000;72:S1343-53.
  14. Van Wymelbeke V, Beridot-Therond ME, de La Gueronniere V, Fantino M. Influence of repeated consumption of beverages containing sucrose or intense sweeteners on food intake. Eur J ClinNutr. 2004;58:154-61
  15. Wang YC, Ludwig DS, Sonneville K, Gortmaker SL. Impact of change in sweetened caloric beverage consumption on energy intake among children and adolescents. Arch PediatrAdolesc Med.2009;163:336-43.
  16. World Health Organization. Obesity and Overweight. Fact sheet n°311. Available at Accessed September 2011.
  17. de Koning L, Malik VS, Rimm EB, Willett WC, Hu FB. Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men. Am J ClinNutr. 2011;93:1321-7.
  18. Palmer JR, Boggs DA, Krishnan S, Hu FB, Singer M, Rosenberg L.Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Arch Intern Med. 2008;168;1487-92.
  19. Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, Hu FB. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA. 2004;292:927-34.
  20. Yoo S, Nicklas T, Baranowski T, Zakeri IF, Yang SJ, Srinivasan SR, Berenson GS. Comparison of dietary intakes associated with metabolic syndrome risk factors in young adults: the Bogalusa Heart Study. Am J ClinNutr. 2004;80:841-8.
  21. Dhingra R, Sullivan L, Jacques PF, Wang TJ, Fox CS, Meigs JB, D'Agostino RB, Gaziano JM, Vasan RS. Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation. 2007;116:480-8.
  22. Ventura AK,Loken E, Birch LL. Risk profiles for metabolic syndrome in a nonclinical sample of adolescent girls. Pediatrics. 2006:118:2434-42.

No comments: