Hydration and health: a review

Summary Water is essential for life and maintaining optimal levels of hydration is important for humans to function well. Water makes up a large proportion of our body weight (60% on average), distributed between the intracellular (inside cells) and extracellular (water in the blood and in between cells) compartments. Water is the major component of body fluids, such as blood, synovial fluid (fluid in the joints), saliva and urine, which perform vital functions in the body. The concentration of solutes (osmolality) in body fluids is closely controlled, and even very small changes in osmolality trigger a physiological response; either to increase body water by reducing urinary output and stimulating thirst; or to excrete excess water as urine. Generally, body water is maintained within narrow limits. However, if water losses are not sufficiently replaced, dehydration occurs. Extreme dehydration is very serious and can be fatal. More mild dehydration (about 2% loss of body weight) can result in headaches, fatigue and reduced physical and mental performance. It is also possible to consume too much water and in rare cases this can result in hyponatraemia (low levels of sodium in the blood). We can get water from almost all drinks and from some foods in the diet. Food provides about 20% on average and this could vary widely depending on the types of food chosen. We also get water from all the drinks we consume, with the exception of stronger alcoholic drinks like wines and spirits. All these can contribute to dietary water, but also have other effects on health both positive and negative. The major concerns with regards to beverages are their energy content and their effect on dental health. With obesity levels continuing to increase it is important for many in the population to control their energy intake, and drinks as well as foods must be considered for their energy content. With regards to dental health, there are two concerns; dental caries and dental erosion. Dental caries are caused by a reduction in pH due to bacterial fermentation of carbohydrates, and so the frequency of consumption of drinks containing sugars is a concern for risk of caries. Dental erosion occurs at a lower pH and is caused by the consumption of acidic foods and drinks, in particular, citrus juices and soft drinks containing acids. Individual water needs vary widely depending on many factors including body size and composition, the environment and levels of physical activity. Thus it is very difficult to make generic recommendations about the amount of water to consume. The FSA currently recommends drinking about 1.2 litres per day (about 6-8 glasses)

Developing a digital toolkit to enhance the communication of health claims: the Health Claims Unpacked project

Consumer understanding and acceptance of health claims are influenced by a variety of factors including personal knowledge and familiarity with the information, characteristics of the product (such as the ingredients) and the way the claim is presented (e.g. wording and visual aids such as symbols). The official wording of authorised EU health claims is set by the European Commission (EC), though there is some flexibility, in that food companies can change the wording to aid consumer understanding of the claim as long as the original meaning is retained and the modified version does not mislead. An EIT Foodfunded project with the consumer-facing title Health Claims Unpacked, consists of an international consortium aiming to develop a digital toolkit to investigate consumers’ responses to health claims and aid their understanding thereof. Developed firstly in English (and now also in other EU languages such as German, French and Polish), the toolkit is informed by research in linguistics, design, nutrition science, technology and behavioural economics as well as focus groups with consumers and interviews with the food industry. The format of the toolkit is an interactive web app comprising activities which are used to gather data regarding consumers’ responses to different kinds of linguistic, semiotic (signs and symbols) and marketing cues related to health claims and how these cues impact their understanding of the relationship between nutrients/food components and health, trust in the message and willingness to pay for products. The data will be used to provide information on the preferences of different demographic groups on the wording of health claims and to provide recommendations for stakeholders aiming to enhance the communication of health claims on food and drink labels

Effect of Galactose Ingestion Before and During Exercise on Substrate Oxidation, Postexercise Satiety, and Subsequent Energy Intake in Females.

OBJECTIVE: To examine the effects of consuming a galactose carbohydrate (CHO) drink on substrate oxidation, postexercise satiety, and subsequent energy intake. METHODS: Nine recreationally active eumenorrheic females undertook 3 trials, each consisting of running for 60 minutes at 65% VO2peak followed immediately by a 90-minute rest period. Prior to (300 ml) and at 15-minute intervals during exercise (150 ml), participants consumed either a glucose (GLU: GI 89) or galactose (GAL: GI 20) drink, each of which contained 45 g of CHO, or an artificially sweetened placebo (PLA). Following the rest period, participants were provided with an ad libitum test lunch and asked to record food intake for the remainder of the day. RESULTS: Plasma glucose was significantly greater throughout exercise and rest following the GLU trial compared with the GAL and PLA trials (P < 0.05); however there were no differences in CHO oxidation. Hunger was significantly lower (P < 0.05) throughout the GAL compared to the GLU and PLA trials. There were no significant differences between trials for energy intake during the postexercise meal. Overall net energy balance for the 24 hours was negative in both the GAL (-162 ± 115 kcal; P < 0.05 vs GLU) and PLA trials (-49 ± 160 kcal). CONCLUSIONS: Results demonstrate that ingesting a solution containing GAL before and during exercise can positively impact postexercise satiety and energy balance throughout the day, compared to a more readily available and widely consumed form of CHO. Despite this, there appears to be no apparent benefit in consuming a CHO beverage on fuel utilization for this moderate exercise intensity and duration

A pilot investigation to optimise methods for a future satiety preload study

Preload studies are used to investigate the satiating effects of foods and food ingredients. However, the design of preload studies is complex, with many methodological considerations influencing appetite responses. The aim of this pilot investigation was to determine acceptability, and optimise methods, for a future satiety preload study. Specifically, we investigated the effects of altering (i) energy intake at a standardised breakfast (gender-specific or non-gender specific), and (ii) the duration between mid-morning preload and ad libitum lunch meal, on morning appetite scores and energy intake at lunch. Participants attended a single study visit. Female participants consumed a 214-kcal breakfast (n = 10) or 266-kcal breakfast (n = 10), equivalent to 10% of recommended daily energy intakes for females and males, respectively. Male participants (n = 20) consumed a 266-kcal breakfast. All participants received a 250-ml orange juice preload 2 h after breakfast. The impact of different study timings was evaluated in male participants, with 10 males following one protocol (protocol 1) and 10 males following another (protocol 2). The duration between preload and ad libitum lunch meal was 2 h (protocol 1) or 2.5 h (protocol 2), with the ad libitum lunch meal provided at 12.00 or 13.00, respectively. All female participants followed protocol 2. Visual analogue scale (VAS) questionnaires were used to assess appetite responses and food/drink palatability. Correlation between male and female appetite scores was higher with the provision of a gender-specific breakfast, compared to non-gender-specific breakfast (Pearson correlation of 0.747 and 0.479, respectively). No differences in subjective appetite or ad libitum energy intake were found between protocols 1 and 2. VAS mean ratings of liking, enjoyment, and palatability were all > 66 out of 100 mm for breakfast, preload, and lunch meals. The findings of this pilot study confirm the acceptability of this methodology for future satiety preload studies. Appetite scores increased from preload to ad libitum lunch meal; however, no specific differences were found between protocols. The results highlight the importance of considering energy intake prior to preload provision, with a gender-specific breakfast improving the correlation between male and female appetite score responses to a morning preload

Association between egg consumption and cardiovascular disease events, diabetes and all-cause mortality

Purpose The association between egg consumption and cardiovascular disease (CVD) or type 2 diabetes (T2D) remains controversial. We investigated the association between egg consumption and risk of CVD (primary outcome), T2D and mortality in the Caerphilly prospective cohort study (CAPS) and National Diet and Nutritional Survey (NDNS). Methods CAPS included 2512 men aged 45–59 years (1979–1983). Dietary intake, disease incidence and mortality were updated at 5-year intervals. NDNS included 754 adults aged 19–64 years from 2008 to 2012. Results Men free of CVD (n = 1781) were followed up for a mean of 22.8 years, egg consumption was not associated with new incidence of CVD (n = 715), mortality (n = 1028) or T2D (n = 120). When stroke (n = 248), MI (n = 477),heart failure (n = 201) were investigated separately, no associations between egg consumption and stroke and MI were identified, however, increased risk of stroke in subjects with T2D and/or impaired glucose tolerance (IGT, fasting plasma glucose ≥ 6.1 mmol/L), adjusted hazard ratios (95% CI) were 1.0 (reference), 1.09 (0.41, 2.88), 0.96 (0.37, 2.50), 1.39 (0.54, 3.56) and 2.87 (1.13, 7.27) for egg intake (n) of 0 ≤ n ≤ 1, 1 < n ≤ 2, 2 < n ≤ 3, 3 < n < 5, and n ≥ 5 eggs/wk, respectively (P = 0.01). In addition, cross-sectional analyses revealed that higher egg consumption was significantly associated with elevated fasting glucose in those with T2D and/or IGT (CAPS: baseline P = 0.02 and 5-year P = 0.04; NDNS: P = 0.05). Conclusions Higher egg consumption was associated with higher blood glucose in subjects with T2D and/or IGT. The increased incidence of stroke with higher egg consumption among T2D and/or IGT sub-group warrants further investigation

Effect of Training on the Reliability of Satiety Evaluation and Use of Trained Panellists to Determine the Satiety Effect of Dietary Fibre: A Randomised Controlled Trial

Background: The assessment of satiety effects on foods is commonly performed by untrained volunteers marking their perceived hunger or fullness on line scales, marked with pre-set descriptors. The lack of reproducibility of satiety measurement using this approach however results in the tool being unable to distinguish between foods that have small, but possibly important, differences in their satiety effects. An alternate approach is used in sensory evaluation; panellists can be trained in the correct use of the assessment line-scale and brought to consensus on the meanings of descriptors used for food quality attributes to improve the panel reliability. The effect of training on the reliability of a satiety panel has not previously been reported. Method: In a randomised controlled parallel intervention, the effect of training in the correct use of a satiety labelled magnitude scale (LMS) was assessed versus no-training. The test-retest precision and reliability of two hour postprandial satiety evaluation after consumption of a standard breakfast was compared. The trained panel then compared the satiety effect of two breakfast meals containing either a viscous or a non-viscous dietary fibre in a crossover trial.Results: A subgroup of the 23 panellists (n = 5) improved their test re-test precision after training. Panel satiety area under the curve, “after the training” intervention was significantly different to “before training” (p < 0.001). Reliability of the panel determined by intraclass correlation (ICC) of test and retest showed improved strength of the correlation from 0.70 pre-intervention to 0.95 post intervention. The trained “satiety expert panel” determined that a standard breakfast with 5g of viscous fibre gave significantly higher satiety than with 5g non-viscous fibre (area under curve (AUC) of 478.2, 334.4 respectively) (p ≤ 0.002). Conclusion: Training reduced between panellist variability. The improved strength of test-retest ICC as a result of the training intervention suggests that training satiety panellists can improve the discriminating power of satiety evaluation

Prevention of Dehydration in Hospital Patients

Dehydration is widely linked to increased risk of mortality in patients who are acutely unwell, and also increases the risk of further illness. Despite being recognised nationwide as a cause for concern, 45% of hospital patients will become dehydrated upon admission; suggesting more needs to be done to prevent dehydration. The use of bedside water devices allow patients to drink freely without assistance. Access to bedside water devices can reduce a patients length of stay in hospital and minimise the risk of a UTI developing, however further research is needed to fully assess the impact of such devices