ABSTRACTS

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Perception of hydration in a group of university students. Differences regarding their body masd index

Aguilar-Aguilar E¹, Mascaraque-Camino M², Villalobos T², Rodríguez-Rodríguez E², Navia-Lombán B².

¹University Hospital Santa Cristina. Madrid.
²Department of Nutrition. Faculty of Pharmacy. Complutense University of Madrid. Madrid.

Introduction: Proper hydration is important, but could be essential in those with weight control problems.
Objective: The aim of this study was to investigate the drinking habit patterns of young people, what is considered correct/recommended, and to analyse the differences regarding body mass index (BMI).
Methods: A group of 113 university students aged 18-27 completed an open-ended-questionnaire with questions about general concepts of hydration, beverage consumption patterns and self-reported anthropometric data. The students were classified according to their BMI (< or ≥ p50). Statistical analysis was performed using SPSS (version 19.0), and differences with p < 0.05 were considered significant.
Results: Those with BMI ≥ p50 considered they should drink more (2.19 ± 0.37 L/day vs. 1.98 ± 0.41 L/day for those with lower BMI, p < 0.05). Reported beverage consumption was also higher in those with BMI ≥ p50 (1.92 ± 0.56 L/day vs. 1.59 ± 0.52 L/day) (p < 0.01).
Conclusion: University students with higher BMI seemed more aware of the importance of hydration, and they reported consuming more beverages. But neither they nor those with lower BMI meet the target set for adequate liquid intake.
Acknowledgements: This work was carried out with funding from the "Research Funding Program for Consolidated Groups Santander-UCM" (Ref: GR35/10-A).

Key words: hydration, perception, beverage consumption, BMI.

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Relation between hydration and jump performance; differences between young elite and regional basketball players

Álvarez-Carnero E¹, Benítez-Flores S¹, Carrillo-de Albornoz M², López-Raya JF¹, Rojo-Rodríguez J¹, Guerrero-Gil T¹.

¹Biodynamic and Body Composition Laboratory. University of Málaga. Málaga.
²Exercise Physiology Laboratory. University of Málaga. Málaga.

Introduction: Hydration has been classically associated with aerobic performance. However, less is known about the relationship between anaerobic performance and hydration parameters.
Objective: Our aim was to analyse the association between jump performance and total (TBW) or intracellular (ICW) hydration.
Methods: Two teams were assessed (elite level (T1, n = 11): age, 17.45 ± 1.5 years; height, 198.6 ± 9.7cm; regional level (T2, n = 10): age, 15.30 ± 1.2 years; height, 179.0 ± 5.3cm). Hydration was estimated by bioelectrical impedance. Dual-energy X-ray absorptiometry (DXA) was used to estimate fat free mass (FFM), fat mass percent (FMP) and limb soft lean tissue (LSLT). FFM hydration (FFMh) and body cell mass (BCM) were calculated. Countermovement jump (CMJ) and CMJ with free arms (CMJA) were measured with a jump map. Partial correlation analyses adjusted to LSLT between jump and hydration variables were carried out. Differences between teams were also analysed.
Results: Significant correlations were found between ICW and CMJ (r = 0.705, p < 0.01). As expected, significant differences were found between T1 and T2 for CMJ (6.77 ± 2.22 cm; p < 0.01) and CMJA (15.41 ± 2.18 cm; p < 0.001); however, ICW was the only significantly different hydration variable among level groups (61.14 ± 0.81% vs. 59.48 ± 1.29%; p < 0.01).
Conclusions: Our findings suggest that ICW must be an explanatory mechanism for jump capacity, mainly when less coordinative skills are involved. Differences between jump performances among levels of competition could be partially explained by ICW. More research is necessary to confirm our results.

Key words: young athletes, body composition, intracellular water.

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Hydration characteristics of male elite climbers

Alvero-Cruz JR¹, Fernández-Vázquez R¹, Fernández-García JC2, Carnero EA².

¹Sports Medicine School. University of Málaga. Málaga.
²Biodynamic and Body Composition Laboratory. University of Málaga. Málaga.

Introduction: Significant scientific documents describe the deleterious effects of reduced total body water (TBW) on endurance performance. However, the influence of hydration on muscular strength, power and high-intensity endurance is poorly understood.
Objective: The aim of this study was to show the differences in hydration status between two levels of performance in elite climbers.
Methods: Thirteen male elite climbers, who had participated in the 2004 International Federation of Sport Climbing (IFSC) World Cup, completed a fasting body composition assessment. TBW was estimated by bioelectrical impedance analysis (SanoCare); FFM hydration and body composition were also calculated. The IFSC ranking was used to classify the performance. Seven were ranked within the top 30. A Mann-Whitney test was carried out to analyse differences between groups. Partial correlations between IFSC ranking and hydration variables were performed and adjusted according to fat percentage.
Results: TBW was greater in climbers who classified within the first 30 (66.05 ± 2.88% versus 61.95 ± 3.59% obtained for climbers with positions after these 30). A relationship between individual ranking and hydration status was also found. These associations must be considered for a better profile of adiposity. It has been speculated that high levels of FFM hydration must be related with performance.

Key words: total body water, bioelectrical impedance analysis, performance, elite climbers.

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Total body water levels in professional football players

Alvero-Cruz JR¹, Muñoz FJ¹, Pérez Frías JC², Fernández-Gere A³, Belmonte F⁴, Fernández-Vázquez R¹.

¹Sports Medicine School. University of Málaga. Málaga. ²Málaga CF. ³Granada FC. ⁴Xérez CD.

Introduction: Continued training produces a decrease of total body water levels with impairment of performance. Significant scientific evidence has documented the deleterious effects of reduced total body water (TBW) on endurance exercise performance.
Objective: The purpose of this study was to investigate the relationship between TBW and player position in football players.
Methods: One hundred twenty-five male professional football players participated in and completed a fasting body composition assessment. TBW and hydration of fat-free mass was estimated by bioelectrical impedance analysis (Tanita SC 240 MA, Japan) in the 2011-2012-2013 pre-seasons. All the athletes were divided by player position (goalkeepers (n = 12), defenders (n = 37), midfielders (n = 57) and forwards (n = 19)). Descriptive statistics (mean± sd) were calculated and one-way analysis of variance to test differences among player positions was performed. Partial correlations were performed and adjusted by percentage of fat. The level of significance for the statistical test was 0.05.
Results: Percentage of TBW was greater in midfielders (61.68 ± 3.09%) followed by forwards (61.23 ± 2.66%), defenders (59.97 ± 2.52%) and goalkeepers (61.68 ± 3.09%), (f-ratio 3.55, p = 0.017). Associations between TBW and player position were not significant when adjusted for fat percentage.
Conclusions: These associations must be considered for a better profile of adiposity and are probably related to a body composition mainly of muscle mass.

Key words: total body water, football players.

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Bioactive compounds with antioxidant activity in milk- and soy milk-juice based beverages

Andrés-Martín V, Mateos-Aparicio I, Villanueva-Suárez MJ, Tenorio-Sanz MD.

Department of Nutrition and Bromatology II. Faculty of Pharmacy. Complutense University of Madrid. Madrid.

Introduction: Milk-juice beverages lack a precise definition and legal recognition even in the most recent legislation. These beverages provide an essential water intake (90%) and their fruit contents contribute vitamin C, provitamin A, minerals (K, Mg, P), fibre, sugars and organic acids. Skimmed milk contains protein, lactose and minerals (Ca, P) and soy-milk protein, fat, carbohydrates, minerals (K, P) and isoflavones. Furthermore, they are a good source of bioactive compounds with potential antioxidant activity helping to promote health.
Objectives: To determine the bioactive compounds, vitamin C and polyphenols and the in vitro antioxidant activity (FRAP) in twenty-four milk- and soy-beverages marketed in Spain.
Methods: Ascorbic acid was analysed by HPLC-DAD. Polyphenols and FRAP assay were determined by spectrophotometry.
Results: The vitamin C values were much higher than those shown on the labels, suggesting that the main intake of this vitamin is due to its inclusion as an additive. The highest concentration of polyphenols was found in the mixed beverages containing orange, apple, pineapple and/or grape as the main fruits. Total antioxidant activity (FRAP) was positively correlated with ascorbic acid (r2 = 0.893) and polyphenol (r2 = 0.896) contents.
Conclusions: Due to the existing legal gap in the scope of these products, we are unable to determine whether the results agree with legal criteria. A regulatory framework would be clearly advantageous for consumers, ensuring they are given full information about the contents and composition of these products.

Key words: ascorbic acid, polyphenols, FRAP.

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Meeting water requirements and affective capacity in a group of institutionalized elderly people

Aparicio-Vizuete A¹, López-Sobaler AM¹, Navia-Lombán B¹, Perea-Sánchez JM², Carvajales PA³, Ortega-Anta RM¹.

¹Department of Nutrition. Faculty of Pharmacy. Complutense University of Madrid. Madrid.
²Faculty of Health Sciences. University Alfonso X El Sabio. Madrid. 'Department of Analytical Chemistry. Faculty of Pharmacy. Complutense University of Madrid. Madrid.

Introduction: Liquid intake can be reduced by many factors, especially in those with psychiatric and cognitive problems, and it may have important health consequences.
Objective: The aim of this study is to analyse to what extent institutionalized elderly people meet water requirements and to evaluate the relationship between water intake and affective capacity in this population.
Methods: This study included 176 institutionalized elderly people from Madrid (Spain) (65-90 years old) whose diets were recorded using a precise weighing method over seven consecutive days. Total water intake (TWI) (food and beverage) was calculated using DIAL software. Water requirements were calculated using 30 mL/kg/day. Affective capacity was assessed using the Geriatric Depression Scale (GDS). Subjects were grouped into non-depressed (GDS ≤ 5) and depressed (GDS > 5).
Results: 77.8 ± 19.5% of the participants met the requirements for water intake (13.7% of the participants took water amounts above the required dose) and the mean GDS score was 5.4 ± 3.5 (43.7% had depression). An inverse relationship between GDS score and TWI (r = -0.382; p < 0.001) was observed. Non-depressed elders had higher TWI (1543 ± 214.3 vs. 1419 ± 243.3 mL/day, p < 0.001), higher beverage consumption (672.0 ± 170.6 vs. 587.7 ± 174.4 mL/day, p < 0.01) and better CWR (81.7 ± 19.9 vs. 74.9 ± 19.0 %, p < 0.05) than depressed elders. Also, it was found that a higher water intake is a protective factor against depression (OR: 0.982; CI: 0.966 - 0.998; p < 0.05).
Conclusion: Depression affects the adequate consumption of water.
This work was supported by Unilever Netherlands via the Universidad-Empresa project (138/2000).

Key words: water requirements, elderly, depression, GDS.

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What do children drink?

Arroyo-Albacete A¹, Sánchez-Padilla Y², Fernández-Martín-Villamuelas MJ³

¹Chind Care Center. Toledo.
²Infanta Cristina Hospital. Health Service Extremadura. Badajoz.
³University Hospital of Getafe. Madrid.

Introduction: Water is essential for organs and tissues to function properly. 6- to-8-year-old children should drink 1.7 litres of water per day, 20% of which is provided by food.
Objective: To become familiar with fluid intake in children from 6 to 8 years old.
Methods: Observation-based descriptive and multi-disciplinary study carried out in Toledo. A 24-hour reminder was used for three days, assessing fluid intake and different groups of drinks.
Results: A total of 178 children (45.1% of those initially screened), mean age 6.73 (DT 0.69) completed the study. 51.4% of them were girls. The average intake was 1663 ml (DT 361.4), with an average of 135 ml higher in girls (p = 0.013). 16.9% of the participants presented lower intake than recommended (1360 ml) with differences in gender (22.1% in boys and 12.1% in girls, p = 0.058). 86.7% had consumed soft drinks, 15.6% with meals and up to 20.8% on weekends. 19% had tasted coffee.
Over the weekend children consumed fewer dairy products than at school (29.2% vs. 45.15%) but more juice (63.1% vs. 50.4%).
Conclusions: Acceptable participation. Sufficient average intake. A difference was found by gender regarding fluid intake in 6-year-old children. This is different from other studies (conducted with 9-year-old children). Daily milk and water intake is recommended while soft drinks should be consumed occasionally. Coffee should not be consumed. People are not aware of the importance of hydration. This is even more significant with vulnerable people such as children.

Key words: children, hydration, water, soft drinks.

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The importance of hydration to the skin

Ávila-Moreno C, García-Ripollés CM, González-Canela C, Bou-Jiménez A, Sánchez-Machío N, Gómez-Rubio E.

University Hospital Vall D'Hebrón. Barcelona.

Introduction: The skin is the largest organ in the human body. In addition to other functions, skin maintains the integrity of its structure and connects it with the environment. This role is fulfilled thanks to its own hydration mechanism, which at the same time maintains the skin flexible and resistant. However, due to diverse factors we are exposed to on a daily basis, the skin's natural mechanism is not enough, so it is necessary to provide extra help to prevent dryness and peeling. Skin care, as well as its hydration, is essential at all ages and all times of the year. With the passage of time, sebaceous glands are less active and the skin loses its capacity to retain water, therefore drying easily.
Objectives: To establish the external factors which facilitate skin dryness. To maintain the internal and external hydration of the skin with the use of external products.
Methods: Introduction of basic recommendations through talks and workshops. Dissemination through posters in hospitals, primary health care centres and schools (parents and children).
Results: Using the required methods, assistance can be given to satisfy one of the most important basic human needs. Recommendations and basic care will be adapted according to age and priority.
Conclusions: Skin care is vital to healthy and sick persons. Because of the environment, our health habits and the natural ageing process are crucial factors in the skin's loss of moisture. Preventing dehydration is in our hands.

Key words: sebaceous, gland, primary health care.

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Physicochemical and organoleptic analysis of bottled natural mineral waters

Benhammou S¹, Monteagudo C1, De la Torre A¹, Mariscal-Arcas M², Rivas A¹, Lorenzo-Tovar ML¹.

¹University Of Granada. Granada.
²University Of Murcia. Murcia.

Introduction: Natural mineral water is distinguished from others by its nature (mineral content, dietary elements and other components), its chemical profile and its original purity. A further differentiating aspect is its taste and odour.
Objectives: To analyse and compare the key physicochemical components in the classification of bottled natural mineral waters according to current legislation and to perform a sensory evaluation.
Methods: The study samples came from bottled natural mineral waters of the same brand but from different springs. The physicochemical analysis was conducted in accordance with Royal Decree 1798/2010 of 30 December, which regulates the exploitation and commercialization of natural mineral waters and spring waters bottled for human consumption. The sensory analysis was carried out using a taste panel from the Seminar of Gastronomy and Oenology Studies at the University of Granada.
Results: The physicochemical analysis results made it possible to classify the samples as weakly mineralised and low-sodium waters, among other characteristics. The sensory analysis showed significant differences in the characteristics of the waters according to the springs from which they came.
Conclusions: These classified and characterised waters are indicated for the preparation of infant foods and low-sodium diets, due to their low sodium content and weak mineralisation. Their contribution to the recommended intake of various minerals is significant; therefore, their consumption is recommended for daily hydration.

Key words: hydration, bottled mineral water, sensory, taste.

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Subcutaneous hydration in terminal stage patients

Bou-Jiménez A¹, Garcia-Ripollés CM, Sánchez-Machío N, Ávila-Moreno C, Gónzalez-Canela C, Gómez-Rubio E.

¹Emergency Centre Pura Fernández Care Center. Barcelona.
²University Hospital Vall d'Hebrón. Barcelona.

Introduction: It is a common practice for oncological patients to be taken care of in a hospital in the final stage of their life. One reason for that is the family's concern about the issues facing a terminal patient, chief amongst them the reduction or inability to intake fluids orally.
Objective: To reduce the symptoms characteristic of the terminal stage that cause the deterioration of the conscious state. The presence of the feeling of thirst and other signs and symptoms negatively impact the patient's quality of life, which causes anxiety for the family and the patient.
Methods: With the use of clean serum, the infusion rhythm oscillates between 20 and 100 ml/h. It can be administered along the subclavian pectoral area, abdominal region, thighs and arms. The puncture spot should be changed every 7 days, and the needle location should be inspected daily. The required materials for the puncture are butterfly needles or teflon cannules.
Results: This is the simplest parenteral method to hydrate or supplement the oral intake of liquids. It does not prolong the agony, requires no hospitalization, presents very few complications and thus allows caretakers to continue with their efforts to alleviate the suffering and improve the patient's quality of life.
Conclusions: The choice to help a terminal patient's hydration and nutrition carries physiopathological, emotional and ethical implications. The therapeutic team walks a fine line between the real needs of the patient and the real needs of the family.

Key words: hydration, subcutaneous hydration, terminal patient, palliative care.

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Importance of hydration during childbrith: scientific evidence

Camacho-Ávila M¹, García-Duarte S², Ruiz-Carmona MM³, Hernández-Sánchez E⁴.

¹Torrevieja Hospital. Alicante.
²La Inmaculada Hospital. Almería.
³Hospital of Torrecárdenas. Almería.
⁴Catholic University of Murcia (UCAM). Murcia.

Introduction: Pregnancy, childbirth and the postpartum period are normal health processes in women. However, labour is mistakenly treated like a disease. Hydration needs are not satisfied during the childbirths that occur in Spanish hospitals. Women spend long hours fasting or with IV fluids in order to prevent Mendelson's syndrome caused by aspirating gastric contents, just in case a Caesarean section can be necessary.
Objectives: To find out if it is necessary to restrict oral hydration during childbirth.
Methods: Descriptive study of the available evidence, using a literature review databases such as Cuiden, Medline, Cochrane or Science as a data collection tool.
Results: Olsson et al., found that the incidence of Mendelson's syndrome is 0.05%. The Spanish Society of Gynaecology recommends not restricting fluids at birth and especially during prolonged processes. The Federation of Midwives Associations, through its Normal Delivery Initiative, recommends the intake of food and fluids according to a woman's needs during normal labour and also state that this is not the norm.
Conclusions: There is no existing evidence that fasting lowers the risk of aspiration. In normal labour without any risk factors, the probability of Mendelson's aspiration syndrome is minimal. The recommendation after preparing this review is to consume isotonic drinks on a regular basis during normal labour.

Key words: hydration, normal delivery.

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Importance of hydration in diabetes insipidus caused by a postpartum hemorrhage: a real case

Camacho Ávila M¹, García Duarte S², Ruiz Carmona MM³, Hernández-Sánchez E⁴.

¹Hospital of Torrevieja. Alicante.
²La Inmaculada Hospital. Almería.
³Hospital of Torrecárdenas. Almería.
⁴Catholic University of Murcia (UCAM).

Introduction: A real case of a woman who suffered a pituitary gland infarction following a postpartum haemorrhage after a Caesarean section is presented. This necrosis caused the development of diabetes insipidus. The patient was a 35-year-old first-time mother without any health problems; her pregnancy was normal and controlled. A Caesarean section was performed after a failed labour induction.
Objectives: To become familiar with the importance of hydration in diabetes insipidus.
Methods: Descriptive study of the available evidence of hydration in diabetes insipidus in general and in this case in particular.
Results: In this case the treatment was based on the pharmacological pattern of vasopressin and assessment of fluid balance, in order to maintain a urine output of less than 2000 ml. Generally, diabetes insipidus is treated, depending on the case, with vasopressin and an assessment of hiccups or hypernatremia is done, taking special care to prevent dehydration.
Conclusions: To highlight the importance of an adequate intake of water in this disease, as it can result in dehydration and patient's decompensation. For this reason, nursing care should focus on health education regarding dietary habits and adherence to treatment, as well as on recognizing the symptoms of decompensation in diabetes insipidus.

Key words: hydration, diabetes insipidus.

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Basal hydration status in Spanish high performance athletes. Assessment by bioelectrical impedance

Canda-Moreno A¹, Díaz-Ruano JA², Segura-Dorado JL¹, Falcón-Murciano I¹, Higueras-Salazar S¹, Sainz-Fernandez L¹, Castiblanco-Ramirez L¹

¹High Council for Sport. Madrid.
²School of Sport Medicine Madrid.

Introduction: To achieve optimal athletic performance, it is essential to maintain a good state of hydration.
Objective: The aim of this study was to assess the total body water (TBW) in basal conditions by bioimpedance (BIA) in elite athletes.
Methods: Resistance and reactance were measured by quadripolar electrodes (BIA 101, Akem) in a sample of 229 white athletes, 104 women and 125 men, aged 16 - 40, covering 17 disciplines and under controlled conditions. As a result, TBW, intracellular water (ICW), extracellular water, (ECW), body cell mass (BCM) and extracellular mass (ECM) values were obtained. The anthropometric parameters recorded were height, weight and skinfold-thickness for the estimation of fat free mass (FFM).
Results: TBW: 41.2 l (59.3%), higher in males (47 l, 61.7%) than in females (34.3 l; 56.3%); ECW: 16.9 l (41.3%), higher in males in absolute vales and lower in percentages (18.6 l; 39.6% ) than for females (14.9; 43.4%); ICW: 24.3 l (58.7%), higher for males (28.4 l; 60.4%) than for females (19.5 l;56.6%); BCM: 33.3 kg, higher for males (39.9 kg) than for females (26.4 kg); ECM: 23.1 kg, higher for males (25.2 kg) than for females (20.4 kg). Younger females obtained a lower % ICW. Differences were found based on the type of discipline and a significant correlation (r = 0.9, p < 0.0001) was observed between FFM and resistance/size.
Conclusion: Athletes have higher % TBW than the general population and this is associated with their higher lean component.

Key words: bioelectrical impedance, body water, athletes.

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Evaluation of liquid intake in triathletes

Frigola Canoves A, Gulden MC, Esteve MJ

University of Valencia. Valencia.

Introduction: When doing physical exercise it is important to take into account liquid intake. Bad hydration produces a decrease in athletic performance and is inadequate from a nutritional point of view.
Objectives: The aim of this work was to evaluate liquid intake in a group of triathletes, before, during and after completing the triathlon.
Methods: A 4-day dietary interview was conducted with 11 triathletes, 8 men (21-33 years old) and 3 women (23-28 years old). The triathletes respectively trained 13 and 10 hours per day, 6 days per week. The majority of the triathletes trained fewer hours in the gymnasium than recommended and therefore the training time was lower than the plan. The individual anamnesis showed that all the sportsmen rest one day a week and each of them engages in sports activities 10 months per season (October-July).
Results: The results obtained from the dietary interview showed that the triathletes had a sufficient consumption of liquids, mainly water (2.5 - 3 L). They also consumed enough isotonic beverages when they had a day of heavy training or on the day of the competition. The consumption of alcohol is not common among triathletes and in general it seems that the participants in the study are highly aware of how to be correctly hydrated.
Conclusions: Overall, correct hydration was observed in the study group. Nevertheless intake should be monitored, especially when the competition begins.

Key words: triathlon, hydration, isotonic beverages.

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TBW assessment by deuterium dilution in Spanish adolescents

Carnero E¹, Alvero-Cruz JR¹, Barrera-Expósito J¹, Sardinha LB²

¹University of Málaga. Málaga.
²University of Lisbon. Lisbon.

Introduction: Total body water (TBW) assessment is a cornerstone in validating equations to estimate body composition components such as fat mass and fat free mass. The deuterium dilution technique (D₂DT) is considered the gold standard method to assess TBW. However in Spain there are no reference data about using D₂DT. The knowledge of specific references for the Spanish population must be a goal for biological studies of Spaniards.
Objective: Our aim was to assess TBW using D₂DT in a sample of Spanish adolescents.
Methods: 224 specimens of urine from 150 adolescents (113 girls and 111 boys) were taken to analyse. A dose of 0.1 grams of 2D₂O per Kg of body weight was administered, followed by a 4-hour stabilization period. The isotope (deuterium oxide (D₂O)) dilution method was used to measure TBW with an isotoperatio mass-spectrometer. Average values by sex and Tanner stages were calculated for %TBW and TBW. A general linear model was used to analyse differences and interactions between groups.
Results: %TBW was significantly different between boys and girls (58.98 ± 5.59% vs. 55.5 ± 4.28%, P < 0.001). Significant differences were found among 12-year-olds and other age groups (15, 16, 17 and 18; P < 0.05) but not for older groups (P > 0.05).
Conclusions: This study was the first of its kind in Spain measuring TBW in vivo using D2DT. These data can be useful to validate new methods and equations from bioimpedance analysis to estimate TBW.

Key words: total body water, deuterium, maturation, sex.

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Evaluation of decreased total antioxidant capacity of sulphurous water

Casado A, López-Fernández E.

Department of Cellular and Molecular Medicine. Biological Research Center. Spanish National Research Council (CSIC). Madrid.

Introduction: Sulphurous water (SW) hydration plays an important role in antioxidant strategies against the oxidative damage associated with aging and related degenerative disorders
Objectives: 1) To determine the total antioxidant capacity (TAC) of SW and, 2) to evaluate its decrease to achieve better results after ingestion.
Methods/Design: TAC was determined 4h before collecting the SW. 1.5 ml aliquots were taken and kept at room temperature, in a refrigerator (4^oC), or frozen at -25^oC and -80^oC. The TAC was determined in the SW aliquots one week, one month, three months and one year after sampling. The assessment of the TAC of SW was performed using the CUPRACBCS method, based on the reduction of copper (II) using a chromogenic reagent.
Results: TAC remained unchanged for one week in all SW aliquots. After one month, only the SW aliquot preserved at -80^oC maintained its TAC, those stored at -25^oC and 4^oC decreased their TAC and the aliquots stored at room temperature lost their TAC. After 6 months only the aliquot preserved at -25^oC and -80^oC retained its TAC and after a year only the one preserved at -80^oC maintained its TAC.
Conclusions: 1) The antioxidant benefits of hydration with SW can only be achieved if the intake is done within the first week after the removal from the spring. 2) Antioxidant benefits are maintained over time while preserving the SW at the right temperature.

Key words: total antioxidant capacity, sulphurous water hydration, oxidative stress, aging.

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Effects of oral salt supplementation on physical performance during a half-ironman triathlon

Del Coso J, González-Millán C, Areces F, Gallo C, Lara B, Ruiz-Vicente D.

Camilo José Cela University. Madrid.

Introduction: Ultra distance athletes frequently consume salt supplements during competitions to compensate for the loss of electrolytes by sweating.
Objective: To investigate the effectiveness of oral salt supplementation on improving exercise performance during a half-Ironman triathlon.
Methods: Twenty-six experienced triathletes were matched for age, anthropometric data and training status and randomly placed into the salt group (113 mmol of Na+ and 112 mmol of Cl-) or control group (cellulose). The experimental and control treatments were provided in unidentifiable capsules and were ingested during the race. Participants competed in a real half-Ironman triathlon and race time was measured by means of chip timing. Pre- and post-race, maximal force during an isometric strength test, maximal jump height, and blood samples were obtained. Sweat samples were obtained during the running section.
Results: Total race time was lower in the salt group than in the control group (307 ± 32 vs. 333 ± 40 min; p = 0.04). After the race, the reduction in isometric strength was lower in the salt group (-10.6 ± 0.8% vs. -13.4 ± 0.8%; p =0.01) although jump height was similarly reduced in both groups (-14.0 ± 5.3 and -18.4 ± 3.5%). Sweat losses (4.0 ± 1.1 L) and sweat Na+ concentration (48.4 ± 15.9 and 45.7 ± 20.9 mM) were similar between groups. However, body mass tended to be less reduced in the salt group than in the control group (-2.8 ± 0.9% vs. -3.4 ± 1.3%; p = 0.09). Post-race serum Na+ and Cl-concentrations were higher in the salt group (p < 0.05).
Conclusion: Oral salt supplementation might be effective way to increase performance and to maintain serum electrolyte concentrations during a real half-Ironman competition.

Key words: sodium, hyponatremia, endurance exercise, hydration, sweat, thirst.

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Dehydration and performance in trail and ultra-trail races. Differences between sexes

Cremades Arroyos D, Serrano E.

Unit of Study and Evaluation of Physical Activity (UNEVAF). University of Zaragoza. Zaragoza.

Introduction: The most direct method to calculate the degree of athlete dehydration is the body weight (BW) loss calculation. Although a loss of 1% BW is associated with a loss of physical performance, decreases of 2-3% BW are tolerable.
Objective: To analyse the incidence of dehydration in trail races and its relationship to physical performance, noting if there is a different response between participants in marathons or ultramarathons, as well as between men and women.
Methods: We analysed 320 trail runners (269 men, 51 women) (age: 37.4 ± 7.4 years) in the Aneto Ultra-Trail 2012 in all of its three distances (96 km + 5960 m, 67 km + 3870 m, 42 km + 1950 m). BW was calculated before and after the race.
Results: The subjects lost 2.27 ± 1.7 kg (p < 0.001) (3.12 ± 25% BW). There are no statistically significant differences between the losses experienced by the trail and ultra-trail runners: 42 km (-2.16 ± 2 p < 0.001), 67 km (- 2.39 ± 1.6 p < 0.001) and 96 km (2.3 ± 1.4 p < 0.001). A relationship exists between physical performance and the alterations of BW (42 K r = -0.203 p < 0.05) (67 K r = -0.237 p < 0.05) (96 K r = -0.275 p < 0.05). When comparing men and women, this relationship is observed in male runners in ultra-trail races (67 K r = -0.246 p < 0.05) (96 K r = -0.298 p < 0.05).
Conclusions: Although we know that performance is a multi-factor variable, dehydration is an agent that determines the athlete's capacity for physical work and can be controlled and trained.

Key words: dehydration, performance, endurance, body weight.

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Relationship between body weight changes and composition of urine in ultra-trail races

Cremades Arroyos D, Serrano E.

Unit of Study and Evaluation of Physical Activity (UNEVAF). University of Zaragoza. Zaragoza.

Introduction: When the air temperature is higher than the body temperature, evaporation of sweat is the only physiological mechanism to prevent the body from over-heating, but excessive sweating causes dehydration. The most direct method to calculate the degree of dehydration in the athlete is the body weight (BW) loss calculation. BW loss along with urine osmolality or urine density are the most valid criteria to assess dehydration.
Objective: To compare methods to assess dehydration in ultra-trail runners.
Methods: We analysed 44 trail runners (36 men and 8 women) (age: 36.7 ± 7.3 years) in the Aneto Ultra-Trail 2012 in all of its three distances (96 km + 5960 m, 67 km + 3870 m, 42 km + 1950 m). BW was measured before and after the race. Density and urinary osmolality were analysed at the end of the race.
Results: The subjects lost an average of 2.27 ± 1.7 kg (p < 0.001) (3.7 ± 2 BW). There are no statistically significant differences between the losses experienced by the participants in the marathon (-2.66 ± 1.7 p < 0.001 3.6%), 67 km distance (-2.85 ± 1.2 p < 0.001 3.9%) and 96 km distance (2.66 ± 1.4 p<0.001 3.4%). 14% of the trail runners lost more than 5% BW. The urine density was 1024.89 ± 5.6 g/L and the osmolality 913.79 ± 227.6 mOsm/kg.
Conclusions: There is significant dehydration in trail and ultra-trail runners, which is evidenced both by alterations in BW and urine density, with a correlation between both values.

Key words: dehydration, density, osmolality.

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Patterns of beverage consumption in a group of Spanish adults

Cuadrado-Soto E, Corral-Grimaldo B, Villalobos-Cruz T, Pecharromán Gutiérrez L, Navia-Lombán B.

Department of Nutrition. Faculty of Pharmacy. Complutense University of Madrid. Madrid.

Introduction: Adequate water intake is necessary to ensure appropriate body performance. Daily loss of body water is continuous and must be recovered.
Objective: To analyse dietary total water intake (TWI) at different meals and evaluate the main sources of fluids.
Methods: Dietary intake in a sample of 466 adults, aged between 18 and 50, was studied using a 3-day food record (including one weekend day). TWI was calculated from water content in food and beverages using DIAL Software.
Results: Mean TWI was 2030.03 ± 734.2 mL/day. Water was mainly consumed at lunch (706.5 ± 253.4 mL), followed by dinner (532.2 ± 272.16 mL), breakfast (305.7 ± 168 mL), mid afternoon (184.2 ± 206.3 mL), midmorning snack (173.1 ± 240 mL) and other moments of the day (55.7 ± 134 mL). The main food sources of water were beverages (including water) (1057.4 ± 330.6 mL), dairy products (303.2 ± 150.2 mL), vegetables (228.7 ± 117.9 mL) and fruits (188.2 ± 179.6 mL).
Conclusions: A high amount of the TWI comes from food sources, which means that the population does not consume enough water. Therefore, increasing beverage consumption is advisable. Furthermore, it should be also recommended that beverage consumption be better distributed throughout the day, instead of concentrating it at main meals.

Key words: water, meals, food sources.

Acknowledgements: This research was supported by a University-Enterprise agreement. Ref 94/2011 and with a funding from the Santander-UCM Research group program (consolidated modality) Ref. GR35/10-A.

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Effect on non-alcoholic beer as a hydration beverage on subjective sleep quality

Cubero J^1,2, Franco L¹, Bravo R¹, Galán C¹, Rodríguez AB¹, Barriga C¹.

¹Neuroimmunophysiology and Chrononutrition Research Group. Department of Physiology. University of Extremadura. Extremadura.
²Laboratory of Health Education, Experimental Sciences Education Area. University of Extremadura. Excellence Campus: HIDRANATURE. Badajoz.

Introduction and Objective: Beer is known for its hydration properties but it also contains hops (Humulus lupulus L.), a plant with sedative effects. Sleep deprivation affects the homeostasis of the physiological functions of the organism. Beer is the only beverage that contains hops. Our objective was to determine the effect of non-alcoholic beer on the participants' sleep quality.
Methods: The test was conducted in a population of 30 university students during the official exam period. The experimental period was 3 weeks; the first 7 days served as a control and during the following 14 days the individuals ingested non-alcoholic beer during dinner. To quantify and analyse nighttime sleep, the Pittsburgh Sleep Questionnaire Index (PSQI) was used.
Results: The results revealed that one non-alcoholic beer ingested during dinner significantly improved (p < 0.05) the PSQI Global Score, as sleep latency (the time period measured from going to bed until the onset of sleep) decreased (p < 0.05) with respect to the control.
Conclusion: The consumption of non-alcoholic beer at dinner is recommended in order to improve the quality of sleep, in addition to providing optimum hydration.

Key words: Sleep, Pittsburgh, hops, beer, stress.

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Study of hydration knowledge among university students from Extremadura

Cubero-Juánez J^1,3, Calderón M¹, Guerra S¹, Luengo LM², Ruiz C¹.

¹University of Extremadura (UEX). Campus of Excellence: HIDRANATURE. Badajoz.
²Infanta Cristina University Hospital (SES). UEX. Badajoz.
³Health Education Lab. Experimental Sciences Education Area. UEX. Badajoz.

Introduction: It is known that proper hydration is crucial for maintaining homeostasis in all physiological processes. It has been shown that a 2% decrease in body hydration leads to a reduction in intellectual capacity. For this reason, our objective was to evaluate knowledge about hydration in a university student population.
Methods: The study was conducted among a population of 110 university students from Extremadura University (62 healthy female and 48 healthy male students, 21 years old). It is important to clarify that after an initial assessment, the students showed no knowledge about hydration. Two sessions of education on human hydration based on the "Libro Blanco de la Hidratación," ed. SEDCA.2013, were held. The results were quantified and analysed by a hydration knowledge questionnaire completed by the participants.
Results: The results revealed that knowledge increased 59% among this university population after the two educational sessions on human hydration. In particular, the female population university showed greater hydration knowledge (62.66%) than the male population in the university (51.42%).
Conclusion: Education on human hydration, in particular among male university students at Extremadura University, is recommended.

Key words: university students, hydration, knowledge, health.

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Study of the relationship between hydration and hypertension in elderly people

Esteve MJ, Rosello-Soto E, Frigola A.

University of Valencia. Valencia.

Introduction: Hydration is a fundamental factor in the elderly, since at this stage of life a major risk of dehydration may exist due to the decrease in the organism's water content. Moreover, a lower sensation of thirst, fear of drinking because of incontinence problems and increased needs due to different diseases have been observed.
Objectives: To establish a correlation between liquid intake and hypertension in elderly people.
Methods: A validated food frequency questionnaire (FFQ) was completed for 50 elderly people from the Valencia metropolitan area to study food intake. Moreover, the pathologies of people studied in this work and their own treatments were recorded.
Results: The analysis of variance (ANOVA) revealed significant differences (p < 0.05) between the liquid intake of people without pathologies (2.20 ± 0.27 L) and those with hypertension and without diuretic treatment of this pathology (1.42 ± 0.25 L). Moreover, a Pearson's test was conducted to evaluate whether there was a relationship between hypertension and sodium intake. As expected, the Pearson's test revealed a positive correlation (r = 0.3595, p < 0.05) between sodium intake and hypertension.
Conclusions: The results obtained from this study suggest that not drinking enough water can lead to hypertension. This fact can be explained because the human body can retain sodium to compensate for a low liquid intake.

Key words: hydration, elderly people, hypertension, sodium, liquid intake.

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Education for health: hydration recommendations during childhood and adolescence

Fernández-Rodríguez M.

Young Agents Program in Health Education (PAJEPS). Foundation for Health Education (FUNDADEPS).

Introduction: Children are one of the groups most at risk for dehydration. Hydration requirements vary depending on the environment, physical activity and type of nutrition. It is possible to establish healthy habits through proper nutritional education.
Objective: To provide hydration recommendations for children and adolescents.
Methods: A literature review of studies on liquid intake recommendations among the population. The search was conducted using Medline and Google.
Results: The recommendations are the same for 4-8 year old-children (group 1), while in the range of 9 to 13 there are differences between boys (group 2) and girls (group 3). The values proposed by EFSA are 1,600, 2,100 and 1,900 mL/day respectively. In the case of FNB, values are 1,700, 2,400 and 2,100 mL/day respectively. The beverage consumption patterns found in the literature are developed for an adult diet of 2200 kcal. On this basis, a model for children and teenagers was calculated, taking into account the groups of beverages suitable for these ages (water, milk and juices) and considering the appropriate energetic intake recommendations. The results suggested a consumption of 1260 mL/day of water, 400ml/day of milk and 100 mL/day of juices for group 1; 1680, 540 and 135 mL/day respectively for group 2; 1570, 500 and 125 mL/day respectively for group 3.
Conclusions: Liquid intake recommendations should form a part of proper health education.

Key words: hydration, education, health, childhood, adolescence.

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Bodily water compartment changes after detraining in young football players

Fernández-Vázquez R¹, Alvero-Cruz JR¹, Ronconi M¹, Fernández-García JC², Correas-Gómez L², Carnero EA².

¹Sports Medicine School. University of Málaga. Málaga.
²Byodinamic and Body Composition Laboratory. University of Málaga. Málaga.

Introduction: Football training and competition can induce chronic dehydration, which in turn influences performance. The detraining period (DP) may help to recover physiological functions; however there is a lack of knowledge about chronic hydration. Our aim was to evaluate changes in total-body water (TBW) and its compartments (extracellular [ECW] and intracellular water [ICW]) after a six-week DP.
Methods: Twenty-eight male football players (age = 13.5 ± 0.82 years, height = 170.9 ± 4.25 cm, body mass = 64.26 ± 6.97 kg) completed a body composition assessment at the end of the season and after finishing the DP. TBW and ECW were estimated by bioelectrical impedance and ICW was calculated. ECW and ICW/TBW ratios were also calculated. The effect of the detraining period was established by impairment of VO₂max. A Wilcoxon test was carried out to analyse differences before and after DP.
Results: Increases of TBW 32.44 ± 3.59 vs. 34.75 ± 4.08 kg (P < 0.001), ECW: 13.62 ± 1.26 vs. 14.40 ± 1.37 kg (P < 0.001) and ICW: 18.90 ± 2.44 vs. 20.36 ± 2.73 kg (P < 0.001) were observed after DP. The ICW/TBW ratio was lower before DP than after it (0.581 ± 0.01 vs. 0.583 ± 0.01, P > 0.05); regarding the ECW/TBW ratio, inverse results were found (0.419 ± 0.01 vs. 0.62 ± 0.03, P > 0.05).
Conclusions: Our data suggest that after six weeks of a DP, football players increase TBW, ECW and ICW and show no changes in ECW/TBW and ICW/TBW ratios. The physiological implications of these results will be described in future studies.

Key words: total body water, ECW, ICW, detraining.

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Hygienic-dietary measures for the prevention of pregnancy and primary urinary tract infections

García-Duarte S¹, Ruiz-Carmona MM², Camacho-Ávila M³, Hernández-Sánchez E⁴

¹La Inmaculada Hospital. Almería.
²Hospital of Torrecárdenas. Almería.
³Hospital of Torrevieja. Alicante.
⁴Catholic University of Murcia (UCAM). Murcia.

Introduction: Urinary tract infections (UTI) are one of the most frequent medical complications in pregnancy beside anaemia, and its importance lies in the impact that they can have on maternal health and on the progress of the pregnancy.
Objectives: To become familiar with the main hygienic-dietary measures to prevent urinary tract infections during pregnancy.
Methods: A literature search was performed using: PubMed, Elsevier, Cochrane, Medline, IME, Cuiden and the University of Almería Library.
Results: Interventions used to prevent UTIs in pregnant patients may be pharmacological (antibiotics) or non-pharmacological.
The first preventative measure is the confirmation that the patient has a UTI in order to receive treatment. In addition, patients should be instructed to perform the following behavioural changes: to increase their fluid intake, post-defecation anal cleansing, post-coital urination, constipation correction and cranberry juice intake.
Conclusions: Special emphasis on the prevention of UTIs is needed from the midwife's antenatal clinic. If the woman is instructed on hygienic dietary modification measures from the beginning of her pregnancy, complications throughout her pregnancy may be prevented.

Key words: pregnancy, urinary tract infection, prevention.

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Role of the midwife in preventing dehydration in the newborn

García-Duarte S¹, Ruiz-Carmona MM², Camacho-Ávila M³, Hernández-Sánchez E⁴

¹La Inmaculada Hospital. Almería.
²Hospital of Torrecárdenas. Almería.
³Hospital of Torrevieja. Alicante.
⁴Catholic University of Murcia (UCAM). Murcia.

Introduction: Breastfeeding provides the best food for a newborn and also provides significant benefits to the mother. However, during the early days, problems can lead to potentially serious complications, such as impaired development, malnutrition and dehydration.
Objectives: To become familiar with the main signs of dehydration in the newborn.
Methods: A literature search was performed using: PubMed, Elsevier, Cochrane, Medline, IME, Cuiden and the University of Almería Library.
Results: The most common type of dehydration is hypernatremic dehydration associated with inadequate breastfeeding. This is due to the low milk intake because of infrequent or poor suction. This also causes ineffective breast emptying, which leads to the production of less milk.
The main signs of dehydration in the newborn include lethargy, jaundice, crying and irritability. Stool and urination are scarce and dark.
The treatment of hypernatremic dehydration requires the hospitalization of the baby.
Conclusions: Breastfeeding should be encouraged since birth. Health staff should review the correct early breastfeeding signs to make sure the baby is breastfeeding successfully. The primary postnatal care midwife should check the newborn and be able to recognize the signs of dehydration signs in case they should arise.

Key words: prevention, dehydration, newborn.

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"Your best action, hydration" health campaign

García-Perea A, Franco-Vargas E, Hardisson-de la Torre A, Martí-del Moral A, Miquel-Fernández JM, Pastor-Martín MR.

General Council of Official Pharmaceutical Colleges. National Committee of Nutrition. Madrid.

Introduction: From July to September 2013 the "Your best action, hydration" health campaign was conducted to educate the populace about the importance of preventing dehydration in order to enjoy an enhanced quality of life and better health.
Methods: During the campaign, pharmacists throughout Spain offered pharmacy customers personalized guidance regarding hydration.
To this end, they used a technical consensus document and a brochure for customers featuring "10 Dehydration Prevention Tips".
These materials were distributed to pharmacies through the General Council of Spanish Pharmacists. Member pharmacists were also able to consult and download materials at www.portalfarma.com.
Results: A total of 46 Spanish provinces participated in the health campaign "Your best action, hydration", from whose pharmacies a total of 667,950 brochures were distributed amongst the general population, offering them "10 Dehydration Prevention Tips."
Conclusions:

• Pharmacists play an essential role informing and providing advice to the public about healthy lifestyle habits.

• The widespread participation in this educational campaign led to preventive and awareness-raising efforts that were essential in the education drive carried out by Spanish pharmacists.

• There is a need for educational health campaigns to establish preventive and informative programmes for people according to their specific needs.

Key words: hydration, mineral salts, water, liquids.

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Effects of dehydration in nurses during busy shifts

García-Ripollés CM, Gómez-Rubio E, González-Canela C, Sánchez-Machío N, Ávila-Moreno C, Bou-Jiménez A, Dura-Molina C.

University Hospital Vall D'Hebron. Barcelona.

Introduction: We know many nurses with health problems related to dehydration. They are busy taking care of patients, speaking to families, answering doctor's calls, meeting with their bosses, etc. Being thirsty and becoming dehydrated are all too common. But unfortunately, it is also very dangerous. When people become dehydrated -and everyone has felt this at one time or another- various symptoms may appear, such as headaches, blurred vision, irritability, mood swings, and fatigue. If the dehydration worsens, complications like decreased blood pressure, dizziness, and even fainting can occur.
Objectives: To make health professionals aware of the need to maintain good hydration during working hours.
Methods: How is it possible to prevent dehydration in nurses?
Drink more water. Many people are not sure of the amount of water they should consume. This is just a recommendation. And carry a water bottle.
Listen to your body. Do not wait until you fall over from dehydration and be aware of how you feel physically during the day.
Results: We found many effects of dehydration in nurses.
Conclusions: Making sure that nurses consume an adequate amount of water is vital for their daily life functions. They need to learn the importance of hydration by consuming the right amount of water every day. Nursing shifts should not hinder health.

Key words: nursing, nurses, dehydration, busy shift.

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Risk of dehydration underwater

García-Ripollés CM, Gómez-Rubio E, González-Canela C, Sánchez-Machío N, Ávila-Moreno C, Bou-Jiménez A, Dura-Molina C.

Hospital Vall D'Hebron. Barcelona.

Introduction: It is ironic that while you are scuba diving you can run the risk of dehydration underwater even though you are surrounded by millions of gallons of water.
Objectives: Is there a relationship between dehydration and headaches?
Methods: None of the divers who were correctly hydrated suffered from migraines or headaches. The divers who were not correctly hydrated did.
Results: Inadequate fluid in the neck and head blood vessels causes headaches, which are the first indication that you may be facing dehydration. Before the dive, examine your urine to ensure that it is clear. Once you have resurfaced, re-hydrate slowly.
Conclusions: It is ironic but true. A scuba diver can become dehydrated if there is an inadequate quantity of water in the body. This can cause major problems, since water is crucial for the smooth functioning of a dozen biophysical systems and biochemical processes. At the cellular level, chemical reactions in the cellular require water. At the tissue level, water keeps the tissues flexible and plump. Water is also needed for blood production and circulation through the cardiovascular system.

Key words: dehydration, headache, scuba diving.

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Hospital La Paz hydration protocol: an initiative to prevent dehydration and hyperhydration in hospitalized patients

Gómez-Candela C, García-Vázquez N, Koester-Weber T, Alarcón T, Suarez L, Nieto J, Pérez-Robledo JP.

Clinical Nutrition Department And Nutrition Commission. Hydration Group. University Hospital La Paz. Health Research Institute (Ideas). Autonomous University Of Madrid. Madrid.

Introduction: Patients in risk groups or in a clinical risk situation may have a compromised hydration status. A previous study developed in our hospital demonstrated a high percentage of abnormal hydration status, mainly in elderly patients (18% dehydration and 24% hyperhydration). Hydration status after hospital admission can influence morbidity and the length of hospitalization.
Objective: The aim of this study was to develop a clinical hydration protocol for hospitalized patients.
Methods: Based on previous clinical experience in our hospital, we decided to create a consensus document to improve clinical practice and to guarantee a normal hydration status in all patients. Our commission carried out monthly meetings during 2013 to review and consolidate the previously acquired knowledge.
Results: The final clinical protocol was presented as an organizational chart. The protocol flow includes the following steps: 1) Risk group identification (elderly, children, pregnant, neurological and psychiatric patients and other clinical risk situations); 2) Hydration status (clinical signs and biochemical parameters); 3) Classification of hydration status as: normal-hydration, dehydration or hyperhydration, as well as type and severity; 4) Requirements of water, sodium, potassium, chloride and glucose; 5) Rehydration therapy, including quantity of fluid to be administered, treatment time, access route and contraindications; 6) Proposal for standard protocol prescription of intravenous fluid therapy. 7) Follow-up assessment.
Conclusion: We consider that this hydration protocol is very important for clinical practice and it is now going to be implemented in our hospital. The final results of this implementation will be evaluated.

Key words: hydration protocol, dehydration, hyper-hydration.

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Analytical study of hydration in child population. Learning drinking routines

Gómez-Martin MJ¹, Arjona-Murube C², Gómez-Martín MC², Zambrana-Cayuso MC³, González-De Canales MP⁴

¹Public Child Education Center Toribio De Velasco. Sevilla.
²Health District of Aljarafe. Sevilla.
³Health District of South Sevilla. Sevilla.
⁴Health District of Huelva. Huelva.

Introduction: The importance of drinking water for children meets a basic health need. In the school environment, it is one of the activities included in the early childhood education stage, as part of teaching autonomy in routine activities and the development of basic health and well-being habits while building personal initiative skills in early childhood (3 to 5).
Objectives:

- To acquire hygiene and hydration habits.

- To strengthen autonomy in personal hygiene and hydration activities.

- To progressively acquire a number of values: responsibility, perseverance, knowledge.

Methods: An analytical study of routine learning in children between the ages of 3 and 5 at set times throughout the school day was carried out, encouraging the child's independence regarding the need to drink. The measurable parameters of the methodology used were: direct and systematic observation of the children, assessment of the hydration activities performed, anecdotal recording of incidents, and family input.
Results: 50% of the three-year-old children drink well and independently; 80% of four-year-olds achieve these routines and 100% of the five-year-olds drink independently when they need it.
Conclusions: 100% of five-year-olds drink independently when they need it.

Key words: hydration, child population, routine, autonomy.

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Influence of beverage characteristics on drinking patterns and hydration status

Gómez-Martínez S, Redondo N, Mujico JR, Marcos A.

Immunonutrition Research Group. Department of Metabolism And Nutrition. Institute of Food Science, Technology And Nutrition (ICTAN). Spanish National Research Council (CSIC). Madrid.

A good hydration status is essential to maintain health at an optimum level. Both food and beverage intakes can contribute to maintaining the correct nutritional status. Children and elderly people are population groups with a high risk of dehydration. However, adolescents are also a susceptible group with respect to maintaining adequate hydration levels, despite the fact that they drink a lot of beverages other than water, which they find tasteless. In fact, they only drink water if there is no other option, since they prefer tasty beverages with higher mouth-feel sensations than water. Beverage consumption habits have recently changed, partially influenced by the increased availability of different types of beverages during the last few years. Consumer preferences for a drink may be due not only to genetic, psychological and environmental factors, but also to the specific characteristics of each beverage. In addition, the different sensations transmitted by the various beverages are important qualities for consumers at all ages and influence their choice. Indeed, taste and mouth-feel sensations influence drink preference and are associated with their consumption, not only in children and young people but also in adults. In conclusion, these characteristics could be used to influence beverage patterns, leading to an improvement in liquid intake and consequently promoting a better hydration status.

Key words: attributes, beverage, preference, hydration.

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Hydration status according to urinary sodium excretion in adolescents

Goncalves C¹, Padrao P¹, Santos R², Abreu S², Mota J², Moreira P^1,2.

¹Faculty of Nutrition and Food Sciences. University of Porto. Portugal.
²Centre in Physical Activity. Health and Leisure. University of Porto. Portugal.

Introduction: High sodium intake may have an impact on hydration status since the excretion of excess sodium requires excretion of water through urine.
Objective: To assess hydration status according to urinary sodium excretion in adolescents.
Methods: 130 adolescents took part (80% female, 14.2 ± 1.5 years) and 24h urine samples were collected and screened for validity (using 24h urinary creatinine excretion in relation to body weight). Sodium intake was assessed by 24h urinary sodium excretion and hydration status was assessed using urinary osmolality (UOsm) and urinary volume (UV). Hydration markers were compared according to the median excretion of sodium.
Results: Median urinary sodium excretion was 2691.0 mg/day in girls and 3622.6 mg/day in boys. The following descriptive (mean ± standard deviation) data for hydration markers were obtained: UOsm - 593.2 ± 187 mOsm/kg in girls and 720.1 ± 163.9 mOsm/kg in boys; UV - 1127 ± 488.1 mL/day in girls and 1,026.9 ± 349.2 mL/day in boys. No significant differences were found in UOsm according to urinary sodium excretion between both genders (p = 0.81 in girls and p = 0.16 in boys), but UV was higher among those with lower sodium excretion (p < 0.01 in both genders).
Conclusions: Hydration status in adolescents estimated by UV was better in subjects with lower sodium excretion.

Key words: sodium, hydration status, urinary osmolality, urinary volume, adolescents.

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Infantile dehydration

González-Canela C, Gómez-Rubio E, Bou-Jiménez A, Ávila-Moreno C, Sánchez-Machío N, García Ripollés CM.

University Hospital Vall D'Hebrón. Barcelona.

Introduction: Dehydration is a disturbance that occurs in a wide variety of circumstances affecting water and salt losses. In Spain diarrhoea is a common cause of mortality among children younger than five. The most commonly associated disease among infants is infectious diarrhoea.
Parental report and clinical signs of dehydration are essential to physicians for diagnosis, classification and to create a treatment plan.
Mild: when total fluid loss reaches 5% or less.
Moderate: when total fluid loss reaches 5-10%.
Severe: when total fluid loss reaches more than 10%, considered an emergency case.
Objectives: To prevent and reduce the rate of child dehydration. To establish the level of dehydration in order to treat it more efficiently.
Methods: Children presenting mild to moderate dehydration should initially be treated with oral rehydration therapy and for those with severe dehydration or hypovolemic shock, the indicated treatment is intravenous therapy.
Results: Prevention is especially important in cases of intense diarrhoea dehydration.
Breastfeeding is exclusive during the first 4-6 months as are measles vaccination and the administration of vitamin A.
Conclusions: A prompt and accurate choice of treatment for dehydration and the accompanying electrolyte imbalances are important for the child's outcome.

Key words: dehydration, children, diarrhoea, imbalances.

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Evaluation of water intake and food sources in schoolchildren from Madrid with different physical activity levels

Selected for oral communications

González-Rodríguez LG, López-Sobaler AM, Aparicio-Vizuete A, Ortega-Anta RM.

Department of Nutrition. Faculty of Pharmacy. Complutense University of Madrid. Madrid.

Introduction: Inadequate fluid intake may contribute to lower cognitive and exercise performance in children.
Objective: To evaluate water intake and food sources in schoolchildren with different physical activity levels in the Community of Madrid.
Methods: 564 schoolchildren (258 boys and 306 girls) aged between 9 and 12 were studied. Dietary data was obtained by applying a food intake record (3 days) and precise weighing. Water intake was compared with the dietary reference intake. Physical activity levels were obtained by applying a questionnaire and criteria established by the IOM. All calculations were made using SPSS (v 19.0) and the statistical significance was set at p < 0.05.
Results: 3.5 percent of schoolchildren had a sedentary level (S), 77.7% had a low level of physical activity (LA) and 18.8% were physically active (A). Mean total water intake was 1,504.6 ± 389.9 mL/day (S:1,475.5 ± 520.2 mL/day, PA:1,498.7 ± 388.9 mL/day and A:1,534.6 ± 368.1 mL/day; P > 0.05). 90% and 95% of S, 97.9% and 99.8% of LA and 98.1% and 100% of A did not meet the dietary reference intake for total water intake and for total beverages (including drinking water), respectively. The major food sources were beverages (S: 46.4%, LA: 38.5%, A: 37.1%, P < 0.05), dairy products (S: 24.1%, LA: 27.7%, A: 28.9%, P > 0.05), vegetables (S: 8.8%, LA: 9.7%, A: 9.7%, P > 0.05) and fruits (S: 7.9%, LA: 10.6%, A: 10.7%, P > 0.05).
Conclusions: Most of the children studied had an inadequate water intake, independently of physical activity level. It would be advisable to increase water intake through beverages and water-rich foods.

Key words: water intake, food sources, schoolchildren.

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Exertional rhabdomyolysis in the military: hydration role

Henriques M.

Navy Doctor. Naval Medical Centre. Almada. Portugal. Physical and Rehabilitation Medicine Resident. North Lisbon Hospital Centre. Santa Maria Hospital. Lisboa.

Introduction: Rhabdomyolysis literally means the breakdown of striated muscle cells with the release of potentially toxic cellular contents into the bloodstream. Exertional rhabdomyolysis (ER) typically occurs in response to excessive, prolonged or repetitive exercise, and is a common disorder encountered in military settings. ER is a significant threat during physical exertion, particularly if it includes inadequate hydration.
Objectives: To review the ER burden in the military and highlight the role of hydration in its prevention.
Methods: A search was made of the expression "exertional rhabdomyolysis" AND ("army" OR "navy" OR "military")" on the PubMed database on 1 August 2013. Articles were selected for full text reading by evaluating the abstracts. When relevant, the references in these articles were also checked.
Results: Last year, the crude incidence rate of ER among U.S. military members was 27.8 per 100,000 person-years and the annual rates of ER increased 30% from 2008 to 2012. Dehydration is an adverse consequence of insufficient liquid consumption and its occurrence during physical exertion is a risk factor for ER. Fluid replacement guidelines should be met as a preventive measure, with specific orientations being available for the military. Each serviceman must pay attention to thirst, body weight loss and/or dark urine to increase water intake if necessary.
Conclusions: ER can have serious and fatal consequences so prevention is very important. Water intake should comply with current guidelines.

Key words: rhabdomyolysis, military, dehydration.

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Total body water as a possible marker of metabolism alteration in obese children and adolescents

Hernández A¹, Díaz LE¹, Nova E¹, Rangel OD², Flores K³, Hoyos R⁴, Maldonado J⁴, Gil-Campos M³, Aguilera CM², Marcos A¹.

¹Immunonutrition Research Group. ICTAN. CSIC. Madrid.
²Department of Biochemistry and Molecular Biology. Institute of Nutrition and Food Technology. University of Granada. Granada.
³Reina Sofía Hospital. University of Córdoba. Córdoba.
⁴Virgen de las Nieves Clinic Hospital. University of Granada. Granada.

Introduction: Total Body Water (TBW) is related to obesity, but its relation to inflammation is not well known.
Objective: To evaluate whether TBW (as a hydration status marker) is associated with inflammatory markers in obese children and adolescents.
Methods: 34 obese children (7-10.9 y) and 49 obese adolescents (11-15 y) participated in this study. Height, weight, serum lipid profile, C-Reactive Protein (CRP), sE-selectin, soluble Intercellular Adhesion Molecule-1 (s-ICAM-1) and soluble Vascular Cell Adhesion Molecule-1 (s-VCAM-1) were measured and the BMI Z-score was calculated. TBW was obtained by Bioelectrical impedance. A bilateral partial correlation test was used to analyse associations related to sex, age, and/or BMI Z-score.
Results: A negative correlation was found between TBW and BMI Z-score in both children and adolescents in boys and girls, separately. In addition, TBW was also negatively correlated with CRP and sE-selectin, which were confirmed in adolescents but not in children. When analysed by sex, TBW was associated with CRP only in boys and with sE-selectin only in girls.
Conclusions: TBW may be considered a marker not only of hydration status, but also of metabolic disorder in a low-grade inflammatory process such as obesity in children and adolescents.
This work was supported by the PRONAOS Study CDTI-2008 1114 and Biosearch.

Key words: TBW, BMI Z-Score, inflammatory markers, obesity, children/adolescents.

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Hydration habits and alcohol consumption in nursing students

Hernández-de Diego E, Martín-Salinas C.

Department of Nursing. Autonomous University of Madrid. Madrid.

Introduction: Establishing healthy habits in young adults, including appropriate hydration, largely determines their future health. Thus, maintaining a correct liquid intake is essential and prevents functional and metabolic disorders, both acute and chronic.
Objectives: To study the hydration habits of university students, including their alcohol consumption.
Methods: A descriptive cross-sectional study of a sample of 157 college students, based on an on-line, anonymous and self-completed questionnaire about health habits and beverage consumption.
Results: Only 23% of those interviewed indicated that they drank at least 8 glasses of water daily. Soft drink consumption was occasional (69%); most of the men chose sugar-sweetened beverages while women chose low-calorie drinks. Regarding the intake of alcoholic beverages, students drank them occasionally, particularly spirits (73%, mean 2.59 (± 1.225) drinks / occasion) compared to wine or beer consumption (59%, mean 2.14 (± 1.029) drinks / occasion), with an average age of onset of alcohol consumption of 15.79 (± 2.439) years.
Conclusions: Hydration campaigns should be carried out to encourage consumption, due to the fact that most students do not meet hydration requirements. Finally, despite occasional alcoholic consumption, the high quantity ingested and the early age of onset of alcohol consumption should be noted.

Key words: hydration, college, alcoholic, beverages.

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Bioelectrical impedance ratio and Watson formula for the calculation of total body water

Jimenez-Arriaga EM, Tlatoa-Ramirez H, Campos-Chavelas AM, Salazar-Carmona G.

Center for Physical Activity and Sports Medicine, Autonomous University, State of Mexico. Mexico.

Introduction: There are several techniques for the calculation of total body water, some of which are easier to apply because they are based on anthropometric parameters, such as the Watson formula, and do not require a large deployment of equipment. However bioimpedance is also recognized as a suitable technique for the determination of total body water, especially when high-tech equipment is available with specific characteristics that allow for a more accurate determination.
Objective: To determine the relationship between bioimpedance and the Watson formula for calculating total body water.
Methods: The study was conducted with 28 professional footballers from a first division Mexican team. Four others were left out of the study as they did not meet the inclusion criteria (2 had some metal attachment, while the other two did not show up on the measurement day).
For the calculation, a Bioespace brand bioimpedance multipole apparatus, Inbody 720 with frequencies at 1, 5, 50, 250, 500 and 1000 kHz was used. The statistical analysis was done with a Student's t test using SPSS v14 software.
Results: No statistically significant differences were observed between the two techniques: bioimpedance 46.7 + 4.4 and 43.9 + 3.1 anthropometry with p = 0.01.
Conclusions: Since no statistically significant differences were observed, both techniques can be applied interchangeably to calculate total body water. However it is considered important to take this result with caution and consider clinical issues mentioned by the athletes.

Key words: total body water, bioimpedance, Watson formula.

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Hydration knowledge and habitas. Bases for an education campaign related to beverage consumption

Jiménez-Ortega AI¹, Martínez-García RM², Manzano-Lorenzo J³, González-Rodríguez S², López-Sobaler AM², Ortega-Anta RM².

¹Pediatric Gastroenterology. San Rafael Hospital. Madrid.
²Department of Nutrition. Faculty of Pharmacy. Complutense University of Madrid. Madrid.
³Association of Nutritional Studies. Madrid.

Introduction: Proper hydration is essential for health, but the lack of knowledge about this subject can influence drinking habits.
Objective: The aim of this study was to analyse drinking habits and hydration knowledge in a group of young people in Madrid.
Methods: We studied 113 college students (18 - 27 years), who answered a questionnaire on drinking habits and knowledge related to proper hydration guidelines. Statistical analyses were made using SPSS (version 19.0) and the statistical significance was established at p < 0.05.
Results: The included students stated that they regularly consumed 1.74 ± 0.57 L/day of fluids (no significant differences were observed by gender). The same individuals stated that they considered suitable liquid consumption to be 2.10 ± 0.38 L/day (2.31 ± 0.38 L/day in males (M) and 2.08 ± 0.38 L/day in females (F), NS). Considering the fluid intake defined by the Institute of Medicine (2004) as adequate (3 L/day for M and 2.2 L/day for F), our results show that 90.9% M and 79.4% F report lower intakes and what 90.9% M and 74.5% F consider an adequate fluid consumption is lower than that recommended by the Institute of Medicine.
Conclusions: We observed a high percentage of individuals who report and inadequate intake of liquids (80.5%) and of subjects lacking knowledge about the subject (76.1%), believing that a lower liquid intake than recommended is adequate. The results highlight the need for education on proper hydration guidelines.

Key words: hydration, knowledge, youth, habits, fluids.

Acknowledgements: The study was supported by the "Research Funding Program for Consolidated Groups Santander-UCM" (Ref: GR35/10-A).

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Parent smoking habits as a modulator of water intake in Madrid schoolchildren

Jiménez-Ortega AI¹, González-Rodríguez LG², Aparicio-Vizuete A³, López-Sobal AM³, Ortega-Anta RM³.

¹Pediatric Gastroenterology. Hospital San Rafael. Madrid.
²Faculty of Health Sciences. University Alfonso X El Sabio. Madrid.
³Department of Nutrition. Faculty of Pharmacy. Complutense University of Madrid.

Introduction: Several studies show that fluid intake may be insufficient in different population groups. This raises the idea of whether smoking parents may have lower fluid intake control of their children.
Objective: To evaluate total water intake (including food and beverages) by schoolchildren in the Community of Madrid according to parental smoking.
Methods: 564 schoolchildren (258 boys and 306 girls) aged 9 -12, were studied. Data on water intake was obtained by applying a food intake record (3 days). Water intake was compared with that established as adequate by the Institute of Medicine (IOM) (2005) (2.4 and 2.1 L/day in boys and girls, respectively). Tobacco consumption was reported by parents. Statistical data was obtained using SPSS (v 19.0) and statistical significance was set at p < 0.05.
Results: 96.8% of children had liquid intakes lower than recommended by the IOM (2005). Those with a non-smoking mother (65.2%) injested more liquid (1533.2 ± 363.0 mL/day) than those with a smoking mother (1445.5 ± 434.2 mL/day) (p < 0.01) and water intake decreased as the number of cigarettes smoked increased (r = -0.228). However there were no differences in water intake in relation to the smoking habits of fathers.
Conclusions: Water intake was below adequate in most of the participants studied. Moreover, maternal smoking is associated with a lower intake of fluids in their offspring, and these children need special counselling to improve their hydration patterns.
Acknowledgements: This study was carried out with financial help from the FISS (project number PI060318).

Key words: children, beverages, water, smoking, parents.

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Educational level as a modulator of hydration in a group of Spanish adults

Jiménez-Ortega SL¹, Manzano-Lorenzo J¹, Hernández-Sánchez C², Pérez-Farinós N³, Dal-Re MA³, Ortega-Anta RM².

¹Association for Nutritional Studies (ASEN). Madrid.
²Department of Nutrition. Faculty of Pharmacy. Complutense University of Madrid. Madrid.
³Spanish Agency for Food Safety and Nutrition (AESAN). Madrid.

Introduction: Proper hydration is very important for health and can be influenced by different factors.
Objective: The objective of this study is to analyse the association between hydration habits and educational level in Spanish adults.
Methods: We studied 418 subjects (aged 18-60) from fifteen Spanish provinces, selected as a representative sample. To determine the state of hydration, urine samples were collected during a 24-hour (h) period. Hydration status was considered inadequate when: urine density was greater than 1.020 and/or urine volume less than 30 mL/h. The educational level was established using a personal interview with the individual and his or her partner. We used SPSS (version 19.0) for statistical analysis of the data. Differences were considered significant at p < 0.05.
Results: The individuals studied or their partners who have a degree or diploma studies (first group) maintain a better hydration level, as evidenced by their greater urine volume (1692.1 ± 699.5 mL/day) compared to individuals and their partners without graduate studies/degree (second group) (n=198, 1534.9 ± 680.1 mL/day) (p < 0.05). Considering urine density, no significant differences were observed, although only 41.3% of the subjects in the first group had a urine density greater than 1.020 compared to 50% in the second group.
Conclusions: There is a high percentage of individuals with mild dehydration and the situation is worse with those with a lower educational level. These individuals should receive further advice to achieve proper hydration.

Key words: hydration, education level, adults.

Acknowledgements: This work was supported by the AESAN (Spanish Agency for Food and Nutritional Safety, Spanish Ministry of Health and Consumer Affairs), (Ref. 337/2008).

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Reducing sugar-sweetened beverage consumption to reduce obesity: strong evidence supporting conjecture, weak evidence of effects

Kaiser KA, Shikany JM, Keating KD, Allison DB.

University of Alabama at Birmingham. USA.

Introduction: We provide arguments about the effects of reducing sugar-sweetened beverages (SSBs) on obesity and update a previous meta-analysis with recently published studies on the effects of SSBs on body weight/composition indices (BWIs).
Methods: We abstracted data from randomized controlled trials examining the effects of consuming SSBs on BWIs.
Results: Six new studies met these criteria: (i) human trials, (ii) > or = 3 weeks duration, (iii) random assignment to conditions differing only in consumption of SSBs and (iv) including a BWI outcome. An updated meta-analysis of a total of seven studies that added SSBs to diets showed dose-dependent increases in weight. An updated meta-analysis of eight studies attempting to reduce SSB consumption showed an equivocal effect on BWIs in all randomized subjects. When limited to subjects overweight at baseline, the meta-analysis showed a significant effect of roughly 0.25 standard deviations (more weight loss/less weight gain) relative to the controls.
Conclusions: The evidence to date is equivocal in showing that decreasing SSB consumption will reduce the prevalence of obesity. Although new evidence suggests that an effect may yet be demonstrable in some populations, the integrated effect size estimate remains very small and of equivocal statistical significance. Problems in this research area and suggestions for future research are highlighted.

Key words: obesity, randomized trials, soft drinks.

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Adequate hydration status promotes a minor concentration of proinflammatory cytokines in healthy people

Selected for oral communications

López-Plaza B, Koester-Weber T, Palma-Milla S, Valero-Pérez M, Santamaría-Jaramillo B, Gómez-Candela C.

Institute for Health Research. La Paz University Hospital (IdiPAZ). Madrid.

Introduction: Good hydration status (HS) is necessary for an adequate homeostasis of the organism. Cytokines are secreted mainly by inflammatory leukocytes that act as intercellular mediators.
Objective: To assess pro/anti-inflammatory cytokine concentration in serum and in the aqueous phase of stools (APhS) from healthy people according to their HS.
Methods: HS data were obtained from 86 healthy individuals aged 45-65 with a BMI ≥ 18.5-< 40 kg/m². HS was measured by bioelectrical impedance with a standardized protocol. Cytokine serum concentrations were determined by multiple ELISAs (Luminex®-LX200). Stools were collected by the participants, frozen, and carefully transported to a laboratory where they were stored at -80^oC until their determination. The stools were ultracentrifuged and cytokines were measured in APhS with an ultrasensible cytokines array (Randox®). All samples were analysed in duplicate.
Results: The mean age was 51.2 ± 4.9 years and BMI = 28.2 ± 4.7 kg/m². Even when the average amount of water from food and beverages was not adequate enough (1411.6 ± 427.4 mL/day) 89.5% showed an adequate HS and only 10.5% clearly showed dehydration. Volunteers who had good HS showed lower values of IFN (2.7 ± 2.4 vs. 6.4 ± 4.3 pg/mL; p < 0.05) and IL6 serum (5.5 ± 13.3 vs. 6.4 ± 16.3 pg/ml; p < 0,01) than those who had a poor HS. MCP1 showed the same tendency (257.4 ± 827.7 vs. 700 ± 357.2 pg/mL; p = 0.062). IL1 from AphS showed lower values in people with good hydration than those who were dehydrated (648.3 ± 615 vs. 1194.0 ± 561.2 pg/mL; p < 0.05). The rest of the results did not show significant differences.
Conclusions: People with an adequate hydration status have a minor concentration of pro-inflammatory cytokines in serum and in APhS than people who showed a dehydrated status.

Key words: hydration status, cytokines, inflammation.

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Body composition in Spanish children regarding the number of water fountains in schools

Lopez-Sobaler AM¹, Robledo T², Dal-Re MA², Labrado E², Ortega RM¹.

¹Department OfNutrition. Faculty Of Pharmacy. Complutense University of Madrid. Madrid.
²Spanish Agency for Food Safety and Nutrition (AESAN). Ministry of Health, Social Services and Equality. Madrid.

Objective: To analyse the relationship between anthropometric parameters and the availability of free access water fountains in schools.
Methods: 7659 6-9-year-old Spanish children (3,841 boys and 3,818 girls) were selected to participate in the ALADINO study. Each child's weight and height, waist and hip circumferences were measured at school, and BMI, waist/hip and waist/height ratios were calculated. Overweight and obesity were defined according to the WHO Reference 2007 Growth Standards. The number of water fountains in each school was recorded. Children were classified considering if their school provided free access to water (F) or not (NF). Data were analysed using SPSS (v.19.0).
Results: 14.3% of children study in schools without free water fountains (NF). There were no differences in sex, age, weight or height of the children when comparing F with NF groups. Neither were there differences in overweight or obesity prevalence, but waist and hip circumferences, waist/hip and waist/height ratios and BMI were significantly higher in NF children (p < 0.05).
Conclusion: Free access to water sources in the school may allow for better hydration of children and could be related to healthy body composition.
Study founded by AESAN.

Key words: children, BMI, fountain, school, environment.

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Frequency of consumption of sugar-sweetened soft beverages and associated factors in Spanish children

Selected for oral communications

López-Sobaler AM¹, Pérez-Farinós N², Villar C², González-Rodríguez LG³, Ortega RM¹.

¹Department OfNutrition. Faculty of Pharmacy. Complutense University of Madrid. Madrid.
²Spanish Agency for Food Safety and Nutrition (AESAN). Ministry of Health. Social Services and Equality, Madrid.
³Alfonso X El Sabio University. Madrid.

Objective: To analyse SSB consumption habits in Spanish children and their relation to physical activity habits and family factors.
Methods: 7659 6-9-year-old Spanish children (3841 boys and 3818 girls) were selected to participate in the ALADINO study. Each child's weight and height were measured, and BMI calculated. Parents answered a questionnaire about the frequency of consumption of some beverages and their child's activity patterns, the parents' weight and height, and other family aspects. Data were analysed regarding the frequency of the consumption of sugar-sweetened beverages (SSB) using SPSS (v.19.0).
Results: 53.5% of children never consumed SSB (Non-drinkers, ND), 36.8% consumed them 1-3 times/week and 9.6% drank SSB more than 3 times/week (frequent drinkers, FD). The children's BMI were similar in all groups. Nevertheless both the father's and mother's BMI were higher in FD groups vs. ND. In comparison with the ND group, in the FD group there were more children who skipped breakfast, spent >2 h/day watching TV or >1 h/day playing with computer games, and lived in families with a higher percentage of smoking parents with less education and lower income.
Conclusion: In this group of Spanish children, the frequency of consumption of SSB is not related to their BMI, but is associated with a more sedentary pattern of activity and unhealthy habits in their families. Study founded by AESAN.

Key words: children, sugar-sweetened beverages, activity, socioeconomic, family.

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Beverage consumption habits in the Cantoblanco platform food and nutritional genomics (GENYAL)

Loria-Kohen V¹, Espinosa-Salinas I¹, Molina S¹, Herranz J¹, Reglero G^1,2, Ramírez-De Molina A¹.

¹IMDEA-Food Institute. CEI UAM+CSIC. Madrid.
²Department of Production and Characterization of Novel Foods. Institute of Food Science Research (CIAL) CEI UAM + CSIC. Madrid.

Introduction: The Cantoblanco Nutritional Genomics and Food Platform (GENYAL) is a high-level tool for Nutrigenomics and Nutrigenetics studies aimed at serving research groups and companies interested in the relationship between food and health.
Objective: The aim of this study was to determine the association between beverage consumption habits and BMI, glucose, lipid profile and genetic variations in GENYAL populations.
Methods: 149 participants (40 men and 109 women), mean age: 37.5 ± 12.5 years and BMI: 24.3 ± 4.3 kg/m² were included in the study. A validated food frequency questionnaire was used to estimate the average consumption of sodas, light sodas, natural juices, artificial juices, infusions (coffee and tea), red wine, white wine, beer, liquor and spirits. Biochemical parameters included: glucose, total cholesterol (TC), LDL and HDL cholesterol and triglycerides. Fourteen single nucleotide polymorphisms (SNPs) in nine genes related to lipid metabolism were determined. A linear regression model was applied and adjusted for potential confounders (sex, age). A codominant model was applied for the genetic association study.
Results: Beer consumption (74.5%) was significantly associated with lower LDL levels (122.2 ± 33.3 vs. 142.0 ± 31.2 mg/dL, p < 0.05) (median 141.1 IQR 212.2 mL/day), independently of the different genetic variants found in GENYAL populations. Consumption of other beverages was not associated with BMI, glucose or lipid profile.
Conclusions: Reasonable beer consumption may be associated with favourable changes in lipid profile. In the near future a better understanding of gene-diet interactions might result in the development of personalized recommendations related to the most appropriate type of diet for preventing or delaying the development of chronic diseases according to the genotype of each individual.

Key words: beverage consumption, nutrigenetics, lipid metabolism.

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Study of the non-alcoholic beverage intake by sportspeople in southern Spain

Mariscal-Arcas M^1,2, Palacín-Arce A¹, Monteagudo C¹, Fernández-de Alba MC³, Lorenzo-Tovar ML¹, Olea-Serrano F¹.

¹Research Group on Nutrition, Diet and Risk Assessment-AGR'55. Nutrition and Food Science Department. University of Granada.
²Department of Food Technology, Nutrition and Food Science. University of Murcia.
³Andalusian Centre of Sport Medicine (CAMD). Junta de Andalucía.

Introduction: Sweat loss during intense exercise ranges from around 0.5 to 2.0 L/h, depending on ambient temperature, body size, and metabolic rhythm. A loss of 2-5% of body-weight through dehydration reduces aerobic effort capacity by 20-30%.
Objectives: To study patterns of non-alcoholic beverage consumption by Andalusian sportspeople according to their sex, age, professional/amateur status and sports type (group/individual).
Methods: We recruited 485 volunteers (72.9% men and 27.1% women) from Sports Medicine Centres in Andalusia. Non-alcoholic beverage intake was estimated from a semiquantitative food frequency questionnaire with more than 140 items. The intake of eight groups of beverages was recorded: water, juices, coffee, infusions, carbonated drinks, sugar-free carbonated drinks, isotonic drinks, and energy drinks. Statistical analysis: descriptive study (means, standard deviations) and Student's t-test (p < 0.05) were performed to compare beverage intake by sex, age, professional/amateur status and sports type (group/individual).
Results: Mean intake of non-alcoholic beverages was 1978.79 mL/day; water was the most consumed drink. Males drank more coffee (p < 0.001) and isotonic drinks (p < 0.05) than females. Under 19-yr-olds drank more juices; over 19-yr-olds consumed more coffee and infusions (p < 0.001 in all cases). Participants in group sports drank more carbonated drinks; participants in individual sports drank more coffee, infusions, isotonic drinks, and energy drinks (p < 0.05 in all cases).
Conclusions: Water is the main drink consumed by these sportspeople, while their beverage intake pattern varies according to sex, age, professional/amateur status and sports type.

Key words: sportspeople, hydration, water intake.

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Daily beverages consumed by Spanish elderly

Maroto-Sánchez B^1,3, Scherer R^1,3, López-Torres O^1,3, Luzardo R^1,3, Tur JA^2,3, Palacios G^1,3, González-Gross M^1,3.

¹ImFine Research Group. Department of Health and Human Performance. Faculty of Physical Activity and Sport Sciences (INEF). Universidad Politécnica de Madrid. Madrid.
²Research Group on Community Nutrition and Oxidative Stress. University of Balearic Islands. Islas Baleares.
³CIBERobn (Physiopathology of Obesity & Nutrition). Madrid.

Introduction: The elderly is a vulnerable population regarding water balance. There is still a lack of data about which beverages contribute to total water intake.
Objectives: To collect and assess data about the amount and type of fluids consumed by Spanish elderly who live alone.
Methods: Within a broader cross-sectional study, 68 elders (50% men) aged 55-80 were assessed regarding drinking habits with a standardized questionnaire using personal interviews. Subjects were asked about the amounts of water and different non-alcoholic beverages they drink during a usual week. Mean daily intake was considered for the analysis.
Results: Mean total daily fluid intake was 1583 ± 616 mL. Percentile distribution was P25 = 900 mL, P50 = 1250 mL, P75 = 2100 mL, P85 = 2500 mL, P95 = 3940 mL. Mean daily intake by beverage, and mean number of days of consumption were as follows: all subjects drank water daily (1024 ± 451 mL); 94% milk (245 ± 133 mL, 7 days); 85% coffee (82 ± 38 mL, 7 days), 34% tea (270 ± 97 mL, 5 days), 22% juice (208 ± 56 mL, 4 days), 13% isotonic drinks (383 ± 240 mL, 2 days), 13% milk drinks (111 ± 33 mL, 5 days), 12% soft drinks (285 ± 88 mL, 3 days), and 7% light soft drinks (454 ± 267 mL, 5 days).
Conclusions: There is a high variability in the amount of fluid intake in the elders analysed. Around 25% of the subjects met the dietary reference intake recommendations. Non-alcoholic beverages (other than water, milk and coffee) contributed to the total amount of fluid intake in only 35% to 7% of the subjects.

Key words: hydration habits, elderly, fluid intake.

Funding: This study is supported by the Instituto de Salud Carlos III of the Spanish Ministry of Economy and Competiveness (FIS PI11/01791 and CIBERobn CB12/03/ 30038) and the European Hydration Institute (E131115081).

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Risk factors related to fluid volume deficit in elderly people

Martínez-Martín ML, Martín-Salinas C, Cid-Galán ML, Canalejas-Pérez C, Vera-Cortés M.

Autonomous University of Madrid. Madrid.

Introduction: Dehydration is a frequent problem in elderly people, independently of whether they are hospitalized or not. It is caused by the low ingestion of water and other fluids and by difficulties that limit access to beverages, together with the fear of drinking provoked by the belief that it can increase the risk of urinary incontinence and the urgency of urination.
Health care professionals can identify the risk of fluid volume deficit as well as the factors that condition it and determine the need for medical intervention.
Objective: To identify the risk of fluid volume deficit in patients older than 75 after the hospitalization period.
Methods: Observational study of 400 patients aged ≥ 75. The study was conducted in La Paz Hospital in Madrid. The data was collected through a direct interview with the patient and a consultation of his clinical and nursing records.
Results: 69% of the patients were diagnosed with "risk of fluid volume deficit". The most related risk factors were: lack of thirst, swallowing impairment, lack of motivation and insufficient knowledge of fluid intake needs.
Conclusion: "Risk of fluid volume deficit" is a fairly common problem in elderly people and it is related to changes associated with aging, functional and cognitive capacity and the emotional state. Nursing interventions should aim to reinforce patterns of conduct that prevent this problem.

Key words: risk of fluid volume deficit, elderly, nursing intervention.

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Avoidance of beverages and perceived health risks and benefits in a young adult population

Mascaraque-Camino M¹, González-Rodríguez LG¹, Aguilar-Aguilar E², Navia-Lombán B¹, Aparicio-Vizuete A¹.

¹Department of Nutrition. Faculty of Pharmacy. Complutense University of Madrid. Madrid.
²University Hospital Santa Cristina. Madrid.

Introduction: The way a beverage is perceived can affect its choice.
Objective: The aim of this study was to evaluate the perception and avoidance of different beverages in a group of university students from Madrid.
Methods: We studied 113 university students aged between 18 and 27, who completed a questionnaire about which beverages were considered healthier or harmful, and which ones they tried to avoid. SPSS (version 19.0) was used for statistical analysis.
Results: The beverage most cited as the healthiest option was water (85.8%), followed by natural juices (36.6%), tea (9.7%) and milk (5.9%). 88.5% of the sample considered beverages with a high alcohol content the most harmful, while sugar-sweetened beverages (SSB) were cited by 17.7% of the population, without significant differences regarding sex in any case. 46.9% of the population stated they avoided some beverages. In this group the most avoided beverages were SSB (44.9%) followed by caffeinated drinks (34.7%) and those containing alcohol (32.7%). There were no differences between the beverage most cited as the healthiest and the most harmful beverages according to whether they were avoided or not.
Conclusions: Men and women have similar perceptions about beverages. No association was found between the perception of a beverage and its avoidance.

Key words: hydration, perception, avoidance, beverages.

Acknowledgements: The study was supported by the "Research Funding Program for Consolidated Groups Santander-UCM" (Ref: GR35/10-A).

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At what time of the day do university students report drinking liquids?

Mascaraque-Camino M¹, Aguilar-Aguilar E², Pecharroman-Gutierrez L¹, Penas-Ruiz C¹, Lopez-Sobaler AM¹.

¹Department of Nutrition. Faculty of Pharmacy. Complutense University of Madrid. Madrid.
²University Hospital Santa Cristina. Madrid.

Introduction: Adequate beverage consumption during the day is essential to maintain body hydration.
Objective: The aim of this study is to evaluate at what time of the day a group of university students usually drink liquids.
Methods: We studied 113 students between 18 and 27 from Madrid, who completed a questionnaire about beverage consumption habits, in which they reported the time of the day they usually drink. SPSS (version 19.0) was used for the statistical analysis. P < 0.05 was considered statistically significant.
Results: 48.5% of the students reported drinking frequently whereas 95.5% drank when they felt thirsty and 42.6% from time to time. In addition, 92.1% of the sample drank liquids with the main meals, 13.7% between meals and 8.0% after heavy meals. Those who reported drinking between meals had significantly higher fluid consumption (1.85 ± 0.52 L/day) in comparison with the rest of the sample (1.60 ± 0.60 L/day). Additionally, 68.3% declared higher beverage consumption when they were with their friends, 38.0% reported that they drink more at weekends and 26.5% after exercising. No significant differences were found according to sex in any case.
Conclusions: There was a lack of knowledge about the best time of day to drink. The results show the need for nutritional education related to hydration.

Key words: hydration, moment of beverages consumption, fluids consumption habits.

Acknowledgements: The study was supported by the "Research Funding Program for Consolidated Groups Santander-UCM" (Ref: GR35/10-A).

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Beverage intake and ponderal status in children: the Cuenca study

Milla-Tobarra M¹, Lahoz-Garcia N², Segura-Fragoso A³, García-Meseguer MJ⁴, García-Hermoso A⁵, Martinez-Vizcaíno V².

¹General Hospital Nuestra Señora Del Prado. Talavera De La Reina. Toledo.
²Center for Social and Health Studies. Cuenca. University of Castilla La Mancha. Cuenca.
³Institute of Health Sciences.Talavera De La Reina. Toledo.
⁴Faculty of Nursing.Campus of Albacete. University of Castilla La Mancha.
⁵Faculty of Health Sciences. Autonomous University of Chile. Chile.

Introduction: Within a healthy diet, hydration is an important guarantee of health. Despite its relevance, few studies have assessed beverage intake in Spanish children and even fewer have evaluated its possible relationship to weight status.
Objective: To evaluate fluid intake patterns and their contribution to daily dietary intake in schoolchildren.
To explore whether consumption of different beverages has any association with weight status in schoolchildren.
Methods: A cross-sectional study with 373 children aged 9 to 11 randomly selected from the Cuenca province (Spain). Measurements included socio-demographic, anthropometric and dietary intake by YANA-C software, validated for a HELENA studies.
Results: Total water intake from food and drinks was around 1531 mL/day in both sexes and intake from fluids alone was 1016 mL/day. Energy from beverages accounts for 16% of total energy intake and 40% of sugars. The most popular drink was water, followed by whole milk, and sugar-sweetened beverages (SSBs). In both sexes, overweight-obese subjects have higher consumption of skimmed milk and less consumption of whole milk than those with normal weight, although the differences were not significant. Analyses were adjusted by age, sex and cardiorespiratory fitness.
Conclusions: Our data show that fluid intake in this population is below the currently recommended levels. Overweight-obese subjects have higher consumption of skimmed milk and less whole milk than normal peers. Moreover, there are greater differences among the sexes in beverage intake. Further studies are needed in Spain to assess long-term hydration habits in schoolchildren and its possible relation to body composition.

Key words: beverages, ponderal status, children, milk.

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Estimation of water intake in a female Spanish population

Monteagudo-Sanchez C¹, Mariscal-Arcas M², De la Torre A¹, Benhammou S¹, Olea-Serrano F¹.

¹University of Granada. Granada.
²University of Murcia. Murcia.

Introduction: The water in foods and the water we drink must ensure that we are correctly hydrated at all ages and in all circumstances.
Objectives: To estimate the water intake of a sample of Spanish women, differentiating between drinking water and the water supplied by foods and beverages, and to identify the main sources of water in their diet.
Methods: The study sample included 3393 women from southern Spain divided into four age groups: children (≤ 9 yrs), adolescents (10-18 yrs), women of childbearing age (19-49 yrs) and women over 50 yrs old. Drinking water intake and food and beverage water intake were estimated based on a validated food frequency questionnaire (FFQ). Statistical analysis: a descriptive analysis (means and standard deviation), ANOVA test (p < 0.001) and stepwise regression analysis were performed.
Results: The mean water intake of the study population significantly decreased (p < 0.001) with age. Although the main source of water was drinking water, the water provided by foods and beverages represented 40% of total daily intake. The foods and beverages supplying the highest water intake were juice and dairy products among children and adolescents, and vegetables, fruit, meat products, beer and alcohol-free beverages among women over 18.
Conclusions: It is necessary to promote adequate water intake at all stages of life in order to ensure an optimal state of hydration.

Key words: hydration, drinking water, water from foods.

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Fruit and vegetable consumption and hydration status in schoolchildren

Montenegro-Bethancourt G, Johner SA, Remer T.

IEL-Nutritional Epidemiology. University Of Bonn. Donald Study at The Research Institute Of Child Nutrition. Dortmund. Germany.

Introduction: In addition to the known positive health effects, fruits and vegetables (F & V) might be important dietary contributors to hydration status (HS) in children.
Objective: To quantify the effect of higher consumption of F & V on HS in a large cohort of German schoolchildren.
Methods: Free water reserve (FWR, measured urine volume (mL/24 h) minus the obligatory urine volume (mL/24 h)) was used as a marker for HS in 1286 24-h urine samples from 442 4-10-year-old participants of the DONALD Study. Dietary intakes from 12 food groups were estimated from 3-day weighed dietary records parallel to the urine samples. The contribution of F & V (solid and juices) to FWR was analysed using repeated-measures regression models (PROC MIXED).
Results: Overall median and interquartile FWR values were 175 (25,370) mL/d. Positive FWR values (euhydration) were observed in 78% of children. In the fully adjusted regression models, a significant positive association between F & V intake and FWR (p < 0.0001) was observed. An increase of 100 g solid F & V intake predicted an increase of ~ 46 mL/d FWR, at the same time controlling all other dietary liquid sources (e.g. drinks and whey-based milk products).
Conclusion: Besides the contribution of the usual water sources for hydration, our results suggest the particular importance of the regular inclusion of F & V in the diet for improving HS in children.

Key words: hydration, schoolchildren, F & V, water intake.

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Study of pharmacy customer liquid intake habits

Morales-Falo EM¹, San-Frutos M², Felipe JV³, Villares M³, Barrios A³, Esteban R¹.

¹Autonomous University of Madrid. Madrid.
²Community Pharmacy of Madrid. Madrid. Pharmacies Trébol.

Objective: To assess the liquid intake habits (LIH) of pharmacy customers and assess the associations with body mass index (IMC), sex, age, perception of thirst and types of pathologies present.
Methods: The data was taken from 503 people: 340 women and 163 men, 41.5 ± 18.2 years old, and IMC of 24.4 ± 4.3 kg/m². The recommended liquid intake (RLI) was considered ≥ 10 liquid glasses/day.
Results: 86% of the sample does not meet the RLI, (88% women, 81% men; p < 0.05). People older than 65 do not hydrate themselves sufficiently (98% people older than 65, 82% young people; p < 0.05). 53% of people older than 65 say they do not meet the RLI, in contrast to 34% of the young people (p < 0.05). 30% are unable to drink without being thirsty. People older than 65 have twice this difficulty in comparison with young individuals (42% people older than 65, 24% young people, p < 0.05). Obese people have better liquid intake habits (23%) than normal-weight people (13%) and among women this difference is significant. No significant differences were found between liquid intake and the number and type of pathologies.
Conclusions: According to the results, LIH are associated significantly with sex, age and IMC but not with pathologies present among the people in the sample. The profile of the user with a risk of low liquid intake corresponds to a normal-weight woman older than 65.

Key words: recommend, hydration, low liquid intake, older people.

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Beverage consumption of healthy adults in Europe

Nissensohn M, Castro-Quezada I, Serra-Majem L.

Department of Clinical Sciences. University of Las Palmas de Gran Canaria. Las Palmas de Gran Canaria.

Introduction: In Europe, no recent epidemiological studies have been conducted that focus on beverage intake. Moreover, no questionnaire has been developed as a research tool for the assessment of beverage intake in the general population. Different sources and methodological characteristics raise issues of comparability that are difficult to address.
Objective: The main objective of this review was to examine the available methods used to evaluate beverage intake in European epidemiological studies and to describe the most frequent method applied to assess it.
Methods: Information on beverage intake available from European surveys and nutritional epidemiological investigations was selected from grey literature. The search was based on the document provided by the European Food Safety Authority (EFSA, 2010).
Results: Relevant information was extracted from twelve European surveys. The studies were conducted on healthy adult population (aged 18-80) between 2003 and 2011. Only the study carried out on the German population used a specific beverage assessment tool (Beverage Dietary History). The 7-day dietary record was the tool most frequently employed.
Conclusion: The limited information available and the heterogeneity of the methodology used make it difficult to draw conclusions. Results show that beverage intake is different between countries. Epidemiological studies that assess beverage intake in Europe are scarce and further research is needed to clarify the amount of beverage intake in the European population.

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Beverage consumption in university students in Madrid, Spain

Nissensohn M¹, Marti-Gascon J², Gallardo-Pino C³, Bencomo-Gómez JF³, Castro-Quezada I¹, Ruano C¹, Álvarez-Pérez J¹, Díaz-Benítez E¹, Ribas L⁴, Serra-Majem L¹.

¹Department of Clinical Sciences. University of Las Palmas de Gran Canaria. Las Palmas de Gran Canarias.
²DBS screening. School of Health Sciences. University Rey Juan Carlos I. Madrid.
³Nutritional Research Foundation. Barcelona Science Park.

Introduction: In Spain epidemiological studies that focus on beverage intake are scarce. Only few questionnaires have been developed to assess beverage intake in the youth population.
Objective: The main objective of this questionnaire was to assess the mean intake of beverages in university students from Madrid.
Methods: A total sample of 785 students aged 19 to 24 from the University Rey Juan Carlos I of Madrid was interviewed during autumn 2012.
Data were collected using a specific beverage frequency questionnaire in a healthy population of university students from Madrid. Coffee, tea and milk intake were not included in this preliminary analysis. Mean intakes and standard deviation (SD) were estimated with SPSS software.
Results: In this study we found that the average water intake was 622.6 mL/day (428.7); for natural juice 111.5 mL/day (162.1) and for sweetened juices 47.8 mL/day (112.4). Regarding soft drinks, total consumption of cola drinks was 53.5 mL/day (112.6) and for diet soft drinks the mean intake was 45.0 mL/day (132.1). The average intake of beer was 57.4 mL/day (124.9). The total non-alcoholic beverage intake was 937.8 mL/day.
Conclusion: The data from this analysis showed that water intake is higher than consumption of other beverages; however, beverage intake in this population did not meet nutritional recommendations. Further research is needed to clarify the amount of beverage intake among the young.

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Association between hydration status and drugs intake amongst institutionalised elderly people

Padrao P¹, Rodrigues S², Inácio C³, Severo M⁴, do Carmo I², Moreira P¹.

¹Hydration and Health Institute. Faculty of Nutrition and Food Sciences of University of Porto. Porto.
²Faculty of Medicine of University of Lisbon. Lisbon.
³Santa Casa da Misericordia de Santarém.
⁴Institute of Public Health of University of Porto. Porto.

Introduction: Dehydration is a common condition among institutionalised elderly people, a population which generally takes many drugs. However, the association of hydration status and drugs intake remains unclear.
Objectives: To ascertain the existence of an association between hydration status and the type, number and frequency of drugs intake in institutionalised elderly people.
Methods: Data were collected from 62 institutionalised elderly individuals aged between 60 and 93. Hydration status was assessed using urinary indicators (first morning urine specific gravity, 24-h urine osmolality and volume), total daily water intake and pain score. Structured interviews were performed to assess several dimensions of health status including the type, number and frequency of drugs intake. Pearson correlations and linear regression were performed to assess potential associations (p-value).
Results: Women needed a greater number of drugs than men (7.6 ± 3.6 vs. 3.0 ± 1.6, p = 0.025), but both take drugs 3 times per day, on average. 24-h urine osmolality was negatively correlated with the total number of drugs (p = 0.021) and with the frequency of drugs intake (p = 0.027). In addition, pain score was positively correlated with these two variables (p = 0.012 and p = 0.011, respectively). 24-h urine volume and pain score also showed significant positive associations with the frequency of drugs intake, even after the adjustment for gender (p = 0.047 and p = 0.031), respectively.
Conclusions: Our findings suggest that institutionalised elderly, who take a greater number of drugs and more times per day, show better levels of indicators of hydration status.

Key words: hydration, drugs, elderly, institutionalised.

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Beverage consumption and knowledge about it according to physical activity in female university students

Pecharromán-Gutiérrez L¹, Ortega-Anta RM¹, Rodríguez-Rodríguez E², López-Sobaler AM¹, Martínez-García RM¹.

¹Department of Nutrition. Faculty of Pharmacy. Complutense University of Madrid. Madrid.
²Department of Analytical Chemistry. Faculty of Pharmacy. Complutense University of Madrid. Madrid.

Introduction: Adequate hydration is essential to preserve health, especially in people who practice physical activities because of their greater risk of dehydration.
Objectives: The aim of the study was to analyse the consumption of beverages and the knowledge about this topic in a group of young female university students in relation to the practice of physical activity.
Methods: 102 female college students aged 18-27 were asked to complete a questionnaire about beverage intake and physical activity. SPSS 19.0 was used for the statistical analysis.
Results: Women considered adequate a beverage consumption of 2.08 ± 0.40 L/day, with no significant difference between sedentary and active women. 77.3% of the sedentary and 64.4% of the active women considered beverage consumption lower than the recommended correct (2.2 L/day). Water intake was 1.497 ± 0.66 L/day; without differences between active and sedentary women (1.50 ± 0.74 L/day vs. 1.49 ± 0.57 L/day, respectively). A significant positive correlation was found between the time spent in physical activities and the intake of beverages (r = 0.238; p < 0.05). 70.8% of the women did not consume the amount of beverages considered adequate by the Institute of Medicine (2004) for women (2.2 L/day).
Conclusions: Beverage consumption considered adequate by women, independently of physical activity practice, was lower than the recommended. Nutritional education on hydration guidelines is needed to meet hydration requirements in young women.
Acknowledgements: The study was supported by the "Research Funding Program for Consolidated Groups Santander-UCM" (Ref: GR35/10-A).

Key words: beverages, knowledge, physical activity, women.

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Lastest trends in evaluating the importance of hydration status in dialysis patients

Perales Garcia A.

Dietitian-Nutritionist. Madrid.

Introduction: Dialysis presents a challenge for patients and health professionals. The main aim in therapy is evaluating the evolution of their nutritional state while taking into account their hydration status.
Objective: Prescription of an appropriate dialysis treatment requires an exhaustive analysis of the hydration status of the patient, which must be multidisciplinary in order to obtain the most accurate results.
Methods: Systematic bibliography review of different studies that offer information about the different tools to measure hydration status and its efficiency.
Results: The state of hydration is one of the most important factors in the clinical judgment: 1) fluid prescriptions must be tailored to the fluid and electrolyte, cardiovascular status and residual renal function of the patient, and 2) various technological tools have been developed to aid the clinician such as bioelectrical impedance analysis (BIA), vena cava collapsibility index, cardiac biomarkers and blood volume monitoring.
Conclusion: Technological tools may certainly aid the clinician in the assessment of fluid state, but should always be interpreted in the clinical context of the patient. Clinical evaluation based solely on body weight, blood pressure, volume of ultrafiltration (UF) and peripheral oedema is insufficient. Controlled studies are needed to definitively establish the role of technological tools in detecting dry weight in order to have the highest prediction of success in the treatment.

Key words: hydration status, dialysis, liquid intake.

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Could excessive gestational weight gain be prevented by exercise

Perales-Santaella M¹, Teulon M², Barakat-Carballo R¹.

¹Faculty of Science of Physical Activity and Sport.
²University Hospital of Fuenlabrada. Madrid.

Introduction: 40% of normal-weight and 60% of overweight women gain excessive weight during pregnancy with adverse health consequences.
Objective: To examine the energy expended in each exercise session and its impact on weight gain within the Institute of Medicine (IOM) recommendations.
Methods: A randomized controlled trial was designed. 39 healthy pregnant women from Hospital Universitario de Fuenlabrada were randomly allocated to exercise group (EG; N=19) or control group (CG; N=20). The study was approved by the Research Ethics Committee of the University Hospital of Fuenlabrada (Madrid). Women in EG participated in a supervised exercise program consisting of three, 55-60 minute sessions per week from 9-11 to 38-40 weeks. The exercise program included 20 min of aerobic conditioning with a target of 55-60% of their heart rate reserve, and 10-15 min of strength exercises. Maternal energy expended was collected during the aerobic conditioning and strength part of each session by a heart rate monitor (Accurex Plus, Polar Electro OY, Finland). Adherence to IOM gestational weight gain recommendations was the main dependent variable.
Results: A higher percentage of women in the EG gained an appropriate amount of weight according to the IOM recommendations (82.4% vs. 47.6%); p=0.02; expending an average of 177.21 ± 52.81 Kcal during each session.
Conclusion: Extra energy expenditure of 177.21 ± 52.81 Kcal during each session may help to control excessive maternal weight gain during pregnancy.

Key words: pregnancy; exercise; energy; IOM recommendations.

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The importance of hydration with llex paraguariensis in the elderly with and without Alzheimer's disease

Ramírez-Pistón JM¹, Carvalho-de Farias MR², Lancho-Poblador CA¹, Poblador-Fernandez MS¹, Gómez-de Diego R³, Lancho-Alonso JL¹.

¹Faculty of Medicine. University of Córdoba. Córdoba.
²Lutheran University of Brazil. ULBRA. Canoas.

Objective: To assess the effect of hydration with llexparaguariensis on attention, concentration, memory, language, praxis and depression in a group of elderly patients with Alzheimer's disease (AD) and in a group of elderly individuals without AD, compared with a placebo group.
Methods: A longitudinal, prospective, double-blind randomized clinical trial was conducted with two groups of elderly people (with and without AD). The subjects from the group without AD (n-20) were randomly assigned to either the mother tincture of the liquid extract of llexparaguariensis, a stock solution or placebo. The group with AD (n-35) was randomly split into two subgroups, which received the stock solution and placebo respectively.
Results: The elderly without AD who took llexparaguariensis showed improved attention, concentration, short-term and long-term memory, measured by RAVLT (p = 0.026) and verbal fluency-animals-tests (p = 0.03). The qualitative evaluation revealed better sleep patterns. The elderly with mild AD showed a statically significant difference in favour of llesparaguariensis (p = 0.015) compared to those who received a placebo, according to the WAIS digit span test, which assesses attention, concentration, mental control and short-term memory. The qualitative analysis demonstrated improvement in depression symptoms. The elderly with moderate AD who took the stock solution improved their psychological and behavioural symptoms, measured by NPI, and showed improvement in attention and in agitated and aggressive behaviour in the qualitative assessment. Finally, the elderly with severe AD improved their depression symptoms, which were measured by the DSM-IV criteria for major depression.
Conclusion: llexparaguariensis had a positive effect on attention, concentration, short-term and long-term memory, and sleep in individuals without AD. In those with AD, positive effects were noted on attention, concentration, short-term memory, depression, agitation and aggressive behaviour.

Key words: llexParaguariensis, St. Hilaire, hydration.

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Influence of hydration status on the immune system of healthy adults

Redondo-Useros N, Mujico JR, Georghe A, Díaz LE, Hernández A, Marcos A.

Institute of Science and Technology of Foods and Nutrition. ICTAN-CSIC. Madrid.

Introduction: Intestinal hydration regulates bacterial-epithelial interactions which could have an effect on the immune system.
Objective: To assess the influence of hydration status on the immune system of healthy adults.
Methods: One hundred and twenty-three healthy adults with normal weight from Madrid participated in the study. Blood samples were collected in order to analyse the levels of cytokines, using Luminex technology, lymphocyte subsets measured by monoclonal antibodies and hydration status assessed by sodium concentration.
Results: The values of lymphocyte subsets (CD3+, CD4+, CD8+, CD16+56+, CD19+) were found within the normal ranges for healthy adults, as were the cytokine levels (IL-4, IL-6, IL-10, IL-12, IL-13, IFN-γ,TNF-α). Sodium concentration or natremia is the main reflection of intracellular hydration and the levels were also in the usual values (135-145 mEq/l). The relationships between the immunological values and hydration levels were statistically evaluated using the Spearman correlation, but the results did not show any correlation.
Conclusions: Although some studies have found an association between the immune system and hydration status, these results show that cytokine levels and lymphocyte subsets do not have a correlation with hydration status in healthy adults.

Key words: hydration status, microbiota, immune system.

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Hydration in relation to bowel habits in Catalonia: results from the Catalan Nutrition Survey

Lourdes-Ribas^1,2, García A¹, Salvador G³, Castells C³, Serra-Majem L^1,2,4.

¹Foundation for Nutritional Research. Barcelona Science Park. Barcelona.
²OBN Ciber Physiopathology of Obesity and Nutrition. Carlos III Institute. Madrid.
³Public Health Agency of Catalonia. Generalitat de Catalunya. Cataluña.
⁴Department of Clinical Sciences. University of Las Palmas de Gran Canaria. Las Palmas de Gran Canaria.

Objective: To analyse beverage intake in relation to bowel habits in the adult population of Catalonia.
Methods: We included 1492 adults, aged 18-64, who participated in the Catalan Nutrition Survey 2003 and responded to a general questionnaire that included frequency of defecation. Consumption of water and beverages was obtained from 24-hour recalls (mL/day).
Results: 26.6% of the sample had a faecal deposition frequency > 1 time/day, 57.2% have a frequency of 1 time/day and 15.9% < 1 time a day. Beverage consumption differs between sexes and age groups, with the consumption of non-alcoholic beverages showing a significant increasing trend since it increases the defecation frequency in the 25-44 age group (from 1040 mL in category "< 1 time/day" to 1229 ml/day in category" > 1 time/day"); this increase is related to the increased consumption of water (from 766 to 912 mL/day). In men, this pattern is also observed in the younger group.
Conclusions: Faecal deposition frequency is related to the intake of soft drinks especially in the 25-44 age group.

Key words: hydration, water, beverages, bowel habits, adults.

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Beverage consumption in relation to dieting in the adult population of Catalonia

Ribas L^1,2 Ngo J¹, Salvador G³, Castells C³, Serra-Majem L^1,2,4.

¹Foundation for Nutritional Research. Barcelona Science Park. Barcelona.
²OBN Ciber Physiopathology of Obesity and Nutrition. Carlos III Institute. Madrid.
³Public Health Agency of Catalonia. Generalitat de Catalunya. Cataluña.
⁴Department of Clinical Sciences. University of Las Palmas de Gran Canaria. Las Palmas de Gran Canaria.

Objectives: To assess beverage consumption in relation to dieting.
Methods: We included 2,052 individuals (949 males and 1103 females) aged 10-75, participants in the Catalan Nutrition Survey 2003, who answered a general questionnaire that included, among others, questions on diet monitoring in the last 12 months. Beverage consumption was obtained from 24-hour recalls (mL/day).
Results: 22.6% of the sample (17.8% in males and 26.7% in females) responded that they were on a diet during the 12 months preceding the interview. When comparing the average beverage consumption in the group that was on a diet vs. the group that was not on a diet, there was significantly higher consumption (p < 0.05) of water (795.7 vs. 733.1 mL / day) and teas or coffees (80.9 vs. 71.7 mL / day) and a lower consumption of soft drinks (69.7 vs. 96.9 mL / day) and alcohol beverages (70.3 vs. 91.7 mL / day). The average beverage consumption excluding alcoholic beverages was higher in the group on a diet (1026.2 vs. 992.9 mL / day). Some differences by gender in the analysed age group were observed.
Conclusions: Overall diet monitoring is related to higher consumption of water and fewer caloric beverages.

Key words: hydration, water, beverages, diet, adults.

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Association between hydration status and depression amongst institutionalised elderly people

Rodrigues S¹, Padrão P², Inácio C³, Severo M⁴, do Carmo I¹, Moreira P².

¹Faculty of Medicine. University of Lisbon. Lisbon.
²Hydration and Health Institute. Faculty of Nutrition and Food Sciences of University of Porto. Porto.
³Santa Casa da Misericòrdia de Santarém.
⁴Institute of Public Health. University of Porto. Porto.

Introduction: Dehydration and depression are common conditions among institutionalised elderly people. However, the relationship between these two conditions is not known.
Objectives: To ascertain the existence of an association between hydration and depression status in institutionalised elderly people.
Methods: Data were collected from 62 institutionalised elderly individuals aged between 60 and 93. Hydration status was assessed using urinary indicators (first morning urine specific gravity, 24-h urine osmolality and volume), total daily water intake and pain score. Validated scales were used in structured interviews to assess cognitive status (minimental state examination, MMSE), anxiety and depression (Geriatric Depression Scale, GDS). Pearson correlations and linear regression were performed to assess potential associations (p-value).
Results: Institutionalized elderly individuals showed an average 24-h urine volume of 1551.6 (SD 507.6) mL, a 24-h urine osmolality of 485.7 (SD 154.4) mOsm/kg and a first morning urine specific gravity of 1.014 (SD 0.005). The mean pain score was 2.3 (SD 1.6). 24-h urine osmolality showed a negative correlation with GDS score (p = 0.023), and pain score showed a positive correlation with GDS score (p = 0.002).
Conclusions: Considering that a lower urine osmolality and a higher pain score are associated with a better hydration status, our findings suggest the existence of an association between depression and hydration status. Further investigation is needed to explore this relationship.

Key words: hydration, depression, elderly, institutionalised.

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Association between hydration status and physical activity amongst institutionalised elderly people

Rodrigues S¹, Padrão P², Inácio C³, Severo M⁴, do Carmo I¹, Moreira P².

¹Faculty of Medicine. University of Lisbon. Lisbon.
²Hydration and Health Institute. Faculty of Nutrition and Food Sciences of University of Porto. Porto.
³Santa Casa da Misericórdia de Santarém.
⁴Institute of Public Health. University of Porto. Porto.

Introduction: Dehydration is a common condition among institutionalized elderly people. The identification of the main factors associated with this condition make early recognition and prevention possible.
Objectives: The main aim of this study was to ascertain the existence of an association between hydration status and physical activity in institutionalized elderly people.
Methods: Data were collected from 62 institutionalized elderly individuals aged between 60 and 93. Hydration status was assessed using urinary indicators (first morning urine specific gravity, 24-h urine osmolality and volume), total daily water intake and pain score. Validated scales were used in structured interviews to assess mobility (Barthel Index) and physical activity (International Physical Activity Questionnaire, IPAQ). Pearson correlations and linear regression were performed to assess potential associations (p-value).
Results: Institutionalised elderly individuals showed an average 24-h urine volume of 1,551.6 (SD 507.6) mL, a 24-h urine osmolality of 485.7 (SD 154.4) mOsm/kg and a first morning urine specific gravity of 1.014 (SD 0.005). The mean pain score was 2.3 (SD 1.6). Urinary parameters did not show any significant association with the Barthel Index. However, 24-h urine volume (p = 0.034) and pain score (p = 0.023) showed negative correlations with physical activity.
Conclusions: Our findings suggest that institutionalised elderly individuals who practice higher levels of physical activity have lower 24-h urine volumes and lower pain scores, which are both indicators of poorer hydration status.

Key words: hydration, activity, mobility, elderly, institutionalised.

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Diet quality may be conditioned hydration status in a representative sample of Spanish adults

Rodriguez-Rodriguez E, Andrés P¹, Perea JM², Ortega RM¹.

¹Complutense University of Madrid. Madrid.
²University Alfonso X El Sabio. Madrid.

Introduction: Studies suggest that energy expenditure and energy intake may be conditioned by hydration status, which suggests that they might also influence diet quality.
Objective: To analyse diet quality according to hydration status in a representative sample of Spanish adults.
Methods: A representative sample of 418 18-60-year-old individuals (196 men and 222 women) was studied. Urine specific gravity (USG) and urine 24h volume (UV) were used as indicators of hydration status, considering USG > 1.020 and UV < 30 mL/h risk of dehydration. Diet quality was determined using the Healthy Eating Index (HEI). DIAL software (Alcelngenieria, 2004) was used to process all data. All calculations were made using SPSS (v19.0). Statistical significance was set at p < 0.05.
Results: 45.5% and 5.0% of the participants were at risk of dehydration considering USG and UV, respectively. People with better hydration status, determined by both USG and UV, showed a better quality diet than those with dehydration (61.44 ± 13.76 vs. 57.06 ± 12.76 points; p < 0.001).
Conclusions: People with better hydration status had higher quality diets than those with dehydration.

Key words: hydration status, diet quality, Spanish adults.

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Drinking habits in the Valencian population

Rubini-Gimenez AT, Silvestre-Castello D, Miranda-Sanz M.

Department of Health Sciences. CEU-UCH University. Valencia.

Introduction: Adequate hydration of the organism is of paramount importance for health.
Objectives: We aimed to assess habits related to liquid consumption, to measure hydration status (HS) and to evaluate the relationship between them.
Methods: Data from 66 individuals from the population of Moncada (Valencia, ES), between 21 and 79, were used. HS of skin was measured on the face with an Impedanciometer (Skin diagnostic s-II) and expressed as percentage (%).
Results: Of all the individuals, 40% drink ≤ 3 glasses per day; 38.7% between 4 and 5 glasses; 35.4% ≥ 6 glasses. This consumption was in general higher among elderly people (> 70years) (p70 years), although not significant enough (p = 0.61). Furthermore there was no significant relationship between HS and consumption of liquids (p = 0.21). 74% of the population consumed bottled water alone, 11% tap water, 11% drank public water and 4% had no preference. 55% of the individuals drank other liquids besides water. 56% drank both at mealtime and not.
Conclusion: Young people drink fewer liquids compared to the elderly, and 50% of young people do not drink the recommended amount of liquid. Elderly people have a lower HS despite their higher liquid intake.

Key words: water consumption, liquids, hydration, drinking habits.

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Beverage consumption evaluation in Spanish homes according to the 2000-2012 food consumption survey

Ruiz E¹, del Pozo S¹, Valero T¹, Rodríguez P¹, Ávila JM¹, Varela-Moreiras G^1,2.

¹Spanish Nutrition Foundation (FEN). Madrid. University CEU San Pablo. Madrid.

Introduction: There is a constant need to update food and beverage consumption and dietary patterns and trends in Spain. The food consumption survey from the Ministry of Agriculture, Food and Environment has been the most reliable source over the last twenty years.
Objectives: To evaluate alcoholic and non-alcoholic beverage intake in the Spanish population, disaggregated by regions as well as socioeconomic levels, divided into four classes: low, medium-low, medium and high; Additionally, to analyse the beverage intake evolution in Spain.
Methods: This study is based on household consumption assessed by the National Institute of Statistics (INE) and the Spanish Ministry of Agriculture, Food and Environment (MAGRAMA), in collaboration with the Spanish Nutrition Foundation (FEN).The sample consisted of homes in the Iberian Peninsula, Balearic and Canary Islands (17,020,860 in 2009, 17,070,198 in 2010, 17,154,090 in 2011 and 17,323,687 in 2012). The data were extracted from the MAGRAMA food consumption survey.
Results: In 2012 the average consumption of non-alcoholic beverages was 316 g / person / day, and alcohol beverage consumption represented 81 g / person / day. Non-alcoholic drink consumption increased by 31.7% from 2000 to 2012, whereas this increase was only 3.3% for alcoholic drinks. By region, alcohol intake was highest in Murcia with 113 g / person / day. Average non-alcoholic intake was highest in the Canary Islands with 538 g / person / day. Regarding socioeconomic status, both alcoholic and non-alcoholic beverage consumption is highest with high and mediumhigh status. Alcoholic beverages provide roughly 2.2% of total energy and 0.7% of carbohydrates whereas non-alcoholic beverages provide 2.6% of the energy and 5.8% of the carbohydrates.
Conclusions: There has been a dramatic increase in non-alcoholic drink consumption in recent years and a very small change with alcoholic drinks. The energy contribution of these groups is low, mainly when compared to other European countries.

Key words: beverages, food consumption survey, energy content.

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Dietary and drinking patterns in a representative sample of university students from Spain*

Ruiz E¹, Valero T¹, del Pozo S¹, Rodríguez P¹, Ávila JM¹, Varela-Moreiras G^1,2.

¹Spanish Nutrition Foundation (FEN). Madrid. University CEU San Pablo. Madrid.

Introduction: Despite the importance of food and dietary habits and patterns during university years, there have been no representative studies conducted in Spain.
Objectives: To analyse food and drink patterns in Spanish university students.
Methods: A descriptive trans-sectional study during 20122013. A 24 hour-recall, food frequency questionnaire (FFQ), drink consumption questionnaire and behaviour, food preference, illness and physical activity questionnaires were used. The final sample was comprised of 978 students (46.4% men; 53.6% woman) from 21 Universities.
Results: The mean menu was composed of: non-alcoholic beverages (1549 g/p/d); milk and derivatives (451 g/p/d); fruits (421 g/p/d); vegetables (382 g/p/d); meat and derivatives (244 g/p/d); alcoholic drinks (169 g/p/d); cereals and derivatives (168 g/p/d); fish and shellfish (117 g/p/d); legumes (53 g/p/d); ready-to-eat foods (39.1 g/p/d); eggs (35 g/p/d); sugar and derivatives (24.4 g/p/d); oils and fats (22.6 g/p/d). The average intake of beverages (g/person/day) and percentage of students that consumed them were respectively: water (1,430/86%) soft drinks (187.6/43%); non-sweetened soft drinks (162.8/25%); fresh juices (109.0 / 44%); canned juices (137.1/47%); fruit juice and milk beverages (17.9/5%); coffee (65.0/55%); herbal teas (36.8/32%); non-alcoholic beer (64.5/4%); beer (194.7 / 56%); wine (25.8/20%); cava and cider (18.1/11%) and high alcohol content drinks (93.9/53%).
Conclusions: Dietary and drinking patterns of non-alcoholic drinks do not differ markedly from other adult population surveys in Spain. However, for alcoholic drinks clear differences are observed: beer, wine and cider consumption is moderate, usually accompanied by food and in a social environment, which clearly differs from regular high alcohol content drinks.

*The study was supported by the Centro de Información Cerveza y Salud, Madrid, SPAIN.

Key words: trans-sectional study, beverages, nutrition, drink pattern, university students.

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Hydration and menopause: a forgotten subject

Ruiz-Carmona MM¹, Camacho-Ávila M², García-Duarte S³, Hernández-Sánchez E⁴.

¹Hospital of Torrecárdenas. Almería.
²Hospital of Torrevieja. Alicante.
²La Inmaculada Hospital. Huercal-Overa. Almeria. Almería.
³Catholic University Of Murcia (UCAM). Murcia.

Introduction: During menopause, women experience a number of changes related to dehydration such as loss of elasticity in the skin and alterations in the hair. In addition, water needs increase due to other associated problems such as taking certain drugs, an increase in water loss and the need to maintain an adequate renal and digestive function.
Objective: To become familiar with the importance of proper hydration during menopause.
Methods: Bibliographic search in databases including Pubmed, Cochrane and Cuiden was performed. The SAS virtual library and Spanish Society of Obstetrics and Gynecology (SEGO) website were also reviewed.
Results: Basal water needs in menopause require the consumption of about 2,500-2,750 mL/day. An extraordinary contribution of water is needed to be able to prevent possible dehydration and associated electrolyte imbalance.
Conclusions: There is, at present, a constant bombardment of information aimed at menopausal women on the importance of the consumption of foods rich in calcium, soy, etc. But the importance of consuming an adequate amount of water at this stage of life is often ignored. Guidelines should be established to guide consumers, as well as various health professionals, on what liquids should be consumed.

Key words: menopause, hydration, nutrition, dehydration.

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Hydration patterns in breastfeeding women

Ruiz-Carmona MM¹, Camacho-Ávila M², García-Duarte S³, Hernández-Sánchez E⁴.

¹Hospital of Torrecárdenas. Almería.
²Hospital of Torrevieja. Alicante.
³La Inmaculada Hospital. Huercal-Overa. Almeria.
⁴Catholic University Of Murcia (UCAM). Murcia.

Introduction: During the breastfeeding period, good hydration helps ensure the production of an adequate quantity of breast milk. Breast milk contains up to 90 percent water, so a breastfeeding mother must drink a sufficient amount of liquid to ensure daily milk production and to maintain a good state of hydration.
Objective: To become familiar with the correct guidelines for hydration in breastfeeding women.
Methods: A bibliographic search in Cochrane and Cuiden databases was performed. the Spanish Society of Obstetrics and Gynecology (SEGO) website was also reviewed.
Results: The estimated average production of 750-800 mL of breast milk requires supplements of 700 mL water daily. It is recommended to consume approximately 2.7 L a day of liquid, i.e. 10 glasses of water a day.
Conclusions: Surprisingly, there are very few data published regarding recommendations for water intake in this phase of a woman's life. Water and other drinks are key to ensure good hydration. Beverages with mineral salts and sugars for quick absorption can facilitate better rehydration. Natural mineral water is the best choice for hydration during breastfeeding.

Key words: breastfeeding, hydration, breast-feeding mother, water balance.

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Characterization of bioimpednace measures in overweight and obese hemodialysed patients

Selected for oral communications

Ruperto-López M¹, Barril-Cuadrado G², Sánchez-Muniz FJ³.

¹Universidad Alfonso XEl Sabio. Madrid.
²University Hospital La Princesa. Madrid.
³Complutense University of Madrid.

Introduction: Bioelectrical impedance analysis (BIA) is a non-invasive, safe method which is usually used to analyse body composition and hydration status in hemodialysis (HD) patients.
Objective: To evaluate the influence of body size by measuring BMI and BIA-derived variables (fat mass (FM), phase angle (PA), and hydration status) in HD patients.
Methods: Cross-sectional study of 80 HD-patients (males, 65%) aged 68 ± 14.4. Diabetes mellitus as primary aetiology of disease (15.8%). Each participant underwent nutritional assessment [malnutrition-inflammation score (MIS)], including anthropomorphic parameters, and laboratory tests. Body composition analysis by vectorial bioimpedance (Akern; RJL101) was performed. Patients were classified into the categories: normal-weight, overweight and obese. Additional nutritional-inflammatory biomarkers and the interaction between them were compared. Analysis by SPSS.
Results: The mean value of BMI was 24.9 ± 4.77. Prevalence of overweight/obesity was 43.8%. Overweight/obese HD patients showed significantly higher values of PA, FM and serum prealbumin than normal-weight patients (p < 0.01) while 60% of malnutrition-inflammation in normal-weight was found. The higher C-reactive protein (CRP) and protein catabolic rate were significantly reduced in normal-weight/obese HD-patients. Significant interactions between BMI with BIA-derived measurements (Na/K exchange, total body water, PA), s-albumin, s-prealbumin and malnutrition-inflammation score (all p < 0.00, respectively) by multivariate analysis were identified.
Conclusion: Body composition analysis measured by BIA may be a useful diagnostic tool to identify alterations in the nutritional-inflammatory-hydration status in overweight/ obese HD-patients.

Key words: bioelectrical impedance analysis, BMI, overweight/obesity, malnutrition, hydration status.

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Hydration status in well nourished and wasted hemodialysis patients

Ruperto-Lopez M¹, Barril-Cuadrado G², Sanchez-Muniz FJ³.

¹Universidad Alfonso X El Sabio. Madrid.
²University Hospital La Princesa. Madrid.
³Complutense University of Madrid. Madrid.

Introduction: Fluid overload is an important problem in the management of hemodialysis (HD) patients. Bioelectrical impedance analysis (BIA) is a useful non-invasive method for evaluating hydration status and body compartments in the dialysis population.
Objective: The study aimed to examine the interrelationship between hydration status, nutrition, and inflammatory state in HD-patients.
Methods: We studied 60 HD patients (men: 67%; aged: 68.8 ± 14.05; time on HD: 42.6 ± 41.6 months). Primary diagnosis was diabetes mellitus (20%). Nutritional assessment by malnutrition-inflammation score (MIS) and additional nutritional-inflammatory markers were considered. Hydration status was evaluated at 30 minutes after HD session by monofrequency bioelectrical impedance analysis. Body composition and hydration status were analysed by vectorial bioimpedance (Akern; RJL101). Subjects were classified by MIS into two groups: well-nourished and protein-energy wasting (PEW). Differences in hydration status and other nutritional-related indicators were analysed. Statistical analysis was performed by SPSS.
Results: Well-nourished individuals represented 31.7% of HD patients. PEW patients had significantly lower intracellular body water (ICW) (p < 0.01), body cell mass (BCM) (p < 0.01) and phase angle (PA) (p < 0.001) than well-nourished patients. Na/K exchange, ICW, BCM were significantly associated with MIS by multivariate analysis. Linear regression showed a significant relation between MIS and s-preal-bumin, Na/K exchange, C-reactive protein, muscle mass and PA (r = 0.72; all, p < 0.01).
Conclusion: PEW is a high prevalence condition characterized by the alteration of several nutritional-inflammatory indicators as well as volume overload and hypoalbuminemiain HD-patients. Hydration status should be managed when malnutrition-inflammation is present.

Key words: hyperhydration, bioelectrical impedance, protein-energy wasting, inflammation, hemodialysis.

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Nursing protocol for managing dehydration in neonates

Sánchez-Machío N, González-Canela C, Bou-Jiménez A, García-Ripollés CM, Ávila-Moreno C, Gómez-Rubio E.

University Hospital Vall D'Hebrón. Barcelona.

Introduction: Dehydration in neonates consists of the loss of water and electrolytes in addition to the insufficient nutrient contribution that may vary according to the pathology that causes it. Dehydration occurs when the amount of liquid intake by the neonate is less than the amount the body expels. Neonates dehydrate faster than adults, due to the fact that the percentage of water in their body is bigger and their balance is much weaker. Dehydration can occur easily when the children have fever, diarrhoea or vomiting.
Objective: To develop a training plan for nursing professionals in order to recognize the signs and symptoms associated with dehydration in neonates quickly.
Methods: Observational descriptive design, with the aim of developing an informative poster of how to manage dehydration in neonates: detection, early diagnosis, aetiology, triggering factors and nursing activity.
Results: Dehydration is the alteration of water and minerals in the plasma of the body, in this case, in neonates. It occurs due to the lack of liquid intake and excess of water elimination.

- The aetiology of dehydration signs identifies: Presence and increase of thirst, irritability, sleepiness, sunken eyes, sunken fontanelle, few or absence of tears, dry oral mucosa, oliguria or anuria, highly concentrated urine in the diaper, slow capillary refill, pallid and cold skin.
- Therapeutic requirements: Breastfeeding, increase intakes, intravenous fluid therapy according to medical prescription.

Conclusions: The preparation of informative and protocolized posters for display in different hospital departments to make them accessible for nursing professionals is advisable. This will improve the quality of healthcare.

Key words: dehydration, neonates, protocolised posters.

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Hydration condition in mountaineers on a high Spanish mountain route

Sanz-Gaspar I¹, Sanvicente-Marqués JL², Cuenca-Peña I², Nerín-Rotger MA³, Allueva-Torres P⁴, Ayora-Hirsch A⁵.

¹Health Sciences Faculty. University of Zaragoza. Zaragoza.
²Mountain Medical Master (MUM). University of Zaragoza. Zaragoza.
³Mountain Medical Master Head (MUM). University of Zaragoza. Zaragoza.
⁴Educational Sciences Faculty. University of Zaragoza. Zaragoza.
⁵High Mountain Military Group (EMMOE). Jaca. Huesca.

Introduction: Spain has several autonomous regions where the mortality rate from mountain accidents mortality exceeds the mortality rate for traffic and work-related accidents, representing a real public health issue. Proper feeding, hydration, training and rest are the four elements that depend exclusively on the mountaineer and contribute to lowering the probability of mountain incidents and accidents.
Objectives: To discover the hydric condition of mountaineers taking the 4 mountain refuge circular route in Huesca during the summer.
Methods: Transversal descriptive study. Giving a validated questionnaire to 489 mountaineers who met the inclusion criteria of the study, during July and August 2010, at an average altitude of 2430 metres.
Results: The average liquid consumption in summer is 444.6 mL/hour. 78% of the sample consumed an additional liquid supply BEFORE the physical activity, 99% DURING it and 94.1% AFTER it. The main reason for drinking liquids during any of the three activity phases is thirst, (76.3%, 85.9% and 82.8% of the sample respectively) and the principal liquid consumed is water.
Conclusion: The mountaineers in the sample were totally dehydrated in all of the three physical activity phases, thus increasing the chances of suffering mountain incidents and accidents directly related to dehydration. Mountaineers must meet the main recommendations of the SENC (Spanish Society of Community Nutrition), which state that the basis of pyramid hydration is water.

Key words: public health, mountain accidents, hydration.

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Water intake decreases with age in Spanish elderly

Scherer R^1,3, Maroto-Sánchez B^1,3, López-Torres O^1,3, Luzardo R^1,3, Tur JA^1,2, Palacios G^1,3, González-Gross M^1,3.

¹Im Fine Research Group. Department of Health and Human Performance. Faculty of Physical Activity and Sport Sciences (INEF). Politécnica University of Madrid. Madrid.
²Research Group on Community Nutrition and Oxidative Stress. University of Balearic Islands. Balearic Islands.
³CIBERobn (Physiopathology of Obesity & Nutrition). Madrid.

Introduction: There is a lack of studies analysing the amount of fluid intake, specifically water, in the elderly population.
Objectives: To supply data on the water intake of independent elderly people in Madrid (Spain).
Methods: Within a broader cross-sectional study, 68 moderately active (120 min exercise/week) elders (50% men) aged 55-80 were assessed for their drinking habits with a standardized questionnaire using personal interviews. Subjects were asked to recall the amounts of water drunk the day before and their usual weekly intake.
Results: Water intake represented 64% of total fluid intake. 94% of consumers drank tap water. The percentile distribution for daily water intake based on the answers about consumption the day before was: P25 = 600 (800) mL, P50 = 800 (1000) mL, P75 = 1500 (1500) mL, P85 = 1600 (1600) mL. 14.7% of subjects stated that they drank more than yesterday and 2.9% less. There were no significant differences in water consumption between men and women. There was a very slightly negative association between age and water intake (r² = 0.014), showing that water consumption decreased as age increased.
Conclusion: There is tendency to overestimate weekly water intake in subjects ≤ P50 when compared to the day before. Water consumption declines with age in both sexes, and no significant differences were observed between elderly men and women.

Key words: water intake, elderly, hydration.

Funding: This study was supported by the Carlos III Health Institute of the Spanish Ministry of Economy and Competiveness (FIS PI11/01791 and CIBERobn CB12/03/30038) and the European Hydration Institute (E131115081).

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Consumption of non-alcoholic beverages and physical activity in children and adolescents in Spain

Serra-Majem L^1,2,4, Román B^1,2, Ribas L^1,2, Pérez-Rodrigo C³, Aranceta J³.

¹Foundation for Nutritional Research. Barcelona Science Park. Barcelona.
²OBN Ciber Physiopathology of Obesity and Nutrition. Carlos III Health Institute. Madrid.
³Unit of Community Nutrition. Local Subdivision of Public Health. Bilbao.
⁴Department of Clinical Sciences. University of Las Palmas de Gran Canaria.

Objective: To analyse the patterns of non-alcoholic drink consumption in Spanish children and young people based on the type of physical activity performed.
Methods: We included a sample of 3125 2-24-year-old individuals who participated in the ENKID study and completed a food frequency questionnaire and a physical activity questionnaire. We analysed the consumption of non-alcoholic drinks (mL / day) in relation to the level of physical activity performed at school and during leisure time in energy-expenditure MET tertiles.
Results: In all age groups significant differences were observed when analysing the consumption of non-alcoholic drinks based on tertiles of physical activity at school and during leisure time. In all cases, the consumption of nonalcoholic drinks increased with increasing physical activity (with more than 200 mL/day on average between extreme tertiles). Likewise, an age-related linear increasing trend of consumption of non-alcoholic beverages was observed.
Conclusions: The increase in non-alcoholic beverage consumption associated with physical activity by children and adolescents is highlighted.

Key words: hydration, beverages, physical activity, children, adolescents.

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Validation of beverage intake methods vs hydration biomarkers

Serra-Majem L, Nissensohn M, Ruano C.

Department of Clinical Sciences. University of Las Palmas de Gran Canarias. Las Palmas de Gran Canaria.

Introduction: Fluid intake is difficult to monitor. Biomarkers of beverage intake are able to assess dietary intake/hydration status without the bias of self-reported dietary intake errors as well as intra-individual variability. Various markers have been proposed to assess hydration; however, to date there is a lack of universally accepted biomarkers that reflect changes in hydration status in response to changes in beverage intake.
Objective: The objective of this review was to discover the questionnaires on beverage intake available in the scientific literature to assess beverage intake and hydration status and their validation against hydration biomarkers.
Methods: A scientific literature search was conducted. Only two articles were selected, in which two different beverage intake questionnaires designed to document usual beverage intake were validated against the urine specific gravity biomarker (Usg). The questionnaires used were the water balance questionnaire (WBQ) and the beverage intake questionnaire (BEVQ) a quantitative food frequency questionnaire (FFQ).
Results: The WBQ reported no correlations (r = -0.11; p = 0.40) and BEVQ found a negative correlation (r = -0.20; p < 0.05). FFQ appears to measure better beverage intake than WBQ when compared with biomarkers. However, the WBQ seems to be a more complete method to evaluate the hydration balance of a given population.
Conclusions: Further research is needed to understand the meaning of the different correlations between intake estimates and biomarkers of beverage intake in distinct population groups and environments.

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Association between hydration status and sodium intake amongst community-dwelling elderly people

Silva J^1,2, Padrao P², Severo M³, Carvalho J⁴, Lopes C⁵, Moreira P².

¹Faculty Of Sciences. University of Porto. Porto.
²Faculty of Nutrition and Food Sciences. University of Porto. Hydration and Health Institute. Porto.
³Institute of Public Health. University of Porto. Porto.
⁴Centre in Physical Activity. Health and Leisure. University of Porto. Porto.
⁵Faculty of Medicine. University of Porto. Porto.

Introduction: Dehydration is a common condition in older people and does not manifest itself in a single form, making it more difficult to assess. The identification of the main factors associated with this condition is crucial.
Objective: The aim of this study was to describe the existence of an association between hydration status and sodium intake in community-dwelling elderly people.
Method: Data were collected from 74 community-dwelling elderly individuals (38% male, 70.2 ± 5.99 years) and 24-h urine samples were collected and screened for validity after a 24-h period (using 24-h urinary creatinine excretion in relation to body weight). Hydration status was assessed using urinary indicators (24-h urine specific gravity, urine osmolality and urinary volume) and sodium intake was assessed by 24-h urinary sodium excretion. Pearson correlations and multivariate regression analysis were performed to assess potential associations.
Results: The average urine volume was 1888.9 ± 654.85 mL, urine osmolality was 422.1 ± 153.86 mOsm/kg and 24-h urine specific gravity was 1.014 ± 0.005. Urine volume and osmolality showed a positive correlation with sodium intake (p = 0.004 and p = 0.014, respectively).
Conclusions: Our findings showed that community-dwelling elderly individuals with a higher level of sodium intake had higher 24-h urine volume and a higher 24-h urine osmolality. These findings suggest that a higher sodium intake is associated with a poorer hydration status in this elderly population since despite the fact that sodium intake activates the thirst mechanisms, the consequent fluid intake is insufficient to reduce urine osmolality.

Key words: hydration, sodium, community-dwelling, elderly.

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Total water intake and beverage consumption in Maputo, Mozambique

Silva V^1,2, Damasceno A^3,4, Novela C³, Santos S^4,5, Padrao P^1,4,6, Lunet N^4,5, Moreira P^1,5,7.

¹Faculty of Nutrition and Food Sciences. University of Porto. Porto.
²Faculty of Sciences. University of Porto. Porto.
³Faculty of Medicine. Eduardo Mondlane University. Maputo.
⁴Department of Clinical Epidemiology. Predictive Medicine and Public Health Faculty of Medicine.
⁵University Institute of Public Health. University of Porto. Porto.
⁶Hydration and Health Institute. Lisboa.
⁷Research Centre in Physical Activity. Health and Leisure. University of Porto. Porto.

Introduction: Total water intake is seldom reported in dietary surveys, despite the existence of recommendations for water ingestion.
Objectives: To describe total water intake, comprising the water ingested through beverages (including plain water) and foods, in Maputo.
Method: Cross-sectional evaluation of a convenience sample of the adult general population (25-64 years) from Maputo (n = 100). A trained interviewer collected dietary intake data using a single 24-hour dietary recall, the Food Processor (ESHA Research, USA)^® was used for the conversion into nutrients. Beverages were classified in 8 groups (plain water, milk, soft drinks, fruit-based drinks, fruit juices, tea, coffee and alcoholic beverages). The World Health Organization (WHO) recommendations were used to assess total water intake adequacy (2.9 L/day, men; 2.2 L/day, women).
Results: The mean total water intake was 2.1 [standard deviation (SD)], 1.0] L, in both sexes, with 20.0% of women and 10.0% of men meeting the recommendations. Foods contributed to 29% of total water intake. Plain water was the main contributor for water intake through beverages (60.6%), followed by tea (24.0%), soft drinks (4.3%), fruit-based drinks (3.6%), coffee (2.8%), milk (2.6%), alcoholic beverages (1.6%) and fruitjuices (0.5%). Mean water-to-energy ratio was 0.9 (SD, 0.4) L/1000 kcal, short of the desirable ≥ 1.0 L/1000 kcal.
Conclusions: Most participants did not meet adequate water intake targets. It is important to promote an adequate hydration in Mozambique.

Key words: total water intake, beverages consumption, Mozambique, Africa.

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Association of urinary biomarkers of cellular oxidation with urine volume osmolality in Guatemalan preschoolers

Selected for oral communications

Soto-Méndez MP, Aguilera CM¹, Schümann K², Solomons NW³, Gil A¹.

¹Department of Biochemistry and Molecular Biology II. Universidad de Granada. Granada.
²Molecular Nutrition Unit, ZIEL. Research Center for Nutrition and Food Science. Technische Universität München. Freising.
³Center for Studies of Sensory Impairment. Aging and Metabolism (CeSSIAM). Guatemala.

Introduction: Much has been described about hydration and biomarkers of cellular oxidation, but information regarding the relationship between these markers in urine is lacking.
Objectives: Our aim was to find any possible association between urine osmolality (UOsm), volume and biomarkers of oxidation.
Methods: Seventy-eight 24-hour urine samples were collected from 2 semi-urban and 1 rural dayccare centres subsidised by the Secretaria de Obras Sociales de la Esposa del Presidente (SOSEP) in Quetzaltenango, Guatemala. We measured volumes and took an aliquot to determine Uosm using a Vogel Löser 850 osmometer and an aliquot to measure 15-isoprostane F2t and 8-Hydroxydeoxyguanosine (8-OHdG) as biomarkers of cellular oxidation.
Results: Median values [95%CI] for urine volume (mL) were 460[136-575], for Uosm (mOsm/kg) 484[464-538], for isoprostanes (ng/mL) 2.4 [1.9-2.8] and for 8OHdG (ng/mL) 5.7 [6.3-9.8]. No differences regarding sex or setting were found. Significant inverse correlations for urine volume with isoprostane concentration (r = -0.603, p < 0.001) and 8OHdG concentration (r = -0.433, p < 0.001) were found as well as for UOsm with these two biomarkers (r = 0.337, p = 0.003 and r = 0.620, p < 0.001), respectively. When oxidation biomarkers were adjusted for creatinine, the strength of the associations declined or lost significance. This confirms that the production of these two all-tissue oxidation biomarkers is not related to that of creatinine.
Conclusions: Our results suggest that a better hydration status reduces free radical generation or propagation down to the cellular level.

Key words: urine osmolality, 8OHdG, isoprostanes, preschool-children, Guatemala.

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Hydration status of preschool children with a largely common weekday meal in western Guatemala

Soto-Méndez MJ¹, Aguilera CM¹, Schümann K², Solomons NW³, Gil A¹.

¹Department of Biochemistry and Molecular Biology II. Universidad de Granada. Granada.
²Molecular Nutrition Unit, ZIEL. Research Center for Nutrition and Food Science. Technische Universität München. Freising.
³Center for Studies of Sensory Impairment. Aging and Metabolism (CeSSIAM). Guatemala.

Introduction: There is increasing evidence that even mild dehydration affects overall health. Urine osmolality (UOsm) is one of the most feasible and accurate methods to determine hydration status.
Objectives: To report on the distribution of urine osmolality (UOsm) and volume in a group of preschool children from Quetzaltenango, Guatemala.
Methods: Three samples of 24-h urine were collected from 78 children from semi-urban and rural day care centres in Quetzaltenango Guatemala. All samples were stored at 0-4^oC or -80^oC to determine Uosm using Vogel Löser 815, and GonotecOsmomat 030 osmometers. Statistics for whole samples were run by subject and only for those that fit the Remer criteria for 24-h urine collection compliance.
Results: Median [95% CI] in mOsm/kg were 473 [476 - 518] by collection (n = 232), and 475 [473 - 526] by subject (n = 78). No significant differences were found between sexes or setting; the r value for age (mo) vs. 24-h urine volume was 0.579 (p = <0.001). When samples meeting the Remer Creatinine Criterion were analysed, median [95% CI] were 495 [490 - 541] by collection (n = 134), and 495 [491 - 558] by subject, meeting the criterion at least once (n = 60), respectively: (p = 0.029) vs. all-subjects.
Conclusions: UOsm for preschool children in Guatemala is lower than reported elsewhere. A significantly higher Uosm was found in subjects that meet the Remer Creatinine Criterion.

Key words: urine osmolality, creatinine, preschool-children, Guatemala.

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Nursing care for an immobilized patient

Utiel-Bermejo I, Serradell-Muñoz S, Aceña-Hernán I.

¹Health Center General Ricardos. Madrid.

Introduction: A 72-year-old patient with hypertension, Diabetes Mellitus 2, cerebral infarction, insomnia and urinary incontinence was hospitalized due to a surgical intervention for grade 4 Ductal carcinoma with chemo-radiotherapy treatment. After the intervention she started experiencing difficulty standing up and presented grade 4 vascular ulcers in both legs. At this point, she began her follow-up, which lasted seventeen months and took place at her home. As she was in a socially vulnerable situation, each home visit lasted at least 60 min and met several demands and needs, such as curing ulcers, nutritional education, regular control of vital signs, emotional help and support with self-care.
Objective: To help the patient to achieve physical and emotional autonomy and overall healing. Specific diagnoses: acute pain in both legs, damage to cutaneous integrity in both legs, risk of falling, social isolation, urinary and faecal incontinence, insomnia.
Methods: Clinical case including home visits 3 times per week with continuous follow-up of the patient.
Results: All types of analgesia were ceased. The vascular ulcers were cured. An improvement of leg damage related to traumatisms was observed. The patient returned to her normal life after seventeen months of home isolation due to her physical handicap, which resulted in emotional imbalance.
Conclusions: The patient regained the autonomy and independence she had prior to her medical situation. After losing 15 kg, her blood pressure improved and she had better diabetic control.

Key words: nursing, immobilized.

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Beverage consumption and total water intake compared to the recommendations in a Spanish adult population

Villalobos T¹, Mascaraque M¹, Löpez-Sobaler AM¹, Perea JM², Ortega-Anta RM¹.

¹Department of Nutrition. Faculty of Pharmacy. Complutense University of Madrid. Madrid.
²University Alfonso XEl Sabio. Madrid.

Introduction: A wide variety of recommendations exists for total water intake (TWI). Only a few studies have examined how consumption patterns, including beverage type and variety, are related to TWI.
Objectives: The aim of this study was to evaluate TWI, compare it with different water intake recommendations, and find out the most consumed beverages.
Methods: Studied subjects were 466 Spanish adults aged 1850 (260 women and 206 men). Beverage intake was obtained from a 3-day food record (including one weekend day). Dial software was used to calculate TWI and g/day of different beverages (water, milk, soft drinks, juices, wine, beer and other alcoholic drinks).
Results: The mean TWI (all food and beverage sources included) was 2030 ± 734 g/day; 93.5% and 74.5% of the population did not meet the adequate intakes of IOM and EFSA respectively. The most consumed beverage was water (99.6% of the subjects consumed water), followed by milk (83.3%), soft drinks (50.9%), juices (49.4%), wine (40.6%) and beer (35%). The mean total beverage intake was 1496 ± 680 g/day.
Conclusion: A high percentage of this population does not meet the recommendations. Increasing beverage intake is advisable. More nutritional and hydration education is needed.

Acknowledgements: This research was supported by a University-Industry Research Agreement. (Ref 94/2011) and by a "Research Funding Program for Consolidated Groups Santander-UCM" (Ref GR35/10-A).

Key words: water intake, beverage.

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Nutritional significance of three locally produced non-alcoholic drinks from Nigeria

Yewande-Bamigboye A, Ebunoluwa-Oluwakemisola-Kukoyi K.

The Polytechnic. Ibadan. Oyo State.

Introduction: Fruits are an important source of both digestible and indigestible carbohydrates, minerals and vitamins, especially vitamin C and (β-carotene. Non-alcoholic beverages are usually prepared from fruits or plant seeds, and they serve as refreshing drinks. In Nigeria, large quantities of fruits are produced and wasted due to post-harvest losses. To guarantee a regular supply of these fruits during the four seasons, they need to be processed and preserved in a form that can extend their shelf life.
Objectives: This study was carried out to prepare and determine the nutrient content and physicochemical characteristics of three locally produced juices (Pineapple, Apple and Kunnu).
Methods: Samples of fruits and millet (for Kunnu) were purchased from Sango market in Ibadan, cleaned, processed into juices by extraction and sieving methods and packaged for further analysis. The samples were analysed for proximate and ascorbic acid composition using standard methods of AOAC.
Results: 100 g portion of the drinks contained 68.29-72.20 g moisture, 0.61-4.50 g protein, 9.85-12.98 g total soluble sugar, and 5.80-21.33 mg ascorbic acid. The pH range was 3.46-5.52, titratable acidity 0.52-4.54, and specific gravity 1.04-1.06.
Conclusions: The values obtained from the analyses of the beverages were within the range for commercial juices, and hence, they are recommended as refreshing drinks.

Key words: fruits, non-alcoholic beverages refreshing drinks.

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Sanitary surveillance of drinking water, health and safety warrants in hydration

Zambrana-Cayuso MC¹, Gómez-Martin MC², Arjona-Murube C², González-De Canales MP³.

¹Health District of South Seville. Seville.
²Health District of Aljarafe. Seville. Seville.
³Health District of Huelva. Huelva.

Introduction: The basic support of hydration is water, which quenches thirst and is easily found. It can be consumed on its own as tap or bottled water or as a part of hydrating liquid foods (soft drinks, broths, infusions).
Tap water is the most commonly consumed, since it is affordable and readily available. Having been treated, it does not contain harmful substances or any microorganisms, thanks to health control and water surveillance, designed to prevent health risks.
The water supply in Seville and its metropolitan area draws on four reservoirs (395 Hm3), located in mountain areas with low industrial concentration, low agricultural activity and low populations, and is thus of very good quality.
Objectives: To study legal compliance with drinking water regulations in this supply area.
Methods: Taking analytical reports recorded in the SINAC (Spanish National Drinking Water Information System), the number of analyses performed in a year in supply infrastructures (water treatment plants, tanks, and distribution networks) was studied and compared with the legal regulations in order to verify compliance.
Results: Water potability is guaranteed and thus its consumption is safe.
Conclusions: The characteristics of the tested water are similar or even better in quality than three brands of bottled water.

Key words: supply, potability, surveillance, health quality.

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An update on caffeine and fluid balance: a meta-analysis

Zhang Y

CBA-Jiaxing. PR. China.

Introduction: Despite its popularity and numerous benefits for physical and mental performance, caffeine is generally recognized as having a diuretic action. For situations where fluid balance is essential, it is often recommended that caffeine be used with caution or simply avoided, as failure to maintain body fluid balance is associated with a wide range of physical and mental decrements in performance.
Objectives: A meta-analytic method was used to determine caffeine's diuretic effect.
Methods: Twelve publications met the selection criteria, providing a total of 19 effect sizes (ESs) for analysis.
Results: Collectively, the results found a moderate ES for caffeine, 0.52 ± 0.84 (95% CI, 0.12-0.93). This corresponds to an absolute change in urine volume of 83 ± 191 mL (95% CI, -8-175 mL). Further analyses confirmed physical activity as a strong moderator, as diuretic action is reduced with exercise (p < 0.05).
Conclusions: The current results suggest that caffeine is mildly diuretic in most cases, and in practice, such a marginal effect on urine volume is minimal and would not negatively affect fluid balance. The practical implications for athletes and occupational workers include the fact that there is no reason to avoid moderate coffee consumption. However, rehydration with caffeinated drinks during rest should be avoided.

Key words: hypohydration, dehydration, diuresis, rehydration.

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