Water intake and hydration state in children
Although low water intake has been associated with adverse health outcomes, available literature indicated that the majority of children do not meet the water intake guidelines and they are underhydrated based on elevated hydration biomarkers. This review examined the water intake habits and hydration status in children from 32 observational studies (n = 36813).
PubMed, Web of Science, and CINAHL were used to identify relevant articles. Total water/fluid intake from 25 countries was compared with water intake recommendations and underhydration (urine osmolality greater than 800 mmol kg−1) was assessed. Risk of bias was assessed using customized categories following the review guideline for observational studies.
From 32 studies, only 11 studies reported both water intake and hydration status. 12 out of 24 studies reported mean/median water/fluid intake below the guidelines, while 4 out of 13 studies that assessed hydration status indicated underhydration based on urine osmolality (greater than 800 mmol kg−1). Among the 19 countries that reported comparison of water/fluid intake with guidelines, 60 ± 24% of children (range 10–98%) failed to meet them.
These findings suggest that children are not consuming enough water to be adequately hydrated.
KeywordsDehydration Hypohydration Hydration assessment Inadequate hydration Underhydration Fluid intake
The authors wish to thank Abigail Colburn and LynnDee Summers for their editorial support.
HS, the lead author, helped developing the search question, conducted the analysis, and wrote the manuscript. SAK helped in developing the search question, provided input on the analytic strategy, reviewed and edited the manuscript. All authors read and approved the manuscript.
The authors have not received any funding for this review.
Compliance with ethical standards
Conflict of interest
SAK has served as scientific consultants for Quest Diagnostics, Standard Process and Danone Research. SAK has active Grants with Danone Research. HS has no conflicts to declare.
- 5.National Academy Press (2005) Panel on dietary reference intakes for electrolytes, water: DRI, dietary reference intakes for water, potassium, sodium, chloride, and sulfate. Institute of Medicine, USGoogle Scholar
- 21.Agostoni C, Bresson J, Fairweather-Tait S, Flynn A, Golly I, Korhonen H, Lagiou P, Løvik M, Marchelli R, Martin A (2010) Scientific opinion on dietary reference values for water. EFSA J 8:3Google Scholar
- 22.Drewnowski A, Rehm CD, Constant F (2013) Water and beverage consumption among children age 4–13 y in the United States: analyses of 2005–2010 NHANES data. Nutr J 12:85-2891-12-85Google Scholar
- 34.Pinket A, Van Lippevelde W, De Bourdeaudhuij I, Deforche B, Cardon G, Androutsos O, Koletzko B, Moreno LA, Socha P, Iotova V (2016) Effect and process evaluation of a cluster randomized control trial on water intake and beverage consumption in preschoolers from six European countries: the ToyBox-study. PLoS One 11(4):e0152928PubMedPubMedCentralCrossRefGoogle Scholar
- 37.National Heart, Lung, and Blood Institute. Study quality assessment tools. Internet. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools
- 38.Iglesia I, Guelinckx I, De Miguel-Etayo PM, Gonzalez-Gil EM, Salas-Salvado J, Kavouras SA, Gandy J, Martinez H, Bardosono S, Abdollahi M, Nasseri E, Jarosz A, Ma G, Carmuega E, Thiebaut I, Moreno LA (2015) Total fluid intake of children and adolescents: cross-sectional surveys in 13 countries worldwide. Eur J Nutr 54(Suppl 2):57–67PubMedPubMedCentralCrossRefGoogle Scholar
- 39.Science Press (2014) Chinese Nutrition Society. Chinese Dietary Reference Intakes, BeijingGoogle Scholar
- 40.Ministry of Health Republic of Indonesia (2013) Recommended nutritional intake for Indonesian population. Ministry of Health Republic of Indonesia, JakartaGoogle Scholar
- 42.Gouda Z, Zarea M, El-Hennawy U, Viltard M, Lepicard E, Hawili N, Constant F (2015) Hydration deficit in 9-to 11-year-old Egyptian children. Glob Pediatr Health 2:2333794 × 15611786Google Scholar
- 45.Guelinckx I, Iglesia I, Bottin JH, De Miguel-Etayo P, Gonzalez-Gil EM, Salas-Salvado J, Kavouras SA, Gandy J, Martinez H, Bardosono S, Abdollahi M, Nasseri E, Jarosz A, Ma G, Carmuega E, Thiebaut I, Moreno LA (2015) Intake of water and beverages of children and adolescents in 13 countries. Eur J Nutr 54(Suppl 2):69–79PubMedPubMedCentralCrossRefGoogle Scholar
- 74.Yaktine AL, Stallings VA (2007) Nutrition standards for foods in schools: leading the way toward healthier youth. National Academies Press, Washington, D.C.Google Scholar
- 75.United States Department of Agriculture (2017) Child nutrition reauthorization 2010: water availability in the CACFP. https://www.fns.usda.gov/cacfp-20-2011-child-nutrition-reauthorization-2010-water-availability-child-and-adult-care-food. Accessed 26 Sept 2017
- 83.Patel AI, Grummon AH, Hampton KE, Oliva A, McCulloch CE, Brindis CD (2016) A trial of the efficacy and cost of water delivery systems in San Francisco Bay Area Middle Schools, 2013. Prev Chron Dis 13:E88Google Scholar
- 98.Lloyd AB, Lubans DR, Plotnikoff RC, Morgan PJ (2015) Paternal lifestyle-related parenting practices mediate changes in children’s dietary and physical activity behaviors: Findings from the Healthy Dads, Healthy Kids community randomized controlled trial. J Phys Act Health 12(9):1327–1335PubMedCrossRefPubMedCentralGoogle Scholar
- 102.Franks B, Lahlou S, Bottin JH, Guelinckx I, Boesen-Mariani S (2017) Increasing water intake in pre-school children with unhealthy drinking habits: a year-long controlled longitudinal field experiment assessing the impact of information, water affordance, and social regulation. Appetite 116:205–214PubMedCrossRefPubMedCentralGoogle Scholar