Fluid and total water intake in a senior mediterranean population at high cardiovascular risk: demographic and lifestyle determinants in the PREDIMED-Plus study



We aimed to evaluate associations between compliance with recommendations for total water intake (TWI) and total water intake from fluids (TWIF), and some socio-demographic and lifestyle factors of a senior Mediterranean population at high cardiovascular risk.


Cross-sectional analysis with data of 1902 participants from the PREDIMED-Plus study. A validated 32-item Spanish fluid-intake questionnaire was used to assess beverage consumption and water intake. Multivariable logistic regression models were used to assess the odds ratio (OR) and the 95% confidence interval (CI) for complying with European Food Safety Agency recommendations for TWI and TWIF according to various socio-demographic and lifestyle factors, and for the joint associations of Mediterranean diet (MedDiet) adherence and moderate–vigorous physical activity (MVPA).


The mean total volume of fluid intake in the population studied was 1934 ± 617 mL/day. Water was the most frequently consumed beverage. Significant differences between sex were only observed in alcoholic and hot beverage consumption. Compliance with TWIF was associated with being women (OR 3.02; 2.40, 3.80), high adherence to MedDiet (OR 1.07; 1.02, 1.12), and participants who were more engaged in physical activity (PA) (OR 1.07; 1.02, 1.13). Age was inversely associated (OR 0.96; 0.94, 0.98). Similar results for TWI recommendations compliance were observed in relation to being women (OR 5.34; 3.85, 7.42), adherence to MedDiet (OR 1.16; 1.02, 1.31) and PA (OR 1.07; 1.00, 1.15). The joint association of PA and MedDiet, showed that participants with higher adherence to MedDiet and meeting WHO recommendations for MVPA complied better with the TWI recommendations (OR 1.66; 1.19, 2.32).


High compliance with recommendations for TWI was associated with being a woman, and a healthy lifestyle characterized by high adherence to the MedDiet and PA.

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CIBEROBN, CIBERESP and CIBERDEM are initiatives of Instituto de Salud Carlos III, Spain. The authors especially thank the PREDIMED-Plus participants for their enthusiastic collaboration, the PREDIMED-Plus personnel for outstanding support, and the personnel of all associated primary care centres for their exceptional effort.


The PREDIMED-Plus trial was supported by the official funding agency for biomedical research of the Spanish government, ISCIII, through the Fondo de Investigacion para la Salud (FIS), which is co-funded by the European Regional Development Fund (four coordinated FIS projects led by Jordi Salas Salvadó and Josep Vidal, including the following projects: PI13/00233, PI13/00462, PI13/00728, PI13/00272, PI13/01123, PI14/01919, PI14/01722, PI14/01374, PI14/00636, PI14/01206, PI16/00533, PI16/00501, PI16/00366, PI16/01873, PI16/01094, PI17/00926, PI17/00764, PI17/01827, PI17/01441. The Special Action Project entitled: Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus Grant to J. S.-S., the European Research Council (Advanced Research Grant 2013–2018, 340918) to M. A. M.-G., the Recercaixa Grant to J. S.-S. (2013ACUP00194), a Grant from the Generalitat Valenciana (PROMETEO/2017/017). Indira Paz Graniel receives a Grant from the Spanish Ministry of Education, Culture and Sports (FPU 17/01925). Laura Gallardo Alfaro receives a Grant from the Spanish Ministry of Education, Culture and Sports (FPU 15/06147). Laura Barrubés receives a Grant from the Spanish Ministry of Education, Culture and Sports (FPU 16/00165). None of the funding sources took part in the design, collection, analysis or interpretation of the data, or in the decision to submit the manuscript for publication.

Author information




IP-G, NB-T, NB and JS-S conducted the statistical analyses and drafted the article. IP-G, JS-S, NB and NB-T made substantial contributions to the conception and design of the work. All authors contributed substantially in the acquisition of data or analysis and interpretation of data. All authors revised the article critically for important intellectual content. All authors approved the final version to be published.

Corresponding authors

Correspondence to Nancy Babio or Jordi Salas-Salvadó.

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Conflict of interest

J. S.-S. reports serving on the board of the International Nut and Dried Fruit Council from which he has also received grant support through his institution, receiving consulting fees from Danone, Font Vella Lanjaron, Nuts for Life, and Eroski, and being given grant support through his institution from Eroski. J.S.-S is member of the executive committee of the Instituto Danone Spain and member of the scientific committee of the Institute Danone International. L. D. reports to receive a Grant from the Fundación Cerveza y Salud. N.-B. declares that she received payments from Danone S.A. for the purposes of scientific and technical consulting but not for preparing this study and grant support through his institution from Font Vella Lanjaron. No other potential conflicts of interest relevant to this article were reported.

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All participants provided written informed consent, and the study protocol and procedures were approved according to the ethical standards of the Declaration of Helsinki.

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Paz-Graniel, I., Babio, N., Serra-Majem, L. et al. Fluid and total water intake in a senior mediterranean population at high cardiovascular risk: demographic and lifestyle determinants in the PREDIMED-Plus study. Eur J Nutr 59, 1595–1606 (2020). https://doi.org/10.1007/s00394-019-02015-3

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  • Total water intake (TWI)
  • Fluid intake
  • Beverages
  • Mediterranean diet