Introduction

Hydration and Health Promotion: A Brief Introduction

Maxime E. Buyckx, MD, MBA The Beverage Institute for Health and Wellness, The Coca-Cola Company, Atlanta, Georgia Water has been recognized as essential for human life since ancient times [1]. It accounts for more than 60% of our bodies and plays important roles in physiological and biochemical functions. In 2004, the Institute of Medicine of the National Academies (IOM) released the Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate report, which states:. . . . The largest single constituent of the human body, water, is essential for cellular homeostasis and life. It provides the solvent for biochemical reactions, is the medium for material transport, and has unique physical properties (high specific heat) to absorb metabolic heat. Water is essential to maintain vascular volume, to support the supply of nutrients to tissues, and to remove waste via the cardiovascular system and renal and hepatic clearance. Body water deficits challenge the ability of the body to maintain homeostasis during perturbations (e.g., sickness, physical exercise, or climatic stress) and can impact function and health. Total water intake includes drinking water, water in other beverages, and water (moisture) in food [2]. Many factors impact our daily hydration requirements and our ability to hydrate: the thirst mechanism, age, genetic background, gender, availability, social environment, and cultural factors [35]. The 2004 IOM report on Dietary Reference Intakes for Water, Potassium, Sodium, Chloride and Sulfate [2] has provided an updated review on all matters related to hydration. This work also provided a comprehensive framework for future research to further the scientific knowledge on hydration. The report stressed the fact that all beverages, as well as foods, can fulfill the daily fluid needs of individuals. An Adequate Intake (AI) was set to prevent deleterious, primary acute, effects of dehydration, which include metabolic and functional abnormalities [2] as it is difficult to determine a specific level of water intake that would ensure adequate hydration and optimal health under all environmental conditions, thus not allowing the establishment of an Estimated Average Requirement (EAR). For example, a total water intake (AI) of 3.7L/day and 2.7L/day was established for men and women ages 19 to 70 and above respectively. The IOM also pointed out that on average 80% of total water intake comes from drinking water and beverages while the remaining 20% comes from food. It is important to note that the above mentioned recommendations and percentages may vary for different populations with different diets and who live in diverse environments and different regions of the world. Innovative research has begun to focus on better understanding the hydration status of individuals relative to their physical needs and overall diet [6]. Until recently fluid and electrolyte research has focused mainly on clinical care, survival, and situations where optimal physical performance (e.g., competition in endurance sports or military operations) can be enhanced [7 8]. Attention has increasingly been paid to understanding the relationship between hydration and the potential prevention of chronic diseases such as urolithiasis, urinary tract infections, bladder cancer, constipation, broncho-pulmonary disorders, hypertension, heart disease, venous thromboembolism, dental diseases, and others [9]. Because very little research has focused on the hydration needs of the average individual in sedentary conditions, more work is now being done to assess the relationship of hydration to mental and physical performance, wellness, and lifestyle [6, 10 12]. The IOMs DRI report, however, made clear that presently there is insufficient evidence to establish water intake recommendations as a means to reduce chronic disease. Therefore, additional studies and clinical work are needed to better understand the benefits of proper hydration for good health. Also many myths and misconceptions persist regarding water and beverages, their physiological capabilities, and their

Address reprint requests to: Dr. Maxime E. Buyckx, Director, Nutrition and Health Sciences, The Beverage Institute for Health and Wellness, The Coca-Cola Company, P.O. Box 1734, Atlanta, GA 30301. E-mail: mbuyckx@na.ko.com Presented at the ILSI North America Conference on Hydration and Health Promotion, November 29 30, 2006 in Washington, DC. Conflict of Interest Disclosure: Dr. Buyckx is employed by The Coca-Cola Company.

Journal of the American College of Nutrition, Vol. 26, No. 5, 533S534S (2007) Published by the American College of Nutrition 533S

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requirements towards maintaining proper hydration. It is therefore important that the public receives appropriate, sound and scientifically-based information about the importance of proper hydration in daily life from national and international organizations, health and sports professionals, media, and through modern communication means like the internet. This is why it is such a great honor and pleasure to welcome many hydration experts to this Hydration and Health Promotion Conference, organized by the ILSI Hydration Technical Committee. The agenda is scientifically rich and challenging with a wide range of themes. The conferences main goal is to build on the existing hydration research that presently exists by establishing hydration formally in the overall debate of better health and well-being. This conference aims to establish a Scientific Consensus Statement on the importance of hydration. We hope that such a consensus will further draw attention to the growing importance of hydration for the general population and assist governments, scientific organizations, health institutions, and other parties including industry to promote appropriate and scientifically-based guidelines related to hydration.
3. Stroebele N, De Castro JM: Effect of ambience on food intake and food choice. Nutrition 20:821838, 2004. 4. Engell D, Kramer M, Malafi T, Salomon M., Lesher L: Effects of effort and social modeling on drinking in humans. Appetite. 26: 129138, 1996. 5. Engel D, Hirsch E: Environmental and sensory modulation of fluid in humans. In Ramsay D, Booth, DA (eds): Thirst: Physiological and Psychological Aspects: ILSI Human Nutrition Reviews. Washington, DC: International Life Sciences Institute, 1991. 6. Grandjean AC, Campbell SM: Hydration: Fluids for Life. Washington, DC: ILSI North America, 2004. 7. Subcommittee on the Tenth Edition of the Recommended Dietary Allowances, Food and Nutrition Board, Commission on Life Sciences, National Research Council: In: Recommended Dietary Allowances, 10th ed. Washington, D.C.: National Academies Press, 1989. 8. Arnaud, M (ed): Hydration throughout life. International Conference Vittel (France) June 912, 1998. Vittel, France: John Libbey Eurotext, 1998 ISBN 2-7420-0226-X. 9. Health effects of mild dehydration, 2nd International Conference on Hydration throughout Life, Dortmund (Germany) October 89, 2001, EJCN, Vol. 57, Suppl.2, December 2003. 10. Supplement from the Nestle Hydration Symposium in Lausanne, Switzerland, November 1516, 2004. Nutr Rev 63(6 Pt 2):S162, 2004. 11. Grandjean AC, Reimers KJ, Haven MC, Curtis GL: The effect on hydration of two diets, one with and one without plain water. J Am Coll Nutr 22:165173, 2003. 12. Grandjean AC, Reimers KJ, Buyckx ME: Hydration: Issues for the 21st Century. Nutr Rev 61:261271, 2003.

REFERENCES
1. Kiple KF, Ornelas KC (eds): The Cambridge World History of Food. New York: Cambridge University Press, 2004. 2. Institute of Medicine and Food and Nutrition Board: Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: National Academies Press, 2004.

Received July 16, 2007

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