Fluid intake of Latin American adults: results of four 2016 Liq.In7 national cross-sectional surveys

Fluid intake of Latin American adults: results of four 2016 Liq.In7 national cross-sectional surveys Purpose To report total fluid intake (TFI) and the intake of different fluid types in adults (≥ 18 years old) from Mexico, Argentina, Brazil and Uruguay. To compare intakes between countries and with recommended adequate intake (AI) of water from fluids. Methods Cross-sectional data were collected using a validated liquid intake 7-day record (Liq.In ) in populations from Argentina (n = 1089), Brazil (n = 477), Mexico (n = 1677) and Uruguay (n = 554). Population characteristics, including age, gender, body mass index and socioeconomic level were recorded. Mean TFI was compared with the AI of water from fluids set by the USA Institute of Medicine. Results The lowest TFI was recorded in Mexican women (1748 mL/day) and the highest in Argentinean men (2318 mL/ day). Median daily TFI was significantly different between countries; Uruguay and Argentina had higher values than Mexico and Brazil. In the former, plain water contributed to only 25% of TFI, the remainder being predominantly from hot bever- ages. Approximately, a third of adults did not drink enough fluid to meet the recommended AI. High SSB consumption was reported, which was significantly different between countries (p < 0.05), the highest being in Mexico (median 25–75th percentiles): 531 (300–895 mL/day. Conclusions This survey highlights the need to increase water consumption and reduce SSB intake in this region to avoid potential associated health risks. These findings may be useful information in monitoring public health policy strategies. Keywords Beverages · Fluid intake · Hydration · Liq.In  · Water · Argentina · Brazil · Mexico · Uruguay Introduction anti-diuretic hormone responsible for fluid homeostasis and urine concentration [3]. Increased levels of copeptin have The role of water consumption and optimal body hydration been linked to cardiometabolic diseases such as type 2 dia- is becoming a subject of great scientific interest. While the betes and heart disease [4, 5]. In addition, increasing water effects of severe dehydration are well documented, [1 ] it intake has been shown to attenuate copeptin levels [6]. is only recently that the effects of low water consumption It is therefore a concern that a significant proportion of are being investigated. Regular low (< 1.2 L/day) drinkers adults in Latin American countries have been shown to con- are able to maintain normal plasma osmolality by reduc- sume less than the recommended intake of water from fluids ing body water losses via urine; this results in low, highly [7]. In a survey of 13 countries worldwide, 57% of Mexican concentrated urinary output [2]. Low drinkers may have adults did not meet the recommended intake levels; 41% of increased levels of copeptin, a precursor of vasopressin, the Brazilian adults and 36% of Argentinian adults were also shown to consume less than the recommendations [7]. In this former analysis, the European Food Safety Authority Electronic supplementary material The online version of this (EFSA) reference values for total water intake [8], adjusted article (https ://doi.org/10.1007/s0039 4-018-1724-z) contains supplementary material, which is available to authorized users. to account for water from food, were used, as countries from all around the world were included. In addition, the EFSA * I. Guelinckx recommendations are more conservative than the reference isabelle.guelinckx@danone.com values set by the USA Institute of Medicine (IOM) [9] and Extended author information available on the last page of the article Vol.:(0123456789) 1 3 S66 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 therefore unlikely to overestimate the number of people not participants’ city of residence. Recruitment of participants in adhering to recommendations. Country-specific recommen- each country was performed via a door-to-door recruitment dations for water intake are not available in Latin American until suitable quotas for age, gender, region and socioeco- countries. Therefore, for future comparisons it would be nomic characteristics, in relation to the total country popu- more appropriate to use the adequate intake of water set by lation, were met. To determine the socioeconomic status the USA IOM [9], in line with other Latin American stud- (SES) of participants, the Asociación Mexicana de Agencias ies [10]. It is now apposite to resurvey fluid consumption in de Investigación de Mercado y Opinión Pública (AMAI) Latin American countries and, as only countries from this system was used in Mexico, Argentina and Uruguay, and region were surveyed, to use the IOM recommendations [9] the ABEP classification in Brazil [21, 22]. Both systems use for comparison purposes. a combination of the following criteria to determine SES: In addition to the links between low fluid consumption work status, occupation, education, medical coverage, num- and chronic diseases, the type of fluids consumed is also ber of domestic servants, number of bathrooms, household important. In particular, the consumption of sugar-sweet- equipment, ownership of an international credit card and/ ened beverages (SSB) has been shown to be linked to obesity or access to public services (e.g., water, type of street). For [11], type 2 diabetes [12] and cardiovascular disease [13]. data analysis, SES classes were harmonized as detailed in Consumption of SSB in Latin America is among the high- supplementary table S1. est in the world [14]. Given the increasing levels of obesity Only one individual per household was eligible to partici- in Latin America, this raises additional cause for concern pate. Apparently healthy individuals were eligible, except [15]. The average body mass index (BMI) of Latin Ameri- individuals working in any capacity in a company associated cans increased twice as fast as the global average between with the manufacture, distribution and/or sale of water and 1980 and 2008, with 70% of Mexicans now considered any other kind of beverage were excluded from participa- either overweight or obese [16]. Unsurprisingly, this has tion. Pregnancy and/or lactation were not exclusion criteria. been accompanied by a rapid increase in associated con- ditions such as type 2 diabetes, metabolic syndrome and Ethical considerations cardiovascular disease [17–19]. It is vital that policy makers understand the drivers behind this epidemic and how best The survey protocol was reviewed and approved by the Uni- to intervene to change behaviors in view of the societal and versity of Arkansas Review Board (ref. 14-12-376). After financial costs of such widespread health problems. receiving a detailed description of the study and its objec- There is a lack of information in relation to the amount tives, following the principles of informed consent, partici- and type of fluids consumed around the world and specifi- pants gave oral approval of their willingness to be included. cally in Latin America. Therefore, the primary aim of the No monetary incentive was offered for taking part in the present study was to report total fluid intake (TFI) and intake study. All data were recorded anonymously. of different fluid types of adults (≥ 18 years) in Argentina, Brazil, Mexico and Uruguay, using a validated 7-day fluid Anthropometry record (the Liq.In diary) [20]. The secondary aims were to make between-country comparisons and association with Height (m) and weight (kg) were self-reported by partici- the IOM recommendations on adequate intake (AI) of water pants; BMI was calculated as kg/m [23]. from fluids [9 ]. Assessment of total fluid intake and its composition Methods Participants were provided with the Liq.In record, a 7-day fluid-specific record validated for accuracy and reliability Design and study population [20] in the official language of the country. Before the sur - vey began, the researcher explained how to complete the The present analysis reports cross-sectional surveys of adults record in an initial face-to-face interview in the participant’s (≥ 18 years) in four Latin America countries: Argentina, home. After a period of 7 days, the record was collected by Brazil, Mexico and Uruguay. The method of recruitment, the researcher and checked for completion with the partici- the instruments for data collection and data treatment were pant. The Liq.In is structured around times of the day from harmonized across the surveys. The data collection was waking up, meal times (breakfast, lunch, dinner), periods performed between March and May 2016 in urban areas in between meals (morning, before lunch/aperitif, afternoon, different regions of Argentina, Mexico and Uruguay. For tea break, before dinner/aperitif, just before going to bed) Brazil, data were only collected in the City of São Paulo and during the night. The participants were instructed to between November and December 2016. Figure  1 shows report all drinking events at any moment of the day with 1 3 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 S67 Fig. 1 Map showing the cities in each country from where participants were recruited the following details: the fluid type, the volume consumed, influenced median daily TFI. An individual was defined as the size of the container from which it was drunk, where it a consumer of a certain fluid type if this fluid type was con- was consumed and whether food was also consumed. How- sumed at least once during the 7-day period. Individual’s ever, the type of food consumed was not reported. To assist daily TFI was compared with the adequate intake of water estimation of the amount of fluid consumed, a booklet with from fluids set by the USA IOM [9 ]. To allow comparison pictures of standard fluid containers was provided. with previously published data, the comparison between observed intakes and the recommendations set by EFSA [8] Classification and analysis of the fluid types is also provided in supplementary figure S2. The proportion of individuals drinking ≤ 1 serving Fluids were classified as water (tap and bottled water), milk (250 mL) of SSB per week, 2–6 servings of SSB per week and milk derivatives, hot beverages (coffee, tea and other), and ≥ 1 serving/day intake of SSB per day was calculated. 100% fruit juices, sugar-sweetened beverages (SSB) (car- These cutoffs were obtained from meta-analyses associating bonated soft drinks (CSD), juice-based drinks, functional such levels of intake with potential risks for the develop- beverages such as energy and sports drinks, ready to drink ment of obesity, type 2 diabetes and metabolic syndrome tea and coffee and flavored water), artificial/non-nutritive [12, 24, 25]. sweeteners beverages (A/NSB) (diet/zero/light soft drinks), alcoholic beverages and other beverages. More details are Statistical analysis given in supplementary table  S2. Total fluid intake was defined as the sum of all these categories. In Uruguay and The demographic and anthropometric characteristics of the Argentina, the Liq.In record had a specific code for Maté study population are presented either as means and standard (a hot infusion of Ilex paraguayensis, which is a cultural deviation for continuous variables, or numbers and percent- beverage largely consumed in Southeast Latin America), as ages for dichotomous variables. Due to the skewed distri- previous surveys had indicated that this beverage heavily bution in intake data, as shown in supplementary Figure 1 3 S68 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 S1, TFI is presented as median with percentiles as well as of the adults surveyed in Mexico and Brazil met the rec- mean and standard error of mean. Different fluid types are ommendations. This proportion rose to 37% in Uruguayan recorded as median (50th percentile) [25th–75th percentiles women and 51% for Argentinian women, while only 14 (P25-P75)] and proportion of consumers. The mean [stand- and 20% of men in these countries, respectively, met the ard error of mean (SEM)] of the different fluid types can be recommended AI for water from fluids. In all four coun- found in supplementary table S4a–d. The contribution of tries, women were more likely than men to meet the rec- each fluid type to TFI was calculated using the mean values ommendations. The percentage of adults drinking ≤ 50% of for TFI. Between groups, comparisons were made with a the recommended intake is particularly high, with nearly Wilcoxon rank test for continuous variables. A Bonferroni half of Mexican adult males (47%) failing to meet 50% of post hoc test was used to correct for multiple comparisons. AI. A similar picture was seen in Uruguay and Brazil at All statistical tests were two-tailed and the significance level 37 and 40%, compared with Argentina where 26% of the was set at p < 0.05. All analyses were performed using the male participants had a mean TFI lower than 50% of the SPSS software version 22.0 (SPSS Inc., Chicago, IL) and recommendation. were verified by a statistician. When the median daily TFI was analyzed by type of bev- erage consumed (Table 3; Fig. 3), statistically significant differences (p < 0.05) were seen between the individual Results countries. Total fluid intakes in Mexico and Brazil were similar; Argentina and Uruguay were significantly different The TFI and type of fluids consumed were analyzed for from each other and the other countries. Although Argen- nearly 4000 adults from Argentina (n = 1089), Brazil tina and Uruguay had the highest median TFI in mL/day, (n = 477), Mexico (n = 1677) and Uruguay (n = 554). The the amount of plain water drunk, either bottled or tap, was general characteristics of the study population, by country, less than 400 mL/day, which represents approximately 25% are shown in Table 1. There was a slight predominance of of TFI. Conversely, the majority of daily TFI (≈ 700 mL) female participants (55%). The mean age in each of these was hot beverages (36 and 44% of mean daily TFI, respec- countries was below 40 years and the number of respondents tively), particularly maté (26 and 37% of mean daily TFI, in each age group was similar. The percentage of overweight respectively) unlike in Mexico and Brazil, where less than and obese participants was higher in Brazil, Argentina and 150 mL of median TFI was attributable to hot beverages Mexico than in Uruguay; in Brazil and Mexico approxi- (12% of the mean daily TFI) (Fig. 3). The median TFI and mately 35% of the sample population were of normal weight fluid types for each country, according to gender, are shown compared with more than 65% in Uruguay. With respect in supplementary Tables S4a–d. The total volume of SSB to socioeconomic classification, the Brazilian participants consumed in the four countries was significantly different were all from SESs AB and C. In Argentina and Mexico, from each other (p < 0.05), with Mexico consuming the approximately 60% of the participants were from SESs AB highest volume [531 (300–895) mL/day], approximately a and C; 48% of Uruguayans were from these SESs. third of daily TFI (Fig. 3). This was over twice the amount Table 2 shows the mean (SEM), median (50%) and per- of SSB drunk daily in Uruguay [251 (30–559) mL/day]. In centile TFI (mL/day) for each country according to gender. Brazil, SSB consumption was 409 (195–669) mL/day. In The TFI ranged from 1748 mL/day in Mexican women to addition, over 80% of Brazilian and Mexican adults drank 2318 mL/day in Argentinean women. There was no signifi- one or more servings per day. This was significantly different cant gender difference in TFI in Mexico, Argentina and Uru- from Argentina and Uruguay where 59 and 50% of adults, guay; however, women drank significantly less than men in respectively (p < 0.05), drank one or more servings of SSB Brazil. Between-country comparisons of TFI for each popu- per day. A consumption of ≤ 1 serving of SSB per week was lation are shown in Table 2. The highest median (P25–P75) reported by 6% of Mexican, 4% of Brazilian, 18% of Argen- daily TFI was in Argentina, 2133 (1524–2865) mL/day, with tinean and 23% of Uruguayan adults (Fig. 4). Mexico having the lowest intake, 1496 (1069–2150) mL/day. Figure 3 shows the contribution of each beverage type There were significant differences in median TFI between to the daily TFI. Supplementary Fig. S3 shows these data the countries. Both Uruguay and Argentina consumed sig- according to gender and country. Mexican adults have nificantly more fluid per day than Mexico and Brazil, TFI median milk and derivatives (8% of mean daily TFI) twice was also significantly higher in Argentina than in Uruguay. as high as adults in Argentina and Uruguay (3 and 4% of The distribution of these data for each country is given in mean daily TFI, respectively). Brazil consumed more of 250 mL/day (an average serving) intervals in the supplemen- 100% fruit juice than the other three countries, and Uru- tary data (Fig. S1). guay and Mexico recorded very low alcohol consumption. When compared with the IOM recommendations One interesting difference is in the contribution of A/NSB (adjusted for water from food) [9] (Fig. 2), only 10–25% which is much higher in Argentina and Uruguay (7 and 5%, 1 3 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 S69 1 3 Table 1 Demographic and anthropometric characteristics of the study population, by country Country Mexico (n = 1677) Brazil (n = 477) Argentina (n = 1089) Uruguay (n = 554) Sample size (N, %)  Men 746 (44) 224 (47) 464 (43) 278 (50)  Women 931 (56) 253 (53) 625 (57) 276 (50) Age (years) 37.6 ± 13.1 39.5 ± 14.0 38.5 ± 13.3 37.7 ± 13.3 Age group  18–25 years 397 (24) 98 (21) 234 (21) 135 (24)  26–35 years 411 (25) 108 (23) 277 (25) 124 (22)  36–50 years 553 (33) 142 (30) 329 (30) 167 (30)  > 50 years 316 (19) 129 (27) 249 (23) 128 (23) Weight (kg) 71.4 ± 14.0 75.9 ± 16.2 72.7 ± 15.8 73.3 ± 22.7 Height (m) 1.6 ± 0.1 1.7 ± 0.1 1.7 ± 0.1 1.7 ± 0.1 2 a BMI (kg/m ) 26.7 ± 4.9 27.0 ± 6.8 26.0 ± 5.6 25.7 ± 10.3 Socioeconomic level (N, %)  AB 125 (7) 210  (56) 14 (1) 90 (16)  C 859 (41) 267  (44) 640 (59) 247 (45)  D 693 (51) ND ND 435 (40) 217 (39) BMI body mass index, ND no data Represented as mean ± standard deviation BMI classification for adults was reported according to WHO [23] S70 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 Table 2 Daily total fluid intake Country Gender N (%) Mean ± SEM Percentiles (mL/day) for adults (≥ 18 years) by country and gender 5 10 25 50 75 90 95 Mexico Men 746 (44) 1762 ± 35 649 771 1083 1543 2172 3003 3668 Women 931 (56) 1748 ± 33 624 743 1049 1469 2145 3129 3906 Brazil Men 224 (47) 1968 ± 71 698 867 1187 1701 2536 3390 4453 Women 253 (53) 1693 ± 57 589 718 1053 1479 2228 2846 3250 Argentina Men 464 (43) 2210 ± 47 772 985 1466 2092 2838 3532 4111 Women 625 (57) 2318 ± 42 885 1097 1563 2174 2884 3725 4392 Uruguay Men 278 (50) 1979 ± 59 622 805 1224 1833 2594 3329 3797 Women 276 (50) 2018 ± 62 666 812 1177 1884 2593 3309 4272 d,e Mexico 1677 1754 ± 24 628 753 1060 1496 2150 3079 3817 d,e Brazil 477 1822 ± 46 625 790 1098 1568 2333 3102 3683 b,c,e Argentina 1089 2272 ± 31 821 1060 1524 2133 2865 3630 4270 b,c,d Uruguay 554 1999 ± 43 638 811 1194 1873 2593 3311 3916 SEM standard error of the mean Wilcoxon test was used for gender comparisons, and Wilcoxon signed-rank test (p < 0.05) was used for between country comparisons Significantly different from Mexico Significantly different from Brazil Significantly different from Argentina Significantly different from Uruguay Fig. 2 Percentage (%) of adults Total 37% 29% 16% 18% having adequate intakes (AI) Men 47% 29% 14% 10% of water from fluids set by the Women 28% 30% 18% 24% Institute of Medicine [9] based Total 34% 28% on the 7-day mean of each 17% 21% participant Men 40% 28% 17% 15% Women 29% 28% 18% 25% ≤50% AI Total 17% 50-75% AI 23% 22% 38% 75-100% AI Men 26% 30% 24% 20% ≥100% AI Women 10% 19% 21% 51% Total 29% 21% 24% 26% Men 37% 25% 24% 14% Women 21% 17% 24% 37% 0% 20%40% 60%80% 100% Percentage of participants respectively) compared with Brazil and Mexico where these TFI. Approximately, 75% of the study population did not make up only 1% of the mean TFI. meet the IOM AI for water from fluids [9 ]; 18% of Mexi- cans, 21% of Brazilians, 38% of Argentinians and 26% of Uruguayans met the IOM recommendations. In the previous Discussion study when the EFSA recommendations were used [7], 43% of Mexicans, 58% of Brazilians and 64% of Argentinians The data collected in these surveys extends and enriches were shown to adhere to the recommendations [8]. Given the information reported previously [7, 26] by focusing spe- the higher AIs for adults from IOM, compared with EFSA, cifically on countries in the Latin American region and, for is it not surprising that the present study found that fewer the first time, including data from a Uruguayan population. participants met the recommendations. The earlier study had Using the validated Liq.In diary [20], the ranking of the used the EFSA recommendations to facilitate comparisons three countries in terms of TFI is the same as previously between the 13 different countries included in the study not shown [7, 26], with Argentina having the highest mean daily to overestimate non-adherence. In the present study, almost 1 3 Uruguay Argentina Brazil Mexico (n=554) (n=1089) (n=477) (n=1677) European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 S71 Table 3 Median (P25–P75) daily intake (mL/day) of different fluid types and the percentage of consumers among adults (≥ 18 years), by country Mexico (n = 1677) Brazil (n = 477) Argentina (n = 1089) Uruguay (n = 554) Median (P25– % Consumers Median (P25– % Consumers Median (P25– % Consumers Median (P25– % Consumers P75) P75) P75) P75) Water 450 (180– 90 599 (349– 100 386 (96– 84 325 (129– 89 b,c,d a,c,d a,b a,b 900) 1004) 855) 721)  Bottled water 390 (120–831) 86 11 (0–311) 52 0 (0–240) 45 214 (0–596) 68  Tap water 0 (0–0) 18 357 (92–736) 84 129 (0-493) 63 0 (0–109) 36 b,c,d a,c,d a,b,d a,b,c Milk and 60 (0–186) 62 34 (0–117) 57 0 (0–46) 32 0 (0–125) 38 derivatives Hot beverages 121 74 150 (51– 88 732 (431– 98 699 (184– 86 b,c,d a,c,d a,b a,b (0–286) 263) 1136) 1356)  Coffee 81 (0–250) 68 131 (35–250) 84 71 (0–241) 63 0 (0–129) 41  Tea 0 (0–9) 25 0 (0–0) 23 0 (0–94) 40 0 (0–0) 21  Mate ND ND ND ND 488 (146–900) 82 514 (0–1204) 63  Other hot ND ND ND ND ND ND 0 (0–0) 1 beverages SSB 531 (300– 94 409 (195– 95 338 (82– 82 215 (30– 77 b,c,d a,c,d a,b,d a,b,c 895) 669) 754) 559) CSD 171 (0–390) 75 168 (36–353) 80 107 (0–366) 65 50 (0–343) 55  Juice-based 17 (0–161) 52 118 (28–275) 79 0 (0–137) 40 0 (0–20) 26 drinks  Functional 0 (0–0) 13 0 (0–0) 13 0 (0–0) 8 0 (0–0) 7 beverages  RTD tea and 0 (0–0) 19 0 (0–0) 20 0 (0–0) 2 0 (0–0) 1 coffee  Flavored 99 (0–300) 66 0 (0–0) 18 0 (0–50) 29 0 (0–0) 20 water b,c,d a,c,d a,b a,b 100% fruit 0 (0–0) 23 50 (0–165) 65 0 (0–0) 15 0 (0–0) 13 juices b,c,d a,c,d a,b,d a,b,c A/NSB 0 (0–0) 13 0 (0–0) 22 0 (0–154) 41 0 (0–110) 33 b,c,d a,d a,d a,b,c Alcoholic 0 (0–0) 13 0 (0–202) 47 0 (0–150) 47 0 (0–0) 24 beverages b,c a,c a,b,d c Other bever- 0 (0–0) 7 0 (0–0) 10 0 (0–0) 3 0 (0–0) 7 ages SSB sugar-sweetened beverages, CSD carbonated sweetened drinks, RTD ready to drink, A/NSB Artificial/non-nutritive sweeteners beverages, ND no data Wilcoxon signed-rank test (p < 0.05) to compare countries Significantly different from Mexico Significantly different from Brazil Significantly different from Argentina Significantly different from Uruguay 40% of adults in Mexico drank less than 50% of the IOM Analysis of the type of fluid that contributed to the AI, which must be considered a concern and merits further mean daily TFI clustered these Latin American countries investigation. A high proportion of adults from each of the into pairs; Mexico and Brazil vs. Argentina and Uruguay. four countries failed to meet at least 50% of IOM-recom- Over 80% of adults surveyed in Mexico and Brazil con- mended intakes, particularly men. It is not possible to draw sumed one or more servings of SSB daily, and in Mexico conclusions about the hydration status of the participants, as the amount of SSB consumed daily exceeded the amount no hydration biomarkers were included in the study. How- of water consumed, whereas in Argentina and Uruguay ever, a proportion of participants would probably be con- these figures were lower, 59 and 50%, respectively. In all sidered low drinkers and therefore may be at increased risk countries, carbonated sweetened drinks (CSDs) were the of cardiometabolic diseases [4, 5] and renal disease [27]. most frequently consumed SSB. This pattern of high SSB 1 3 S72 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 Fig. 3 Contribution of dif- Mexico ferent fluid types (%) to total 38% 8% 12% 2% 37% 1% (n=1677) fluid intake among adults (≥ 18 years), by country Water Brazil 42% 5% 11% 27% 6% 1% 8% Milk & derivatives (n=477) Hot beverages SSB 100% fruit juices Argentina 26% 3% 36% 21% 1% 7% 6% (n=1089) A/NSB Alcoholic beverages Other beverages Uruguay 25% 4% 44% 1% 5% 18% 2% (n=554) 0% 10%20% 30%40% 50%60% 70%80% 90%100% Contribution of each fluid types to TFI (%) Fig. 4 Percentage (%) of adults ≤ 1 serving per week 2-6 serving per day ≥ 1 serving per day drinking SSB daily, or less frequently, by country Total 6% 13% 82% Men 4% 11% 85% Women 7% 14% 80% Total 4% 16% 81% Men 4% 14% 82% Women 4% 17% 79% Total 18% 23% 59% Men 14% 23% 63% Women 22% 23% 56% Total 23% 27% 50% Men 23% 28% 49% Women 22% 25% 52% 0% 10%20% 30%40% 50%60% 70%80% 90%100% Percentage of participants (%) consumption is similar to that found in a previous sur- Interesting differences were seen between the present data vey in these populations (Uruguay was not included in for Brazil and those collected previously [26]. The data pre- the earlier study) [26] and also reflects several studies in sented here show a much greater consumption of SSB, 27% Mexico that have drawn attention to the increase in SSB of daily TFI, with 80% of the participants drinking at least consumption and its potential contribution to chronic dis- one serving per day on average, and a lower consumption ease [16, 28–30]. of fruit juice. These differences may be explained by the Mexico is widely considered to have the highest con- present survey being conducted only in an urban area with sumption of SSB in the world [28]. This has been linked to participants from a higher overall SES and therefore greater the transition from traditional nutrition patterns, as shown by purchasing power and easier access to a greater variety of decreased expenditure on fruits and vegetables and a move SSB in terms of proximity to well-stocked local stores in toward more concentrated carbohydrate sources, particularly urban areas of Brazil [33]. SSBs [31]. In a previous study [26], SSB consumption in In Argentina, the contribution of sweet drinks (SSB, A/N Mexico was shown to contribute approximately equally in SSB and juices) to daily TFI has previously been shown to terms of volume to daily TFI as water; in the present study, be greater than that from water [26]; the present survey sug- SSB consumption was higher than water intake. However, gested that slightly more water was consumed proportion- in 2014 Mexico introduced a tax aimed at reducing SSB ally. This was also found to be the case for adults in Uruguay consumption, which is predicted to result in a significant who were not included in the previous study. However, these reduction in diabetes and cardiovascular disease [32]. differences are small and may be due to variations in the 1 3 Uruguay Argentina Brazil Mexico (n=554) (n=1089) (n=477) (n=1677) European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 S73 study populations; the same validated methodology was used future public health and health-care policy in these emerging and therefore such differences cannot be methodical in ori- middle-income countries [36]. gin. In the present study, Argentina and Uruguay had similar Acknowledgements Participant recruitment and data collection in all drinking preferences, which were die ff rent from Mexico and countries were performed by IPSOS. Brazil in having fewer participants who drank one or more servings of SSB per day and had high maté consumption. Compliance with ethical standards The data from the present study are strengthened by the large numbers of participants and the fact that they were Conflict of interest CM and IG are full-time employees of Danone Re- collected using a validated fluid intake diary, the Liq.In search. JS-S, LAM, SAK, JG and HM are members of the advisory board on fluid intake of Danone Research and have received consultan- record [20], which has been shown to produce accurate and cies from Danone Research. SAK was a scientific consultant for Quest reliable data. The use of harmonized survey methodology Diagnostics and has active research grants from Danone Research. JS- and comparable populations, similar in age and gender, has S, EC and LAM have received consultancies from Danone. SA, JLA allowed direct and meaningful comparisons between the and CP report no conflicts of interest. countries to be made. However, the limitations of the study Ethical approval All data were recorded anonymously. The protocol must be acknowledged. Like all diary assessment method- of the surveys was reviewed and approved by the Institutional Review ologies, the Liq.In record creates a situation that focuses Board, Office of Research Compliance of the University of Arkansas the participants’ attention on the data being collected and (IRB Protocol # 14-12-376). may therefore distort intake. A more valid limitation is the Informed consent All the participants gave their consent prior to the possible bias from having included only one city in Bra- inclusion in the study. zil, which may account for some of the differences reported here and the previous Liq.In study [26]. In addition, data Open Access This article is distributed under the terms of the Crea- on food intake were not collected, and therefore informa- tive Commons Attribution 4.0 International License (http://creat iveco tion on food moisture was not avaialble. As a result, it is not mmons.or g/licenses/b y/4.0/), which permits unrestricted use, distribu- possible to show whether or not individuals within the lower tion, and reproduction in any medium, provided you give appropriate quartiles of TFI compensated by eating high moisture foods. credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. However, a recent study has shown that low drinkers are unlikely to compensate for low water intakes in this manner [34]. Additionally, hydration markers were not included in the study; therefore, it is not possible to draw conclusions References about the hydration status of these populations. In the pre- 1. Sawka MN, Cheuvront SN, Carter R III (2005) Human water sent study, height and weight were self-reported, as is com- needs. Nutr Rev 63(6 Pt 2):S30–S39 mon in epidemiological studies, and therefore are likely to 2. Perrier ET, Bottin JH, Vecchio M, Lemetais G (2017) Criterion underestimate overweight and obesity [35]. A considerable values for urine-specific gravity and urine color representing ade - proportion (up to 22%) of participants did not report their quate water intake in healthy adults. Eur J Clin Nutr 71(4):561– 563. https ://doi.org/10.1038/ejcn.2016.269 BMI in Mexico. 3. Perrier E, Vergne S, Klein A, Poupin M, Rondeau P, Le Bellego L, Armstrong LE, Lang F, Stookey J, Tack I (2013) Hydration biomarkers in free-living adults with different levels of habitual Conclusions fluid consumption. Br J Nutr 109(9):1678–1687. https ://doi. org/10.1017/S0007 11451 20036 01 4. Enhörning S, Struck J, Wirfält E, Hedblad B, Morgenthaler NG, The present study reports data from large surveys conducted Melander O (2011) Plasma copeptin, a unifying factor behind the on adults in four Latin American countries, namely, Argen- metabolic syndrome. J Clin Endocrinol Metab 96:E1065–E1072 tina, Brazil, Mexico and Uruguay, using the same methodol- 5. Enhorning S, Hedblad B, Nilsson PM, Engstrom G, Melander O (2015) Copeptin is an independent predictor of diabetic heart ogy. It extends the present knowledge of fluid and types of disease and death. Am Heart J 169(4):549–556 e541. https ://doi. fluid consumed and compared TFI to recommendations for org/10.1016/j.ahj.2014.11.020 AI of water from fluids [9 ]. The majority of adults did not 6. Lemetais G, Melander O, Vecchio M, Bottin JH, Enhorning S, drink as much fluid as is recommended. The intake of SSB Perrier ET (2017) Effect of increased water intake on plasma copeptin in healthy adults. Eur J Nutr. https ://doi.org/10.1007/ remains high, further increasing the risk of obesity [11], s0039 4-017-1471-6 type 2 diabetes [12] and cardiovascular disease [13]. While 7. Ferreira-Pego C, Guelinckx I, Moreno LA, Kavouras SA, Gandy policies are being implemented in some Latin American J, Martinez H, Bardosono S, Abdollahi M, Nasseri E, Jarosz A, countries to reduce SSB intake and increase water consump- Babio N, Salas-Salvado J (2015) Total fluid intake and its deter - minants: cross-sectional surveys among adults in 13 countries tion, data presented here provide further insight into TFI worldwide. Eur J Nutr 54(Suppl 2):35–43. https: //doi.org/10.1007/ and type of fluid consumed and may aid monitoring of the s0039 4-015-0943-9 policy changes. This, and similar studies, will help to guide 1 3 S74 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 8. EFSA Panel on Dietetic Products Nutrition and Allergies (NDA) 23. WHO (2000) BMI classification. WHO. http://apps.who.int/bmi/ (2010) Scientific opinion on dietary reference values for water. index .jsp?intro Page=intro _3.html. Accessed Dec 2017 EFSA J 8(3):1459–1507. https://doi.or g/10.2903/j.efsa.2010.1459 24. Imamura F, O’Connor L, Ye Z, Mursu J, Hayashino Y, Bhupathi- 9. Institute of Medicine, Food and Nutrition Board (2004) Dietary raju SN, Forouhi NG (2015) Consumption of sugar sweetened Reference Intakes for water, potassium, sodium, chloride and sul- beverages, artificially sweetened beverages, and fruit juice and fate. National Academies Press, Washington DC. https ://www. incidence of type 2 diabetes: systematic review, meta-analysis, nap.edu/read/10925 /chapt er/1. Accessed Apr 2018 and estimation of population attributable fraction. BMJ 351:h3576 10. Fisberg M, Kovalskys I, Gomez G, Rigotti A, Cortes LY, Herrera- 25. InterAct Consortium, Romaguera D, Norat T, Wark PA, Vergnaud Cuenca M, Yepez MC, Pareja RG, Guajardo V, Zimberg IZ, Chia- AC, Schulze MB, van Woudenbergh GJ, Drogan D, Amiano P, vegatto Filho ADP, Pratt M, Koletzko B, Tucker KL, Group ES Molina-Montes E, Sanchez MJ, Balkau B, Barricarte A, Beulens (2016) Latin American Study of Nutrition and Health (ELANS): JW, Clavel-Chapelon F, Crispim SP, Fagherazzi G, Franks PW, rationale and study design. BMC Public Health 16:93. https: //doi. Grote VA, Huybrechts I, Kaaks R, Key TJ, Khaw KT, Nilsson P, org/10.1186/s1288 9-016-2765-y Overvad K, Palli D, Panico S, Quiros JR, Rolandsson O, Sacer- 11. Hu FB, Malik VS (2010) Sugar-sweetened beverages and dote C, Sieri S, Slimani N, Spijkerman AM, Tjonneland A, Tormo risk of obesity and type 2 diabetes: epidemiologic evidence. MJ, Tumino R, van den Berg SW, Wermeling PR, Zamara-Ros R, Physiol Behav 100(1):47–54. https ://doi.or g/10.1016/j.ph y sb Feskens EJ, Langenberg C, Sharp SJ, Forouhi NG, Riboli E, Ware- eh.2010.01.036 ham NJ (2013) Consumption of sweet beverages and type 2 diabetes 12. Malik VS, Pan A, Willett WC, Hu FB (2013) Sugar-sweetened incidence in European adults: results from EPIC-InterAct. Diabeto- beverages and weight gain in children and adults: a systematic logia 56(7):1520–1530. https://doi.or g/10.1007/s00125-013-2899-8 review and meta-analysis. Am J Clin Nutr 98(4):1084–1102. https 26. Guelinckx I, Ferreira-Pego C, Moreno LA, Kavouras SA, Gandy J, ://doi.org/10.3945/ajcn.113.05836 2 Martinez H, Bardosono S, Abdollahi M, Nasseri E, Jarosz A, Ma 13. Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB G, Carmuega E, Babio N, Salas-Salvado J (2015) Intake of water (2009) Sweetened beverage consumption and risk of coronary and different beverages in adults across 13 countries. Eur J Nutr heart disease in women. Am J Clin Nutr 89(4):1037–1042. https 54(Suppl 2):S45–S55. https://doi.or g/10.1007/s00394-015-0952-8 ://doi.org/10.3945/ajcn.2008.27140 27. Strippoli GF, Craig JC, Rochtchina E, Flood VM, Wang JJ, Mitch- 14. Singh GM, Micha R, Khatibzadeh S, Shi P, Lim S, Andrews ell P (2011) Fluid and nutrient intake and risk of chronic kidney KG, Engell RE, Ezzati M, Mozaffarian D, Global Burden of Dis- disease. Nephrology (Carlton) 16(3):326–334. https ://doi.org/10 eases N, Chronic Diseases Expert G (2015) Global, regional, and .1111/j.1440-1797.2010.01415 .x national consumption of sugar-sweetened beverages, fruit juices, 28. Barquera S, Campos I, Rivera JA (2013) Mexico attempts to tackle and milk: a systematic assessment of beverage intake in 187 coun- obesity: the process, results, push backs and future challenges. tries. PLoS One 10(8):e0124845. https ://doi.org/10.1371/journ Obes Rev 14 (Suppl 2):69–78. https://doi.or g/10.1111/obr.12096 al.pone.01248 45 29. Barquera S (2010) The Mexican experience: from public health 15. NCD Risk Factor Collaboration (NCD-RisC) (2017) Worldwide concern towards national beverage guidelines. Nutr Today trends in body-mass index, underweight, overweight, and obesity 45(6):S18–S21 from 1975 to 2016: a pooled analysis of 2416 population-based 30. Barquera S, Hernandez-Barrera L, Tolentino ML, Espinosa J, Ng measurement studies in 128.9 million children, adolescents, and SW, Rivera JA, Popkin BM (2008) Energy intake from bever- adults. Lancet 390 (10113):2627–2642. https ://doi.org/10.1016/ ages is increasing among Mexican adolescents and adults. J Nutr S0140 -6736(17)32129 -3 138(12):2454–2461. https ://doi.org/10.3945/jn.108.09216 3 16. Heisler M, Kaselitz E, Rana GK, Piette JD (2016) Diabetes pre- 31. Rivera JA, Barquera S, Campirano F, Campos I, Safdie M, Tovar vention interventions in Latin American countries: a scoping V (2002) Epidemiological and nutritional transition in Mexico: review. Curr Diab Rep 16(9):80. https ://doi.org/10.1007/s1189 rapid increase of non-communicable chronic diseases and obe- 2-016-0778-7 sity. Public Health Nutr 5(1A):113–122. https ://doi.org/10.1079/ 17. Severi C, Moratorio X (2014) Double burden of undernutrition PHN20 01282 and obesity in Uruguay. Am J Clin Nutr 100(6):1659S–1662S. 32. Sanchez-Romero LM, Penko J, Coxson PG, Fernandez A, Mason https ://doi.org/10.3945/ajcn.114.08380 8 A, Moran AE, Avila-Burgos L, Odden M, Barquera S, Bibbins- 18. Lotufo PA (2016) Knowing for whom the bell tolls: acting locally Domingo K (2016) Projected impact of Mexico’s sugar-sweet- and thinking globally. Brazil, Latin America and the Global Bur- ened beverage tax policy on diabetes and cardiovascular disease: den of Diseases, 2015. Sao Paulo Med J 134(6):469–472. https:// a modeling study. PLoS Med 13(11):e1002158. https ://doi. doi.org/10.1590/1516-3180.2016.13461 71016 org/10.1371/journ al.pmed.10021 58 19. Marquez-Sandoval F, Macedo-Ojeda G, Viramontes-Horner D, 33. Duran AC, de Almeida SL, Latorre Mdo R, Jaime PC (2016) The Fernandez Ballart JD, Salas Salvado J, Vizmanos B (2011) The role of the local retail food environment in fruit, vegetable and sugar- prevalence of metabolic syndrome in Latin America: a system- sweetened beverage consumption in Brazil. Public Health Nutr atic review. Public Health Nutr 14(10):1702–1713. https ://doi. 19(6):1093–1102. https ://doi.org/10.1017/S1368 98001 50015 24 org/10.1017/S1368 98001 00033 20 34. Guelinckx I, Tavoularis G, Konig J, Morin C, Gharbi H, Gandy J 20. Johnson EC, Peronnet F, Jansen LT, Capitan-Jimenez C, Adams (2016) Contribution of water from food and fluids to total water JD, Guelinckx I, Jimenez L, Mauromoustakos A, Kavouras SA intake: analysis of a French and UK population surveys. Nutrients (2017) Validation testing demonstrates efficacy of a 7-day fluid 8(10):630. https ://doi.org/10.3390/nu810 0630 record to estimate daily water intake in adult men and women 35. Engstrom JL, Paterson SA, Doherty A, Trabulsi M, Speer KL when compared with total body water turnover measurement. J (2003) Accuracy of self-reported height and weight in women: an Nutr 147(10):2001–2007. https ://doi.org/10.3945/jn.117.25337 7 integrative review of the literature. J Midwifery Womens Health 21. Asociación Mexicana de Inteligencia de Mercado y Opinión 48(5):338–345 (AMAI) (2016) Mexico. Niveles Socioeconómicos http://nse. 36. Nakhimovsky SS, Feigl AB, Avila C, O’Sullivan G, Macgregor- amai.org/. Accessed Jan 2018 Skinner E, Spranca M (2016) Taxes on sugar-sweetened bever- 22. Associacao Brasileira de Empresas de Pesquisa. Brazilian Criteria ages to reduce overweight and obesity in middle-income coun- tries: a systematic review. PLoS One 11(9):e0163358. https://doi. 2015 and social class distribution update for 2016 (2018) Brazil. org/10.1371/journ al.pone.01633 58 http://www.abep.org. Accessed Jan 2018 1 3 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 S75 Affiliations 1 2 3,4 5 6 6 7,8 H. Martinez  · C. Morin  · J. Gandy  · E. Carmuega  · J. L. Arredondo  · C. Pimentel  · L. A. Moreno  · 9,10 8,11 2 S. A. Kavouras  · J. Salas‑Salvadó  · I. Guelinckx 1 8 Hospital Infantil de México Federico Gómez, Mexico City, CIBERobn (Centro de Investigación Biomédica en Red Mexico Fisiopatología de la Obesidad y Nutrición), Institute of Health Carlos III, Madrid, Spain Department of Hydration and Health, Danone Research, Route Départemental 128, 91767 Palaiseau, France Hydration Science Lab, University of Arkansas, Fayetteville, AR, USA British Dietetic Association, Birmingham, UK Division of Endocrinology, University of Arkansas School of Life and Medical Sciences, University for Medical Sciences, Little Rock, AR, USA of Hertfordshire, Hatfield, UK Human Nutrition Unit, Biochemistry and Biotechnology Center of Studies on Infant Nutrition (CESNI) Buenos Aires, Department, Faculty of Medicine and Health Sciences, Buenos Aires, Argentina Hospital Universitari de Sant Joan de Reus, IISPV (Institut Unidad de Apoyo a la Investigación Clínica, Instituto d’Investigació Sanitària Pere Virgili), Universitat Rovira i Nacional de Pediatría, Mexico City, Mexico Virgili, Reus, Spain GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto Investigación Sanitaria Aragón (IIS Aragón) Zaragoza, Zaragoza, Spain 1 3 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Nutrition Springer Journals

Fluid intake of Latin American adults: results of four 2016 Liq.In7 national cross-sectional surveys

Free
11 pages
Loading next page...
 
/lp/springer_journal/fluid-intake-of-latin-american-adults-results-of-four-2016-liq-in7-yEfjVawIkK
Publisher
Springer Berlin Heidelberg
Copyright
Copyright © 2018 by The Author(s)
Subject
Chemistry; Nutrition
ISSN
1436-6207
eISSN
1436-6215
D.O.I.
10.1007/s00394-018-1724-z
Publisher site
See Article on Publisher Site

Abstract

Purpose To report total fluid intake (TFI) and the intake of different fluid types in adults (≥ 18 years old) from Mexico, Argentina, Brazil and Uruguay. To compare intakes between countries and with recommended adequate intake (AI) of water from fluids. Methods Cross-sectional data were collected using a validated liquid intake 7-day record (Liq.In ) in populations from Argentina (n = 1089), Brazil (n = 477), Mexico (n = 1677) and Uruguay (n = 554). Population characteristics, including age, gender, body mass index and socioeconomic level were recorded. Mean TFI was compared with the AI of water from fluids set by the USA Institute of Medicine. Results The lowest TFI was recorded in Mexican women (1748 mL/day) and the highest in Argentinean men (2318 mL/ day). Median daily TFI was significantly different between countries; Uruguay and Argentina had higher values than Mexico and Brazil. In the former, plain water contributed to only 25% of TFI, the remainder being predominantly from hot bever- ages. Approximately, a third of adults did not drink enough fluid to meet the recommended AI. High SSB consumption was reported, which was significantly different between countries (p < 0.05), the highest being in Mexico (median 25–75th percentiles): 531 (300–895 mL/day. Conclusions This survey highlights the need to increase water consumption and reduce SSB intake in this region to avoid potential associated health risks. These findings may be useful information in monitoring public health policy strategies. Keywords Beverages · Fluid intake · Hydration · Liq.In  · Water · Argentina · Brazil · Mexico · Uruguay Introduction anti-diuretic hormone responsible for fluid homeostasis and urine concentration [3]. Increased levels of copeptin have The role of water consumption and optimal body hydration been linked to cardiometabolic diseases such as type 2 dia- is becoming a subject of great scientific interest. While the betes and heart disease [4, 5]. In addition, increasing water effects of severe dehydration are well documented, [1 ] it intake has been shown to attenuate copeptin levels [6]. is only recently that the effects of low water consumption It is therefore a concern that a significant proportion of are being investigated. Regular low (< 1.2 L/day) drinkers adults in Latin American countries have been shown to con- are able to maintain normal plasma osmolality by reduc- sume less than the recommended intake of water from fluids ing body water losses via urine; this results in low, highly [7]. In a survey of 13 countries worldwide, 57% of Mexican concentrated urinary output [2]. Low drinkers may have adults did not meet the recommended intake levels; 41% of increased levels of copeptin, a precursor of vasopressin, the Brazilian adults and 36% of Argentinian adults were also shown to consume less than the recommendations [7]. In this former analysis, the European Food Safety Authority Electronic supplementary material The online version of this (EFSA) reference values for total water intake [8], adjusted article (https ://doi.org/10.1007/s0039 4-018-1724-z) contains supplementary material, which is available to authorized users. to account for water from food, were used, as countries from all around the world were included. In addition, the EFSA * I. Guelinckx recommendations are more conservative than the reference isabelle.guelinckx@danone.com values set by the USA Institute of Medicine (IOM) [9] and Extended author information available on the last page of the article Vol.:(0123456789) 1 3 S66 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 therefore unlikely to overestimate the number of people not participants’ city of residence. Recruitment of participants in adhering to recommendations. Country-specific recommen- each country was performed via a door-to-door recruitment dations for water intake are not available in Latin American until suitable quotas for age, gender, region and socioeco- countries. Therefore, for future comparisons it would be nomic characteristics, in relation to the total country popu- more appropriate to use the adequate intake of water set by lation, were met. To determine the socioeconomic status the USA IOM [9], in line with other Latin American stud- (SES) of participants, the Asociación Mexicana de Agencias ies [10]. It is now apposite to resurvey fluid consumption in de Investigación de Mercado y Opinión Pública (AMAI) Latin American countries and, as only countries from this system was used in Mexico, Argentina and Uruguay, and region were surveyed, to use the IOM recommendations [9] the ABEP classification in Brazil [21, 22]. Both systems use for comparison purposes. a combination of the following criteria to determine SES: In addition to the links between low fluid consumption work status, occupation, education, medical coverage, num- and chronic diseases, the type of fluids consumed is also ber of domestic servants, number of bathrooms, household important. In particular, the consumption of sugar-sweet- equipment, ownership of an international credit card and/ ened beverages (SSB) has been shown to be linked to obesity or access to public services (e.g., water, type of street). For [11], type 2 diabetes [12] and cardiovascular disease [13]. data analysis, SES classes were harmonized as detailed in Consumption of SSB in Latin America is among the high- supplementary table S1. est in the world [14]. Given the increasing levels of obesity Only one individual per household was eligible to partici- in Latin America, this raises additional cause for concern pate. Apparently healthy individuals were eligible, except [15]. The average body mass index (BMI) of Latin Ameri- individuals working in any capacity in a company associated cans increased twice as fast as the global average between with the manufacture, distribution and/or sale of water and 1980 and 2008, with 70% of Mexicans now considered any other kind of beverage were excluded from participa- either overweight or obese [16]. Unsurprisingly, this has tion. Pregnancy and/or lactation were not exclusion criteria. been accompanied by a rapid increase in associated con- ditions such as type 2 diabetes, metabolic syndrome and Ethical considerations cardiovascular disease [17–19]. It is vital that policy makers understand the drivers behind this epidemic and how best The survey protocol was reviewed and approved by the Uni- to intervene to change behaviors in view of the societal and versity of Arkansas Review Board (ref. 14-12-376). After financial costs of such widespread health problems. receiving a detailed description of the study and its objec- There is a lack of information in relation to the amount tives, following the principles of informed consent, partici- and type of fluids consumed around the world and specifi- pants gave oral approval of their willingness to be included. cally in Latin America. Therefore, the primary aim of the No monetary incentive was offered for taking part in the present study was to report total fluid intake (TFI) and intake study. All data were recorded anonymously. of different fluid types of adults (≥ 18 years) in Argentina, Brazil, Mexico and Uruguay, using a validated 7-day fluid Anthropometry record (the Liq.In diary) [20]. The secondary aims were to make between-country comparisons and association with Height (m) and weight (kg) were self-reported by partici- the IOM recommendations on adequate intake (AI) of water pants; BMI was calculated as kg/m [23]. from fluids [9 ]. Assessment of total fluid intake and its composition Methods Participants were provided with the Liq.In record, a 7-day fluid-specific record validated for accuracy and reliability Design and study population [20] in the official language of the country. Before the sur - vey began, the researcher explained how to complete the The present analysis reports cross-sectional surveys of adults record in an initial face-to-face interview in the participant’s (≥ 18 years) in four Latin America countries: Argentina, home. After a period of 7 days, the record was collected by Brazil, Mexico and Uruguay. The method of recruitment, the researcher and checked for completion with the partici- the instruments for data collection and data treatment were pant. The Liq.In is structured around times of the day from harmonized across the surveys. The data collection was waking up, meal times (breakfast, lunch, dinner), periods performed between March and May 2016 in urban areas in between meals (morning, before lunch/aperitif, afternoon, different regions of Argentina, Mexico and Uruguay. For tea break, before dinner/aperitif, just before going to bed) Brazil, data were only collected in the City of São Paulo and during the night. The participants were instructed to between November and December 2016. Figure  1 shows report all drinking events at any moment of the day with 1 3 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 S67 Fig. 1 Map showing the cities in each country from where participants were recruited the following details: the fluid type, the volume consumed, influenced median daily TFI. An individual was defined as the size of the container from which it was drunk, where it a consumer of a certain fluid type if this fluid type was con- was consumed and whether food was also consumed. How- sumed at least once during the 7-day period. Individual’s ever, the type of food consumed was not reported. To assist daily TFI was compared with the adequate intake of water estimation of the amount of fluid consumed, a booklet with from fluids set by the USA IOM [9 ]. To allow comparison pictures of standard fluid containers was provided. with previously published data, the comparison between observed intakes and the recommendations set by EFSA [8] Classification and analysis of the fluid types is also provided in supplementary figure S2. The proportion of individuals drinking ≤ 1 serving Fluids were classified as water (tap and bottled water), milk (250 mL) of SSB per week, 2–6 servings of SSB per week and milk derivatives, hot beverages (coffee, tea and other), and ≥ 1 serving/day intake of SSB per day was calculated. 100% fruit juices, sugar-sweetened beverages (SSB) (car- These cutoffs were obtained from meta-analyses associating bonated soft drinks (CSD), juice-based drinks, functional such levels of intake with potential risks for the develop- beverages such as energy and sports drinks, ready to drink ment of obesity, type 2 diabetes and metabolic syndrome tea and coffee and flavored water), artificial/non-nutritive [12, 24, 25]. sweeteners beverages (A/NSB) (diet/zero/light soft drinks), alcoholic beverages and other beverages. More details are Statistical analysis given in supplementary table  S2. Total fluid intake was defined as the sum of all these categories. In Uruguay and The demographic and anthropometric characteristics of the Argentina, the Liq.In record had a specific code for Maté study population are presented either as means and standard (a hot infusion of Ilex paraguayensis, which is a cultural deviation for continuous variables, or numbers and percent- beverage largely consumed in Southeast Latin America), as ages for dichotomous variables. Due to the skewed distri- previous surveys had indicated that this beverage heavily bution in intake data, as shown in supplementary Figure 1 3 S68 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 S1, TFI is presented as median with percentiles as well as of the adults surveyed in Mexico and Brazil met the rec- mean and standard error of mean. Different fluid types are ommendations. This proportion rose to 37% in Uruguayan recorded as median (50th percentile) [25th–75th percentiles women and 51% for Argentinian women, while only 14 (P25-P75)] and proportion of consumers. The mean [stand- and 20% of men in these countries, respectively, met the ard error of mean (SEM)] of the different fluid types can be recommended AI for water from fluids. In all four coun- found in supplementary table S4a–d. The contribution of tries, women were more likely than men to meet the rec- each fluid type to TFI was calculated using the mean values ommendations. The percentage of adults drinking ≤ 50% of for TFI. Between groups, comparisons were made with a the recommended intake is particularly high, with nearly Wilcoxon rank test for continuous variables. A Bonferroni half of Mexican adult males (47%) failing to meet 50% of post hoc test was used to correct for multiple comparisons. AI. A similar picture was seen in Uruguay and Brazil at All statistical tests were two-tailed and the significance level 37 and 40%, compared with Argentina where 26% of the was set at p < 0.05. All analyses were performed using the male participants had a mean TFI lower than 50% of the SPSS software version 22.0 (SPSS Inc., Chicago, IL) and recommendation. were verified by a statistician. When the median daily TFI was analyzed by type of bev- erage consumed (Table 3; Fig. 3), statistically significant differences (p < 0.05) were seen between the individual Results countries. Total fluid intakes in Mexico and Brazil were similar; Argentina and Uruguay were significantly different The TFI and type of fluids consumed were analyzed for from each other and the other countries. Although Argen- nearly 4000 adults from Argentina (n = 1089), Brazil tina and Uruguay had the highest median TFI in mL/day, (n = 477), Mexico (n = 1677) and Uruguay (n = 554). The the amount of plain water drunk, either bottled or tap, was general characteristics of the study population, by country, less than 400 mL/day, which represents approximately 25% are shown in Table 1. There was a slight predominance of of TFI. Conversely, the majority of daily TFI (≈ 700 mL) female participants (55%). The mean age in each of these was hot beverages (36 and 44% of mean daily TFI, respec- countries was below 40 years and the number of respondents tively), particularly maté (26 and 37% of mean daily TFI, in each age group was similar. The percentage of overweight respectively) unlike in Mexico and Brazil, where less than and obese participants was higher in Brazil, Argentina and 150 mL of median TFI was attributable to hot beverages Mexico than in Uruguay; in Brazil and Mexico approxi- (12% of the mean daily TFI) (Fig. 3). The median TFI and mately 35% of the sample population were of normal weight fluid types for each country, according to gender, are shown compared with more than 65% in Uruguay. With respect in supplementary Tables S4a–d. The total volume of SSB to socioeconomic classification, the Brazilian participants consumed in the four countries was significantly different were all from SESs AB and C. In Argentina and Mexico, from each other (p < 0.05), with Mexico consuming the approximately 60% of the participants were from SESs AB highest volume [531 (300–895) mL/day], approximately a and C; 48% of Uruguayans were from these SESs. third of daily TFI (Fig. 3). This was over twice the amount Table 2 shows the mean (SEM), median (50%) and per- of SSB drunk daily in Uruguay [251 (30–559) mL/day]. In centile TFI (mL/day) for each country according to gender. Brazil, SSB consumption was 409 (195–669) mL/day. In The TFI ranged from 1748 mL/day in Mexican women to addition, over 80% of Brazilian and Mexican adults drank 2318 mL/day in Argentinean women. There was no signifi- one or more servings per day. This was significantly different cant gender difference in TFI in Mexico, Argentina and Uru- from Argentina and Uruguay where 59 and 50% of adults, guay; however, women drank significantly less than men in respectively (p < 0.05), drank one or more servings of SSB Brazil. Between-country comparisons of TFI for each popu- per day. A consumption of ≤ 1 serving of SSB per week was lation are shown in Table 2. The highest median (P25–P75) reported by 6% of Mexican, 4% of Brazilian, 18% of Argen- daily TFI was in Argentina, 2133 (1524–2865) mL/day, with tinean and 23% of Uruguayan adults (Fig. 4). Mexico having the lowest intake, 1496 (1069–2150) mL/day. Figure 3 shows the contribution of each beverage type There were significant differences in median TFI between to the daily TFI. Supplementary Fig. S3 shows these data the countries. Both Uruguay and Argentina consumed sig- according to gender and country. Mexican adults have nificantly more fluid per day than Mexico and Brazil, TFI median milk and derivatives (8% of mean daily TFI) twice was also significantly higher in Argentina than in Uruguay. as high as adults in Argentina and Uruguay (3 and 4% of The distribution of these data for each country is given in mean daily TFI, respectively). Brazil consumed more of 250 mL/day (an average serving) intervals in the supplemen- 100% fruit juice than the other three countries, and Uru- tary data (Fig. S1). guay and Mexico recorded very low alcohol consumption. When compared with the IOM recommendations One interesting difference is in the contribution of A/NSB (adjusted for water from food) [9] (Fig. 2), only 10–25% which is much higher in Argentina and Uruguay (7 and 5%, 1 3 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 S69 1 3 Table 1 Demographic and anthropometric characteristics of the study population, by country Country Mexico (n = 1677) Brazil (n = 477) Argentina (n = 1089) Uruguay (n = 554) Sample size (N, %)  Men 746 (44) 224 (47) 464 (43) 278 (50)  Women 931 (56) 253 (53) 625 (57) 276 (50) Age (years) 37.6 ± 13.1 39.5 ± 14.0 38.5 ± 13.3 37.7 ± 13.3 Age group  18–25 years 397 (24) 98 (21) 234 (21) 135 (24)  26–35 years 411 (25) 108 (23) 277 (25) 124 (22)  36–50 years 553 (33) 142 (30) 329 (30) 167 (30)  > 50 years 316 (19) 129 (27) 249 (23) 128 (23) Weight (kg) 71.4 ± 14.0 75.9 ± 16.2 72.7 ± 15.8 73.3 ± 22.7 Height (m) 1.6 ± 0.1 1.7 ± 0.1 1.7 ± 0.1 1.7 ± 0.1 2 a BMI (kg/m ) 26.7 ± 4.9 27.0 ± 6.8 26.0 ± 5.6 25.7 ± 10.3 Socioeconomic level (N, %)  AB 125 (7) 210  (56) 14 (1) 90 (16)  C 859 (41) 267  (44) 640 (59) 247 (45)  D 693 (51) ND ND 435 (40) 217 (39) BMI body mass index, ND no data Represented as mean ± standard deviation BMI classification for adults was reported according to WHO [23] S70 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 Table 2 Daily total fluid intake Country Gender N (%) Mean ± SEM Percentiles (mL/day) for adults (≥ 18 years) by country and gender 5 10 25 50 75 90 95 Mexico Men 746 (44) 1762 ± 35 649 771 1083 1543 2172 3003 3668 Women 931 (56) 1748 ± 33 624 743 1049 1469 2145 3129 3906 Brazil Men 224 (47) 1968 ± 71 698 867 1187 1701 2536 3390 4453 Women 253 (53) 1693 ± 57 589 718 1053 1479 2228 2846 3250 Argentina Men 464 (43) 2210 ± 47 772 985 1466 2092 2838 3532 4111 Women 625 (57) 2318 ± 42 885 1097 1563 2174 2884 3725 4392 Uruguay Men 278 (50) 1979 ± 59 622 805 1224 1833 2594 3329 3797 Women 276 (50) 2018 ± 62 666 812 1177 1884 2593 3309 4272 d,e Mexico 1677 1754 ± 24 628 753 1060 1496 2150 3079 3817 d,e Brazil 477 1822 ± 46 625 790 1098 1568 2333 3102 3683 b,c,e Argentina 1089 2272 ± 31 821 1060 1524 2133 2865 3630 4270 b,c,d Uruguay 554 1999 ± 43 638 811 1194 1873 2593 3311 3916 SEM standard error of the mean Wilcoxon test was used for gender comparisons, and Wilcoxon signed-rank test (p < 0.05) was used for between country comparisons Significantly different from Mexico Significantly different from Brazil Significantly different from Argentina Significantly different from Uruguay Fig. 2 Percentage (%) of adults Total 37% 29% 16% 18% having adequate intakes (AI) Men 47% 29% 14% 10% of water from fluids set by the Women 28% 30% 18% 24% Institute of Medicine [9] based Total 34% 28% on the 7-day mean of each 17% 21% participant Men 40% 28% 17% 15% Women 29% 28% 18% 25% ≤50% AI Total 17% 50-75% AI 23% 22% 38% 75-100% AI Men 26% 30% 24% 20% ≥100% AI Women 10% 19% 21% 51% Total 29% 21% 24% 26% Men 37% 25% 24% 14% Women 21% 17% 24% 37% 0% 20%40% 60%80% 100% Percentage of participants respectively) compared with Brazil and Mexico where these TFI. Approximately, 75% of the study population did not make up only 1% of the mean TFI. meet the IOM AI for water from fluids [9 ]; 18% of Mexi- cans, 21% of Brazilians, 38% of Argentinians and 26% of Uruguayans met the IOM recommendations. In the previous Discussion study when the EFSA recommendations were used [7], 43% of Mexicans, 58% of Brazilians and 64% of Argentinians The data collected in these surveys extends and enriches were shown to adhere to the recommendations [8]. Given the information reported previously [7, 26] by focusing spe- the higher AIs for adults from IOM, compared with EFSA, cifically on countries in the Latin American region and, for is it not surprising that the present study found that fewer the first time, including data from a Uruguayan population. participants met the recommendations. The earlier study had Using the validated Liq.In diary [20], the ranking of the used the EFSA recommendations to facilitate comparisons three countries in terms of TFI is the same as previously between the 13 different countries included in the study not shown [7, 26], with Argentina having the highest mean daily to overestimate non-adherence. In the present study, almost 1 3 Uruguay Argentina Brazil Mexico (n=554) (n=1089) (n=477) (n=1677) European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 S71 Table 3 Median (P25–P75) daily intake (mL/day) of different fluid types and the percentage of consumers among adults (≥ 18 years), by country Mexico (n = 1677) Brazil (n = 477) Argentina (n = 1089) Uruguay (n = 554) Median (P25– % Consumers Median (P25– % Consumers Median (P25– % Consumers Median (P25– % Consumers P75) P75) P75) P75) Water 450 (180– 90 599 (349– 100 386 (96– 84 325 (129– 89 b,c,d a,c,d a,b a,b 900) 1004) 855) 721)  Bottled water 390 (120–831) 86 11 (0–311) 52 0 (0–240) 45 214 (0–596) 68  Tap water 0 (0–0) 18 357 (92–736) 84 129 (0-493) 63 0 (0–109) 36 b,c,d a,c,d a,b,d a,b,c Milk and 60 (0–186) 62 34 (0–117) 57 0 (0–46) 32 0 (0–125) 38 derivatives Hot beverages 121 74 150 (51– 88 732 (431– 98 699 (184– 86 b,c,d a,c,d a,b a,b (0–286) 263) 1136) 1356)  Coffee 81 (0–250) 68 131 (35–250) 84 71 (0–241) 63 0 (0–129) 41  Tea 0 (0–9) 25 0 (0–0) 23 0 (0–94) 40 0 (0–0) 21  Mate ND ND ND ND 488 (146–900) 82 514 (0–1204) 63  Other hot ND ND ND ND ND ND 0 (0–0) 1 beverages SSB 531 (300– 94 409 (195– 95 338 (82– 82 215 (30– 77 b,c,d a,c,d a,b,d a,b,c 895) 669) 754) 559) CSD 171 (0–390) 75 168 (36–353) 80 107 (0–366) 65 50 (0–343) 55  Juice-based 17 (0–161) 52 118 (28–275) 79 0 (0–137) 40 0 (0–20) 26 drinks  Functional 0 (0–0) 13 0 (0–0) 13 0 (0–0) 8 0 (0–0) 7 beverages  RTD tea and 0 (0–0) 19 0 (0–0) 20 0 (0–0) 2 0 (0–0) 1 coffee  Flavored 99 (0–300) 66 0 (0–0) 18 0 (0–50) 29 0 (0–0) 20 water b,c,d a,c,d a,b a,b 100% fruit 0 (0–0) 23 50 (0–165) 65 0 (0–0) 15 0 (0–0) 13 juices b,c,d a,c,d a,b,d a,b,c A/NSB 0 (0–0) 13 0 (0–0) 22 0 (0–154) 41 0 (0–110) 33 b,c,d a,d a,d a,b,c Alcoholic 0 (0–0) 13 0 (0–202) 47 0 (0–150) 47 0 (0–0) 24 beverages b,c a,c a,b,d c Other bever- 0 (0–0) 7 0 (0–0) 10 0 (0–0) 3 0 (0–0) 7 ages SSB sugar-sweetened beverages, CSD carbonated sweetened drinks, RTD ready to drink, A/NSB Artificial/non-nutritive sweeteners beverages, ND no data Wilcoxon signed-rank test (p < 0.05) to compare countries Significantly different from Mexico Significantly different from Brazil Significantly different from Argentina Significantly different from Uruguay 40% of adults in Mexico drank less than 50% of the IOM Analysis of the type of fluid that contributed to the AI, which must be considered a concern and merits further mean daily TFI clustered these Latin American countries investigation. A high proportion of adults from each of the into pairs; Mexico and Brazil vs. Argentina and Uruguay. four countries failed to meet at least 50% of IOM-recom- Over 80% of adults surveyed in Mexico and Brazil con- mended intakes, particularly men. It is not possible to draw sumed one or more servings of SSB daily, and in Mexico conclusions about the hydration status of the participants, as the amount of SSB consumed daily exceeded the amount no hydration biomarkers were included in the study. How- of water consumed, whereas in Argentina and Uruguay ever, a proportion of participants would probably be con- these figures were lower, 59 and 50%, respectively. In all sidered low drinkers and therefore may be at increased risk countries, carbonated sweetened drinks (CSDs) were the of cardiometabolic diseases [4, 5] and renal disease [27]. most frequently consumed SSB. This pattern of high SSB 1 3 S72 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 Fig. 3 Contribution of dif- Mexico ferent fluid types (%) to total 38% 8% 12% 2% 37% 1% (n=1677) fluid intake among adults (≥ 18 years), by country Water Brazil 42% 5% 11% 27% 6% 1% 8% Milk & derivatives (n=477) Hot beverages SSB 100% fruit juices Argentina 26% 3% 36% 21% 1% 7% 6% (n=1089) A/NSB Alcoholic beverages Other beverages Uruguay 25% 4% 44% 1% 5% 18% 2% (n=554) 0% 10%20% 30%40% 50%60% 70%80% 90%100% Contribution of each fluid types to TFI (%) Fig. 4 Percentage (%) of adults ≤ 1 serving per week 2-6 serving per day ≥ 1 serving per day drinking SSB daily, or less frequently, by country Total 6% 13% 82% Men 4% 11% 85% Women 7% 14% 80% Total 4% 16% 81% Men 4% 14% 82% Women 4% 17% 79% Total 18% 23% 59% Men 14% 23% 63% Women 22% 23% 56% Total 23% 27% 50% Men 23% 28% 49% Women 22% 25% 52% 0% 10%20% 30%40% 50%60% 70%80% 90%100% Percentage of participants (%) consumption is similar to that found in a previous sur- Interesting differences were seen between the present data vey in these populations (Uruguay was not included in for Brazil and those collected previously [26]. The data pre- the earlier study) [26] and also reflects several studies in sented here show a much greater consumption of SSB, 27% Mexico that have drawn attention to the increase in SSB of daily TFI, with 80% of the participants drinking at least consumption and its potential contribution to chronic dis- one serving per day on average, and a lower consumption ease [16, 28–30]. of fruit juice. These differences may be explained by the Mexico is widely considered to have the highest con- present survey being conducted only in an urban area with sumption of SSB in the world [28]. This has been linked to participants from a higher overall SES and therefore greater the transition from traditional nutrition patterns, as shown by purchasing power and easier access to a greater variety of decreased expenditure on fruits and vegetables and a move SSB in terms of proximity to well-stocked local stores in toward more concentrated carbohydrate sources, particularly urban areas of Brazil [33]. SSBs [31]. In a previous study [26], SSB consumption in In Argentina, the contribution of sweet drinks (SSB, A/N Mexico was shown to contribute approximately equally in SSB and juices) to daily TFI has previously been shown to terms of volume to daily TFI as water; in the present study, be greater than that from water [26]; the present survey sug- SSB consumption was higher than water intake. However, gested that slightly more water was consumed proportion- in 2014 Mexico introduced a tax aimed at reducing SSB ally. This was also found to be the case for adults in Uruguay consumption, which is predicted to result in a significant who were not included in the previous study. However, these reduction in diabetes and cardiovascular disease [32]. differences are small and may be due to variations in the 1 3 Uruguay Argentina Brazil Mexico (n=554) (n=1089) (n=477) (n=1677) European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 S73 study populations; the same validated methodology was used future public health and health-care policy in these emerging and therefore such differences cannot be methodical in ori- middle-income countries [36]. gin. In the present study, Argentina and Uruguay had similar Acknowledgements Participant recruitment and data collection in all drinking preferences, which were die ff rent from Mexico and countries were performed by IPSOS. Brazil in having fewer participants who drank one or more servings of SSB per day and had high maté consumption. Compliance with ethical standards The data from the present study are strengthened by the large numbers of participants and the fact that they were Conflict of interest CM and IG are full-time employees of Danone Re- collected using a validated fluid intake diary, the Liq.In search. JS-S, LAM, SAK, JG and HM are members of the advisory board on fluid intake of Danone Research and have received consultan- record [20], which has been shown to produce accurate and cies from Danone Research. SAK was a scientific consultant for Quest reliable data. The use of harmonized survey methodology Diagnostics and has active research grants from Danone Research. JS- and comparable populations, similar in age and gender, has S, EC and LAM have received consultancies from Danone. SA, JLA allowed direct and meaningful comparisons between the and CP report no conflicts of interest. countries to be made. However, the limitations of the study Ethical approval All data were recorded anonymously. The protocol must be acknowledged. Like all diary assessment method- of the surveys was reviewed and approved by the Institutional Review ologies, the Liq.In record creates a situation that focuses Board, Office of Research Compliance of the University of Arkansas the participants’ attention on the data being collected and (IRB Protocol # 14-12-376). may therefore distort intake. A more valid limitation is the Informed consent All the participants gave their consent prior to the possible bias from having included only one city in Bra- inclusion in the study. zil, which may account for some of the differences reported here and the previous Liq.In study [26]. In addition, data Open Access This article is distributed under the terms of the Crea- on food intake were not collected, and therefore informa- tive Commons Attribution 4.0 International License (http://creat iveco tion on food moisture was not avaialble. As a result, it is not mmons.or g/licenses/b y/4.0/), which permits unrestricted use, distribu- possible to show whether or not individuals within the lower tion, and reproduction in any medium, provided you give appropriate quartiles of TFI compensated by eating high moisture foods. credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. However, a recent study has shown that low drinkers are unlikely to compensate for low water intakes in this manner [34]. Additionally, hydration markers were not included in the study; therefore, it is not possible to draw conclusions References about the hydration status of these populations. In the pre- 1. Sawka MN, Cheuvront SN, Carter R III (2005) Human water sent study, height and weight were self-reported, as is com- needs. Nutr Rev 63(6 Pt 2):S30–S39 mon in epidemiological studies, and therefore are likely to 2. Perrier ET, Bottin JH, Vecchio M, Lemetais G (2017) Criterion underestimate overweight and obesity [35]. A considerable values for urine-specific gravity and urine color representing ade - proportion (up to 22%) of participants did not report their quate water intake in healthy adults. Eur J Clin Nutr 71(4):561– 563. https ://doi.org/10.1038/ejcn.2016.269 BMI in Mexico. 3. Perrier E, Vergne S, Klein A, Poupin M, Rondeau P, Le Bellego L, Armstrong LE, Lang F, Stookey J, Tack I (2013) Hydration biomarkers in free-living adults with different levels of habitual Conclusions fluid consumption. Br J Nutr 109(9):1678–1687. https ://doi. org/10.1017/S0007 11451 20036 01 4. Enhörning S, Struck J, Wirfält E, Hedblad B, Morgenthaler NG, The present study reports data from large surveys conducted Melander O (2011) Plasma copeptin, a unifying factor behind the on adults in four Latin American countries, namely, Argen- metabolic syndrome. J Clin Endocrinol Metab 96:E1065–E1072 tina, Brazil, Mexico and Uruguay, using the same methodol- 5. Enhorning S, Hedblad B, Nilsson PM, Engstrom G, Melander O (2015) Copeptin is an independent predictor of diabetic heart ogy. It extends the present knowledge of fluid and types of disease and death. Am Heart J 169(4):549–556 e541. https ://doi. fluid consumed and compared TFI to recommendations for org/10.1016/j.ahj.2014.11.020 AI of water from fluids [9 ]. The majority of adults did not 6. Lemetais G, Melander O, Vecchio M, Bottin JH, Enhorning S, drink as much fluid as is recommended. The intake of SSB Perrier ET (2017) Effect of increased water intake on plasma copeptin in healthy adults. Eur J Nutr. https ://doi.org/10.1007/ remains high, further increasing the risk of obesity [11], s0039 4-017-1471-6 type 2 diabetes [12] and cardiovascular disease [13]. While 7. Ferreira-Pego C, Guelinckx I, Moreno LA, Kavouras SA, Gandy policies are being implemented in some Latin American J, Martinez H, Bardosono S, Abdollahi M, Nasseri E, Jarosz A, countries to reduce SSB intake and increase water consump- Babio N, Salas-Salvado J (2015) Total fluid intake and its deter - minants: cross-sectional surveys among adults in 13 countries tion, data presented here provide further insight into TFI worldwide. Eur J Nutr 54(Suppl 2):35–43. https: //doi.org/10.1007/ and type of fluid consumed and may aid monitoring of the s0039 4-015-0943-9 policy changes. This, and similar studies, will help to guide 1 3 S74 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 8. EFSA Panel on Dietetic Products Nutrition and Allergies (NDA) 23. WHO (2000) BMI classification. WHO. http://apps.who.int/bmi/ (2010) Scientific opinion on dietary reference values for water. index .jsp?intro Page=intro _3.html. Accessed Dec 2017 EFSA J 8(3):1459–1507. https://doi.or g/10.2903/j.efsa.2010.1459 24. Imamura F, O’Connor L, Ye Z, Mursu J, Hayashino Y, Bhupathi- 9. Institute of Medicine, Food and Nutrition Board (2004) Dietary raju SN, Forouhi NG (2015) Consumption of sugar sweetened Reference Intakes for water, potassium, sodium, chloride and sul- beverages, artificially sweetened beverages, and fruit juice and fate. National Academies Press, Washington DC. https ://www. incidence of type 2 diabetes: systematic review, meta-analysis, nap.edu/read/10925 /chapt er/1. Accessed Apr 2018 and estimation of population attributable fraction. BMJ 351:h3576 10. Fisberg M, Kovalskys I, Gomez G, Rigotti A, Cortes LY, Herrera- 25. InterAct Consortium, Romaguera D, Norat T, Wark PA, Vergnaud Cuenca M, Yepez MC, Pareja RG, Guajardo V, Zimberg IZ, Chia- AC, Schulze MB, van Woudenbergh GJ, Drogan D, Amiano P, vegatto Filho ADP, Pratt M, Koletzko B, Tucker KL, Group ES Molina-Montes E, Sanchez MJ, Balkau B, Barricarte A, Beulens (2016) Latin American Study of Nutrition and Health (ELANS): JW, Clavel-Chapelon F, Crispim SP, Fagherazzi G, Franks PW, rationale and study design. BMC Public Health 16:93. https: //doi. Grote VA, Huybrechts I, Kaaks R, Key TJ, Khaw KT, Nilsson P, org/10.1186/s1288 9-016-2765-y Overvad K, Palli D, Panico S, Quiros JR, Rolandsson O, Sacer- 11. Hu FB, Malik VS (2010) Sugar-sweetened beverages and dote C, Sieri S, Slimani N, Spijkerman AM, Tjonneland A, Tormo risk of obesity and type 2 diabetes: epidemiologic evidence. MJ, Tumino R, van den Berg SW, Wermeling PR, Zamara-Ros R, Physiol Behav 100(1):47–54. https ://doi.or g/10.1016/j.ph y sb Feskens EJ, Langenberg C, Sharp SJ, Forouhi NG, Riboli E, Ware- eh.2010.01.036 ham NJ (2013) Consumption of sweet beverages and type 2 diabetes 12. Malik VS, Pan A, Willett WC, Hu FB (2013) Sugar-sweetened incidence in European adults: results from EPIC-InterAct. Diabeto- beverages and weight gain in children and adults: a systematic logia 56(7):1520–1530. https://doi.or g/10.1007/s00125-013-2899-8 review and meta-analysis. Am J Clin Nutr 98(4):1084–1102. https 26. Guelinckx I, Ferreira-Pego C, Moreno LA, Kavouras SA, Gandy J, ://doi.org/10.3945/ajcn.113.05836 2 Martinez H, Bardosono S, Abdollahi M, Nasseri E, Jarosz A, Ma 13. Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB G, Carmuega E, Babio N, Salas-Salvado J (2015) Intake of water (2009) Sweetened beverage consumption and risk of coronary and different beverages in adults across 13 countries. Eur J Nutr heart disease in women. Am J Clin Nutr 89(4):1037–1042. https 54(Suppl 2):S45–S55. https://doi.or g/10.1007/s00394-015-0952-8 ://doi.org/10.3945/ajcn.2008.27140 27. Strippoli GF, Craig JC, Rochtchina E, Flood VM, Wang JJ, Mitch- 14. Singh GM, Micha R, Khatibzadeh S, Shi P, Lim S, Andrews ell P (2011) Fluid and nutrient intake and risk of chronic kidney KG, Engell RE, Ezzati M, Mozaffarian D, Global Burden of Dis- disease. Nephrology (Carlton) 16(3):326–334. https ://doi.org/10 eases N, Chronic Diseases Expert G (2015) Global, regional, and .1111/j.1440-1797.2010.01415 .x national consumption of sugar-sweetened beverages, fruit juices, 28. Barquera S, Campos I, Rivera JA (2013) Mexico attempts to tackle and milk: a systematic assessment of beverage intake in 187 coun- obesity: the process, results, push backs and future challenges. tries. PLoS One 10(8):e0124845. https ://doi.org/10.1371/journ Obes Rev 14 (Suppl 2):69–78. https://doi.or g/10.1111/obr.12096 al.pone.01248 45 29. Barquera S (2010) The Mexican experience: from public health 15. NCD Risk Factor Collaboration (NCD-RisC) (2017) Worldwide concern towards national beverage guidelines. Nutr Today trends in body-mass index, underweight, overweight, and obesity 45(6):S18–S21 from 1975 to 2016: a pooled analysis of 2416 population-based 30. Barquera S, Hernandez-Barrera L, Tolentino ML, Espinosa J, Ng measurement studies in 128.9 million children, adolescents, and SW, Rivera JA, Popkin BM (2008) Energy intake from bever- adults. Lancet 390 (10113):2627–2642. https ://doi.org/10.1016/ ages is increasing among Mexican adolescents and adults. J Nutr S0140 -6736(17)32129 -3 138(12):2454–2461. https ://doi.org/10.3945/jn.108.09216 3 16. Heisler M, Kaselitz E, Rana GK, Piette JD (2016) Diabetes pre- 31. Rivera JA, Barquera S, Campirano F, Campos I, Safdie M, Tovar vention interventions in Latin American countries: a scoping V (2002) Epidemiological and nutritional transition in Mexico: review. Curr Diab Rep 16(9):80. https ://doi.org/10.1007/s1189 rapid increase of non-communicable chronic diseases and obe- 2-016-0778-7 sity. Public Health Nutr 5(1A):113–122. https ://doi.org/10.1079/ 17. Severi C, Moratorio X (2014) Double burden of undernutrition PHN20 01282 and obesity in Uruguay. Am J Clin Nutr 100(6):1659S–1662S. 32. Sanchez-Romero LM, Penko J, Coxson PG, Fernandez A, Mason https ://doi.org/10.3945/ajcn.114.08380 8 A, Moran AE, Avila-Burgos L, Odden M, Barquera S, Bibbins- 18. Lotufo PA (2016) Knowing for whom the bell tolls: acting locally Domingo K (2016) Projected impact of Mexico’s sugar-sweet- and thinking globally. Brazil, Latin America and the Global Bur- ened beverage tax policy on diabetes and cardiovascular disease: den of Diseases, 2015. Sao Paulo Med J 134(6):469–472. https:// a modeling study. PLoS Med 13(11):e1002158. https ://doi. doi.org/10.1590/1516-3180.2016.13461 71016 org/10.1371/journ al.pmed.10021 58 19. Marquez-Sandoval F, Macedo-Ojeda G, Viramontes-Horner D, 33. Duran AC, de Almeida SL, Latorre Mdo R, Jaime PC (2016) The Fernandez Ballart JD, Salas Salvado J, Vizmanos B (2011) The role of the local retail food environment in fruit, vegetable and sugar- prevalence of metabolic syndrome in Latin America: a system- sweetened beverage consumption in Brazil. Public Health Nutr atic review. Public Health Nutr 14(10):1702–1713. https ://doi. 19(6):1093–1102. https ://doi.org/10.1017/S1368 98001 50015 24 org/10.1017/S1368 98001 00033 20 34. Guelinckx I, Tavoularis G, Konig J, Morin C, Gharbi H, Gandy J 20. Johnson EC, Peronnet F, Jansen LT, Capitan-Jimenez C, Adams (2016) Contribution of water from food and fluids to total water JD, Guelinckx I, Jimenez L, Mauromoustakos A, Kavouras SA intake: analysis of a French and UK population surveys. Nutrients (2017) Validation testing demonstrates efficacy of a 7-day fluid 8(10):630. https ://doi.org/10.3390/nu810 0630 record to estimate daily water intake in adult men and women 35. Engstrom JL, Paterson SA, Doherty A, Trabulsi M, Speer KL when compared with total body water turnover measurement. J (2003) Accuracy of self-reported height and weight in women: an Nutr 147(10):2001–2007. https ://doi.org/10.3945/jn.117.25337 7 integrative review of the literature. J Midwifery Womens Health 21. Asociación Mexicana de Inteligencia de Mercado y Opinión 48(5):338–345 (AMAI) (2016) Mexico. Niveles Socioeconómicos http://nse. 36. Nakhimovsky SS, Feigl AB, Avila C, O’Sullivan G, Macgregor- amai.org/. Accessed Jan 2018 Skinner E, Spranca M (2016) Taxes on sugar-sweetened bever- 22. Associacao Brasileira de Empresas de Pesquisa. Brazilian Criteria ages to reduce overweight and obesity in middle-income coun- tries: a systematic review. PLoS One 11(9):e0163358. https://doi. 2015 and social class distribution update for 2016 (2018) Brazil. org/10.1371/journ al.pone.01633 58 http://www.abep.org. Accessed Jan 2018 1 3 European Journal of Nutrition (2018) 57 (Suppl 3):S65–S75 S75 Affiliations 1 2 3,4 5 6 6 7,8 H. Martinez  · C. Morin  · J. Gandy  · E. Carmuega  · J. L. Arredondo  · C. Pimentel  · L. A. Moreno  · 9,10 8,11 2 S. A. Kavouras  · J. Salas‑Salvadó  · I. Guelinckx 1 8 Hospital Infantil de México Federico Gómez, Mexico City, CIBERobn (Centro de Investigación Biomédica en Red Mexico Fisiopatología de la Obesidad y Nutrición), Institute of Health Carlos III, Madrid, Spain Department of Hydration and Health, Danone Research, Route Départemental 128, 91767 Palaiseau, France Hydration Science Lab, University of Arkansas, Fayetteville, AR, USA British Dietetic Association, Birmingham, UK Division of Endocrinology, University of Arkansas School of Life and Medical Sciences, University for Medical Sciences, Little Rock, AR, USA of Hertfordshire, Hatfield, UK Human Nutrition Unit, Biochemistry and Biotechnology Center of Studies on Infant Nutrition (CESNI) Buenos Aires, Department, Faculty of Medicine and Health Sciences, Buenos Aires, Argentina Hospital Universitari de Sant Joan de Reus, IISPV (Institut Unidad de Apoyo a la Investigación Clínica, Instituto d’Investigació Sanitària Pere Virgili), Universitat Rovira i Nacional de Pediatría, Mexico City, Mexico Virgili, Reus, Spain GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto Investigación Sanitaria Aragón (IIS Aragón) Zaragoza, Zaragoza, Spain 1 3

Journal

European Journal of NutritionSpringer Journals

Published: Jun 1, 2018

References

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off