Key Tips on Hydration (Volume 1)Hydration needs for different life stagesIndex• Key Tips on Hydration for infants and children.• Key Tips on Hydration for adolescents and adults.• Key Tips on Hydration for elderly people.• Key Tips on Hydration for pregnant and breastfeeding women.
for infants and childrenKEY TIPSON HYDRATIONThe hydration needs of children are not thatdifferent to those of adults. However, infants andchildren are more susceptible to dehydrationthan adults. According to the Panel on DieteticProducts, Nutrition and Allergies from theEuropean Food Safety Authority (EFSA)12010,the values for total water intake shown in theadjacent table are those recommended for infantsand children under conditions of moderateenvironmental temperature and moderatephysical activity levels.Age range Daily adequate water intake1Infants0-6 months680 mL/day or 100-190 mL/kg/day. From human milk/infant formula.6-12 months0.8-1.0 L/day. From humanmilk/infant formula andcomplementary foods andbeverages.1-2 years 1.1-1.2 L/dayChildren2-3 years 1.3 L/day4-8 years 1.6 L/day• Compared to children and adults, infants have a higher total body water content. In newborns thetotal body water content can be as much as 75% and this decreases to 50-60% by the time theyreach adulthood.• Infants and children need water not only to replace the losses via respiration, sweating and urine,but also for growth.• Instances of diarrhoea and vomiting are frequent in infants and young children and both can leadto dehydration if water losses are not replaced .• Infants cannot easily communicate their needs and active children can be so involved in what theyare doing that they forget to drink, so it is important for those caring for them to be alert to thepossibility of dehydration especially during hot weather or during periods of illness.It is important to remember that:The Panel on Dietetic Products, Nutrition and Allergies from the European Food Safety Authority (EFSA)* issued referenceintakes for water in 2010. These are defined as total water intake, which is water from beverages (including drinking water)and from food moisture. It is normally assumed that the contribution of food to total dietary water intake is 20 to 30%, while 70to 80% is provided by beverages. This relationship is not fixed and depends on the type of beverage and on the choice of foods.For HeaLthcare Professionaldistribution only
KEY TIPS ON HYDRATIONHow to ensure proper hydrationof infants and childrenInfantsDuring breastfeeding healthy infants can maintain adequate hydration status while exclusivelybreastfed without additional water, even in very hot weather.Additional water intake may be needed from 0 to 6 months when an infant formula is used, or from6 to 12 months when formula or other weaning food with higher energy and nutrient density is used.ChildrenThese are practical tips to keep active children hydrated, especially in hot environments:• Have children drink before heading out to play and call them in frequently for drinks.• To avoid overheating, encourage regular breaks in the shade when the sun is hot.• Keep drinks cool whenever possible and offer beverages that your child enjoys. All beverages,including water, milk, juice, soft-drinks, and other fluids, can help meet a child’s hydration needs..• Remember that many foods have a high water content and contribute to total fluid intake. Fruits,vegetables, and some other foods are high in water content.There is some evidence that providing drinks to children can help them to perform better instandardised tests of concentration, short term memory and other essential elements of the learningprocess. Hydration needs should therefore also be considered when children are at school.70-80%from beverages (all types, not justplain water)1,220-30%typically comes from food andIt is calculated that ofthe total water consumed…However, this may vary greatlydepending of the diet that an individualchooses.1,2To know more about the sources of water, please visit us at:http://www.europeanhydrationinstitute.org/nutrition_and_beverages.html1. EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on Dietary reference values for water. EFSA Journal 2010; 8(3):1459.Available online: http://www.efsa.europa.eu/en/efsajournal/pub/1459.htm2. Manz F, Johner SA, Wentz A, Boeing H, Remer T. Water balance throughout the adult lifespan in a German population. Br J Nutr 2011; 1-9 [Epub aheadof print]
for adolescents and adultsKEY TIPSON HYDRATIONThe body requires water to survive and functionproperly. Humans cannot live without drinkingfor more than a few days – depending on weather,activity levels and other factors- whereas othernutrients may be neglected for weeks or months.Although commonly it is treated rather trivially,no other nutrient is more essential or is neededin such large amounts.Water requirements vary between individualsand according to diet, environmental conditions,activity levels and a range of other factors. As areference, the adjacent table shows the values fortotal water intake for each age group, as issuedby the Panel on Dietetic Products, Nutritionand Allergies from the European Food SafetyAuthority (EFSA)1on 2010.Age rangeDaily adequatewater intake1Adolescents (Males / Females)9-13 years 2.1 L/day / 1.9 L/day14-18 years 2.5 L/day / 2.0 L/dayAdults (Males / Females)*›19 years 2.5 L/day/ 2.0 L/day* Some groups are at a higher risk of dehydration (elderly people) or are special cases that need higher quantities of water (pregnant and lactatingwomen). Please read our special advice for these groups at: http://www.europeanhydrationinstitute.org/elderly_people.html andhttp://www.europeanhydrationinstitute.org/pregnancy_a_lactation.htmlThat the amount of water that is deemedadequate includes not only water fromdrinking water, but also beverages of allkinds and from food moisture.That the reference values included in thisrecommendation only apply to conditions ofmoderate environmental temperature andmoderate physical activity levels.That thirst appears in the middle-stageof dehydration so it’s better to drink on aregular basis.To know more about the water requirements ofyour body, please visit us at:http://www.europeanhydrationinstitute.org/hydration_needs.htmlIt is important to take intoaccount...Are you aware of how muchwater you need?For HeaLthcare Professionaldistribution only
KEY TIPS ON HYDRATIONType of beverage / food Water contentNon-alcoholic beverages*Water, tea, coffee, light refreshments, sports drinks, soft drinks, lemonade, vegetable juice 90% to 100%Milk, fruit juice, juice beverages 85% to 90%SoupsIncluding consommé and creams made with milk, etc. 80% to 95%Fruits and vegetablesStrawberry, melon, grapefruit, grape, peach, pear, orange, apple, cucumber, lettuce, celery, tomato,pumpkin, broccoli, onion, carrot80% to 95%Banana, potato, corn 70% to 80%Dairy productsFresh whole milk 87 to 90%Yoghurt 75% to 85%Ice creams 60% to 65%Cheese 40% to 60%CerealsRice (boiled) 65% to 70%Pasta (spaghetti, macaroni, noodles) 75% to 85%**Bread, cookies 30% to 40%Breakfast cereals (ready to eat) 2% to 5%Meat, Fish, EggsFish and seafood 65% to 80%Eggs (scrambled, fried, poached), omelette, egg substitute 65% to 75%Beef, chicken, lamb, pig, veal 40% to 65%Cured meat, bacon 15% to 40%Adapted from: Holland B. et al (1991) McCance and Widdowson. The Composition of Foods 5th ed. The Royal Society of Chemistry Cambridge, UK.* Softer alcoholic beverages such as beer may have an important cultural weight in some countries. Beer and wine contain 85% to 95% of waterwhereas distilled alcoholic drinks typically contain only 57% - 70% water.**Note that these values are approximations only and values will depend on source of the food, cooking method, etc. For example pasta cooked “aldente” (Italian style) will have a slightly lower water content than shown here** and is between 50 and 60%. There are many good online databasesthat will give food composition values for a much wider range of foods.1. EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on Dietary reference values for water. EFSA Journal 2010;8(3):1459. Available online: “http://www.efsa.europa.eu/en/efsajournal/pub/1459.htm”www.efsa.europa.eu/en/efsajournal/pub/1459.htm2. Manz F, Johner SA, Wentz A, Boeing H, Remer T. Water balance throughout the adult lifespan in a German population. Br J Nutr 2011; 1-9 [Epubahead of print]Where can I get the water from?70-80%from beverages (all types, not justplain water)1,2The following are the average water contents of different kinds of non-alcoholic beverages and foods,which may give you an idea of the water intake you get according to your own food choices.20-30%typically comes from food andIt is calculated that ofthe total water consumed…However, this may vary greatlydepending of the diet that an individualchooses.1,2
for ELDERLY PEOPLEKEY TIPSON HYDRATION• People usually drink in response to thirst, but by the age of 60, if people only drink when theyare thirsty, they may not get as much water as they need.• Renal concentrating capacity generally declines with the age, leading to an increased loss ofwater via urine.• Diminished appetite and poor food choices may lead to a reduction of fluid intake from food.• Some older adults may suffer from poor memory, immobility, or illness which may affect fluidintake. In addition, certain medications can also block the thirst mechanism.• Dehydration can cause serious problems in older adults. Elderly people are at greatest riskof dehydration and its potentially life-threatening consequences: People aged between 85-99years are 6 times more likely to be hospitalised for dehydration than those aged 65-69 years.• Chronic dehydration constitutes a serious problem and is associated with an increased riskof falls, urinary tract infections, dental disease, bronchopulmonary disorders, kidney stones,constipation, and impaired cognitive function.Special considerations for the elderlyAre you aware of theirincreased risk oF dehydration?2 L for women2.5 L for menunder conditions of moderate environmentaltemperature and moderate physical activity levels.But age-related changes can lead to an increased risk ofdehydration with consequent effects on health and wellness.The EFSA adult recommendations for the dailyintake of water from all sources*(water, beverages and food) do not fall with ageFor HeaLthcare Professionaldistribution only
KEY TIPS ON HYDRATIONHow to ensure properhydration IN THE ELDERLY These are practical tips to help keep elderly people well hydrated• A hydration programme should include advice on drinking, offering fluids at mealtime and inbetween meals. Fluids should be readily available and physically accessible both day and night.• Carers should be familiar with dietary changes so that appropriate hydration recommendationscan be made.•Environmentaltemperaturesinsideshouldbemoderate.Inhotenvironments,itisrecommendedthat intake of liquids be increased by 250 mL for each degree centigrade over 37ºC.• Strong (distilled) alcoholic beverages may provoke dehydration and are not recommended.• Many types of foods contain a substantial amount of water. If an older person finds it difficultto increase the amount of fluid drunk, increasing the intake of foods, such as soups or fruitand vegetables, which typically contain 80-90 per cent water, can help to maintain an adequatewater intake as well as being good sources of essential nutrients.• Varying flavours and even colours can improve palatability of beverages offered and can helpfacilitate adequate hydration.To know more about the sources of water, please visit us at:http://www.europeanhydrationinstitute.org/nutrition_and_beverages.html* Source: EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on Dietary reference values for water. EFSA Journal 2010;8(3):1459. Available online: http://www.efsa.europa.eu/en/efsajournal/pub/1459.htmThe Panel on Dietetic Products, Nutrition and Allergies from the European Food Safety Authority (EFSA)* issued referenceintakes for water in 2010. These are defined as total water intake, which is water from beverages (including drinkingwater) and from food moisture. It is normally assumed that the contribution of food to total dietary water intake is 20 to30%, while 70 to 80% is provided by beverages. This relationship is not fixed and depends on the type of beverage and onthe choice of foods.
for PrEgnant andbreastfeeding womenKEY TIPSON HYDRATION• Pregnancy Increased water needs inpregnancy arise because of the weightgained (typically 10-15 kg), the higher energyintake, the increase in blood volume, theformation of amniotic fluid and because ofincreased water output which can occur as aresult of morning sickness.Meeting water needs through diet maybe more difficult in pregnant than in nonpregnant women because of food aversionsand/or avoidance of fluid intake whenmorning sickness appears. It follows thatpregnant women may be more vulnerable todehydration.• Breastfed babies take in an average of about750 mL of milk per day (600-900 mL) betweenthe ages of 1 and 6 months. Breastfeedingmothers therefore lose significant amountsof fluid during nursing and need to increasetheir fluid intake to compensate.Mild dehydration does not affect milksupply, but moderate to severe dehydrationmay have an effect, including changing thecomposition of the milk and decreasing theamount of milk produced. Dehydration willalso add to feelings of tiredness at what canbe a very stressful time.For HeaLthcare Professionaldistribution onlyWater needs increase during pregnancyand breastfeeding:WATER INTAKE RECOMMENDATIONThe European Food Safety Authority (EFSA)1has made the following recommendations foradequate intakes of water for pregnant and breastfeeding women:Status EFSA RecommendationDaily adequate intake ofwater from all sourcesPregnantAn additional water intake of 300 mL on top ofthe 2 L per day adequate intake recommendedfor non-pregnant women.2.3 LBreastfeedingAn additional 600 – 700 mL per day on top ofthe 2 L per day adequate intake recommendedfor non-breastfeeding women.2.7 L
KEY TIPS ON HYDRATIONTo know more about the sources of water, please visit us at:http://www.europeanhydrationinstitute.org/nutrition_and_beverages.html1. EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on Dietary reference values for water. EFSA Journal 2010;8(3):1459. Available online: http://www.efsa.europa.eu/en/efsajournal/pub/1459.htm2. Manz F, Johner SA, Wentz A, Boeing H, Remer T. Water balance throughout the adult lifespan in a German population. Br J Nutr 2011; 1-9 [Epubahead of print]What to drink?Good choices include water (mineral or tap), fruit juices, herbal teas, soft drinks, and decaffeinatedtea and coffee.70-80%from beverages (all types,not just plain water)1,220-30%typically comes from food andIt is calculated that ofthe total water consumed…However, this may vary greatlydepending of the diet that anindividual chooses.1,2HOW TO ENSURE PROPERHYDRATION WHILST PREGNANTOR BREASTFEEDINGDrink plenty of fluids:• During pregnancy hydration plays an essential role since an adequate supply of water is essentialfor meeting the water needs of your body and of the baby (water represents 94% of the baby’sweight at the end of the first trimester). Water is also needed for the renewal of amniotic fluid,the baby’s living environment. Not drinking enough water can lead to constipation and then tohaemorrhoids which are a common complication during pregnancy.• Proper hydration during breastfeeding ensures milk supply. It is always good practice to have abeverage nearby whilst breastfeeding.• When choosing food and beverages it is important to take into account that small amounts of foodor beverages can pass to the baby via the breast milk. Drinks containing caffeine can affect yourbaby and may keep them awake. While your baby is young, drink caffeinated drinks occasionallyrather than every day. Caffeine occurs naturally in many foods and drinks, including coffee, teaand chocolate. It’s also added to some soft drinks and energy drinks, and to some cold and fluremedies.