Establishment of reference intake of water for Korean adults in 2015

Jae-Hyun Lee; Sun-Hyo Kim

doi:10.4163/jnh.2017.50.2.121

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Lee and Kim: Establishment of reference intake of water for Korean adults in 2015

Review

J Nutr Health 2017;50(2):121-132.

Published online: 20 January 2017

DOI: https://doi.org/10.4163/jnh.2017.50.2.121

Establishment of reference intake of water for Korean adults in 2015

Jae-Hyun Lee¹, Sun-Hyo Kim^†

¹Department of Health Convergence, Ewha Womans University, Seoul 03760, Korea

²Department of Technology and Home Economics Education, Kongju National University, Gongju 32588, Korea

^†To whom correspondence should be addressed. tel: +82-41-850-8307, E-mail: shkim@kongju.ac.kr

Received 6 February 2017 Revised 21 February 2017 Accepted 24 March 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This review was performed to establish a reference intake of water for Korean (KDRI-water) adults in 2015 by examining current knowledge of the relationship between water intake and health and the general status of water intake and loss. We expect that this study will be utilized for further refinement of KDRI-water. Methods: Documents were searched using RISS, NDSL, DBPIA, CINAHL, and Pubmed with the keywords ‘water intake, water supply, water ingestion, hydration, dehydration, water balance, and fluid balance'. Results: Water balance is essential for the maintenance of health. Based on this assumption, numerous studies have been performed to investigate the association of water intake with several diseases such as urolithasis, obesity, diabetes, and cancer as well as other health problems, including constipation, cognition, and fetal weight. Effects of water intake for prevention or relief of these health problems vary. Water is supplied to the body by eating foods and drinking liquids such as plain water and beverages. Metabolic water is another source of water input. Water is lost through urine, skin, respiration, and feces. KDRI-water 2015 was set by adequate intake (AI) based on water intake volume, which was the sum of water intakes from foods and fluids reported by the Korea National Health and Nutrition Examination Survey, with extra milk intake of 200 mL. AIs in some age groups were modified considering their estimated energy requirements. Conclusion: Accurate data of water intake is critically important for the establishment of KDRI-water. Therefore, improvement of systems investigating water intake is required, and more studies on the status of water intake and loss in Korean people are needed for definite KDRI-water establishment.

Keywords: dietary reference intake, water, water intake, water loss, health

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Fig. 1.

Establishment method of reference intake of water for Korean adults 1) Ministry of Health and Welfare of Korea, The Korean Nutrition Society, 2015⁴ 2) Park, 1988³⁹ 3) Korea Centers for Disease Control & Prevention, 2008∼2012⁴⁸ 4) It refers to ‘beverage and alcohol' reported in Korea National Health and Nutrition Examination Survey 2008∼2012⁴⁸ 5) Intake of ‘beverage and alcohol' in Korea National Health and Nutrition Examination Survey 2008∼2012⁴⁸ does not include milk intake, so adds 200 mL of milk intake in order to recommend milk intake.

Table 1.

The relationship between water intake and health

Health problem	Subjects	Findings	References
	n = 1,019, newly diagnosed kidney stone patients/ n = 987, healthy control subjects	Enough fluid drinking (> 2,000 mL/d) showed a significant protective effect against kidney stone in men (OR = 0.57).	Dai et al., 2013¹¹
Urolitheasis, kidney stone	review	There was a strong evidence that increased fluid intake and hydration status reduces stone recurrence.	Popkin et al., 2010¹²
	review	11 of 13 epidemiological reports showed a significant association between favorable hydration status and lower stone recurrence rate.	Manz and Wentz, 2005¹³
	MF, 61.3 y, n = 24 (7 men / 17 women), overweight and obese adults	13% reduction of meal energy intake in water preload condition, compared with the no-preload condition.	Davy et al., 2008¹⁴
	F, 25 ∼ 50 y, n = 173, pre-menopausal overweight women	Increasing daily water consumption in overweight women was associated with increased weight loss, during a 12 month dietary intervention.	Stookey et al., 2008¹⁷
Obesity	MF, 55 ∼ 75 y, n = 48	Consumption of water prior to hypo-caloric meals led to greater weight loss than a hypo-caloric diet alone in 12 weeks.	Dennis et al., 2010¹⁵
	MF, > 18 y, n = 4,755, 1999 ∼ 2001 NHANES	Water consumers consumed 194 fewer kcal/d than those did not drink water.	Popkin et al., 2005¹⁶
	MF, ≥ 20 y, n = 4,112, NHANES 2005 ∼ 2006	Body mass index (BMI) showed positive associations with beverage moisture and total water (p < 0.01) but not with plain water.	Kant et al., 2009¹⁸
		· Plain water intake was not significantly associated with risk of type 2 diabetes (T2D).
Hyperglycemia, diabetes	F, 26 ∼ 45 y, n = 82,902, Nurses' Health Study II	· Substitution of 1 cup plain water/d for 1 serving sugar-sweetened beverages (SSB) or fruit juices/d was associated with 7% and 8% lower risk of T2D. · Substitution of coffee or milk for SSBs or fruit juices was associated with a 12 ∼ 17% significant reduction in risk.	Pan et al., 2012¹⁹
Hyperglycemia, diabetes	MF, middle-aged, n = 3,615	Self-reported water intake was inversely and independently associated with the risk of developing hyperglycemia.	Roussel et al., 2011²⁰
	n = 765, cases/ n = 765 matched controls	The results do not support the relationship between total fluid consumption and bladder cancer risk.	Geoffroy-Perez and Cordier, 2001²¹
Bladder cancer	review	· The results on the relationship between fluid consumption and bladder cancer risk are inconsistent. · A decreased fluid intake could result in a greater concentration of carcinogens in the urine or in a prolonged time of contact with the bladder mucosa.	Altieri et al., 2003²²
Cololectal	55 to 69 y, n = 120,852	Total fluid intake was not associated with colorectal cancer risk in either men or women.	Simons et al., 2010²³
cancer	review	Fluid intake may reduce colon cancer risk by decreasing bowel transit time and reducing mucosal contact with carcinogens.	Altieri et al., 2003²²
Constipation	F, 18 ∼ 20 y, n = 3,835, Japanese dietetic students	· Neither dietary fiber intake nor intakes of total water and water from fluids were associated with constipation. · Low intake of water from foods was associated with an increasing prevalence of constipation.	Murakami et al., 2007²⁶
Cognition	review	Mild dehydration produces alterations in a number of important aspects of cognitive function such as concentration, alertness and short-term memory in children, young adult and in the oldest adults. However, mild dehydration does not appear to alter cognitive functioning in a consistent manner.	Popkin et al., 2010¹²
Fetal weight	F, ≥ 18 y, n = 2,039, pregnant women, n = 1,854, live births	High water intake may be associated with higher mean birth weight following adjustment for confounding.	Wright et al., 2010²⁸

MF: males and females, F: females, y: years

Table 2.

Water intake in healthy adults

Subjects	Total water intake	Plain water	Beverages	Plain water+Beverage	Water in foods	Reference
review	2,550 mL/d (metabolic water: 300 mL/d)			1,575 mL/d	675 mL/d	Jéquier and Constant, 2010²
MF, 19 ∼ 64 y, n = 1,724, UK	2,270 g/d (M 2,533, F 2,059)	278 g/d (M 242, F 306)	1,428 g/d (M 1,674, F 1,229)	1,706 g/d (M 1,918, F 1,536)	564 g/d (M 615, F 523)	Gibson and Shirreffs, 2013²⁹
MF, ≥ 20 y, n = 4,112, US	3,180 mL/d (M 3,467, F 2,897)	M 1,044, F 1,079 mL/d	M 1,783, F 1,298 mL/d		M 641 mL/d, F 520 mL/d	Kant et al., 2009¹⁸
F, 18 ∼ 20 y, n = 3,835, Japan	1,028 g/4,186 kJ			654 g/4,186 kJ	374 g/4,186 kJ	Murakami et al., 2007²⁶
F, 22 ∼ 60 y, n = 27, Netherlands	Summer: 2.4 mL/d Winter: 2.5 mL/d					Westerterp et al., 2005³¹
	Summer 3,875 mL/d	Summer: 2,225 mL/d	Summer: 860 mL/d	Summer: 3,142 mL/d	Summer: 560 mL/d
MF, < 19 y or ≥ 20 y, n = 892,	(M 4,120, F 3,658)	(M 2,458, F 2,016)	(M 934, F 783)	(M 3,429, F 2,891)	(M 561, F 629)	Malisova et al.,
Greece	Winter: 2,892 mL/d	Winter: 1,352 mL/d	Winter: 716 mL/d	Winter: 2,154 mL/d	Winter: 656 mL/d	2013³²
	(M 2,813, F 2,774)	(M 1,426, F 1,277)	(M 748, F 712)	(M 2,269, F 2,037)	(M 608, F 681)
		19 ∼ 29 y: 1,564 mL/d	19 ∼ 29 y: 456 mL/d		19 ∼ 29 y: 592 mL/d
MF, ≥ 19 y, n = 25,122,		30 ∼ 49 y: 1,245 mL/d	30 ∼ 49 y: 445 mL/d		30 ∼ 49 y: 717 mL/d	Lee et al.,
Korea		50 ∼ 64 y: 1,218 mL/d	50 ∼ 64 y: 395 mL/d		50 ∼ 64 y: 762 mL/d	2016³⁰
		65+ y: 1,098 mL/d	65+ y: 296 mL/d		65+ y: 621 mL/d
		(median value, g/d)	(median value, g/d)
MF, 19 ∼ 64 y, n = 15,312, Korea		19 ∼ 29 y: M 975.2, F 765.6 30 ∼ 39 y: M 1,017.0, F 778.8 40 ∼ 49 y: M 1,003.4, F 774.2	19 ∼ 29 y: M 34.0, F 23.5 30 ∼ 39 y: M 104.9, F 15.2 40 ∼ 49 y: M 90.5, F 16.3			MHWK and KNS, 2015⁴
		50 ∼ 64 y: M 928.5, F 764.1	50 ∼ 64 y: M 44.4, F 11.9
		∗1 cup = 200 mL
MF, 20 ∼ 64 y, n = 14,428, Korea		20 ∼ 29 y: M 6.6, F 4.8 cups 30 ∼ 39 y: M 6.4, F 4.5 cups 40 ∼ 49 y: M 6.2, F 4.5 cups				Kim and Yang, 2014³³
		50 ∼ 64 y: M 6.1, F 4.5 cups
MF, 20.9 y (avg.), n = 357, Korea		M 790.9 mL/d, F 583.5 mL/d		M 1,526.4 mL/d, F 1,151.5 mL/d		Kim, 2009³⁴
		·	30 ∼ 49 y: M 169.0, F 28.7 mL/d
MF, 30 ∼ 79 y, n = 382, Korea		·	· 50 ∼ 64 y: M 92.5, F 32.4 mL/d			Kim and Yu, 2001³⁵
		·	· 65 ∼ 79 y: M 56.1, F 16.6 mL/d
			Total: M 91.8, F 25.8 mL/d
				19 ∼ 23 y: 1,391.3 mL/d, water > alco-
MF, 19 ∼ 60 y, n = 476, Korea				holic drinks > soft drinks > milk		Kim and Ahn, 1987³⁷
				24 ∼ 60 y: 1,281.9 mL/d, water > alcoholic drinks > milk > soft drinks, coffee
				1.98 L/d (Mexico: 1.81/ Brazil: 2.22/
MF, ≥ 18 y, n = 16,276, 13 countries				Argentina: 2.30/ Spain: 1.90/ France: 1.56/ UK: 2.32/ Germany: 2.47/ Poland: 1.64/ Turkey: 2.21/ Iran: 1.92/ China:		Guelinckx et al., 2015³⁶
				1.76/ Indonesia: 2.28/ Japan: 1.50)

M: males, F: females, MF: males and females, y: years, avg.: average

Table 3.

Water output in healthy adults

Subjects	Total water output	Urine	Stool	Insensible loss	Reference
review	2,550 mL/d	1,600 mL/d	200 mL/d	750 mL/d (skin 450 mL/d, respiration 300 mL/d)	Jéquier and Constant, 2010²
F, 22 ∼ 60 y, n = 27, Netherlands	Summer: 3.1 L/d Winter: 3.0 L/d				Westerterp et al., 2005³¹
	Summer: 3,635 mL/d
MF, < 19 or ≥ 20 y, n = 892, Greece	(M 3,760, F 3,545) Winter: 2,637 mL/d				Malisova et al., 2013³²
	(M 2,562, F 2,675)
F, 24 y (avg.), n = 8, Korea		889 ∼ 1,037 mL/d			Koo, 1987⁴¹
F, 20's, n = 21, Korea		608 ∼ 763 mL/d			Park, 1988³⁹
F, 20's, n = 15, Korea		1,152 ∼ 1,120 mL/d			Kim, 2004⁴²
F, 40 y (avg.), n = 30, Korea		1,342 mL/d			Rhie et al., 1990⁴³
MF, 20 ∼ 59 y, n = 205, Korea		M 1,357, F 1,326, Total 1,336 mL/d			Son et al., 2007⁴⁴
		Low drinkers vs. High drinkers
MF, 25 ∼ 40 y, n = 71, France		24-hour urine volume:			Perrier et al., 2013⁵
		1.0 vs 2.4 L/d
MF, 40 ∼ 79 y, n = 458, US		40 ∼ 49 y: M 2.09, F 2.05 L/d 50 ∼ 59 y: M 2.00, F 2.27 L/d 60 ∼ 69 y: M 2.45, F 2.27 L/d		40 ∼ 49 y: M 1.61, F 1.11 L/d 50 ∼ 59 y: M 1.53, F 0.65 L/d 60 ∼ 69 y: M 1.00, F 0.49 L/d	Raman et al., 2004⁴⁵

M: males, F: females, MF: males and females, y: years, avg.: average

Table 4.

Fluid water intake of adults based on Korea National Health and Nutrition Examination Survey 2008 ∼ 2012¹⁾

Age (years)	Number of subjects	50th percentile			Milk intake³⁾ (g/d)
Age (years)	Number of subjects	Drinking water intake (g/d)	Beverage intake (g/d)	Fluid water intake²⁾ (g/d)	Milk intake³⁾ (g/d)
Males
19 ∼ 29	653	975.2	34.0	1,009.2	+200
30 ∼ 49	2,160	1,017.0	104.9	1,121.9	+200
50 ∼ 64	1,172	928.5	44.4	972.9	+200
Females
19 ∼ 29	877	765.6	23.5	789.1	+200
30 ∼ 49	2,804	778.8	15.2	794.0	+200
50 ∼ 64	1,152	764.1	11.9	776.0	+200

¹⁾ Korea Centers for Disease Control & Prevention. 2008∼2012⁴⁸ 2) It is sum of median of drinking water intake and median of beverage intake. 3) Intake of ‘beverage and alcohol' in Korea National Health and Nutrition Examination Survey 2008∼2012⁴⁸ does not nclude milk intake, so adds 200 g/d of milk intake in order to recommend milk consumption from 6 years of age.

Table 5.

Calculation of reference intake of water of Korean adults

Category	Calculation	Adequate intake (AI, mL/d)
		Fluid water	Total water
	AI of water (mL/d) = Water intake from foods (mL/d)^∗ + Water intake from fluid (mL/d)^∗∗
	∗ Water intake from foods (mL/d) = Estimated energy requirement (EER, kcal/d)¹⁾ according to
	age¹⁾ × Water content ratio of Korean regular foods (0.53 mL/kcal)²⁾	–	–
	∗∗ Water intake from fluid (mL/d) = Median of drinking water intake (mL/d)³⁾ + Median of beverage intake (mL/d)³⁾ + 200 mL/d of milk intake
Males
19 ∼ 29 y AI = (2,600 kcal/d × 0.53 mL/kcal) + 975 mL + 34 mL + 200 mL ≒ 1,400 mL + 1,200 mL ≒ 2,600 mL/d		1,200	2,600
	AI = (2,400 kcal/d × 0.53 mL/kcal) + 1,017 mL + 105 mL + 200 mL ≒ 1,300 mL + 1,300 mL ≒ 2,600 mL/d → 2,500 mL/d
30 ∼ 49 y Considering that the EER of male aged 30 ∼ 49 y is 200 kcal/d lower than that of the male aged 19 ∼ 29 y, the AI is lowered by 100 mL/d and thus the fluid water intake is adjusted from 1,300 mL/d to 1,200 mL/d.		1,200	2,500
	AI = (2,200 kcal/d × 0.53 mL/kcal) + 929 mL + 44 mL + 200 mL ≒ 1,200 mL + 1,200 mL ≒ 2,400 mL/d → 2,200 mL/d
50 ∼ 64 y Considering that the EER of male aged 50 ∼ 64 y is 400 kcal/d lower than that of the male aged 19–29 y, the AI is lowered by 200 mL/d and thus the fluid water intake is adjusted from 1,200 mL/d to 1,000 mL/d.		1,000	2,200
Females
19 ∼ 29 y AI = (2,100 kcal/d × 0.53 mL/kcal) + 766 mL + 24 mL + 200 mL ≒ 1,100 mL + 1,000 mL ≒ 2,100 mL/d		1,000	2,100
30 ∼ 49 y AI = (1,900 kcal/d × 0.53 mL/kcal) + 779 mL + 15 mL + 200 mL ≒ 1,000 mL + 1,000 mL ≒ 2,000 mL/d		1,000	2,000
	AI = (1,800 kcal/d × 0.53 mL/kcal) + 764 mL + 12 mL + 200 mL ≒ 1,000 mL + 1,000 mL ≒ 2,000 mL/d → 1,900 mL/d
50 ∼ 64 y Considering that the EER of female aged 50 ∼ 64 y is 300 kcal/d lower than that of the female aged 19 ∼ 29 y, the AI is lowered by 100 mL/d and thus the fluid water intake is adjusted from 1,000 mL/d to 900 mL/d.		900	1,900

y: years 1) Ministry of Health and Welfare of Korea, The Korean Nutrition Society, 2015⁴ 2) Park, 1988³⁹ 3) Korea Centers for Disease Contro & Prevention, 2008∼2012⁴⁸

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