Hydration in the Aging

Conclusion: With aging, body water stores decrease, thirst sensation is disturbed and kidneys are less able to concentrate urine, putting the elderly at increased risk of dehydration.  More…

Evidence-based nutrition education:Elderly hydration issues

Dehydration is a serious, yet modifiable clinical problem for older adults.
The purpose of this study was to evaluate and compare the impact of two hydration
education methods, brochure and individual counseling, on clinical, cognitive, behavioral,…

Oral Hydration in Older Adults: Greater awareness is needed in preventing, recognizing, and treating dehydration.

OVERVIEW: Maintaining adequate fluid balance is an essential component of health at every stage of life. Age-related changes make older adults more vulnerable to shifts in water balance that can result in over-hydration or, more frequently, dehydration. This article reviews age-related changes, risk factors, assessment measures, and nursing interventions for dehydration.


Effect of increased water intake on plasma copeptin in healthy adults

Published online: June 3 2017 European Journal of Nutrition (IF 3.239).  Guillaume Lemetais · Olle Melander · Mariacristina Vecchio · Jeanne H. Bottin ·
Sofa Enhörning · Erica T. Perrier



Inter-individual variation in median plasma copeptin is associated with incident type 2 diabetes mellitus, progression of chronic kidney disease, and cardiovascular events. In this study, we examined whether 24-h urine osmolality was associated with plasma copeptin and whether increasing daily water intake could impact circulating plasma copeptin.


This trial was a prospective study conducted at a single investigating center. Eighty-two healthy adults (age 23.6 ± 2.9 years, BMI 22.2 ± 1.5 kg/m2, 50% female) were stratified based upon habitual daily fluid intake volumes: arm A (50-80% of EFSA dietary reference values), arm B (81-120%), and arm C (121-200%). Following a baseline visit, arms A and B increased their drinking water intake to match arm C for a period of 6 consecutive weeks.


At baseline, plasma copeptin was positively and significantly associated with 24-h urine osmolality (p = 0.002) and 24-h urine specific gravity (p = 0.003) but not with plasma osmolality (p = 0.18), 24-h urine creatinine (p = 0.09), and total fluid intake (p = 0.52). Over the 6-week follow-up, copeptin decreased significantly from 5.18 (3.3;7.4) to 3.90 (2.7;5.7) pmol/L (p = 0.012), while urine osmolality and urine specific gravity decreased from 591 ± 206 to 364 ± 117 mOsm/kg (p < 0.001) and from 1.016 ± 0.005 to 1.010 ± 0.004 (p < 0.001), respectively.


At baseline, circulating levels of copeptin were positively associated with 24-h urine concentration in healthy young subjects with various fluid intakes. Moreover, this study shows, for the first time, that increased water intake over 6 weeks results in an attenuation of circulating copeptin.




Copeptin; Fluid intake; Hydration; Urine osmolality; Water intake; drinking water

Effect of increased water intake on plasma copeptin in healthy adults


Effective Immediately: Healthcare Facilities Required to Reduce Legionellosis Risks from Tap Water

Published July 2017

By Kelly A. Reynolds, MSPH, PhD

If you follow On Tap frequently, you know that the bacterium, Legionella, has been a repeated topic in recent years. Once again, Legionella is at the forefront of discussions due to continuing waterborne outbreaks and new directives in healthcare facilities for prevention. On June 2, the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) issued a memo that will undoubtedly expand the awareness of Legionella risks and further drive the implementation of preventative approaches.

Microbial Health Risks of Regulated Drinking Water in the United States

Edberg, S.C., DWRF, September 2013

Drinking water regulations are designed to protect the public health. In the United States, the Environmental Protection Agency (EPA) is tasked with developing and maintaining drinking water regulations for the 276,607,387 people served by the country’s 54,293 community water systems. The Food and Drug Administration (FDA) regulates bottled water as a food product. By federal law, the FDA’s regulations for bottled water must be at least as protective of public health as the EPA’s regulations for public water system drinking water. Despite many similarities in EPA and FDA regulations, consumer perception regarding the safety of drinking waters varies widely. This paper examines and compares the microbial health risks of tap water and bottled water, specifically examining differences in quality monitoring, regulatory standards violations, advisories, and distribution system conditions. It also includes comparison data on the number of waterborne illness outbreaks caused by both tap and bottled water. Based on a review of existing research, it is clear that as a consequence of the differences in regulations, distribution systems, operating (manufacturing) practices, and microbial standards of quality, public drinking water supplies present a substantially higher human risk than do bottled waters for illness due to waterborne organisms.

Influence of progressive fluid restriction on mood and physiological markers of dehydration in women

Pross, N., et al., British Journal of Nutrition, 109, 313-321, January 2013

The present study evaluated, using a well-controlled dehydration protocol, the effects of 24 h fluid deprivation (FD) on selected mood and physiological parameters. In the present cross-over study, twenty healthy women (age 25 (SE 0·78) years) participated in two randomised sessions: FD-induced dehydration v. a fully hydrated control condition. In the FD period, the last water intake was between 18.00 and 19.00 hours and no beverages were allowed until 18.00 hours on the next day (23–24 h). Water intake was only permitted at fixed periods during the control condition. Physiological parameters in the urine, blood and saliva (osmolality) as well as mood and sensations (headache and thirst) were compared across the experimental conditions. Safety was monitored throughout the study. The FD protocol was effective as indicated by a significant reduction in urine output. No clinical abnormalities of biological parameters or vital signs were observed, although heart rate was increased by FD. Increased urine specific gravity, darker urine colour and increased thirst were early markers of dehydration. Interestingly, dehydration also induced a significant increase in saliva osmolality at the end of the 24 h FD period but plasma osmolality remained unchanged. The significant effects of FD on mood included decreased alertness and increased sleepiness, fatigue and confusion. The most consistent effects of mild dehydration on mood are on sleep/wake parameters. Urine specific gravity appears to be the best physiological measure of hydration status in subjects with a normal level of activity; saliva osmolality is another reliable and noninvasive method for assessing hydration status.

Clues to the Future of the Park Doctrine

Burroughs, A.D., and Rin, D., Food and Drug Law Institute, November/December 2012

This article examines three recent cases brought under the controversial Park doctrine in search of clues to the doctrine’s future. The responsible corporate officer (RCO) doctrine, also known as the Park doctrine, allows for criminal prosecution of individuals, typically high-ranking corporate executives of pharmaceutical companies, for violations of the Food, Drug and Cosmetic Act (FDCA), even absent any proof of the individual defendant’s knowledge of or participation in the violation. It is relevant to drinking water because the Park law applies to bottled water, but not to tap water.

Bottled Water & Tap Water: Just the Facts

Drinking Water Research Foundation, October 2011

The information presented in this report supports the fact that drinking water, whether from the tap or a bottle, is generally safe, and that regulatory requirements for both tap water and bottled water provide Americans with clean, safe drinking water. There are some differences in regulations for each, but those differences highlight the differences between drinking water delivered by a public water system and drinking water delivered to the consumer in a sealed container. Perhaps the most notable difference between tap water and bottled water is the method of delivery. Community water systems deliver water to consumers (businesses and private residences) through miles of underground iron (unlined and poly-lined), PVC, and lead service lines that can be subject to leakage with age of the system and accidental failures, resulting in the risk of post-treatment contamination of the water that is delivered to consumers. Bottled water is delivered to consumers in sanitary, sealed containers that were filled in a bottling facility under controlled conditions in a fill room.

Association between children’s blood lead levels, lead service lines, and water disinfection

Brown, M.J., Raymond, J., Homa, D., Kennedy, C., Sinks, T., Environmental Research, October 2010

Evaluate the effect of changes in the water disinfection process, and presence of lead service lines (LSLs), on children’s blood lead levels (BLLs) in Washington, DC. Three cross-sectional analyses examined the relationship of LSL and changes in water disinfectant with BLLs in children o6 years of age. The study population was derived from the DC Childhood Lead Poisoning Prevention Program blood lead surveillance system of children who were tested and whose blood lead test results were reported to the DC Health Department. The Washington, DC Water and Sewer Authority (WASA) provided information on LSLs. The final study population consisted of 63,854 children with validated addresses. Controlling for age of housing, LSL was an independent risk factor for BLLs Z10 mg/dL, and Z5 mg/dL even during time periods whenwater levelsmet theUS Environmental Protection Agency (EPA) action level of 15 parts per billion (ppb). When chloramine alone was used to disinfect water, the risk for BLL in the highest quartile among children in homes with LSL was greater than when either chlorine or chloramine with orthophosphate was used. For children tested after LSLs in their houses were replaced, those with partially replaced LSL were 43 times as likely to have BLLs Z10 mg/dL versus children who never had LSLs. LSLs were a risk factor for elevated BLLs even when WASA met the EPA water action level. Changes in water disinfection can enhance the effect of LSLs and increase lead exposure. Partially replacing LSLs may not decrease the risk of elevated BLLs associated with LSL exposure.

Analysis of the February 1999 Natural Resources Defense Council Report on Bottled Water

Drinking Water Research Foundation, 1999

In February 1999, the Natural Resources Defense Council (NRDC) issued a report entitled “Bottled Water: Pure Drink or Pure Hype?” in which numerous wrong allegations against bottled water are raised. This document provides an extensive analysis and rebuttal of NRDC’s conclusions, highlighting the various mistakes and wrong allegations made by NRDC.