Beverage Consumption Habits and Association with Total Water and Energy Intakes in the Spanish Population: Findings of the ANIBES Study

Abstract

Background: Inadequate hydration is a public health issue that imposes a significant economic burden. In Spain, data of total water intake (TWI) are scarce. There is a clear need for a national study that quantifies water and beverage intakes and explores associations between the types of beverages and energy intakes. Methods: The Anthropometry, Intake and Energy Balance Study ANIBES is a national survey of diet and nutrition conducted among a representative sample of 2285 healthy participants aged 9–75 years in Spain. Food and beverage intakes were assessed in a food diary over three days. Day and time of beverage consumption were also recorded. Results: On average, TWI was 1.7 L (SE 21.2) for men and 1.6 L (SE 18.9) for women. More than 75% of participants had inadequate TWI, according to European Food Safety Authority (EFSA) recommendations. Mean total energy intake (EI) was 1810 kcal/day (SE 11.1), of which 12% was provided by beverages. Water was the most consumed beverage, followed by milk. The contribution of alcoholic drinks to the EI was near 3%. For caloric soft drinks, a relatively low contribution to the EI was obtained, only 2%. Of eight different types of beverages, the variety score was positively correlated with TWI (r = 0.39) and EI (r = 0.23), suggesting that beverage variety is an indicator of higher consumption of food and drinks. Conclusions: The present study demonstrates that well-conducted surveys such as the ANIBES study have the potential to yield rich contextual value data that can emphasize the need to undertake appropriate health and nutrition policies to increase the total water intake at the population level promoting a healthy Mediterranean hydration pattern.

Comparison of beverage consumption in adult populations from three different countries: do the international reference values allow establishing the adequacy of water and beverage intakes?

“…Table II shows the evaluation of adequacy between TWI value of each included study and the aTWI values provided by EFSA, IOM and the ratio ml/kcal. In the ANIBES study from Spain, only 12% of men and 21% of women fulfilled the EFSA recommendation of aTWI (data not shown) (18). Men reached only 69% of the 2.5 l/ day recommended, which translates as a deficit of 0.78 l/day (or 31% below the daily recommendation).…”

“…Caloric soft drinks contribution for the entire population was 2.3% of the total kcal per day. However, consumption was lower among adults than in adolescents and among women than in men (18).…”

“…A food photographic atlas was used to assist in assigning gram weights to portion sizes (16,17). Beverages were combined into eight categories for further analysis: a) hot beverages included hot tea and coffee (iced teas in cans or bottles were considered as caloric soft drinks); b) milk (all types of milk without separation by fat percentage); c) fruit and vegetable juices (including nectars and juice-milk blends); d) caloric soft drinks (including sports drinks such as isotonic drinks with mineral salts and caffeinated energy drinks, among others); e) diet soft drinks (with non-sugar sweeteners); f) alcoholic drinks, including two groups: low alcohol grade (mostly beer, wine, and cider) and high alcohol grade; g) water (including tap water and bottled water); and h) other beverages (including soy-based beverages and non-alcoholic beer, among others) (18). On average, the TWI for adults' age range 18 to 64 years was 1.72 l/day for men and 1.61 l/day for women.…”

“…The study was carried out in the months that represent the transition from summer to autumn seasons (September to November). Season variability is one of the conditions to take into account when the evaluation of the hydration status is performed, so it is also the use of hydration biomarkers that would allow assessment of dietary beverage intake and hydration status without the bias of self-reported dietary intake as well as intra-individual variability (18).…”

Nutritional differences in malnourished patients according to their liquid-intake habits after hospital discharge

“…It is known and generally accepted that a good hydration state contributes to health and wellbeing; hence, the effect of hydration habits on health of malnourished patients can be useful information for healthcare practice. Specially, if we take into account that the liquid intake of the Spanish population is below the recommended levels (8).…”