Qualitative and/or Quantitative Drinking Water Recommendations for Pediatric Obesity Treatment

Abstract

Objective The qualitative recommendation to ‘drink water instead of caloric beverages’ may facilitate pediatric obesity treatment by lowering total energy intake. The quantitative recommendation to ‘drink enough water to dilute urine’ might further facilitate weight loss by increasing fat oxidation via cell hydration-mediated changes in insulin. Methods This 8 week randomized intervention tested whether both qualitative-plus-quantitative (QQ) drinking water recommendations result in more weight loss than the qualitative recommendation alone (Q) in 25 children (9–12y) with body mass index at or above the 85th Percentile, given a reduced glycemic diet and usual physical activity. Random urine osmolality, saliva insulin, and body weight were assessed weekly. Mixed models explored if insulin mediated an effect of urine osmolality on weight loss. Results In intention-to-treat analyses, QQ and Q participants did not differ significantly with respect to level of urine osmolality, saliva insulin, or weight loss. Only 4 out of 16 QQ participants complied with instruction to drink enough water to dilute urine, however. In completers analyses, the compliant QQ participants, who diluted urine osmolality from 910 ± 161 mmol/kg at baseline to below 500 mmol/kg over time (8 week mean±SE: 450 ± 67 mmol/kg), had significantly lower saliva insulin over time (8 week mean±SE: 13 ± 8 pmol/l vs. 22 ± 4 pmol/l) and greater weight loss (mean ± SE: −3.3 ± 0.7kg vs. −2.0 ± 0.5 kg) than compliant Q participants (7 out of 9 participants) who maintained elevated urine osmolality over time (8- week mean±SE: 888 ± 41 mmol/kg). Urine osmolality below 500 mmol/kg was significantly associated with weight loss. Change in saliva insulin partially explained the association. Conclusions QQ recommendations may increase weight loss for those able to dilute urine. Work is warranted to pursue cell hydration effects of drinking water for pediatric obesity treatment.

Negative, Null and Beneficial Effects of Drinking Water on Energy Intake, Energy Expenditure, Fat Oxidation and Weight Change in Randomized Trials: A Qualitative Review

“…Small absolute increases in drinking water have a null effect on weight change [ 27 , 129 ]. Muckelbauer et al [ 27 ] increase drinking water by one glass/d in normal weight, overweight and obese children, with ad libitum diet and usual exercise conditions.…”

Underhydration Is Associated with Obesity, Chronic Diseases, and Death Within 3 to 6 Years in the U.S. Population Aged 51–70 Years

“…Fasting serum sodium, spot urine volume, and spot urine osmolality were used to classify study participants according to previously defined hydration criteria [1,53,54], which are consistent with zero electrolyte free water clearance [55], proposed cutoffs for urine osmolality [56,57], and possible chronic health benefits [58][59][60]. For urine osmolality, the cutoff of 500 mmol/kg was selected because of its sensitivity to cell swelling, suppressed vasopressin release, and urine dilution.…”

Drinking to thirst influences fluid replacement in adolescents judokas

“…Ingestion of water instead of caloric beverages has been recommended to patients who needed to reduce body weight 30 . Somebody that needs to maintain body weight within standards, such as dancers and fighters, can avoid the ingestion of caloric isotonic beverages to avoid weight gain.…”