August 2010 at Changi General hospital

1. Hydration Science and Knowledge Dr. Maxime Buyckx Chair, ILSI North America Hydration Committee and The Beverage Institute for Health and Wellness The Coca-Cola Company

2. Hydration Topics Water / fluids requirements for healthy adults Measurements of hydration status Impact of factors like age, gender, physical activity, environment Contribution of different foods and beverages to hydration status Hydration and health

3. Kendrick Fincher Memorial Foundation: Heat Illness & Hydration(www.kendrickfincher.org) *75% of the body, 80% of the brain are made up of water*75% of the muscles, 92% of the blood are made up of water*Water carries nutrients and oxygen to the body, helps convert food into energy and regulates body temperature *1% dehydration results in thirst and there is a 10% decrease in mental performance when you feel thirsty*2% dehydration reduces your ability to work*4% dehydration results in lethargy, apathy and mental symptoms*If you are dehydrated you are more likely to have trouble concentrating, be more irritable and have more headaches *Long-term effects of being dehydrated include kidney and urinary tract infections, constipation, and kidney stones.*Drinking more water helps reduce obesity and bed-wetting in children*If you are well hydrated, exercise feels more and more enjoyable.

4. In recent years, the importance of proper hydration has been increasingly recognized The USA 2004 IOM / NAS DRI Report had 80 pages and 24 pages of scientific references But there are still many >Misperceptions and >Misinformation

5. Myth of Caffeine and Dehydration Statements by dieticians in the USA during the 1990s… Caffeinated beverages dehydrate Drink eight glasses of water a day For each caffeinated beverage that you drink, you must drink the same amount of water to compensate for the dehydration due to caffeine…

6. What you Need to Know about Caffeine Caffeine per se has a mild diuretic effect However, caffeine does not have a diuretic effect in individuals who normally consume caffeine, as they develop tolerance Caffeine can have a diuretic effect in caffeine naive people and four / five days of abstinence from caffeine are needed to become naive 1 – 4 days of caffeine intake are sufficient to develop tolerance

8. Caffeine Has No Effect On Hydration Status Eighteen healthy adult males in a counterbalanced, crossover designed study consumed the following beverages in four separate occasions: Water only ( 0 mg caffeine) Water + caffeinated cola (1.4mg/kg bw caffeine) Water + caffeinated diet cola (1.4mg/kg bw caffeine) Water + caffeinated cola + caffeinated diet cola + coffee (3.13mg/kg bw caffeine) Ann Grandjean et al, JACN 5:591-600, 2000

9. Caffeine Has No Effect On Hydration Status No significant different in the effect of various combinations of beverages on hydration status of healthy adult males. Advising people to disregard caffeinated beverages as part of the daily fluid intake is not substantiated by the results of this study. Ann Grandjean et al, JACN 5:591-600, 2000

10. DRI Report for Water & Electrolytes, USA 2004 Hence, unless additional evidence becomes available indicating cumulative total water deficits in individuals with habitual intakes of significant amounts of caffeine, caffeinated beverages appear to contribute to the daily total water intake similar to that contributed by non-caffeinated beverages.

12. Inclusion or Exclusion of Plain Drinking Water Had No Effect on Hydration Twenty-seven males, 19~38 years of age Random, crossover and counterbalanced design Two three-day confinement periods Controlled diet, physical activity and environment Ann Grandjean et al, JACN 22:165-173, 2003

13. Inclusion or Exclusion of Plain Drinking Water Had No Effect on Hydration Ann Grandjean et al, JACN 22:165-173, 2003

14. Inclusion of plain drinking water compared to exclusion of plain drinking water in the diet did not affect the markers of hydration used in this study. Ann Grandjean et al, JACN 22:165-173, 2003

15. DRI Report for Water & Electrolytes, USA 2004 Although water is thought of as the primary fluid to maintain hydration, fluids in different types of beverages and foods contribute significantly to a person’s daily fluid needs.

16. Proper Fluid Intake has some Influence on … Kidney stones (urolithiasis) Urinary tract infections Colorectal and bladder cancer Dental disease Constipation Protein and lipid metabolism

18. Relative Risk of Bladder Cancer Associated with Total Daily Fluid Intake* * 10 years among 47,909 participants in the Perspective Health Professionals Follow-up study Michaud, et al. NEJM, 18:1390-1397, 1999

19. Beverages Consumed Michaud, et al. NEJM, 18:1390-1397, 1999

20. DRI Report for Water & Electrolytes, USA 2004 Although a low intake of total water has been associated with some chronic diseases, this evidence is insufficient to establish water intake recommendations as a means to reduce the risk of chronic disease. Instead, an Adequate Intake (AI) for total water is set to prevent deleterious, primarily acute, effects of dehydration, which include metabolic and functional abnormalities.

21. Adequate Intake (AI) DRI Report for Water and Electrolytes, USA 2004 Children 1-3 years = 1.3 Liter (as total water, 20% food) 4-8 years= 1.7 L Adolescents 9-13 years= 2.4 L males and 2.1 L females 14-18 years= 3.3 L males and 2.3 L females Adults 19-70+ years= 3.7 L males and 2.7 L females

22. DRI Report for Water & Electrolytes, USA 2004 Total water intake includes drinking water, water in beverages, and water that is part of food.

23. ILSI NA Hydration Committee

24. Hydration Summary: Scientific facts Impact on physical performance Impact on mental performance Impact on the wellness and lifestyles of children, adults and elderly people Relationship with diseases ILSI work to understand better the benefits of Hydration in daily life…

25. Conference on Hydration and Health Promotion 29 – 30 November 2006 Washington D.C., USA

27. Scientific Consensus Statement Regarding the Importance of Hydration and Total Water Intake for Health and Disease 29 November 2006 Washington, DC USA

30. Importance of Hydration and Total Water Intake for Health and Disease It is agreed that scientific evidence links adequate water intake to survival, health promotion, sustained physical performance, maintenance of mental performance, and safety and productivity in the workplace.

31. Importance of Hydration and Total Water Intake for Health and Disease Water is essential for life The perception of thirst does not always guarantee appropriate total water intake. Foods and beverages contribute varying amounts of water in the diet. Non-caffeinated and caffeinated beverages such as water, milk, tea, coffee, juice, soft drinks and sport drinks contribute to hydration.

32. Importance of Hydration and Total Water Intake for Health and Disease Foods including fruits, vegetables, soups, and dairy products can also contribute to meet the body’s water requirement. Appropriate beverage and food choices for an individual vary based on energy, nutrient, and water needs, as well as consumer preference.

34. Also Foods Contain Water that your Body can Use… Water content of foods % Water Most fruits and vegetables 70-85% Cooked pasta and cereals 65-90% Cheese 40-60% Breads 30-45% Fish and seafood 70-80% Beef and other meat 45-65% Nuts and seeds 1-5% Chips and other snacks 1-10%

35. Enjoy your Hydration… Studies, especially in children, show that you’re likely to drink moreand stay better hydrated if you like the taste of the fluids you drink.

38. Thank You!