How Does Hydration Education Change One’s Misconception of Hydration and Its

Effects on Our Body?

Elizabeth Joa, Nelcy Mylonas, Kelsey Macaluso

Queens College Dietetic Internship

2017-2018

 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

Abstract

Water consumption is an indispensable part of our bodies. It performs a plethora of different

functions that are crucial for optimal health. However, with so many options available, there
seems to be a misconception of what types of drinks are best to hydrate our bodies. The
question then becomes whether there is a need for better refined water recommendations,
and whether education on the importance of a well hydrated body for optimal health is
necessary.
An assessment on hydration knowledge among Queens College students and staff
determined if this population has an understanding on how proper hydration impacts our
bodies. A cross-sectional study with utilization of pre and post-surveys provided an insight
of impact achieved after a hydration education intervention. Sixty staff members and
students were randomly selected for the study to test campus knowledge on hydration. A
table was set up showing water contents in a variety of foods, sugar contents in campus
drinks, various flyers, and a brochure handout for participants. These education tools and
materials were presented to show how water is the best means to hydrate oneself; rather
than consuming other drinks that also may contain an excessive amount of sugar and
dehydrate you instead.

Keywords: hydration; water; misconception; intervention; health

Introduction

The most basic necessity of survival is staying hydrated. Water can come from

beverages, but also from eating foods like broths, tomatoes, melon, and even dairy and meat

products.1 They all contain a different amount of water.1 The water consumed is absorbed

into the body and used to help with joint lubrication, regulating the normal body

temperature, as well as cushioning the spinal cord and other sensitive tissues throughout

the body.1 In addition, it aids in physical performance, concentration, maintaining bacteria

level in the mouth, maintaining skin, blood volume, blood pressure, kidney functions,

gastrointestinal function, and keeps one from feeling lethargic and fatigued.2 Water becomes

a necessity when it is needed to cool the body during physical activity, when the body is

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

exposed to a hot climate, when an individual is sick and running a fever, when an individual

is experiencing vomiting/diarrhea, or excretion from everyday bodily processes.1

The way the body utilizes water is by absorbing fluids during the process of breaking

down these nutrients from foods in the small intestine through metabolic processes.3 Water

is used as the medium between all chemical and enzymatic reactions that occur throughout

the body. The body depends on water for the movement of hormones, antibodies, oxygen,

and nutrients through the lymphatic system and bloodstream throughout all organs and

tissues of the body. Products of salt and metabolism are removed and filtered out by the

kidneys and finally excreted out of the body.3 Without the proper amount of water necessary

to hydrate the body, it then creates a toxic and acidic environment leading to other metabolic

problems that inhibits the maintenance of homeostasis.4 Water is excreted through a

person’s digestive tract via salivary glands, respiratory system when breathing, sweat

glands, and kidneys.4

When experiencing dehydration, an individual may have dizziness, may faint,

experience fatigue, muscles cramps, headaches, and overall decrease in mental and physical

performance. A physical sign of dehydration would be the coloration of an individual’s urine.

A dark yellow and cloudy color is a sign that the individual is dehydrated and in need of

fluids. This is an indication that the kidneys are not fully eliminating nitrogenous waste, and

therefore becoming harmful. The skin can become dried and cracked, and absence of bowel

movements lead to constipation due to water in stool being reabsorbed for better use in

other metabolic processes. If a person is adequately hydrated, the excretion of urine should

be an opaque light/yellow color.2

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

Hydration is needed at every age and the amount of fluids we consume daily must

compensate for the amount of water that is lost. People seem to have a misunderstanding of

the amount of water that is needed every day for our body to function. Water consumption

depends on your gender, age, activity level and health status, and whether you are a healthy

individual or having an illness.3 Water also binds to muscles more than it does to fat.

Genetically speaking, men tend to have a greater amount of lean muscle mass than women,

therefore, men have a higher percentage of water in their body mass.3 Women have an

average of 52-55% water to total body mass and men have an estimated 60% of water.3 As

the body ages, less water is bound to the body and if someone becomes overweight or obese,

more fat is found in the body causing there to be a decrease in water. Water contents during

infancy makes up 75% of body weight and in the elderly population, 55% of their body

composition is made up of water to maintain homeostasis in the body.2 If a person is

physically active they would also need to increase their total water intake to replace the

water that they lost.2 It is not uncommon for athletes to lose 6-10% water during extreme

physical activity2. The recommendations for water intake for infants 0-12 months old is 0.6-

0.7 L/d, children 1-8 years of age is 1.3-1.7 L/d, adolescent males 9-18 years old is 2.4-3.3

L/d, adult males 19 and up is 3.7 L/d.5 Adolescent females recommendations for 9-18 years

old is 2.1-2.3 L/d, adult females 19 and up is 2.7 L/d, females during pregnancy is 3.0 L/d

and for females who are lactating require 3.9L/d.

Water for the body comes mainly from what we drink, but also from what we eat.

Different fluids and foods contain different amounts of water to keep the body hydrated.

Foods that are high in moisture are the best sources to gain hydration in the body. Some

examples are; soups, meats, fruits like watermelon, oranges, apples, and vegetables such as

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

leafy greens and cucumbers. The best option to keep the body well hydrated is water, but

with the countless number of beverage options and the need for sugar and flavor, it becomes

challenging to make the right choices. Better drink choices are: water, sparkling waters,

black tea and black coffee. Even though, coffees and teas were once considered to be a large

contributor to dehydration because of its diuretic properties, recent research indicated that

if consumed in moderate amounts it has the same effect that water has on hydrating the

body.6 Some of the worst beverages to consume would include, but are not limited to, soda,

juice, energy drinks, smoothies, milkshakes, large amounts of caffeinated beverages like

lattes, Frappuccinos, and electrolyte replenishing drinks. This is mainly for the reason of the

sugar content and fat that act more of a source to dehydrate than to hydrate the individual

who is consuming the product. When an individual is consuming a beverage that is high in

sugar or fat, the water that is in that beverage will be absorbed with the broken-down sugars

and fats and will aid in the digestion of those nutrients. Whereas if water was consumed, the

water would be utilized throughout the body for other metabolic processes. All nutrients

need water in the process of being broken down to create energy that is utilized in the body.

For example, this can be done through the process of the electron transport chain which

occurs in the mitochondria of each cell where energy is created in the form of ATP.7

In a study conducted by School of Sport, Exercise and Health Sciences Loughborough

University in the United Kingdom, concluded that among their population there were many

uncertainties and confusion about the amount of fluid consumption that should be taken

daily.7 The paper investigates the amount of water that was taken in on an international scale

and beverage habit consumption in adults in the UK. Researchers found that people in the

United States drink more beverages that contain more energy. However, the trend in water

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

products in the past 10 years shows that people are drinking more water and getting less of

an energy consumption from beverages.7 After the study, the researcher still felt the need to

refine recommendations for water intake in order for the population to stay hydrated.

Another study was also done on children between the ages of 4-13 years old in the

United States and concluded that children are not meeting the recommended amounts of

water consumption each day. This is found to be a cause of concern for the young

population.9 The research found that out of 4,766 children that were examined through a 3

day-24 hour recall fluid intake, 75% of the children did not meet the DRI for water.9

The study conducted on the Queens College campus, investigated the need for hydration

among students and faculty. It took a closer look into the population’s understanding on

hydration and its’ need in the body. The team examined the common knowledge among the

campus and distinguished any misconceptions the campus population might have about

certain beverages. Showing the population of Queens College the overall importance of the

need for proper hydration could give them further insight to their daily lives about

beverage and food choices, as well as improve performance in their teachings and learnings

in the classroom. The research team addressed and helped clear up any questions the

population had about the amount of water that should be consumed daily. The aim of this

intervention was to make aware of better foods to select that can aid in proper hydration.

Another aim was to educate on common, campus beverage choices that will better hydrate

the body. As a population health initiative that targets a life-course nutrition intervention;

this study is part of the 10 change drivers in the Future Scan 2012-2020 that affect the

Dietetic workforce supply and demand. Nutrition initiatives are increasing in demand,

which create new opportunities for dietetic practitioners to implement nutrition

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

interventions alongside nutrition education to populations. This study created a great

opportunity for students to be part of what is currently driving the supply and demand

workforce in nutrition and dietetics10.

Methodology

The target study population is Queens College students and faculty of all ages.

Collection of data and nutrition education took place at Queens College dining hall on

February 28th, 2018. An information table was set up during the day with laptops available

to collect data as part of an environmentally friendly approach to reduce paper waste

(Appendix 1)11. A cross-sectional study using a survey method was used to determine if

education on hydration will impact their knowledge to make healthy behavior choices that

students and faculty can continue to improve as part of a healthy lifestyle.12 Inferential

statistics was used to determine the outcome of the hypothesis in frequency form to

determine the percentage of students and changes they would make after the intervention.13

Statistical data analysis was evaluated with the use of Excel sheets, where data from surveys

was analyzed to determine objective outcomes measurements to see if there were noticeable

changes on hydration choices and improvement in answers14 . Part of the data collection

and education includes what types of drinks students and faculty consume daily and can

contribute to their hydration status as well as their current knowledge of hydration and its’

importance in the body.

This study is part of Queens College’s current mission to deliver nutrition

interventions throughout the campus. The purpose and mission for this study was to deliver

hydration education to students and faculty on campus as part of get FRUVED; a nation-wide

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

movement aiming to support healthy living among college students.15 This movement is

currently involving “over 80 Colleges and Universities, more than 130 Phd researchers, and

1,000s of students,” in efforts to work in partnership and deliver nutrition education. The

target population are students and staff of these institutions to promote health messages and

advocate for healthier environments.15

The information table included hydration charts (Appendix 2) according to age,

gender, and weight, along with a color urine chart (Appendix 3) that allows for a quick

assessment on hydration status16, and a chart that shows the percentage of water in certain

foods (Appendix 4).

A display of several common drinks currently available in vending machines

throughout campus was presented to show the sugar content in each of these drinks. The

drinks selected for display were (Appendix 5): Sparkling water: 33.8 fl oz– no sugar,

Gatorade: 32 fl oz - 53g sugar = 13 tsp [21 g sugar= 5 tsp (one serving)], Lipton Iced Tea

Green Tea Citrus: 16 fl oz-32g sugar= 7.6 tsp, Florida Natural Lemonade: 14 fl oz- 47g sugar=

11.2 tsp, Coca cola: 16 fl oz- 52g sugar=12.4 tsp, and Mountain Dew: 20 fl oz- 77g sugar=

18.3 tsp. The empty bottles were filled with the corresponding sugar that is found in each

drink, and labeled with the amount of fluid, and sugar content. The purpose of the display

was to show which drinks students and faculty members are consuming that may be more

dehydrating. In addition, a food display showing the content of water in each of these foods

will educate about water content of several food choices. Water content display of foods

(Appendix 6) included 1 small apple (5.5 fl oz), 1 medium Banana (4 oz)– 3.4 fl oz, romaine

salad (3 oz)- 2.8 fl oz., yogurt (8 oz)- 6.8fl oz, white rice (4 oz) -2.7 fl oz, oatmeal (6 oz)- 4.5fl

oz, and grilled chicken (4 oz)- 2 fl oz. The portioned-out food was displayed on dishes with

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

the water contents set alongside it in a clear plastic cup. Each food was labeled with its’ food

name, amount of food, and amount of water.

A total of 60 surveys were collected from students and staff that approached the

information table with a before and after education assessment on hydration. These surveys

compared how much knowledge was gained and what some of the misconceptions the

participants had about hydration.

Results

During the education, participants were most surprised about the water content in

food displayed. The most impactful information attained in the results can be seen in

question 5 where participants were asked what types of foods contain the most water. In

the pre-survey, we find that many participants did not believe that the one serving of yogurt

contained the most water content relative to the other options (Chart 1.1). After the

education, many chose yogurt to have the highest water content when compared to pre-

education survey (Chart 1.1 & 1.2). Many believed that the salad and apple had the most

water, but when compared on portion sizes shown the highest water content came from the

yogurt.

Therefore, this shows that people know that vegetables and fruits contain a large

amount of water, but did not know there are other foods that have a water content as well.

When participants were asked where they think hydration comes from, the pre and

post- survey showed similar results in that the majority knew that hydration comes from

food and drinks we consume (Charts 2.1 & 2.2). Therefore, if the participants knew that food

and drinks contribute to hydration status, they may just be lacking in the knowledge of what

foods contain the most water to contribute to hydration.

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

Chart 1.1 Pre-education survey question #5

Chart 1.2 Post-education survey question #5

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

Chart 2.1 Pre-education survey question #1

Chart 2.2 Post-education survey question #1

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

Discussion

Water is an indispensable part of our daily lives and necessary to promote and

maintain an array of physiological needs for overall good health. Therefore, proper hydration

is an important component of our health and body regulations. Temperature control, joint

lubrication, adequate blood volume, and several organ functions essential for homeostasis

in body systems, are all regulated by water.

Another part of the education focused on how some foods can dehydrate you, based

on its content of sugars or fat. The more fat or sugar in a product, the more molecules of

water are needed to help break down the food ingested. In turn, people average 1 milliliter

intake of water per kilocalorie of food each day.

Many may not be aware that the adequate amounts of water needed for good health

is based on factors like age, gender, and physical activity level. Therefore, one goal of this

education was to provide accurate information alike, on proper hydration so that it can make

a positive impact on health. The research question and idea were inspired by the nutrition

interventions by “FRUVED College Campus Health Promotion Toolkit” and through the

“Nutrition and You: Trends 2011.”15,17 The American Dietetic Association recognized that

67% of the college-aged population believe that diet and nutrition are very important.17 With

this knowledge, it was decided that hydration education would be beneficial for the college-

aged population at Queens College. Healthy knowledge about hydration will help promote a

healthy lifestyle in diet and nutrition. Moreover, education on hydration will be beneficial as

this population has been shown to believe that diet and nutrition are very important. As part

of get FRUVED efforts to deliver nutrition education to school campuses and promote good

nutrition and healthy habits, adequate hydration is often an overlooked nutritional

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

component for good health. The focus of this research was to obtain a nutrition assessment

of Queens College students and staff on their current hydration knowledge. This approach

helped determine if this population has an understanding of how hydration impacts our

body. Education was provided to address hydration knowledge and the benefits of proper

hydration.

Conclusion

After the pre and post-surveys, participants were able to acknowledge the strong

need for water in their diet. They also became more self aware of the foods and drinks they

consumed that were either hydrating them or dehydrating them. The results of this study is

useful in showing that more education should be conducted on what specific foods and

drinks promote a person’s hydration status. This study showed that there is a lack of

knowledge in the campus community, on the water content in foods and drinks.

The post-survey results also show a decrease in the number of wrong answers to the

following question: “True or false? The sugar content in some drinks have no effect on the

amount of water being absorbed in our body?” Therefore, this study was helpful in

debunking the fact that other contents of foods and drinks, such as sugar content, have no

effect on our hydration status. The education was able to clarify the misconception.

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Appendix
Appendix 1. Pre and Post Survey Questions:
Link to survey
https://forms.office.com/Pages/DesignPage.aspx?fragment=FormId%3DrY0rR3eFekqF9dkWZK
5-
4Eroa3GfOg1NoG_qIUdXrNBUREgzWVBHR0tJVk9FREpKSEwwRDZTTjIxNi4u%26Token
%3Dbfbda4399c9549c18acb330a52c1a807

1. Where does hydration come from?

a. Only from water
b. From all drinks and food
c. Only from Gatorade

2. How much water is consumed depends on which of the following reasons?

a. Gender
b. Age
c. Activity level
d. Health status
e. All the above

3. True or false? The sugar content in some drinks have no effect on the amount of water being
absorbed in our body?

4. Which of the following beverages will provide the best hydration?

a. Juice
b. Water
c. Energy drinks
d. Gatorade or Powerade
e. All of the above

5. Which of the following foods contains more water?

a. 1 cup of yogurt
b. 1 medium banana
c. 1 small apple
d. 4 oz grilled chicken
e. 3 oz salad

6. True or False? Water is only necessary when the temperature is above 70 degrees Fahrenheit.
7. True or False? Water is only used to hydrate our body?

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

Appendix 2.1 - Visuals18

Appendix 2.2 - Visuals14

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

Appendix 3 - Visuals16

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

Appendix 4 - Water content in some fruits

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

Appendix 5
Demonstration set up on the table- fluid/sugar content (which will dehydrate more)20,22,23

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

Sparkling water- 33.8 fl oz– no sugar20

Gatorade- 32 fl oz - 53g sugar = 13 tsp (whole bottle), 21 g sugar= 5 tsp (one serving)20
Lipton Iced Tea, Green Tea Citrus- 16 fl oz-32g sugar= 7.6 tsp20
Florida Natural Lemonade- 14 fl oz- 47g sugar= 11.2 tsp20
Coca cola- 16 fl oz- 52g sugar=12.4 tsp20
Mountain Dew 20 fl oz- 77g sugar= 18.3 tsp20

Appendix 6

Demonstrations/Education

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

Demonstration set up on the table- Foods/water content17,20,21

Apple- 1 small apple- 5.5 fl oz White Rice- 4 oz -2.7 fl oz
Banana 1 medium (4 oz)– 3.4 fl oz Oatmeal-6 oz- 4.5 fl oz
Salad romaine- 3 oz salad (about 1 cup)- 2.8 Grilled Chicken 4 oz chicken- 2 fl oz
fl oz
Total ounces of water-~28 fl oz
Yogurt 1 cup- 6.8 fl oz

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 How Does Hydration Education Change One’s Misconception of Hydration and Its Effects on Our Body?

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22