Water Requirements, Impinging Factors, and Recommended Intakes
Water Requirements, Impinging Factors, and Recommended Intakes
Introduction
Water is an essential nutrient for all known forms of life and the
mechanisms by which fluid and electrolyte homeostasis is maintained in
humans are well understood. Until recently, our exploration of water
requirements has been guided by the need to avoid adverse events such as
dehydration. Our increasing appreciation for the impinging factors that must be
considered when attempting to establish recommendations of water intake
presents us with new and challenging questions.
This paper, for the most part, will concentrate on water requirements,
adverse consequences of inadequate intakes, and factors that affect fluid
requirements. Other pertinent issues will also be mentioned. For example, what
are the common sources of dietary water and how do they vary by culture,
geography, personal preference, and availability, and is there an optimal fluid
intake beyond that needed for water balance?
Adverse Consequences
Dehydration is the adverse consequence of inadequate water intake. The
symptoms of acute dehydration vary with the degree of water deficit (1). For
example, fluid loss at 1% of body weight impairs thermoregulation and, thirst
occurs at this level of dehydration. Thirst increases at 2%, with dry mouth
appearing at approximately 3%. Vague discomfort and loss of appetite appear
at 2%. The threshold for impaired exercise thermoregulation is 1% dehydration,
and at 4% decrements of 20-30% is seen in work capacity. Difficulty
concentrating, headache, and sleepiness are observed at 5%. Tingling and
numbness of extremities can be seen at 6%, and collapse can occur at around
7% dehydration. A 10% loss of body water through dehydration is life-
threatening (2). During the Six-day War of 1967, more than 20,000 Egyptian
soldiers died from heat stroke. Egyptian troops were following practices of
strict water rationing. During the same time, Israeli troops with abundant field
water supplies and command-enforced water policies had minimal heat
casualties (3)
trials. The mean amount of total water from food and beverages, consumed by
subjects in this study, was 1.1 mL/kcal.
Table 1 Previous army fluid replacement guidelines for hot weather training a
7
Criteria Controls
Heat WBGT* Index Water Intake Work-Rest
Condition/ (ºF) (qt/h) Cycle (min)
Category
1 78-81.9 At least 0.5 Continuous
2 82-84.9 At least 0.5 50/10
3 85-87.9 At least 1 45/15
4 88-89.9 At least 1.5 30/30
5 90+ More than 2 20/40
a
Adapted from: Montain SJ, et al. Fluid Replacement Recommendations for
Training in Hot Weather. Military Medicine, 164,7:502-508, 1999.
* WBGI = Wet Bulb Globe Temperature
It was determined that the Army’s guidelines may need revision after
190 military personnel were hospitalized for water intoxication
(hyposmolality/hyponatremia) between 1989 and 1999 (38). Hyponatremia
should be considered a risk when large volumes of plain drinking water are
consumed, especially when combined with a diet low in salt (sodium chloride).
8
Age and gender specific Adequate Intakes (AI) for water were
established in 2004 by the Food and Nutrition Board (5). The Dietary Reference
Intakes (DRI) for water are shown in Tables 3 and 4.
9
9 – 13 years
Boys 2.4 L/day
Girls 2.1 L/day
14 – 18 years
Boys 3.3 L/day
Girls 2.3 L/day
19 – 70+
Men 3.7 L/day
Women 2.7 L/day
on water intake report only tap water, and therefore, water provided as other
beverages are not included in the calculations. Williams, et. al. (48) reported
that estimates of mean water intake rates reported in the literature range from
1.04 to 1.63 L/person/day.
Table 5. Market shares (liter per capita) of beverages in various countries a,b
Water content of beverages varies. Plain drinking water and diet soft drinks
are 100% water, whereas coffee and tea are 99.5%, and sport drinks are 95%.
11
Fruit juices vary from 90 to 94% water. Skim milk, 2% fat milk, and whole
milk are 91%, 89%, and 87% respectively. While not consumption data, the
market share data in Table 5 reflects consumption patterns. Water intake from
these beverages could be estimated with the possible exception of beverages
containing alcohol.
Establishing Recommendations/Guidelines
Table 6 shows the WHO requirements for adults (19) and also
estimates from several the studies reviewed in this paper. While studies have
shown that a low intake of fluid is associated with some chronic diseases,
evidence is insufficient, at this time, to delineate specific amounts needed to
prevent various diseases.
15
Future challenges
For six decades, the driving force behind fluid and electrolyte research has
been medical care, survival, and optimal physical performance. Empirical and
clinical research, and field studies have been conducted on military personnel,
athletes, and hospitalized patients. Missing, however, is comprehensive data
16
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