Encouraging Consumption of Water in School and Child Care Settings: Access, Challenges, and

Strategies for Improvement

Children and adolescents are not consuming enough water, instead opting for sugar-sweetened
beverages (sodas, sports and energy drinks, milks, coffees, and fruit-flavored drinks with added sugars),
100% fruit juice, and other beverages. Drinking sufficient amounts of water can lead to improved weight
status, reduced dental caries, and improved cognition among children and adolescents.

Because children spend most of their day at school and in child care, ensuring that safe, potable drinking
water is available in these settings is a fundamental public health measure.

We sought to identify challenges that limit access to drinking water; opportunities, including promising
practices, to increase drinking water availability and consumption; and future research, policy efforts,
and funding needed in this area.

Effects of hydration status on cognitive performance and mood

Although it is well known that water is essential for human homeostasis and survival, only recently have
we begun to understand its role in the maintenance of brain function. Herein, we integrate emerging
evidence regarding the effects of both dehydration and additional acute water consumption on
cognition and mood. Current findings in the field suggest that particular cognitive abilities and mood
states are positively influenced by water consumption. The impact of dehydration on cognition and
mood is particularly relevant for those with poor fluid regulation, such as the elderly and children. We
critically review the most recent advances in both behavioural and neuroimaging studies of dehydration
and link the findings to the known effects of water on hormonal, neurochemical and vascular functions
in an attempt to suggest plausible mechanisms of action. We identify some methodological weaknesses,
including inconsistent measurements in cognitive assessment and the lack of objective hydration state
measurements as well as gaps in knowledge concerning mediating factors that may influence water
intervention effects. Finally, we discuss how future research can best elucidate the role of water in the
optimal maintenance of brain health and function.
The effect of the consumption of water on the memory and attention of children

The impact of asking children to drink water during their school days, and its possible influence on
school performance, has been little considered using intervention studies. Therefore in the afternoon
the cognitive functioning of 40 children (mean of 8 years and 7 months) was assessed twice, once after
drinking 300 ml of water and on another day when no water was provided. Memory was assessed by the
recall of 15 previously presented objects. Recall was significantly better on the occasions when water
had been consumed. The ability to sustain attention was measured by asking the child to respond to a
light that followed an auditory warning after a delay of either 3 or 12 s. The ability to sustain attention
was not significantly influenced by whether water had been drunk.

The Hydration Equation: Update on Water Balance and Cognitive Performancez

CONDENSED VERSION AND BOTTOM LINE

Water is a crucial nutrient and euhydration is necessary for optimal daily functioning. Water balance is
precisely regulated within the body and many methods exist for assessing hydration status. Cognitive
performance measures an individual’s attentiveness, critical thinking skills, and memory. Traditionally a
2% or more body water deficit was thought to produce cognitive performance decrements; however,
recent literature suggests that even mild dehydration – a body water loss of 1–2% – can impair cognitive
performance. Counseling clients about their health and wellbeing should include conveying the
importance of water for normal body functioning, as well as its effects on physical and cognitive
performance.

Keywords: fluid, cognitive function, hydration assessment, water intake, mood

Although it is often overlooked as an essential nutrient, water is vital for life as it serves several critical
functions. Total body water comprises approximately 45–75% of a person’s body weight (27). Muscle
mass is 70–75% water, while water in fat tissue can vary between 10 and 40% (25). Water acts as a
transporter of nutrients, regulates body temperature, lubricates joints and internal organs, provides
structure to cells and tissues, and can help preserve cardiovascular function (26). Water consumption
may also facilitate weight management (15,17). Water deficits can impact physical performance (25,38),
and recent research suggests that cognitive performance may also be impacted (4,13,20–22,35,36). This
article will address water balance, hydration assessment, and the effect of water balance on cognitive
performance.

Water Balance

Water balance (i.e., input vs. output) is influenced by dietary intake, physical activity level, age, and
environmental conditions. Although total body water balance is tightly regulated over a 24-hour period
(25), deficits and excesses can occur. Dehydration develops from inadequate fluid intake or excessive
fluid losses, and overhydration can result from excessive water (or fluid) intake with or without proper
electrolyte replacement (25,33).
The Relationship between Total Water Intake and Cognitive Control among Prepubertal Children

Background: Cognitive control (also known as executive function) encompasses mental processes that
underlie goal-directed behavior, and it enables us to adjust our behavior according to changing
environmental demands. Previous research among children has demonstrated that aerobic fitness and
obesity have contrasting and selective effects on cognitive control. However, the relationship between
water intake and childhood cognitive control remains inadequately studied. This study investigated the
relationship between total water intake and cognitive control among prepubertal children (8-9-year
olds). Methods: Children between 8 and 9 years of age (n = 63) performed a modified flanker task to
assess cognitive control related to inhibition (ability to resist distractions and maintain focus). Diet was
measured using 3-day food records. Total water was defined as water consumed from drinking water,
beverages, and food. Results: A comparison of task performance across the median intake of total water
revealed that children above the median exhibited shorter reaction times across multiple conditions of
the flanker task, requiring variable amounts of cognitive control. Further, after adjustment of age, IQ,
socioeconomic status, weight status, and aerobic fitness level, the proportion of intake comprised of
water (%TW) was negatively correlated with reaction time interference, that is, the ability to maintain
task performance when task conditions demanded greater inhibition. Conclusions:These results indicate
an association between water intake and cognitive control using a task that modulates inhibition.
Specifically, higher water intake correlated with greater ability to maintain task performance when
inhibitory demands are increased. Future work is needed to determine the mechanism by which water
influences cognitive control among children.

Effect of Water Supplementation on Cognitive Performances and Mood among Male College Students
in Cangzhou, China: Study Protocol of a Randomized Controlled Trial

Introduction: Water accounts for about 75% of brain mass. Cognitive performances and mood may be
impaired by hypohydration and improved by water supplementation. Two surveys conducted in China
demonstrated that a large proportion of adults and children drank less fluid than the amounts
recommended by the Chinese Nutrition Society. The association between hypohydration and cognitive
performance has not been reported in China. The purpose of this study is to explore the effect of water
supplementation on cognitive performances and mood among male college students in Cangzhou,
China. Methods and Analysis: A randomized controlled trial is designed to test the hypothesis. A total of
68 male college students aged 18–25 years will be recruited and randomly assigned into water-
supplementation group (WS group, n = 34) and no water-supplementation group (NW group, n = 34)
after an overnight fasting, i.e., without eating foods and drinking fluid for 12 h. The first morning urine
will be collected to determine urine osmolality on the water supplementation day. Cognitive
performances and mood will be performed before water supplementation by researchers with
questionnaire. Subjects in the WS group will drink 400 mL purified water within 5 min, while those in
NW group will not drink any fluid. One hour later, urine will be collected and urine osmolality, cognitive
performances and mood will be measured again. Mixed model of repeated measures ANOVA will be
used to investigate the effect of water supplementation on cognitive performances. The study would
provide information about the benefit of water supplementation on cognitive performances. Ethics and
Dissemination: The study protocol is reviewed and approved by the Ethical Review Committee of the
Chinese Nutrition Society. Ethical approval project identification code is CNS-2015-001. Results will be
published according to the CONSORT statement and will be reported in peer-reviewed journals. Trial
registration: Chinese clinical trial registry. Identifier: ChiCTR-IOR-15007020. Registry name “The effect of
hydration on cognitive performance”.