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Review
. 2021 Apr;60(3):1167-1180.
doi: 10.1007/s00394-020-02296-z. Epub 2020 Jul 6.

Hydration for health hypothesis: a narrative review of supporting evidence

Erica T Perrier  1 , Lawrence E Armstrong  2   3 , Jeanne H Bottin  4 , William F Clark  5 , Alberto Dolci  4 , Isabelle Guelinckx  4 , Alison Iroz  4 , Stavros A Kavouras  6 , Florian Lang  7 , Harris R Lieberman  8 , Olle Melander  9 , Clementine Morin  4 , Isabelle Seksek  4 , Jodi D Stookey  10 , Ivan Tack  11 , Tiphaine Vanhaecke  4 , Mariacristina Vecchio  4 , François Péronnet  12
Affiliations
Review

Hydration for health hypothesis: a narrative review of supporting evidence

Erica T Perrier et al. Eur J Nutr. 2021 Apr.

Abstract

Purpose: An increasing body of evidence suggests that excreting a generous volume of diluted urine is associated with short- and long-term beneficial health effects, especially for kidney and metabolic function. However, water intake and hydration remain under-investigated and optimal hydration is poorly and inconsistently defined. This review tests the hypothesis that optimal chronic water intake positively impacts various aspects of health and proposes an evidence-based definition of optimal hydration.

Methods: Search strategy included PubMed and Google Scholar using relevant keywords for each health outcome, complemented by manual search of article reference lists and the expertise of relevant practitioners for each area studied.

Results: The available literature suggest the effects of increased water intake on health may be direct, due to increased urine flow or urine dilution, or indirect, mediated by a reduction in osmotically -stimulated vasopressin (AVP). Urine flow affects the formation of kidney stones and recurrence of urinary tract infection, while increased circulating AVP is implicated in metabolic disease, chronic kidney disease, and autosomal dominant polycystic kidney disease.

Conclusion: In order to ensure optimal hydration, it is proposed that optimal total water intake should approach 2.5 to 3.5 L day-1 to allow for the daily excretion of 2 to 3 L of dilute (< 500 mOsm kg-1) urine. Simple urinary markers of hydration such as urine color or void frequency may be used to monitor and adjust intake.

Keywords: Arginine vasopressin; Copeptin; Metabolic; Renal; Water.

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Conflict of interest statement

ETP, JHB, AD, IG, AI, CM, IS, TV and MV are or were employed by Danone Research during the writing of this review. LEA, WCC, SAK, FL, HRL, OM, JDS, IT and FP have previously received consulting honoraria and/or research grants from Danone Research. No financial compensation was provided for the conception, drafting or critical revision of this manuscript.

Figures

Fig. 1
Fig. 1
Terminology and associated cut-off values for common biomarkers of hydration.*Defined as ‘impending dehydration’. †In the original text, these values are described as limits for euhydration (e.g., POsm < 290, UOsm < 700). For clarity we have positioned these values as limits for dehydration (e.g., POsm ≥ 290, UOsm ≥ 700) in order to avoid the interpretation that these values were limits for insufficient hydration. ‡Decision level for 95% probability of dehydration. §Approximate range of plasma copeptin in bottom quartile or other reference interval (lowest risk for kidney or cardiometabolic disease)—see Table 2. ||Approximate range of plasma copeptin for increased risk for kidney or cardiometabolic disease—see Table 2
See this image and copyright information in PMC

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