. 2022 Nov 25;378(6622):909-915.

doi: 10.1126/science.abm8668. Epub 2022 Nov 24.

Variation in human water turnover associated with environmental and lifestyle factors

Yosuke Yamada^#^{1

2}, Xueying Zhang^#^{3

4}, Mary E T Henderson^#⁵, Hiroyuki Sagayama⁶, Herman Pontzer^{7

8}, Daiki Watanabe^{1

2

9}, Tsukasa Yoshida^{1

2}, Misaka Kimura², Philip N Ainslie¹⁰, Lene F Andersen¹¹, Liam J Anderson^{12

13}, Lenore Arab¹⁴, Issad Baddou¹⁵, Kweku Bedu-Addo¹⁶, Ellen E Blaak¹⁷, Stephane Blanc^{18

19}, Alberto G Bonomi²⁰, Carlijn V C Bouten²¹, Pascal Bovet²², Maciej S Buchowski²³, Nancy F Butte²⁴, Stefan G Camps^{21

25}, Graeme L Close¹², Jamie A Cooper²⁶, Richard Cooper²⁷, Sai Krupa Das²⁸, Lara R Dugas^{29

30}, Simon Eaton³¹, Ulf Ekelund^{32

33}, Sonja Entringer^{34

35}, Terrence Forrester³⁶, Barry W Fudge³⁷, Annelies H Goris²¹, Michael Gurven³⁸, Lewis G Halsey⁵, Catherine Hambly⁴, Asmaa El Hamdouchi¹⁵, Marije B Hoos²¹, Sumei Hu³⁹, Noorjehan Joonas⁴⁰, Annemiek M Joosen²¹, Peter Katzmarzyk⁴¹, Kitty P Kempen²¹, William E Kraus⁴², Wantanee Kriengsinyos⁴³, Robert F Kushner⁴⁴, Estelle V Lambert⁴⁵, William R Leonard⁴⁶, Nader Lessan^{47

48}, Corby K Martin⁴¹, Anine C Medin^{11

49}, Erwin P Meijer²¹, James C Morehen^{12

50}, James P Morton¹², Marian L Neuhouser⁵¹, Theresa A Nicklas²⁴, Robert M Ojiambo^{52

53}, Kirsi H Pietiläinen⁵⁴, Yannis P Pitsiladis⁵⁵, Jacob Plange-Rhule¹⁶, Guy Plasqui⁵⁶, Ross L Prentice⁵¹, Roberto A Rabinovich⁵⁷, Susan B Racette⁵⁸, David A Raichlen⁵⁹, Eric Ravussin⁴¹, Leanne M Redman⁴¹, John J Reilly⁶⁰, Rebecca M Reynolds⁶¹, Susan B Roberts²⁸, Albertine J Schuit⁶², Luis B Sardinha⁶³, Analiza M Silva⁶³, Anders M Sjödin⁶⁴, Eric Stice⁶⁵, Samuel S Urlacher^{66

67}, Giulio Valenti^{20

21}, Ludo M Van Etten²¹, Edgar A Van Mil⁶⁸, Jonathan C K Wells⁶⁹, George Wilson¹², Brian M Wood^{70

71}, Jack A Yanovski⁷², Alexia J Murphy-Alford⁷³, Cornelia U Loechl⁷³, Amy H Luke⁷⁴, Jennifer Rood⁴¹, Klaas R Westerterp⁷⁵, William W Wong²⁴, Motohiko Miyachi^{1

9}, Dale A Schoeller⁷⁶, John R Speakman^#^{3

4

77

78}; International Atomic Energy Agency (IAEA) Doubly Labeled Water (DLW) Database Consortium§

Affiliations

¹ National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan.
² Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan.
³ Shenzhen Key Laboratory of Metabolic Health, Center for Energy Metabolism and Reproduction, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
⁴ Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK.
⁵ School of Life and Health Sciences, University of Roehampton, London, UK.
⁶ Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan.
⁷ Department of Evolutionary Anthropology, Duke University, Durham, NC, USA.
⁸ Duke Global Health Institute, Duke University, Durham, NC, USA.
⁹ Faculty of Sport Sciences, Waseda University, Saitama, Japan.
¹⁰ Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada.
¹¹ Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
¹² Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
¹³ School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
¹⁴ David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
¹⁵ Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN-Université Ibn Tofail URAC39, Regional Designated Center of Nutrition Associated with AFRA/IAEA, Rabat, Morocco.
¹⁶ Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
¹⁷ Department of Human Biology, Maastricht University, Maastricht, Netherlands.
¹⁸ Nutritional Sciences, University of Wisconsin, Madison, WI, USA.
¹⁹ Institut Pluridisciplinaire Hubert Curien, CNRS Université de Strasbourg, UMR7178, France.
²⁰ Phillips Research, Eindoven, Netherlands.
²¹ Maastricht University, Maastricht, Netherlands.
²² University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland.
²³ Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, TN, USA.
²⁴ Department of Pediatrics, Baylor College of Medicine, US Department of Agriculture (USDA)/Agricultural Research Service (ARS) Children's Nutrition Research Center, Houston, TX, USA.
²⁵ Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency of Science, Technology and Research (A*STAR), Singapore.
²⁶ Nutritional Sciences, University of Georgia, Athens, GA, USA.
²⁷ Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL, USA.
²⁸ USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.
²⁹ Public Health Sciences, Loyola University of Chicago, Maywood, IL, USA.
³⁰ Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
³¹ Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, London, UK.
³² Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
³³ Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.
³⁴ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany.
³⁵ Department of Pediatrics, University of California Irvine, Irvine, CA, USA.
³⁶ Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica.
³⁷ Aspire Academy, Doha, Qatar.
³⁸ Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA, USA.
³⁹ Beijing Technology and Business University, Beijing, China.
⁴⁰ Central Health Laboratory, Ministry of Health and Wellness, Mauritius.
⁴¹ Pennington Biomedical Research Center, Baton Rouge, LA, USA.
⁴² Department of Medicine, Duke University, Durham, NC, USA.
⁴³ Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakon-Pathom, Thailand.
⁴⁴ Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
⁴⁵ Health Through Physical Activity, Lifestyle and Sport Research Centre (HPALS) Division of Exercise Science and Sports Medicine (ESSM), FIMS International Collaborating Centre of Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
⁴⁶ Department of Anthropology, Northwestern University, Evanston, IL, USA.
⁴⁷ Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates.
⁴⁸ Imperial College London, London, UK.
⁴⁹ Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.
⁵⁰ The FA Group, Burton-Upon-Trent, Staffordshire, UK.
⁵¹ Division of Public Health Sciences, Fred Hutchinson Cancer Center and School of Public Health, University of Washington, Seattle, WA, USA.
⁵² Kenya School of Medicine, Moi University, Eldoret, Kenya.
⁵³ Rwanda Division of Basic Sciences, University of Global Health Equity, Rwanda.
⁵⁴ Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, and Abdominal Center, Obesity Center, HealthyWeightHub, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁵⁵ School of Sport and Service Management, University of Brighton, Eastbourne, UK.
⁵⁶ Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, Netherlands.
⁵⁷ The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
⁵⁸ Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA, and College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
⁵⁹ Biological Sciences and Anthropology, University of Southern California, Los Angeles, CA, USA.
⁶⁰ University of Starthclyde, Glasgow, Scotland.
⁶¹ Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
⁶² School of Social and Behavioral Sciences, University of Tilburg, Tilburg, Netherlands.
⁶³ Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, Portugal.
⁶⁴ Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark.
⁶⁵ Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
⁶⁶ Department of Anthropology, Baylor University, Waco, TX, USA.
⁶⁷ Child and Brain Development Program, Canadian Institute for Advanced Research (CIFAR), Toronto, Ontario, Canada.
⁶⁸ Maastricht University, Brightlands Campus Greenport Venlo and Lifestyle Medicine Center for Children, Jeroen Bosch Hospital, Hertogenbosch, Netherlands.
⁶⁹ Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.
⁷⁰ Department of Anthropology, University of California Los Angeles, Los Angeles, CA, USA.
⁷¹ Max Planck Institute for Evolutionary Anthropology, Department of Human Behavior, Ecology, and Culture, Leipzig, Germany.
⁷² Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
⁷³ Nutritional and Health-Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
⁷⁴ Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, USA.
⁷⁵ NUTRIM, Maastricht University, Maastricht, Netherlands.
⁷⁶ Biotechnology Center and Department of Nutritional Sciences, University of Wisconsin, Madison, WI, USA.
⁷⁷ State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China.
⁷⁸ CAS Center of Excellence in Animal Evolution and Genetics, Kunming, China.

^# Contributed equally.

PMID: 36423296
PMCID: PMC9764345
DOI: 10.1126/science.abm8668

Variation in human water turnover associated with environmental and lifestyle factors

Yosuke Yamada et al. Science. 2022.

. 2022 Nov 25;378(6622):909-915.

doi: 10.1126/science.abm8668. Epub 2022 Nov 24.

Authors

Affiliations

¹ National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan.
² Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan.
³ Shenzhen Key Laboratory of Metabolic Health, Center for Energy Metabolism and Reproduction, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
⁴ Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK.
⁵ School of Life and Health Sciences, University of Roehampton, London, UK.
⁶ Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan.
⁷ Department of Evolutionary Anthropology, Duke University, Durham, NC, USA.
⁸ Duke Global Health Institute, Duke University, Durham, NC, USA.
⁹ Faculty of Sport Sciences, Waseda University, Saitama, Japan.
¹⁰ Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada.
¹¹ Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
¹² Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
¹³ School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
¹⁴ David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
¹⁵ Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN-Université Ibn Tofail URAC39, Regional Designated Center of Nutrition Associated with AFRA/IAEA, Rabat, Morocco.
¹⁶ Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
¹⁷ Department of Human Biology, Maastricht University, Maastricht, Netherlands.
¹⁸ Nutritional Sciences, University of Wisconsin, Madison, WI, USA.
¹⁹ Institut Pluridisciplinaire Hubert Curien, CNRS Université de Strasbourg, UMR7178, France.
²⁰ Phillips Research, Eindoven, Netherlands.
²¹ Maastricht University, Maastricht, Netherlands.
²² University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland.
²³ Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, TN, USA.
²⁴ Department of Pediatrics, Baylor College of Medicine, US Department of Agriculture (USDA)/Agricultural Research Service (ARS) Children's Nutrition Research Center, Houston, TX, USA.
²⁵ Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency of Science, Technology and Research (A*STAR), Singapore.
²⁶ Nutritional Sciences, University of Georgia, Athens, GA, USA.
²⁷ Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL, USA.
²⁸ USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.
²⁹ Public Health Sciences, Loyola University of Chicago, Maywood, IL, USA.
³⁰ Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
³¹ Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, London, UK.
³² Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
³³ Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.
³⁴ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany.
³⁵ Department of Pediatrics, University of California Irvine, Irvine, CA, USA.
³⁶ Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica.
³⁷ Aspire Academy, Doha, Qatar.
³⁸ Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA, USA.
³⁹ Beijing Technology and Business University, Beijing, China.
⁴⁰ Central Health Laboratory, Ministry of Health and Wellness, Mauritius.
⁴¹ Pennington Biomedical Research Center, Baton Rouge, LA, USA.
⁴² Department of Medicine, Duke University, Durham, NC, USA.
⁴³ Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakon-Pathom, Thailand.
⁴⁴ Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
⁴⁵ Health Through Physical Activity, Lifestyle and Sport Research Centre (HPALS) Division of Exercise Science and Sports Medicine (ESSM), FIMS International Collaborating Centre of Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
⁴⁶ Department of Anthropology, Northwestern University, Evanston, IL, USA.
⁴⁷ Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates.
⁴⁸ Imperial College London, London, UK.
⁴⁹ Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.
⁵⁰ The FA Group, Burton-Upon-Trent, Staffordshire, UK.
⁵¹ Division of Public Health Sciences, Fred Hutchinson Cancer Center and School of Public Health, University of Washington, Seattle, WA, USA.
⁵² Kenya School of Medicine, Moi University, Eldoret, Kenya.
⁵³ Rwanda Division of Basic Sciences, University of Global Health Equity, Rwanda.
⁵⁴ Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, and Abdominal Center, Obesity Center, HealthyWeightHub, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁵⁵ School of Sport and Service Management, University of Brighton, Eastbourne, UK.
⁵⁶ Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, Netherlands.
⁵⁷ The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
⁵⁸ Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA, and College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
⁵⁹ Biological Sciences and Anthropology, University of Southern California, Los Angeles, CA, USA.
⁶⁰ University of Starthclyde, Glasgow, Scotland.
⁶¹ Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
⁶² School of Social and Behavioral Sciences, University of Tilburg, Tilburg, Netherlands.
⁶³ Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, Portugal.
⁶⁴ Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark.
⁶⁵ Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
⁶⁶ Department of Anthropology, Baylor University, Waco, TX, USA.
⁶⁷ Child and Brain Development Program, Canadian Institute for Advanced Research (CIFAR), Toronto, Ontario, Canada.
⁶⁸ Maastricht University, Brightlands Campus Greenport Venlo and Lifestyle Medicine Center for Children, Jeroen Bosch Hospital, Hertogenbosch, Netherlands.
⁶⁹ Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.
⁷⁰ Department of Anthropology, University of California Los Angeles, Los Angeles, CA, USA.
⁷¹ Max Planck Institute for Evolutionary Anthropology, Department of Human Behavior, Ecology, and Culture, Leipzig, Germany.
⁷² Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
⁷³ Nutritional and Health-Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
⁷⁴ Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, USA.
⁷⁵ NUTRIM, Maastricht University, Maastricht, Netherlands.
⁷⁶ Biotechnology Center and Department of Nutritional Sciences, University of Wisconsin, Madison, WI, USA.
⁷⁷ State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China.
⁷⁸ CAS Center of Excellence in Animal Evolution and Genetics, Kunming, China.

^# Contributed equally.

PMID: 36423296
PMCID: PMC9764345
DOI: 10.1126/science.abm8668

Abstract

Water is essential for survival, but one in three individuals worldwide (2.2 billion people) lacks access to safe drinking water. Water intake requirements largely reflect water turnover (WT), the water used by the body each day. We investigated the determinants of human WT in 5604 people from the ages of 8 days to 96 years from 23 countries using isotope-tracking (²H) methods. Age, body size, and composition were significantly associated with WT, as were physical activity, athletic status, pregnancy, socioeconomic status, and environmental characteristics (latitude, altitude, air temperature, and humidity). People who lived in countries with a low human development index (HDI) had higher WT than people in high-HDI countries. On the basis of this extensive dataset, we provide equations to predict human WT in relation to anthropometric, economic, and environmental factors.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: Y.Y. has a patent pending that is partly related to the publication. The other authors have no conflicts of interest to declare.

Figures

**Fig. 1.**
**(A)** Conceptual diagram showing sources of water influx and efflux on human body. * Metabolic water produced inside a living organism as an end product of the oxidation of energy-containing substances in their food. **(B)** Hydrogen isotope dilution and elimination provides an objective measure of total body water (TBW) and water turnover (WT). DLW; doubly labeled water.

**Fig. 2.**
Relationships between age and total body water (TBW) or water turnover (WT) in 3729 females (orange) and 1875 males (blue) aged 0 to 96 years with mean and SD. **(A)** displays WT (L/d), **(B)** TBW (kg), **(C)** WT per TBW (%), **(D)** TBW per body weight (%), **(E)** WT per total energy expenditure (TEE) (L/MJ), or **(F)** TEE (MJ/d). Water turnover increases with age until about 30 years and is higher in men (4.3 L/d) than women (3.4 L/d). Water turnover significantly decreases after 30 years in men and 55 years in women, reaching an average water turnover of 3.1 and 2.8 L/d in men and women aged over 70 years, respectively. The average water turnover rate as a percent of total body water is a maximum of ~25% in neonates, decreases with development, and is ~15% in 5-year-old children. At puberty, water turnover falls to ~10% and remains constant until age 40 years in men and 65 years in women, after which it decreases. The average water turnover per TEE is about 0.33 L/MJ (~1.4 ml/kcal) in adults. Note that the variation in water turnover is incredibly large – the low end for men and women is ~1–1.5 L/day while the upper end is around ~6 L/day – and the outliers lie in the 10L/d range. On average, water accounts for 60% of the body weight in infants, 50% in older adults, and only 42% in women at 60 years of age, reflecting a larger % body fat.

**Fig. 3.**
Relationships between water turnover (WT) against (A) fat-free mass (FFM), (B) percent body fat, (C) total energy expenditure (TEE), (D) physical activity level (PAL), (E) air temperature, and (F) effective latitude in 1657 females (upper panels; red) and 1013 males (lower panels; blue) aged 20 to 60 years. The blue line represents generalized additive models with integrated smoothness (GAM). Pearson correlation analysis shows positive correlations between water turnover and fat-free mass (r = 0.442, P < 0.001), TEE (r = 0.488, P < 0.001), PAL (r = 0.388, P < 0.001), and altitude (r = 0.100, P < 0.001). Water turnover was negatively correlated with percent body fat (−0.311, P < 0.001). Outdoor air temperature was only weakly correlated with water turnover in the whole sample (r = 0.160, P < 0.001). A significant curvilinear relationship between water turnover and the air temperature and a significant curvilinear relationship between water turnover and effective latitude was observed (see text for details). Average water turnover reached the highest values at around 0° and the lowest at around −50° or +50° of effective latitude. People who lived near the Arctic Circle had higher average water turnover than those who lived around −50° or +50° of effective latitude.

**Fig. 4.**
**(A)** Repeated measures of 72 people (31 females and 41 males) shows water turnover (WT) was significantly higher in the summer (3.7 ± 1.0 L/d) with an average temperature of 29°C than in the spring (3.0 ± 0.7 L/d) with 18°C (P < 0.001). **(B)** In contrast, total energy expenditure (TEE) was not significantly different between summer and spring (P = 0.233). **(C)** Repeated measures of 63 pregnant women show that total water turnover was significantly higher during late pregnancy and lactation (data from Butte *et al*. 2005). (Pre = Before pregnancy; Post = 27 weeks postpartum).

**Fig. 5.**
**(A)** Athletes had higher water turnover (WT) than non-athletes, even after adjusting for physiological and environmental variables (P < 0.001). **(B)** Hunter-gatherers (HG), mixed farmer and hunter-gatherer (HGF), and subsistence agriculturalists (SA) had higher water turnover than other people (C), even after adjusting for physiological and environmental variables (P < 0.001). Note that there are no males in the database who fell into the SA category. **(C)** People who lived in countries with a low Human Development Index (HDI) had higher WT than people who lived in countries with high or middle HDI, even after adjusting for physiological and environmental variables (P < 0.001). **(D-F)** Relationship between water turnover and outdoor air temperature, physical activity level (PAL), or fat-free mass. The countries were categorized as high (red), middle (green), and low (blue) HDI. **(D)** A significant interaction (P < 0.001) was observed between outdoor air temperature and HDI in water turnover. The association between outdoor air temperature and water turnover is weak in high HDI countries (r = 0.086, P < 0.001) but strong in men in low HDI countries (r = 0.604, P < 0.001). **(E, F)** A significant interaction (P < 0.001) was observed between HDI and PAL or FFM in water turnover. Correlation coefficients were significantly higher (P < 0.001) in low HDI countries (r = 0.484 to 0.670, P < 0.001) than in high HDI countries (r = 0.367 to 0,510, P < 0.001).

**Fig. 6.**
Determinants of human water turnover. Objective measures of water turnover from a large global dataset indicate that water turnover is strongly related to anthropometric, lifestyle, and environmental factors. PAL = Physical activity level (Total energy expenditure/Basal energy expenditure), HDI = Human development index.

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Comment in

Understanding human water turnover in times of water scarcity.
Fanzo J. Fanzo J. Cell Metab. 2023 Feb 7;35(2):231-232. doi: 10.1016/j.cmet.2023.01.005. Cell Metab. 2023. PMID: 36754016

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Variation in human water turnover associated with environmental and lifestyle factors

Affiliations

Variation in human water turnover associated with environmental and lifestyle factors

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

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Grants and funding

LinkOut - more resources

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