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Published in: BMC Public Health 1/2020

Open Access 01-12-2020 | Research article

Risk factor analysis of insufficient fluid intake among urban adults in Wuxi, China: a classification and regression tree analysis

Authors: Hao Zheng, Juan Fei, Lan Zhang, Weijie Zhou, Zhen Ding, Wenbiao Hu

Published in: BMC Public Health | Issue 1/2020

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Abstract

Background

Dehydration due to insufficient fluid intake (IFI) is detrimental to health. This cross-sectional study aimed to assess the fluid intake of urban adults in Wuxi, China, and to identify potential risk factors contributing to IFI.

Methods

Adults were selected from the urban area of Wuxi, China, using a multiple-stage random sampling method. The fluid intake information was obtained with a 24-h self-reported diary over seven consecutive days in both summer and winter of 2015. A classification and regression tree (CART) analysis was conducted to detect the potential risk factors associated with IFI. CART is a machine-learning algorithm that portions the data into subsets by threshold.

Results

A total of 584 adults aged 18–87 years were included. The results showed that the median (P25–P75) values of daily fluid intake of the participants were 1100 (800–1550) mL in summer and 1000 (750–1300) mL in winter. Women had a higher prevalence of IFI than men in both summer (odds ratio (OR) = 2.683, 95% confidence interval (CI): 1.830–3.934) and winter (OR = 2.636, 95% CI: 1.677–4.142). The results of CART analysis showed that, in summer, BMI < 25 kg/m2 (probability: 64.2%) and age < 64 years (probability: 67.4%) were main risk factors of IFI for men, and BMI < 29 kg/m2 (probability: 81.6%) and living in C Community (probability: 86.7%) were main risk factors for women. In winter, age < 40 years (probability: 81.8%) and BMI < 20 kg/m2 (probability: 94.5%) were identified as main risk factors of IFI for men and women, respectively.

Conclusions

Most of the participants living in the study site had IFI. The fluid consumption varied by gender, age, location, and BMI. The findings could be useful for the implementation and optimization of intervention programs by identifying the individuals who may at greater risk of dehydration.
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Literature
1.
go back to reference Jequier E, Constant F. Water as an essential nutrient: the physiological basis of hydration. Eur J Clin Nutr. 2010;64(2):115–23.PubMedCrossRef Jequier E, Constant F. Water as an essential nutrient: the physiological basis of hydration. Eur J Clin Nutr. 2010;64(2):115–23.PubMedCrossRef
3.
go back to reference El-Sharkawy AM, Sahota O, Lobo DN. Acute and chronic effects of hydration status on health. Nutr Rev. 2015;73(Suppl 2):97–109.PubMedCrossRef El-Sharkawy AM, Sahota O, Lobo DN. Acute and chronic effects of hydration status on health. Nutr Rev. 2015;73(Suppl 2):97–109.PubMedCrossRef
4.
5.
go back to reference Ritz P, Berrut G. The importance of good hydration for day-to-day health. Nutr Rev. 2005;63(6 Pt 2):S6–13.PubMedCrossRef Ritz P, Berrut G. The importance of good hydration for day-to-day health. Nutr Rev. 2005;63(6 Pt 2):S6–13.PubMedCrossRef
6.
go back to reference Armstrong LE. Challenges of linking chronic dehydration and fluid consumption to health outcomes. Nutr Rev. 2012;70(Suppl 2):S121–7.PubMedCrossRef Armstrong LE. Challenges of linking chronic dehydration and fluid consumption to health outcomes. Nutr Rev. 2012;70(Suppl 2):S121–7.PubMedCrossRef
7.
go back to reference Lieberman HR. Hydration and cognition: a critical review and recommendations for future research. J Am Coll Nutr. 2007;26(5 Suppl):555S–61S.PubMedCrossRef Lieberman HR. Hydration and cognition: a critical review and recommendations for future research. J Am Coll Nutr. 2007;26(5 Suppl):555S–61S.PubMedCrossRef
8.
9.
go back to reference Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press; 2005. Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press; 2005.
10.
go back to reference EFSA. Scientific Opinion on Dietary Reference Values for water. EFSA J. 2010;8(3):1459–506. EFSA. Scientific Opinion on Dietary Reference Values for water. EFSA J. 2010;8(3):1459–506.
11.
go back to reference Laurent Le Bellego CJ, Jimenez L, Magnani C. Understanding fluid consumption patterns to improve healthy hydration. Nutrtion Today. 2010;45:22.CrossRef Laurent Le Bellego CJ, Jimenez L, Magnani C. Understanding fluid consumption patterns to improve healthy hydration. Nutrtion Today. 2010;45:22.CrossRef
12.
go back to reference Chinese Nutrition Society. Chinese Dietary Gudielines. Beijing: People's Medical Publishing House; 2016. Chinese Nutrition Society. Chinese Dietary Gudielines. Beijing: People's Medical Publishing House; 2016.
13.
go back to reference Ma G, Zhang Q, Liu A, Zuo J, Zhang W, Zou S, Li X, Lu L, Pan H, Hu X. Fluid intake of adults in four Chinese cities. Nutr Rev. 2012;70(Suppl 2):S105–10.PubMedCrossRef Ma G, Zhang Q, Liu A, Zuo J, Zhang W, Zou S, Li X, Lu L, Pan H, Hu X. Fluid intake of adults in four Chinese cities. Nutr Rev. 2012;70(Suppl 2):S105–10.PubMedCrossRef
14.
go back to reference Zhang N, Morin C, Guelinckx I, Moreno LA, Kavouras SA, Gandy J, Martinez H, Salas-Salvado J, Ma G. Fluid intake in urban China: results of the 2016 Liq.In (7) national cross-sectional surveys. Eur J Nutr. 2018;57(Suppl 3):77–88.PubMedPubMedCentralCrossRef Zhang N, Morin C, Guelinckx I, Moreno LA, Kavouras SA, Gandy J, Martinez H, Salas-Salvado J, Ma G. Fluid intake in urban China: results of the 2016 Liq.In (7) national cross-sectional surveys. Eur J Nutr. 2018;57(Suppl 3):77–88.PubMedPubMedCentralCrossRef
15.
go back to reference Du S, Hu X, Zhang Q, Wang X, Liu A, Pan H, He S, Ma G. Total drinking water intake and sources of children and adolescent in one district of Shenzhen. Wei Sheng Yan Jiu. 2013;42(3):433–6.PubMed Du S, Hu X, Zhang Q, Wang X, Liu A, Pan H, He S, Ma G. Total drinking water intake and sources of children and adolescent in one district of Shenzhen. Wei Sheng Yan Jiu. 2013;42(3):433–6.PubMed
16.
go back to reference Zhang Q, Hu XQ, Du SM, Pan H, Wang XJ, Zhang D, Zhu ZN, Luo Y, Ju Y, Ma GS. Drinking in different periods of a day of primary and middle school students in four cities of China. Zhonghua Yu Fang Yi Xue Za Zhi. 2013;47(3):214–8.PubMed Zhang Q, Hu XQ, Du SM, Pan H, Wang XJ, Zhang D, Zhu ZN, Luo Y, Ju Y, Ma GS. Drinking in different periods of a day of primary and middle school students in four cities of China. Zhonghua Yu Fang Yi Xue Za Zhi. 2013;47(3):214–8.PubMed
17.
go back to reference Du SM, Pan H, Hu XQ, Zhang Q, Wang XJ, Lu LX, Zou SR, Fan JW, Li XH, Ma GS. Water intake of primary and middle school students in four cities of China. Zhonghua Yu Fang Yi Xue Za Zhi. 2013;47(3):210–3.PubMed Du SM, Pan H, Hu XQ, Zhang Q, Wang XJ, Lu LX, Zou SR, Fan JW, Li XH, Ma GS. Water intake of primary and middle school students in four cities of China. Zhonghua Yu Fang Yi Xue Za Zhi. 2013;47(3):210–3.PubMed
18.
go back to reference Du SM, Hu XQ, Zhang Q, Wang XJ, Pan H, Gao JM, Song J, Gao CL, He ZF, Ma GS. Daily intake of plain water and beverages of primary and middle school students in four cities of China. Zhonghua Yu Fang Yi Xue Za Zhi. 2013;47(3):202–5.PubMed Du SM, Hu XQ, Zhang Q, Wang XJ, Pan H, Gao JM, Song J, Gao CL, He ZF, Ma GS. Daily intake of plain water and beverages of primary and middle school students in four cities of China. Zhonghua Yu Fang Yi Xue Za Zhi. 2013;47(3):202–5.PubMed
19.
go back to reference Zhang Q, Zuo J, Pan H, Wang X, Zou S, Li X, Lu L, Nie S, Hu X, Ma G. Drinking behaviors of adults at different time of day in four cities of China in summer. Wei Sheng Yan Jiu. 2013;42(2):263–8.PubMed Zhang Q, Zuo J, Pan H, Wang X, Zou S, Li X, Lu L, Nie S, Hu X, Ma G. Drinking behaviors of adults at different time of day in four cities of China in summer. Wei Sheng Yan Jiu. 2013;42(2):263–8.PubMed
20.
go back to reference Wang XJ, Hu XQ, Du SM, Pan H, Zhang Q, Yan L, Wang ZY, Nie SP, Yang JB, Ma GS. The relationship between within-day drinking occasion and intake amount of water of primary and middle school students in four cities of China. Zhonghua Yu Fang Yi Xue Za Zhi. 2013;47(3):206–9.PubMed Wang XJ, Hu XQ, Du SM, Pan H, Zhang Q, Yan L, Wang ZY, Nie SP, Yang JB, Ma GS. The relationship between within-day drinking occasion and intake amount of water of primary and middle school students in four cities of China. Zhonghua Yu Fang Yi Xue Za Zhi. 2013;47(3):206–9.PubMed
21.
go back to reference Zhang N, Du S, Tang Z, Zheng M, Yan R, Zhu Y, Ma G. Hydration, fluid intake, and related urine biomarkers among male College Students in Cangzhou, China: a cross-sectional study-applications for assessing fluid intake and adequate water intake. Int J Environ Res Public Health. 2017;14(5):513–24.PubMedCentralCrossRef Zhang N, Du S, Tang Z, Zheng M, Yan R, Zhu Y, Ma G. Hydration, fluid intake, and related urine biomarkers among male College Students in Cangzhou, China: a cross-sectional study-applications for assessing fluid intake and adequate water intake. Int J Environ Res Public Health. 2017;14(5):513–24.PubMedCentralCrossRef
22.
go back to reference Wang Z, Shi A, Chen Y, Cheng W, Song J, Zhu Z, Zou S, Ma G. Water intake and its influencing factors of children and adolescents in Shanghai. Wei Sheng Yan Jiu. 2014;43(1):66–9.PubMed Wang Z, Shi A, Chen Y, Cheng W, Song J, Zhu Z, Zou S, Ma G. Water intake and its influencing factors of children and adolescents in Shanghai. Wei Sheng Yan Jiu. 2014;43(1):66–9.PubMed
23.
go back to reference Zheng C, Yang Y. Influencing factors of the amount of drinking water by Changsha college students: a multilevel model analysis. Wei Sheng Yan Jiu. 2018;47(4):593–8.PubMed Zheng C, Yang Y. Influencing factors of the amount of drinking water by Changsha college students: a multilevel model analysis. Wei Sheng Yan Jiu. 2018;47(4):593–8.PubMed
24.
go back to reference Xu P, Huang SB, Wang ZJ. Water consumption habit in general population of Shanghai and Beijing, China. Asican J Etotoxicol. 2008;3(3):224–30. Xu P, Huang SB, Wang ZJ. Water consumption habit in general population of Shanghai and Beijing, China. Asican J Etotoxicol. 2008;3(3):224–30.
25.
go back to reference Zhao J, Wei J, Chen H, Liu Y, Li T, Sun Q, Liu Q. Multilevel model analysis on the relevant factors influencing the total amount of drinking water consumed daily by Beijing residents. Wei Sheng Yan Jiu. 2012;41(5):809–13.PubMed Zhao J, Wei J, Chen H, Liu Y, Li T, Sun Q, Liu Q. Multilevel model analysis on the relevant factors influencing the total amount of drinking water consumed daily by Beijing residents. Wei Sheng Yan Jiu. 2012;41(5):809–13.PubMed
26.
go back to reference Roche SM, Jones AQ, Majowicz SE, McEwen SA, Pintar KD. Drinking water consumption patterns in Canadian communities (2001-2007). J Water Health. 2012;10(1):69–86.PubMedCrossRef Roche SM, Jones AQ, Majowicz SE, McEwen SA, Pintar KD. Drinking water consumption patterns in Canadian communities (2001-2007). J Water Health. 2012;10(1):69–86.PubMedCrossRef
27.
go back to reference Jones AQ, Majowicz SE, Edge VL, Thomas MK, MacDougall L, Fyfe M, Atashband S, Kovacs SJ. Drinking water consumption patterns in British Columbia: an investigation of associations with demographic factors and acute gastrointestinal illness. Sci Total Environ. 2007;388(1–3):54–65.PubMedCrossRef Jones AQ, Majowicz SE, Edge VL, Thomas MK, MacDougall L, Fyfe M, Atashband S, Kovacs SJ. Drinking water consumption patterns in British Columbia: an investigation of associations with demographic factors and acute gastrointestinal illness. Sci Total Environ. 2007;388(1–3):54–65.PubMedCrossRef
28.
go back to reference Ferreira-Pego C, Guelinckx I, Moreno LA, Kavouras SA, Gandy J, Martinez H, Bardosono S, Abdollahi M, Nasseri E, Jarosz A, et al. Total fluid intake and its determinants: cross-sectional surveys among adults in 13 countries worldwide. Eur J Nutr. 2015;54(Suppl 2):35–43.PubMedPubMedCentralCrossRef Ferreira-Pego C, Guelinckx I, Moreno LA, Kavouras SA, Gandy J, Martinez H, Bardosono S, Abdollahi M, Nasseri E, Jarosz A, et al. Total fluid intake and its determinants: cross-sectional surveys among adults in 13 countries worldwide. Eur J Nutr. 2015;54(Suppl 2):35–43.PubMedPubMedCentralCrossRef
29.
go back to reference Lemon SC, Roy J, Clark MA, Friedmann PD, Rakowski W. Classification and regression tree analysis in public health: methodological review and comparison with logistic regression. Ann Behav Med. 2003;26(3):172–81.PubMedCrossRef Lemon SC, Roy J, Clark MA, Friedmann PD, Rakowski W. Classification and regression tree analysis in public health: methodological review and comparison with logistic regression. Ann Behav Med. 2003;26(3):172–81.PubMedCrossRef
30.
go back to reference Yang J. Wuxi Statistical Yearbook 2015. Beijing: China Statistical Press; 2015. Yang J. Wuxi Statistical Yearbook 2015. Beijing: China Statistical Press; 2015.
31.
go back to reference Lwanga SK, Lemeshow S. Sample size determination in health studies: a practical manual. Geneva: World Health Organization; 1991. Lwanga SK, Lemeshow S. Sample size determination in health studies: a practical manual. Geneva: World Health Organization; 1991.
33.
go back to reference Zhang J, Zhang N, Liang S, Wang Y, Liu S, Liu S, Du S, He H, Xu Y, Cai H, et al. The amounts and contributions of total drinking fluids and water from food to total water intake of young adults in Baoding, China. Eur J Nutr. 2019;58(7):2669–77.PubMedCrossRef Zhang J, Zhang N, Liang S, Wang Y, Liu S, Liu S, Du S, He H, Xu Y, Cai H, et al. The amounts and contributions of total drinking fluids and water from food to total water intake of young adults in Baoding, China. Eur J Nutr. 2019;58(7):2669–77.PubMedCrossRef
34.
go back to reference Brooks CJ, Gortmaker SL, Long MW, Cradock AL, Kenney EL. Racial/ethnic and socioeconomic disparities in hydration status among US adults and the role of tap water and other beverage intake. Am J Public Health. 2017;107(9):1387–94.PubMedPubMedCentralCrossRef Brooks CJ, Gortmaker SL, Long MW, Cradock AL, Kenney EL. Racial/ethnic and socioeconomic disparities in hydration status among US adults and the role of tap water and other beverage intake. Am J Public Health. 2017;107(9):1387–94.PubMedPubMedCentralCrossRef
35.
go back to reference O'Connor L, Walton J, Flynn A. Water intakes and dietary sources of a nationally representative sample of Irish adults. J Hum Nutr Dietetics. 2014;27(6):550–6.CrossRef O'Connor L, Walton J, Flynn A. Water intakes and dietary sources of a nationally representative sample of Irish adults. J Hum Nutr Dietetics. 2014;27(6):550–6.CrossRef
36.
go back to reference Gandy J. First findings of the United Kingdom fluid intake study. Nutr Today. 2012;47:S14–6.CrossRef Gandy J. First findings of the United Kingdom fluid intake study. Nutr Today. 2012;47:S14–6.CrossRef
37.
go back to reference Martinez H. Fluid intake in Mexican adults; a cross-sectional study. Nutr Hosp. 2014;29(5):1179–87.PubMed Martinez H. Fluid intake in Mexican adults; a cross-sectional study. Nutr Hosp. 2014;29(5):1179–87.PubMed
38.
go back to reference Ferreira-Pego C, Babio N, Fenandez-Alvira JM, Iglesia I, Moreno LA, Salas-Salvado J. Fluid intake from beverages in Spanish adults; cross-sectional study. Nutr Hosp. 2014;29(5):1171–8.PubMed Ferreira-Pego C, Babio N, Fenandez-Alvira JM, Iglesia I, Moreno LA, Salas-Salvado J. Fluid intake from beverages in Spanish adults; cross-sectional study. Nutr Hosp. 2014;29(5):1171–8.PubMed
39.
go back to reference Ozen AE, Bibiloni Mdel M, Pons A, Tur JA. Fluid intake from beverages across age groups: a systematic review. J Hum Nutr Dietetics. 2015;28(5):417–42.CrossRef Ozen AE, Bibiloni Mdel M, Pons A, Tur JA. Fluid intake from beverages across age groups: a systematic review. J Hum Nutr Dietetics. 2015;28(5):417–42.CrossRef
40.
go back to reference Kant AK, Graubard BI, Atchison EA. Intakes of plain water, moisture in foods and beverages, and total water in the adult US population--nutritional, meal pattern, and body weight correlates: National Health and nutrition examination surveys 1999-2006. Am J Clin Nutr. 2009;90(3):655–63.PubMedPubMedCentralCrossRef Kant AK, Graubard BI, Atchison EA. Intakes of plain water, moisture in foods and beverages, and total water in the adult US population--nutritional, meal pattern, and body weight correlates: National Health and nutrition examination surveys 1999-2006. Am J Clin Nutr. 2009;90(3):655–63.PubMedPubMedCentralCrossRef
41.
go back to reference Phillips PA, Rolls BJ, Ledingham JG, Forsling ML, Morton JJ, Crowe MJ, Wollner L. Reduced thirst after water deprivation in healthy elderly men. N Engl J Med. 1984;311(12):753–9.PubMedCrossRef Phillips PA, Rolls BJ, Ledingham JG, Forsling ML, Morton JJ, Crowe MJ, Wollner L. Reduced thirst after water deprivation in healthy elderly men. N Engl J Med. 1984;311(12):753–9.PubMedCrossRef
42.
go back to reference Sawka MN. Physiological consequences of hypohydration: exercise performance and thermoregulation. Med Sci Sports Exerc. 1992;24(6):657–70.PubMed Sawka MN. Physiological consequences of hypohydration: exercise performance and thermoregulation. Med Sci Sports Exerc. 1992;24(6):657–70.PubMed
43.
go back to reference Drewnowski A, Rehm CD, Constant F. Water and beverage consumption among adults in the United States: cross-sectional study using data from NHANES 2005-2010. BMC Public Health. 2013;13:1068.PubMedPubMedCentralCrossRef Drewnowski A, Rehm CD, Constant F. Water and beverage consumption among adults in the United States: cross-sectional study using data from NHANES 2005-2010. BMC Public Health. 2013;13:1068.PubMedPubMedCentralCrossRef
44.
go back to reference Ji K, Kim Y, Choi K. Water intake rate among the general Korean population. Sci Total Environ. 2010;408(4):734–9.PubMedCrossRef Ji K, Kim Y, Choi K. Water intake rate among the general Korean population. Sci Total Environ. 2010;408(4):734–9.PubMedCrossRef
45.
go back to reference Martinez H, Guelinckx I, Salas-Salvado J, Gandy J, Kavouras SA, Moreno LA. Harmonized Cross-Sectional Surveys Focused on Fluid Intake in Children, Adolescents and Adults: The Liq.In7 Initiative. Ann Nutr Metab. 2016;68 Suppl 2:12–8.PubMedCrossRef Martinez H, Guelinckx I, Salas-Salvado J, Gandy J, Kavouras SA, Moreno LA. Harmonized Cross-Sectional Surveys Focused on Fluid Intake in Children, Adolescents and Adults: The Liq.In7 Initiative. Ann Nutr Metab. 2016;68 Suppl 2:12–8.PubMedCrossRef
46.
go back to reference Vieux F, Maillot M, Constant F, Drewnowski A. Water and beverage consumption patterns among 4 to 13-year-old children in the United Kingdom. BMC Public Health. 2017;17(1):479.PubMedPubMedCentralCrossRef Vieux F, Maillot M, Constant F, Drewnowski A. Water and beverage consumption patterns among 4 to 13-year-old children in the United Kingdom. BMC Public Health. 2017;17(1):479.PubMedPubMedCentralCrossRef
47.
go back to reference Johnson EC, Peronnet F, Jansen LT, Capitan-Jimenez C, Adams JD, Guelinckx I, Jimenez L, Mauromoustakos A, Kavouras SA. Validation testing demonstrates efficacy of a 7-day fluid record to estimate daily water intake in adult men and women when compared with Total body water turnover measurement. J Nutr. 2017;147(10):2001–7.PubMedCrossRef Johnson EC, Peronnet F, Jansen LT, Capitan-Jimenez C, Adams JD, Guelinckx I, Jimenez L, Mauromoustakos A, Kavouras SA. Validation testing demonstrates efficacy of a 7-day fluid record to estimate daily water intake in adult men and women when compared with Total body water turnover measurement. J Nutr. 2017;147(10):2001–7.PubMedCrossRef
48.
go back to reference Hernandez-Cordero S, Lopez-Olmedo N, Rodriguez-Ramirez S, Barquera-Cervera S, Rivera-Dommarco J, Popkin B. Comparing a 7-day diary vs. 24 h-recall for estimating fluid consumption in overweight and obese Mexican women. BMC Public Health. 2015;15:1031.PubMedPubMedCentralCrossRef Hernandez-Cordero S, Lopez-Olmedo N, Rodriguez-Ramirez S, Barquera-Cervera S, Rivera-Dommarco J, Popkin B. Comparing a 7-day diary vs. 24 h-recall for estimating fluid consumption in overweight and obese Mexican women. BMC Public Health. 2015;15:1031.PubMedPubMedCentralCrossRef
Metadata
Title
Risk factor analysis of insufficient fluid intake among urban adults in Wuxi, China: a classification and regression tree analysis
Authors
Hao Zheng
Juan Fei
Lan Zhang
Weijie Zhou
Zhen Ding
Wenbiao Hu
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2020
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-020-8380-y

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