Hydration and health at ages 40 to 70 years in Salzburg Austria is associated with a median total water intake over 40 mL/kg including at least 1L/d plain drinking water

Jodi Dunmeyer Stookey^1*Patrick Langthaler²Thomas K. Felder¹Vanessa N. Frey²Antje Van Der Zee-Neuen¹Karin Schindler³Ludmilla Kedenko¹Bernhard Iglseder²Eugen Trinka²Florian Lang⁴Dieter Häussinger⁵Markus Ritter¹Bernhard Paulweber¹

• ¹Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
• ²Uniklinikum Salzburg - Christian-Doppler-Klinik, Salzburg, Austria
• ³Medizinische Universitat Wien, Vienna, Austria
• ⁴Eberhard Karls Universitat Tubingen, Tübingen, Germany
• ⁵LVR-Klinikum Dusseldorf - Kliniken der Heinrich-Heine-Universitat Dusseldorf, Düsseldorf, Germany

This is a provisional file, not the final typeset article To address longstanding questions about how much plain water to drink for hydration and long-term health, this study described the plain water intake (PWI) of people without chronic health conditions, at ages 40-70 years, who met hydration criteria (Healthy+Hydrated). Cross-sectional analyses described the PWI of Healthy+Hydrated adults, compared to groups not meeting criteria for hydration (Healthy+Not Hydrated), chronic health condition (CHC+Hydrated), or both (CHC+Not Hydrated), and relative to body weight and total water intake (TWI). Community-dwelling participants in the population-based Paracelsus 10,000 study in Salzburg, Austria (n=5,817, 40-70y), completed the EPIC diet questionnaire, blood and urine collection, and clinical assessment for chronic health conditions, including obesity, diabetes, hypertension, metabolic syndrome, cancer, and liver, digestive tract, lung, kidney, cardiovascular and cerebrovascular disorders. Participants with serum tonicity 285-294 mOsmol/L and urine specific gravity <1.013 were classified as Hydrated. For Healthy+Hydrated women, the median PWI and TWI were 1.5 L/d (22 mL/kg) and 2.9 L/d (45 mL/kg), respectively. For Healthy+Hydrated men, the median PWI and TWI were 1.3 L/d (17 mL/kg) and 3.0 L/d (40 mL/kg). None of the Healthy+Hydrated reported zero PWI. In gender-specific Poisson models, the Healthy+Hydrated group had significantly lower relative risk of PWI<20mL/kg AND TWI<45 mL/kg than each of the CHC+Hydrated, Healthy+Not Hydrated, and CHC+Not Hydrated groups. For Healthy+Hydrated participants with >60% of TWI from PWI, PWI ranged between 20-45 mL/kg/d. In the Paracelsus 10,000 study population, hydration and health at ages 40-70 years was associated with a median PWI of at least 1L/d.