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What is the cell hydration status of healthy children in the USA? Preliminary data on urine osmolality and water intake

  • Jodi D. Stookey (a1), Bernie Brass (a1), Ava Holliday (a1) and Allen Arieff (a2)
  • DOI:
  • Published online: 27 January 2012

Hyperosmotic stress on cells limits many aspects of cell function, metabolism and health. International data suggest that schoolchildren may be at risk of hyperosmotic stress on cells because of suboptimal water intake. The present study explored the cell hydration status of two samples of children in the USA.


Cross-sectional study describing the urine osmolality (an index of hyperosmotic cell shrinkage) and water intake of convenience samples from Los Angeles (LA) and New York City (NYC).


Each participant collected a urine sample at an outpatient clinic on the way to school on a weekday morning in spring 2009. Each was instructed to wake, eat, drink and do as usual before school, and complete a dietary record form describing the type and amounts of all foods and beverages consumed after waking, before giving the sample.


The children (9–11 years) in LA (n 337) and NYC (n 211) considered themselves healthy enough to go to school on the day they gave the urine sample.


Elevated urine osmolality (>800 mmol/kg) was observed in 63 % and 66 % of participants in LA and NYC, respectively. In multivariable-adjusted logistic regression models, elevated urine osmolality was associated with not reporting intake of drinking water in the morning (LA: OR = 2·1, 95 % CI 1·2, 3·5; NYC: OR = 1·8, 95 % CI 1·0, 3·5). Although over 90 % of both samples had breakfast before giving the urine sample, 75 % did not drink water.


Research is warranted to confirm these results and pursue their potential health implications.

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2.RD Andrew & BA MacVicar (1994) Imaging cell volume changes and neuronal excitation in the hippocampal slice. Neuroscience 62, 371383.

4.D Le Bihan (2007) The ‘wet mind’: water and functional neuroimaging. Phys Med Biol 52, R57R90.

5.EG Krause , AD deKloet , JN Flak et al. (2011) Hydration state controls stress responsiveness and social behavior. J Neurosci 31, 54705476.

6.PH Yancey , ME Clark , SC Hand et al. (1982) Living with water stress: evolution of osmolyte systems. Science 217, 12141222.

7.D Haussinger (2008) Osmosensing and osmosignaling in the liver. Wien Med Wochenschr 158, 549552.

8.M Hernanz-Schulman , R Vanholder , MA Waterloos et al. (2000) Effect of radiographic contrast agents on leukocyte metabolic response. Pediatr Radiol 30, 361368.

11.CM Brown , L Barberini , AG Dulloo et al. (2005) Cardiovascular responses to water drinking: does osmolality play a role? Am J Physiol Regul Integr Comp Physiol 289, R1687R1692.

12.NF Capra & JY Ro (2004) Human and animal experimental models of acute and chronic muscle pain: intramuscular algesic injection. Pain 110, 37.

13.DA Judelson , CM Maresh , LM Yamamoto et al. (2008) Effect of hydration state on resistance exercise-induced endocrine markers of anabolism, catabolism, and metabolism. J Appl Physiol 105, 816824.

16.F Schliess & D Haussinger (2003) Cell volume and insulin signaling. Int Rev Cytol 225, 187228.

19.PN Ainslie , IT Campbell , KN Frayn et al. (2002) Energy balance, metabolism, hydration, and performance during strenuous hill walking: the effect of age. J Appl Physiol 93, 714723.

20.MN Sawka (1992) Physiological consequences of hypohydration: exercise performance and thermoregulation. Med Sci Sports Exerc 24, 657670.

22.H Trachtman (1992) Cell volume regulation: a review of cerebral adaptive mechanisms and implications for clinical treatment of osmolal disturbances. Pediatr Nephrol 6, 104112.

23.M Vercellino , GP Bezante & M Balbi (2009) Contrast medium induced nephropathy: new insights into prevention and risk management. Cardiovasc Hematol Agents Med Chem 7, 166180.

24.GB Pier (2002) CFTR mutations and host susceptibility to Pseudomonas aeruginosa lung infection. Curr Opin Microbiol 5, 8186.

25.T Kuroda , T Harada , H Tsutsumi et al. (1997) Hypernatremic suppression of neutrophils. Burns 23, 338340.

27.J Tripette , G Loko , A Samb et al. (2010) Effects of hydration and dehydration on blood rheology in sickle cell trait carriers during exercise. Am J Physiol Heart Circ Physiol 299, H908H914.

29.S Hahn , Y Kim & P Garner (2001) Reduced osmolarity oral rehydration solution for treating dehydration due to diarrhoea in children: systematic review. BMJ 323, 8185.

31.HM Alshayeb , A Showkat , F Babar et al. (2011) Severe hypernatremia correction rate and mortality in hospitalized patients. Am J Med Sci 341, 356360.

32.JD Stookey , CF Pieper & HJ Cohen (2004) Hypertonic hyperglycemia progresses to diabetes faster than normotonic hyperglycemia. Eur J Epidemiol 19, 935944.

33.JD Stookey , JL Purser , CF Pieper et al. (2004) Plasma hypertonicity: another marker of frailty? J Am Geriatr Soc 52, 13131320.

34.A Kroke , F Manz , M Kersting et al. (2004) The DONALD Study. History, current status and future perspectives. Eur J Nutr 43, 4554.

35.RA Star (1990) Southwestern internal medicine conference: Hyperosmolar states. Am J Med Sci 300, 402412.

36.F Manz & A Wentz (2003) 24-h hydration status: parameters, epidemiology and recommendations. Eur J Clin Nutr 57, Suppl. 2, S10S18.

38.F Manz , A Wentz & W Sichert-Hellert (2002) The most essential nutrient: defining the adequate intake of water. J Pediatr 141, 587592.

39.WS Uttley , J Paxton & D Thistlethwaite (1972) Urinary concentrating ability and growth failure in urinary tract disorders. Arch Dis Child 47, 436441.

40.Y Bar-David , J Urkin & E Kozminsky (2005) The effect of voluntary dehydration on cognitive functions of elementary school children. Acta Paediatr 94, 16671673.

41.Y Bar-David , J Urkin , D Landau et al. (2009) Voluntary dehydration among elementary school children residing in a hot arid environment. J Hum Nutr Diet 22, 455460.

43.K Van Hoeck , A Bael , H Lax et al. (2007) Circadian variation of voided volume in normal school-age children. Eur J Pediatr 166, 579584.

45.SJ Merson , RJ Maughan & SM Shirreffs (2008) Rehydration with drinks differing in sodium concentration and recovery from moderate exercise-induced hypohydration in man. Eur J Appl Physiol 103, 585594.

47.O Bar-Or (2001) Nutritional considerations for the child athlete. Can J Appl Physiol 26, Suppl., S186S191.

48.KE D'Anci , F Constant & IH Rosenberg (2006) Hydration and cognitive function in children. Nutr Rev 64, 457464.

49.A Stahl , A Kroke , K Bolzenius et al. (2007) Relation between hydration status in children and their dietary profile – results from the DONALD study. Eur J Clin Nutr 61, 13861392.

50.AK Kant & BI Graubard (2010) Contributors of water intake in US children and adolescents: associations with dietary and meal characteristics – National Health and Nutrition Examination Survey 2005–2006. Am J Clin Nutr 92, 887896.

54.L Bond , J Clements , N Bertalli et al. (2006) A comparison of self-reported puberty using the Pubertal Development Scale and the Sexual Maturation Scale in a school-based epidemiologic survey. J Adolesc 29, 709720.

55.AC Petersen , L Crockett , M Richards et al. (1988) A self-report measure of pubertal status: reliability, validity and initial norms. J Youth Adolesc 17, 117133.

56.EA Shirtcliff , RE Dahl & SD Pollak (2009) Pubertal development: correspondence between hormonal and physical development. Child Dev 80, 327337.

57.Y Ikeda , I Tanaka , Y Oki et al. (1993) Testosterone normalizes plasma vasopressin response to osmotic stimuli in men with hypogonadism. Endocr J 40, 387392.

58.NS Stachenfeld (2008) Sex hormone effects on body fluid regulation. Exerc Sport Sci Rev 36, 152159.

59.AT Weston , R Petosa & RR Pate (1997) Validation of an instrument for measurement of physical activity in youth. Med Sci Sports Exerc 29, 138143.

60.GJ Welk , DA Dzewaltowski & JL Hill (2004) Comparison of the computerized ACTIVITYGRAM instrument and the previous day physical activity recall for assessing physical activity in children. Res Q Exerc Sport 75, 370380.

65.F Schmitt , JL Bresson , N Beressi et al. (2003) Influence of plasma amino acid level on vasopressin secretion. Diab Metab 29, 352361.

66.J Seifert , J Harmon & P DeClercq (2006) Protein added to a sports drink improves fluid retention. Int J Sport Nutr Exerc Metab 16, 420429.

67.SM Shirreffs , LF Aragon-Vargas , M Keil et al. (2007) Rehydration after exercise in the heat: a comparison of 4 commonly used drinks. Int J Sport Nutr Exerc Metab 17, 244258.

69.GE Vist & RJ Maughan (1994) Gastric emptying of ingested solutions in man: effect of beverage glucose concentration. Med Sci Sports Exerc 26, 12691273.

70.N Vaisman , H Voet , A Akivis et al. (1996) Effect of breakfast timing on the cognitive functions of elementary school students. Arch Pediatr Adolesc Med 150, 10891092.

71.ML Moritz (2008) Urine sodium composition in ambulatory healthy children: hypotonic or isotonic? Pediatr Nephrol 23, 955957.

72.RR Alfieri & PG Petronini (2007) Hyperosmotic stress response: comparison with other cellular stresses. Pflugers Arch 454, 173185.

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