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http://dx.doi.org/10.1016/j.phrp.2016.08.007
pISSN 2210-9099 eISSN 2233-6052
- ORIGINAL ARTICLE -
*Corresponding author.
E-mail: epiko@khu.ac.kr (S.-G. Ko).
Copyright ª 2016 Korea Centers for Disease Control and Prevention. Published by Elsevier Korea LLC. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
290 S. Jang, et al
pectoris after gradually adjusting for confounding fac- were men (2,227 persons) and 59.9% of whom were
tors affecting water intake. women (3,328 persons).
Table 1 summarizes the group distributions by sex,
Model 1: Adjusted for water intake age, smoking, alcohol, stress, dietary supplements, hy-
Model 2: Adjusted for water intake, sex, and age pertension, diabetes mellitus, dyslipidemia, myocardial
Model 3: Adjusted for water intake, sex, age, smok- infarction, angina pectoris, body weight, sleeping hours,
ing, alcohol, stress, dietary supplements, body severe physical activity, moderate physical activity,
weight, severe physical activity, moderate physical total calorie intake, water intakes from food, sodium
activity, total calorie intake, water intakes from food, intake, and water intake.
and sodium intake Items with a statistically significant intergroup dif-
ference (p < 0.05) were age, smoking, alcohol, stress,
The data analysis was performed using IBM SPSS dietary supplements, body weight, severe physical ac-
Statistics 21 (IBM Co., Armonk, NY, USA) at a sig- tivity, moderate physical activity, total calorie intake,
nificance level of p Z 0.05. water intakes from food, sodium intake, and water
intake (Table 1).
respectively. The OR of myocardial infarction in recommended daily intake of water (Figure 2). Few men
Models 1, 2, and 3 were 0.60 (95% CI, 0.22e1.69), 0.84 and women in this study achieved the target daily water
(95% CI, 0.30e2.37), and 5.36 (95% CI: 0.67e43.20), intake.
respectively. The OR of angina pectoris in Models 1, 2, During aging, water consumption decreases as a
and 3 were 0.68 (95% CI, 0.34e1.35), 1.02 (95% CI, result of reduced metabolic activities [11]. These find-
0.51e2.07), and 2.25 (95% CI, 0.88e57.84), ings correspond with the results of another study using
respectively. National Health and Nutrition Examination Survey
On the logistic regression analysis, none of the three (NHANES) data [12]. In addition, the groups of the
metabolic diseases or two heart diseases showed a sig- current study showed significant differences in factors
nificant difference in prevalence according to water intake. such as smoking, alcohol, stress, dietary supplements,
body weight, physical activity, total calorie intake, water
intake, and sodium intake (Table 1). Group Above AI
4. Discussion included more current smokers and fewer nonsmokers
than Group Below AI. Smoking dries out the mouth,
This study analyzed the correlation between water increases the mouth’s temperature, and results in water
intake and the prevalence of metabolic/heart diseases loss via the saliva [13]. Drinking alcohol triggers a
using logistic regression analyses. The distributions of diuretic effect and dehydration due to the degradation of
daily water intake were similar in men and women. Both ethanol, inevitably increasing water intake [14].
graphs were right-skewed, which shows that the ma- There was no statistically significant difference in the
jority of Korean people drink less than the OR of the five diseases examined in Group Above AI
Relationship Between Water Intake and Metabolic Heart Diseases 293
Table 1. Health behaviors between Group Above AI and Group Below AI.
and Group Below AI. The correlation between water which increases low-density lipoprotein and triglyceride
intake and these five diseases (Table 2) can be explained levels in the liver, causing dyslipidemia [16,17].
as follows. Angina pectoris tends to be accompanied by throm-
Diabetes mellitus is a metabolic disorder caused by bosis [18]. Therefore, drinking an adequate amount of
abnormal insulin secretion, and patients with uncon- water may help reduce blood coagulation and result in a
trolled diabetes mellitus would suffer thirst and drink lower OR for angina pectoris. In addition, heart failure
increased amounts of water to compensate [15]. Because has symptoms related to salt and water retention;
of this, the higher OR of diabetes mellitus in the logistic therefore, its management includes restricted water
regression analysis (Model 2) should not be interpreted intake. This factor should be considered in the inter-
to mean that drinking more water is a risk factor for pretation of the OR of heart diseases [19].
diabetes mellitus. However, hypertension and dyslipi- There is little evidence that clearly reveals any cor-
demia commonly accompany diabetes mellitus. They relation between water consumption and metabolic/heart
are due to fatty acid secretion by adipose cells being diseases. In a U.S. cohort study on risk levels of heart
triggered by insulin resistance of diabetes mellitus, disease involving approximately 20,000 participants, a
294 S. Jang, et al
Table 2. Odds ratio of metabolic diseases and heart diseases associated with water intake.
1 (Above AI)
Disease 0 (Below AI) OR (95% CI) p
Hypertension
Model 1a 1.0 (ref.) 0.85 (0.71e1.02) 0.076
Model 2b 1.0 (ref.) 1.25 (1.02e1.53) 0.032
Model 3c 1.0 (ref.) 1.22 (0.58e2.55) 0.599
Diabetes mellitus
Model 1 1.0 (ref.) 1.13 (0.87e1.47) 0.370
Model 2 1.0 (ref.) 1.55 (1.17e2.05) 0.002
Model 3 1.0 (ref.) 1.38 (0.51e3.73) 0.384
Dyslipidemia
Model 1 1.0 (ref.) 1.02 (0.84e1.23) 0.866
Model 2 1.0 (ref.) 1.19 (0.98e1.45) 0.082
Model 3 1.0 (ref.) 0.94 (0.47e1.86) 0.853
Myocardial infarction
Model 1 1.0 (ref.) 0.60 (0.22e1.69) 0.603
Model 2 1.0 (ref.) 0.84 (0.30e2.37) 0.737
Model 3 1.0 (ref.) 5.36 (0.67e43.20) 0.115
Angina pectoris
Model 1 1.0 (ref.) 0.68 (0.34e1.35) 0.268
Model 2 1.0 (ref.) 1.02 (0.51e2.07) 0.952
Model 3 1.0 (ref.) 2.25 (0.88e57.84) 0.624
a
Model 1: adjusted for water intake; bModel 2: adjusted for water intake, sex, and age; cModel 3: adjusted for water intake, sex, age, smoking, alcohol, stress,
dietary supplements, body weight, severe physical activity, moderate physical activity, total calorie intake, water intakes from food, sodium intake.
CI Z confidence interval; OR Z odds ratio; ref. Z Group Below AI.
group of individuals drinking 4 cups of water daily generated by the oxidation of carbohydrate, protein, and
showed a significantly lower risk of heart disease fat was also ignored in the calculation of daily water
compared to a group drinking < 2 cups of water daily intake [26]. This may have induced error to the study
[20]. Other studies found that drinking water prior to results. Finally, other possible confounding factors be-
meals affected weight loss and fat reduction [21,22]. tween water intake and cardiovascular disorders were
One cross-sectional study examined the correlation limited [27].
between water intake and cardiovascular disorders based In conclusion, this study revealed no statistically
on the NHANES publications [23]. The study divided significant differences in the prevalence of hypertension,
the participants into three groups according to water diabetes mellitus, dyslipidemia, myocardial infarction,
intake, and the group with the highest intake showed a and angina pectoris between people drinking or not
low prevalence of heart diseases such as coronary artery drinking more water than the daily recommended
disease and angina pectoris, although there was no sig- amount. Even though interest in the effects of water has
nificant correlation with OR. Likewise, our study failed only recently increased, related studies are still insuffi-
to reveal a correlation between water intake and meta- cient. Therefore, this study can be used as a reference in
bolic/heart diseases. future studies, including clinical trials to determine the
This study has several limitations. First, the daily ideal daily water intake and its associated effects on the
water intake reference has not been verified because the human body.
WHO references serve as a recommendation that is not
based on clinical experiments. Moreover, water intake
has a variety of standards, each of which has a different Conflicts of interest
calculation method. Second, there are various kinds of
drinking water, for example, tap water, bottled water, The authors declare that they have no conflicts of
and mineral-rich water. Mineral-rich water contains interest concerning this article.
antioxidants that could protect against metabolic syn-
dromes [24]. Hard water can also reduce the prevalence
of cardiovascular diseases [25]. However, this type of Acknowledgments
association could not be considered because the
KHNANES does not investigate water type or hardness. This study was supported by and awarded grants
Third, the study failed to consider water intake from from the Korea Healthcare Technology R&D Project,
food as well as beverages and alcohol. Metabolic water Ministry for Health & Welfare, Korea (HI12C1889).
Relationship Between Water Intake and Metabolic Heart Diseases 295
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