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Distinguishing Low and High Water Consumers—A Paradigm of Disease Risk

Professor Emeritus, Human Performance Laboratory and Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269, USA
Assistant Professor, Department of Health Sciences, University of Hartford, West Hartford, CT 06117, USA
Registered Dietitian, Riverside Behavioral Health Center, Hampton, VA 23666, USA
Author to whom correspondence should be addressed.
Nutrients 2020, 12(3), 858;
Received: 21 February 2020 / Revised: 18 March 2020 / Accepted: 20 March 2020 / Published: 23 March 2020
(This article belongs to the Section Macronutrients and Human Health)
A long-standing body of clinical observations associates low 24-h total water intake (TWI = water + beverages + food moisture) with acute renal disorders such as kidney stones and urinary tract infections. These findings prompted observational studies and experimental interventions comparing habitual low volume (LOW) and high volume (HIGH) drinkers. Investigators have learned that the TWI of LOW and HIGH differ by 1–2 L·d−1, their hematological values (e.g., plasma osmolality, plasma sodium) are similar and lie within the laboratory reference ranges of healthy adults and both groups appear to successfully maintain water-electrolyte homeostasis. However, LOW differs from HIGH in urinary biomarkers (e.g., reduced urine volume and increased osmolality or specific gravity), as well as higher plasma concentrations of arginine vasopressin (AVP) and cortisol. Further, evidence suggests that both a low daily TWI and/or elevated plasma AVP influence the development and progression of metabolic syndrome, diabetes, obesity, chronic kidney disease, hypertension and cardiovascular disease. Based on these studies, we propose a theory of increased disease risk in LOW that involves chronic release of fluid-electrolyte (i.e., AVP) and stress (i.e., cortisol) hormones. This narrative review describes small but important differences between LOW and HIGH, advises future investigations and provides practical dietary recommendations for LOW that are intended to decrease their risk of chronic diseases. View Full-Text
Keywords: arginine vasopressin; cortisol; plasma osmolality; dietary protein; dietary salt; thirst arginine vasopressin; cortisol; plasma osmolality; dietary protein; dietary salt; thirst
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Armstrong, L.E.; Muñoz, C.X.; Armstrong, E.M. Distinguishing Low and High Water Consumers—A Paradigm of Disease Risk. Nutrients 2020, 12, 858.

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