Korean Public Health Research (대한보건연구)

The Korean Public Health Association (대한보건협회)
권호 표지

Dehydration Risk from Age, BMI, and Disease Exposure

연령, BMI, 질병노출로 인한 탈수 위험

  • Kim, Sun-Hee (Department of Public Health, Sahmyook University Graduate School) ;
  • Chun, Sung-Soo (Department of Health Management, Sahmyook University) ;
  • Choi, Myung-Sup (Sahmyook Medical Center Seoul Adventist Hospital) ;
  • Yun, Mi-Eun (Department of Food and Nutrition, Sahmyook University)
  • 김선희 (삼육대학교 일반대학원 보건학과) ;
  • 천성수 (삼육대학교 보건관리학과) ;
  • 최명섭 (삼육서울병원) ;
  • 윤미은 (삼육대학교 식품영양학과)
  • Received : 2017.05.04
  • Accepted : 2018.10.30
  • Published : 2018.11.30

⟨ Previous Next ⟩

Abstract

Objective : The purpose of this study was to investigate the risk factors of dehydration from the subjects who underwent anthropometric and blood parameters testing during a comprehensive health screening. Methods : For the study analysis, 5,391 samples with valid data of the levels of Sodium($Na^+$), BUN (Blood Urea Nitrogen) and FBS(Fasting Blood Sugar) were selected to calculate a dehydration indicator of plasma osmolality. The study data was collected from the health screening examinees who visited Sahmyook Medical Center Seoul Adventist Hospital Comprehensive Health Check-up Center from 2014.01.01 to 2015.12.31. The relationship between dehydration and age group, BMI, disease exposures(hypertension, diabetes mellitus, dyslipidemia, kidney disorder) were analyzed by gender. Results : The odds ratio of dehydration showed statistical significance from age ${\geq}50$ in both male and female, respectively. The female obese group was vulnerable to dehydration while the male study group showed no statistical significance in the BMI difference. The disease exposed groups(hypertension, diabetes mellitus, dyslipidemia, kidney disorder) were vulnerable to dehydration. Also, the more types of disease carried by the exposed patients, the higher odds ratio and susceptibility to dehydration. Conclusions : Aging, increasing BMI, and exposed to diseases were found to be the risk factors for vulnerability to dehydration. To prevent dehydration, special caution to be taken for those in the ${\geq}50s$ group, along with controlling BMI and chronic diseases. Further studies are suggested to investigate the risk factors of dehydration that may affect increasing plasma osmolality as a potential stimulus mechanism in disease outbreaks.

연구목적: 본 연구의 목적은 종합건강검진 수검자의 신체측정과 혈액검사를 통해 탈수 위험요인에 대해 조사하는 것이다. 연구방법: 연구 분석을 위해 Sodium ($Na^+$), BUN (Blood Urea Nitrogen) 및 FBS (Fasting Blood Sugar)의 데이터가 유효한 5,391개의 샘플을 선택하여 혈장삼투압 탈수지표를 계산하였다. 조사 데이터는 2014.01.01과 2015.12.31사이에 삼육서울의료원 종합건강검진센터를 방문한 검진 수검자로부터 수집되었다. 탈수와 연령, 체질량지수(BMI), 질병노출(고혈압, 당뇨병, 이상지질혈증, 신장장애)의 관계를 성별로 구분하여 분석하였다. 연구결과: 탈수 교차비는 남성과 여성 모두 50대 이상 연령부터 통계적 유의성이 나타났다. 비만여성은 탈수에 취약했으나 남성은 BMI 차이에 통계적 유의성이 나타나지 않았다. 질병에 노출된 그룹(고혈압, 당뇨병, 이상 지질 혈증, 신장 장애)은 탈수에 취약하였다. 또한 질병노출 수가 많을수록 교차비가 높아 탈수 위험도가 높은 것으로 나타났다. 결론: 노화, BMI증가, 질병노출은 탈수에 취약하게 하는 위험요인으로 나타났다. 50세 이후 연령대는 탈수예방을 위해 BMI와 만성질환 조절에 특별한 주의가 요구된다. 질병발생에 잠재적인 자극 메커니즘으로 혈장 삼투압 증가에 영향을 끼치는 탈수 위험요인에 대한 추가 연구를 제안한다.

Keywords

References

  1. The Korean Nutrition Society. Dietary Reference Intakes for Koreans 2010: Water. Available from: http://www.kns.or.kr/FileRoom/FileRoom_view.asp?idx=79&BoardID=Kdr
  2. Rose BD, Post TW. Clinical physiology of acid-base and electrolyte disorders. 5th edn. New York: McGraw-Hill Medical Pub. Division; 2001, p. 992.
  3. Stookey JD, Constant F, Popkin BM, Gardner CD. Drinking water is associated with weight loss in overweight dieting women independent of diet and activity. Obes. 2008;16(11):2481-2488. https://doi.org/10.1038/oby.2008.409
  4. Kleiner, S. M., (1999). Water: an essential but overlooked nutrient. J Am Diet Assoc, 99, 200-206. https://doi.org/10.1016/S0002-8223(99)00048-6
  5. Oxford Center for Evidence-Based Medicine Levels of Evidence Working Group. The Oxford Center for Evidence-Based medicine 2011 Levels of Evidence. Available from: http://www.cebm.net/index.aspx?o=5653
  6. Food and Nutrition Board(FNB). Dietary reference intakes for water, potassium, sodium, chloride, and sulfates. Washington, DC: National Academy Press; 2018. Available from: https://www.nap.edu/download/10925
  7. Gropper SS, Smith JL. Advanced nutrition and human metabolism: Cengage Learning; 2012. p. 549-550.
  8. McCartney D, Desbrow B, Irwin C. The Effect of Fluid Intake Following Dehydration on Subsequent Athletic and Cognitive Performance: a Systematic Review and Meta-analysis. Sports Med Open. 2017;3(1):13. https://doi.org/10.1186/s40798-017-0079-y
  9. Cowen LE, Hodak SP, Verbalis JG. Age-associated abnormalities of water homeostasis. Endocrinol Metab Clin North Am. 2013; 42(2):349-370. https://doi.org/10.1016/j.ecl.2013.02.005
  10. El-Sharkawy AM, Sahota O, Lobo DN. Acute and chronic effects of hydration status on health. Nutr Rev. 2015;73(2): 97-109. https://doi.org/10.1093/nutrit/nuv038
  11. Kempton MJ, Ettinger U, Schmechtig A, Winter EM, Smith L, McMorris T, Smith MS. Effects of acute dehydration on brain morphology in healthy humans. Human brain mapping. 2009;30(1):291-298. https://doi.org/10.1002/hbm.20500
  12. Jimenez CAR, Ishimoto T, Lanaspa MA, Rivard CJ, Nakagawa T, Ejaz AA, Miyazaki M. Fructokinase activity mediates dehydration-induced renal injury. Kidney int. 2014;86(2):294-302. https://doi.org/10.1038/ki.2013.492
  13. Ainslie PN, Campbell IT, Frayn KN, Humphreys SM, Maclaren DP, Reilly TJ. Physiological and metabolic responses to a hill walk. Appl Physiol, 2002;92(1):179-187. https://doi.org/10.1152/jappl.2002.92.1.179
  14. Metheny NM. Fluid and electrolyte balance: Jones & Bartlett Publishers; 2011, p. 3-5.
  15. Bennett JA, Thomas V, Riegel B. Unrecognized chronic dehydration in older adults: examining prevalence rate and risk factors. J Gerontological Nurs. 2004;30(11):22-28.
  16. Hooper L, Bunna D, Jimoha F, Fairweather-Taita SJ. Water-loss dehydration and aging. Mech Ageing Dev. 2014;136-137:50-58. https://doi.org/10.1016/j.mad.2013.11.009
  17. Martin AD, Daniel MZ, Drinkwater DT, Clarys JP. Adipose tissue density, estimated adipose lipid fraction and whole body adiposity in male cadavers. Int J Obes Relat Metab Disord. 1994;18:79-83.
  18. Kim, SH. Correlation among dehydration, lifestyle, and chronic diseases[PhD thesis]. Seoul: Sahmyook University: 2018.
  19. Thomas DR, Cote TR, Lawhorne L, Levenson SA, Rubenstein LZ, Smith DA, et al. Understanding clinical dehydration and its treatment. J Am Med Direct Assoc. 2008;9(5):292-301. https://doi.org/10.1016/j.jamda.2008.03.006
  20. Lab Tests Online. Available from: https://labtestsonline.org/tests/osmolality
  21. Purssell RA, Pudek M, Brubacher J, Abu-Laban RB. Derivation and validation of a formula to calculate the contribution of ethanol to the osmolal gap. Ann Emerg Med. 2001;38(6):653-659. https://doi.org/10.1067/mem.2001.119455
  22. Korean Society for The Study of Obesity. Common sense of obesity. Available from: http://general.kosso.or.kr/html/?pmode=obesityDiagnosis
  23. JNC7(Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure). 2004. Available form: https://www.nhlbi.nih.gov/files/docs/guidelines/jnc7full.pdf
  24. Korean Diabetes Association. Normal Fasting Glucose level. Available from: http://www.diabetes.or.kr/general/counsel/faq_list.php?category=B
  25. Korean Academy of Medical Sciences. Korean Medical Guideline Information Center. Dyslipidemia. 2008. Available from: http://www.guideline.or.kr/chronic/view.php?number=90
  26. The Korean Society of Nephrology. Chronic renal disease. 2016. Available from:http://www.ksn.or.kr/
  27. Harrison M. Effects of thermal stress and exercise on blood volume in humans. Physiol. Rev. 1985;65:149-209. https://doi.org/10.1152/physrev.1985.65.1.149
  28. Wu SJ, Wang HH, Yeh SH, Wang YH, Yang YM. Hydration status of nursing home residents in Taiwan: a cross-sectional study. J adv nurs. 2011;67(3):583-590. https://doi.org/10.1111/j.1365-2648.2010.05514.x
  29. Chishaki T, Umeda T, Takahashi I, Matsuzaka M, Iwane K, Matsumoto H, Ishibashi G, Ueno Y, Kashiwa N, Nakaji S. Effects of dehydration on immune functions after a judo practice session. Luminescence, 2013;28(2):114-20. doi: 10.1002/bio.2349.
  30. Ritz P, Berrut G, Tack I, Arnaud M, Tichet J. Influence of gender and body composition on hydration and body water spaces. Clin Nutr. 2008;27(5):740-746. https://doi.org/10.1016/j.clnu.2008.07.010
  31. Kim SH, Yun ME, Yoo JH, Chun SS. Correlation of Dehydration with Body Mass Index and Blood Lipid Levels. J Kor Diet Assoc. 2017;23(1):27-38.
  32. Campbell NR, Wickert W, Magner P, Shumak SL. Dehydration during fasting increases serum lipids and lipoproteins. Clin Invest Med. 1994;17(6):570-576.
  33. Thornton SN. Increased Hydration Can Be Associated with Weight Loss. Front Nutr. 2016;3: 18. doi:10.3389/fnut.2016.00018
  34. Burg MB, Ferraris JD, Dmitrieva NI. Cellular response to hyperosmotic stresses. Physiol Rev. 2007;87(4):1441-1474. https://doi.org/10.1152/physrev.00056.2006
  35. Santos BC, Chevaile A, Hebert MJ, Zagajeski J, Gullans SR. A combination of NaCl and urea enhances survival of IMCD cells to hyperosmolality. Am J Physiol-Ren Physiol. 1998;274(6):F1167-F1173. 6):e0128870. doi:10.1371/journal.pone.0128870
  36. Di Ciano-Oliveira C, Sirokmany G, Szaszi K, Arthur WT, Masszi A, Peterson M, Rotstein OD, et al. Hyperosmotic stress activates Rho: differential involvement in Rho kinase-dependent MLC phosphorylation and NKCC activation. Am J Physiol Cell Physiol 2003;285: C555-C566. https://doi.org/10.1152/ajpcell.00086.2003
  37. Tian W, Cohen DM. Urea stress is more akin to EGF exposure than to hypertonic stress in renal medullary cells. Am J Physiol Renal Physiol 2002;283:F388-F398. https://doi.org/10.1152/ajprenal.00031.2002
  38. Yancey PH, Clark ME, Hand SC, Bowlus RD, Somero GN. Living with water stress: evolution of osmlyte systems. Sci 1982;217:1214-1222. https://doi.org/10.1126/science.7112124
  39. Armstrong LE. Challenges of linking chronic dehydration and fluid consumption to health outcomes. Nutr Rev. 2012;70 Suppl 2:S121-127. https://doi.org/10.1111/j.1753-4887.2012.00539.x
  40. Hattori M, Azami Y. Searching for prevent measures of cardiovascular events in age Japanese taxi drivers-the daily rhythm of cardiovascular risk factors during a night duty day. J Hum Ergol. 2001;30(1-2):321-326.
  41. Chan J, Knutsen SF, Blix GG, Lee JW, Fraser GE. Water, other fluids, and fatal coronary heart disease the adventist health study. Am J epidemiol. 2002;155(9):827-833. https://doi.org/10.1093/aje/155.9.827
  42. Tokarz P, Blasiak J. Role of mitochondria in carcinogenesis. Acta Biochim Pol. 2014;61:671-678.
  43. Picone P, Nuzzo D, Caruana L, Scafidi V, Di Carlo M. Mitochondrial dysfunction: different routes to Alzheimer's disease therapy. Sci. 1982;217:1214-1222. https://doi.org/10.1126/science.7112124