An investigation into the relationship between plain water intake and glycated Hb (HbA1c): a sex-stratified, cross-sectional analysis of the UK National Diet and Nutrition Survey (2008–2012)

Harriet A. Carroll* (Corresponding Author), James A. Betts, Laura Johnson

*Corresponding author for this work

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Abstract

The aim of this study was to analyse the association between plain water intake and glycated Hb (HbA1c) in the National Diet and Nutrition Survey (2008–2012) rolling survey. These data included diet (4-d diaries) and HbA1c (fasted blood sample) measures of 456 men and 579 women aged 44 (sd 18) years with full information on covariates of interest (age, ethnicity, BMI, smoking status, education, other beverage intake, energy intake and fibre). Data were analysed using sex-stratified linear and logistic regressions modelling the associations of cups per d (240 ml) of plain water with HbA1c, and odds of HbA1c≥5·5 %, respectively. Substitution analyses modelled the replacement of sugar-sweetened beverages, fruit juice and artificially sweetened beverages with plain water. After adjustment, 1 cup/d of plain water was associated with a −0·04 % lower HbA1c (95 % CI −0·07, −0·02) in men. In logistic regression, men had a 22 % (95 % CI 10, 32 %) reduced odds of HbA1c≥5·5 %/cup per d of plain water. There was no evidence of an association with either HbA1c or odds of HbA1c≥5·5 % in women. None of the substitution models was associated with a change in odds of HbA1c≥5·5 %. Plain water intake was associated with lower HbA1c in men but not in women. Substituting water for specific beverages was not associated with a reduced odds of HbA1c≥5·5 %, suggesting that the addition of water is the more pertinent factor. Future trials should test whether the relationships between water intake and HbA1c is causal as this could be a cost-effective and simple health intervention.
Original languageEnglish
Pages (from-to)1770-1780
Number of pages11
JournalBritish Journal of Nutrition
Volume116
Issue number10
Early online date10 Nov 2016
DOIs
Publication statusPublished - 28 Nov 2016

Bibliographical note

The authors thank the study participants, the NDNS team, the UK Data Service and the dietary assessment assistants at MRC Human Nutrition Research who coded the food diaries.

The NDNS was funded by the Food Standards Agency, the Department for Health in England and Public Health England. This work was supported by the Economic and Social Research Council (grant no.: ES/J50015X/1). The Economic and Social Research Council had no role in the design, analysis or writing of this article.

All authors formulated the research questions and analysis plan. H. A. C., L. J. analysed the data. H. A. C. drafted the article. J. A. B., L. J. critically reviewed the article. All authors have approved the final version of the manuscript.

All authors have received funding from the European Hydration Institute. J. A. B. has received funding from GlaxoSmithKline and PepsiCo.

Keywords

  • fluid balance
  • metabolism
  • hydration
  • glycated Hb
  • Type 2 diabetes

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