title: Qualitative and/or quantitative drinking water recommendations for pediatric obesity treatment.
abstract: OBJECTIVE
  The qualitative recommendation to 'drink water instead of caloric beverages' may facilitate pediatric obesity treatment by lowering total energy intake. The quantitative recommendation to 'drink enough water to dilute urine' might further facilitate weight loss by increasing fat oxidation via cell hydration-mediated changes in insulin.
  
  
  METHODS
  This 8 week randomized intervention tested whether both qualitative-plus-quantitative (QQ) drinking water recommendations result in more weight loss than the qualitative recommendation alone (Q) in 25 children (9-12y) with body mass index at or above the 85thPercentile, given a reduced glycemic diet and usual physical activity. Random urine osmolality, saliva insulin, and body weight were assessed weekly. Mixed models explored if insulin mediated an effect of urine osmolality on weight loss.
  
  
  RESULTS
  In intention-to-treat analyses, QQ and Q participants did not differ significantly with respect to level of urine osmolality, saliva insulin, or weight loss. Only 4 out of 16 QQ participants complied with instruction to drink enough water to dilute urine, however. In completers analyses, the compliant QQ participants, who diluted urine osmolality from 910 ± 161 mmol/kg at baseline to below 500 mmol/kg over time (8 week mean±SE: 450 ± 67 mmol/kg), had significantly lower saliva insulin over time (8 week mean±SE: 13 ± 8 pmol/l vs. 22 ± 4 pmol/l) and greater weight loss (mean ± SE: -3.3 ± 0.7kg vs. -2.0 ± 0.5 kg) than compliant Q participants (7 out of 9 participants) who maintained elevated urine osmolality over time (8- week mean±SE: 888 ± 41 mmol/kg). Urine osmolality below 500 mmol/kg was significantly associated with weight loss. Change in saliva insulin partially explained the association.
  
  
  CONCLUSIONS
  QQ recommendations may increase weight loss for those able to dilute urine. Work is warranted to pursue cell hydration effects of drinking water for pediatric obesity treatment.
authors: Children's Hospital Oakland Research Institute, Oakland, CA, USA.
authors: Jodi D
authors: JD
authors: Stookey
authors: Children's Hospital Oakland Research Institute, Oakland, CA, USA.
authors: Rigoberto
authors: R
authors: Del Toro
authors: Children's Hospital Oakland Research Institute, Oakland, CA, USA.
authors: Janice
authors: J
authors: Hamer
authors: Children's Hospital Oakland Research Institute, Oakland, CA, USA.
authors: Alma
authors: A
authors: Medina
authors: Pediatric Clinical Research Center, Oakland, CA, USA.
authors: Annie
authors: A
authors: Higa
authors: Pediatric Clinical Research Center, Oakland, CA, USA.
authors: Vivian
authors: V
authors: Ng
authors: Healthy Hearts Program for Weight Management, Children's Hospital & Research Center, Oakland, CA, USA.
authors: Lydia
authors: L
authors: TinajeroDeck
authors: Healthy Hearts Program for Weight Management, Children's Hospital & Research Center, Oakland, CA, USA.
authors: Lourdes
authors: L
authors: Juarez
keywords: Adolescents; Children; Drinking water; Saliva insulin; Urine osmolality; Weight loss
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