title: A Water and Education Provision Intervention Modifies the Diet in Overweight Mexican Women in a Randomized Controlled Trial.
abstract: BACKGROUND
  There is minimal information on the impact of replacing sugar-sweetened beverage (SSB) consumption with water on diet quality from randomized controlled trials.
  
  
  OBJECTIVE
  We evaluated the effect of a water intake intervention on diet quality in overweight Mexican women.
  
  
  METHODS
  Women with a body mass index ≥25 and <39, 18-45 y old, and a self-reported high intake of SSBs (≥250 kcal/d) were randomly allocated to either the water and education provision (WEP) group (n = 120) or the education provision (EP) only group (n = 120). Each group received monthly nutrition counseling, and the WEP group received biweekly water deliveries for 9 mo. Three 24-h recalls, anthropometry, and demographic information were collected at baseline, and 3, 6, and 9 mo. Energy, macronutrient, sugar, SSB, fruit and vegetable, salty snack, cake and cookie, and fast food intakes were assessed in study completers (n = 189) classified by intervention assignment and by actual water intake at every time point (low <1200 vs. high ≥1200 mL/d).
  
  
  RESULTS
  The WEP group reported greater decreases in SSB intake than the EP group (from 20.9% to 10.3% of energy/d vs. from 20.1% to 17.8%). Thirty-eight percent of the EP group and 84.3% of the WEP group reported attaining a water intake ≥1200 mL/d. Reductions in energy intake and food groups were similar across intervention groups. However, the high actual water intake group reported greater increases vs. the lower intake group in intake of fruits and vegetables (117 vs. 47 g/d), as well as larger reductions in salty snacks (4.6 vs. 0.7 g/d) and cakes and cookies (31.7 vs. 14.7 g/d).
  
  
  CONCLUSIONS
  Other than SSBs, improvements in food group intake did not differ by intervention group in overweight Mexican women. However, post hoc analyses suggested that achieving a high actual water intake was associated with additional beneficial changes in food group intake. This trial was registered at clinicaltrials.gov as NCT01245010.
authors.affiliation: Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico;
authors.forename: Sonia
authors.initials: S
authors.lastname: Rodríguez-Ramírez
authors.affiliation: Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico;
authors.forename: Teresa
authors.initials: T
authors.lastname: González de Cosío
authors.affiliation: Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC;
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Mendez
authors.affiliation: Department of Clinical Laboratory and Nutritional Sciences, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA; and.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Tucker
authors.affiliation: Department of Probability and Statistics, Institute of Research in Applied Mathematics and Systems, National University of Mexico, Mexico City, Mexico.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Méndez-Ramírez
authors.affiliation: Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico;
authors.forename: Sonia
authors.initials: S
authors.lastname: Hernández-Cordero
authors.affiliation: Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC; popkin@unc.edu.
authors.forename: Barry M
authors.initials: BM
authors.lastname: Popkin
mesh_terms: D000328:Adult; D001628:Beverages; D004326:Drinking; D005260:Female; D006801:Humans; D050177:Overweight / Q000628:therapy*; D014867:Water; D061217:Weight Reduction Programs; D055815:Young Adult
chemical_list: D014867:Water
keywords: dietary intake; overweight women; randomized controlled trial; sugar-sweetened beverages; water intervention