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Nutritionreviews64 0457
Nutritionreviews64 0457
Adequate fluid intake is critical for survival. While tain fluid balance in most people. Moreover, cultural
adults are at liberty to drink fluids as wanted, children patterns of fluid intake are sufficient to override a true
Figure 2. Total body water, intracellular fluid, and extracellular Cognitive function can be clustered into several
fluid as a percentage of body weight and a function of age. main domains: memory functions, attention functions,
(Used with permission from Behrman et al., 2004.7) perceptual functions, executive functions, psychomotor
functions, and language skills. Each of the cognitive
domains can be further divided in a number of more
becoming more common as a risk factor for dehydration
specified functions. Memory functions, for example, in-
in infants.12 Nursing mothers with insufficient milk may
clude short-term and long-term memory encoding, stor-
not recognize the signs of progressive dehydration in
age and retrieval functions, and working memory. Further
their infants, and parents may not recognize signs of
differentiation is made with regard to the type of infor-
dehydration in older children. One report suggests that
mation that is processed; for example, auditory, visual,
although most parents understand what dehydration is,
verbal, spatial, abstract, or procedures. Attention can be
only about two-thirds could identify more than one sign
subdivided in selective, divided, and sustained attention
of dehydration.13
functions, whereas executive functions encompass more
complex processes such as reasoning, planning, concept
Hydration and Physical Activity in Children formation, evaluation, and strategic thinking.22
Research in our laboratory and others supports the
Children may also be at greater risk for “voluntary hypothesis that mild dehydration produces alterations in a
dehydration,” a state of water deficit where fluids have number of important aspects of cognitive function such as
been ingested to the point where thirst no longer provides concentration, alertness, and short-term memory in young
a drive to drink, but where adequate repletion of fluids adults 18 to 25 years of age23-27 and in the oldest adults 50
has not been achieved. Voluntary dehydration is seen to 82 years of age.28 Most of the cited studies were ran-
most commonly in child athletes or following climatic domized, controlled trials. The results vary with respect to
heat stress. Children may not recognize the need to magnitude of effect on cognition and in direction of effect.
replace lost fluids, so children and coaches need specific In some studies, cognitive performance was not altered by
guidelines for fluid intake.14 Additionally, children may mild dehydration.29 In others, mild dehydration produced
require longer acclimation to increases in environmental
temperature than do adults. It is recommended that child
Table 1. Total Water Intakes of US and German
athletes or children in hot climates begin athletic activ-
Children
ities in a well-hydrated state and drink fluids over and
US* German†
above the thirst threshold. One study published in 1994
found that one-third of British school-aged children had mean mL/d
nothing to drink prior to the beginning of the school day, Boys and Girls
reflecting a fluid fast of over 12 hours.15 Since then, Age 1–3 (US) 2–3 (G) 1420 1114
several programs have been instituted in the United Age 4–8 1779 1363
Kingdom to promote adequate water intake in school- Boys age 9–13 2535 1891
children.16,17 Girls age 9–13 2240 1676
Research suggests that, especially at the beginning *Fluid intake from food and beverages (data from Food and
of the season, young athletes are at particular risk for Nutrition Board, Institute of Medicine, 20043).
dehydration due to lack of acclimatization to weather †Total water from food, beverages, and metabolic water (data
conditions or suddenly increased activity levels.18,19 from Sichert-Hellert et al., 20019).
Glutamate receptor antagonists are associated with by Bar-David et al.34 seem to indicate negative effects on
memory impairments,49 but excitotoxicity produced by cognition induced by mild dehydration in children. How-
chronically high levels of glutamate agonists can also in- ever, much remains unknown about the short- and long-
duce hippocampal damage and produce cognitive decre- term effects of dehydration on cognitive function in chil-
ments.50 Dehydration is associated with a decrease in neu- dren, so these results need to be confirmed by future
ronal cell proliferation that is reversed by rehydration.51 research. Several countries, including the United States and
Using a model of lead exposure, Al Shuaib et al.52 found the United Kingdom, are already encouraging water intake
that dehydration in combination with lead exposure signif- in school-age children to promote good health and improve
icantly impairs synaptic transmission at the neuromuscular academic performance.16,17,53
junction. Neuromuscular impairments can be reflected in
decrements in psychomotor performance. Although any
links between these animal studies and human cognitive ACKNOWLEDGEMENTS
performance would be speculative, the existing research
suggests that dehydration produces many different physio- This project was supported in part by RO1-
logical effects that can individually or in combination affect DK065114 and with funds from the US Department of
cognitive and psychomotor performance. Agriculture, Agricultural Research Service, under con-
tract number 53000-063-01A (IHR) and T32 DK007651
CONCLUSIONS (KED). The contents of this publication do not necessar-
ily reflect the views or policies of the US Department of
Although the effects of dehydration on cognitive func- Agriculture, nor does mention of trade names, commer-
tion are now well documented in adults, there are few cial products, or organizations imply endorsement by the
studies examining the relationship between hydration status US Government. This review was partly supported by an
and cognitive function in children (Table 3). Data reported educational grant from Nestlé Waters.