Abstract  Swimming and recreating in lakes, oceans, and rivers is common, yet the literature suggests children may be at greater risk of illness following such exposures. These effects might be due to differences in immunity or differing behavioral factors such as poorer hygiene, longer exposures to, and greater ingestion of potentially contaminated water and sand. We pooled data from 12 prospective cohorts (n=68,685) to examine exposures to potentially contaminated media such as beach water and sand among children compared with adults, and conducted a simulation using self-reported time spent in the water and volume of water swallowed per minute by age to estimate the total volume of water swallowed per swimming event by age category. Children aged 4-7 and 8-12 years had the highest exposures to water, sand, and algae compared with other age groups. Based on our simulation, we found that children (6-12 years) swallow a median of 36 ml (90th percentile=150 ml), whereas adults aged ≥35 years swallow 9 ml (90th percentile=64 ml) per swimming event, with male children swallowing a greater amount of water compared with females. These estimates may help to reduce uncertainty surrounding routes and durations of recreational exposures and can support the development of chemical and microbial risk assessments.

Abstract  BACKGROUND: Little is known about the association of contributors of total water intake with dietary characteristics in US children.

OBJECTIVE: We examined intakes of total water and its contributors and their associations with diet and meal reporting in children and adolescents.

DESIGN: Dietary data for children 2-19 y of age (n = 3978) from the National Health and Nutrition Examination Survey 2005-2006 were used to compute usual intake of total water. The association of total water and its contributors with sociodemographic characteristics and dietary and meal attributes was examined by using multiple regression analysis.

RESULTS: The adjusted mean intakes of total water in Americans aged 2-5, 6-11, and 12-19 y were 1.4, 1.6, and 2.4 L, respectively. The mean usual intake of total water was generally less than the Adequate Intake; overall, more boys reported intakes of at least the Adequate Intake. The percentage of total water intake from plain water increased with age. Plain water intake was inversely associated with the intake of beverage moisture and the energy density of foods; conversely, beverage moisture was positively associated with dietary energy, fat, and the energy density of foods. Associations of water contributors with meal patterns (number of eating occasions, reporting of breakfast or snack) were inconsistent across age groups. Nearly 80% of food moisture, >66% of beverage moisture, and ≈30% of plain water were reported with main meals.

CONCLUSIONS: Intake of total water over 24 h from different contributors varied by age. Qualitative differences in dietary intake in association with the amount of plain water and beverage moisture in the recalls were observed. American children and adolescents consumed more than two-thirds of their daily beverages with main meals.

Abstract  The last comprehensive water consumption planning factors study was conducted in 1983 and revised in 1988 and 1994. The US Army requires current, accurate planning factors to determine force structure and for combat planning. Force structure developers must determine the number and types of units required to support the total Army in world-wide commitments. Combat planners must determine the number and type units required to support specific operational plans and establish a phased deployment plan to ensure that support is available for deploying forces. This study revisited the factors currently in force, and challenged proponents of water consuming processes to validate or revise those factors

Abstract  This report provides a set of early-life stage age groups for U.S. Environmental Protection Agency (EPA, or the Agency) scientists to consider when assessing children's exposure to environmental contaminants and the resultant potential dose. These recommended age groups are based on current understanding of differences in behavior and physiology that may impact exposures in children. A consistent set of early-life age groups, supported by an underlying scientific rationale, is expected to improve Agency exposure and risk assessments for children by increasing the consistency and comparability of risk assessments across the Agency, improving accuracy and transparency in assessments for those cases where current practice might too broadly combine behaviorally and physiologically disparate age groups, and fostering a consistent approach to future exposure surveys and monitoring efforts to generate improved exposure factors for children.

Abstract  This report presents estimates of Total Water and Tapwater intake in the population of the continental United States. The methods used to derive the estimates are described in detail. The data used for this analysis were collected during the 1977-78 Nationwide Food Consumption Survey (NFCS) of the U.S. Department of Agriculture. The authors created a special database to quantify the total moisture and tapwater content of the foods and beverages consumed by the NFCS study subjects. All food and beverage sources, as well as drinking water, are incorporated in the estimates of Total Water intake. Estimates of Tapwater intake include drinking water and tapwater added in final home or restaurant preparation of beverages and foods. Data are presented by age group, sex, season and geographic region, and separately for pregnant women, lactating women, and breast-fed children. Average intake for all participants (n=26,081) (excluding pregnant women, lactating women, and breast-fed children) was 2,072 ± 803 g/day of Total Water, including 1,193 ± 702 g/day of Tapwater. Tapwater intake thus accounted for 55 ± 18% of Total Water consumed. For all age groups combined, drinking water contributed approximately 30% of Total Water and 54% of Tapwater, foods, 26% of Total Water and 10% of Tapwater, and other beverages, 44% of Total Water and 36% of Tapwater. Median daily Total Water intake, by age group, was 1,120 g (<1 year), 1,497 g (1-10 years), 1,874 g (11-19 years), 2,109 g (20-64 years), and 2,109 g (65+ years). Median daily Tapwater intake was 240 g (<1 year), 665 g (1-10 years), 867 g (11-19 years), 1,252 g (20-64 years), and 1,367 g (65+ years). Among adults 20-64 years old, the 5th and 95th percentiles of Total Water consumption were 1,133 g and 3,793 g. Comparable percentiles of Tapwater intake were 416 g and 2,707 g, respectively. Observation of expected trends for sex, geographical region, and season, as well as for age, reinforces the general usefulness of this approach.

Abstract  Data from a population-based case-control interview study of incident bladder cancer in 10 areas of the United States were used to estimate relative risks among white men (2,116 cases, 3,892 controls) and women (689 cases, 1,366 controls) according to beverage intake level and type of water source. Individual year-by-year profiles of water source and treatment were developed by linking lifetime residential information with historical water utility data from an ancillary survey. Risk of bladder cancer increased with intake level of beverages made with tap water. The odds ratio (OR) for the highest vs. lowest quintile of tap water consumption was 1.43 [95% confidence interval (CI) = 1.23, 1.67; chi 2 for trend = 26.3, P less than .001]. The risk gradient with intake was restricted to persons with at least a 40-year exposure to chlorinated surface water and was not found among long-term users of nonchlorinated ground water. The ORs for the highest vs. lowest quintiles of tap water intake were 1.7 and 2.0, respectively, among subjects with 40-59 and greater than or equal to 60 years' exposure. Duration of exposure to chlorinated surface water was associated with bladder cancer risk among women and nonsmokers of both sexes. Among non-smoking respondents with tap water consumption above the population median, the OR increased with exposure duration to a level of 3.1 (CI = 1.3, 7.3; chi 2 for trend = 6.3, P = .01) for greater than or equal to 60 years of residence at places served by chlorinated surface water (vs. non-chlorinated ground water users). These results extend findings of earlier epidemiologic studies and are consistent with environmental chemistry and toxicologic data demonstrating the presence of genotoxic by-products of chlorine disinfection in treated surface waters.

Abstract  Women in the child-bearing age of 15 to 44 years and, in particular, pregnant and lactating women in this age cohort are considered a sensitive subpopulation when assessing risk from ingestion of water because water borne contaminants may pose a risk not only to the mother but to the fetus or infant. This article presents estimates of daily average per capita water ingestion for women of child-bearing age and in three subgroups: pregnant, lactating, and non-pregnant/non-lactating women. Estimates of means and upper percentiles of subgroup ingestion distributions were generated using participant responses and survey weights from the United States Department of Agriculture's (USDA) 1994–96 and 1998 Continuing Survey of Food Intake by Individuals (CSFII). The ingestion estimates are empirical and not based on an assumed parametric distribution of daily average amount of water ingestion. Water occurring naturally in foods or added by manufacturers to commercial products is not included in the estimates presented. These estimates of water ingestion by women of child-bearing age are compared to those attributed to Ershow and Cantor (1989) by Burmaster. These estimates, based on data collected in 1978, were used by Burmaster to characterize the distribution of daily average per capita ingestion as lognormal. The lognormal estimates of total water ingestion are generally greater than the total water ingestion estimates based on the CSFII data. Possible explanations for the differences are discussed.

Abstract  OBJECTIVE: To determine the relative validity of a quantitative beverage frequency questionnaire in assessing beverage, calcium, and vitamin D intakes using 3-day food diaries for reference.

DESIGN: Parents were asked to complete questionnaires for the preceding week and diaries for the following week for their children. Calcium and vitamin D intakes were estimated from human milk, infant formulas, and cow's milk ("beverages") for questionnaires and diaries and from "all foods and beverages" for diaries. Data collected at 6 and 12 months and 3 and 5 years of age as part of the Iowa Fluoride Study (N=700) were analyzed cross-sectionally.

SUBJECTS: Children (N=240); 60 randomly selected from each quartile of energy intake at 6 months of age.

STATISTICAL ANALYSES: Spearman correlation coefficients, weighted kappa statistics, and percentages of exact agreement were used to assess associations between tools.

RESULTS: Correlations between mean daily beverage intakes estimated from questionnaires and diaries ranged from 0.95-0.99 for human milk, 0.84-0.85 for infant formula, 0.63-0.86 for cow's milk, 0.54-0.69 for juice/drinks, 0.26-0.59 for liquid soft drinks, 0.35-0.74 for powdered soft drinks and 0.54-0.70 for water. Correlations between mean daily nutrient intakes estimated from questionnaires and diaries "beverages" ranged from 0.64-0.74 for calcium and 0.60-0.80 for vitamin D; and between questionnaires and diaries "all foods and beverages" ranged from 0.41-0.63 for calcium and 0.43-0.80 for vitamin D.

APPLICATIONS: A quantitative beverage frequency questionnaire can provide a relative estimate of beverage, calcium, and vitamin D intakes.

Abstract  OBJECTIVE: To describe transitions and patterns in infants' and toddlers' beverage intakes, with focus on nonmilk beverages.

DESIGN: A cross-sectional study was conducted by telephone to obtain a 24-hour dietary recall of infants' and toddlers' food intakes, as reported by mothers or other primary caregivers.

SUBJECTS: A nationwide sample of infants and toddlers (n=3,022) ages 4 to 24 months, who participated in the Feeding Infants and Toddlers Study (FITS).

ANALYSES: Beverages were categorized as total milks (ie, breast milk, infant formulas, cow's milk, soy milk, goat's milk), 100% juices, fruit drinks, carbonated beverages, water, and "other." Analyses included means +/- standard deviations, percentages, frequencies, nutrient densities, and linear regression.

RESULTS: Beverages provided 84% of total daily food energy for infants 4 to 6 months of age, decreasing to 36% at ages 19 to 24 months. Apple juice and apple-flavored fruit drinks were the most frequently consumed beverages in the 100% juice and fruit drink categories, respectively. Juices, fruit drinks, and carbonated beverages appeared to displace milk in toddlers' diets (P<.0001).

APPLICATIONS/CONCLUSIONS: This research shows that beverages make important contributions to infants' and toddlers' energy and nutrient needs, but they must be wisely chosen. Registered dietitians should advise parents and caregivers that excessive intakes of any beverage, including milks and 100% juices, may displace other foods and beverages in the diet and/or contribute to excess food energy (kcal). Further research is needed to define excessive amounts in each beverage category, and such guidance could be very useful to parents and caregivers of infants and toddlers.

Abstract  This publication contains estimates of food and nutrient intakes by individuals residing in households in the 48 conterminous States and Washington, DC. The estimates are based on information provided by 15,128 individuals who participated in the 1989-91 Continuing Survey of Food Intakes by Individuals conducted by the U.S. Department of Agriculture. One-day food and nutrient intake data for individuals of all ages were collected between April 1989 and March 1992 using a l-day recall in an in person interview. Food and nutrient intake estimates are tabulated for individuals by sex and age, race, Food Stamp Program participation, poverty status, income level, and region. For 71 food groups and subgroups, mean quantities of foods eaten per individual in a day and percentages of individuals who reported eating any food from the specified food groups and subgroups are presented. Also presented are tables of the mean intakes of food energy and nutrients; nutrient intakes per 1,000 kilocalories; nutrient intakes expressed as percentages of the 1989 Recommended Dietary Allowances; macronutrient sources of food energy; frequency of eating; percentage of individuals reporting specified eating occasions; mean intakes and percentages of individuals reporting drinking plain water; percentages of individuals reporting special diets by type of diet; usage of vitamin and mineral supplements by type of supplement; and frequency of salting food at the table.

Abstract  From a historical perspective there is solid evidence for concern about the significant increase in the association between environmental agents and cancer or other diseases. These agents may be single substances or complex mixtures; they may be consumables or contaminants, and they may exist in the workplace and/or outside of it. From the latter part of the last decade and into the foreseeable future, interest in professional sports and sports for personal leisure-time enjoyment and physical fitness will undoubtedly continue to involve an ever-increasing following. To date there has been no study conducted on the possible adverse effects of consumables (drugs, liniments, etc.) or contaminants (air pollutants, ultraviolet radiation, etc.) on professional or amateur athletes. A recent case report suggests that benzene in rubber cement used by a marathon runner to keep adhesive tape in place over blistered areas of the feet may have contributed to the development of aplastic anemia. Other substances to which a great number of athletes are exposed are alcohol- or petroleum-based liniments and balsams, dust from talc and chalk, and drugs. The nature of absorption, metabolism, and pharmacokinetics in athletic exercise; dose (duration and intensity); response (threshold, interaction); latent period; and reversibility of adverse reaction are factors that have not been so far addressed in pharmacology and toxicology. We are pleased to have the opportunity to discuss our studies on the absorption and excretion of a swimming pool chlorine stabilizer by recreational long-distance swimmers.

Abstract  About 15% of the population have personal wells. Although it has been estimated that less than 2% of the groundwater in the U.S. is contaminated, well owners should be concerned about water quality. The booklet outlines potential ground water contamination sources, how to determine and maintain the adequacy of drinking water from wells, and what to do to remedy any problems with water from personal wells.

Abstract  BACKGROUND: Literature reporting total daily water intake of community-dwelling older adults is limited. We evaluated differences in total water intake, water sources, water from meal and snack beverages, timing of beverage consumption, and beverage selection for three older age groups (young-old, 65-74 years; middle-old, 75-84 years; and oldest-old, >or=85 years).

METHODS: Data for 2,054 older adults from the 1999-2002 National Health and Nutrition Examination Survey were used for this study. Multivariate analyses controlling for age, sex, race-ethnicity, education, and marital status were conducted to determine differences in water intake variables across the age groups.

RESULTS: Total water intakes found for the middle-old and oldest-old age groups were significantly lower than those found for the young-old age group. The relative contributions of beverages to total water intake were 40.8%, 38.3%, and 36.4% for the young-old, middle-old, and oldest-old, respectively. The water intakes from beverages consumed at snack occasions were significantly lower for the middle-old and oldest-old groups than those for the young-old group. All groups consumed the greatest amount of water in the morning. Coffee was the predominant source of water from beverages for all groups.

CONCLUSIONS: This study fills a gap in the literature by providing an analysis of the daily water intake of middle-old and oldest-old adults. We found that the total water intake for the middle-old and oldest-old was significantly lower than that for the young-old. Future research needs to investigate the clinical outcomes associated with declining water intakes of community-dwelling older adults.

Abstract  OBJECTIVES: To provide summary estimates of gastroenteritis risks and illness burden associated with recreational water exposure and determine whether children have higher risks and burden.

METHODS: We combined individual participant data from 13 prospective cohorts at marine and freshwater beaches throughout the United States (n = 84 411). We measured incident outcomes within 10 days of exposure: diarrhea, gastrointestinal illness, missed daily activity (work, school, vacation), and medical visits. We estimated the relationship between outcomes and 2 exposures: body immersion swimming and Enterococcus spp. fecal indicator bacteria levels in the water. We also estimated the population-attributable risk associated with these exposures.

RESULTS: Water exposure accounted for 21% of diarrhea episodes and 9% of missed daily activities but was unassociated with gastroenteritis leading to medical consultation. Children aged 0 to 4 and 5 to 10 years had the most water exposure, exhibited stronger associations between levels of water quality and illness, and accounted for the largest attributable illness burden.

CONCLUSIONS: The higher gastroenteritis risk and associated burden in young children presents important new information to inform future recreational water quality guidelines designed to protect public health.

Abstract  Drinking water is a potential source of toxic contaminant and it is well known that water intake on a body weight basis decreases rapidly with increasing age. Nevertheless, few studies have been conducted on water intake of very young infants who might be particularly sensitive to some toxic chemicals. The objective of this study was to describe the mean and distribution of total water intake of 2-month old infants living in agricultural areas. Mothers (n=642) of 8 to 9 week old infants were interviewed by phone to evaluate their feeding practice, including juice and cereal intake. There were 393 infants (61%) who drank some quantity of water and 278 (43%) consumed formula reconstituted with water. For formula-fed infants, the 10, 50 and 90th percentiles of daily water intake were 79, 112, and 179 ml/kg respectively. These values are much higher than the intake recommended by US EPA for infants under one year (US EPA, 1997). This study demonstrates the importance of considering water distribution intake in very young infants who may be particularly susceptible to water contaminants.

Abstract  It has long been known that individuals can survive much longer without food than they can without water. Only in recent decades has science been able to quantify the factors that influence the body’s ability to maintain optimal water levels and the physiological consequences of water imbalance. This monograph presents information to assist the caregiver—whether physician, medic, unit leader, or fellow soldier—in understanding the influence of environment, physical activity, body size and gender, and load carriage in maintaining water balance.

Abstract  Studies of disinfection byproducts (DBPs) in drinking water and risk of adverse reproductive outcome have usually relied on approximate measures of exposure. Individual differences in consumption of bottled or filtered water, variability in tap water consumption at home and at work, dermal and inhalation exposure to volatile contaminants, and changes in residency during pregnancy may lead to exposure misclassification. We characterized exposures to tap water and other risk factors among 71 pregnant and 43 non-pregnant women attending public health clinics. Nearly all residences had a municipal water source, but 25% of women drank filtered or bottled water. Fifty percent of the women in our sample reported working outside the home where, on average, one third of their daily water intake took place. Pregnant women consumed more water than non-pregnant women (3.4 vs. 3.0 total l/day), especially cold tap water at home (1.8 vs. 1.3 l/day, 95% CI for the difference=0.1, 0.9). Patterns of showering were similar for both groups of women, but pregnant women were more likely to bathe and to bathe more frequently. The prevalence of smoking was lower among pregnant women (22.5% vs. 32.6%), as was the consumption of alcohol (4.2% vs. 53.5%, 95% CI for the difference=-64.9, -33.7). Thirty-two percent of women had moved during their current pregnancy. The data reaffirm the importance of collecting individual-level data for water consumption and exposure to potential confounders to avoid misclassification bias. This study is the first to target women of low socio-economic status (SES) and therefore of particular interest in studies of adverse reproductive outcomes for which this group is at increased risk.