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Nutrition and health (including climate and ecological aspects)

Combining urine color and void number to assess hydration in adults and children

European Journal of Clinical Nutrition volume 75, pages 1262–1266 (2021)Cite this article

Subjects

Abstract

Background/objectives

To test the diagnostic ability of two combined practical markers for elevated urine osmolality (underhydration) in free-living adults and children.

Subjects/methods

One hundred and one healthy adults (females n = 52, 40 ± 14 y, 1.70 ± 0.95 m, 76.7 ± 17.4 kg, 26.5 ± 5.5 kg/m2) and 210 children (females = 105, 1.49 ± 0.13 m, 43.4 ± 12.6 kg, 19.2 ± 3.2 kg m−2) collected urine for 24-h. Urine was analyzed for urine osmolality (UOsm), color (UC), while the number of voids (void) was also recorded. Receiver Operating Characteristic (ROC) analysis was performed for UC, void, and combination of UC and void, to determine markers’ diagnostic ability for detecting underhydration based on elevated UOsm (UOsm ≥ 800 mmol kg−1).

Results

Linear regression analysis revealed that UC was significantly associated with UOsm in both adults (R2 = 0.38; P < 0.001) and children (R2 = 0.45; P < 0.001). Void was significantly associated with UOsm in both adults (R2 = 0.13; P < 0.001) and children (R2 = 0.15; P < 0.001). In adults, when UC > 3 and void <7 were combined, the overall diagnostic ability for underhydration was 97% with sensitivity and specificity of 100% and 88%, respectively. In children, UC > 3 and void <5 had an overall diagnostic ability for underhydration of 89% with sensitivity and specificity of 100% and 62%, respectively.

Conclusions

Urine color alone and the combination of urine color with void number can a valid and simple field-measure to detect underhydration based on elevated urine osmolality.

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Fig. 1: Internal regression analysis of urine color as a predictor of urine osmolality.
Fig. 2: Internal regression analysis of urine void number as a predictor of urine osmolality.
Fig. 3: Urine osmolality for samples of different concentrations based on combination of color and void number.

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Acknowledgements

The authors would like to thank Costas Bardis, Spiridoula Tsipouridi, Thomas Vidal, Mickey Hammer, Nicholas Lane, Ainsley Huffman, Berkley Vaughan, and Lauren Smith for their help during data collection.

Funding

The studies were supported by research grants from Danone Research.

Author information

Authors and Affiliations

  1. Department of Health and Human Performance, College of Charleston, Charleston, SC, USA

    J. D. Adams

  2. Department of Nutrition and Dietetics, Harokopio University, Athens, Greece

    Giannis Arnaoutis, Dimitris Bougatsas & Demosthenes B. Panagiotakos

  3. Human Integrated Physiology Laboratory, University of Wyoming, Laramie, WY, USA

    Evan C. Johnson

  4. New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children’s Hospital, Boston, MA, USA

    Lisa T. Jansen

  5. Harvard Medical School, Boston, MA, USA

    Lisa T. Jansen

  6. Department of Nutrition, Universidad Hispanoamericana, San Jose, Costa Rica

    Catalina Capitan-Jimenez

  7. Agricultural Statistics Lab, University of Arkansas, Fayetteville, AR, USA

    Andy Mauromoustakos

  8. Health, Hydration and Nutrition Science, Danone Research, Palaiseau, France

    Erica T. Perrier & Isabelle Guelinckx

  9. Hydration Science Lab, College of Health Solutions, Arizona State University, Phoenix, AZ, USA

    Stavros A. Kavouras

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Contributions

SAK, ECJ, IG, and ETP designed the research study; JDA, LTJ, GA, DB, and CCJ, conducted data collection and sample analysis; JDA, AM, and DBP analyzed the data; JDA, LTJ, GA, and ECJ wrote the paper. SAK was the principal investigator and had primary responsibility for the final content. All authors read, critically revised, and approved the final paper.

Corresponding author

Correspondence to Stavros A. Kavouras.

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Conflict of interest

SAK has served as an occasional scientific consultant for Quest Diagnostics, Standard Process, and Danone Research and has active grants with Danone Research and Standard Process. ETP and IG are Danone Research Employees.

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Adams, J.D., Arnaoutis, G., Johnson, E.C. et al. Combining urine color and void number to assess hydration in adults and children. Eur J Clin Nutr 75, 1262–1266 (2021). https://doi.org/10.1038/s41430-020-00834-w

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