DRINKING HABITS AND HYDRATION STATUS AMONG TEENAGERS AND ADULTS IN TWO DIFFERENT ECOLOGICAL AREAS (Kebiasaan Minum dan Status Hidrasi pada Remaja dan Dewasa di Dua Wilayah Ekologi yang Berbeda)

Abstract

Water is an important nutrient required for the human body. There is a tendency that some people neglect its important roles for health, and it is sometime called a forgotten nutrient. About two-third of our body weight is water. Water have many important roles in the body such as a solvent, catalyst, lubricate, temperature regulator, and as a body mineral and electrolyte supplier. Several studies done in overseas showed that adequate intake of water prevents many symptoms of diseases; improve physical performance and memory capacity. Thirsty is an early and simple indication of predehydration. However, water is not only required when thirsty. Study in Singapore showed that the teenagers and adults (15 – 24 years) are more likely to be vulnerable to mild dehydration. However, there is no such evidence in Indonesia. Therefore, PERGIZI PANGAN Indonesia, Department of Community Nutrition, Faculty of Human Ecology (FEMA) IPB and Danone Aqua Indonesia conducted this study in Indonesia. The main objective of the study is to obtain scientific evidences on types, amount, sources and habitual intake of water among teenagers and adults in two different ecological areas of Indonesia. The specific objectives of the study were: 1) the types, amount and sources of drinking water and beverages; 2) the habitual intake of drinking water and beverages (frequency, time, place); 3) the reasons of choosing several types of drinking water and beverages (bottle water, fountain water, boiled water, soft drink, sport drink, energy drink, milk, juice, and etc); 4) the knowledge on healthy drinking; and 5) the magnitude of mild and moderate dehydration among teenagers and adults. A cross sectional study design was applied to address the above objectives. Considering the influence of the different altitude and temperature (ecological area) on the water supply and intake, two study sites are being chosen, namely: 1) West Bandung, close to Lembang (a highland area with 700-1050 meters above sea level), which reflects a medium temperature (daily temperature is about 22oC); and 2) North Jakarta (a low land area with 5-50 meters above sea level), which reflects a high temperature (daily temperature is about 28oC). This study conducted in October 2008. The sample or subjects for this study is teenagers and adults both male and female). Inclusions criteria of the subjects were: 1) adolescents aged 15 – 18 year and adults aged 25 – 50 year, 2) they spent most of their time in the study site, and 3) healthy. Exclusion criteria of the samples were they did not suffering from: 1) renal failure, 2) diabetic, or 3) liver failure. Exclusion criteria determined by medical examination and urine analysis. The minimum sample size for each study site was calculated based on the minimum sample formula, which is 50 people for each age-sex and study site group, and the total number of all the samples reached 400 persons. The primary data collected consisted data on socio-economic-demography, water & beverage consumption, habitual drinking on water and beverages, knowledge on healthy drinking and its benefits, body weight and height, physical activities, morning urine, dehydration symptoms, physical activities and physical assessment. To gain high quality data, four procedures of data quality control applied in the study, namely: 1) Expert meeting and consultation for improving the study design and method; 2) Pre-testing of questionnaires; 3) Controlling II variation of inter-observer; and 4) Supervision during data collection. Dehydration status (mild dehydration status) was determined based on both urine analysis and dehydration symptoms. Subjects categorized as dehydrated if they meet all of the following criteria: 1) urine specific gravity is more than >1.020, 2) urine color is dark yellow 3) erythrocyte 1- 5/lpb, leukocyte 1-5/lpb or positive cylinder hialin, 4) light proteinuria; and having two of the following symptoms such as thirsty/dry throat, headache/dizziness, dry skin, dry lip/mouth, rapid heart rate, high body temperature, rarely urinated, and small amount of urine volume. Normal BMI (Body Mass Index) if BMI 18.5 – 23.0. Physical activity levels categorized based on US-DHHS criteria (2008); light activity level if intense physical activity less than 150 minutes/week; medium activity level if 150-300 minutes/week, and heavy activity level if more than 300 minutes/week. The data was analyzed statistically. The results of the data analysis were presented in the form of tables, diagrams and graphs in order to answer the objectives of the study. The results showed that in the highland area most of the teenager subjects stated that the sources of family drinking water are gallon water (38.1 %), wellspring (27.8%), pump-water (26.8%) and well-water (20.6%). Similarly the sources of family drinking water of adult subjects are gallon-water (34.8 %), wellspring (30.4%), well-water (21.7%) and pump-water (15.2%). While in the low land, more gallon-water is consumed, which is 74.3% for teenagers and 72.5% for adult? The second source of drinking water among teenagers in the low land is pump-water 32.1%, and then the third is 33.3% respectively. The family consumption of gallon water of teenager group both in the highland and in the lowland was 2.3 and 7.8 gallons/month respectively. About two-third (65-70%) of teenagers consumed branded gallon water, and 88.2% of them using Aqua brand. The family consumption of gallon water of adult group was 1.6 and 7.3 gallons/moth in the highland and lowland areas respectively. There are 70 - 72% of the adult samples used the branded gallon water which is 45 - 50% used Aqua brand. Most of the teenagers (73.2%) in the highland prefer to drink unbottled water rather than the bottled ones. Meanwhile in the lowland, the number of the teenagers who prefer to drink the unbottled water is relatively similar to the bottled ones which are 52.3% and 47.4% respectively. The frequency of bottled water consumption in the lowland is higher than in the highland which is 3.9 times/day compare to 1.8 times per day. Among adult group, about 70.7% in the lowland and 50.0% in the highland prefer to drink unbottled water. The safety of the water drink is the main reason of 80 - 85% teenagers to use bottled or packed water. Tea and coffee is the next beverage that is being chosen by the teenagers. The number of the teenagers who consume tea and coffee is 79% in lowland and 84% in highland area. The frequency of tea/coffee consumption in the lowland is 1.5 times/day and in the highland 1.6 times/day. For the beverages, a taste is the main reason to choose it. There are only 25.0% of the adult in the highland and 18.6% in the lowland prefer to drink the beverages. Adult preference in consuming drinking water is based on the safety reason which is 63.1% in the highland and 80.4% in the lowland. Regarding the knowledge of healthy drink, most of the teenagers in the mountain (53.6%) is categorized as medium and in the lowland as low (57.8%). However, the most of the adults in the highland (57.6%) and the lowland (59.8%) are both categorized as medium. Based on the knowledge aspect on the water function, water food source, and dehydration symptoms; these aspects are the poor score of knowledge in the teenagers and the adult in both ecological areas. The proportion of mild dehydration teenagers is 24.75% in the highland and 41.70% in the lowland. The proportion of mild dehydration adults is 15.40% in the III highland and 24.05 % in the low land. The percentage of mild dehydration in the two groups of sample is higher in the lowland than in the highland area. This research recommends strengthening the role of government, education institution and private industries, especially the drinking water industries, in educating the public regarding several issues related to clean, safe and healthy drinking water. The government and education institutions such as schools and universities could increase the student’s knowledge on healthy drinking water through the class meetings or extracurricular activities. The private industries could educate the consumers through various commercial advertisement of the product in the mass-media, seminar, workshop; and also by exposing related information in the product packages. The number of the teenagers and the adults in Indonesia reaches 70 million people; the sooner the efforts to prevent dehydration among this productive age the better the physical and mental performance, stamina and health of them.