Li Menglong, Shu Wen, Amaerjiang Nubiya, Xiao Huidi, Zunong Jiawulan, Vermund Sten H, Huang Dayong, Hu Yifei
Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China.
Office of the Dean, Yale School of Public Health, Yale University, New Haven, CT, United States.
Front Nutr. 2022 Jun 23;9:910291. doi: 10.3389/fnut.2022.910291. eCollection 2022.
Optimal water intake positively affects various aspects of human physiology, especially renal function. Physical activity (PA) may have an impact on hydration status and renal health, but the interaction of hydration status and PA level on renal function is not well-studied in children.
We conducted four waves of urine assays in our child cohort () study from October 2018 to November 2019 in Beijing, China. We measured urinary specific gravity, β-microglobulin (β-MG), and microalbumin (MA) excretion to assess hydration status and renal damage in the context of PA level and other covariates among 1,914 primary school children. We determined the associations of renal damage with the interaction of hydration status and PA level using generalized linear mixed-effects models.
The prevalence of dehydration was 35.0%, 62.1%, 63.9%, and 63.3%, and the prevalence of insufficient PA was 86.2%, 44.9%, 90.4%, and 90.2% from wave 1 to wave 4 among 1,914 primary school children. From wave 1 to wave 4, the prevalence of renal tubular damage had a significant increasing trend of 8.8%, 15.9%, 25.7%, and 29.0% ( = 16.9, < 0.001), while the prevalence of glomerular damage revealed a declining trend of 5.6%, 5.5%, 4.4%, and 4.1% ( = -2.4, = 0.016). There were stable longitudinal associations of renal tubular and glomerular damage with hydration status (euhydration: OR = 0.50 and 0.33, respectively) but not with PA level. In multivariate analysis, significant interactions of hydration status and PA level were noted with renal tubular damage (β = 0.43, = 0.014) and glomerular damage (β = 0.60, = 0.047). Children with euhydration and insufficient PA were less likely to have renal tubular damage (OR = 0.46, 95% CI: 0.39, 0.53) or glomerular damage (OR = 0.28, 95% CI: 0.20, 0.39); children with euhydration and sufficient PA were also less likely to have renal tubular damage (OR = 0.57, 95% CI: 0.44, 0.75) or glomerular damage (OR = 0.47, 95% CI: 0.30, 0.74), adjusting for age, sex, BMI z-score, standardized SBP, sleep duration, computer/cell phone screen time, and fruit and vegetable intake.
Children with euhydration and either sufficient or insufficient PA were less likely to have early renal damage. Adequate daily water intake for children is important, especially after PA.
最佳水摄入量对人体生理的各个方面都有积极影响，尤其是对肾功能。身体活动（PA）可能会影响水合状态和肾脏健康，但在儿童中，水合状态和PA水平对肾功能的相互作用尚未得到充分研究。
2018年10月至2019年11月，我们在中国北京对儿童队列进行了四轮尿液检测。我们测量了尿比重、β-微球蛋白（β-MG）和微量白蛋白（MA）排泄，以评估1914名小学生在PA水平及其他协变量背景下的水合状态和肾脏损伤情况。我们使用广义线性混合效应模型确定了肾脏损伤与水合状态和PA水平相互作用之间的关联。
在1914名小学生中，从第一波到第四波，脱水患病率分别为35.0%、62.1%、63.9%和63.3%，PA不足患病率分别为86.2%、44.9%、90.4%和90.2%。从第一波到第四波，肾小管损伤患病率呈显著上升趋势，分别为8.8%、15.9%、25.7%和29.0%（χ² = 16.9，P < 0.001），而肾小球损伤患病率呈下降趋势，分别为5.6%、5.5%、4.4%和4.1%（χ² = -2.4，P = 0.016）。肾小管和肾小球损伤与水合状态存在稳定的纵向关联（水合正常时：OR分别为0.50和0.33），但与PA水平无关。在多变量分析中，水合状态和PA水平与肾小管损伤（β = 0.43，P = 0.014）和肾小球损伤（β = 0.60，P = 0.047）存在显著交互作用。水合正常且PA不足的儿童发生肾小管损伤（OR = 0.46，95%CI：0.39，0.53）或肾小球损伤（OR = 0.28，95%CI：0.20，0.39）的可能性较小；在调整年龄、性别、BMI z评分、标准化收缩压、睡眠时间、电脑/手机屏幕使用时间以及水果和蔬菜摄入量后，水合正常且PA充足的儿童发生肾小管损伤（OR = 0.57，95%CI：0.44，0.75）或肾小球损伤（OR = 0.47，95%CI：0.30，0.74）的可能性也较小。
水合正常且PA充足或不足的儿童发生早期肾脏损伤的可能性较小。儿童每日摄入充足水分很重要，尤其是在进行身体活动之后。
