Interaction of Hydration Status and Physical Activity Level on Early Renal Damage in Children: A Longitudinal Study
Menglong Li1, Wen Shu1, Nubiya Amaerjiang1
1Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China.
Insights
Maintaining adequate hydration is crucial for children's kidney health, especially when combined with physical activity (PA). Euhydration, regardless of PA level, significantly reduces the risk of early renal damage in children.
Area of Science:
- Pediatric Nephrology
- Environmental Health
- Exercise Physiology
Background:
- Optimal water intake is vital for physiological functions, particularly renal health.
- The interplay between hydration status and physical activity (PA) on children's renal function remains understudied.
Purpose of the Study:
- To investigate the combined effects of hydration status and physical activity levels on renal damage markers in primary school children.
- To determine the association between hydration, PA, and indicators of renal tubular and glomerular damage.
Main Methods:
- A cohort of 1,914 primary school children in Beijing underwent four waves of urine assays.
- Measurements included urinary specific gravity, β2-microglobulin (β2-MG), and microalbumin (MA) excretion.
- Generalized linear mixed-effects models were used to analyze the interaction of hydration status and PA level on renal damage.
Main Results:
- Prevalence of dehydration was high (35.0%-63.9%), and insufficient PA was also common (44.9%-90.4%).
- Renal tubular damage showed an increasing trend (8.8% to 29.0%), while glomerular damage declined (5.6% to 4.1%).
- Euhydration was associated with reduced risk of both renal tubular (OR=0.50) and glomerular damage (OR=0.33). Significant interactions between hydration and PA were found for both types of renal damage.
Conclusions:
- Children maintaining euhydration, irrespective of their PA level, exhibited a lower likelihood of developing early renal damage.
- Adequate daily water intake is essential for children's renal health, particularly following physical activity.
Background:
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.
Methods:
We conducted four waves of urine assays in our child cohort (PROC) study from October 2018 to November 2019 in Beijing, China. We measured urinary specific gravity, β2-microglobulin (β2-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.
Results:
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% (Z = 16.9, P < 0.001), while the prevalence of glomerular damage revealed a declining trend of 5.6%, 5.5%, 4.4%, and 4.1% (Z = -2.4, P = 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, P = 0.014) and glomerular damage (β = 0.60, P = 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.
Conclusion:
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.
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