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Water hardness and digestive diseases: a large-scale population-based prospective cohort study.

Qida He1,2, Mengtong Sun1,2,3, Jingting Huang1

  • 1Department of Data Science, City University of Hong Kong, Hong Kong, SAR, China.

International Journal of Surgery (London, England)
|September 10, 2025
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Summary
This summary is machine-generated.

Drinking water hardness impacts digestive health. Very hard water may lower risks for some digestive issues, while moderately hard water might increase risks for others like peptic ulcers.

Keywords:
UK Biobankcalciumdrinking waterinflammatory bowel diseasemagnesiumnon-alcoholic fatty liver disease

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Area of Science:

  • Environmental Health
  • Epidemiology
  • Gastroenterology

Background:

  • Water hardness, defined by dissolved calcium and magnesium, is a public health concern.
  • The link between water hardness and digestive diseases is not well-understood.
  • Rising digestive disorder prevalence necessitates large-scale research on water quality impacts.

Purpose of the Study:

  • To investigate the association between domestic water hardness and digestive disorder risk.
  • To analyze data from a large prospective cohort of 356,000 individuals.
  • To examine the relationship between varying water hardness levels and 16 specific digestive diseases.

Main Methods:

  • Water hardness assessed using regional CaCO3 concentrations (soft, moderately hard, hard, very hard).
  • Prospective cohort study design with 356,000 participants.
  • Cox proportional hazard regression models used to analyze disease risk.

Main Results:

  • A nonlinear association was observed between water hardness and digestive health.
  • Higher water hardness (>180 mg/L CaCO3) inversely correlated with dyspepsia, constipation, and gallbladder disease risk.
  • Moderately hard water (60-120 mg/L CaCO3) linked to increased risks of peptic ulcer and GERD.

Conclusions:

  • Drinking water hardness is epidemiologically associated with various digestive system diseases.
  • Water quality, specifically hardness, may influence public health outcomes related to digestion.
  • Further research can elucidate the mechanisms behind these observed associations.