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Cited by 144Thermoregulation and physiological responsesElectrolyte and hormonal disordersNutrition, Health and Food Behavior

A randomized trial to assess the potential of different beverages to affect hydration status: development of a beverage hydration index

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Maughan, Ronald J, Watson, Phillip, Cordery, Philip AA, Walsh, Neil P, Oliver, Samuel J, Dolci, Alberto, Rodriguez-Sanchez, Nidia, Galloway, Stuart DR·2016·The American Journal of Clinical Nutrition
DOI 10.3945/ajcn.115.114769
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Abstract

Background The identification of beverages that promote longer-term fluid retention and maintenance of fluid balance is of real clinical and practical benefit in situations in which free access to fluids is limited or when frequent breaks for urination are not desirable. The postingestion diuretic response is likely to be influenced by several beverage characteristics, including the volume ingested, energy density, electrolyte content, and the presence of diuretic agents.Objective This study investigated the effects of 13 different commonly consumed drinks on urine output and fluid balance when ingested in a euhydrated state, with a view to establishing a beverage hydration index (BHI), i.e., the volume of urine produced after drinking expressed relative to a standard treatment (still water) for each beverage.Design Each subject (n = 72, euhydrated and fasted male subjects) ingested 1 L still water or 1 of 3 other commercially available beverages over a period of 30 min. Urine output was then collected for the subsequent 4 h. The BHI was corrected for the water content of drinks and was calculated as the amount of water retained at 2 h after ingestion relative to that observed after the ingestion of still water.Results Total urine masses (mean ± SD) over 4 h were smaller than the still-water control (1337 ± 330 g) after an oral rehydration solution (ORS) (1038 ± 333 g, P < 0.001), full-fat milk (1052 ± 267 g, P < 0.001), and skimmed milk (1049 ± 334 g, P < 0.001). Cumulative urine output at 4 h after ingestion of cola, diet cola, hot tea, iced tea, coffee, lager, orange juice, sparkling water, and a sports drink were not different from the response to water ingestion. The mean BHI at 2 h was 1.54 ± 0.74 for the ORS, 1.50 ± 0.58 for full-fat milk, and 1.58 ± 0.60 for skimmed milk.Conclusions BHI may be a useful measure to identify the short-term hydration potential of different beverages when ingested in a euhydrated state. This trial was registered at www.isrctn.com as ISRCTN13014105.

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  • Drinking water alone may not optimize hydration status, as it has a low BHI value owing to the absence of osmotic nutrient content such as electrolytes, carbohydrate, and protein.

    “drinking water alone may not optimize hydration status, as it has a low BHI value owing to the absence of osmotic nutrient content such as electrolytes, carbohydrate, and protein [109]”

    From Nutritional Strategies to Improve Post-exercise Recovery and Subsequent Exercise Performance: A Narrative Review (2025) · cites this paper as [109]

    The Beverage Hydration Index results show that milk and oral rehydration solution had higher BHIs than still water. The Discussion identifies electrolytes and energy-providing nutrients, including carbohydrate and protein, as possible influences on fluid retention. However, it says the study could not determine the relative effects of individual components, so it does not establish that water’s lower BHI was caused by their absence. The findings concern short-term responses after drinking in a euhydrated state, not an overall optimum for hydration status. (LLM, conf=0.86)

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  • Drinks including water, sparkling water, flavored water, hot or cold tea, coffee, milk and milky drinks, fruit juices, soups, sports or soft drinks and smoothies provide fluid with a hydrating effect.

    “Drinks providing fluid with a hydrating effect on our bodies include water, sparkling water, flavored water, hot or cold tea, coffee, milk and milky drinks, fruit juices, soups, sports or soft drinks and smoothies (257).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [257]

    The Drinks and drink preparation section lists water, sparkling water, tea, coffee, milk, orange juice, cola and a sports drink among the beverages tested. The Abstract reports their short-term hydration responses. The paper does not test flavored water, soups or smoothies, so it does not support the full list attributed to it. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • There is little reason to believe that the findings on hydration potential of non-alcoholic drinks would not apply to older adults.

    “Although these findings are based on studies in younger adults (257, 258), there is little reason to believe that they would not apply to older adults.”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [257]

    The Pre-Trial Standardization/Exclusion criteria section says participants were healthy men aged 18–35, and the Urine output and fluid balance section reports differences in fluid retention among beverages. The Discussion considers extrapolation to a longer time scale, but not to older adults. The source therefore supports the findings in younger adults, not the claim that they would also apply to older adults. Page numbers were not available in our copy. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Oral rehydration solutions, skimmed milk, whole milk, and orange juice had higher beverage hydration index values compared with water.

    “finding oral rehydration solutions, skimmed milk, whole milk, and orange juice had higher BHI values compared with water”

    From Nutritional Strategies to Improve Post-exercise Recovery and Subsequent Exercise Performance: A Narrative Review (2025) · cites this paper as [109]

  • The hydration potential for most non-alcoholic drinks is very similar to that of water.

    “There is good evidence from two randomized controlled trials (RCTs) that the hydration potential for most non-alcoholic drinks is very similar to those of water (257,258).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [257]

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Cites

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Research works printed but not linked: 2

  1. [7]7. Institute of Medicine (IOM). Panel on dietary reference intakes for electrolytes and water, dietary reference intakes for water, potassium, sodium, chloride and sulfate. Food and Nutrition Board 2005. The National Academies Press: Washington, DC.
  2. [8]8. EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific Opinion on dietary reference values for water. EFSA Journal 2010;8:1459.

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Authors
Maughan, R. J., Watson, P., Cordery, P. A., Walsh, N. P., Oliver, S. J., Dolci, A., Rodriguez-Sanchez, N., & Galloway, S. D.
Affiliations
  • Loughborough University (GB)
  • Bangor University (GB)
  • University of Stirling (GB)
Corresponding author
Maughan, Ronald J
ORCID
Venue
The American Journal of Clinical Nutrition
Publisher
Elsevier BV
Published
2016-03
Volume
103
Issue
3
Pages
717-723
ISSN
0002-9165 (ISSN-L)
DOI
10.3945/ajcn.115.114769
OpenAlex
W2197956449
Cited by
144
References
24
Citations by year
2026: 16 · 2025: 15 · 2024: 15 · 2023: 17 · 2022: 12 · 2021: 14 · 2020: 19 · 2019: 19 · 2018: 10 · 2017: 4 · 2016: 2 · 2014: 1
FWCI
3.93
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Clinical Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • Liverpool John Moores University (acceptedVersion)
  • Stirling Online Research Repository (University of Stirling) (submittedVersion, public-domain)
Funders
European Hydration Institute
Topics
  • Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
fluid balance, urine output, diuretic response, oral rehydration solution, milk, sports drinks, cola, coffee and tea, orange juice, fluid retention, euhydration, electrolytes
MeSH terms
Adult, Animals, Beverages, Dehydration, Drinking, Fluid Therapy, Humans, Male, Time Factors, Urination, Water, Water-Electrolyte Balance, Young Adult

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