European Journal of Clinical Nutrition (2010) 64, 350355

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ORIGINAL ARTICLE
A study of fluid intake from beverages in a sample
of healthy French children, adolescents and adults
F Bellisle1, SN Thornton2,3, P Hebel4, M Denizeau4 and M Tahiri5

1
Departement de Medecine Sociale et Preventive, Faculte de Medecine, Universite Laval, Quebec, Canada; 2INSERM, U684, Vandoeuvre
les Nancy, France (SNT); 3Universite Henri Poincare, Nancy Universite, Nancy, France (SNT); 4CREDOC (Centre de Recherche pour
lEtude et lObservation des Conditions de Vie), Paris, France and 5Coca-Cola France, Issy-les-Moulineaux, France

Background/Objectives: To assess the intake of fluid in healthy French children, adolescents, adults and seniors, considering
amounts, types of beverages, time and place of consumption.
Subjects/Methods: Data regarding fluid intake were extracted and analyzed from the National Intake Survey, which was
conducted in quota samples of the French population (Comportement et Consommations Alimentaires en France study).
Seven-day questionnaires were administered to free-living individuals in 20022003. A total of 566 children (aged 611 years),
333 adolescents (aged 1219 years), 831 adults (aged 2054 years) and 443 seniors (aged X55 years) were included in
this study.
Results: The average total intake of fluid was 11.3 l per day depending on age groups. Water accounted for about one-half of
daily fluid intake. The contribution of other types of beverages varied with age (for example, dairy drinks in children and
adolescents; alcoholic drinks in adults and seniors). Intake of sodas (including regular and light) was highest in adolescents
(169 ml a day). Beverages were mainly consumed at home during meals.
Conclusions: This is the first description of fluid intake in French children, adolescents, adults and seniors, considering amounts,
types of beverages, time and place of intake. It shows that water is the main source of fluid in all age groups. Selection of various
types of beverages is different according to age.
European Journal of Clinical Nutrition (2010) 64, 350355; doi:10.1038/ejcn.2010.4; published online 17 February 2010

Keywords: fluid intake; children; adolescents; adults; seniors

Introduction is an alteration of many crucial physical and mental

functions that affect life expectancy (Ferry, 2005; Szinnai
Body hydration is essential for adequate physical and et al., 2005; Mentes, 2006). Similar, although not as
mental function. A number of symptoms have been dramatic, results have also been reported in children (DAnci
described corresponding to various degrees of dehydration. et al., 2006).
Whereas mild dehydration can result in adverse effects on Fluid needs vary in the human species depending on a
both mental and physical performance, more severe dehy- large number of factors. Age and body size are important, as
dration induces important impairment of survival capacity well as level of perspiration (affected by temperature and
and, ultimately can lead to death (Lieberman, 2007). intensity of physical exercise, among many factors) and food
In elderly individuals, one important effect of dehydration habits (such as intake of salt), in addition to other individual
or environmental contributors (Lieberman, 2007; Manz,
2007). Given this large inter-individual variability of needs,
Correspondence: Dr F Bellisle, Departement de Medecine Sociale et
it is difficult to propose recommendations for the general
Preventive, Faculte de Medecine, Universite Laval, Quebec, Canada.
E-mail: france.bellisle@videotron.ca public, as has been done in many countries for energy and
Contributors: MT initiated and supervised this research. The database was nutrient intakes.
collected under the responsibility of PH. Statistical analyses were carried out by The French national recommendations for daily fluid
MD. FB and ST identified the critical parameters to be investigated, analyzed
intake encourage a level of intake adequate for body weight,
and interpreted the data, and wrote the manuscript.
Received 7 November 2008; revised 24 June 2009; accepted 24 August 2009; age, physical activity and other factors (Martin, 2001). For
published online 17 February 2010 adults, it is stated that fluid intake should be sufficient to
 Beverage intake in the French
F Bellisle et al
351
cover daily needs that vary according to each individuals times the metabolic rate), in accordance with earlier
characteristics and lifestyle. Seniors should be particularly CREDOC studies, such as the INCA (Enquete Individuelle
careful that their fluid intake is sufficient, as dehydration can et Nationale sur les Consommations Alimentaires) survey of
have dramatic consequences. In addition to fluid intake 1999 (Volatier, 2000) and the ASPCC (Association Sucre-
from drinks, about one more liter of water should be Produits Sucres Communication Consommation) 1994 sur-
obtained from the fluid contained in ingested foods, so that vey (Volatier and Verger, 1999). Subjects were excluded if
under the usual conditions, the total daily intake of fluid their reported intake was inconsistent with the estimated
should be B2.6 l (Martin, 2001). energy needs. Among excluded subjects, the proportion of
In spite of the general consensus that an appropriate level overweight and obese individuals (body mass index425 kg/m2)
of fluid intake is of paramount importance for health and was larger than among the included participants (w2 30;
even survival, the actual intake of fluid or total water is not Po0.00001). Gender distribution and education level were
often reported as such in studies of food or nutrient intakes. not different between the included and excluded subjects.
A study of water intake in the participants of the NHANES A group of 1090 children (aged 314 years) were also
(National Health and Nutrition Examination Survey) 1999 included in the CCAF study.
2002 indicated a mean total water intake (from foods From the participants in the CCAF study, a sample was
and beverages) of B1.4 l a day in children and adolescents extracted to study fluid intake in several age groups. The
(418 years) and of 2 l in adults (Fulgoni, 2007). Plain final sample for this analysis comprised 566 children (aged
drinking water contributed to more than half of this total 611 years), 333 adolescents (aged 1219 years), 831 adults
intake (0.78 l in 418 year olds; 1.28 l in adults). By contrast, (aged 2054 years) and 443 seniors (X55 years). Weight and
in a recent study of beverage intake in American preschool height, physical activity and sedentary behaviour were
children, beverage intake was examined but water intake was reported in the questionnaires. Data for children were
excluded, because water is not part of the US Department of obtained either from the parents or from the children
Agricultures Food and Nutrient Database categories (OCon- themselves.
nor et al., 2006). Clearly, more information is required
regarding the total fluid intake of populations, whether or
not it is associated with the intake of nutrients. Seven-day intake
This study presents the self-reported intake of beverages, Intake was assessed on the basis of a 7-day report of all
recorded in a quota sample recruited to be representative of intakes (fluid and solid), with recording of occasions,
the general population in France. Intake in different age circumstances, location, people present, etc. This survey
groups was assessed: children, adolescents, adults and allowed a highly detailed analysis of food and beverage
seniors. consumption. Food and portion reporting was made
easier by the use of a validated reference book showing
various portions of the common food and beverage choices
Methods (Suvimax, 2000).
Special attention was devoted to beverages. Six categories
Participants of beverages were considered: water (all kinds), hot beverages
The sample included in this was a subset of the participants (tea, coffee, etc.), sodas (regular or light), dairy drinks, juices
in a national survey conducted by the CREDOC (Centre de and fruit-flavored drinks, as well as alcoholic beverages. As
Recherche pour lEtude et lObservation des Conditions de an inherent part of the CCAF study, energy and nutrient
Vie), a nonprofit governmental research organization whose intakes were also studied, as well as the circumstances of
goal is to follow living conditions in France. The national each intake occasion. The content in energy and nutrients
survey dealt with food/beverage choices and intake in France (including water) was obtained from a French food composi-
(Comportements et Consommations Alimentaires en France, tion table (Favier et al., 1995).
CCAF study). Previous papers have been published to present To control for seasonal differences in intake, the study was
some of the results obtained from this particular survey carried out in four phases (OctoberDecember, January
(Hebel, 2007). The survey was carried out between fall 2002 March, AprilMay and JuneJuly). In each phase, the survey
and summer 2003 and included 1042 families, representative sample was representative of the French population.
of French households. All family members aged X3 years
were interviewed. To have a sufficient number of children,
an additional sample of 622 households was constituted in Statistics
which only 1 child was interviewed. The statistical procedures used were the same as those used
The details of participant recruitment have been described in earlier analyses in the context of the CCAF study. We used
fully in an earlier paper (Hebel, 2007). In brief, on the basis of the generalized ranking procedure to improve the quality of
a quota sample of the French population, 1361 adults (X15 estimators for each sample. The SAS 8.0 software was used for
years) were included. The energy intake reported by these statistical analysis (SAS Institute Inc., Cary, NC, USA). The
adults was consistent with the estimated energy needs (1.05 statistical procedures included PROC FREQ to assess the

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 Beverage intake in the French
F Bellisle et al
352
Table 1 Daily intake of total fluid and of six types of beverages (ml) in four age groups (children (611 years), adolescents (1219 years),
adults (2054 years) and seniors (X55 years)

Children (611 years) n 566 Adolescents (1219 years) n 333

Mean s.e.m. Min Max Mean s.e.m. Min Max

Alcohol 0.6 0.2 0.0 57.1 16.8 2.8 0.0 311.4

Water 549.0 13.3 0.0 1818.6 577.8 17.8 0.0 2107.1
Hot drinks 6.7 1.3 0.0 385.7 28.6 4.5 0.0 585.7
Juice 128.4 6.4 0.0 1628.6 104.0 7.1 0.0 750.0
Sodas 114.5 6.9 0.0 1257.1 169.3 13.3 0.0 1640.0
Dairy drinks 246.7 6.3 0.0 1392.9 215.3 8.1 0.0 771.4
Total fluid 1046.0 15.2 372.9 2487.1 1111.8 20.7 404.3 2528.6

Adults (2054 years) n 831 Seniors (X55 years) n 443

Alcohol 183.9 9.0 0.0 1528.6 185.6 10.9 0.0 1532.1

Water 564.2 13.9 0.0 3292.9 547.9 17.6 0.0 2028.6
Hot drinks 266.6 8.9 0.0 2548.6 250.1 11.3 0.0 1604.3
Juice 54.0 3.1 0.0 607.1 33.2 3.8 0.0 471.4
Sodas 92.9 6.0 0.0 1650.0 16.7 3.0 0.0 612.9
Dairy drinks 144.4 6.1 0.0 1165.7 164.2 8.5 0.0 842.9
Total fluid 1306.0 16.6 415.7 4315.7 1197.7 20.2 387.1 2902.1

Abbreviations: CCAF, Comportements et Consommations Alimentaires en France; CREDOC, Centre de Recherche pour lEtude et lObservation des Conditions de Vie.
Means, s.e.m., lowest and highest individual values are given for each group.
Source: CCAF 2004 SurveyCREDOC.

effects of independent variables on qualitative effects. report the intake of light sodas, they did not necessarily do
Differences between proportions were tested using w2. so. It is thus likely that the reported intake of sodas included
To assess effects on quantitative variables (such as intakes), a certain proportion of light products, which were not
we used the generalized lineal model (PROC GLM) and necessarily identified as such. In France, it is not usual to give
Students t-tests. Means and s.e.m. are presented in text and light sodas to children. Consequently, the reported figure
in Tables. for children (114.5 ml) most likely represents intake of sugar-
containing sodas. The intake of sodas (both sugar containing
and light) by adults and seniors was very low (7 and 1.4% of
Results daily fluid, respectively).
Table 2 shows that most beverages were ingested during
Table 1 presents the average (s.e.m.) daily fluid intake from main meals (breakfast, lunch and dinner), with small
beverages, as well as the minimum and maximum intakes amounts consumed between meals. In children and adoles-
recorded in each age group. The first observation is that cents, 410% of the total daily intake was consumed along
inter-individual differences were extremely large in all age with the afternoon snack, which is a traditional eating
groups. Differences in fluid intake appeared between the occasion for youths in France. The survey also showed that
successive survey phases in three age groups (children, B80% of total daily fluid intake was consumed at home.
adolescents and adults; Pp0.0137) but not in seniors. Fluid This was confirmed for each beverage type and age group.
intake increased over successive study phases: in the last The total amount of energy ingested from beverages was
phase (JuneJuly), the intake was 24 (children), 13 (adoles- 238, 239, 233, 194 kcal per day, representing 12.5, 10.8,
cents) and 4% (adults) higher than during the first phase 10.3, 9.2% of total energy intake in the four age groups,
(OctoberDecember). The estimated amount of fluid in- respectively. These figures were computed from data
gested from solid foods was 593, 673, 719 and 819 ml in the collected from the total sample (as opposed to data restricted
four age groups, respectively. to consumers of a certain type of beverage).
Water represented about one-half of daily beverage intake A few overweight or obese individuals were present in the
in all groups. Dairy drinks contributed to B20% of the total sample, according to the definitions proposed by the WHO
fluid intake in children and adolescents, whereas alcoholic (1998) and the Obesity Task Force (Cole et al., 2000) (N 140,
beverages were consumed by adults and seniors. Sodas were N 40, N 232 and N 230 in the four age groups,
consumed by all groups, but adolescents showed the highest respectively). In this category of respondents, the total daily
intake (169.3 ml a day; 15% of daily fluid). In the case of fluid intake was 1075.5, 1106.2, 1364.8 and 1225.3 ml per day,
sodas, it is impossible to discriminate the proportion of the respectively, in the four age groups. The associated intake
reported intake that corresponded to regular (sugar contain- of energy was 236, 193, 256 198 kcal per day, respectively.
ing) versus light products. Although the respondents could Those numbers are extremely close to those observed for the

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 Beverage intake in the French
F Bellisle et al
353
Table 2 Intake of beverages (ml) at various occasions according to age occurs with meals and is consumed at home. Beyond this
groups very general observation, it seems that beverage choices vary
Children (611 years) Adolescents (1219 years) with age. Soda intake is mainly reported by teenagers,
n 566 n 333 whereas alcoholic drinks and hot drinks (mainly tea and
coffee) are reported by adults and seniors. Dairy drinks
Mean s.e.m. Mean s.e.m.
(mainly milk) contribute to the fluid intake of children and
Breakfast 274.1 4.9 280.6 5.8 adolescents.
Morning snack 8.3 1.2 8.5 1.6 Our data are difficult to compare with those reported
Lunch 285.1 5.6 324.7 7.7 for the American participants in the NHANES 19992002.
Afternoon snack 161.9 4.2 119.0 5.7 While total water intake (foods plus beverages) was 1.4 l in
Before dinner snack 29.5 2.9 30.2 3.9
Dinner 277.9 5.3 341.1 8.6 American children (up to the age of 18 years) and 2 l for
Night snack 9.3 1.7 7.7 1.8 adults, the reported plain water intake was 0.8 l in children
Total fluid 1046.0 15.2 1111.8 20.7 and 1.28 l for adults. These figures indicate higher fluid
intakes in the French (as the beverage intake in the French
Adults (2054 years) Seniors (X55 years)
n 831 n 443 was just below the total intake from foods plus beverages in
the Americans), but the intake of plain water was higher in
Breakfast 325.7 5.1 325.5 6.8 Americans (Fulgoni, 2007). This apparent inconsistency
Morning snack 27.1 2.6 17.5 3.6
Lunch 407.0 6.2 386.1 8.0 might be derived from the fact that total water intake in
Afternoon snack 59.7 3.2 59.6 4.3 the American sample was computed on the basis of a 24 h
Before dinner snack 67.8 5.0 64.7 6.5 recall of intake, and plain water data were extrapolated from
Dinner 395.8 6.2 330.4 7.4 a food frequency question. Intake of sodas reported in this
Night snack 22.9 2.7 13.9 2.4
Total fluid 1306.0 16.6 1197.7 20.2 study agrees with the observation made by the CANADEAN
organisation (Hants, UK; 2006 unpublished report) showing
Abbreviations: CCAF, Comportements et Consommations Alimentaires en that the French ingest smaller amounts of sodas than do
France; CREDOC, Centre de Recherche pour lEtude et lObservation des
comparable populations of 15 other European countries.
Conditions de Vie.
Source: CCAF 2004 SurveyCREDOC. These data indicate that energy from beverages represents
200250 kcal a day, or B10% of daily energy intake. There
are large variations around the mean. In some individuals, in
whole sample (within the range means.e.m.), suggesting all age groups, the energy input from fluids can be relatively
no statistical difference. large. However, it is impossible to decide whether such
intake represents an adequate complement to the energy
obtained from solid foods or comes in excess of body energy
Discussion needs. Intake of energy from liquids and solids contributes to
the body energy balance and can induce weight gain or
This study addresses ingestion of beverages in a quota-based weight loss only if it does not match individual energy
sample of the French population. The total amount of fluid needs. Therefore, the intake of energy from fluids appears
is examined in the four age groups, along with the type of modest on average, although it may in some cases contribute
beverages contributing to this total input, and the circum- to excessive intake of energy relative to body needs.
stances of intake. Attention was paid to fluid intake in Given the large variations around mean values, it seems
overweight respondents. that some people might be at risk of insufficient hydration.
The intake data presented in this study were declared by This situation could potentially induce adverse effects in the
the participants or by a parent in the case of children. This short and long term. There may be a potentially adverse effect
survey method, as used in the cross-sectional French INCA1 on the cardiovascular system (see below). The consequences
food consumption survey, is recognized as the best method of dehydration are an increase in blood osmolality and a
to evaluate intakes in a representative sample (Lioret et al., decrease in blood volume or hypovolemia. In response to
2007). The data agree with other sources of information these physiological events, the body releases three hormones
about beverage intake in the French. For example, the 2006 (namely antidiuretic hormone, angiotensin and aldosterone),
CANADEAN unpublished report for the food and drink in an attempt to try and maintain the blood supply to the
industry reveals a soda consumption of 124.3 ml per day per brain and other essential organs. It is interesting to note that
capita, whereas our respondents declared B100 ml per day. antihypertensive medication is currently prescribed against
However, in certain cases, the possibility of some under- these very same hormones (Deedwania, 2007; Nesbitt, 2007).
declaration cannot be ruled out. For example, there might be In 2002, a meeting was organized in Dortmund to study the
some underdeclaration for alcohol intake, because of social physiological effects of mild dehydration, yet the majority of
overtones. presentations showed the benefits of increased consumption
The largest part of fluid intake, in all age groups, is from of fluid, be it at the level of cognition (Wilson and Morley,
water. Most beverage intake (water and other categories) 2003), exercise performance (Maughan, 2003), urolithiasis

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 Beverage intake in the French
F Bellisle et al
354
(Siener and Hesse, 2003), urinary tract infection (Beetz, 2003), CREDOC and the preparation of this paper were supported
dental disease (Smith and Shaw, 2003), constipation (Arnaud, by a grant from Coca-Cola.
2003) or even broncho-pulmonary infection (Kalhoff, 2003).
Such reports are the outcome of scientific studies, rather
than urban myths found on the Internet (Negoianu and
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