The most essential nutrient: defining the adequate intake of water.

Although water is quantitatively the most import nutrient, there are no recommended dietary allowances (RDA) or adequate intake (AI) values. Based on 718 assessments of 24-hour total water intake, urine volume, and urine osmolality, individual hydration status was characterized in 479 healthy boys and girls of the DONALD study aged 4.0 to 6.9 years and 7.0 to 10.9 years. Mean 24-hour total water intake ranged from 0.90 mL/kcal to 0.96 mL/kcal, and median 24-hour urine osmolality ranged from 683 mosm/kg to 854 mosm/kg. A maximum urine osmolality of 830 mosm/kg (mean - 2 SD) in healthy children with a typical affluent Western-type diet was the physiologic criterion of the upper limit of euhydration. "Water reserve" (24-hour urine volume - hypothetical urine volume to excrete 24 urine solutes at a concentration of 830 mosm/kg) was a quantitative measure of individual 24-hour hydration status and ensuring euhydration in 97% of the subjects in each group; AI values of total water in the 4 age and sex groups ranged from 1.01 mL/kcal to 1.05 mL/kcal. These procedures to quantify 24-hour hydration status may prove valuable in investigating the effects on health of different states of euhydration.