Associations between urinary hydration markers and metabolic dysfunction: a cross-sectional analysis of NHANES data, 2008–2010

Purpose Growing evidence suggests hydration plays a role in metabolic dysfunction, however data in humans are scarce. This study examined the cross-sectional association between hydration and metabolic dysfunction in a representative sample of the US population. Methods Data from 3961 adult NHANES (National Health and Nutrition Examination Survey) participants (49.8% female; age 46.3 ± 0.5 years) were grouped by quartile of urine specific gravity ( U SG , 2007–2008 cohort) or urine osmolality ( U Osm , 2009–2010 cohort) as measures of hydration. Metabolic dysfunction was assessed by glycemic and insulinemic endpoints and by components of the metabolic syndrome. Multivariate-adjusted linear and logistic regression models were used. Results Increasing quartiles of U SG but not U Osm was associated with higher fasting plasma glucose (FPG), glycated hemoglobin (all P < 0.01), HOMA-IR and elevated insulin (all P < 0.05). Compared with the lowest quartile, those with the highest U SG but not U Osm had greater risk of metabolic syndrome (Q4 vs. Q1, OR (99% CI): 1.6 (1.0, 2.7), P = 0.01) and diabetes (Q4 vs. Q1, OR: 1.8 (1.0, 3.4), P < 0.05). Additionally, those with U SG > 1.013 or U Osm > 500 mOsm/kg, common cut-off values for optimal hydration based on retrospective analyses of existing data, had less favorable metabolic markers. In a subset of participants free from diabetes mellitus, impaired kidney function, hypertension and diuretic medication, U SG remained positively associated with FPG ( P < 0.01) and elevated FPG ( P < 0.05). Conclusion These analyses provide population-based evidence that U SG as a proxy for hydration is associated with glucose homeostasis in NHANES 2007–2008. The same association was not significant when U Osm was used as a proxy for hydration in the 2009–2010 wave. Clinical trial registry Not applicable, as this was a reanalysis of existing NHANES data.