High prevalence and associated risk factors of dehydration among college students: implications for health and academic performance

Christopher E. Ekpenyong, Itoro-Abasi M. Akpan


Background: Existing data indicate that poor hydration status adversely affects academic performance and health status of college students, but hydration studies among students have not received sufficient research and educational attention. The aim of this study was to determine the prevalence and associated risk factors of dehydration among college students in Southern Nigeria.

Methods: A total of 500 students (190 males and 310 females), ages between 18 and 35 years filled out a supervised questionnaire which included questions pertaining to socio-demographics, lifestyle habits, perceived symptoms, academic performance, urinary characteristics and water/fluid intake. Hydration status was determined using urinary specific gravity during the month of October 2016. Mean values were calculated and used to determine the hydration status of participants. Multivariable regression analysis was used to determine odds ratios (ORs) and 95% confidence interval for factors associated with poor hydration status of participants.

Results: About 46.4% of participants were dehydrated. Insufficient water intake (OR=6.41, 95% CI:2.121-19.385, P=0.001), alcohol drinking habits (OR=4.17, 95% CI: 1.313-13.258, P=0.015), night clubbing habits (OR=2.51, 95% CI:1.261-3.822, P=0.034) and being exposed to hot environment (OR=2.16, 95% CI:1.998-4.656, P=0.041) were factors associated with increased odds of dehydration among participants. Other factors associated with higher odds of dehydration include regular coffee intake (OR=2.93, 95% CI:1.788-5.622, P=0.017), experiencing academic stress (OR=1.53, 95% CI:1.041-2.251, P=0.031) and having parents or guardians of middle or low SES (OR=2.21, 95% CI:1.70-4.267, P=0.42) and (OR=3.42, 95% CI:1.655-7.82, P=0.015) respectively.

Conclusions: Indeed, there is a high prevalence of dehydration and associated risk factors among college students. Intervention programs to reduce dehydration among students should include these factors among others for improved quality of life and academic performance.


Dehydration, Students, Risk factors, Cognitive function, Health effect

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Sebastian RS, Wilkinson Enns. C, Goldman JD. Drinking water intake in the US: What we eat America NHANES 2005-2008. Food Surveys Research Group Dietary Data Brief No. 7. Sep. 2011 Available at

docs.htm?docid=19476. Accessed on 15 February 2015.

Patel AI, Bogart LM, Kien DJ, Cowgill B, Uyeda KE, Hawes-Dawson J, et al. Middle School Student Attitudes about school drinking fountains and water intake. Acad Pediatr. 2014;14(5):471-7.

Lee HS, Park S, Kim MH. Factors associated with low water intake among South Korean adolescent-Korea. National Health and Nutrition Examination Survey. 2007-2010. Nutr Res Pract. 2014;8(1):74-80.

Park S, Blank HN, Sherry B, O’Toole TP. Factors Associated with low water intake among US high school students-National Youth Physical Activity and Nutrition Study, 2010. J Acad Nutr Diet. 2012;112(9):1421-7.

Kenney EL, Long MW, Cradock AL, Ciortmarker SL. Prevalence of inadequate hydration among US children and dis participants by gender and race/ethnicity: National Health and Nutrition Examination Survey, 2009-2012. Am J Public Health. 2015;105(8):113-8.

Krecar IM, Kolega M, Kunac SF. Effects of Drinking water on attention. Procedia-social Behav Sci. 2014:159:577-83.

Sawka MN, Mortain SJ. Fluid and Electrolyte supplementation for exercise heat stress. Am J Clin Nutr. 2000;72:5645-725.

Szinnai G, Schachinger H, Arnaud MJ, Linder L, Keller U. Effect of water deprivation on cognitive-motor performance in healthy men and women. Am J Physiol Regul Integr Comp Physiol. 2005;289:275-80.

Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev. 2010;68(8):439-58.

Ekpenyong CE, Daniel NE, Akpan EE. Vaginal douching behavior among young adult women and the perceived adverse health effects. J Public Health Epidemiol. 2014;6(5):182-91.

Edmonds CJ, Jeffes B. Does having a drink help you think? 6-7-years-old children show improvements in cognitive performance from baseline to test after having a drink of water. Appetite. 2009:53(3);469-72.

D’Anci KE, Constant F, Rosenberg IH. Hydration and cognitive function in children, Nutr Rev. 2006;64:457-64.

Benton D and Burgess N. The effect of the consumption of water on the memory and attention of children. Appetite. 2009;53(1):143-6.

Cian C, Barraud PA, Melin B, Raphel C. Effects of fluid ingestion on cognitive function after heat stress or exercise-induced dehydration. Int J Psychophysiol. 2001;42:243-5.

Lieberman MD. Social cognitive neuroscience: a review of core processes. Ann Rev Psychol. 2007;58:259-89.

Maughan RJ, Shirreffs SM and Watson P. Exercise heat hydration and the brain J Am Coll Nutr. 2007;26:604-12.

Kirschbaum C, Wolf OT, May M, Wippich W, Hellhammer DH. Stress and treatment induced elevations of cortisol levels associated with impaired declarative memory in healthy adults. Life Sci. 1996;58:1475-83.

Institution of Medicine (IOM). Dietary Reference Intakes for Water, Postassium, Sodium Chloride and Sulfate. Institution of Medicine Panel on Dietary Reference Intakes for Electrolytes and Water. Washington DC. The National Academics Press, 2005.

Padräo P, Neto M, Pinto M, Oliveira AC, Moreira A, Moreira P. Urinary hydration biomarkers and dietary intake in children. Nutr Hosp. 2016;33(3):314.

Armstrong LE, Soto JA, Hacker FT Jr, Casa DJ, Kavouras SA, Maresh CM. Urinary indices during dehydration, exercise and rehydration. Int J Sport Nutr. 1998;8:345-55.

Carter A, Muller R. Hydration knowledge, behaviours and status of staff at the residential camp of a fly-in/fly-out minerals extraction and processing operation in tropical North-Eastern Australia. Ind Health. 2007;45(4):579–89.

Ekpenyong CE, Davis, KG, Akpan UP, Daniel NE. Academic Stress and Menstrual Disorders among Female Undergraduates in Uyo, South Eastern Nigeria: The Need for Health Education. Nig J Physiol Sci. 2011;26:193-8.

Ghosh A, Chosh T. Modification of Kuppuswamy’s socio-economic status scale in context to Nepal. Ind Pediatr. 2009;46(12):1104-5.

Ekpenyong CE, Etukumana EA. Ethnicity, Family Socio-economic Inequalities, and Prevalence of Vaginal Douching among College Student: the Implication for Health. J Am Coll Health. 2013;61(4):222-30.

Decher NR, Casa DJ, Yeargin SW Ganio MS, Levreault ML, Dann CL, et al. Hydration status, knowledge, and behavior in young at summer sport camps. Int J Sport Physiol Perform, 2008;3:262-78.

Tyrwhitt-Drake R, Ferragud MA, de Andres RU. Knowledge and perception of hydration: a survey among adults in the United Kingdom, France and Spain. Rev Esp Nutr Communitarian. 2014;20(4):128-36.

Minton D, Eberman LE. Best of practice for clinical hydration measurement. Athl Ther Today. 2009;14(1):9-11.

Bates GP, Miller VS, Joubert DM. Hydration status of expatriate manual workers during summer in the Middle East. Ann Occup Hyg. 2010;54(2):137-43.

Armstrong LE, Maresh CM, Castellani JW Bergeron MF, Kenefick RW, LaGasse KE, et al. Urinary indices of hydration status. Int J Sport Nutr. 1994;4:265-79.

Stookey JD, Brass B, Holliday A, Arieff A. What is the cell hydration status of healthy children in the USA? Preliminary data on urine osmolality and water intake. Public Health Nutr. 2012;15(11):2148-56.

Kavouras SA, Bougatsas D, Johnson EC, Arnaoutis G, Tsipoundi S, Panagiotakos DB. Water intake and urinary hydration biomarkers in children 2016. dio:1038/ejcn.2016.218.

Senterre C, Dramaix M, Thiebaut I. Fluid intake survey among school children in Belgium. BMC Public Health 2014;14:651.

Kant AK, Graubard BI. Contributors of water intake in US children and adolescent: Association with dietary and meal characteristics-National Health and Nutrition. Examination Survey 2005-2006. Am J Clin Nutr. 2010;92(4):887-96.

Park S, Sherry B, O’Toole T, Huang Y. Factors associated with low drinking water intake among adolescents: the Florida Youth Physical Activity and Nutrition Survey, 2007. J Am Dietetic Assoc. 2011;111:1211-7.

Daniels MC, Popkin BM. Impact of water intake on energy intake and weight status: A systematic review. Nutr Rev. 2010;68(9):505-21.

Manz F, Wentz A. Hydration status in the United States and Germany. Nutr Rev. 2005;63(6):55-62.

Kant AK, Graubard BI, Atchison EA. Intake of plain water, moisture in foods and beverages, and total water in the adult US population. Nutritional meal pattern and body weight correlates: National Health and Nutritional Examination Surveys 1999-2006. Am J Clin Nutr. 2009;90(3):655-63.

Bellisle F, Thornton SN, Hebel P, Denizeau M, Tahiri M. A study of fluid intake from beverages in a sample of healthy French children adolescents and adults. Eur J Clin Nutr. 2010;64(4):350-5.

Goodman AB, Blanck HM, Sherry B, Park S, Nebeling L, Yarock AL. Behavoirs and Attitudes Associated With Low Drinking Water Intake Among US Adults, Food Attitudes and Behaviors Survey, 2007. Prev Chronic Dis. 2013;10:1-10.

Darmon N, Drewnowski. Does social class predict diet quality? Am J Clin Nutr. 2008;87:1170-7.

Groth MV, Fagi S, Brondsted L. Social determinates of dietary habits in Denmark. Eur J Clin Nutr. 2001;55:959-66.

Ekpenyong C. Risk of dehydration among construction workers in relation to work task and personal characteristics. Ital J Occup Environ Hyg. 2016;7(2):99-111.

Kan K, Tsai WD. Obesity and Risk knowledge. J Health Econ. 2004;23:907-34.

Viscusi WK. Age variation in risk perceptions and smoking decision. R Econ Stat. 1991;73(4):577-88.

Nyaruhucha CN, Achen JH, Msuya JM, Shayo NB, Kulwa KBM. Prevalence and awareness of obesity among people of different age groups in educational institutions in Morogoro, Tanzania. East Afr Med J. 2003;80(2):68-72.

Thakur ND, Amico F. Relationship of Nutrition knowledge and obesity in adolescence. Clin Res Methods. 1999;31(2):122-7.

Fizpatrick C, Mileti DS. Public risk communication. In: Dyness RR, Tierney KJ (eds.) Disasters. Collective behaviour, and Social organization. Newark. NJ: University of Delaware Press; 1994: 77-84.

Decher NR, Casa DJ, Yeargin SW, Ganio MS, Levreauit ML, Dann CL, et al. Hydration status, knowledge and behavior in Youths at summer sport camps. Int Sports Physiol Perform. 2008;3:262-78.

Casa DJ, Armstrong LE, Hillman SK, Montain SJ, Reiff RV, Rich BSE, et al. National athletic Trainers Association position statement: Fluid replacement for athletics. J Athl Train. 2000;35(2):212-24.

Maughan RJ, Leiper JB, Shirreffs SM. The restoration of fluid and electrolyte balance after exercise in the heat. British J Sports Med. 1997;31(1):175-82.

Yeargin SW, Casa DJ, Judelson DA, McDermott BP, Ganio MS Lee EC, et al. Thermoregulatory Responses and hydration practices in heat-acclimatization adolescents during preseason high school football. J of Athl Train. 2010;45(2):136-46.

Shirreffs SM, Maughan RJ Restoration of fluid balance after exercise induces dehydration. Effects of alcohol consumption. J Appli Physiol. 1997;83:1152-8.

Mora-Rodriguez R, Ortega JF, Fernandez-Elias VE, Kapsokefalou M, Malisova O, Athanasatou A, et al. 2016. Influence of physical activity and ambient temperature on hydration: The European Hydration Research Study (EHRS). Nutrients. 2016;8(5):252.

Coulson R, Scheinman SJ. Vanthine effect on renal proximal tubular function and cyclic. AMP Metabolism J. of Pharmacol. Exp. Ther. 1989:248(2):589-594.

Rieg T, Steigele H, Schnermann J, Richter K, Osswald H, Vallon V. requirement of intact adenosine AI receptors for the diuretic and natriuretic action of the methylxathines theophylline and caffeine. J Pharmacol Exp Ther. 2005;313(1):403-9.

Grandjean A. Hydration: more than just water. The beverage institute for health and wellness. Available at: www.the

professionals/hydration-asthma. Accessed on 16 December 2015.

Killer SC, Blannin AK, Jeukendrup AE. NO evidence of dehydration with moderate daily coffee intake: A counterbalance cross-over study in a free living population. PLOS ONE. 2014:9(1):84154.

Riesenhuber A, Boehm M, Posch M, Aufricht C. Diuretic potential of energy drinks. Amino acids. 2006;31(1):81-3.

Alomar, MZ, Akkam A, Alashqar S, Eldai A. Decreased hydration status of emergency department physicians and nurses by the end of their shift. Inter J Emerg Med. 2013;6:27.

Jia YA, Rowlinson S, Ciccarelli M. Climatic and psychosocial risks of heat illness incidents on construction site. Appl Ergon. 2016;53:25-35.

Kenney WL. A review of comparative responses of men and women to heat stress. Environ Res. 1985;37(1):1-11.

Shapiro Y, Pandolf KB, Avellini BA, Pimental NA, Goldman RF. Physiological responses of men and women to human and dry heat. J Appl Physiol. 1980;49:1-8.

Westerterp KR, Plasqui, G, Goris, AH. Water loss as a function of energy intake, physical activity and season. Br J Nutr. 2005;93(2):199-203.

Gopinathan PM, Pichan G, Sharma VM. Role of dehydration in heat stress induced variations in mental performance. Arch Environ Health. 1988;43(1):15-7.

Clapp AJ, Bishop PA, Walker JL. Fluid replacement preference in heat-exposed workers. Am Ind Hyg Assoc J. 1999;60:747-51.

Hubbard RW, Sandick BL, Mathew WT, Francesconi RP, Sampson JB, Durkot MJ, et al. Voluntary dehydration and alliesthesia for water. J Appl Physiol Respir Environ Exerc Physiol. 1984;57:868-73.