An investigation into the relationship between plain water intake and glycated Hb (HbA1c): A sex-stratified, cross-sectional analysis of the UK National Diet and Nutrition Survey (2008-2012)

The aim of this study was to analyse the association between plain water intake and glycated haemoglobin (HbA1c) in the National Diet and Nutrition Survey (2008–2012) rolling survey. These data included diet (4-day diaries) and HbA1c (fasted blood sample) measures of 456 men and 579 women aged 44 ± 18 years with full information on covariates of interest (age, ethnicity, BMI, smoking, education, other beverage intake, energy intake and fibre). Data were analysed using sex-stratified linear and logistic regressions modelling the associations of cups/day (240mL) of plain water with HbA1c, and odds of HbA1c ≥5.5%, respectively. Substitution analyses modelled the replacement of sugar-sweetened beverages (SSBs), fruit juice and artificially-sweetened beverages (ASBs) with plain water. After adjustment, one cup/d of plain water was associated with a -0.04% lower HbA1c (95% CI: -0.07, -0.02) in men. In logistic regression, men had a 22% (10%, 32%) reduced odds of HbA1c ≥5.5% per cup/d of plain water. There was no evidence of an association with either HbA1c or the odds of HbA1c ≥5.5% in women. None of the substitution models were associated with a change in odds of HbA1c ≥5.5%. Plain water intake was associated with lower HbA1c in men but not women. Substituting water for specific beverages was not associated with a reduced odds of HbA1c ≥5.5%, suggesting the addition of water is the more pertinent factor. Future trials should test whether the relationships between water intake and HbA1c is causal as this could be a cost-effective and simple health intervention.