Hypohydration may be more widespread than realized since it does not always arouse a sense of thirst. When thirst is felt, it is often ignored, or satisfied before euhydration is achieved. There is growing evidence indicating that hypohydration contributes to acute and chronic illnesses, and to rheological factors associated with coronary heart disease (CHD) and stroke. Therefore the relationship of fluid intake with risk of total natural-cause mortality, CHD and stroke death was examined using data on 34,192 white, non-Hispanic participants in the Adventist Health Study.

Among the 27,342 reporting no CHD, stroke or diabetes at baseline, during six years of follow-up and adjusting for traditional risk factors for CHD, RR for fatal CHD in males drinking five or more, compared to two or less, glasses of water a day, was 0.40 (95% Cl 0.24-0.67) and in females, 0.60 (95% Cl 0.34-1.07). The RR for non-fatal CHD in males consuming one or more, compared to less than one, daily glasses of water, was 0.37 (95% Cl 0.14-0.94).

The RR of fatal CHD in females consuming five or more versus two or less, daily servings of fluids other than water was 2.99 (95% Cl 1.10-8.11). No associations were found for males.

During 12 years of follow-up, those who reported stroke (n=246) or CHD (n=726) at baseline and drank more than five, compared to two or less, glasses of water per day, had a RR of stroke death of 0.42 (95% Cl 0.21-0.85) and 0.43 (95% Cl 0.22-0.84) respectively, after adjusting for age, sex, high blood pressure, smoking, education and BMI. No associations with stroke death could be found among those who reported no prevalent disease at baseline or with fluids other than water or total fluid intake.

Total natural-cause mortality showed similar directions in associations with water and fluids other than water, in the age- and sex- adjusted model in males without disease, and males and females with disease.

This study suggests that increasing water intake and decreasing intake of fluids other than water, is associated with decreased risk of CHD, fatal stroke and possibly total natural-cause mortality.


School of Public Health

First Advisor

Glen G. Blix

Second Advisor

Synnove M. F. Knutsen

Third Advisor

Jerry W. Lee

Fourth Advisor

Kenneth Burke

Degree Name

Doctor of Public Health (DrPH)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Coronary Disease; Cerebrovascular Disorders; Fluid Therapy; Dehydration.



Page Count

xiii; 147

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives