Abstract  The foods and diets of FDA's Total Diet Study have been revised according to current food consumption patterns. A representative subset of 234 foods, selected from aggregated NFCS and NHANES II data, is collected and analyzed by the Kansas City Field Office Laboratory for 11 essential minerals and more than 120 chemical contaminants. The daily intake by weight of these 234 foods has been extrapolated to represent 100% of the usual diet for eight age-sex groups. These extrapolated food intakes will be used to assess daily contaminant and mineral intakes. The revised food list and diets will be used until the results of another national food consumption survey show the necessity to further revise the diets for the Total Diet Study Program.

Abstract  This document provides technical support concerning cancer and noncancer risk assessment methods used in the Methodology for Deriving Ambient Water Quality Criteria for the Protection of Human Health (2000) (USEPA, 2000a; hereafter the 2000 Human Health Methodology). Ambient water quality criteria (AWQC) developed under Section 304(a) of the Clean Water Act (hereafter the CWA or the Act) are based solely on data and scientific judgments on the relationship between pollutant concentrations and environmental and human health effects. The 304(a) criteria do not reflect consideration of economic impacts or the technological feasibility of meeting the chemical concentrations in ambient water. As discussed below, 304(a) criteria are used by States and authorized Tribes to establish water quality standards, and ultimately provide a basis for controlling discharges or releases of pollutants.

Abstract  The Safe Drinking Water Act of 1974 (PL93-523) required the Administrator of the Environmental Protection Agency to arragne for a study that would serve as a scientific basis for revising the primary drinking water regulations that were promulgated under the Act. The Study was conducted by the Safe Drinking Water Committee of the National Research Council. A thorough study of the scientific literature was undertaken in order to assess the implications for human health of the constituents of drinking water in the United States. Assessment of the health benefits and the economic or technological feasibility of achieving a given level of contaminant control is outside the scope of the study, although the beneficial effects of some constituents of drinking water were considered. The risk to man of contaminants ingested in drinking water was evaluated on the basis of both epidemiological studies and studies of toxicity in laboratory animals.

Abstract  Disinfection by-products in tap water have been found in some studies to be associated with adverse pregnancy outcomes, but little is known about how water use and consumption might change during early pregnancy. Estimating water-related activities only at one time during pregnancy could easily lead to exposure misclassification. To evaluate changes in water use among pregnant women, we used data from a large epidemiologic study in which 1990 women were interviewed around 9 and 20 weeks' gestation. The water variables that were examined included ingestion of cold and hot tap water as well as of bottled water, showering and bathing. Changes were detected between early and mid-pregnancy for ingested cold tap water and showering. Thirty-three percent of the subjects changed cold-water ingestion by >= 1.0 liters/day and 44% changed their time showering by >= 35 min per week during this period. Increases in cold tap water intake were associated with age > 35 years, income < $40,000, and non-Hispanic white ethnicity. We also found that the proportion of the total variation due to within-subject variability was 62% for hot tap water ingestion but only 35% for showering and similar to 50% for cold tap water, bottled water and bathing. Limited resources in epidemiologic studies often require a decision between collecting data for a large number of people or collecting multiple measurements for a smaller number of people. The results in this study will be useful to researchers who need to determine where to invest their effort when assessing water-related exposures and should help in evaluation of previously performed studies. Journal of Exposure Science and Environmental Epidemiology (2009) 19, 593-602; doi:10.1038/jes.2008.59; published online 1 October 2008

Abstract  OBJECTIVE: To investigate water contributors in relation to dietary and serum micronutrient profiles.

DESIGN: A cross-sectional study. The main exposures were water contributors. Selected dietary and serum micronutrient levels were outcome measures. Settings The US population and its subgroups.

SUBJECTS: US adults (n 2691) aged ≥20 years from the National Health and Nutrition Examination Survey 2005-2006.

RESULTS: The daily mean total water intake was 3.1 (se 0.047) litres, with 68 % of adults consuming below the Adequate Intake level. Total water intake was higher in adults with higher BMI and physical activity, those taking dietary supplements and alcohol consumers (P < 0.05). Plain water intake was positively associated with food moisture and negatively with beverage moisture (P < 0.001). Beverage moisture was negatively associated with food moisture (P < 0.001). In multivariate regression analyses, plain water and food moisture intakes were positively associated with Fe, Ca, vitamins A, B, C, E and K and carotenoid intakes (P < 0.05). However, beverage moisture was unrelated to Ca, niacin and vitamin B6 intakes, and negatively associated with Fe, vitamin A, folate, vitamins C, E and K and carotenoid intakes (P < 0.05). Concentrations of serum vitamins A and C and carotenoids increased with plain water and food moisture intakes (P < 0.05) but decreased (P < 0.01) or were unrelated to beverage moisture intake.

CONCLUSIONS: Various contributors of total water intake differed in their associations with dietary and serum micronutrient profiles in US adults. The study provides evidence of plain water benefits on micronutrient adequacy over beverages.

Abstract  Data currently available on drinking water intakes do not support dietary exposure estimates for contaminants that have acute effects lasting less than 24 h. Realistic exposure estimates for these types of contaminants in drinking water require detailed information on amounts and time of consumption for each drinking occasion during a day. A nationwide water consumption survey was conducted to address how often, when, and how much water is consumed at specific times during the day. The survey was conducted in two waves, to represent two seasons, and the survey instrument consisted of 7-day water consumption diaries. Data on total daily amounts consumed, number of drinking occasions per day, amounts consumed per drinking occasion, and intervals between drinking occasions show larger between-subjects variation than within-subject variation. Statistically significant associations were also observed between drinking water consumption patterns and participants' ages and sex and geographical regions in which these participants live. The number of drinking occasions on a given day varied from 0 to 19, with the majority of respondents reporting 6 or less drinking occasions per day. The average interval between drinking occasions varied from 1 to 17 h, with 57% of the person-days reporting average intervals at least 3 h apart. The mean amount consumed per drinking occasion showed little association with the number of drinking occasions and fluctuated between 8 and 10 oz. To our knowledge, this survey is the only source of information on within-day patterns (i.e., when and how much) of drinking water consumption for a nationally representative sample of the US population. The detailed water consumption data from this survey can be used to support less than 24-h dietary exposure estimates for contaminants in drinking water.

Abstract  Enteric pathogens in pool water can be unintentionally ingested during swimming, increasing the likelihood of acute gastrointestinal illness (AGI). AGI cases in outbreaks are more likely to submerge heads than non-cases, but an association is unknown since outbreak data are self-reported and prone to bias. In the present study, head submersion frequency and duration were observed and analyzed for associations with pool water ingestion measured using ultra high pressure liquid chromatography - tandem mass spectrometry. Frequency of splashes to the face was also quantified. Reliable tools that assess activities associated with pool water ingestion are needed to identify ingestion risk factors and at-risk populations. Objectives were to determine if the observed activities were associated with ingestion, and to test environmental sensor and videography assessment tools. Greater frequency and duration of head submersion were not associated with ingestion, but frequency of splashes to the face, leisurely swimming, and being ≤18 were. Videography was validated for assessing swimmer head submersion frequency. Results demonstrate ingestion risk factors can be identified using videography and urine analysis techniques. Expanding surveys to include questions on leisure swimming participation and frequency of splashes to the face is recommended to improve exposure assessment during outbreak investigations.

Abstract  Assessment of risk to infants and children resulting from the ingestion of contaminants in water is an important component of the analysis of possible environmental hazards. Children and infants represent a sensitive life stage because exposure to contaminants in early life can have developmental and long-lasting adverse effects. Children and infants tend to ingest relatively large amounts of water on a bodyweight-adjusted basis, especially those that are fed in early life with formula that is re-constituted or diluted with water. This article presents statistical estimates of the amounts of community water ingested by formula-fed infants based on nationwide sample survey data that support identification of respondents who consume formula and the amounts of water they ingest. Included are specific estimates of the amounts of community water ingested in formula. Estimates of total community water ingestion by children and infants who consume formula can be especially useful in exposure assessment since they represent a highly exposed population. For example, mean community water ingestion by infants 1 to 3 months of age who consume formula is 627mL/day (136mL/kg/day) and the 95th percentile is 1096mL/day (290mL/kg/day).

Abstract  Quantitative risk assessments have estimated health risks of water recreation. One input to risk assessment models is the rate of water ingestion. One published study estimated rates of water ingestion during swimming, but estimates of water ingestion are not available for common limited contact water recreation activities such as canoeing, fishing, kayaking, motor boating, and rowing. In the summer of 2009 two related studies were conducted to estimate water ingestion during these activities. First, at Chicago area surface waters, survey research methods were utilized to characterize self-reported estimates of water ingestion during canoeing, kayaking, and fishing among 2705 people. Second, at outdoor swimming pools, survey research methods and the analysis of cyanuric acid, a tracer of swimming pool water, were used to characterize water ingestion among 662 people who engaged in a variety of full-contact and limited-contact recreational activities. Data from the swimming study was used to derive translation factors that quantify the volume of self-reported estimates. At surface waters, less than 2% of canoers and kayakers reported swallowing a teaspoon or more and 0.5% reported swallowing a mouthful or more. Swimmers in a pool were about 25-50 times more likely to report swallowing a teaspoon of water compared to those who participate in limited-contact recreational activities on surface waters. Mean and upper confidence estimates of water ingestion during limited-contact recreation on surface waters are about 3-4 mL and 10-15 mL, respectively. These estimates of water ingestion rates may be useful in modeling the health risks of water recreation.

Abstract  Disinfection by-products (DBPs) in drinking water may be associated with adverse pregnancy outcomes. However, the results from previous epidemiological studies are not consistent, perhaps in part due to individual variation in water use and consumption. This study was performed to evaluate and describe demographic and behavioral characteristics as predictors of ingested water, showering, bathing, and swimming among pregnant women. Water use and consumption data were collected through telephone interviews with 2297 pregnant women from three geographical sites in the southern United States. The data were analyzed according to demographic, health, and behavioral variables expected to be predictors of water use and thus potential confounding factors relating water use to pregnancy outcome. The candidate predictors were evaluated using backward elimination in regression models. Demographic variables tended to be more strongly predictive of the use and consumption of water than health and behavior-related factors. Non-Hispanic white women drank 0.4 (95% confidence interval (CI) 0.2; 0.7) liters more cold tap water per day than Hispanic women and 0.3 (95% CI 0.1; 0.4) liters more than non-Hispanic black women. Non-Hispanic white women also reported drinking a higher proportion of filtered tap water, whereas Hispanic women replaced more of their tap water with bottled water. Lower socioeconomic groups reported spending a longer time showering and bathing, but were less likely to use swimming pools. The results of this study should help researchers to anticipate and better control for confounding and misclassification in studies of exposure to DBPs and pregnancy outcomes.

Abstract  OBJECTIVES: The purpose of this project was to determine racial/ethnic differences in water consumption levels and nursing habits of children younger than 2 years old.

METHODS: Data from the 1994-96 Continuing Survey of Food intakes by individuals (CSFII) were used for these analyses. Water consumption and breast-feeding data on 946 children younger than 2 years old were used.

RESULTS: For black non-Hispanic children younger than 2 years old (n = 121), 5.3 percent of the children were currently being breast fed. This percentage was less than that seen in other racial/ethnic groups. For white non-Hispanic children (n = 620), this percentage was 10.8 percent; for Hispanic children (n = 146), 12.2 percent; for "other" children, 18.5 percent (n = 59). Black non-Hispanic children had the highest total water consumption (128.6 ml/kg/day) among all groups, white non-Hispanic had the lowest (113.2 ml/kg/day). These differences were not statistically significant in multivariate regression modeling. Black non-Hispanic children also drank more tap water (21.3 ml/kg/day) than white non-Hispanic children (12.7 ml/kg/day) and Hispanic children (14.9 ml/kg/day). The difference was statistically significant in multivariate regression modeling.

CONCLUSIONS: The differences in breast feeding and water consumption observed among black children younger than 2 years of age could be a factor in the observed higher levels of fluorosis in black children compared to other children.

Abstract  Bathing water compliant with bathing water legislation may nevertheless contain pathogens to such a level that they pose unacceptable health risks for swimmers. Quantitative Microbiological Risk Assessment (QMRA) can provide a proper basis for protective measures, but the required data on swimmer exposure are currently limited or lacking. The objective of this study was to collect exposure data for swimmers in fresh water, seawater and swimming pools, i.e. volume of water swallowed and frequency and duration of swimming events. The study related to swimming in 2007, but since the summer of 2007 was wet and this might have biased the results regarding surface water exposure, the study was repeated relating to swimming in 2009, which had a dry and sunny summer. Exposure data were collected through questionnaires administered to approximately 19 000 persons representing the general Dutch population. Questionnaires were completed by 8000 adults of whom 1924 additionally answered the questions for their eldest child (< 15 years). The collected data did not differ significantly between 2007 and 2009. The frequency of swimming and the duration of swimming were different for men, women and children and between water types. Differences between men and women were small, but children behaved differently: they swam more often, stayed in the water longer, submerged their heads more often and swallowed more water. Swimming pools were visited most frequently (on average 13-24 times/year) with longest duration of swimming (on average 67-81 min). On average, fresh and seawater sites were visited 6-8 times/year and visits lasted 41-79 min. Dependent on the water type, men swallowed on average 27-34 ml per swimming event, women 18-23 ml, and children 31-51 ml. Data on exposure of swimmers to recreational waters could be obtained by using a questionnaire approach in combination with a test to measure mouthfuls of water for transformation of categorical data to numerical data of swallowed volumes of water. Previous assumptions on swimmer exposure were replaced with estimates of exposure parameters, thus reducing uncertainty in assessing the risk of infection with waterborne pathogens and enabling identification of risk groups. QMRA for Cryptosporidium and Giardia was demonstrated based on data from previous studies on the occurrence of these pathogens in recreational lakes and a swimming pool.

Abstract  We fit lognormal distributions to data collected in a national survey for both total water intake and tap water intake by children and adults for these age groups in years: 0 less than age less than 1; 1 less than or equal to age less than 11; 11 less than or equal to age less than 20; 20 less than or equal to age less than 65; 65 less than or equal to age; and all people in the survey taken as a single group. These distributions are suitable for use in public health risk assessments.

Abstract  OBJECTIVE: Describe the design, data collection procedures, and sample characteristics of the Feeding Infants and Toddlers Study.

DESIGN: We conducted up to three telephone interviews with a random sample of parents or caregivers of infants and toddlers four to 24 months of age from March to July 2002. The three interviews included (a) a recruitment and household interview; (b) a 24-hour dietary recall, with supplementary questions on growth, development, and feeding patterns; and (c) a second dietary recall for a random subset of the sample. Two age subgroups of infants (four to six months and nine to 11 months) were over sampled. Sample weights adjusted for over sampling, nonresponse, and under coverage of some subgroups in the sample frame.

SUBJECTS: A national random sample of 3,022 infants and toddlers, with two days of dietary recall available for 703 sample members.

RESULTS: Of sampled households that could be located and had an eligible child in the study age range, the response rate to the recruitment interview was 73%. Of recruited households, the response rate for the dietary recall interview was 94%.

APPLICATIONS/CONCLUSIONS: The Feeding Infants and Toddlers Study (FITS) provides a wealth of data on the food and nutrient intakes, background characteristics, growth and development milestones, and feeding patterns and transitions for a nationally representative sample of infants and toddlers. Subsequent papers in this journal issue present study findings and conclusions from in-depth analysis of the FITS data.

Abstract  Water ingestion estimates are important for the assessment of risk to human populations of exposure to water-borne pollutants. This paper reports mean and percentile estimates of the distributions of daily average per capita water ingestion for a number of age range groups. The age ranges, based on guidance from the US EPA's Risk Assessment Forum, are narrow for younger ages when development is rapid and wider for older ages when the rate of development decreases. Estimates are based on data from the United States Department of Agriculture's (USDA's) 1994-1996 and 1998 Continuing Survey of Food Intake by Individuals (CSFII). Water ingestion estimates include water ingested directly as a beverage and water added to foods and beverages during preparation at home or in local establishments. Water occurring naturally in foods or added by manufacturers to commercial products (beverage or food) is not included. Estimates are reported in milliliters (ml/person/day) and milliliters per kilogram of body weight (ml/kg/day). As a by-product of constructing estimates in terms of body weight of respondents, distributions of self-reported body weights based on the CSFII were estimated and are also reported here.

Abstract  This two-disk CD-ROM contains microdata on food and nutrient intakes from The Supplemental Children's Survey (CSFII 1998) to the 1994-96 Continuing Survey of Food Intakes by Individuals (CSFII 1994-96). CSFII 1998 was conducted in response to the Food Quality Protection Act of 1996, which required the U. S. Department of Agriculture to provide data from a larger sample of children for use by the Environmental Protection Agency in estimating exposure to pesticide residues in the diets of children. The CSFII 1998 adds intake data from 5,559 children birth through age 9 years to the intake data collected from 4,253 children of the same ages participating in the CSFII 1994-96. The CSFII 1994-96 included the collection of data from persons of all ages (1-day dietary intake data for 16,103 individuals). The 1998 survey was designed so that the data could be combined with those from the 1994-96 survey, thus the approaches to sample selection, data collection, data file preparation, and weighting in CSFII 1998 were consistent with those used in the CSFII 1994-96. The survey data files on these disks contain data from both the CSFII 1994-96 and CSFII 1998; all 4 years of data are nationally representative surveys conducted by the Agricultural Research Service of the U.S. Department of Agriculture. The data set may be analyzed in a variety of ways: the combined 1994-96, 1998 data; the 1998 data separately; the 3-year CSFII 1994-96 data; or any of the 3 years of the CSFII 1994-96 separately. The seven data files include: household, household member, sample person, food line item, daily intake (food group amounts), daily intake (nutrients), and Diet and Health Knowledge Survey (from the 1994-96 survey only).

Abstract  This two-disk CD-ROM contains microdata on food and nutrient intakes from The Supplemental Children's Survey (CSFII 1998) to the 1994-96 Continuing Survey of Food Intakes by Individuals (CSFII 1994-96). CSFII 1998 was conducted in response to the Food Quality Protection Act of 1996, which required the U. S. Department of Agriculture to provide data from a larger sample of children for use by the Environmental Protection Agency in estimating exposure to pesticide residues in the diets of children. The CSFII 1998 adds intake data from 5,559 children birth through age 9 years to the intake data collected from 4,253 children of the same ages participating in the CSFII 1994-96. The CSFII 1994-96 included the collection of data from persons of all ages (1-day dietary intake data for 16,103 individuals). The 1998 survey was designed so that the data could be combined with those from the 1994-96 survey, thus the approaches to sample selection, data collection, data file preparation, and weighting in CSFII 1998 were consistent with those used in the CSFII 1994-96. The survey data files on these disks contain data from both the CSFII 1994-96 and CSFII 1998; all 4 years of data are nationally representative surveys conducted by the Agricultural Research Service of the U.S. Department of Agriculture. The data set may be analyzed in a variety of ways: the combined 1994-96, 1998 data; the 1998 data separately; the 3-year CSFII 1994-96 data; or any of the 3 years of the CSFII 1994-96 separately. The seven data files include: household, household member, sample person, food line item, daily intake (food group amounts), daily intake (nutrients), and Diet and Health Knowledge Survey (from the 1994-96 survey only).

Abstract  A section of the chapter, "Minerals and Water."

Abstract  The United States Environmental Protection Agency (U.S. EPA) generated the estimates in this report in response to legislative mandates in the Safe Drinking Water Act Amendments of 1996. These mandates require up-to-date information on water ingestion to identify subpopulations at elevated risk of health effects from exposure to contaminants in drinking water. The estimates also support characterization of health risks to sensitive populations from contaminants in drinking water. The estimates in this document characterize the empirical distributions of 2-day average per capita ingestion of water for specific subpopulations. Subpopulation estimates apply to demographic categories, but do not distinguish individuals with a history of serious illness or with lifestyles that effect water ingestion.

Abstract  Perchlorate exposure may be higher in infants compared with older persons, due to diet (infant formula) and body weight versus intake considerations. Our primary objective was to quantitatively assess perchlorate concentrations in commercially available powdered infant formulas (PIFs). Secondary objectives were: (1) to estimate exposure in infants under different dosing scenarios and compare them with the perchlorate reference dose (RfD); (2) estimate the perchlorate concentration in water used for preparing PIFs that would result in a dose exceeding the RfD; and (3) estimate iodine intakes from PIFs. We quantified perchlorate levels in three samples (different lot numbers) of reconstituted PIF (using perchlorate-free water) from commercial brands of PIF in each of the following categories: bovine milk-based with lactose, soy-based, bovine milk-based but lactose-free, and elemental (typically consisting of synthetic amino acids). Exposure modeling was conducted to determine whether the RfD might be exceeded in 48 dosing scenarios that were dependent on age, centile energy intake per unit of body weight, body weight percentile, and PIF perchlorate concentration. We obtained three different samples in each of the five brands of bovine- and soy-based PIF, three different samples in each of the three brands of lactose-free PIF, and three different samples in two brands of elemental PIF. The results were as follows: bovine milk-based with lactose (1.72 microg/l, range: 0.68-5.05); soy-based (0.21 microg/l, range: 0.10-0.44); lactose-free (0.27 microg/l, range: 0.03-0.93); and elemental (0.18 microg/l, range: 0.08-0.4). Bovine milk-based PIFs with lactose had a significantly higher concentration of perchlorate (P<0.05) compared with all. Perchlorate was a contaminant of all commercially available PIFs tested. Bovine milk-based PIFs with lactose had a significantly higher perchlorate concentration perchlorate than soy, lactose-free, and elemental PIFs. The perchlorate RfD may be exceeded when certain bovine milk-based PIFs are ingested and/or when PIFs are reconstituted with perchlorate-contaminated water.

Abstract  We describe beverage intakes during the transition stage of infant nutrition. Mean daily intakes of infant formula, cow's milk, combined juice and juice drinks, water, and other beverages estimated from a beverage frequency questionnaire were analyzed cross-sectionally at ages six through 24 months (n=701). Most children (97%) consumed human milk, infant formula, or cows' milk at each age studied. Mean daily intakes of combined infant formula and cows' milk declined from 28.0 oz at six months to 12.1 oz at 24 months. The percentage of children consuming juice and/or juice drinks increased with age, and mean daily consumption peaked at 9.1 oz at 20 months. Combined formula and cows' milk intakes were inversely associated with juice and juice drink intakes at all ages (-0.25 < r < 0; P<.01). Juice and juice drinks appear to replace formula and milk intakes during the transition stage of infant nutrition.

Abstract  Water intake was evaluated and time trends in water intake and beverage consumption were assessed on the basis of 3 d weighed dietary records (n = 3,736) of 2-13-y-old males (n = 354) and females (n = 379) enrolled in the DONALD Study (Dortmund Nutritional and Anthropometric Longitudinally Designed Study, 1985-1999). Total water intake increased with age from 1,114 g d(-1) in the 2-3-y-olds to 1,363 g d(-1) in the 4-8-y-olds and further to 1,801 g d(-1) (1,676 g d(-1)) in the 9-13-y-old boys (girls); 33-38% came from food, 49-55% from beverages and 12-13% from oxidation. Total water intake per body weight decreased with age from 77.5 g kg(-1) (boys and girls) to 48.9 and 42.6 g kg(-1) in boys and girls, respectively. Milk (9-17%) and mineral water (12-15%) were the most important source of total water intake. In the 15 y period a significant increase in total water intake (+1.7 to +3.2 g MJ(-1) y(-1)) in all three age groups irrespective of sex was found. The increase of total water intake was mainly due to an increase in beverage consumption (+0.32 to +0.47% y(-1)). This study offers a differentiated insight into water intake and patterns of beverage consumption in German children and adolescents. CONCLUSION: The comparison of these data with other surveys points to a low total water intake, especially a low tap water intake, in German children and adolescents and underlines cultural influences on food and drinking habits.

Abstract  OBJECTIVE: Recommended fluoride concentrations in US public water systems are between 0.7-1.2 ppm, depending on the mean daily maximum temperature. This range assumes that water intake is higher in warmer than in cooler climates, based on research from the 1950s. The aim of this analysis is to relate fluid consumption among American children aged 1-10 years to the local climate under modern conditions.

METHODS: The quantities of daily total fluid intake per body weight (ml/kg) and plain water intake per body weight (ml/kg) of children were calculated from the 24-hour recall diet survey in the third National Health and Nutrition Examination Survey (NHANES III, 1988-94). The mean daily maximum temperature from 1961 to 1990, averaged for the month during which the NHANES III exam was conducted, was obtained for each survey location from the US Local Climate Historical Database. Multiple regression analysis was conducted using SAS and SUDAAN.

RESULTS: Fluid intake was significantly associated with age, sex, socioeconomic status (SES), and race and ethnicity. No significant association could be found between the amount of either total fluid or plain water intake and mean daily maximum temperature, either before and after controlling for sex, age, SES, and race or ethnicity.

CONCLUSIONS: Results indicate that there is no evidence that fluid consumption among children is significantly related to mean temperature in modern conditions. This suggests that the national temperature-related guidelines for fluoride concentration in drinking water may be due for reevaluation.