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Concept: Bottled water


Abstract. In developing countries, safe piped drinking water is generally unavailable, and bottled water is unaffordable for most people. Purchasing drinking water from community-scale decentralized water treatment and refill kiosks (referred to as isi ulang depots in Indonesia) is becoming a common alternative. This study investigates the association between diarrhea risk and community-scale water treatment and refill kiosk. We monitored daily diarrhea status and water source for 1,000 children 1-4 years of age in Jakarta, Indonesia, for up to 5 months. Among children in an urban slum, rate of diarrhea/1,000 child-days varied significantly by primary water source: 8.13 for tap water, 3.60 for bottled water, and 3.97 for water kiosks. In multivariable Poisson regression analysis, diarrhea risk remained significantly lower among water kiosk users (adjusted rate ratio [RR] = 0.49, 95% confidence interval [CI] = 0.29-0.83) and bottled water users (adjusted RR = 0.45, 95% CI = 0.21-0.97), compared with tap water users. In a peri-urban area, where few people purchased from water kiosk (N = 28, 6% of total population), diarrhea rates were lower overall: 2.44 for well water, 1.90 for bottled water, and 2.54 for water kiosks. There were no significant differences in diarrhea risk for water kiosk users or bottled water users compared with well water users. Purchasing water from low-cost water kiosks is associated with a reduction in diarrhea risk similar to that found for bottled water.

Concepts: Water quality, Prediction interval, Water purification, Tap water, Bottled water, Poisson regression, Drinking water, Regression analysis


BACKGROUND: Few studies have examined water consumption patterns among US children. Additionally, recent data on total water consumption as it relates to the Dietary Reference Intakes (DRI) are lacking. This study evaluated the consumption of plain water (tap and bottled) and other beverages among US children by age group, gender, income-to-poverty ratio, and race/ethnicity. Comparisons were also made to DRI values for water consumption from all sources. METHODS: Data from two non-consecutive 24-hour recalls from 3 cycles of NHANES (2005–2006, 2007–2008 and 2009–2010) was used to assess water and beverage consumption among 4,766 children age 4-13y. Beverages were classified into 9 groups: water (tap and bottled), plain and flavored milk, 100% fruit juice, soda/soft drinks (regular and diet), fruit drinks, sports drinks, coffee, tea, and energy drinks. Total water intakes from plain water, beverages, and food were compared to DRIs for the US. Total water volume per 1,000 kcal was also examined. RESULTS: Water and other beverages contributed 70-75% of dietary water, with 25-30% provided by moisture in foods, depending on age. Plain water, tap and bottled, contributed 25-30% of total dietary water. In general, tap water represented 60% of drinking water volume whereas bottled water represented 40%. Non-Hispanic white children consumed the most tap water, whereas Mexican-American children consumed the most bottled water. Plain water consumption (bottled and tap) tended to be associated with higher incomes. No group of US children came close to satisfying the DRIs for water. At least 75% of children 4-8y, 87% of girls 9-13y, and 85% of boys 9-13y did not meet DRIs for total water intake. Water volume per 1,000 kcal, another criterion of adequate hydration, was 0.85-0.95 L/1,000 kcal, short of the desirable levels of 1.0-1.5 L/1,000 kcal. CONCLUSIONS: Water intakes at below-recommended levels may be a cause for concern. Data on water and beverage intake for the population and among socio-demographic group may provide useful information to target interventions for increasing water intake among children.

Concepts: Kefir, Drinking, Water supply network, Bottled water, Coffee, Drink, Water, Drinking water


This study was carried out to measure and compare the concentration of bacterial endotoxin in a variety of samples from drinking tap and bottled water available in Kuwait by using the Limulus Amoebocyte lysate test. A total of 29 samples were tested. Samples were collected from a variety of locations throughout the six governorates of Kuwait and 23 brands of local and imported bottled water samples were collected from the local market. The concentration of bacterial endotoxin was measured by using the standard Limulus Amoebocyte lysate test, gel clot method. This study showed that measured endotoxin concentrations in tap drinking water varied from 2.4 to 33.8 EU/ml with the average endotoxin concentration of 14.2 EU/ml. While the results of endotoxin concentrations in the bottled water were <0.03 to 20.1 EU/ml with an average of 1.96 EU/ml. The average concentration of endotoxin in bottled water is 13.5 % of the average concentration of endotoxin in tap drinking water. This experimental investigation has proved that drinking bottled water has less endotoxin as compared to tap water in Kuwait. It is also demonstrated that the endotoxin concentration did not exceed the acceptable level in drinking tap water.

Concepts: Concentration, Measurement, Test method, Tap water, Water pollution, Bottled water, Drinking water


A panel of reporter gene assays (RGAs) coupled with a single solid phase extraction (SPE) step was developed and used to screen bottled mineral water for the presence of four classes of endocrine disruptors (EDs), oestrogens, androgens, progestagens and glucocorticoids. Fourteen brands of bottled mineral water in triplicate (42 samples) were analysed. Overall, hormonal activity was found in 78% of the samples. Oestrogenic, androgenic, progestagenic and glucocorticoid activity was found in 38%, 38%, 36% and 55% of the samples, respectively at an average concentration of 10 ng/l 17β-estradiol equivalent (EEQ), 26 ng/l testosterone equivalent (TEQ), 123 ng/l progesterone equivalent (PEQ) and 13.5 ng/l hydrocortisone equivalent (HEQ). The level of oestrogenic, androgenic and progestagenic activity observed is not considered a matter of concern for the consumers' health. It is unknown whether the glucocorticoid levels observed are safe. The ED source, long term exposure and mixture effects remain to be investigated.

Concepts: Mineral water, Testosterone, Bottled water, Steroid, Androgen, Endocrine system, Estrogen, Adrenal cortex


Human exposure to phthalates was assessed through digestive and respiratory intakes. Six phthalates (DMP, DEP, DnBP, BBP, DEHP, DnOP) were investigated in drinking water, in current foodstuff and in ambient air. Digestive intake was prevailing (92 %) with a major contribution of food (95.5 %). Phthalate intake from water was mainly due to bottled water (60 %) in spite of the minor volume absorbed daily. From the respiratory tract, it was dominated by DEP: 30.3 ng kg(-1) bw day(-1) and the part played by indoor air prevailed. Total intake were as ng kg(-1) bw day(-1), for DEHP: 1458, DnBP: 191.8, BBP: 164.3, DEP: 107.7, DMP: 79.1.

Concepts: Assessment, Intake, Phthalates, Plasticizer, Water, Bottled water, Bis(2-ethylhexyl) phthalate, Phthalate


The consumption of bottled water in Italy began in the 1970s. Since then, this usage has grown considerably, also as a result of changes in habits. The environmental impact as a result of the water production chain is very significant; it would be considered, for example, the use of plastic bottles, the consumption of oil in the production of the bottles, the emission of air from the vehicles that transport the bottles, non-recycled plastic packaging, etc. In this study, considering the comparison between two situations, use of bottled water and use of water kiosk (WK), an environmental and economic impact evaluation has been done. The study considered the production of a WK in a town with 9000 inhabitants, which supplies controlled, still and sparkling water, with an organoleptic quality higher than tap water coming from the aqueduct. In particular, taking into consideration the environmental aspects, specific attention was paid both to CO2 emissions and PET bottle waste reduction. The economic impact evaluation was carried out from the consumer’s point of view. In order to provide a supply service that was economically sustainable, a calculation was done with the aim of determining a specific fee for the supplied water. Moreover, a comparison has been made between quality parameters achieved with the analysis of water from aqueducts with the limits established in the Italian legislation and the parameters of several Italian water brands. The study has the aim at considering the opportunity to follow a different people’s habits, closer to the concept of sustainability, reducing the environmental charge related to the realization, transport and consumption of plastic water bottles without significant reduction of the quality of the service and with convenient and interesting economic implications. In fact the results of the study show that the alternative of WKs is more efficient in economic and environmental terms respect to the use of bottled water.

Concepts: Plastic bottle, Recycling, Bottles, Recyclable materials, Bottled water, Aqueduct, Carbon dioxide, Bottle


Objectives. We estimated the relationship between soft drink consumption and obesity and diabetes worldwide. Methods. We used multivariate linear regression to estimate the association between soft drink consumption and overweight, obesity, and diabetes prevalence in 75 countries, controlling for other foods (cereals, meats, fruits and vegetables, oils, and total calories), income, urbanization, and aging. Data were obtained from the Euromonitor Global Market Information Database, the World Health Organization, and the International Diabetes Federation. Bottled water consumption, which increased with per-capita income in parallel to soft drink consumption, served as a natural control group. Results. Soft drink consumption increased globally from 9.5 gallons per person per year in 1997 to 11.4 gallons in 2010. A 1% rise in soft drink consumption was associated with an additional 4.8 overweight adults per 100 (adjusted B; 95% confidence interval [CI] = 3.1, 6.5), 2.3 obese adults per 100 (95% CI = 1.1, 3.5), and 0.3 adults with diabetes per 100 (95% CI = 0.1, 0.8). These findings remained robust in low- and middle-income countries. Conclusions. Soft drink consumption is significantly linked to overweight, obesity, and diabetes worldwide, including in low- and middle-income countries. (Am J Public Health. Published online ahead of print March 14, 2013: e1-e7. doi:10.2105/AJPH.2012.300974).

Concepts: Bottled water, Malnutrition, Statistics, International Diabetes Federation, Childhood obesity, World Health Organization, Nutrition, Obesity


Microplastics are anthropogenic contaminants which have been found in oceans, lakes and rivers. Investigations focusing on drinking water are rare and studies have mainly been using micro-Fourier Transform Infrared Spectroscopy (μ-FT-IR). A major limitation of this technique is its inability to detect particles smaller than 20 μm. However, micro-Raman spectroscopy is capable of detecting even smaller particle sizes. Therefore, we show that this technique, which was used in this study, is particularly useful in detecting microplastics in drinking water where particle sizes are in the low micrometer range. In our study, we compared the results from drinking water distributed in plastic bottles, glass bottles and beverage cartons. We tested the microplastic content of water from 22 different returnable and single-use plastic bottles, 3 beverage cartons and 9 glass bottles obtained from grocery stores in Germany. Small (-50-500 μm) and very small (1-50 μm) microplastic fragments were found in every type of water. Interestingly, almost 80% of all microplastic particles found had a particle size between 5 and 20 μm and were therefore not detectable by the analytical techniques used in previous studies. The average microplastics content was 118 ± 88 particles/l in returnable, but only 14 ± 14 particles/l in single-use plastic bottles. The microplastics content in the beverage cartons was only 11 ± 8 particles/l. Contrary to our assumptions we found high amounts of plastic particles in some of the glass bottled waters (range 0-253 particles/l, mean 50 ± 52 particles/l). A statistically significant difference from the blank value (14 ± 13) to the investigated packaging types could only be shown comparing to the returnable bottles (p < 0.05). Most of the particles in water from returnable plastic bottles were identified as consisting of polyester (primary polyethylene terephthalate PET, 84%) and polypropylene (PP; 7%). This is not surprising since the bottles are made of PET and the caps are made of PP. In water from single-use plastic bottles only a few micro-PET-particles have been found. In the water from beverage cartons and also from glass bottles, microplastic particles other than PET were found, for example polyethylene or polyolefins. This can be explained by the fact that beverage cartons are coated with polyethylene foils and caps are treated with lubricants. Therefore, these findings indicate that the packaging itself may release microparticles. The main fraction of the microplastic particles identified are of very small size with dimensions less than 20 μm, which is not detectable with the μ-FT-IR technique used in previous studies.

Concepts: Statistical significance, Polyethylene terephthalate, Polypropylene, Spectroscopy, Bottled water, Water, Bottle, Recyclable materials


BACKGROUND: Previous studies of prenatal exposure to drinking water nitrate and birth defects in offspring have not accounted for water consumption patterns or potential interaction with nitrosatable drugs. OBJECTIVES: We examined the relation between prenatal exposure to drinking water nitrate and selected birth defects, accounting for maternal water consumption patterns and nitrosatable drug exposure. METHODS: With data from the National Birth Defects Prevention Study, we linked addresses of 3300 case-mothers and 1121 control-mothers from the Iowa and Texas sites to public water supplies and respective nitrate measurements. We assigned nitrate levels for bottled water from collection of representative samples and standard laboratory testing. Daily nitrate consumption was estimated from self-reported water consumption at home and work. RESULTS: With the lowest tertile of nitrate intake around conception as the referent group, mothers of babies with spina bifida were 2.0 times more likely (95% CI: 1.3, 3.2) to ingest ≥ 5 mg nitrate daily from drinking water (vs. <0.91 mg) than control-mothers. During one month preconception through the first trimester, mothers of limb deficiency, cleft palate, and cleft lip cases were, respectively, 1.8 (95% CI: 1.1, 3.1), 1.9 (95% CI: 1.2, 3.1), and 1.8 (95% CI: 1.1, 3.1) times more likely than control-mothers to ingest ≥ 5.42 mg of nitrate daily (vs. <1.0 mg). Higher water nitrate intake did not increase associations between prenatal nitrosatable drug use and birth defects. CONCLUSIONS: Higher water nitrate intake was associated with several birth defects in offspring, but did not strengthen associations between nitrosatable drugs and birth defects.

Concepts: PHF8, Drug addiction, Drinking water, Cleft lip and palate, Water crisis, Desalination, Bottled water, Folic acid


Non-carbonated natural mineral waters contain microorganisms that regularly grow after bottling despite low concentrations of dissolved organic matter (DOM). Yet, the compositions of bottled water microbiota and organic substrates that fuel microbial activity, and how both change after bottling, are still largely unknown.

Concepts: Mineral, Bottled water, Mineral water, Water