Natural mineral waters: chemical characteristics and health effects

Summary

Water contributes significantly to health and a daily intake of 1.5 to 2 liters of water should be guaranteed, because a good hydration is substantive to maintain the body water equilibrium, although needs may vary among people. however, global population is far from the Recommended Allowance for water consumption. Among the waters for human uses, there are ‘ waters ( treated or not ), intended for drink, used for the food and beverages training or for early domestic purposes ’ and natural mineral waters, that are ‘ originated from an aquifer or clandestine reservoir, jump from one or more natural or behave sources and have specific hygienic features and, finally, healthy properties ’. According to the european Legislation ( 2009/54/EC Directive ), physical and chemical portrayal is used to make a categorization of the different mineral waters, basing on the psychoanalysis of main parameters. Mineral composition enables to classify natural mineral waters as bicarbonate mineral waters, sulfate mineral waters, chloride mineral waters, calcic mineral waters, magnesiac mineral waters, fluorurate mineral waters, ferric mineral waters and sodium-rich mineral waters. Although the concerns about bottle mineral waters ( due to plasticizers and endocrine gland disruptors ), many are the health effects of natural mineral waters and respective studies explored their properties and their character in different physiological and diseased conditions.

Keywords:

natural mineral waters, calcium, bicarbonate, magnesium, sulphate, bottled water, endocrine disruptors

Introduction

Water covers most of the earth coat and composes most of the human body ; this can illustrate the critical linkages between water, health and ecosystems ( 1 ). From outer outer space, the earth looks like a “ amobarbital sodium ” planet because most of its surface is covered by water. only 2.5 % of that water is fresh, and most of that lies flash-frozen and inaccessible in the icecaps and Greenland, leaving less than 1 % of fresh water system accessible in lakes, river channels and metro. alone about one third of the universe ’ s potential fresh urine can be used for human needs. As contamination increases, the sum of useable water decreases. Water contributes significantly to health and good health is the kernel of development. however water ’ mho protective function is largely spiritual world and taken for granted in the wealthier countries. Its contribution to health is directly within households through food and nutrition, and indirectly as a means of maintaining a healthy, diverse environment. These two precious resources — urine and health — together could enhance prospects for development ( 2 ). In humans, about 60 % of soundbox burden ( BW ) is represented by sum consistency water system ( TBW ), distributed into intracellular and extracellular fluid compartments, which contain about 65 and 35 % of sum soundbox water, respectively ( 3, 4 ). Water is involved in many body functions, since it serves as a carrier of nutrients and substances in the circulative system. furthermore, it is the vehicle to excrete products and eliminate godforsaken and toxins and it besides lubricates and provide geomorphologic supports to tissues and joints. however, there is no efficient mechanism of body ’ randomness body of water storehouse ; consequently, a constant issue of fluids is needed to keep water contentedness ( 4 ). The water needs can be partially satisfied by an overall diet and water contained in food ( 5 ) : yield, vegetables and milk are composed for the 85 % by body of water. Meat, pisces, eggs and fresh tall mallow contain the 50–80 % of water ; and cooked pasta and rice about 60–65 %. Whereas, bread and pizza contain water for 20–40 % and bakery products ( like biscuits, rusks and breadsticks ) are composed by water only for less than 10 % ( 6 ). however, a day by day consumption of 1.5 to 2 liters of water should be guaranteed, because a good hydration is all-important to maintain the body urine balance, although needs may vary among people because of long time, physical bodily process, personal circumstances and weather conditions ( 7 ). In are reported the Recommended Daily Allowances for water in the remainder long time ranges and physiological conditions in Italy ( 8 ) .

Table 1

LARN WATER (mL/die)
Age rangesAI
Adequate IntakeINFANTS6–12 months800
CHILDREN-TEENAGERS1–3 years12004–6 years16007–10 years1800
Males11–14 years210015–17 years2500
Females11–14 years190015–17 years2000
ADULTSMales18–29 years250030–59 years250060–74 years2500≥75 years2500
Females18–29 years200030–59 years200060–74 years2000≥75 years2000
PREGNANCY+350
BREASTFEEDING+700Open in a separate window The option of the water to drink can be variable and it depends on the personal necessity. By european Community legislation ( directive number 98/38 ), among the waters for human uses, there are waters ( treated or not ), intended for drink, used for the food and beverages planning or for other domestic purposes ( in Italy, D. Leg. N. 31 of 02/02/2001 ). Drinking body of water has to be “ clear, odorless, tasteless, colorless and harmless, that is barren of infective microorganisms and harmful chemicals to humans ” and safety on the basis of microbiological, physics and chemicals parameters control condition ( in Italy, D.M. n. 84 of 26 March 1991 ). mineral waters represent a valid choice to meet the daily water intake. As reported in the european legislation ( 2009/54/EC Directive ) natural mineral waters are “ originated from an aquifer or underground reservoir, spring from one or more natural or bore sources and have specific hygienic features and, finally, healthy properties ” ( in Italy, D. Leg. N. 176 of 2011 ). They are different from drink water because of their leap purity and conservation, for the changeless level of minerals ( trace elements or early constituents ) and, where appropriate, for certain effects they can determine. Food and drug administration ( FDA, USA ) regulates bottle water as a food and identifies natural mineral waters as “ body of water containing not less than 250 parts per million ( ppm ) total disband solids ( TDS ), coming from a source at one or more hold holes or springs, originating from a geologically and physically protected belowground water reservoir ” ( Code of Federal Regulations, Title 21, Part 165 – Beverages ). The consumption of bottle mineral waters has greatly increased during the past few years, cosmopolitan. The U.S. and International Developments and Statistics report that United States, western european countries and several asian nations registered an increase in bottle water markets ( 9 ) and by 2017, people all over the earth are expected to consume about 391 billion liters of bottle water ( 10 ). many studies have focused attention on the safety of bottle mineral water system, in especial on the migration of chemicals from plastic containers to water. Plasticizers ( additives used to impart flexibility and handling properties to several kinds of plastics ) ( 11 ) and endocrine gland disruptors ( EDs – chemicals that interfere with function of the endocrine gland system ) ( 12 ) are the chief compounds involved in adverse effects on human health. however, natural mineral waters have intrinsic demonstrated properties and this review intends to explore them and their wide-eyed proved effects on the prevention and the discussion of different physiologic and pathological condition .

Characteristics of natural mineral waters

“ Natural mineral water ” means ‘ microbiologically wholesome ’ body of water, but ensures the absence of the main contamination indicators ( parasites and infective microorganisms, Escherichia coli and faecal streptococcus, sporulated sulphite-reducing anaerobes, pseudomonas aeruginosa ) both at source and during its market ( 13 ). The characteristics of a natural mineral water have to be proved from unlike points of opinion :

• geological and hydrological, that requires a detailed description of the catchment site, considering the nature of the terrain, the stratigraphy of the hydrogeological layer and a description of the catchment operations ;
• physical, chemical and physicochemical, that implies a report about the independent physical and chemical psychoanalysis to describe the final characteristics of the mineral water system ( i.e. rate of flow of the spring, temperature at reservoir, dry residues at 180°, ph, anions and cations, trace elements, perniciousness of certain constituent elements ) ;
• microbiological, ensuring the absence of the main contamination indicators ;
• potential pharmacological, physiological and clinical effects. The clinical researches should be conducted in order to certificate the physiological effects and benefits on human health ; they should be scientific studies, conducted in farseeing term periods and with different methodologies ( 13, 14 ) .

According to the european Legislation ( 2009/54/EC Directive ), physical and chemical characterization is used to make a classification of the different mineral waters, basing on the analysis of chief parameters ( 3 ). First of all, lifelike mineral waters are classified by the fix residue at 180°, that is the sum of residual mineral salts ( in magnesium ) after the dehydration of 1 L of water at 180°C ( ) .

Table 2

Fixed residue at 180°CDefinition< 50 mg/LVery low mineral content water (or light mineral water)50–500 mg/LLow mineral content water500–1500 mg/LMedium mineral content water> 1500 mg/LRich mineral content waterOpen in a separate window By law, there is no upper or lower limits for minerals contents in natural mineral water ; rather of the water faucet drink urine, that are strictly regulated as regards the fixed residue at 180°C. mineral waters are besides classified by other physical parameters, like ph, temperature and hardness. With esteem to pH, mineral waters are classified as acid water ( ph < 7 ) or alkaline water ( ph > 7 ). By temperature, mineral waters may be cold ( < 20°C at source ), hypotermal ( 20–30°C at source ), mesothermal waters ( 30–40°C at source ) and hyperthermal waters ( > 40°C at beginning ). Hardness indicates the presence of alkaline ground metals and mineral waters may be identical indulgent ( 0–100 mg/L of CaCO3 ), voiced ( 100–200 mg/L of CaCO3 ), hard ( 200–300 mg/L of CaCO3 ) or very intemperate ( > 300 mg/L of CaCO3 ) ( 15 ). The effect of the water in many metabolic pathways is associated, in many cases, to its function of suppling and transporting different minerals. Minerals are inorganic compounds with biological essential functions, as bone and tooth mineralization, regulation of hydrosaline proportion at the basis of cellular exchanges, activation of assorted metabolic pathways ( ) .

Table 3

CategoryMineralSome biological functionsMacronutrients present in the human body in modest quantitiesCalciumBone development, regulation of muscle contraction and myocardium activity, blood clotting, nerve impulses transmission, regulation of cell permeability.Chlorine (Cloruri)Hydrochloric acid formation (digestive juices for digestion process).PhosphorusProtein synthesis, ATP synthesis and transport of energy in biological systems.MagnesiumBone formation, nervous and muscular activities, lipid metabolism and protein synthesis, CVD protection.PotassiumMuscles and myocardium activities, neuromuscular excitability, acid-base balance, water retention and osmotic pressure.SodiumFundamental regulation of cell permeability and body fluids; defency is rare, but an excessive intake may be associated with high blood pressure.Sulphur (Solphate)Essential amino acids, cartilage, hair and nails formation, enzyme activity in redox processes and cellular respiration, intestinal peristalsis.Micro-nutrients trace elements, essential for some biological functionsCobaltConstituent of vitamin B12: growth factor, nucleic acid synthesis, hematopoiesis.ChromiumEnzymatic reactions involved in the metabolism of carbohydrates, lipids and proteins.IronBlood and muscle tissues: hemoglobin, myoglobin.Flourine (Fluoride)Protection and prevention of tooth decay, bone development; diseases related to excess.Iodium (Iodide)Essential for the synthesis of hormones that are involved in the growth process and body development.ManganeseSynthesis of several enzymes involved in the metabolism of proteins and sugars, bone development.MolybdenumProduction of enzymes associated to uric acid.CopperFunctionality of several enzymes in blood and muscles.SeleniumProtection of the muscle membrane integrity, antioxidant.Open in a separate window They are necessity for humans because the organism can not produce them, so it ’ south necessity a regular consumption from foods and water. The handiness of minerals from food is less than mineral water, because in foods minerals are bound to complex molecules that can limit their absorbability, alternatively in water they are present as free ions ( 16 ). On the footing of minerals subject, waters have been classified in several ways : Marotta and Sica classification ( 1933 ) represents in Italy the first reference point and it takes into consideration temperature, fixed residue and chemical writing, according to a scheme that includes classes and subclasses. They gave a name to each mineral water considering, first, the prevailing anion and second, the cation ; they classified waters as salt waters, salty-sulfate waters, bicarbonate-sulfate waters, salt-bromine-iodine waters, etc. ( 3 ). Although in Europe and in United States there are many categorizations of mineral waters ( 17, 18 ), nowadays the 2009/54/EC Directive is the european reference to classify them. As reported in the EC Directive, mineral waters can be :

• “ Water with bicarbonate ”, if bicarbonate contented is > 600 mg/L
• “ Water with sulfate ”, if sulfate content is > 200 mg/L
• “ Water with chloride ”, if chloride content is > 200 mg/L
• “ Water with calcium ”, if calcium capacity is > 150 mg/L
• “ Water with magnesium ”, if magnesium subject is > 50 mg/L
• “ Water with fluoride ”, if fluoride contentedness is > 1 mg/L ( More than 1,5 mg/L of fluoride is undesirable for children below the old age of 7 )
• “ Acid water ”, if the CO2 content is > 250 mg/L
• “ Water with sodium ”, if sodium contentedness is > 200 mg/L. The lettering “ indicate for low sodium diet ” can be added to labels if sodium subject is < 20 mg/L.

  Read more: How To Enjoy Eating Healthy

Natural mineral waters and administration

The classification of natural mineral waters on the basis of the mineral content is besides utilitarian to identify the health properties of each type. The italian Geothermal Union has largely investigated the roles and the effects of the natural mineral waters ( 19 ) and have sporadically diffused news about the use of the different type of natural mineral waters for specific upsets ( ) .

Table 4

Type of Natural mineral waterContent of the main mineral (mg/L)ApplicationsBICARBONATE>600 mg/LPromote digestion, because neutralizes gastric acidity.SULPHATE>200 mg/LLightly laxative; it is suggested for hepatobiliary diseases.CHLORIDE>200 mg/LBalance of intestine, bile ducts and liver; laxative effect.CALCIC>150 mg/LIt is suggested for adolescents, pregnant women, subjects who don’t consume dairy products, elderly men; contributes to prevent osteoporosis and hypertension.MAGNESIAC>50 mg/LPromote digestion.FLUORURATE>1 mg/LStrengthen teeth structure and prevent dental decay; helps in osteoporosis.FERROUS>1 mg/LIt is suggested for anemia and iron deficiency.SODIUM-RICH>200 mg/LIt is suggested for intense physical activity (to replenish the salts leaked through sweating).LOW-SODIUM<20 mg/LIt is suggested in case of hypertension.Open in a separate window however, many are the clinical studies and researches that have been developed to demonstrate healthy properties of natural mineral waters .

“Bicarbonate mineral waters”

Bicarbonate natural mineral waters are cold and alkaline mineral waters with humble mineral message and diuretic drug properties. several studies have demonstrated the positive effects of bicarbonate mineral waters on digestive nerve pathway. Studies on crenotherapy treatments ( 20 ) and on patients with functional indigestion show that the consumption of bicarbonate mineral body of water may neutralize acid secretion, increase the ph level in the gastric lumen, accelerate gastric empty and stimulate the exhaust of digestive hormones ( known to have pivotal roles in the regulation of gastric function ) ( 21 ). The base load of this mineral water seems to be crucial for the decrease of bone resorption. few studies investigated the properties of bicarbonate-rich mineral water, particularly waters with a powerfully negative likely nephritic acid load. They proved to create an alkaline environment and decrease cram resorption and bone resorption markers ( C-telopeptides ) ( 23 ). This effect is demonstrated in subjects with adequate calcium intake and in comparison with acid calcium-rich mineral waters ( sulphate calcium-rich mineral waters ) ( 24 ). many studies show the health effects of bicarbonate mineral water on cardiometabolic risk biomarkers ( reducing specially total-cholesterol, fasting glucose and LDL-cholesterol ) ( 25 ) and in the prevention of cardiovascular Diseases ( CVD ). In particular, sodium-bicarbonate waters demonstrated to importantly decrease serum entire cholesterol and LDL-cholesterol, to increase HDL-cholesterol and, furthermore, produce a significant decrease in soluble intercellular attachment atom ( 26, 27 ). furthermore, compared to low mineral waters, sodium-bicarbonate waters decrease post-prandial lipemia and aldosterone levels ( 28 ). The capability of reducing lipemia after meals may be associated to the capacity of lowering increase in cholecystokinin concentration and lowering gallbladder vacate, which may limit the release of biliary salts into the duodenum and therefore reduce postprandial lipemia ( 29 ), particularly the plasma triglyceride ( VLDL triglyceride and chylomicron triglyceride ) ( 30 ) .

“Sulphate mineral waters”

Sulphate mineral water is characterized by the presence of sulfate anion, with different cations ( 4 ). The presence of specific cations combined with sulfate enhance the properties of these waters : magnesium sulfate and sodium sulfate mineral waters demonstrated to be in truth efficient for functional stultification conditions ( 31 ). Drinking mineral body of water full-bodied in magnesium sulfate and sodium sulfate can confer significant benefits for goodly digestion, in terms of improvement of constipation symptoms, overall intestine movements and stool consistency ( 32 ). A more building complex mineral arrangement, as the sulphate-bicarbonate-calcium-magnesiac mineral water, has a curative activity in the functional disorders of the biliary tract : this water is peculiarly effective thanks to elective anions that exert choleresis and cholagogue actions, helping to remove the gallbladder hypomotility and to correct the leaning to biliary sludge ( 33 ). Sulphate is an compel food for numerous metabolic and cellular processes, peculiarly in fetal emergence and development. For this reason sulfate mineral waters demonstrate to be an alternate choice for diet of fraught women ( 34 ) .

“Chloride mineral waters”

Chloride mineral waters are composed by chloride as overriding component and the most abundant cations are sodium, calcium and magnesium. Although studies about their health effects are barely, chloride mineral water may exert their properties for intestine functions : they may stimulate intestinal peristalsis and intestinal secretion of body of water and electrolytes ( 3 ). furthermore, they may have a choleretic and cholagoge military action by increasing biliary secretion and bile inflow into duodenum ( 4 ). Chloride is frequently present in combination with sodium and they are the main constituents of “ Salt mineral waters ”. They may be used for hydropinic therapy and can be either hypo-, hyso- or hyperthermal waters inducing unlike biological effects, such as a stimulate effect on both gastric evacuate and interdigestive cyclic motive natural process of the gastro-duodenal tract ( 15 ). Their use is in particular indicated for hydropinic therapy for disease of the gastrointestinal system ( 35 ). The salt-bromine-iodine waters are characterized by the combination of chloride and sodium with tincture of iodine and bromine. They are well known for their anti-inflammatory activity and are used in a diverseness of pathological conditions, such as diseases of the gastrointestinal arrangement ( 36 ) .

“Calcic mineral waters”

calcium is the main mineral of the calcic mineral waters. It is broadly recognized that calcium inhalation is significant for skeletal health and that it may be beneficial to several non-skeletal body systems, as anxious system, muscle and blood system ( 37 ). calcium is a cation that can be associated with different anions, that give to calcium mineral waters specific properties. The chief anions are bicarbonate and sulfate. Some studies investigated the potential character of bicarbonate calcium-rich body of water in maintaining an alkaline environment and in improving acid-base balance in the soundbox ( 38, 39 ). In fact, diet components ( and besides mineral waters ) may have basic or acerb effects and their function on cram mineral concentration, specially in aged, have been largely studied ( 40 ). The cogitation conducted by Wynn et aluminum. on european and north american commercial waters reveals that bicarbonate calcium-rich water has an alkalizing might and may increase serum and urinary ph, creating an optimum environment for cram mineralization ( 39 ). A french study shows that in post-menopausal women, with abject calcium consumption, the consumption of high calcium mineral urine lowers indices of bone recast ( 41 ). A systematic review and a meta-analysis on five studies shows that, although alone a few studies with a relatively small count of subjects are available, the calcium bioavailability of mineral waters is at least comparable to, and possibly better than, that from dairy products or pharmaceutical preparations ( 42 ). Because of calcium bioavailability, high-calcium mineral waters represent an important dietary generator of calcium and should be recognized as good low-calorie nutritional calcium supplements ( 43 ). The beneficial effects of calcium-rich mineral water on bone mineralization is widely demonstrated. A study conducted by Costi et alabama. on 255 women shows that using regularly water rich in calcium improves the average spur mineral concentration ( 44 ). like results was shown in the study of Aptel that included 4434 women over 75 years of old age. An increase of 100 mg/day in calcium from drinking water was associated to a 0.5 % increase in femoral cram concentration ( 45 ). european Food Safety Agency ( EFSA ) recognized the Health call on calcium ‘ is crucial for the development of bones ’ and in this prospective calcium-rich mineral waters may be consumed as ‘ functional foods ’ ( 46 ) .

“Magnesiac mineral waters”

Magnesiac mineral waters are characterized by magnesium as the essential part. This water may be utilitarian in obstetric-gynecologic pathologies : pre-menstrual syndrome, climaterium and postmenopausal osteoporosis ( 3 ). magnesium may be combined with other minerals. Magnesium sulfate mineral waters improves intestine serve, in terms of reduction of constipation, improvement in the stultification symptoms and overall intestine movements ( 32 ). In vitro studies demonstrated that magnesium sulfate may act as a cathartic by increasing the aquaporin 3 ( AQP3 ) expression level and by changing osmotic blackmail in the colon ( 47 ). Sulphate-bicarbonate-calcium-magnesiac mineral waters proved to have therapeutic activity in the functional disorders of the bilious tract. high magnesium message favors the Oddi sphincter relaxation and allows the bile flowing, improving biliary ducts activeness ( 33 ). Results from a recent meta-analysis prove that in european population, ( in particular in scandinavian population ), high levels of magnesium in drink water system may reduce the risk of Coronary Heart Disease ( CHD ) deathrate ( 48 ) .

“Fluorurate mineral waters”

mineral waters with fluoride may be indicated for children, because they can reduce the incidence of decay and promote cram mineralization. however, fluorurate mineral water system consumption has to be maintained low ( 49 ). The concerns about high fluoride consumption are related to their possible carcinogenic effect, but actually the results of epidemiologic and animal models studies show that fluorurate mineral urine is not directly associated to cancer hazard ( 50, 51 ). high fluorurate mineral water consumption may have some toxic effects : from dental fluorosis to bony fluorosis, if fluoride inhalation is above than 10 mg/L ( 49 ). For this reason, the european Food Safety Agency ( EFSA ) established fluoride upper limit of exposure to 1,5 mg/L/die ( 52 ). This respect limit is confirmed besides by World Health Organization ( 53 ) .

“Ferrous mineral waters”

There are two principal types of ferric waters : sulphate-ferrous/ferric waters and bicarbonate ferric waters. The sulphate-ferrous/ferric waters are very concentrated and are arsenic-rich. The ph is very gloomy for the presence of sulfate and phosphate acids. The bicarbonate-ferrous waters are arsenic-poor, the ph is of about 6 and they have important hematopoietic properties ( 15 ). They are indicated in iron-deficiency anemia and they are besides recommended for fraught women, specifically in the discussion of anemia ( 54 ). In fact, the bioavailability of iron in this water is very high due to the presence of other trace elements : copper, zinc, manganese, lithium and aluminum ( 4 ). furthermore, they demonstrated beneficial remedy effects on specific chronic phloglosis of the upper respiratory tract ( 55 ) .

“Sodium-rich mineral waters”

Sodium-rich mineral waters are characterized by the presence of sodium as the main cation, that can be associated to unlike anions. The refer about the consumption of this water and the association with high blood pressure is reasonable when sodium is bound to chloride. In this case, they are not recommended to subjects suffering for cardiovascular diseases ( CVD ) ( 4 ). Although few are the studies that investigate bicarbonate sodium-rich mineral urine properties, some report health effects of this water. Schoppen et alabama. reputation that in post-menopausal women bicarbonate sodium-rich mineral body of water may be protective against CVD risk ( 26 ) and may increase insulin sensitivity ( 56 ). An animal analyze investigated the likely character of hypersaline sodium-rich naturally sparkling mineral water in the protection against Metabolic Syndrome ( MS ) : in an environmental exemplar for MS, the intake of sodium-rich water demonstrated to maintain low some parameters normally involved in the MS development ( as insulin, leptin, aldosterone, melatonine ) ( 57 ) .

Conclusions

The concerns about bottle mineral water are related to the spill of chemicals from bottles to water. Among these are the plasticizers, like the Di ( 2-ethylexyl ) phthalate ( DEHP ) that is wide used as plasticizer and is besides present in PET bottles ( 11 ). Polyethylene terephthalate ( PET ) is a material chemical inactive, but some in vitro studies proved that repositing conditions ( like exposure to sunlight and high temperature ) may contribute to the release of chemicals from bottles to water ( 32, 58, 59 ). The EDs defend another crucial issue for bottle urine. Some in vitro studies investigated the exposure to chemicals with estrogen-like natural process in bottle mineral water. Pinto et alabama. analyzed 30 samples of nine italian mineral waters, stored in PET bottles, and the results show that 90 % of samples elicited an estrogenic bodily process lower than 10 % of the activity induced by the address model ( 12 ). On the contrary, analysis on german mineral water, stored in PET, glass and TetraPak bottles, demonstrate a significantly elevated estrogenic activity in 12 of 20 brands ( 60 ). In an update study, bioanalytical techniques and in vivo experiments with molluskan mannequin are used to determine the estrogenicity of bottle water. The estrogenic action of bottle water shape PET containers is approximately twice compared to products from glass bottles ( 61 ). The release of estrogenic compounds from fictile fabric has been investigated besides for tap water, that is distributed through credit card pipes. The summarize results show that the migration of 2,4-di-tert-butylphenol ( 2,4-d-t-BP ) from fictile pipes could result in chronic vulnerability and the migration levels varied greatly among different plastic pipe materials and manufacturing brands ( 62 ). It is not demonstrated if the concerns about bottle water determine water intake. however, nowadays, Mediterranean countries population, as Italy, Spain and France prove to be below the EFSA Allowance Intake ( AI ) for sum Water Intake ( TWI ) ( 63 – 65 ). besides US population is far from the Recommended Allowance for water inhalation, both in males and in females ( 66 ). Studies prove that socio-economic condition influence the consumption of water as a beverage : adults with higher incomes consumed more body of water as a beverage than adults with lower incomes ( 65, 66 ). adequate water inhalation, and specially drinking natural mineral water system, is associated with higher diet quality : in France, women with the largest consumption of drink water consumption had higher diet quality and less department of energy dense diets, besides thanks to healthier food choices ( for example, more fruits and vegetables and fewer sweets ). furthermore, the study in french population demonstrated that micronutrients intake is positively associated to the body of water inhalation ( 65 ). The National Health and Nutrition Examination Study in US besides documented a incontrovertible association of total water, plain water and moisture in foods with dietary and serum minerals, vitamins and carotenoids ( 67 ). natural mineral waters are characterized by specific mineral content and are classified on the basis of the main elements that compose them. several Authors explored the properties and health effects of mineral waters, sometimes through not update studies or with gloomy number of subjects. Gastrointestinal arrangement results to be stimulated by natural mineral waters. In particular, bicarbonate and chloride mineral waters proved to have positive effects for gastric routine. Animal and in vivo studies on an italian bicarbonate mineral water system show its character in neutralising acidic secretion, increasing ph flat in the gastric lumen and stimulating the spill of digestive hormones ( 21 ). Chloride mineral waters are chiefly used for hydropinic therapy, stimulating gastric empty and gastro-duodenal peristalsis ( 35 ). Bowel serve results to be promoted by sulfate and magnesium mineral waters, in terms of reduction of constipation, improvement in the constipation symptoms and overall intestine movements ( 31, 32 ). Biliary nerve pathway functionality is favored by a more complex mineral system, as the sulphate-bicarbonate-calcium-magnesiac mineral water, that is particularly efficient thanks to elective anions that exert choleresis and cholagogue actions, helping to remove the gall-bladder hypomotility and to correct the tendency to biliary sludge. high magnesium content favors the Oddi sphincter liberalization and allows the bile flowing, improving biliary ducts activeness ( 33 ). In iron-deficiency anemia and in the treatment of anemia for fraught woman, ferric waters are highly recommended ( 54 ). mineral waters with fluoride may be indicated for children, because they can reduce the incidence of decay and promote bone mineralization. however, fluorurate mineral water system consumption has to be maintained abject ( 49 ). bony health and bone mineralization need a regular calcium intake and calcic mineral waters represent an crucial dietary beginning of calcium and should be recognized as good low-calorie nutritional calcium supplements ( 43 ). The calcium bioavailability of mineral waters has been investigated by different Authors and it is demonstrated that calcium from mineral waters is bioavailable as dairy products, sometimes besides more than milk ( 37, 42 ). furthermore, calcium-rich mineral waters increase bone mineralization, considering both femoral and spinal bone mineral density after calcic waters intake ( 44, 45 ). EFSA identified calcium with the health claim ‘ is authoritative for the development of bones ’ and calcium-rich mineral waters may be recognised as ‘ functional foods ’ ( 46 ).

Emerging studies on CVD report that bicarbonate mineral water may have health effects on cardiometabolic hazard biomarkers ( reducing particularly total-cholesterol, fasting glucose and LDL-cholesterol ) ( 25 ) and, compared to abject mineral waters, sodium-bicarbonate waters decrease post-prandial lipemia and aldosterone levels ( 28 ). The capacity of reducing lipemia after meals may be associated to the capability of lowering increase in cholecystokinin concentration and lowering gallbladder emptying, which may limit the free of biliary salts into the duodenum and consequently reduce postprandial lipemia ( 29 ), particularly the plasma triglyceride ( VLDL triglyceride and chylomicron triglyceride ) ( 30 ). furthermore, Schoppen et aluminum. report that in post-menopausal women bicarbonate sodium-rich mineral water system may be protective against CVD gamble ( 26 ) and may increase insulin sensitivity ( 56 ). A holocene meta-analysis, rather, demonstrated that in european population, ( in particular in scandinavian population ) senior high school levels of magnesium in drink in body of water may reduce the risk of Coronary Heart Disease ( CHD ) mortality ( 48 ). metabolic Syndrome ( MS ) is an increasing burden and the pulmonary tuberculosis mineral waters may help to prevent it. An animal study investigated the potential function of hypersaline sodium-rich naturally sparkling mineral urine in the protection against MS : in an environmental model for MS, the inhalation of sodium-rich water demonstrated to maintain abject some parameters normally involved in the MS exploitation ( as insulin, leptin, aldosterone, melatonine ) ( 57 ). In conclusion, natural mineral waters represent a valid option in everyday life to satisfy water needs of body and, because of their documented characteristics ( about mineral composition and health benefits ), they may be consume in different physiologic and diseased conditions. however, other studies could be useful to understand the biochemical pathways involved in health effects of lifelike mineral waters .