Effects of Ammonia and Density on Filtering of Commensal and Pathogenic <Emphasis Type="Italic">Escherichia coli</Emphasis> by the Cladoceran <Emphasis Type="Italic">Daphnia magna</Emphasis>

Grazing by cladocerans can reduce the survival of enteric bacteria associated with fecal pollution. This study examined the potential of Daphnia magna to filter commensal and pathogenic Escherichia coli of human origin. Grazing on commensal and pathogenic bacteria was comparable, but slightly greater at 20 compared to 15 and 25°C. Filtering activity was strongly dependent on D. magna and E. coli densities at environmentally relevant bacterial concentrations. Maximum feeding rates were >10⁷ cells h^?1 daphnid^?1, clearance rates were 1–6 mL h^?1 daphnid^?1, and filtering was independent of bacterial cell sizes between 0.7 and 1.8 µm. Filtering and ingestion of E. coli by D. magna was susceptible to acute inhibition by unionized ammonia with a 24 h EC50 of 0.18 mg L^?1 NH₃–N, and a LOEC of 0.09 mg L^?1 NH₃–N. The study indicated that biological and chemical constraints should be considered when applying Daphnia for attenuation of fecal pollution.     

<Emphasis Type="Italic">van</Emphasis>A Gene Harboring Enterococcal and Non-enterococcal Isolates Expressing High Level Vancomycin and Teicoplanin Resistance Reservoired in Surface Waters

Untreated wastewaters and treated effluents even after final disinfection contain antibiotic resistant bacteria and resistance genes before they are released into surface waters. A correlation between resistant bacteria and antibiotics in surface waters has been found, as have antibiotic resistance genes. Of particular interest are vancomycin-resistant enterococci harboring vanA gene that confers high level of resistance to glycopeptide antibiotics including teicoplanin. Therefore, in this study, river water samples were analysed to investigate vancomycin- and teicoplanin-resistant bacterial isolates harboring vanA gene. Out of 290, 15 surface water isolates displayed resistance to both antibiotics. These glycopeptide resistant enterococcal and non-enterococcal isolates, identified by 16S rRNA sequencing, were found to harbor vanA gene with sequence similarities of 50?% to 100?%. The presence of d-alanine-d-lactate ligase encoded by vanA gene was also shown for all vancomycin- and teicoplanin-resistant isolates through western blot analysis. Due to reuse of treated wastewater and release of untreated wastewaters to water bodies, antibiotic resistant bacteria and resistance genes are being introduced into surface waters and present human health risks. Therefore, surface waters are not only hot spots for vanA harboring enterococcal isolates but also non-enterococcal isolates due to gene dissemination and require special scientific consideration.     

Prevalence of childhood diarrhea and associated risk factors in Dire Dawa,eastern Ethiopia

Aim

Childhood diarrhea caused by enteric bacteria remains an important public health problem in the developing countries. Therefore, this study aimed to determine the prevalence of childhood diarrhea, etiological agents, antibiotic susceptibility patterns and associated risk factors in Eastern Ethiopia.

Subjects and methods

A total of 196 children under the age of 5 years with diarrhea were chosen for the study. Stool specimens were collected for the isolation of bacterial agents and their antibiotic susceptibility pattern using standard methods. Analysis of data was done using SPSS version 16.

Results

The overall prevalence of enteric bacteria observed in this study was 21.9%. The bacterial isolates identified were Escherichia coli (12.8%), Shigella species (5.6%) and Salmonella species (3.6%). Children using an unprotected spring/well source for their water supply were more likely to be infected with diarrhea-causing bacteria (AOR = 4.74, 95% CI: 1.48,15.13). None of the bacterial isolates showed resistance to ceftriaxone, while resistance to amoxicillin was observed for Shigella (100%), Salmonella (85.7%) and E. coli (56%) isolates. Resistance to ampicillin was found to be 90.9%, 71.4% and 52% for Shigella, Salmonella and E. coli isolates. All Shigella isolates were found to be multidrug resistant.

Conclusion

Interventions aimed to improve safe drinking water access should be strengthened/considered in the study area.

     

Evaluation of the Sensitivity of Freshwater Organisms Used in Toxicity Tests of Wastewater from Explosives Company

Explosives industries are a source of toxic discharge. The aim of this study was to compare organisms sensitivity (Daphnia similis, Danio rerio, Escherichia coli and Pseudomonas putida) in detecting acute toxicity in wastewater from two explosives, 2,4,6-TNT (TNT) and nitrocellulose. The samples were collected from an explosives company in the Paraiba Valley, São Paulo, Brazil. The effluents from TNT and nitrocellulose production were very toxic for tested organisms. Statistical tests indicated that D. similis and D. rerio were the most sensitive organisms for toxicity detection in effluents from 2,4,6-TNT and nitrocellulose production. The P. putida bacteria was the organism considered the least sensitive in indicating toxicity in effluents from nitrocellulose.     

Phytoremediation Potential of <Emphasis Type="Italic">Saccharina japonica</Emphasis> and <Emphasis Type="Italic">Sargassum horneri</Emphasis> (Phaeophyceae): Biosorption Study of Strontium

Strontium (Sr) is an important nuclide in nuclear polluted seawater. Algal biosorption is regarded as an efficient and cost-effective way to scavenge detrimental metal ions of low concentration from polluted waters. In this study, we selected two algal species (Saccharina japonica and Sargassum horneri) through comparing background Sr contents in six algal species and explored their potential to scavenge Sr of low concentration from seawater in culture conditions. It was found that biosorption of Sr in S. japonica and S. horneri increased in response to increased Sr concentrations in the seawater and S. horneri adsorbed more Sr than S. japonica. The equilibrium established in their biosorption process follows both Langmiur and Freundlich equations well. The Sr biosorption process of S. horneri fits the pseudo-second-order kinetic model well, implying that adsorption was the rate-limiting step of the biosorption process. Results suggest S. japonica and S. horneri could become efficient biosorbents for in situ scavenging Sr from nuclear polluted seawater.     

Indication of Risk of Mother-to-Child <Emphasis Type="Italic">Toxoplasma gondii</Emphasis> Transmission in the Greater Accra Region of Ghana

Objectives Congenital infection with Toxoplasma gondii is known to result in neurological and brain disorders including ophthalmic disorders later in life. Research in Ghana revealed high sero-prevalence among pregnant women and eye patients. This study determines the risk of congenital transmission of T. gondii infection in Accra, Ghana. Methods One hundred consented pregnant women aged 18–45 years (mean 29.85 ± 5.76) participated. Venous blood and tissue samples were taken from the maternal side of each placenta after delivery. Cord blood samples were also taken after they were separated from the infants. Finger-prick blood was taken from infants of participating women at 2 or 6 weeks post-natal. ELISA was used to detect T. gondii antibodies in all blood samples while Nested-PCR was used to detect T. gondii DNA from placental tissues. Data was analysed using SPSS v. 16. Results Overall, 37.6 % of maternal blood, 39.5 % of umbilical cord blood, and 57.5 % of post-natal infant blood were positive for anti-T. gondii IgG. No anti-T. gondii IgM was detected in any of those samples. Toxoplasma gondii DNA was detected in 39.8 % of placental tissue samples. Strong association was observed in the occurrence of placental T. gondii DNA and anti-T. gondii IgG positive women (ø = 0.810, p < 0.00001) as well as high Relative risk shown in the likelihood of foetal exposure to infection in latently-infected women (RR 10.39; CI 4.47–24.17; p < 0.00001). Conclusions for Practice The presence of anti-T. gondii IgG antibodies only, and T. gondii DNA in placental tissues indicate the women might have been infected early during the pregnancy, placing about 39.8 % of the babies at risk. These results can strongly influence policy to screen and treat pregnant women for T. gondii infection.     

Prävalenz der E.-coli-Antibiotikaresistenz in der Allgemeinbevölkerung

The continued increase of antimicrobial resistance reduces therapeutic options in the treatment of infectious diseases and leads to high costs in the public health system. To assess the spread of antibiotic resistant fecal Escherichia coli in the general population, stool samples of patients attending three general practitioners in the region of Ulm, Germany, were investigated. Patient risk factors for the development of antibiotic resistance were also analysed. We found that the proportion of resistant isolates in the general population was much lower than is reported for patients treated in university hospitals. The main risk factor to acquire E. coli strains with antibiotic resistance was the present but not the previous use of antibiotics. Patients who had undergone hospitalisation in the 12 month time period before our investigation showed a higher prevalence of resistant E. coli than patients without a previous stay in a hospital. The consumption of meat, daily or at least once a week, did not result in a higher prevalence of resistance.     

Distribution of <Emphasis Type="Italic">Aeromonas</Emphasis> species in environmental water used in daily life in Okinawa Prefecture,Japan

Objectives

The genus Aeromonas is known to causes diseases such as food poisoning, sepsis, and wound infection. However, the mode of Aeromonas transmission from environment to humans is not clearly understood. To evaluate the health risks of Aeromonas spp. in environmental freshwater, the number, proportion and putative virulence factors of Aeromonas species were investigated in Okinawa Prefecture, Japan.

Methods

Environmental freshwater samples were collected from three dams, two springs and three private wells. Aeromonas strains were identified by the biochemical method and the viable count was calculated. The production of extracellular enzymes and the virulence genes were investigated for possessing putative virulence factors using representative isolates.

Results

At least seven species of already-known Aeromonas isolates as well as unidentified Aeromonas spp. with/without arginin dehydrolase (ADH) exist in water at these sites. Aeromonas spp. was found to exist at over 1000 CFU/100 ml in one spring and two wells. A. veronii biovar sobria and A. jandaei were the predominant species in dams, and A. hydrophila and/or A. eucrenophila were predominant in wells. Almost all the sampled Aeromonas species produced protease, gelatinase, lipase, esterase and DNase, but A. caviae, A. caviae-like bacteria, and A. eucrenophila had low hemolytic activity. Most sampled A. hydrophila strains possessed both aerolysin gene (aer) and hemolysin gene (hlyA), but A. caviae and A. eucrenophila strains did not possess either gene.

Conclusions

Since these results indicated that several Aeromonas species having potential pathogenicity exist in environmental water in Okinawa, surveys are recommended as a public health measure.

     

<Emphasis Type="Italic">Trichomonas vaginalis</Emphasis> infection and the diagnostic significance of detection tests among Ghanaian outpatients

Background

There is little data on Trichomonas vaginalis infection in Ghana. This study evaluated the prevalence of trichomoniasis using different diagnostic methods and determined the risk factors for infection in patients.

Methods

A structured questionnaire was administered. Vaginal swabs, urethral swabs and urine specimens were obtained from consenting patients; and the samples processed following standard protocols. The presence of T. vaginalis was determined using wet mount microscopy and polymerase chain reaction (PCR) as gold standard. We also assessed the diagnostic performance the JD’s Trichomonas V® rapid antigen test to inform clinical practice.

Results

The PCR assay detected T. vaginalis positivity in 64 of 150 patients (42.6, 95%CI:35.0, 50.6) including all positive samples of wet mount microscopy and JD’s Trichomonas V® test. Wet mount microscopy showed low sensitivity (31.6%), high specificity (100%), moderate positive predictive value (75.0%), moderate positive likelihood ratio (3.0), and weak agreement (Cohen’s kappa, 0.283) with PCR assay. The JD’s Trichomonas V® test displayed lower sensitivity (25.0%), specificity (83.3%), and weaker measure of agreement (Cohen’s kappa, 0.233) with PCR. In multivariate analysis, the strongest independent predictor for T. vaginalis was female gender [adjusted odds ratio (AOR), 24.89; 95% confidence interval (CI): 10.58, 51.21; P-value<?0.001]. Knowledge of STI showed a protective effect against infection with the parasite (AOR, 0.13; 95%CI: 0.07, 0.29; P-value<?0.017).

Conclusion

The sensitivity of wet mount microscopy was low for T. vaginalis screening in our region. The JD’s Trichomonas V® test should not be considered as an alternative test. We recommend mandatory PCR assay for confirmation of negative wet mount results.

     

Effects of <Emphasis Type="Italic">Dracontomelon duperreanum</Emphasis> Leaf Litter on the Growth and Photosynthesis of <Emphasis Type="Italic">Microcystis aeruginosa</Emphasis>

This study investigated the use of Dracontomelon duperreanum leaf litter extract (DDLLE) in inhibiting the growth and photosynthesis of the algae Microcystis aeruginosa. The goal of the study was to evaluate a potential solution for cyanobacterial bloom prevention. M. aeruginosa was exposed to extract concentrations from 0.4 to 2.0 g L^?1. Chlorophyll-a (Chl-a) content and photosynthesis levels were assessed using pulse amplitude modulated fluorimetry phytoplankton analyzer. Results suggested that the extract could efficiently suppress M. aeruginosa growth. The content of Chl-a was only 19.0 µg L^?1 and achieved 96.0% inhibition rate when exposed to 2.0 g L^?1 on day 15. Growth rate in response to different extract concentrations were consistent with changes in the photosynthesis efficiency (alpha), maximal relative electron transport rate and maximal photochemical efficiency of photosystem II (F _v /F _m ). Furthermore, several kinds of volatile chemicals and their concentrations in DDLLE had been identified by GC–MS, which of them play major role to suppress the growth of M. aeruginosa should be further studied.     

Microcystin Bioaccumulation in Freshwater Fish at Different Trophic Levels from the Eutrophic Lake Chaohu,China

The spatial and temporal variations of microcystins (MCs) in fishes with different trophic levels were studied monthly in Lake Chaohu in 2014. MCs content in muscle was highest in phytoplanktivorous Hypophthalmichthys molitrix (H. molitrix), followed by omnivorous Carassius auratus (C. auratus), and was lowest in herbivorous Parabramis pekinensis (P. pekinensis) and carnivorous Coilia ectenes (C. ectenes). MCs concentration in liver was highest in C. auratus, followed by H. molitrix, and was lowest in P. pekinensis and C. ectene. The main uptake routes of MCs for C. auratus and H. molitrix were via the diet. The mechanism to counteract MCs had not been well developed in C. ectenes. H. molitrix and C. auratus from the western region as they had higher mean concentrations of MCs than fishes from the eastern region. The estimated daily intakes of MCs in 45.4% of muscle samples were higher than the provisional tolerable daily intake set by WHO.     

Arbuscular Mycorrhizal Fungi Favor the Initial Growth of <Emphasis Type="Italic">Acacia mangium,Sorghum bicolor</Emphasis>, and <Emphasis Type="Italic">Urochloa brizantha</Emphasis> in Soil Contaminated with Zn,Cu, Pb,and Cd

This study evaluated the effect of inoculation with a mixture of spores of arbuscular mycorrhizal fungi (AMF) (Glomus macrocarpum, Paraglomus occultum, and Glomus sp.) on the initial establishment of Acacia mangium, Sorghum bicolor, and Urochloa brizantha in soil contaminated with heavy metals. The experiment was conducted in a greenhouse, in plastic pots containing 1.8 kg of soil, which presented 7200, 1140, 480, and 72 mg of Zn, Cu, Pb, and Cd, respectively. The chlorophyll content (SPAD index) of inoculated plants of A. mangium and U. brizantha was higher than those of non-inoculated plants (p?<?0.05). No differences were detected for the concentration of heavy metals in plant shoots, whether the plant was inoculated or not. However, inoculated plants had greater root length (S. bicolor and U. brizantha) (p?<?0.05) and greater plant height (A. mangium) (p?<?0.05). The present results demonstrate that the beneficial effects of AMF on plant growth and the alleviation of contaminants are imperative factors for the rehabilitation of soils contaminated with heavy metals.     

<Emphasis Type="Italic">AMP!</Emphasis>: A Cross-site Analysis of the Effects of a Theater-based Intervention on Adolescent Awareness,Attitudes, and Knowledge about HIV

AMP! (Arts-based, Multiple component, Peer-education) is an HIV intervention developed for high school adolescents. AMP! uses interactive theater-based scenarios developed by trained college undergraduates to deliver messages addressing HIV/STI prevention strategies, healthy relationships, and stigma reduction towards people living with HIV/AIDS. We used a pre-test/post-test, control group study design to simultaneously assess intervention effect on ninth grade students in an urban county in California (N?=?159) and a suburban county in North Carolina (N?=?317). In each location, the control group received standard health education curricula delivered by teachers; the intervention group received AMP! in addition to standard health education curricula. Structural equation modeling was used to determine intervention effects. The post-test sample was 46 % male, 90 % self-identified as heterosexual, 32 % reported receiving free or reduced lunch, and 49 % White. Structural models indicated that participation in AMP! predicted higher scores on HIV knowledge (p?=?0.05), HIV awareness (p?=?0.01), and HIV attitudes (p?=?0.05) at the post-test. Latent means comparison analyses revealed post-test scores were significantly higher than pre-test scores on HIV knowledge (p?=?0.001), HIV awareness (p?=?0.001), and HIV attitudes (p?=?0.001). Further analyses indicated that scores rose for both groups, but the post-test scores of intervention participants were significantly higher than controls (HIV knowledge (p?=?0.01), HIV awareness (p?=?0.01), and HIV attitudes (p?=?0.05)). Thus, AMP!’s theater-based approach shows promise for addressing multiple adolescent risk factors and attitudes concerning HIV in school settings.     

Bioaccumulation of Uranium and Thorium by <Emphasis Type="Italic">Lemna minor</Emphasis> and <Emphasis Type="Italic">Lemna gibba</Emphasis> in Pb-Zn-Ag Tailing Water

This study focused on the ability of Lemna minor and Lemna gibba to remove U and Th in the tailing water of Keban, Turkey. These plants were placed in tailing water and individually fed to the reactors designed for these plants. Water and plant samples were collected daily from the mining area. The plants were ashed at 300°C for 1 day and analyzed by ICP-MS for U and Th. U was accumulated as a function of time by these plants, and performances between 110?% and 483?% for L. gibba, and between 218?% and 1194?% for L. minor, were shown. The highest Th accumulations in L. minor and L. gibba were observed at 300?% and 600?% performances, respectively, on the second day of the experiment. This study indicated that both L. gibba and L. minor demonstrated a high ability to remove U and Th from tailing water polluted by trace elements.     

Variations in the structure of airborne bacterial communities in Tsogt-Ovoo of Gobi desert area during dust events

Asian dust events transport the airborne bacteria in Chinese desert regions as well as mineral particles and influence downwind area varying biological ecosystems and climate changes. However, the airborne bacterial dynamics were rarely investigated in the Gobi desert area, where dust events are highly frequent. In this study, air samplings were sequentially performed at a 2-m high above the ground at the sampling site located in desert area (Tsogt-Ovoo of Gobi desert; Mongolia 44.2304°N, 105.1700°E). During the dust event days, the bacterial cells and mineral particles increased to more than tenfold of concentrations. MiSeq sequencing targeting 16S ribosomal DNA revealed that the airborne bacteria in desert area mainly belonged to the classes Acidobacteria, Actinobacteria, Bacteroidetes, Chloroflexi, Bacilli, Alpha-proteobacteria, Beta-proteobacteria, and Gamma-proteobacteria. The bacterial community structures were different between dust events and non-dust events. The air samples collected at the dust events indicated high abundance rates of Alpha-proteobacteria, which were reported to dominate on the leaf surfaces of plants or in the saline lake environments. After the dust events, the members of Firmicutes (Bacilli) and Bacteroidetes, which are known to form endospore and attach with coarse particles, respectively, increased their relative abundances in the air samples. Presumably, the bacterial compositions and diversities in atmosphere significantly vary during dust events, which carry some particles from grassland (phyllo-sphere), dry lake, and sand surfaces, as well as some bacterial populations such as Firmicutes and Bacteroidetes maintain in the atmosphere for longer time.     

<Emphasis Type="Italic">Enterococcus hirae</Emphasis> biofilm formation on hospital material surfaces and effect of new biocides

Background

Nowadays, the bacterial contamination in the hospital environment is of particular concern because the hospital-acquired infections (HAIs), also known as nosocomial infections, are responsible for significant morbidity and mortality. This work evaluated the capability of Enterococcus hirae to form biofilm on different surfaces and the action of two biocides on the produced biofilms.

Methods

The biofilm formation of E. hirae ATCC 10541 was studied on polystyrene and stainless steel surfaces through the biomass quantification and the cell viability at 20 and 37 °C. The effect of LH IDROXI FAST and LH ENZYCLEAN SPRAY biocides on biomasses was expressed as percentage of biofilm reduction. E. hirae at 20 and 37 °C produced more biofilm on the stainless steel in respect to the polystyrene surface. The amount of viable cells was greater at 20 °C than with 37 °C on the two analyzed surfaces. Biocides revealed a good anti-biofilm activity with the most effect for LH ENZYCLEAN SPRAY on polystyrene and stainless steel at 37 °C with a maximum biofilm reduction of 85.72 and 86.37%, respectively.

Results

E. hirae is a moderate biofilm producer depending on surface material and temperature, and the analyzed biocides express a remarkable antibiofilm action.

Conclusion

The capability of E. hirae to form biofilm can be associated with its increasing incidence in hospital-acquired infections, and the adoption of suitable disinfectants is strongly recommended.

     

Relationships of alcohol dehydrogenase 1B (<Emphasis Type="Italic">ADH1B</Emphasis>) and aldehyde dehydrogenase 2 (<Emphasis Type="Italic">ALDH2</Emphasis>) genotypes with alcohol sensitivity,drinking behavior and problem drinking in Japanese older men

Objectives

Many East Asians have the genetic polymorphisms rs1229984 in alcohol dehydrogenase 1B (ADH1B) and rs671 in aldehyde dehydrogenase 2 (ALDH2). Here we analyzed the relationships of the two genotypes with alcohol sensitivity, drinking behavior and problem drinking among older and younger men living in rural areas of Japan.

Methods

The subjects were 718 Japanese men aged 63.3 ± 10.8 (mean ± SD), categorized into the older (≥65 years, n = 357) and younger (<65 years, n = 361) groups. Facial flushing frequency, drinking behavior and positive CAGE results were compared among the genotypes using Bonferroni-corrected χ² test and a multivariate logistic regression analysis adjusting for age, BMI and lifestyle factors.

Results

The frequency of ‘always’ facial flushing among the ADH1B*1/*2 carriers was significantly lower than that among the ADH1B*2/*2 carriers in the older group (P < 0.01). The alcohol consumption (unit/day) in the ADH1B*1/*2 carriers tended to be higher compared with that in the ADH1B*2/*2 carriers among the older group (P = 0.050). In the younger group, no significant differences in alcohol sensitivity and drinking habits were generally found among the ADH1B genotypes. The ADH1B*1/*1 genotype tended to be positively associated with problem drinking in the older group (P = 0.080) but not in the younger group. The ALDH2 genotypes consistently and strongly affected the alcohol sensitivity, drinking behavior and problem drinking in both the younger and older group.

Conclusions

We for the first time observed a significant difference in alcohol sensitivity between ADH1B*1/*2 and ADH1B*2/*2 in older men aged 65 and above.

     

Allelopathic Effects of <Emphasis Type="Italic">Myriophyllum aquaticum</Emphasis> on Two Cyanobacteria of <Emphasis Type="Italic">Anabaena flos-aquae</Emphasis> and <Emphasis Type="Italic">Microcystis aeruginosa</Emphasis>

Allelopathy has been proposed as a sustainable means to control undesired algal growth and to reduce blooms threatening freshwater systems worldwide. In this study, the allelopathic effects of Myriophyllum aquaticum and its exudate on two typical bloom-forming cyanobacteria, Microcystis aeruginosa and Anabaena flos-aquae, were investigated under laboratory conditions. The growth of the cyanobacteria was strongly inhibited by live M. aquaticum while the primary addition of M. Aquaticum exudates had a significant inhibitory effect on the growth of M. aeruginosa but not A. flos-aquae. The results suggested that the persistent release of allelochemicals from live M. aquaticum was needed to effectively constrain the growth of A. flos-aquae. Analysis of cyanobacterial physiological indexes indicated that M. aquaticum produced an inhibitory effect on SOD enzyme activity of A. flos-aquae, while it affected membrane lipid peroxidation in M. aeruginosa. The results show the potential of M. aquaticum to mitigate cyanobacterial blooms in coexistence systems.     

Fluid intake patterns of children and adolescents: results of six Liq.In<Superscript>7</Superscript> national cross-sectional surveys

Purpose

This study aimed to identify and characterize patterns of fluid intake in children and adolescents from six countries: Argentina, Brazil, China, Indonesia, Mexico and Uruguay.

Methods

Data on fluid intake volume and type amongst children (4–9 years; N?=?1400) and adolescents (10–17 years; N?=?1781) were collected using the validated 7-day fluid-specific record (Liq.In⁷ record). To identify relatively distinct clusters of subjects based on eight fluid types (water, milk and its derivatives, hot beverages, sugar-sweetened beverages (SSB), 100% fruit juices, artificial/non-nutritive sweetened beverages, alcoholic beverages, other beverages), a cluster analysis (partitioning around k-medoids algorithm) was used. Clusters were then characterized according to their socio-demographics and lifestyle indicators.

Results

The six interpretable clusters identified were: low drinkers–SSB (n 523), low drinkers–water and milk (n 615), medium mixed drinkers (n 914), high drinkers–SSB (n 513), high drinkers–water (n 352) and very high drinkers–water (n 264). Country of residence was the dominant characteristic, followed by socioeconomic level, in all six patterns.

Conclusions

This analysis showed that consumption of water and SSB were the primary drivers of the clusters. In addition to country, socio-demographic and lifestyle factors played a role in determining the characteristics of each cluster. This information highlights the need to target interventions in particular populations aimed at changing fluid intake behavior and improving health in children and adolescents.