Validation of a urine color scale for assessment of urine osmolality in healthy children

Stavros A. Kavouras, Evan C. Johnson, Dimitris Bougatsas, Giannis Arnaoutis, Demosthenes B. Panagiotakos, Erica Perrier, Alexis Klein

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


Aim: Urine color (UC) is a practical tool for hydration assessment. The technique has been validated in adults, but has not been tested in children. Purpose: The purpose of the study was to test the validity of the urine color scale in young, healthy boys and girls, as a marker of urine concentration, investigate its diagnostic ability of detecting hypohydration and examine the ability of children to self-assess UC. Methods: A total of 210 children participated (age: 8–14 years, body mass: 43.4 ± 12.6 kg, height: 1.49 ± 0.13 m, body fat: 25.2 ± 7.8 %). Data collection included: two single urine samples (first morning and before lunch) and 24-h sampling. Hydration status was assessed via urine osmolality (UOsmo) and UC via the eight-point color scale. Results: Mean UC was 3 ± 1 and UOsmo 686 ± 223 mmol kg−1. UC displayed a positive relationship as a predictor of UOsmo (R2: 0.45, P < 0.001). Based on the receiver operating curve, UC has good overall classification ability for the three samples (area under the curve 85–92 %), with good sensitivity (92–98 %) and specificity (55–68 %) for detecting hypohydration. The overall accuracy of the self-assessment of UC in the morning or the noon samples ranged from 67 to 78 %. Further threshold analysis indicated that the optimal self-assessed UC threshold for hypohydration was ≥4. Conclusions: The classical eight-point urine color scale is a valid method to assess hydration in children of age 8–14 years, either by researchers or self-assessment.

Original languageEnglish (US)
Pages (from-to)907-915
Number of pages9
JournalEuropean Journal of Nutrition
Issue number3
StatePublished - Apr 1 2016
Externally publishedYes


  • Children
  • Dehydration
  • Hydration assessment
  • Hydration status
  • Hypohydration markers

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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