Amy L. McKenzie

Assessment of hydration biomarkers including salivary osmolality during passive and active dehydration

BACKGROUND/OBJECTIVES:Hydration state can be assessed via body mass change (BMΔ), serum and urine osmolality (Sosm, Uosm), urine-specific gravity (Usg) and urine volume (Uvol). As no hydration index has been shown to be valid in all circumstances, value exists in exploring novel biomarkers such as salivary osmolality (Vosm). Utilizing acute BMΔ as the reference standard, this research examined the efficacy of Sosm, Vosm, Uosm, Uvol and Usg, during passive (PAS) and active (ACT) heat exposure.SUBJECTS/METHODS:Twenty-three healthy men (age, 22±3 years; mass, 77.3±12.8 kg; height, 179.9±8.8cm; body fat, 10.6±4.5%) completed two randomized 5-h dehydration trials (36±1 °C). During PAS, subjects sat quietly, and during ACT, participants cycled at 68±6% maximal heart rate. Investigators measured all biomarkers at each 1% BMΔ.RESULTS:Average mass loss during PAS was 1.4±0.3%, and 4.1±0.7% during ACT. Significant between-treatment differences at −1% BMΔ were observed for Sosm (PAS, 296±4; ACT, 301±4 mOsm/kg) and Uosm (PAS, 895±207; ACT, 661±192 mOsm/kg). During PAS, only Uosm, Uvol and Usg increased significantly (−1 and −2% BMΔ versus baseline). During ACT, Vosm most effectively diagnosed dehydration ⩾2% (sensitivity=86%; specificity=91%), followed by Sosm (sensitivity=83%; specificity=83%). Reference change values were validated for Sosm, Usg and BMΔ.CONCLUSIONS:The efficacy of indices to detect dehydration ⩾2% differed across treatments. At rest (PAS), only urinary indices increased in concert with body water loss. During exercise (ACT), Sosm and Vosm exhibited the highest sensitivity and specificity. Sosm, Usg and BMΔ exhibited validity in serial measurements. These findings indicate hydration biomarkers should be selected by considering daily activities.

Interpreting common hydration biomarkers on the basis of solute and water excretion

Background/Objectives:This investigation evaluated 12 hydration biomarkers, to determine which represent 24-h whole-body water balance (that is, measured as water retention or clearance (WR-C) by the kidneys).Subjects/Methods:Healthy males (n=59; body mass, 75.1±7.9 kg; height, 178±6 cm; age, 22±3 years; body mass index, 23.9±2.4 kg/m2) met with a registered dietitian each morning (days 1–11) to optimize completeness and accuracy of food and fluid records, then went about ordinary daily activities. These men visited the laboratory for blood samples and collected all urine produced on days 1, 3, 6, 9 and 12. The reference standard (WR-C) was calculated using 24-h urine volume, 24-h urine osmolality, and serum osmolality (single morning venous sample).Results:Statistical regression analyses indicated that, among the 12 hydration biomarkers, only 24-h urine osmolality (r2=0.60, P<0.0001) and 24-h urine specific gravity (r2=0.52, P<0.0001) strongly predicted WR-C. The 24-h fluid intake, 24-h body mass change, 24-h urine color and 24-h urine volume were weak (P>0.05) predictors of WR-C, similar to serum osmolality and other single measurements (range of r2 values, 0.19–0.0001).Conclusions:These observations of healthy, active young men demonstrate that WR-C is strongly related to the 24-h concentration of urine, which in turn reflects the excretion of total solids in the diet. Although morning urine assessments provided information about a single time point, 24-h urine osmolality and 24-h urine specific gravity were the best predictors of 24-h body water balance.

Habitual total water intake and dimensions of mood in healthy young women

Acute negative and positive mood states have been linked with the development of undesirable and desirable health outcomes, respectively. Numerous factors acutely influence mood state, including exercise, caffeine ingestion, and macronutrient intake, but the influence of habitual total water intake remains unknown. The purpose of this study was to observe relationships between habitual water intake and mood. One hundred twenty healthy females (mean ± SD; age = 20 ± 2 y, BMI = 22.9 ± 3.5 kg⋅m(-2) ) recorded all food and fluids consumed for 5 consecutive days. Investigators utilized dietary analysis software to determine Total Water Intake (TWI; total water content in foods and fluids), caffeine, and macronutrient consumption (i.e. protein, carbohydrate, fat). On days 3 and 4, participants completed the Profile of Mood State (POMS) questionnaire, which examined tension, depression, anger, vigor, and confusion, plus an aggregate measure of Total Mood Disturbance (TMD). For comparison of mood, data were separated into three even groups (n = 40 each) based on TWI: low (LOW; 1.51 ± 0.27 L/d), moderate (MOD; 2.25 ± 0.19 L/d), and high (HIGH; 3.13 ± 0.54 L/d). Regression analysis was performed to determine continuous relationships between measured variables. Group differences (p < 0.05) were observed for tension (MOD = 7.2 ± 5.4, HIGH = 4.4 ± 2.9), depression (LOW = 4.5 ± 5.9, HIGH = 1.7 ± 2.3), confusion (MOD = 5.9 ± 3.4, HIGH = 4.0 ± 2.1), and TMD (LOW=19.0 ± 21.8, HIGH=8.2 ± 14.2). After accounting for other mood influencers, TWI predicted TMD (r(2) = 0.104; p = 0.050). The above relationships suggest the amount of water a woman consumes is associated with mood state.

An empirical method to determine inadequacy of dietary water

OBJECTIVES The physiological regulation of total body water and fluid concentrations is complex and dynamic. The human daily water requirement varies because of differences in body size, dietary solute load, exercise, and activities. Although chronically concentrated urine increases the risk of renal diseases, an empirical method to determine inadequate daily water consumption has not been described for any demographic group; instead, statistical analyses are applied to estimate nutritional guidelines (i.e., adequate intake). This investigation describes a novel empirical method to determine the 24-h total fluid intake (TFI; TFI = water + beverages + moisture in food) and 24-h urine volume, which correspond to inadequate 24-h water intake (defined as urine osmolality of 800 mOsm/kg; U800). METHODS Healthy young women (mean ± standard deviation; age, 20 ± 2 y, mass, 60.8 ± 11.7 kg; n = 28) were observed for 7 consecutive days. A 24-h urine sample was analyzed for volume and osmolality. Diet records were analyzed to determine 24-h TFI. RESULTS For these 28 healthy young women, the U800 corresponded to a TFI ≥2.4 L/d (≥39 mL/kg/d) and a urine volume ≥1.3 L/d. CONCLUSIONS The U800 method could be employed to empirically determine 24-h TFI and 24-h urine volumes that correspond to inadequate water intake in diverse demographic groups, residents of specific geographic regions, and individuals who consume specialized diets or experience large daily water turnover. Because laboratory expertise and instrumentation are required, this technique provides greatest value in research and clinical settings.

Endurance Cyclist Fluid Intake, Hydration Status, Thirst, and Thermal Sensations: Gender Differences.

This field investigation assessed differences (e.g., drinking behavior, hydration status, perceptual ratings) between female and male endurance cyclists who completed a 164-km event in a hot environment (35 °C mean dry bulb) to inform rehydration recommendations for athletes. Three years of data were pooled to create 2 groups of cyclists: women (n = 15) and men (n = 88). Women were significantly smaller (p < .001) than men in height (166 ± 5 vs. 179 ± 7 cm), body mass (64.6 ± 7.3 vs. 86.4 ± 12.3 kg), and body mass index (BMI; 23.3 ± 1.8 vs. 26.9 ± 3.4) and had lower preevent urinary indices of hydration status, but were similar to men in age (43 ± 7 years vs. 44 ± 9 years) and exercise time (7.77 ± 1.24 hr vs. 7.23 ± 1.75 hr). During the 164-km ride, women lost less body mass (-0.7 ± 1.0 vs. -1.7 ± 1.5 kg; -1.1 ± 1.6% vs. -1.9 ± 1.8% of body weight; p < .005) and consumed less fluid than men (4.80 ± 1.28 L vs. 5.59 ± 2.13 L; p < .005). Women consumed a similar volume of fluid as men, relative to body mass (milliliters/kilogram). To control for performance and anthropomorphic characteristics, 15 women were pair-matched with 15 men on the basis of exercise time on the course and BMI; urine-specific gravity, urine color, and body mass change (kilograms and percentage) were different (p < .05) in 4 of 6 comparisons. No gender differences were observed for ratings of thirst, thermal sensation, or perceived exertion. In conclusion, differences in relative fluid volume consumed and hydration indices suggest that professional sports medicine organizations should consider gender and individualized drinking plans when formulating pronouncements regarding rehydration during exercise.

Accuracy of Urine Color to Detect Equal to or Greater Than 2% Body Mass Loss in Men.

CONTEXT Clinicians and athletes can benefit from field-expedient measurement tools, such as urine color, to assess hydration state; however, the diagnostic efficacy of this tool has not been established. OBJECTIVE To determine the diagnostic accuracy of urine color assessment to distinguish a hypohydrated state (≥2% body mass loss [BML]) from a euhydrated state (<2% BML) after exercise in a hot environment. DESIGN Controlled laboratory study. SETTING Environmental chamber in a laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-two healthy men (age = 22 ± 3 years, height = 180.4 ± 8.7 cm, mass = 77.9 ± 12.8 kg, body fat = 10.6% ± 4.6%). INTERVENTION(S) Participants cycled at 68% ± 6% of their maximal heart rates in a hot environment (36°C ± 1°C) for 5 hours or until 5% BML was achieved. At the point of each 1% BML, we assessed urine color. MAIN OUTCOME MEASURE(S) Diagnostic efficacy of urine color was assessed using receiver operating characteristic curve analysis, sensitivity, specificity, and likelihood ratios. RESULTS Urine color was useful as a diagnostic tool to identify hypohydration after exercise in the heat (area under the curve = 0.951, standard error = 0.022; P < .001). A urine color of 5 or greater identified BML ≥2% with 88.9% sensitivity and 84.8% specificity (positive likelihood ratio = 5.87, negative likelihood ratio = 0.13). CONCLUSIONS Under the conditions of acute dehydration due to exercise in a hot environment, urine color assessment can be a valid, practical, inexpensive tool for assessing hydration status. Researchers should examine the utility of urine color to identify a hypohydrated state under different BML conditions.

Ultraendurance Cycling in a Hot Environment: Thirst, Fluid Consumption, and Water Balance

Abstract Armstrong, LE, Johnson, EC, McKenzie, AL, Ellis, LA, and Williamson, KH. Ultraendurance cycling in a hot environment: thirst, fluid consumption, and water balance. J Strength Cond Res 29(4): 869–876, 2015—The purpose of this field investigation was to identify and clarify factors that may be used by strength and conditioning professionals to help athletes drink adequately but not excessively during endurance exercise. A universal method to accomplish this goal does not exist because the components of water balance (i.e., sweat rate, fluid consumed) are different for each athlete and endurance events differ greatly. Twenty-six male cyclists (mean ± SD; age, 41 ± 8 years; height, 177 ± 7 cm; body mass, 81.85 ± 8.95 kg) completed a summer 164-km road cycling event in 7.0 ± 2.1 hours (range, 4.5–10.4 hours). Thirst ratings, fluid consumed, indices of hydration status, and body water balance (ingested fluid volume − [urine excreted + sweat loss]) were the primary outcome variables. Measurements were taken before the event, at designated aid stations on the course (52, 97, and 136 km), and at the finish line. Body water balance during exercise was not significantly correlated with exercise time on the course, height, body mass, or body mass index. Thirst ratings were not significantly correlated with any variable. We also observed a wide range of total sweat losses (4.9–12.7 L) and total fluid intakes (2.1–10.5 L) during this ultraendurance event. Therefore, we recommend that strength and conditioning professionals develop an individualized drinking plan for each athlete, by calculating sweat rate (milliliter per hour) on the basis of body mass change (in kilograms), during field simulations of competition.

Hydration status affects mood state and pain sensation during ultra-endurance cycling.

Abstract Laboratory-based studies indicate mild dehydration adversely affects mood. Although ultra-endurance events often result in mild to moderate dehydration, little research has evaluated whether the relationship between hydration status and mood state also exists in these arduous events. Therefore, the purpose of this study was to evaluate how hydration status affected mood state and perceptual measures during a 161 km ultra-endurance cycling event. One hundred and nineteen cyclists (103 males, 16 females; age = 46 ± 9 years; height = 175.4 ± 17.9 cm; mass = 82.8 ± 16.3 kg) from the 2011 and 2013 Hotter’N Hell events participated. Perceived exertion, Thermal, Thirst, and Pain sensations, Brunel Profile of Mood States, and urine specific gravity (USG) were measured pre- (~1 h before), mid- (~97 km), and post-ride. Participants were classified at each time point as dehydrated (USG ≥ 1.022) or euhydrated (USG ≤ 1.018). Independent of time point, dehydrated participants (USG = 1.027 ± 0.004) had decreased Vigour and increased Fatigue, Pain, Thirst, and Thermal sensations compared to euhydrated participants (USG = 1.012 ± 0.004; all P < 0.01). USG significantly correlated with Fatigue (r = 0.36), Vigour (r = −0.27), Thirst (r = 0.15), and Pain (r = 0.22; all P < 0.05). In conclusion, dehydrated participants had greater Fatigue and Pain than euhydrated participants. These findings indicate dehydration may adversely affect mood state and perceptual ratings during ultra-endurance cycling.

Evaluation of Uosm:Posm ratio as a hydration biomarker in free-living, healthy young women

Background/objectives:Urinary and plasma indices are utilized to assess whole-body water balance in healthy adults, whereas the urine-to-plasma osmolality ratio (Uosm:Posm) rarely is. To explore the efficacy of Uosm:Posm as a hydration biomarker, diet records of 120 college women were analyzed (beverage water+food water=total fluid intake (TFI); 5 days) to identify habitual high-volume (HIGH) and low-volume (LOW) drinkers.Subjects/methods:The experimental protocol first involved two ad libitum baseline days for HIGH (TFI, 3.21 l per 24 h; n=14) and LOW (TFI, 1.64 l per 24 h; n=14). During a controlled intervention (days 3–6), mineral water was the only beverage; HIGH consumed less than baseline (TFI, 2.00 l per 24 h), and LOW consumed more than baseline (TFI, 3.50 l per 24 h). During ad libitum recovery (day 7), TFI were 3.17 and 1.71 l per 24 h for HIGH and LOW, respectively. Duplicate Uosm (24 h collection) and Posm (morning) samples were analyzed on all days via freezing point depression osmometry.Results:In the evaluation of relative water excess (Uosm:Posm<1.0), 11/13 values occurred for HIGH on days 1, 2 and 7; for LOW, 28/29 occurred on intervention days 3–6. Chi-squared analysis indicated that the treatment and Uosm:Posm were significantly associated (χ21:0.001=23.5, P<0.001). Statistical regression analyses detected a strong, significant relationship between renal free-water clearance (FWC) and Uosm:Posm (r2=0.86, P<0.00001); this was not true for FWC and Posm (r2=0.00, P=0.40) because Posm values were stable across 7 days.Conclusions:These findings support the use of Uosm:Posm as a hydration biomarker.

The acute testosterone, growth hormone, cortisol and interleukin-6 response to 164-km road cycling in a hot environment.

Abstract This study investigated the acute endocrine responses to a 164-km road cycling event in a hot environment. Thirty-four male experienced cyclists (49.1 ± 8.3 years, 86.8 ± 12.5 kg, 178.1 ± 5.1 cm) participating in a 164-km road cycling event were recruited. Blood samples were collected within 0.3–2.0 h before the start (PRE: ~0500–0700 h) and immediately following the ride (POST). Samples were analysed for testosterone, growth hormone (GH), cortisol and interleukin-6 (IL-6). The temperature and humidity during the event were 35.3 ± 4.9°C and 47.2 ± 14.0%, respectively. Based on the finishing time, results for the fastest (FAST, 305 ± 10 min) and the slowest (SLOW, 467 ± 31 min) quartiles were compared. At POST, testosterone concentration was significantly (P < 0.05) lower (PRE, 20.8 ± 8.6; POST, 18.2 ± 6.7 nmol · L−1), while GH (PRE, 0.3 ± 0.1; POST, 2.3 ± 0.3 µg · L−1), cortisol (PRE, 661 ± 165; POST, 1073 ± 260 nmol · L−1) and IL-6 (PRE, 4.0 ± 3.4; POST, 22.4 ± 15.2 pg · mL−1) concentrations were significantly higher than those at PRE. At POST, GH and cortisol were significantly higher for the FAST group than for the SLOW group (GH, 3.6 ± 2.0 and 1.0 ± 0.8 µg · L−1; cortisol, 1187 ± 209 and 867 ± 215 nmol · L−1). Participation in an ultra-endurance road cycling event in a hot environment induced significant acute changes in concentrations of circulating hormones, with a greater augmentation of GH and cortisol in those completing the ride fastest.