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Adams WM, Vandermark LW, Belval LN, Casa DJ. The Utility of Thirst as a Measure of Hydration Status Following Exercise-Induced Dehydration. Nutrients 2019; 11:nu11112689. [PMID: 31703247 PMCID: PMC6893511 DOI: 10.3390/nu11112689] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to examine the perception of thirst as a marker of hydration status following prolonged exercise in the heat. Twelve men (mean ± SD; age, 23 ± 4 y; body mass, 81.4 ± 9.9 kg; height, 182 ± 9 cm; body fat, 14.3% ± 4.7%) completed two 180 min bouts of exercise on a motorized treadmill in a hot environment (35.2 ± 0.6 °C; RH, 30.0 ± 5.4%), followed by a 60 min recovery period. Participants completed a euhydrated (EUH) and hypohydrated (HYPO) trial. During recovery, participants were randomly assigned to either fluid replacement (EUHFL and HYPOFL; 10 min ad libitum consumption) or no fluid replacement (EUHNF and HYPONF). Thirst was measured using both a nine-point scale and separate visual analog scales. The percent of body mass loss (%BML) was significantly greater immediately post exercise in HYPO (HYPOFL, 3.0% ± 1.2%; HYPONF, 2.6% ± 0.6%) compared to EUH (EUHFL, 0.2% ± 0.7%; EUHNF, 0.6% ± 0.5%) trials (p < 0.001). Following recovery, there were no differences in %BML between HYPOFL and HYPONF (p > 0.05) or between EUHFL and EUHNF (p > 0.05). Beginning at minute 5 during the recovery period, thirst perception was significantly greater in HYPONF than EUHFL, EUHNF, and HYPOFL (p < 0.05). A 10 min, ad libitum consumption of fluid post exercise when hypohydrated (%BML > 2%), negated differences in perception of thirst between euhydrated and hypohydrated trials. These results represent a limitation in the utility of thirst in guiding hydration practices.
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Affiliation(s)
- William M. Adams
- Department of Kinesiology, University of North Carolina at Greensboro, 1408 Walker Avenue, 237L Coleman Building, Greensboro, NC 27412, USA
- Correspondence: ; Tel.: +1-336-256-1455; Fax: +1-336-334-3238
| | - Lesley W. Vandermark
- Department of Health, Human Performance, & Recreation, University of Arkansas, HPER 310D, Fayetteville, AR 72701, USA
| | - Luke N. Belval
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, 7232 Greenville Ave, Dallas, TX 75231, USA
| | - Douglas J. Casa
- Korey Stringer Institute, Human Performance Laboratory, Department of Kinesiology, University of Connecticut, 2095 Hillside Rd, Unit 1110, Storrs, CT 06269, USA
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102
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A Portable System to Monitor Saliva Conductivity for Dehydration Diagnosis and Kidney Healthcare. Sci Rep 2019; 9:14771. [PMID: 31611585 PMCID: PMC6791883 DOI: 10.1038/s41598-019-51463-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/28/2019] [Indexed: 12/13/2022] Open
Abstract
Chronic kidney disease (CKD) has become a major issue in long-term healthcare. It is caused by recurrent kidney injury, which is possible induced by dehydration and heat stress. Therefore, it is important to access the dehydration diagnosis on fields. Conventional instruments for assessing dehydration from blood and urine samples are expensive and time-consuming. These disadvantages limit their applications in high-risk groups susceptible to kidney disease. To address this unmet need, this study presents a portable miniaturized device for dehydration diagnosis with clinical saliva samples. With co-plane coating-free gold electrodes, the dehydration diagnosis was achieved with a saliva specimen at low volumes (50–500 μL). To examine the characteristics, the developed device was assessed by using standard conductivity solutions and the examined variation was <5%. To validate the use for field applications, saliva samples were measured by the developed device and the measured results were compared with standard markers of serum osmolality (N = 30). These data indicate that the measured saliva conductivity is consistent with serum osmolality. And it shows significant difference between healthy adults and healthy farmers (p < 0.05), who typically suffer high risks of CKD. Based on this work, the proposed device and measurement offer a useful method to diagnosis dehydrations and indicate possible potential for CKD.
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103
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Schlader ZJ, Hostler D, Parker MD, Pryor RR, Lohr JW, Johnson BD, Chapman CL. The Potential for Renal Injury Elicited by Physical Work in the Heat. Nutrients 2019; 11:nu11092087. [PMID: 31487794 PMCID: PMC6769672 DOI: 10.3390/nu11092087] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023] Open
Abstract
An epidemic of chronic kidney disease (CKD) is occurring in laborers who undertake physical work in hot conditions. Rodent data indicate that heat exposure causes kidney injury, and when this injury is regularly repeated it can elicit CKD. Studies in humans demonstrate that a single bout of exercise in the heat increases biomarkers of acute kidney injury (AKI). Elevations in AKI biomarkers in this context likely reflect an increased susceptibility of the kidneys to AKI. Data largely derived from animal models indicate that the mechanism(s) by which exercise in the heat may increase the risk of AKI is multifactorial. For instance, heat-related reductions in renal blood flow may provoke heterogenous intrarenal blood flow. This can promote localized ischemia, hypoxemia and ATP depletion in renal tubular cells, which could be exacerbated by increased sodium reabsorption. Heightened fructokinase pathway activity likely exacerbates ATP depletion occurring secondary to intrarenal fructose production and hyperuricemia. Collectively, these responses can promote inflammation and oxidative stress, thereby increasing the risk of AKI. Equivalent mechanistic evidence in humans is lacking. Such an understanding could inform the development of countermeasures to safeguard the renal health of laborers who regularly engage in physical work in hot environments.
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Affiliation(s)
- Zachary J Schlader
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA.
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN 47405, USA.
| | - David Hostler
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Mark D Parker
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA
- Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Riana R Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - James W Lohr
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Blair D Johnson
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Christopher L Chapman
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
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104
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Unexplained Variance in Hydration Study. Nutrients 2019; 11:nu11081828. [PMID: 31394869 PMCID: PMC6722508 DOI: 10.3390/nu11081828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/23/2019] [Accepted: 07/30/2019] [Indexed: 12/21/2022] Open
Abstract
With the collection of water-intake data, the National Health and Nutrition Examination Survey (NHANES) is becoming an increasingly popular resource for large-scale inquiry into human hydration. However, are we leveraging this resource properly? We sought to identify the opportunities and limitations inherent in hydration-related inquiry within a commonly studied database of hydration and nutrition. We also sought to critically review models published from this dataset. We reproduced two models published from the NHANES dataset, assessing the goodness of fit through conventional means (proportion of variance, R2). We also assessed model sensitivity to parameter configuration. Models published from the NHANES dataset typically yielded a very low goodness of fit R2 < 0.15. A reconfiguration of variables did not substantially improve model fit, and the goodness of fit of models published from the NHANES dataset may be low. Database-driven inquiry into human hydration requires the complete reporting of model diagnostics in order to fully contextualize findings. There are several emergent opportunities to potentially increase the proportion of explained variance in the NHANES dataset, including novel biomarkers, capturing situational variables (meteorology, for example), and consensus practices for adjustment of co-variates.
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105
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Adams WM, Adams J, Karras EM, Rysanek E. Validity of temperature, duration, and vessel seal on 24-hour urinary hydration markers. PLoS One 2019; 14:e0220724. [PMID: 31381592 PMCID: PMC6681950 DOI: 10.1371/journal.pone.0220724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/22/2019] [Indexed: 02/04/2023] Open
Abstract
The purpose of this study was to examine the effect of storage temperature, duration, and storage vessel seal on 24 h urinary hydration markers. Twenty-one males (n = 8) and females (n = 13) (mean±SD; age, 24±5 y; body mass, 68.9±24.2 kg; height, 160.2±32.1 cm) without a history of renal disease or currently taking any medications or supplements known to affect the accuracy of urinary hydration markers were enrolled in this study. Participants provided a 24 h urine sample in a clean container with each urine sample being separate into four separate containers, two in each of the following temperatures: 7°C and 22°C. One specimen container at each temperature was either sealed using the manufacturers cap (single sealed) or the manufacturers cap plus laboratory wrapping film (double sealed). Each sample was analyzed after 1, 2, 3, 7 and 10 days. Urine samples were assessed for urine osmolality (UOSMO), urine specific gravity (USG) and urine color (UCOL). UOSMO was stable at 7°C for two days (mean difference [95% CI]; +1 mmol·kg-1 [0+3], p>0.05) and three days (+1 mmol·kg-1 [0, +3], p>0.05) for single sealed and double sealed containers, respectively. USG measures were stable for singled sealed and double sealed for up to ten days when stored at 22°C. UCOL measures were maintained for up to three days in all storage methods (p>0.05). In conclusion, if immediate analysis is unavailable, such as in the case of field based or longitudinal research, it is recommended that 24 h urine samples are stored in a refrigerated environment and hydration markers (UOSMO and UCOL) be assessed within 48 h.
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Affiliation(s)
- William M. Adams
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States of America
- * E-mail:
| | - J.D. Adams
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, MN, United States of America
| | - Eleni M. Karras
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States of America
| | - Erin Rysanek
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States of America
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106
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Tucker MA, Caldwell AR, Ganio MS. Adequacy of Daily Fluid Intake Volume Can Be Identified From Urinary Frequency and Perceived Thirst in Healthy Adults. J Am Coll Nutr 2019; 39:235-242. [PMID: 31347984 DOI: 10.1080/07315724.2019.1639566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Achieving and maintaining an optimal level of hydration has significant implications for both acute and chronic health, yet many hydration assessments are not feasible for the general public. Urinary frequency (UF) is a reliable method to self-assess hydration status in healthy individuals, and thirst can provide additional sensory information on adequacy of daily fluid intake volume (DFI). However, threshold values for these indices to detect optimal hydration have not been determined. In this study, we sought to determine threshold values for 24-hour UF and perceived thirst that could accurately distinguish between optimal and suboptimal hydration states.Methods: Thirty-two healthy adults (age 22 ± 3 years, body mass index 24.9 ± 4.1 kg/m2) collected urine over 24 hours on four separate occasions, where UF was recorded as well as thirst at each void using a numbered perceptual scale. Using urine osmolality as the criterion standard, all samples were either classified as representing an optimal (≤500 mOsm·kg-1) or suboptimal hydration status (>500 mOsm·kg-1).Results: A 24-hour UF ≤6 was able to detect suboptimal hydration with good accuracy (area under the curve [AUC] 0.815) and a 24-hour average perceived thirst rating > 3 ("a little thirsty") could detect it with reasonable accuracy (AUC 0.725). In addition, a UF ≤4 had a considerably higher positive likelihood ratio to detect suboptimal hydration versus a UF ≤6 (9.03 versus 2.18, respectively).Conclusions: These analyses suggest that individuals with a 24-hour UF ≤6 or perceiving themselves to be, on average, "a little thirsty" throughout the day are likely to be suboptimally hydrated and thus underconsuming an adequate DFI.
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Affiliation(s)
- Matthew A Tucker
- Georgia Prevention Institute, Department of Population Health Sciences, Augusta University, Augusta, Georgia, USA.,Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
| | - Aaron R Caldwell
- Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
| | - Matthew S Ganio
- Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
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107
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Biological variation of resting measures of ventilation and gas exchange in a large healthy cohort. Eur J Appl Physiol 2019; 119:2033-2040. [DOI: 10.1007/s00421-019-04190-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
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108
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Caldwell AR, Cheuvront SN. Basic statistical considerations for physiology: The journal Temperature toolbox. Temperature (Austin) 2019; 6:181-210. [PMID: 31608303 PMCID: PMC6773229 DOI: 10.1080/23328940.2019.1624131] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 12/26/2022] Open
Abstract
The average environmental and occupational physiologist may find statistics are difficult to interpret and use since their formal training in statistics is limited. Unfortunately, poor statistical practices can generate erroneous or at least misleading results and distorts the evidence in the scientific literature. These problems are exacerbated when statistics are used as thoughtless ritual that is performed after the data are collected. The situation is worsened when statistics are then treated as strict judgements about the data (i.e., significant versus non-significant) without a thought given to how these statistics were calculated or their practical meaning. We propose that researchers should consider statistics at every step of the research process whether that be the designing of experiments, collecting data, analysing the data or disseminating the results. When statistics are considered as an integral part of the research process, from start to finish, several problematic practices can be mitigated. Further, proper practices in disseminating the results of a study can greatly improve the quality of the literature. Within this review, we have included a number of reminders and statistical questions researchers should answer throughout the scientific process. Rather than treat statistics as a strict rule following procedure we hope that readers will use this review to stimulate a discussion around their current practices and attempt to improve them. The code to reproduce all analyses and figures within the manuscript can be found at https://doi.org/10.17605/OSF.IO/BQGDH.
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Affiliation(s)
- Aaron R. Caldwell
- Exercise Science Research Center, University of Arkansas–Fayetteville, Fayetteville, NC, USA
| | - Samuel N. Cheuvront
- Biophysics and Biomedical Modelling Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
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109
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Abstract
Structural firefighting is a highly stressful occupation with firefighters performing intense bouts of physical activity in environmental extremes while wearing impermeable, heavy and restrictive personal protective equipment. The aim of this study was to investigate the impact of performing occupational tasks during an active structural fire on firefighters’ hydration status. Nine fully qualified firefighters (mean ± SD age = 39.22 ± 7.89 years) completed a 15 min ‘live’ fire scenario while performing occupational tasks. Urine Specific Gravity (USG), body weight and tympanic membrane temperature were measured pre-scenario and at 0 and 20 min post-scenario. There was a significant decrease in body weight (0 min and 20 min p < 0.0005) and increase in tympanic membrane temperature (0 min and 20 min p < 0.0005) following the fire scenario. There was no significant change in USG post-scenario. Short duration firefighting operations can cause significant fluid loss, as measured by change in body weight but not necessarily USG.
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110
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Nanayakkara I, Dissanayake RK, Nanayakkara S. The presence of dehydration in paddy farmers in an area with chronic kidney disease of unknown aetiology. Nephrology (Carlton) 2019; 25:156-162. [PMID: 31099943 DOI: 10.1111/nep.13605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2019] [Indexed: 02/05/2023]
Abstract
AIM Kidney disease of unknown aetiology (CKDu) has been a health problem in the rural farming community of the North Central province of Sri Lanka since the 1990s and various environmental factors have been postulated as contributing factors for this disease. The aim of our study was to find out whether farmers undergo dehydration which would lead to concentration of urine and the water soluble potentially toxic substance in the kidney, leading to damage of the renal tubules. Therefore, we studied a sample of healthy farmers who were CKDu-free to determine whether they were dehydrated. METHODS Sample included healthy male paddy farmers of Padaviya in the Anuradhapura district. Plasma and urine osmolarity were recorded upon waking up in the morning and evening during the non-farming and farming seasons. Basic statistics and a 2 × 2 anova was done to test the interaction of time of day with farming activity. RESULTS Farmers were dehydrated according to the plasma osmolarity especially in the mornings, irrespective of whether they were farming or not. Approximately 40% of the sample also demonstrated acute dehydration at the end of the day due to farming activity as indicated by both plasma and urine osmolarity and specific gravity. CONCLUSION This study revealed that the farmers of the Padaviya area were either dehydrated or at the upper limit of euhydration sometime during the day irrespective of their activities during the day.
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Affiliation(s)
- Indumathie Nanayakkara
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ruchira K Dissanayake
- Department of Allied Health Science, Faculty of Medical Sciences, University of Sri Jayawardenepura, Nugegoda, Sri Lanka
| | - Saman Nanayakkara
- Division of Anaesthesiology, Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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111
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Scott BE, Laursen PB, James LJ, Boxer B, Chandler Z, Lam E, Gascoyne T, Messenger J, Mears SA. The effect of 1,3-butanediol and carbohydrate supplementation on running performance. J Sci Med Sport 2019; 22:702-706. [DOI: 10.1016/j.jsams.2018.11.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/31/2018] [Accepted: 11/29/2018] [Indexed: 11/27/2022]
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112
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Wittbrodt MT, Millard-Stafford M. Dehydration Impairs Cognitive Performance: A Meta-analysis. Med Sci Sports Exerc 2019; 50:2360-2368. [PMID: 29933347 DOI: 10.1249/mss.0000000000001682] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Dehydration (DEH) is believed to impair cognitive performance but which domains are affected and at what magnitude of body mass loss (BML) remains unclear. PURPOSE To conduct systematic literature review and meta-analysis to determine the effect size (ES) of DEH on cognitive performance and influence of experimental design factors (e.g., DEH > 2% BML). METHODS Thirty-three studies were identified, providing 280 ES estimates from 413 subjects with DEH ranging from 1% to 6% BML. Outcome variables (accuracy, reaction time), cognitive domains, and methods to induce DEH varied. Effect sizes were calculated using standardized mean differences and multivariate meta-analysis. RESULTS Impairment of cognitive performance (all domains/outcomes) with DEH was small but significant (ES = -0.21; 95% confidence interval [CI]: -0.31 to -0.11; P < 0.0001) with significant heterogeneity (Q(279) = 696.0, P < 0.0001; I = 37.6%). Tasks of executive function (ES = -0.24; 95% CI: -0.37 to -0.12), attention (ES = -0.52; 95% CI: -0.66 to -0.37), and motor coordination (ES = -0.40 to 95% CI: -0.63 to -0.17) were significantly impaired (P ≤ 0.01) after DEH, and attention/motor coordination was different (P < 0.001) from reaction time specific tasks (ES = -0.10; 95% CI: -0.23 to 0.02). Body mass loss was associated with the ES for cognitive impairment (P = 0.04); consequently, impairment was greater (P = 0.04) for studies reporting >2% BML (ES = -0.28; 95% CI: -0.41 to -0.16) compared with ≤2%; (ES = -0.14; 95% CI: -0.27 to 0.00). CONCLUSIONS Despite variability among studies, DEH impairs cognitive performance, particularly for tasks involving attention, executive function, and motor coordination when water deficits exceed 2% BML.
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Affiliation(s)
- Matthew T Wittbrodt
- Exercise Physiology Laboratory, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA
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113
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Cvirn MA, Dorrian J, Smith BP, Vincent GE, Jay SM, Roach GD, Sargent C, Larsen B, Aisbett B, Ferguson SA. The effects of hydration on cognitive performance during a simulated wildfire suppression shift in temperate and hot conditions. APPLIED ERGONOMICS 2019; 77:9-15. [PMID: 30832782 DOI: 10.1016/j.apergo.2018.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/21/2018] [Accepted: 12/28/2018] [Indexed: 06/09/2023]
Abstract
The effects on dehydration and cognitive performance from heat and/or physical activity are well established in the laboratory, although have not yet been studied for personnel working in occupations such as wildland firefighting regularly exposed to these types of conditions. This study aimed to investigate the effects of temperature and dehydration on seventy-three volunteer firefighters (35.7 ± 13.7 years, mean ± standard deviation) during a simulation of wildfire suppression under either control or hot (18-20; or 33-35 °C) temperature conditions. Results showed cognitive performance on the psychomotor vigilance task declined when participants were dehydrated in the heat and Stroop task performance was impaired when dehydrated late in the afternoon. Firefighters may be at risk of deteriorations in simple cognitive functions in the heat whilst dehydrated, although may also experience impairments in complex cognitive functions if dehydrated late in the day, irrespective of the environmental temperature.
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Affiliation(s)
- Michael A Cvirn
- Appleton Institute, Central Queensland University, Adelaide, Australia.
| | - Jillian Dorrian
- Centre for Sleep Research, University of South Australia, Adelaide, Australia
| | - Bradley P Smith
- Appleton Institute, Central Queensland University, Adelaide, Australia
| | - Grace E Vincent
- Appleton Institute, Central Queensland University, Adelaide, Australia
| | - Sarah M Jay
- Appleton Institute, Central Queensland University, Adelaide, Australia
| | - Greg D Roach
- Appleton Institute, Central Queensland University, Adelaide, Australia
| | - Charli Sargent
- Appleton Institute, Central Queensland University, Adelaide, Australia
| | - Brianna Larsen
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, Victoria, Australia
| | - Brad Aisbett
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, Victoria, Australia
| | - Sally A Ferguson
- Appleton Institute, Central Queensland University, Adelaide, Australia
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114
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Lacey J, Corbett J, Forni L, Hooper L, Hughes F, Minto G, Moss C, Price S, Whyte G, Woodcock T, Mythen M, Montgomery H. A multidisciplinary consensus on dehydration: definitions, diagnostic methods and clinical implications. Ann Med 2019; 51:232-251. [PMID: 31204514 PMCID: PMC7877883 DOI: 10.1080/07853890.2019.1628352] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/28/2019] [Accepted: 05/28/2019] [Indexed: 01/02/2023] Open
Abstract
Background: Dehydration appears prevalent, costly and associated with adverse outcomes. We sought to generate consensus on such key issues and elucidate need for further scientific enquiry. Materials and methods: A modified Delphi process combined expert opinion and evidence appraisal. Twelve relevant experts addressed dehydration's definition, objective markers and impact on physiology and outcome. Results: Fifteen consensus statements and seven research recommendations were generated. Key findings, evidenced in detail, were that there is no universally accepted definition for dehydration; hydration assessment is complex and requires combining physiological and laboratory variables; "dehydration" and "hypovolaemia" are incorrectly used interchangeably; abnormal hydration status includes relative and/or absolute abnormalities in body water and serum/plasma osmolality (pOsm); raised pOsm usually indicates dehydration; direct measurement of pOsm is the gold standard for determining dehydration; pOsm >300 and ≤280 mOsm/kg classifies a person as hyper or hypo-osmolar; outside extremes, signs of adult dehydration are subtle and unreliable; dehydration is common in hospitals and care homes and associated with poorer outcomes. Discussion: Dehydration poses risk to public health. Dehydration is under-recognized and poorly managed in hospital and community-based care. Further research is required to improve assessment and management of dehydration and the authors have made recommendations to focus academic endeavours. Key messages Dehydration assessment is a major clinical challenge due to a complex, varying pathophysiology, non-specific clinical presentations and the lack of international consensus on definition and diagnosis. Plasma osmolality represents a valuable, objective surrogate marker of hypertonic dehydration which is underutilized in clinical practice. Dehydration is prevalent within the healthcare setting and in the community, and appears associated with increased morbidity and mortality.
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Affiliation(s)
- Jonathan Lacey
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Jo Corbett
- Department of Sport & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Lui Forni
- Intensive Care Unit, Royal Surrey County Hospital, Guildford, UK
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Fintan Hughes
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Gary Minto
- Department of Anaesthesia, University Hospitals Plymouth, Plymouth, UK
- Peninsula School of Medicine, Plymouth, UK
| | - Charlotte Moss
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Susanna Price
- Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Greg Whyte
- Research Institute for Sport & Exercise Science, Liverpool John Moores University, UK
| | - Tom Woodcock
- Formerly Consultant University Hospitals Southampton NHS Trust, Southampton, UK
| | - Michael Mythen
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Hugh Montgomery
- Centre for Human Health and Performance, University College London, London, UK
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115
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Harris PR, Keen DA, Constantopoulos E, Weninger SN, Hines E, Koppinger MP, Khalpey ZI, Konhilas JP. Fluid type influences acute hydration and muscle performance recovery in human subjects. J Int Soc Sports Nutr 2019; 16:15. [PMID: 30947727 PMCID: PMC6449982 DOI: 10.1186/s12970-019-0282-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/19/2019] [Indexed: 11/16/2022] Open
Abstract
Background Exercise and heat trigger dehydration and an increase in extracellular fluid osmolality, leading to deficits in exercise performance and thermoregulation. Evidence from previous studies supports the potential for deep-ocean mineral water to improve recovery of exercise performance post-exercise. We therefore wished to determine whether acute rehydration and muscle strength recovery was enhanced by deep-ocean mineral water following a dehydrating exercise, compared to a sports drink or mountain spring water. We hypothesized that muscle strength would decrease as a result of dehydrating exercise, and that recovery of muscle strength and hydration would depend on the type of rehydrating fluid. Methods Using a counterbalanced, crossover study design, female (n = 8) and male (n = 9) participants performed a dehydrating exercise protocol under heat stress until achieving 3% body mass loss. Participants rehydrated with either deep-ocean mineral water (Deep), mountain spring water (Spring), or a carbohydrate-based sports drink (Sports) at a volume equal to the volume of fluid loss. We measured relative hydration using salivary osmolality (Sosm) and muscle strength using peak torque from a leg extension maneuver. Results Sosm significantly increased (p < 0.0001) with loss of body mass during the dehydrating exercise protocol. Males took less time (90.0 ± 18.3 min; P < 0.0034) to reach 3% body mass loss when compared to females (127.1 ± 20.0 min). We used a mono-exponential model to fit the return of Sosm to baseline values during the rehydrating phase. Whether fitting stimulated or unstimulated Sosm, male and female participants receiving Deep as the hydrating fluid exhibited the most rapid return to baseline Sosm (p < 0.0001) regardless of the fit parameter. Males compared to females generated more peak torque (p = 0.0005) at baseline (308.3 ± 56.7 Nm vs 172.8 ± 40.8 Nm, respectively) and immediately following 3% body mass loss (276.3 ± 39.5 Nm vs 153.5 ± 35.9 Nm). Participants experienced a loss. We also identified a significant effect of rehydrating fluid and sex on post-rehydration peak torque (p < 0.0117). Conclusion We conclude that deep-ocean mineral water positively affected hydration recovery after dehydrating exercise, and that it may also be beneficial for muscle strength recovery, although this, as well as the influence of sex, needs to be further examined by future research. Trial registration clincialtrials.gov PRS, NCT02486224. Registered 08 June 2015.
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Affiliation(s)
- Preston R Harris
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, 85721, USA
| | - Douglas A Keen
- Department of Physiology, University of Arizona, Tucson, AZ, 85721, USA
| | - Eleni Constantopoulos
- Department of Physiology, University of Arizona, Tucson, AZ, 85721, USA.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ, 85724, USA
| | | | - Eric Hines
- Department of Physiology, University of Arizona, Tucson, AZ, 85721, USA.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ, 85724, USA
| | - Matthew P Koppinger
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, 85721, USA
| | - Zain I Khalpey
- Department of Surgery, University of Arizona, Tucson, AZ, 85721, USA
| | - John P Konhilas
- Department of Physiology, University of Arizona, Tucson, AZ, 85721, USA. .,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ, 85724, USA.
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Differing Water Intake and Hydration Status in Three European Countries-A Day-to-Day Analysis. Nutrients 2019; 11:nu11040773. [PMID: 30987139 PMCID: PMC6520853 DOI: 10.3390/nu11040773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 01/21/2023] Open
Abstract
Adequate hydration is essential for maintaining health and functionality of the human body. Studies assessing both daily water intake and hydration status are lacking. This study explored data from the European Hydration Research Study (EHRS) and focused on total water intake (TWI), 24 h hydration status, and day-to-day variations in a sample of 573 healthy adults. TWI was assessed by food records and hydration status (urine osmolality and urine volume) was measured from 24 urine samples collected over seven consecutive days. On all weekdays, mean TWI was higher (p < 0.001 for all days) for the German subjects compared to the Greek and Spanish participants. In 37% of the male and 22% of the female subjects, the individual mean TWI was below the European Food Safety Authority (EFSA) recommendation, with 16% men (4% women) being below the EFSA recommendation on every testing day. Twenty-four hour urine osmolality was lower in women compared to men (595 ± 261 vs. 681 ± 237 mOsmol/kg; p < 0.001). More men (40%) showed a urine osmolality ≥800 mOsmol/kg at least on four days of the study period compared to women (26%) and more participants from Spain (46%) compared to Greece (29%) and Germany (11%). A large number of individuals showed an inadequate hydration status on several days per week, which may have a negative health and cognitive impact on daily life.
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117
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Bunn DK, Hooper L. Signs and Symptoms of Low-Intake Dehydration Do Not Work in Older Care Home Residents-DRIE Diagnostic Accuracy Study. J Am Med Dir Assoc 2019; 20:963-970. [PMID: 30872081 DOI: 10.1016/j.jamda.2019.01.122] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/04/2019] [Accepted: 01/05/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess the diagnostic accuracy of commonly used signs and symptoms of low-intake dehydration in older care home residents. DESIGN Prospective diagnostic accuracy study. SETTING 56 care homes offering residential, nursing, and/or dementia care to older adults in Norfolk and Suffolk, United Kingdom. PARTICIPANTS 188 consecutively recruited care home residents aged ≥65 years, without cardiac or renal failure and not receiving palliative care. Overall, 66% were female, the mean age was 85.7 years (standard deviation 7.8), and the median Mini-Mental State Examination MMSE score was 23 (interquartile range 18-26). INDEX TESTS Over 2 hours, participants underwent double-blind assessment of 49 signs and symptoms of dehydration and measurement of serum osmolality from a venous blood sample. Signs and symptoms included skin turgor; mouth, skin, and axillary dryness; capillary refill; sunken eyes; blood pressure on resting and after standing; body temperature; pulse rate; and self-reported feelings of thirst and well-being. REFERENCE STANDARD Serum osmolality, with current dehydration defined as >300 mOsm/kg, and impending dehydration ≥295 mOsm/kg. OUTCOME MEASURES For dichotomous tests, we aimed for sensitivity and specificity >70%, and for continuous tests, an area under the curve in receiver operating characteristic plots of >0.7. RESULTS Although 20% of residents had current low-intake dehydration and a further 28% impending dehydration, none of the commonly used clinical signs and symptoms usefully discriminated between participants with or without low-intake dehydration at either cut-off. CONCLUSIONS/IMPLICATIONS This study consolidates evidence that commonly used signs and symptoms of dehydration lack even basic levels of diagnostic accuracy in older adults, implying that many who are dehydrated are not being identified, thus compromising their health and well-being. We suggest that these tests be withdrawn from practice and replaced with a 2-stage screening process that includes serum osmolarity, calculated from sodium, potassium, urea, and glucose levels (assessed routinely using the Khajuria and Krahn equation), followed by serum osmolality measurement for those identified as high risk (calculated serum osmolarity >295 mmol/L).
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Affiliation(s)
- Diane K Bunn
- School of Health Sciences, Norwich Research Park, University of East Anglia, Norwich, Norfolk, England, United Kingdom.
| | - Lee Hooper
- Norwich Medical School, Norwich Research Park, University of East Anglia, Norwich, Norfolk, England, United Kingdom
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118
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Zubac D, Paravlic A, Reale R, Jelaska I, Morrison SA, Ivancev V. Fluid balance and hydration status in combat sport Olympic athletes: a systematic review with meta-analysis of controlled and uncontrolled studies. Eur J Nutr 2019; 58:497-514. [DOI: 10.1007/s00394-019-01937-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
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119
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Jimoh OF, Brown TJ, Bunn D, Hooper L. Beverage Intake and Drinking Patterns-Clues to Support Older People Living in Long-Term Care to Drink Well: DRIE and FISE Studies. Nutrients 2019; 11:E447. [PMID: 30795521 PMCID: PMC6412353 DOI: 10.3390/nu11020447] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/06/2019] [Accepted: 02/16/2019] [Indexed: 11/16/2022] Open
Abstract
Low-intake dehydration, due to insufficient beverage intake, is common in older people and associated with increased mortality and morbidity. We aimed to document the drinking patterns of older adults living in long-term care and compared patterns in those drinking well with those not drinking enough. One-hundred-and-eighty-eight people aged ≥ 65 years living in 56 UK long-term care homes were interviewed and hydration status was assessed in the Dehydration Recognition In our Elders (DRIE) study. In 22 DRIE residents, the Fluid Intake Study in our Elders (FISE) directly observed, weighed and recorded all drinks intake over 24 h. Twenty percent of DRIE participants and 18% of FISE participants had low-intake dehydration (serum osmolality > 300 mOsm/kg). Mean total drinks intake was 1787 mL/day (SD 693) in FISE participants (2033 ± 842 mL/day in men; 1748 ± 684 mL/day in women). Most drinks intake was between meals (59%, including 10% with medications). Twelve (55%) FISE participants achieved European Food Safety Authority drinks goals (3/6 men drank ≥ 2.0 L/day, 9/16 women drank ≥ 1.6 L/day). Those drinking well were offered beverages more frequently and drank more with medications and before breakfast (beverage variety did not differ). Promising strategies to support healthy drinking include offering drinks more frequently, particularly before and during breakfast and with medication.
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Affiliation(s)
- Oluseyi F Jimoh
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
| | - Tracey J Brown
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
| | - Diane Bunn
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
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120
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Matias A, Dudar M, Kauzlaric J, Frederick KA, Fitzpatrick S, Ives SJ. Rehydrating efficacy of maple water after exercise-induced dehydration. J Int Soc Sports Nutr 2019; 16:5. [PMID: 30744654 PMCID: PMC6371469 DOI: 10.1186/s12970-019-0273-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/05/2019] [Indexed: 11/10/2022] Open
Abstract
Dehydration impairs physiological function and physical performance, thus understanding effective rehydration strategies is paramount. Despite growing interest in natural rehydrating beverages, no study has examined maple water (MW). PURPOSE To investigate the rehydrating efficacy of MW after exercise-induced dehydration. METHODS Using a single-blind, counterbalanced, crossover design, we compared the rehydrating efficacy of MW vs. maple-flavored bottled water (control) in 26 young healthy (22 ± 4 yrs., 24 ± 4 kg/m2) males (n = 13) and females (n = 13) after exercise-induced dehydration (~ 2.0%ΔBody Weight [BW]) in the heat (30 °C, 50% relative humidity [RH]). Hydration indicators (BW, salivary and urine osmolality [SOsm/UOsm], urine specific gravity [USG], urine volume [UV], urine color [UC]), thirst, fatigue, and recovery (heart rate [HR)], and HR variability [HRV]) were taken at baseline, post-exercise, 0.5, 1, and 2 h post-consumption of 1 L of MW or control. RESULTS Following similar dehydration (~ 2%ΔBW), MW had no differential (p > 0.05) impact on any measure of rehydration. Likely due to greater beverage osmolality (81 ± 1.4 vs. 11 ± 0.7 mOsmol/kg), thirst sensation remained 12% higher with MW (p < 0.05). When sex was considered, females had lower UV, elevated UOsm (p < 0.05), trends for higher ΔBW, USG, but similar SOsm. Analysis of beverages and urine for antioxidant potential (AP) revealed a four-fold greater AP in MW, which increased peak urine AP (9.4 ± 0.7 vs. 7.6 ± 1.0 mmol, MW vs. control, p < 0.05). CONCLUSION Electrolyte-containing MW, was similar in effectiveness to water, but has antioxidant properties. Furthermore, trends for sex differences were discovered in urinary, but not salivary, hydration markers, with discrepancies in kinetics between fluid compartments both warranting further study.
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Affiliation(s)
- Alexs Matias
- Health and Human Physiological Sciences Department, Skidmore College, 815 N. Broadway, Saratoga Springs, NY, 12866, USA
| | - Monique Dudar
- Health and Human Physiological Sciences Department, Skidmore College, 815 N. Broadway, Saratoga Springs, NY, 12866, USA
| | | | | | | | - Stephen J Ives
- Health and Human Physiological Sciences Department, Skidmore College, 815 N. Broadway, Saratoga Springs, NY, 12866, USA.
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Rosinger AY, Pontzer H, Raichlen DA, Wood BM, Tanner SN, Sands JM. Age-related decline in urine concentration may not be universal: Comparative study from the U.S. and two small-scale societies. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2019; 168:705-716. [PMID: 30706445 DOI: 10.1002/ajpa.23788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Evidence from industrialized populations suggests that urine concentrating ability declines with age. However, lifestyle factors including episodic protein intake and low hypertension may help explain differences between populations. Whether this age-related decline occurs among small-scale populations with active lifestyles and non-Western diets is unknown. We test the universality of age-related urine concentration decline. MATERIALS AND METHODS We used urine specific gravity (Usg) and urine osmolality (Uosm) data from 15,055 U.S. nonpregnant adults without kidney failure aged 18-80 in 2007-2012 participating in the National Health and Nutrition Examination Survey (NHANES). We tested the relationship of age on urine concentration biomarkers with multiple linear regressions using survey commands. We compared results to longitudinal data on Usg from 116 Tsimane' forager-horticulturalists (266 observations) adults aged 18-83 in 2013-2014 from Lowland Bolivia, and to 38 Hadza hunter-gatherers (156 observations) aged 18-75 in 2010-2015 from Tanzania using random-effects panel linear regressions. RESULTS Among U.S. adults, age was significantly negatively associated with Usg (Adjusted beta [B] = -0.0009 g/mL/10 years; SE = 0.0001; p < 0.001) and Uosm (B = -28.1 mOsm/kg/10 yr; SE = 2.4; p < 0.001). In contrast, among Tsimane' (B = 0.0003 g/mL/10 yr; SE = 0.0002; p = 0.16) and Hadza (B = -0.0004 g/mL/10 yr; SE = 0.0004; p = 0.29) age was not associated with Usg. Older Tsimane' and Hadza exhibited similar within-individual variability in Usg equivalent to younger adults. DISCUSSION While U.S. adults exhibited age-related declines in urine concentration, Tsimane' and Hadza adults did not exhibit the same statistical decline in Usg. Mismatches between evolved physiology and modern environments in lifestyle may affect kidney physiology and disease risk.
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Affiliation(s)
- Asher Y Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, State College, Pennsylvania.,Department of Anthropology, Pennsylvania State University, State College, Pennsylvania
| | - Herman Pontzer
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina
| | | | - Brian M Wood
- Department of Anthropology, University of California Los Angeles, Los Angeles, California.,Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Susan N Tanner
- Department of Anthropology, University of Georgia, Athens, Georgia
| | - Jeff M Sands
- Department of Medicine, Renal Division, Emory University, Atlanta, Georgia
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122
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Variability of Body Mass and Urine Specific Gravity in Elite Male Field Hockey Players During a Pre-Olympic Training Camp. Int J Sport Nutr Exerc Metab 2019; 29:46-50. [PMID: 29893591 DOI: 10.1123/ijsnem.2018-0121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/23/2018] [Indexed: 11/18/2022]
Abstract
This field-based observational study was designed to examine the intraindividual variation of first morning body mass and urine specific gravity (Usg) in male hockey players (n = 22) during a 10-day training camp. It was also designed to evaluate the prevalence and interrelationship of morning hypohydration and postmatch dehydration using Usg and changes in body mass, respectively. Body mass and Usg were measured upon waking; body mass was also measured before and after matches. Individual means, SD, and coefficient of variation (CV) were calculated for morning body mass and Usg using 3, 6, and 8 days. Daily prevalence for euhydration and postmatch dehydration using morning Usg (<1.020) and changes in body mass (>-2%), respectively, were determined. Measurement of morning body mass and Usg for 3 days had low variability (CV < 1%) with no improvement at 6 or 8 days. Between 36% and 73% of players were considered euhydrated based on morning Usg. Postmatch body mass was reduced >1% in 50-85% of players, with up to 40% experiencing changes >-2%. Postmatch changes in body mass were unrelated to Usg the subsequent morning. These outcomes can be helpful in establishing criteria for detecting meaningful changes in morning body mass and Usg in similar settings, helping to monitor hydration status in elite male athletes. Despite ample fluid availability and consumption, many players experienced hypohydration and dehydration during the camp, indicating that careful monitoring and an individual fluid replacement approach are warranted in these environments.
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123
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Liska D, Mah E, Brisbois T, Barrios PL, Baker LB, Spriet LL. Narrative Review of Hydration and Selected Health Outcomes in the General Population. Nutrients 2019; 11:nu11010070. [PMID: 30609670 PMCID: PMC6356561 DOI: 10.3390/nu11010070] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/07/2018] [Accepted: 12/27/2018] [Indexed: 12/16/2022] Open
Abstract
Although adequate hydration is essential for health, little attention has been paid to the effects of hydration among the generally healthy population. This narrative review presents the state of the science on the role of hydration in health in the general population, specifically in skin health, neurological function (i.e., cognition, mood, and headache), gastrointestinal and renal functions, and body weight and composition. There is a growing body of evidence that supports the importance of adequate hydration in maintaining proper health, especially with regard to cognition, kidney stone risk, and weight management. However, the evidence is largely associative and lacks consistency, and the number of randomized trials is limited. Additionally, there are major gaps in knowledge related to health outcomes due to small variations in hydration status, the influence of sex and sex hormones, and age, especially in older adults and children.
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Affiliation(s)
- DeAnn Liska
- Biofortis, Mérieux NutriSciences, Addison, IL 60101, USA.
| | - Eunice Mah
- Biofortis, Mérieux NutriSciences, Addison, IL 60101, USA.
| | | | | | - Lindsay B Baker
- Gatorade Sports Science Institute, Barrington, IL 60010, USA.
| | - Lawrence L Spriet
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W, Canada.
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124
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King RE, Steed K, Rivera AE, Wisco JJ, Thibeault SL. Magnetic resonance imaging quantification of dehydration and rehydration in vocal fold tissue layers. PLoS One 2018; 13:e0208763. [PMID: 30521642 PMCID: PMC6283588 DOI: 10.1371/journal.pone.0208763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/20/2018] [Indexed: 01/18/2023] Open
Abstract
Clinicians commonly recommend increased hydration to patients with voice disorders. However, effects on clinical voice outcome measures have been inconsistent. Hydration-induced change within different layers of vocal fold tissue is currently unknown. Magnetic Resonance Imaging (MRI) is a promising method of noninvasively measuring water content in vocal folds. We sought to image and quantify changes in water content within vocal fold mucosa and thyroarytenoid muscle after dehydration and rehydration. Excised porcine larynges were imaged using proton density (PD) weighted MRI (1) at baseline and (2) after immersion in one of five hypertonic, isotonic, or hypotonic solutions or in dry air. Larynges dehydrated in hypertonic solutions or dry air were rehydrated and imaged a third time. Scans revealed fluid-rich vocal fold mucosa that was distinct from muscle at baseline. Baseline normalized signal intensity in mucosa and muscle varied by left vs. right vocal fold (p < 0.01) and by anterior, middle, or posterior location (p < 0.0001). Intensity changes in the middle third of vocal fold mucosa differed by solution after immersion (p < 0.01). Hypertonic solutions dehydrated the middle third of mucosa by over 30% (p < 0.001). No difference from baseline was found in anterior or posterior mucosa or in muscle after immersion. No association was found between intensity change in mucosa and muscle after immersion. After rehydration, intensity did not differ by solution in any tissue, and was not different from baseline, but post-rehydration intensity was correlated with post-immersion intensity in both mucosa and muscle (p < 0.05), suggesting that degree of change in vocal fold water content induced by hypertonic solutions ex vivo persists after rehydration. These results indicate that PD-MRI can be used to visualize large mammalian vocal fold tissue layers and to quantify changes in water content within vocal fold mucosa and thyroarytenoid muscle independently.
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Affiliation(s)
- Renee E. King
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Kevin Steed
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, Utah, United States of America
| | - Ana E. Rivera
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico, United States of America
| | - Jonathan J. Wisco
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, Utah, United States of America
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Neurobiology and Anatomy, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Susan L. Thibeault
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
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125
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Armstrong LE, Johnson EC. Water Intake, Water Balance, and the Elusive Daily Water Requirement. Nutrients 2018; 10:E1928. [PMID: 30563134 PMCID: PMC6315424 DOI: 10.3390/nu10121928] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 11/11/2018] [Accepted: 11/27/2018] [Indexed: 12/12/2022] Open
Abstract
Water is essential for metabolism, substrate transport across membranes, cellular homeostasis, temperature regulation, and circulatory function. Although nutritional and physiological research teams and professional organizations have described the daily total water intakes (TWI, L/24h) and Adequate Intakes (AI) of children, women, and men, there is no widespread consensus regarding the human water requirements of different demographic groups. These requirements remain undefined because of the dynamic complexity inherent in the human water regulatory network, which involves the central nervous system and several organ systems, as well as large inter-individual differences. The present review analyzes published evidence that is relevant to these issues and presents a novel approach to assessing the daily water requirements of individuals in all sex and life-stage groups, as an alternative to AI values based on survey data. This empirical method focuses on the intensity of a specific neuroendocrine response (e.g., plasma arginine vasopressin (AVP) concentration) employed by the brain to regulate total body water volume and concentration. We consider this autonomically-controlled neuroendocrine response to be an inherent hydration biomarker and one means by which the brain maintains good health and optimal function. We also propose that this individualized method defines the elusive state of euhydration (i.e., water balance) and distinguishes it from hypohydration. Using plasma AVP concentration to analyze multiple published data sets that included both men and women, we determined that a mild neuroendocrine defense of body water commences when TWI is ˂1.8 L/24h, that 19⁻71% of adults in various countries consume less than this TWI each day, and consuming less than the 24-h water AI may influence the risk of dysfunctional metabolism and chronic diseases.
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Affiliation(s)
- Lawrence E Armstrong
- University of Connecticut, Human Performance Laboratory and Department of Nutritional Sciences, Storrs CT 06269-1110, USA.
| | - Evan C Johnson
- University of Wyoming, Human Integrated Physiology Laboratory, Division of Kinesiology and Health, Laramie, WY 82071, USA.
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126
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Sollanek KJ, Kenefick RW, Cheuvront SN. Importance of sample volume to the measurement and interpretation of plasma osmolality. J Clin Lab Anal 2018; 33:e22727. [PMID: 30474168 PMCID: PMC6818608 DOI: 10.1002/jcla.22727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 11/12/2022] Open
Abstract
Background Small sample volumes may artificially elevate plasma osmolality (Posm) measured by freezing point depression. The purpose of this study was to compare two widely different sample volumes of measured Posm (mmol/kg) to each other, and to calculated osmolarity (mmol/L), across a physiological Posm range (~50 mmol/kg). Methods Posm was measured using freezing point depression and osmolarity calculated from measures of sodium, glucose, and blood urea nitrogen. The influence of sample volume was investigated by comparing 20 and 250 μL Posm samples (n = 126 pairs). Thirty‐two volunteers were tested multiple times while EUH (n = 115) or DEH (n = 11) by −4.0% body mass. Protinol™ (240, 280, and 320 mmol/kg) and Clinitrol™ (290 mmol/kg) reference solutions were compared similarly (n = 282 pairs). Results The 20 μL samples of plasma showed a 7 mmol/kg positive bias compared to 250 μL samples and displayed a nearly constant proportional error across the range tested (slope = 0.929). Calculated osmolarity was lower than 20 μL Posm by the same negative bias (−6.9 mmol/kg) but not different from 250 μL Posm (0.1 mmol/kg). The differences between 20 and 250 μL samples of Protinol™ were significantly higher than Clinitrol™. Conclusions These results demonstrate that Posm measured by freezing point depression will be ~7 mmol/kg higher when using 20 μL vs 250 μL sample volumes. Approximately half of this effect may be due to plasma proteins. Posm sample volume should be carefully considered when calculating the osmole gap or assessing hydration status.
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Affiliation(s)
- Kurt J Sollanek
- Department of Kinesiology, Sonoma State University, Rohnert Park, California
| | - Robert W Kenefick
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Samuel N Cheuvront
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
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Isik O, Yildirim I, Ersoz Y, Koca HB, Dogan I, Ulutas E. Monitoring of pre-competition dehydration- induced skeletal muscle damage and inflammation levels among elite wrestlers. J Back Musculoskelet Rehabil 2018; 31:533-540. [PMID: 29562489 DOI: 10.3233/bmr-170955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Weight loss practice before competitions is a common method in weight sports. OBJECTIVE The current study aimed to monitor Plasma Osmolarity (POsm), skeletal muscle damage and inflammation levels induced by pre-competition dehydration among elite wrestlers. METHODS Twenty-four male elite wrestlers participated in the study. A survey information form that assessed pre-competition weight loss practices were administered to the wrestlers. Additionally, Total Creatine Kinase (CK), Lactate Dehydrogenase (LDH), Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), C-reactive Protein (C-RP) and POsm, analyses were evaluated by a specialist at the biochemical laboratory. POsm level for euhydration is ⩽ 290 mOsm/L. But if POsm level is > 290, then dehydration occurs. The wrestlers were divided into two groups according to POsm levels as weight loss and non-weight loss group. RESULTS There were differences in the pre and post-test POsm levels of weight loss group. Similarly; it was identified that there were also statistically significant differences in terms of ALT, LDH and CK levels of weight loss group between pre and post-test. CONCLUSIONS It was seen that POsm and levels of all indicators of skeletal muscle damage were higher than non-weight loss group. However, it was found that there were not any differences in terms of C-RP levels.
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Affiliation(s)
- Ozkan Isik
- Faculty of Sport Sciences, Sakarya University, Sakarya, Turkey
| | - Irfan Yildirim
- School of Physical Education and Sports, Mersin University, Mersin, Turkey
| | - Yasin Ersoz
- School of Physical Education and Sports, Mersin University, Mersin, Turkey
| | - Halit Bugra Koca
- Department of Biochemistry, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Ilkay Dogan
- Department of Biostatistics, Faculty of Veterinary, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Elmas Ulutas
- Department of Physiology, Faculty of Veterinary, Afyon Kocatepe University, Afyonkarahisar, Turkey
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Bright FM, Chaseling GK, Jay O, Morris NB. Self-paced exercise performance in the heat with neck cooling, menthol application, and abdominal cooling. J Sci Med Sport 2018; 22:371-377. [PMID: 30270195 DOI: 10.1016/j.jsams.2018.09.225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/19/2018] [Accepted: 09/06/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate whether the exercise performance benefits with neck cooling in the heat are attributable to neck-specific cooling, general body cooling, a cooler site-specific thermal perception or a combination of the above. DESIGN Counter-balanced crossover design. METHODS Twelve healthy participants cycled in the heat (34°C, 30% relative humidity), at a power output (PO) self-selected to maintain a fixed rating of perceived exertion (RPE) of 16. Each participant underwent four experimental trials: no cooling (CON), neck cooling (NEC), abdominal cooling (ABD), or neck cooling with menthol (MEN). Participants cycled for 90min or until their workload reduced by <70% of their initial PO. Changes in PO, rectal temperature (Tre), mean skin temperature (Tsk), whole-body thermal sensation (TSwb) and thermal sensation of the neck (TSneck) were recorded throughout. RESULTS The mean reduction in PO throughout exercise was similar (p=0.431) for CON (175±10W), NEC (176 ±12W), ABD (172±13W) and MEN (174±12W). The ΔTre at the end of exercise was similar (p=0.874) for CON (0.83±0.5°C), NEC (0.85±0.5°C), ABD (0.82±0.5°C) and MEN (0.81±0.5°C). TSwb was cooler (p<0.013) in MEN (125±8mm) compared to CON (146±19mm), NEC (135±11mm) and ABD (141±16mm). CONCLUSIONS No differences in exercise performance or thermal strain were observed in any of the cooling trials compared to the CON trial, despite significantly cooler TSwb values in the MEN and NEC trials compared to the CON trial. These findings differ from previous observations and highlight that the benefit of neck cooling may be situation dependent.
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Affiliation(s)
- Felicity M Bright
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, University of Sydney, Australia
| | - Georgia K Chaseling
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, University of Sydney, Australia
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, University of Sydney, Australia; Charles Perkins Centre, University of Sydney, Australia
| | - Nathan B Morris
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, University of Sydney, Australia; Center for Technology Research and Innovation, Cyprus; Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
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Betomvuko P, de Saint-Hubert M, Schoevaerdts D, Jamart J, Devuyst O, Swine C. Early diagnosis of dehydration in hospitalized geriatric patients using clinical and laboratory criteria. Eur Geriatr Med 2018; 9:589-595. [DOI: 10.1007/s41999-018-0100-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 08/21/2018] [Indexed: 12/28/2022]
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Johnson P, Hahn RG. Signs of Dehydration in Nursing Home Residents. J Am Med Dir Assoc 2018; 19:1124-1128. [PMID: 30228079 DOI: 10.1016/j.jamda.2018.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/25/2018] [Accepted: 07/28/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Although dehydration can affect mental and physical health, there is no clear, consistent, and reproducible diagnostic tool for this condition in older people. We applied multiple methods to detect dehydration with the aim of assessing the value of using urine analysis for this purpose. DESIGN Nonrandomized cohort study. SETTING AND PARTICIPANTS Sixty nursing home residents, aged 64-103 (mean 84) years. METHODS Sampling of morning urine, blood analyses, and clinical examination. A previously validated algorithm summarized the urine specific gravity, osmolality, creatinine, and color to a Fluid Retention Index (FRI). RESULTS The cut-off for renal fluid conservation consistent with dehydration (FRI ≥ 4.0) was reached by 51% of the cohort. No statistically significant linear correlation was found between FRI and serum osmolality (mean 307.5 mOsmol/kg) or plasma sodium (mean 139 mmol/L), but the subjects reported less thirst with increasing FRI scores (linear correlation r = -0.35; P < .03). Clinical examinations of mucous membranes and tongue furrows did not correlate with other markers of dehydration. Subjects with sunken eyes had higher C-reactive protein (P < .02) and lower albumin (P < .002) concentrations in plasma than the others, while impaired skin turgor only correlated with age (P < .04). CONCLUSIONS/IMPLICATIONS Renal fluid conservation consistent with dehydration was found in half of the nursing home residents, which could partially be accounted for by decreased thirst. Clinical examinations probably reflected the physical status and age more than dehydration. The lack of correlation between the serum osmolality and the FRI, both of which are purported to be gold standards for dehydration, raises questions about whether a gold standard exists.
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Affiliation(s)
- Peter Johnson
- Department of Geriatrics and Internal Medicine, Södertälje Hospital, Södertälje, Sweden
| | - Robert G Hahn
- Department of Research, Södertälje Hospital, Södertälje, Sweden; Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, Sweden.
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Brescon C, Pegaz PY, Godet P, Malgoyre A, Charlot K. Effect of Urinary Sheath Use on Hydration Status of Fighter Pilots Under Severe Thermal Stress: An Observational Study. Mil Med 2018; 184:e217-e222. [DOI: 10.1093/milmed/usy233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/12/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Caroline Brescon
- Forces Françaises aux Emirats Arabes Unis, Centre Médical des Armées, Base Aérienne d’Al Dhafra, United Arab Emirates
| | - Pierre-Yves Pegaz
- Forces Françaises aux Emirats Arabes Unis, Centre Médical des Armées, Base Aérienne d’Al Dhafra, United Arab Emirates
| | - Patrick Godet
- Forces Françaises aux Emirats Arabes Unis, Base Aérienne d’Al Dhafra, United Arab Emirates
| | - Alexandra Malgoyre
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
| | - Keyne Charlot
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels, Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
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132
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Prevalence and Risk Factors of Dehydration Among Nursing Home Residents: A Systematic Review. J Am Med Dir Assoc 2018; 19:646-657. [DOI: 10.1016/j.jamda.2018.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 12/24/2022]
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Wittbrodt MT, Sawka MN, Mizelle JC, Wheaton LA, Millard‐Stafford ML. Exercise-heat stress with and without water replacement alters brain structures and impairs visuomotor performance. Physiol Rep 2018; 6:e13805. [PMID: 30136401 PMCID: PMC6105626 DOI: 10.14814/phy2.13805] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/26/2018] [Indexed: 01/08/2023] Open
Abstract
Effects of exercise-heat stress with and without water replacement on brain structure and visuomotor performance were examined. Thirteen healthy adults (23.6 ± 4.2 years) completed counterbalanced 150 min trials of exercise-heat stress (45°C, 15% RH) with water replacement (EHS) or without (~3% body mass loss; EHS-DEH) compared to seated rest (CON). Anatomical scans and fMRI Blood-Oxygen-Level-Dependent responses during a visuomotor pacing task were evaluated. Accuracy decreased (P < 0.05) despite water replacement during EHS (-8.2 ± 6.8% vs. CON) but further degraded with EHS-DEH (-8.3 ± 6.4% vs. EHS and -16.5 ± 10.2% vs. CON). Relative to CON, EHS elicited opposing volumetric changes (P < 0.05) in brain ventricles (-5.3 ± 1.7%) and periventricular structures (cerebellum: 1.5 ± 0.8%) compared to EHS-DEH (ventricles: 6.8 ± 3.4, cerebellum: -0.7 ± 0.7; thalamus: -2.7 ± 1.3%). Changes in plasma osmolality (EHS: -3.0 ± 2.1; EHS-DEH: 9.3 ± 2.1 mOsm/kg) were related (P < 0.05) to thalamus (r = -0.45) and cerebellum volume (r = -0.61) which, in turn, were related (P < 0.05) to lateral (r = -0.41) and fourth ventricle volume (r = -0.67) changes, respectively; but, there were no associations (P > 0.50) between structural changes and visuomotor accuracy. EHS-DEH increased neural activation (P < 0.05) within motor and visual areas versus EHS and CON. Brain structural changes are related to bidirectional plasma osmolality perturbations resulting from exercise-heat stress (with and without water replacement), but do not explain visuomotor impairments. Negative impacts of exercise-heat stress on visuomotor tasks are further exacerbated by dehydration.
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Affiliation(s)
| | - Michael N. Sawka
- School of Biological SciencesGeorgia Institute of TechnologyAtlantaGeorgia
| | - J. C. Mizelle
- Department of KinesiologyEast Carolina UniversityGreenvilleNorth Carolina
| | - Lewis A. Wheaton
- School of Biological SciencesGeorgia Institute of TechnologyAtlantaGeorgia
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Stookey JD, Hamer J, Killilea DW. Change in hydration indices associated with an increase in total water intake of more than 0.5 L/day, sustained over 4 weeks, in healthy young men with initial total water intake below 2 L/day. Physiol Rep 2018; 5:5/22/e13356. [PMID: 29150589 PMCID: PMC5704074 DOI: 10.14814/phy2.13356] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/09/2017] [Accepted: 06/23/2017] [Indexed: 01/11/2023] Open
Abstract
This secondary data analysis addressed gaps in knowledge about effects of chronic water intake. Longitudinal data from the Adapt Study were used to describe effects of prescribing a sustained increase in water intake relative to baseline, for 4 weeks, on multiple indices of total body water (TBW) flux, regulation, distribution, and volume in five healthy, free-living, young men, with mean total water intake initially below 2 L/day. Indices were measured weekly. Within-person fixed effect models tested for significant changes in indices over time and associations between changes in indices. Agreement between indices was described. Mixed models tested if baseline between-person differences in hydration indices modified changes in indices over time. Body water flux: The half-life of water in the body decreased significantly. Body water regulation: Serum osmolality decreased significantly. Urine anti-diuretic hormone, sodium, potassium, and osmolality decreased significantly. Plasma aldosterone and serum sodium increased significantly. Body water distribution: No significant changes were observed. Body water volume: Saliva osmolality decreased significantly. Body weight increased significantly by a mean ± SEM of 1.8% ± 0.5% from baseline over 4 weeks. Changes in indices were significantly inter-correlated. Agreement between indices changed over 4 weeks. Baseline saliva osmolality significantly modified responses to chronic water intake. The results motivate hypotheses for future studies: Chronic TBW deficit occurs in healthy individuals under daily life conditions and increases chronic disease risk; Sustained higher water intake restores TBW through gradual isotonic retention of potassium and/or sodium; Saliva osmolality is a sensitive and specific index of chronic hydration status.
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Affiliation(s)
- Jodi D Stookey
- Children's Hospital Oakland Research Institute, Oakland, California
| | - Janice Hamer
- Children's Hospital Oakland Research Institute, Oakland, California
| | - David W Killilea
- Children's Hospital Oakland Research Institute, Oakland, California
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135
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ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2018; 38:10-47. [PMID: 30005900 DOI: 10.1016/j.clnu.2018.05.024] [Citation(s) in RCA: 652] [Impact Index Per Article: 108.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
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Sollanek KJ, Tsurumoto M, Vidyasagar S, Kenefick RW, Cheuvront SN. Neither body mass nor sex influences beverage hydration index outcomes during randomized trial when comparing 3 commercial beverages. Am J Clin Nutr 2018; 107:544-549. [PMID: 29635499 DOI: 10.1093/ajcn/nqy005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/27/2017] [Indexed: 11/14/2022] Open
Abstract
Background The beverage hydration index (BHI) assesses the hydration potential of any consumable fluid relative to water. The BHI is a relatively new metric, and the impact of body mass, sex, and reproducibility has yet to be investigated. Objectives To assess the independent impact of body mass and sex on BHI using beverages not previously assessed, including an amino acid-based oral rehydration solution (AA-ORS), a glucose-containing ORS (G-ORS), and a sports drink (SpD), compared with water (control). The reproducibility of the results was examined using statistical modeling (bootstrap analysis). Design Using a repeated-measures design, 40 euhydrated and fasted subjects (17 male, 23 female; urine specific gravity <1.025) were studied on 4 separate occasions. During each trial, subjects ingested 1 L of each beverage, and urine output was measured immediately postingestion and at 1-h intervals for the next 4 h. The BHI was calculated as a ratio of each individual's cumulative urine output after drinking 1 L of water over their cumulative urine output after drinking each of the test beverages. Results The calculated mean ± SD BHIs of the beverages were as follows: water (1.0 ± 0.0), AA-ORS (1.15 ± 0.28), G-ORS (1.21 ± 0.28), and SpD (1.09 ± 0.26). The BHI for both AA-ORS and G-ORS was greater than that for water (P < 0.05). Despite overall differences in body mass, neither body mass nor sex independently affected BHI. Based upon statistical modeling, our results demonstrate excellent reproducibility of outcomes and external validity. Conclusions Our results suggest that the BHI may be used and interpreted with confidence independently of body mass or sex. Furthermore, a novel carbohydrate-free AA-ORS and a traditional commercially available G-ORS were superior to water in optimizing hydration, whereas SpD was not. This trial was registered at clinicaltrials.gov as NCT03262597.
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Affiliation(s)
- Kurt J Sollanek
- Department of Kinesiology, Sonoma State University, Rohnert Park, CA
| | - Matthew Tsurumoto
- Department of Kinesiology, Sonoma State University, Rohnert Park, CA
| | - Sadasivan Vidyasagar
- Department of Radiation Oncology, University of Florida Health Cancer Center, Cancer and Genetics Research, Gainesville, FL
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Bhutani S, Kahn E, Tasali E, Schoeller DA. Composition of two-week change in body weight under unrestricted free-living conditions. Physiol Rep 2018; 5:5/13/e13336. [PMID: 28676555 PMCID: PMC5506524 DOI: 10.14814/phy2.13336] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 05/29/2017] [Indexed: 11/24/2022] Open
Abstract
The composition of weight change has a large impact on energy balance calculations. Composition of long-term weight change interventions is well-documented, but information on short-term weight change under unrestricted free-living conditions is limited. The composition and energy density of the changes in body weight during 2-week free-living conditions were analyzed in adults from two cohorts: cohort 1 (n = 24) included participants from the reproducibility subset of the Observing Protein and Energy Nutrition study; cohort 2 (n = 22) included participants who were studied under free-living conditions in an ongoing study in the Chicago area. Change in body weight, total body water (TBW) by stable isotope dilution (cohort 1), and fat mass (FM) and fat-free mass (FFM) by serial DXA (cohort 2) were measured. To determine the fractional composition of the change in body weight we analyzed the linear associations between changes in body weight and changes in body composition. In the combined dataset, the average change in body weight (0.26 ± 1.2 kg) was consistent with being in energy balance. Average change in body weight was associated with the change in TBW (P < 0.0001) in cohort 1 and the change in FFM (P = 0.0002) in cohort 2. A unit change in body weight was composed of 84% change in FFM in the combined dataset indicating that 2-week fluctuation in body weight is largely composed of FFM The energy density of 1-3 kg short-term changes in body weight averaged 2380 kcal/kg.
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Affiliation(s)
- Surabhi Bhutani
- Department of Nutritional Sciences, University of Wisconsin, Madison, Wisconsin .,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eva Kahn
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Esra Tasali
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Dale A Schoeller
- Department of Nutritional Sciences, University of Wisconsin, Madison, Wisconsin
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Abstract
PURPOSE To determine the reliability and diagnostic accuracy of noninvasive urinary dehydration markers in field-based settings on a day-to-day basis in elite adolescent amateur boxers. METHODS Sixty-nine urine samples were collected daily from 23 athletes (17.3 ± 1.9 y) during their weight-stable phase and analyzed by field and laboratory measures of hydration status. Urine osmolality (UOSM), urine specific gravity (USG), total protein content (TPC), and body-mass stability were evaluated to determine fluid balance and hydration status. Overall macronutrient and water intake were determined using dietary records. According to their anthropometric characteristics, athletes were assigned into 2 groups: lightweight (LWB) and heavyweight (HWB) boxers. RESULTS Data presented on UOSM demonstrated a uniform increment by 11.2% ± 12.8% (LWB) and 19.9% ± 22.7% (HWB) (P < .001) over the course of the study, even during the weight-stable phase (body mass, ICC = .99) and ad libitum fluid intake (42 ± 4 mL · kg-1 · d-1). The intraclass correlation coefficients (ICCs) ranged from .52 to .55 for USG and .38 to .52 for UOSM, further indicating inconsistency of the urinary dehydration markers. Poor correlations were found between USG and TPC metabolites (r = .27, P = .211). CONCLUSIONS Urinary dehydration markers (both USG and UOSM) exhibit high variability and seem to be unreliable diagnostic tools to track actual body-weight loss in real-life settings. The ad libitum fluid intake was apparently inadequate to match acute fluid loss during and after intense preparation. The applicability of a single-time-point hydration-status assessment concept may preclude accurate assessment of actual body-weight deficits in youth boxers.
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139
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Willshire C, Bron AJ, Gaffney EA, Pearce EI. Basal Tear Osmolarity as a metric to estimate body hydration and dry eye severity. Prog Retin Eye Res 2018; 64:56-64. [PMID: 29476817 DOI: 10.1016/j.preteyeres.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/02/2018] [Accepted: 02/20/2018] [Indexed: 01/28/2023]
Abstract
The osmolarities of various bodily fluids, including tears, saliva and urine, have been used as indices of plasma osmolality, a measure of body hydration, while tear osmolarity is used routinely in dry eye diagnosis, the degree of tear hyperosmolarity providing an index of disease severity. Systemic dehydration, due to inadequate water intake or excessive water loss is common in the elderly population, has a high morbidity and may cause loss of life. Its diagnosis is often overlooked and there is a need to develop a simple, bedside test to detect dehydration in this population. We hypothesize that, in the absence of tear evaporation and with continued secretion, mixing and drainage of tears, tear osmolarity falls to a basal level that is closer to that of the plasma than that of a tear sample taken in open eye conditions. We term this value the Basal Tear Osmolarity (BTO) and propose that it may be measured in tear samples immediately after a period of evaporative suppression. This value will be particular to an individual and since plasma osmolarity is controlled within narrow limits, it is predicted that it will be stable and have a small variance. It is proposed that the BTO, measured immediately after a defined period of eye closure, can provide a new metric in the diagnosis of systemic dehydration and a yardstick against which to gauge the severity of dry eye disease.
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Affiliation(s)
- C Willshire
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - A J Bron
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK; Nuffield Department of Clinical Neurosciences and Nuffield Laboratory of Ophthalmology, University of Oxford, UK.
| | - E A Gaffney
- Wolfson Centre of Mathematical Biology, Mathematical Institute, University of Oxford, UK
| | - E Ian Pearce
- School of Health and Life Sciences, Glasgow Caledonian University, UK
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Schlader ZJ, Chapman CL, Sarker S, Russo L, Rideout TC, Parker MD, Johnson BD, Hostler D. Firefighter Work Duration Influences the Extent of Acute Kidney Injury. Med Sci Sports Exerc 2018; 49:1745-1753. [PMID: 28272268 DOI: 10.1249/mss.0000000000001254] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE We tested the hypothesis that elevations in biomarkers of acute kidney injury are influenced by the magnitude of hyperthermia and dehydration elicited by two common firefighter work durations. METHODS Twenty-nine healthy adults (10 females) wearing firefighter protective clothing completed two randomized trials where they walked at 4.8 km·h, 5% grade in a 38°C, 50% RH environment. In the short trial, subjects completed two 20-min exercise bouts. In the long trial (LONG), subjects completed three 20-min exercise bouts. Each exercise bout was separated by 10 min of standing rest in an ~20°C environment. Venous blood samples were obtained before and immediately after exercise, and after 1 h recovery. Dependent variables included changes in core temperature, body weight, plasma volume, serum creatinine, and plasma neutrophil gelatinase-associated lipocalin, a marker of renal tubule injury. RESULTS Changes in core temperature (+2.0°C ± 0.7°C vs +1.1°C ± 0.4°C, P < 0.01), body weight (-0.9% ± 0.6% vs -0.5% ± 0.5%, P < 0.01), and plasma volume (-11% ± 5% vs -8% ± 6%, P < 0.01) during exercise were greater in LONG. Increases in creatinine were higher in LONG postexercise (0.18 ± 0.15 vs 0.08 ± 0.07 mg·dL, P < 0.01) and after recovery (0.21 ± 0.16 vs 0.14 ± 0.10 mg·dL, P < 0.01). Increases in neutrophil gelatinase-associated lipocalin were greater in LONG postexercise (27.0 ± 20.5 vs 12.7 ± 18.0 ng·mL, P = 0.01) and after recovery (16.9 ± 15.6 vs 1.5 ± 15.1 ng·mL, P = 0.02). CONCLUSIONS Biomarkers of acute kidney injury are influenced by the magnitude of hyperthermia and hypovolemia elicited by exercise in the heat.
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Affiliation(s)
- Zachary J Schlader
- 1Department of Exercise and Nutrition Sciences, Center for Research and Education in Special Environments, University at Buffalo, Buffalo, NY; and 2Department of Physiology and Biophysics, University at Buffalo, Buffalo, NY
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Villiger M, Stoop R, Vetsch T, Hohenauer E, Pini M, Clarys P, Pereira F, Clijsen R. Evaluation and review of body fluids saliva, sweat and tear compared to biochemical hydration assessment markers within blood and urine. Eur J Clin Nutr 2018; 72:69-76. [PMID: 28853743 PMCID: PMC5765170 DOI: 10.1038/ejcn.2017.136] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/22/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022]
Abstract
Evaluating and testing hydration status is increasingly requested by rehabilitation, sport, military and performance-related activities. Besides commonly used biochemical hydration assessment markers within blood and urine, which have their advantages and limitations in collection and evaluating hydration status, there are other potential markers present within saliva, sweat or tear. This literature review focuses on body fluids saliva, sweat and tear compared to blood and urine regarding practicality and hydration status influenced by fluid restriction and/or physical activity. The selected articles included healthy subjects, biochemical hydration assessment markers and a well-described (de)hydration procedure. The included studies (n=16) revealed that the setting and the method of collecting respectively accessing body fluids are particularly important aspects to choose the optimal hydration marker. To obtain a sample of saliva is one of the simplest ways to collect body fluids. During exercise and heat exposures, saliva composition might be an effective index but seems to be highly variable. The collection of sweat is a more extensive and time-consuming technique making it more difficult to evaluate dehydration and to make a statement about the hydration status at a particular time. The collection procedure of tear fluid is easy to access and causes very little discomfort to the subject. Tear osmolarity increases with dehydration in parallel to alterations in plasma osmolality and urine-specific gravity. But at the individual level, its sensitivity has to be further determined.
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Affiliation(s)
- M Villiger
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
- THIM University of Applied Sciences, Landquart, Switzerland
| | - R Stoop
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
| | - T Vetsch
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
| | - E Hohenauer
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
- THIM University of Applied Sciences, Landquart, Switzerland
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - M Pini
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
| | - P Clarys
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - F Pereira
- Faculty of Medicine, Imperial College London, London, Great Britain
- CSEM Centre Suisse d’Electronique et de Microtechnique SA, Landquart, Switzerland
| | - R Clijsen
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
- THIM University of Applied Sciences, Landquart, Switzerland
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
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142
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Garrett DC, Rae N, Fletcher JR, Zarnke S, Thorson S, Hogan DB, Fear EC. Engineering Approaches to Assessing Hydration Status. IEEE Rev Biomed Eng 2017; 11:233-248. [PMID: 29990109 DOI: 10.1109/rbme.2017.2776041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dehydration is a common condition characterized by a decrease in total body water. Acute dehydration can cause physical and cognitive impairment, heat stroke and exhaustion, and, if severe and uncorrected, even death. The health effects of chronic mild dehydration are less well studied with urolithiasis (kidney stones) the only condition consistently associated with it. Aside from infants and those with particular medical conditions, athletes, military personnel, manual workers, and older adults are at particular risk of dehydration due to their physical activity, environmental exposure, and/or challenges in maintaining fluid homeostasis. This review describes the different approaches that have been explored for hydration assessment in adults. These include clinical indicators perceived by the patient or detected by a practitioner and routine laboratory analyses of blood and urine. These techniques have variable accuracy and practicality outside of controlled environments, creating a need for simple, portable, and rapid hydration monitoring devices. We review the wide array of devices proposed for hydration assessment based on optical, electromagnetic, chemical, and acoustical properties of tissue and bodily fluids. However, none of these approaches has yet emerged as a reliable indicator in diverse populations across various settings, motivating efforts to develop new methods of hydration assessment.
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143
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Posch AM, Luippold AJ, Mitchell KM, Bradbury KE, Kenefick RW, Cheuvront SN, Charkoudian N. Sympathetic neural and hemodynamic responses to head-up tilt during isoosmotic and hyperosmotic hypovolemia. J Neurophysiol 2017; 118:2232-2237. [PMID: 28747468 DOI: 10.1152/jn.00403.2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 11/22/2022] Open
Abstract
We hypothesized that muscle sympathetic nerve activity (MSNA) during head-up tilt (HUT) would be augmented during exercise-induced (hyperosmotic) dehydration but not isoosmotic dehydration via an oral diuretic. We studied 26 young healthy subjects (7 female, 19 male) divided into three groups: euhydrated (EUH, n = 7), previously exercised in 40°C while maintaining hydration; dehydrated (DEH, n = 10), previously exercised in 40°C during which ~3% of body weight was lost via sweat loss; and diuretic (DIUR, n = 9), a group that did not exercise but lost ~3% of body weight via diuresis (furosemide, 80 mg by mouth). We measured MSNA, heart rate (HR), and blood pressure (BP) during supine rest and 30° and 45° HUT. Plasma volume (PV) decreased similarly in DEH (-8.5 ± 3.3%) and DIUR (-11.4 ± 5.7%) (P > 0.05). Plasma osmolality was similar between DIUR and EUH (288 ± 4 vs. 284 ± 5 mmol/kg, respectively) but was significantly higher in DEH (299 ± 5 mmol/kg) (P < 0.05). Mixed-model ANOVA was used with repeated measures on position (HUT) and between-group analysis on condition. HR and MSNA increased in all subjects during HUT (main effect of position; P < 0.05). There was also a significant main effect of group, such that MSNA and HR were higher in DEH compared with DIUR (P < 0.05). Changes in HR with HUT were larger in both hypovolemic groups compared with EUH (P < 0.05). The differential HUT response "strategies" in each group suggest a greater role for hypovolemia per se in controlling HR responses during dehydration, and a stronger role for osmolality in control of SNA.NEW & NOTEWORTHY Interactions of volume regulation with control of vascular sympathetic nerve activity (SNA) have important implications for blood pressure regulation. Here, we demonstrate that SNA and heart rate (HR) during hyperosmotic hypovolemia (exercise-induced) were augmented during supine and tilt compared with isoosmotic hypovolemia (diuretic), which primarily augmented the HR response. Our data suggest that hypovolemia per se had a larger role in controlling HR responses, whereas osmolality had a stronger role in control of SNA.
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Affiliation(s)
- Alexander M Posch
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Adam J Luippold
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Katherine M Mitchell
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Karleigh E Bradbury
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Robert W Kenefick
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Samuel N Cheuvront
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
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144
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Willshire C, Buckley RJ, Bron AJ. Estimating basal tear osmolarity in normal and dry eye subjects. Cont Lens Anterior Eye 2017; 41:34-46. [PMID: 28958415 DOI: 10.1016/j.clae.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/23/2017] [Accepted: 09/08/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Tear osmolarity (tOsm) is used as a measure of severity in dry eye disease (DED) and has been proposed as an index of body hydration. In DED the level of tear hyperosmolarity is compared with that of a control population. It is proposed here that a better index of body hydration and a more valid reference point in DED can be acquired by measuring the tOsm after a period of evaporative suppression. METHOD 8 normal and DED subjects were recruited, their tOsm measured in uncontrolled environmental 'clinic conditions'. Then in experiment 1 they entered a controlled environment chamber and had tOsm measured after 45 minutes of eye closure and then, with the eyes open, at 15 minute intervals for a further 45 minutes, at a relative humidity (RH) of 45%. Alternatively, in experiment 2, they had tOsm measured every 15 minutes for 45 minutes during exposure to 70% RH, as a separate measure to suppress evaporation. RESULTS A significant decrease in tOsm occurred in both normal and DED subjects after lid closure in experiment 1 (normal RE p=0.015; normal LE p=0.006; DED RE p=0.0002; DED LE p=0.01). The tOsm also fell slightly after exposure to 70% RH in experiment 2 significant in the LE of normal group only (normal LE p=0.045). CONCLUSIONS Suppression of tear evaporation resulted in a fall in tOsm, close to that of plasma osmolarity (285-295mOsm/L). It is proposed that this new measure, termed Basal Tear Osmolarity (BTO), could provide a valuable index of plasma osmolarity and hence of body hydration and in DED, a personal baseline against which to gauge the severity of tear hyperosmolarity.
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Affiliation(s)
| | - Roger J Buckley
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - Anthony J Bron
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK; Nuffield Department of Clinical Neurosciences and Nuffield Laboratory of Ophthalmology, University of Oxford, UK
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145
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Ring M, Lohmueller C, Rauh M, Mester J, Eskofier BM. Salivary Markers for Quantitative Dehydration Estimation During Physical Exercise. IEEE J Biomed Health Inform 2017; 21:1306-1314. [PMID: 28880151 DOI: 10.1109/jbhi.2016.2598854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Salivary markers have been proposed as noninvasive and easy-to-collect indicators of dehydrations during physical exercise. It has been demonstrated that threshold-based classifications can distinguish dehydrated from euhydrated subjects. However, considerable challenges were reported simultaneously, for example, high intersubject variabilities in these markers. Therefore, we propose a machine-learning approach to handle the intersubject variabilities and to advance from binary classifications to quantitative estimations of total body water (TBW) loss. For this purpose, salivary samples and reference values of TBW loss were collected from ten subjects during a 2-h running workout without fluid intake. The salivary samples were analyzed for previously investigated markers (osmolality, proteins) as well as additional unexplored markers (amylase, chloride, cortisol, cortisone, and potassium). Processing all these markers with a Gaussian process approach showed that quantitative TBW loss estimations are possible within an error of 0.34 l, roughly speaking, a glass of water. Furthermore, a data analysis illustrated that the salivary markers grow nonlinearly during progressive dehydration, which is in contrast to previously reported linear observations. This insight could help to develop more accurate physiological models for salivary markers and TBW loss. Such models, in turn, could facilitate even more precise TBW loss estimations in the future.
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146
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McDermott BP, Anderson SA, Armstrong LE, Casa DJ, Cheuvront SN, Cooper L, Kenney WL, O'Connor FG, Roberts WO. National Athletic Trainers' Association Position Statement: Fluid Replacement for the Physically Active. J Athl Train 2017; 52:877-895. [PMID: 28985128 PMCID: PMC5634236 DOI: 10.4085/1062-6050-52.9.02] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To present evidence-based recommendations that promote optimized fluid-maintenance practices for physically active individuals. BACKGROUND Both a lack of adequate fluid replacement (hypohydration) and excessive intake (hyperhydration) can compromise athletic performance and increase health risks. Athletes need access to water to prevent hypohydration during physical activity but must be aware of the risks of overdrinking and hyponatremia. Drinking behavior can be modified by education, accessibility, experience, and palatability. This statement updates practical recommendations regarding fluid-replacement strategies for physically active individuals. RECOMMENDATIONS Educate physically active people regarding the benefits of fluid replacement to promote performance and safety and the potential risks of both hypohydration and hyperhydration on health and physical performance. Quantify sweat rates for physically active individuals during exercise in various environments. Work with individuals to develop fluid-replacement practices that promote sufficient but not excessive hydration before, during, and after physical activity.
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147
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Taniguchi H, Ushigome K. The development of a pre-dehydration check sheet for independent community dwelling elderly. -A continuation of research about pre-dehydration among elderly individuals who had been admitted to or regularly visited an elderly-care institution. Nihon Ronen Igakkai Zasshi 2017; 54:381-391. [PMID: 28855463 DOI: 10.3143/geriatrics.54.381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM In the present study, we defined the state of pre-dehydration (PD) as the suspected loss of body fluids, not accompanied by subjective symptoms (serum osmotic pressure: 292-300 mOsm/kg・H2O). The goal of this study was to develop a non-invasive PD check sheet for independent home care for the elderly. METHODS We evaluated the serum osmotic pressure of 222 independent community dwelling elderly individuals who were >65 years of age. We then determined the association between the serum osmotic pressure and various dehydration-related diagnostic factors that we identified in a previous study. We performed a logistic regression analysis to determine the risk factors for dehydration and allotted scores based on the odds ratio. We developed a non-invasive PD check sheet consisting of items with high scores and categorized the risks based on the positive predictive value of the total score of the applied items. RESULTS PD was confirmed in 46 subjects (20.7%) based on their serum osmotic pressure. We developed a PD assessment sheet which consisted of 6 items, (1) Dislike rehydrating before sleeping, as it induces the need to use the toilet (3 points), (2) Using diuretics (8 points), (3) Casual blood sugar ≥126 mg/dl (9 points), (4) Age ≥85 years (3 points), (5) Male sex (4 points), (6) Body weight ≥60 kg (3 points). Patients with a score of >13 points on this sheet were considered to have a high risk of PD (maximum score: 30 points) (positive predictive value, 72%; negative predictive value, 85.6%; P<0.0001). CONCLUSION In the present study, we found that 20.7% of elderly subjects had PD. Based on these data, we developed an effective noninvasive tool for detecting PD among independent community dwelling elderly.
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Affiliation(s)
- Hideki Taniguchi
- Department of Perioperative Support Center, Saiseikai Yokohama-shi Tobu Hospital
| | - Keiko Ushigome
- Department of Perioperative Support Center, Saiseikai Yokohama-shi Tobu Hospital
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148
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Trabelsi K, Stannard SR, Chtourou H, Moalla W, Ghozzi H, Jamoussi K, Hakim A. Monitoring athletes’ hydration status and sleep patterns during Ramadan observance: methodological and practical considerations. BIOL RHYTHM RES 2017. [DOI: 10.1080/09291016.2017.1368214] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Khaled Trabelsi
- Laboratory of Pharmacology, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Stephen R. Stannard
- School of Sport and Exercise, Massey University, Palmerston North, New Zealand
| | - Hamdi Chtourou
- UR15JS01: Education, Motricity, Sport and Health, High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
| | - Wacim Moalla
- UR15JS01: Education, Motricity, Sport and Health, High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
| | - Hanène Ghozzi
- Laboratory of Pharmacology, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Kamel Jamoussi
- Department of Biochemistry, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Ahmed Hakim
- Laboratory of Pharmacology, Faculty of Medicine, University of Sfax, Sfax, Tunisia
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149
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McKenzie AL, Perrier ET, Guelinckx I, Kavouras SA, Aerni G, Lee EC, Volek JS, Maresh CM, Armstrong LE. Relationships between hydration biomarkers and total fluid intake in pregnant and lactating women. Eur J Nutr 2017; 56:2161-2170. [PMID: 27519184 PMCID: PMC5579181 DOI: 10.1007/s00394-016-1256-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 06/22/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Previous research established significant relationships between total fluid intake (TFI) and urinary biomarkers of the hydration process in free-living males and females; however, the nature of this relationship is not known for pregnant (PREG) and lactating (LACT) women. PURPOSE To determine the relationship between urinary and hematological hydration biomarkers with TFI in PREG and LACT. METHODS Eighteen PREG/LACT (age: 31 ± 3 years, pre-pregnancy BMI: 24.26 ± 5.85 kg m-2) collected 24-h urine samples, recorded TFI, and provided a blood sample at 5 time points (15 ± 2, 26 ± 1, 37 ± 1 weeks gestation, 3 ± 1 and 9 ± 1 weeks postpartum during lactation); 18 pair-matched non-pregnant (NP), non-lactating (NL) women (age: 29 ± 4 years, BMI: 24.1 ± 3.7 kg m-2) provided samples at similar time intervals. Twenty-four-hour urine volume (U VOL), osmolality (U OSM), specific gravity (U SG), and color (U COL) were measured. Hematocrit, serum osmolality (S OSM), and serum total protein (S TP) were measured in blood. RESULTS Significant relationships were present between TFI and urinary biomarkers in all women (P < 0.004); these relationships were not different between PREG and NP, and LACT and NL, except U VOL in PREG (P = 0.0017). No significant relationships between TFI and hematological biomarkers existed (P > 0.05). CONCLUSION Urinary biomarkers of hydration, but not hematological biomarkers, have a strong relationship with TFI in PREG, LACT, NP, and NL women. These data suggest that urinary biomarkers of hydration reflect TFI during pregnancy and breast-feeding.
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Affiliation(s)
- Amy L McKenzie
- Department of Kinesiology, Human Performance Laboratory, University of Connecticut, 2095 Hillside Road, Storrs, CT, 06269-1110, USA.
| | | | | | - Stavros A Kavouras
- Human Performance Laboratory, Department of Health, Human Performance and Recreation, University of Arkansas, 155 Stadium Drive, HPER 321, Fayetteville, AR, 72701, USA
| | - Giselle Aerni
- University of Connecticut Health, Family Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - Elaine C Lee
- Department of Kinesiology, Human Performance Laboratory, University of Connecticut, 2095 Hillside Road, Storrs, CT, 06269-1110, USA
| | - Jeff S Volek
- Department of Human Sciences, Ohio State University, PAES Building, 305 W. 17th Ave, Columbus, OH, 43210, USA
| | - Carl M Maresh
- Department of Human Sciences, Ohio State University, PAES Building, 305 W. 17th Ave, Columbus, OH, 43210, USA
| | - Lawrence E Armstrong
- Department of Kinesiology, Human Performance Laboratory, University of Connecticut, 2095 Hillside Road, Storrs, CT, 06269-1110, USA
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Mac VVT, Tovar-Aguilar JA, Flocks J, Economos E, Hertzberg VS, McCauley LA. Heat Exposure in Central Florida Fernery Workers: Results of a Feasibility Study. J Agromedicine 2017; 22:89-99. [PMID: 28118110 DOI: 10.1080/1059924x.2017.1282906] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to determine the feasibility of field-based biomonitoring of heat-related illness (HRI) phenomena in Florida farmworkers. The authors determined feasibility through participant interviews regarding acceptability, data capture, recruitment and retention, and observed barriers and challenges to implementation. METHODS Study participants were employed in fernery operations in northeast Central Florida where ornamental ferns are grown and harvested in a seasonally high-heat environment. In this pilot, a total of 43 farmworkers participated during summers 2012 and 2013 and measurements included body core temperature, heart rate, energy expenditure, urine and blood osmolality, and self-reported HRI symptoms. RESULTS Data capture was approximately 90%. Participants reported that the study methods were nonobtrusive to their work, and that they were comfortable with study measures. CONCLUSIONS These results open possibilities for characterizing HRI utilizing physiologic biomonitoring in vulnerable occupational groups.
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Affiliation(s)
- Valerie Vi Thien Mac
- a Nell Hodgson Woodruff School of Nursing , Emory University , Atlanta , Georgia , USA
| | | | - Joan Flocks
- c Levin College of Law , University of Florida , Gainsville , Florida , USA
| | | | - Vicki S Hertzberg
- a Nell Hodgson Woodruff School of Nursing , Emory University , Atlanta , Georgia , USA
| | - Linda A McCauley
- a Nell Hodgson Woodruff School of Nursing , Emory University , Atlanta , Georgia , USA
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