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Kim HK, Sagayama H, Yoshida T, Oishi K, Nakayama Y, Kimura M, Ono R, Yamada Y. Predictors of Water Turnover in Older Adults: A Doubly Labeled Water- and Triaxial Accelerometer-Based Study. J Nutr 2024:S0022-3166(24)00226-8. [PMID: 38649093 DOI: 10.1016/j.tjnut.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/01/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Water is one of the most essential nutrients for life. The water turnover (WT), total body water (TBW), and total energy expenditure (TEE) can be measured using the doubly labeled water (DLW) method. WT and TBW are lower in older adults than in young adults, and the former are susceptible to dehydration, necessitating to identify predictors of the WT in older adults. OBJECTIVES The current study aimed to examine the association between WT and physical activity, physical function, and body composition in Japanese adults aged ≥65 y and identify predictors for WT in this population. METHODS This study enrolled 133 older adults (women, n = 61; men, n = 72) aged 65-88 y. WT, TBW, TEE, fat-free mass (FFM), and percent body fat (%Fat) were determined using the DLW method. The fitness age score (FAS) was obtained from 5 physical fitness tests. Physical activity and the step count were assessed using a previously validated triaxial accelerometer. Multiple regression analyses were performed with WT as the dependent variable. RESULTS WT was positively associated with weight, physical activity level (PAL), moderate-vigorous physical activity, and TEE, and negatively associated with sedentary behavior. We examined potential predictors for WT using age, sex, height, weight, FFM, %Fat, TEE, PAL, and FAS in older Japanese adults. CONCLUSIONS Our results confirmed that age, sex, weight, FFM, TEE, and PAL are the potential predictors of WT in older Japanese adults aged ≥65 y.
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Affiliation(s)
- Hyeon-Ki Kim
- National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Hiroyuki Sagayama
- Institute of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Tsukasa Yoshida
- National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Kan Oishi
- National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan; Graduate School of Health and Sports Science, Doshisha University, Kyoto, Japan; Japan Society for the Promotion of Sciences, Tokyo, Japan
| | - Yui Nakayama
- National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Misaka Kimura
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan
| | - Rei Ono
- National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Yosuke Yamada
- National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan.
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McGrosky A, Swanson ZS, Rimbach R, Bethancourt H, Ndiema E, Nzunza R, Braun DR, Rosinger AY, Pontzer H. Total daily energy expenditure and elevated water turnover in a small-scale semi-nomadic pastoralist society from Northern Kenya. Ann Hum Biol 2024; 51:2310724. [PMID: 38594936 DOI: 10.1080/03014460.2024.2310724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/21/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Pastoralists live in challenging environments, which may be accompanied by unique activity, energy, and water requirements. AIM Few studies have examined whether the demands of pastoralism contribute to differences in total energy expenditure (TEE) and water turnover (WT) compared to other lifestyles. SUBJECTS AND METHODS Accelerometer-derived physical activity, doubly labelled water-derived TEE and WT, and anthropometric data were collected for 34 semi-nomadic Daasanach adults from three northern Kenyan communities with different levels of pastoralist activity. Daasanach TEEs and WTs were compared to those of other small-scale and industrialised populations. RESULTS When modelled as a function of fat-free-mass, fat-mass, age, and sex, TEE did not differ between Daasanach communities. Daasanach TEE (1564-4172 kcal/day) was not significantly correlated with activity and 91% of TEEs were within the range expected for individuals from comparison populations. Mean WT did not differ between Daasanach communities; Daasanach absolute (7.54 litres/day men; 7.46 litres/day women), mass-adjusted, and TEE-adjusted WT was higher than most populations worldwide. CONCLUSIONS The similar mass-adjusted TEE of Daasanach and industrialised populations supports the hypothesis that habitual TEE is constrained, with physically demanding lifestyles necessitating trade-offs in energy allocation. Elevated WT in the absence of elevated TEE likely reflects a demanding active lifestyle in a hot, arid climate.
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Affiliation(s)
| | - Zane S Swanson
- Evolutionary Anthropology, Duke University, Durham, NC, USA
- Global Food and Water Security Program, Center for Strategic and International Studies, Washington, WA, USA
| | - Rebecca Rimbach
- Evolutionary Anthropology, Duke University, Durham, NC, USA
- Department of Behavioural Biology, University of Münster, Münster, Germany
| | | | - Emmanuel Ndiema
- Department of Earth Sciences, National Museums of Kenya, Nairobi, Kenya
| | | | - David R Braun
- Center for the Advanced Study of Human Paleobiology, Anthropology Department, George Washington University, Washington, WA, USA
- Technological Primate Research Group, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Asher Y Rosinger
- Department of Biobehavioral Health, PA State University, University Park, PA, USA
- Department of Anthropology, Pennsylvania State University, State College, PA, USA
| | - Herman Pontzer
- Evolutionary Anthropology, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
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Watanabe D, Inoue Y, Miyachi M. Distribution of water turnover by sex and age as estimated by prediction equation in Japanese adolescents and adults: the 2016 National Health and Nutrition Survey, Japan. Nutr J 2023; 22:64. [PMID: 38017435 PMCID: PMC10685525 DOI: 10.1186/s12937-023-00896-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/23/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Although water is essential to the maintenance of health and life, standard values for human water requirements are yet to be determined. This study aimed to evaluate the distribution of water turnover (WT) according to sex and age, estimated using a prediction equation, in Japanese adolescents and adults. METHODS This cross-sectional study used data from the 2016 National Health and Nutrition Survey, Japan. Data were obtained from electronically available aggregated reports in the survey's official website. Participants aged between 15 and 80 years (10,546 men, 12,355 women) were selected using stratified random sampling. WT was calculated considering lifestyle and environmental factors, and using an equation (coefficient of determination = 0.471) previously developed by the international doubly labelled water (DLW) database group. As data on physical activity levels (PAL) were not collected in the survey, we used two evaluation methods: (1) energy intake assessed by dietary records and (2) total energy expenditure measured by the DLW method reported in previous Japanese studies, divided by basal metabolic rate predicted using the equation. We evaluated the relationship between WT and age using a restricted cubic spline model. RESULTS The average WT for the 15-19, 20-29, 30-39, 40-49, 50-59, 60-69, and ≥ 70 years was 3291, 3151, 3213, 3243, 3205, 3104, and 2790 ml/day, respectively in men, and 2641, 2594, 2741, 2739, 2753, 2707, and 2482 ml/day, respectively in women. In the spline model, WT showed an inverse association with age in men older than 50 years, whereas women showed a reverse U-shaped relationship between WT and age (p for non-linearity < 0.001), although results differed with body weight adjustment. Similar results were found for both PAL evaluation methods, and the range of WT per body weight was 45-56 ml/day for both sexes. CONCLUSIONS We determined the standard values of WT in Japanese population using a prediction equation and national large-scale survey data. These findings may be useful for setting water requirements for dietary guidelines in future.
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Affiliation(s)
- Daiki Watanabe
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-city, Saitama, 359-1192, Japan.
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 17-34 Senrioka-Shimmachi, Settsu-city, Osaka, 566-0002, Japan.
| | - Yumiko Inoue
- Graduate School of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-city, Saitama, 359-1192, Japan
| | - Motohiko Miyachi
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-city, Saitama, 359-1192, Japan
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 17-34 Senrioka-Shimmachi, Settsu-city, Osaka, 566-0002, Japan
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Rosinger AY, Bethancourt HJ, Swanson ZS, Lopez K, Kenney WL, Huanca T, Conde E, Nzunza R, Ndiema E, Braun DR, Pontzer H. Cross-cultural variation in thirst perception in hot-humid and hot-arid environments: Evidence from two small-scale populations. Am J Hum Biol 2022; 34:e23715. [PMID: 34942040 PMCID: PMC9177510 DOI: 10.1002/ajhb.23715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/18/2021] [Accepted: 12/11/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Thirst is an evolved central homeostatic feedback system that helps regulate body water for survival. Little research has examined how early development and exposure to extreme environments and water availability affect thirst perception, particularly outside Western settings. Therefore, we compared two indicators of perceived thirst (current thirst and pleasantness of drinking water) using visual scales among Tsimane' forager-horticulturalists in the hot-humid Bolivian Amazon and Daasanach agro-pastoralists in hot-arid Northern Kenya. METHODS We examined how these measures of perceived thirst were associated with hydration status (urine specific gravity), ambient temperatures, birth season, age, and population-specific characteristics for 607 adults (n = 378 Tsimane', n = 229 Daasanach) aged 18+ using multi-level mixed-effect regressions. RESULTS Tsimane' had higher perceived thirst than Daasanach. Across populations, hydration status was unrelated to both measures of thirst. There was a significant interaction between birth season and temperature on pleasantness of drinking water, driven by Kenya data. Daasanach born in the wet season (in utero during less water availability) had blunted pleasantness of drinking water at higher temperatures compared to those born in the dry season (in utero during greater water availability). CONCLUSIONS Our findings suggest hydration status is not a reliable predictor of thirst perceptions in extreme-hot environments with ad libitum drinking. Rather, our findings, which require additional confirmation, point to the importance of water availability during gestation in affecting thirst sensitivity to heat and water feedback mechanisms, particularly in arid environments. Thirst regulation will be increasingly important to understand given climate change driven exposures to extreme heat and water insecurity.
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Affiliation(s)
- Asher Y. Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
- Department of Anthropology, Pennsylvania State University, University Park, PA, USA
| | - Hilary J. Bethancourt
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Zane S. Swanson
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA
| | - Kaylee Lopez
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - W. Larry Kenney
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Tomas Huanca
- Centro Boliviano de Investigación y Desarrollo Socio Integral, San Borja, Bolivia
| | - Esther Conde
- Centro Boliviano de Investigación y Desarrollo Socio Integral, San Borja, Bolivia
| | - Rosemary Nzunza
- Center for Virus Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Emmanuel Ndiema
- Department of Earth Sciences, National Museums of Kenya, Nairobi, Kenya
| | - David R. Braun
- Center for the Advanced Study of Human Paleobiology, Department of Anthropology, The George Washington University, Washington, DC, USA
- Department of Human Evolution, Max Planck Institute of Evolutionary Anthropology, 04103 Leipzig, Germany
| | - Herman Pontzer
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA
- Global Health Institute, Duke University, Durham, NC, USA
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Green DR, Olack G, Tütken T, Leichliter J, Winkler DE, Clauss M, Vonhof H, Colman AS. A simple CO 2 equilibration method for measuring blood oxygen isotope compositions. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2022; 36:e9256. [PMID: 35028987 DOI: 10.1002/rcm.9256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/02/2022] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
RATIONALE Blood water oxygen isotope compositions can provide valuable insights into physiological processes and ecological patterns. While blood samples are commonly drawn for medical or scientific purposes, blood fractions are infrequently measured for oxygen isotopic compositions (δ18 O) because such measurements are time consuming and expensive. METHODS We sampled blood from sheep, goats, and iguanas raised in field and animal laboratories into serum, EDTA, heparin, and uncoated plastic vials commonly used in medical and scientific research, then separated red blood cell (RBC) and plasma or serum blood fractions. These were injected into helium-flushed Exetainer tubes where they naturally outgassed endogenous CO2 (goat blood), or into He- and CO2 -flushed tubes (iguana blood). The CO2 gas was sampled on a GasBench II system, and δ18 O was measured by an isotope ratio mass spectrometer (IRMS). RESULTS Repeated δ18 O measurements were stable over multiple days. The addition of desiccated blood solids to water standards had little impact on their δ18 O measurements, suggesting that organic molecular constituents within blood serum and plasma do not interfere with blood water δ18 O values. We observed slight but statistically significant δ18 O offsets between plasma, serum and RBC fractions. Mass-dependent body water turnover times for iguanas were derived from the data. CONCLUSIONS We demonstrate that a simple blood-CO2 equilibration method using the GasBench can quickly, reliably and accurately characterize water δ18 O in the plasma, RBC, and whole blood fractions of mammalian and reptilian blood samples (precision ≤ 0.1‰). This method will expand the application of blood stable isotope analysis in physiological and medical research.
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Affiliation(s)
- Daniel R Green
- Lamont-Doherty Earth Observatory and Earth Institute, Columbia University, New York, NY, USA
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Gerard Olack
- Department of the Geophysical Sciences, University of Chicago, Chicago, IL, USA
| | - Thomas Tütken
- Applied and Analytical Palaeontology, Institute of Geosciences, Johannes Gutenberg University, Mainz, Germany
| | - Jennifer Leichliter
- Applied and Analytical Palaeontology, Institute of Geosciences, Johannes Gutenberg University, Mainz, Germany
| | - Daniela E Winkler
- Applied and Analytical Palaeontology, Institute of Geosciences, Johannes Gutenberg University, Mainz, Germany
- Department of Natural Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Marcus Clauss
- Clinic for Zoo Animals, Exotic Pets and Wildlife, Vetsuisse Faculty, University of Zürich, Zurich, Switzerland
| | - Hubert Vonhof
- Climate Geochemistry Department, Max Planck Institute for Chemistry, Mainz, Germany
| | - Albert S Colman
- Department of the Geophysical Sciences, University of Chicago, Chicago, IL, USA
- Department of Earth, Environmental and Planetary Sciences, Rice University, Houston, TX, USA
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6
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Arns-Glaser L, Zandberg L, Assey VD, Baumgartner J, Abdallah F, Galetti V, Dary O, Zimmermann MB, Andersson M. Seasonal effects on urinary iodine concentrations in women of reproductive age: An observational study in Tanzania and South Africa. Am J Clin Nutr 2022; 115:298-309. [PMID: 34601579 DOI: 10.1093/ajcn/nqab327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Iodine intake in populations is usually assessed by measuring urinary iodine concentrations (UICs) in spot samples. Hot climate conditions may reduce urine volume, thus leading to overestimations of UIC and thereby masking inadequate iodine intake. OBJECTIVES We investigated the effects of season on UICs in 2 populations exposed to high-temperature climates. METHODS In this observational study, we examined women (18-49 years) in Tanzania (ncold = 206; nhot = 179) and South Africa (ncold = 157; nhot = 126) during cold and hot seasons. From each woman in both seasons, we obtained two 24-hour urine collections and 2 spot urine samples, as well as salt, water, and cow's milk samples. We measured the urine volume, UIC, and urinary creatinine concentration (UCC). The 24-hour urinary iodine excretion (UIE) was calculated and used to estimate the iodine intake. We used linear mixed-effects models to test for differences between seasons. RESULTS In Tanzanian women, we observed no seasonal effect on the urine volume, 24-hour UIE, 24-hour UIC, spot UIC, spot UIC:UCC ratio, or salt iodine concentration. In South African women, the median 24-hour urine volume was 1.40 L (IQR, 0.96-2.05 L) in the winter and 15% lower in the summer (P < 0.001). The median 24-hour UIE was 184 µg/day (IQR, 109-267 µg/day) in the winter and 34% lower in the summer (P < 0.001), indicating a lower iodine intake. As a result, UICs did not significantly differ between seasons in 24-hour collections and spot samples, whereas the spot UIC:UCC ratio differed by 21% (P < 0.001) and reflected the lower iodine intake. In both study populations, the within- and between-person variabilities in urine volume, 24-hour UICs, and spot UICs were higher than the variability between seasons. CONCLUSIONS Spot UIC may slightly overestimate the iodine intake in hot temperatures due to concentrated urine, and methods to correct for urine volume may be considered. Local seasonal differences in iodine intakes may also occur in some populations. This trial was registered at http://www.clinicaltrials.gov as NCT03215680.
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Affiliation(s)
- Leonie Arns-Glaser
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland
| | - Lizelle Zandberg
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Vincent D Assey
- Nutrition Services Section Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania.,Iodine Global Network, Ottawa, Canada
| | - Jeannine Baumgartner
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland.,Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Fatma Abdallah
- Iodine Global Network, Ottawa, Canada.,Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Valeria Galetti
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland
| | - Omar Dary
- Division of Nutrition and Environmental Health, Office of Maternal and Child Health and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, DC, USA
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland.,Iodine Global Network, Ottawa, Canada
| | - Maria Andersson
- Iodine Global Network, Ottawa, Canada.,Nutrition Research Unit, Children's Research Centre, University Children's Hospital Zurich, Zürich, Switzerland
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Disher AE, Stewart KL, Bach AJE, Stewart IB. Contribution of Dietary Composition on Water Turnover Rates in Active and Sedentary Men. Nutrients 2021; 13:nu13062124. [PMID: 34205676 PMCID: PMC8234797 DOI: 10.3390/nu13062124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/05/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022] Open
Abstract
Body water turnover is a marker of hydration status for measuring total fluid gains and losses over a 24-h period. It can be particularly useful in predicting (and hence, managing) fluid loss in individuals to prevent potential physical, physiological and cognitive declines associated with hypohydration. There is currently limited research investigating the interrelationship of fluid balance, dietary intake and activity level when considering body water turnover. Therefore, this study investigates whether dietary composition and energy expenditure influences body water turnover. In our methodology, thirty-eight males (19 sedentary and 19 physically active) had their total body water and water turnover measured via the isotopic tracer deuterium oxide. Simultaneous tracking of dietary intake (food and fluid) is carried out via dietary recall, and energy expenditure is estimated via accelerometery. Our results show that active participants display a higher energy expenditure, water intake, carbohydrate intake and fibre intake; however, there is no difference in sodium or alcohol intake between the two groups. Relative water turnover in the active group is significantly greater than the sedentary group (Mean Difference (MD) [95% CI] = 17.55 g·kg-1·day-1 [10.90, 24.19]; p = < 0.001; g[95% CI] = 1.70 [0.98, 2.48]). A penalised linear regression provides evidence that the fibre intake (p = 0.033), water intake (p = 0.008), and activity level (p = 0.063) predict participants' relative body water turnover (R2= 0.585). In conclusion, water turnover is faster in individuals undertaking regular exercise than in their sedentary counterparts, and is, in part, explained by the intake of water from fluid and high-moisture content foods. The nutrient analysis of the participant diets indicates that increased dietary fibre intake is also positively associated with water turnover rates. The water loss between groups also contributes to the differences observed in water turnover; this is partly related to differences in sweat output during increased energy expenditure from physical activity.
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Affiliation(s)
- Alice E. Disher
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane 4059, Australia; (A.E.D.); (K.L.S.); (A.J.E.B.)
| | - Kelly L. Stewart
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane 4059, Australia; (A.E.D.); (K.L.S.); (A.J.E.B.)
| | - Aaron J. E. Bach
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane 4059, Australia; (A.E.D.); (K.L.S.); (A.J.E.B.)
- National Climate Change Adaptation Research Facility (NCCARF), Griffith University, Gold Coast 4222, Australia
| | - Ian B. Stewart
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane 4059, Australia; (A.E.D.); (K.L.S.); (A.J.E.B.)
- Correspondence:
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Leonard WR. Water & Human Biology and New Developments for the American Journal of Human Biology. Am J Hum Biol 2020; 32:e23389. [PMID: 31916639 DOI: 10.1002/ajhb.23389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- William R Leonard
- Department of Anthropology & Program in Global Health Studies, Northwestern University, Evanston, Illinois
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