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Nusshag C, Theobald V, Wortmann M, Kaimann P, Dietrich M, Gruneberg D, Tourelle K, von der Forst M, Weigand MA, Bischoff MS, Böckler D, Schmitt FCF. Biomarker-guided detection of acute kidney injury in abdominal aortic surgery: the new and the old. Front Med (Lausanne) 2024; 11:1386018. [PMID: 39021823 PMCID: PMC11251966 DOI: 10.3389/fmed.2024.1386018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Acute kidney injury (AKI) is a common complication in patients undergoing major vascular surgery. Despite significant research efforts in this area, the incidence of AKI remains high, posing a significant challenge to healthcare systems, especially in situations where resources are limited. Early prediction of AKI severity and individualized postoperative care is therefore essential. Methods The primary objective of this exploratory study was to assess the diagnostic value of urine cell-cycle arrest biomarkers [(TIMP-2) × (IGFBP7)] and soluble urokinase plasminogen activator receptor (suPAR) for predicting moderate or severe AKI within 24 h after open aortic surgery, and compared to routine kidney biomarkers. Seventy-five patients undergoing elective aortic surgery were included. Clinical parameters, urine and blood samples were collected preoperatively, immediately postoperatively, and 24 h later. AKI was defined using KDIGO criteria. Individual and combined diagnostic performance of biomarkers were evaluated. Results Of the 75 patients, 61% developed AKI, of which 28% developed moderate or severe AKI within 24 h of surgery. Baseline demographics, comorbidities and kidney parameters did not differ between patients with moderate or severe AKI (AKI II/III) and none or mild AKI (AKI 0/I), except for higher preoperative suPAR levels in later AKI II/III patients. Urine osmolality, Cystatin C and serum creatinine had the highest predictive power for AKI II/III with AUCs of 0.75-0.72. (TIMP-2) × (IGFBP7), and neither (TIMP-2) × (IGFBP7) nor suPAR individually showed superior diagnostic value. Combining CysC or SCr with urine osmolality and 6 h urine output gave the best performance with AUCs of 0.86 (95% CI, 0.74-0.96) and 0.85 (95% CI, 0.75-0.95) respectively. Conclusion Our study suggests that routine parameters like urine osmolality, CysC, SCr and 6 h urine output perform best in predicting postoperative AKI after aortic surgery compared to the new biomarkers (TIMP-2) × (IGFBP7) and suPAR. Combining biomarkers, particularly CysC or SCr with urine output, urine osmolality, may enhance diagnostic accuracy. Further validation in larger cohorts and clinical settings is warranted to establish their clinical utility.
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Affiliation(s)
- Christian Nusshag
- Department of Nephrology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Vivienne Theobald
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Markus Wortmann
- Department of Vascular, Endovascular Surgery and Transplant Surgery, Stuttgart Hospital, Stuttgart, Germany
| | - Philipp Kaimann
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Maximilian Dietrich
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Daniel Gruneberg
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Kevin Tourelle
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Maik von der Forst
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Markus A. Weigand
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Moritz S. Bischoff
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix C. F. Schmitt
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
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Rosinger AY, John JD, Murdock K. Ad libitum dehydration is associated with poorer performance on a sustained attention task but not other measures of cognitive performance among middle-to-older aged community-dwelling adults: A short-term longitudinal study. Am J Hum Biol 2024; 36:e24051. [PMID: 38356336 PMCID: PMC11144104 DOI: 10.1002/ajhb.24051] [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: 12/04/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE Hydration status and water intake are critical to physiological health. Despite a popular narrative that dehydration impairs cognitive performance, results are mixed in the literature. Therefore, we tested how hydration status was associated with cognitive performance in an ad libitum state over the course of 3 months. METHODS Data come from a short-term longitudinal study among middle-to-older aged US adults (n = 78) measured three times (207 observations). All participants were scheduled for 8:00 a.m. visits for the baseline, two-week, and 3-month examinations where they completed surveys, neuropsychological tests to measure cognitive performance, anthropometrics, and a blood draw for biomarker analysis. Serum osmolality (Sosm) was measured as a biomarker of hydration status using osmometry. Four cognitive performance tasks were assessed, including inhibition, working memory, cognitive flexibility, and sustained attention. RESULTS Panel random effects linear regressions demonstrate that there was an inverse association between dehydration and sustained attention, whereas there were no significant relationships between dehydration and inhibition, working memory, and cognitive flexibility. Adults who were dehydrated (defined as Sosm >300 mOsm/kg) performed substantially worse (B = 0.65 z-score; SE = 0.28; p = .020) on the sustained attention task than those who were not dehydrated adjusting for time fixed effects, age, body mass index, sex, and educational attainment. CONCLUSION This short-term longitudinal study found that dehydration was only associated with poorer performance on a cognitive performance task that required sustained attention. Maintaining adequate hydration may be increasingly important for middle-to-older aged adults to ensure proper cognitive function, particularly as water needs increase in future climatic scenarios.
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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
| | - Jason D. John
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Kyle Murdock
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
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Francisco R, Jesus F, Nunes CL, Santos P, Alvim M, Campa F, Schoeller DA, Lukaski H, Mendonca GV, Sardinha LFCB, Silva AMLDA. H2OAthletes study protocol: effects of hydration changes on neuromuscular function in athletes. Br J Nutr 2024; 131:1579-1590. [PMID: 38299306 DOI: 10.1017/s0007114524000308] [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] [Indexed: 02/02/2024]
Abstract
We aim to understand the effects of hydration changes on athletes' neuromuscular performance, on body water compartments, fat-free mass hydration and hydration biomarkers and to test the effects of the intervention on the response of acute dehydration in the hydration indexes. The H2OAthletes study (clinicaltrials.gov ID: NCT05380089) is a randomised controlled trial in thirty-eight national/international athletes of both sexes with low total water intake (WI) (i.e. < 35·0 ml/kg/d). In the intervention, participants will be randomly assigned to the control (CG, n 19) or experimental group (EG, n 19). During the 4-day intervention, WI will be maintained in the CG and increased in the EG (i.e. > 45·0 ml/kg/d). Exercise-induced dehydration protocols with thermal stress will be performed before and after the intervention. Neuromuscular performance (knee extension/flexion with electromyography and handgrip), hydration indexes (serum, urine and saliva osmolality), body water compartments and water flux (dilution techniques, body composition (four-compartment model) and biochemical parameters (vasopressin and Na) will be evaluated. This trial will provide novel evidence about the effects of hydration changes on neuromuscular function and hydration status in athletes with low WI, providing useful information for athletes and sports-related professionals aiming to improve athletic performance.
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Affiliation(s)
- Rúben Francisco
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, 1499-002 Cruz-Quebrada, Lisbon, Portugal
| | - Filipe Jesus
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, 1499-002 Cruz-Quebrada, Lisbon, Portugal
| | - Catarina L Nunes
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, 1499-002 Cruz-Quebrada, Lisbon, Portugal
| | - Paulo Santos
- Neuromuscular Research Lab, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Marta Alvim
- National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Francesco Campa
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Dale A Schoeller
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Henry Lukaski
- Department of Kinesiology and Public Health Education, Hyslop Sports Center, University of North Dakota, Grand Forks, ND, USA
| | - Goncalo V Mendonca
- Neuromuscular Research Lab, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
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Dmitrieva NI, Boehm M, Yancey PH, Enhörning S. Long-term health outcomes associated with hydration status. Nat Rev Nephrol 2024; 20:275-294. [PMID: 38409366 DOI: 10.1038/s41581-024-00817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/28/2024]
Abstract
Body water balance is determined by fundamental homeostatic mechanisms that maintain stable volume, osmolality and the composition of extracellular and intracellular fluids. Water balance is maintained by multiple mechanisms that continuously match water losses through urine, the skin, the gastrointestinal tract and respiration with water gains achieved through drinking, eating and metabolic water production. Hydration status is determined by the state of the water balance. Underhydration occurs when a decrease in body water availability, due to high losses or low gains, stimulates adaptive responses within the water balance network that are aimed at decreasing losses and increasing gains. This stimulation is also accompanied by cardiovascular adjustments. Epidemiological and experimental studies have linked markers of low fluid intake and underhydration - such as increased plasma concentration of vasopressin and sodium, as well as elevated urine osmolality - with an increased risk of new-onset chronic diseases, accelerated aging and premature mortality, suggesting that persistent activation of adaptive responses may be detrimental to long-term health outcomes. The causative nature of these associations is currently being tested in interventional trials. Understanding of the physiological responses to underhydration may help to identify possible mechanisms that underlie potential adverse, long-term effects of underhydration and inform future research to develop preventative and treatment approaches to the optimization of hydration status.
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Affiliation(s)
- Natalia I Dmitrieva
- Laboratory of Cardiovascular Regenerative Medicine, National Heart Lung and Blood Institute, NIH, Bethesda, Maryland, USA.
| | - Manfred Boehm
- Laboratory of Cardiovascular Regenerative Medicine, National Heart Lung and Blood Institute, NIH, Bethesda, Maryland, USA
| | - Paul H Yancey
- Biology Department, Whitman College, Walla Walla, Washington, USA
| | - Sofia Enhörning
- Perinatal and Cardiovascular Epidemiology, Lund University Diabetes Centre, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
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Gäckler A, Ertasoglu O, Rohn H, Friebus-Kardash J, Ickerott PC, Witzke O, Kribben A, Vogt B, Dahdal S, Arampatzis S, Eisenberger U. Urinary Biomarkers for Cell Cycle Arrest TIMP-2 and IGFBP7 for Prediction of Graft Function Recovery after Kidney Transplantation. Int J Mol Sci 2024; 25:4169. [PMID: 38673754 PMCID: PMC11050222 DOI: 10.3390/ijms25084169] [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: 02/17/2024] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
TIMP-2 and IGFBP7 have been identified and validated for the early detection of renal injury in critically ill patients, but data on recovery of allograft function after kidney transplantation (KTx) are scarce. In a prospective observational multicenter cohort study of renal transplant recipients, urinary [TIMP-2] × [IGFBP7] was evaluated daily from day 1 to 7 after KTx. Different stages of early graft function were defined: immediate graft function (IGF) (decrease ≥ 10% in serum creatinine (s-crea) within 24 h post KTx); slow graft function (SGF) (decrease in s-crea < 10% within 24 h post KTx); and delayed graft function (DGF) (any dialysis needed within the first week after KTx). A total of 186 patients were analyzed. [TIMP-2] × [IGFBP7] was significantly elevated as early as day 1 in patients with DGF compared to SGF and IGF. ROC analysis of [TIMP-2] × [IGFBP7] at day 1 post-transplant for event "Non-DGF" revealed a cut-off value of 0.9 (ng/mL)2/1000 with a sensitivity of 87% and a specificity of 71%. The positive predictive value for non-DGF was 93%. [TIMP-2] × [IGFBP7] measured at day 1 after KTx can predict early recovery of transplant function and is therefore a valuable biomarker for clinical decision making.
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Affiliation(s)
- Anja Gäckler
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| | - Onurcan Ertasoglu
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| | - Hana Rohn
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (H.R.); (O.W.)
| | - Justa Friebus-Kardash
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| | - Philipp-Christopher Ickerott
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (H.R.); (O.W.)
| | - Andreas Kribben
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| | - Bruno Vogt
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Julie-von-Jenner-Haus, Freiburgstraße 15, 3010 Bern, Switzerland; (B.V.); (S.D.); (S.A.)
| | - Suzan Dahdal
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Julie-von-Jenner-Haus, Freiburgstraße 15, 3010 Bern, Switzerland; (B.V.); (S.D.); (S.A.)
| | - Spyridon Arampatzis
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Julie-von-Jenner-Haus, Freiburgstraße 15, 3010 Bern, Switzerland; (B.V.); (S.D.); (S.A.)
| | - Ute Eisenberger
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
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Armstrong LE, Bergeron MF, Muñoz CX, Kavouras SA. Low daily water intake profile-is it a contributor to disease? Nutr Health 2024:2601060241238826. [PMID: 38515347 DOI: 10.1177/02601060241238826] [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: 03/23/2024]
Abstract
Few previous review articles have focused on the associations between inadequate daily water intake (LOW) or urinary biomarkers of dehydration (UD; low urine volume or high urine osmolality) and multiple diseases. Accordingly, we conducted manual online searches (47 key words) of the PubMed, Embase, and Google Scholar databases with these inclusion criteria: English language, full-text, peer reviewed, no restriction on research design, and three publications minimum. Initially, 3,903 articles were identified based on their titles and abstracts. Evaluations of full length .pdf versions identified 96 studies that were acceptable for inclusion. We concluded that the evidence is insufficient or conflicting for seven disorders or diseases (i.e. suggesting the need for additional clarifying research) and it is lacking for all-cause mortality. Differential characterizations among women and men have been reported in the results of nine studies involving five diseases. Finally, the evidence for associations of LOW or UD is strong for both kidney stones and type 2 diabetes with hyperglycemia. This suggests that great public health value (i.e. reduced disease risk) may result from increased daily water intake-a simple and cost-effective dietary modification.
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Affiliation(s)
- Lawrence E Armstrong
- Human Performance Laboratory and Department of Nutritional Sciences, University of Connecticut, Storrs, CT, USA
| | - Michael F Bergeron
- Performance Health, WTA Women's Tennis Association, St. Petersburg, FL, USA
- Hydration Health Center and Department of Health Sciences, University of Hartford, West Hartford, CT, USA
| | - Colleen X Muñoz
- Hydration Health Center and Department of Health Sciences, University of Hartford, West Hartford, CT, USA
| | - Stavros A Kavouras
- Hydration Science Lab, College of Health Solutions, Arizona State University, Phoenix, AZ, USA
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Chapman CL, Holt SM, O'Connell CT, Brazelton SC, Medved HN, Howells WAB, Reed EL, Needham KW, Halliwill JR, Minson CT. Hypohydration attenuates increases in creatinine clearance to oral protein loading and the renal hemodynamic response to exercise pressor reflex. J Appl Physiol (1985) 2024; 136:492-508. [PMID: 38205553 PMCID: PMC11212816 DOI: 10.1152/japplphysiol.00728.2023] [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: 10/11/2023] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 01/12/2024] Open
Abstract
Insufficient hydration is prevalent among free living adults. This study investigated whether hypohydration alters 1) renal functional reserve, 2) the renal hemodynamic response to the exercise pressor reflex, and 3) urine-concentrating ability during oral protein loading. In a block-randomized crossover design, 22 healthy young adults (11 females and 11 males) underwent 24-h fluid deprivation (Hypohydrated) or 24-h normal fluid consumption (Euhydrated). Renal functional reserve was assessed by oral protein loading. Renal hemodynamics during the exercise pressor reflex were assessed via Doppler ultrasound. Urine-concentrating ability was assessed via free water clearance. Creatinine clearance did not differ at 150 min postprotein consumption between conditions [Hypohydrated: 246 mL/min, 95% confidence interval (CI): 212-280; Euhydrated: 231 mL/min, 95% CI: 196-265, P = 0.2691] despite an elevated baseline in Hypohydrated (261 mL/min, 95% CI: 218-303 vs. 143 mL/min, 95% CI: 118-168, P < 0.0001). Renal artery vascular resistance was not different at baseline (P = 0.9290), but increases were attenuated in Hypohydrated versus Euhydrated at the end of handgrip (0.5 mmHg/cm/s, 95% CI: 0.4-0.7 vs. 0.8 mmHg/cm/s 95% CI: 0.6-1.1, P = 0.0203) and end occlusion (0.2 mmHg/cm/s, 95% CI: 0.1-0.3 vs. 0.4 mmHg/cm/s 95% CI: 0.3-0.6, P = 0.0127). There were no differences between conditions in free water clearance at 150 min postprotein (P = 0.3489). These data indicate that hypohydration 1) engages renal functional reserve and attenuates the ability to further increase creatinine clearance, 2) attenuates increases in renal artery vascular resistance to the exercise pressor reflex, and 3) does not further enhance nor impair urine-concentrating ability during oral protein loading.NEW & NOTEWORTHY Insufficient hydration is prevalent among free living adults. This study found that hypohydration induced by 24-h fluid deprivation engaged renal functional reserve and that oral protein loading did not further increase creatinine clearance. Hypohydration also attenuated the ability to increase renal vascular resistance during the exercise pressor reflex. In addition, hypohydration neither enhanced nor impaired urine-concentrating ability during oral protein loading. These data support the importance of mitigating hypohydration in free living adults.
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Affiliation(s)
- Christopher L Chapman
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Sadie M Holt
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Cameron T O'Connell
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Shaun C Brazelton
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Hannah N Medved
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - William A B Howells
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Emma L Reed
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Karen Wiedenfeld Needham
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - John R Halliwill
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Christopher T Minson
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
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8
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Wardenaar FC, Whitenack L, Vento KA, Seltzer RGN, Siegler J, Kavouras SA. Validity of combined hydration self-assessment measurements to estimate a low vs. high urine concentration in a small sample of (tactical) athletes. Eur J Nutr 2024; 63:185-193. [PMID: 37794214 DOI: 10.1007/s00394-023-03254-1] [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: 05/19/2023] [Accepted: 09/08/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE Relationships between body weight, urine color (Uc), and thirst level (WUT) have been proposed as a simple and inexpensive self-assessment method to predict dehydration. This study aimed to determine if this method also allowed us to accurately identify a low vs. high urine concentration in (tactical) athletes. METHODS A total of n = 19 Army Reserve Officer Training Corps cadets and club sports athletes (22.7 ± 3.8 years old, of which 13 male) were included in the analysis, providing morning body weight, thirst sensation, and Uc for five consecutive days. Each item received a score 0 or 1, resulting in a WUT score ranging from 0 (likely hydrated) to 3 (very likely dehydrated). WUT model and individual item outcomes were then compared with a ≥ 1.020 urine specific gravity (USG) cut-off indicating a high urine concentration, using descriptive comparisons, generalized linear mixed models, and logistic regression (to calculate the area under the curve (AUC)). RESULTS WUT score was not significantly predictive of urine concentration, z = 1.59, p = 0.11. The AUC ranged from 0.54 to 0.77 for test days, suggesting a fair AUC on most days. Only Uc was significantly related to urine concentration, z = 2.49, p = 0.01. The accuracy of the WUT model for correctly classifying urine samples with a high concentration was 68% vs. 51% of samples with a low concentration, resulting in an average accuracy of 61%. CONCLUSION This study shows that WUT scores were not predictive of urine concentration, and the method did not substantially outperform the accuracy of Uc scoring alone.
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Affiliation(s)
- Floris C Wardenaar
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
| | - Lauren Whitenack
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Kaila A Vento
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Ryan G N Seltzer
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Jason Siegler
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
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9
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Hahn RG. Detection of low urine output by measuring urinary biomarkers. BMC Nutr 2024; 10:13. [PMID: 38217039 PMCID: PMC10785494 DOI: 10.1186/s40795-024-00823-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Urine output < 1 L per 24 h is a clinical warning sign that requires attention from hospital staff, who should determine whether the low flow is due to low habitual intake of water or disease-induced dehydration. The incidence of this condition is unclear. METHODS A cohort of 20 healthy volunteers (mean age 42 years, range 23-62 years) recorded their food and water intakes daily for 8 days. They also collected and measured all urine and delivered first morning urine samples for analysis of osmolality and creatinine. Optimal cutoffs for these biomarkers to indicate urine output of < 1 L or 15 mL/kg during the preceding 24 h were applied with and without correction for age to cross-sectional data from 1,316 subjects in various clinical settings, including healthy volunteers, preoperative patients, patients seeking acute care at a hospital, and patients receiving institutional geriatric care. RESULTS The urine output amounted to < 1 L during 22 of the 159 evaluable study days and was indicated by urine osmolality > 760 mosmol/kg or urine creatinine > 13 mmol/L, which had sensitivity and specificity of approximately 80%. Days with urine output < 1 L were associated with significantly less intake of both water (-41%) and calories (-22%) compared to other days. Application of age-corrected biomarker cutoffs to the 1,316 subjects showed a stronger dependency of low urine output on age than the clinical setting, occurring in 44% of the 72 participants aged 15-30 years and 18% of the 62 patients aged 90-104 years. CONCLUSION Biomarkers measured in morning urine of young and middle-aged volunteers indicated urine output of < 1 L with good precision, but the cutoffs should be validated in older age groups to yield reliable results. TRIAL REGISTRATIONS ISRCTN12215472 at http://www.isrctn.com ; NCT01458678 at ClinicalTrials.gov, and ChiCTR-TNRC-14,004,479 at the chictr.org/en.
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Affiliation(s)
- Robert G Hahn
- Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, 182 88, Sweden.
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Hahn RG, Weinberg L, Li Y, Bahlmann H, Bellomo R, Wuethrich PY. Concentrated urine, low urine flow, and postoperative elevation of plasma creatinine: A retrospective analysis of pooled data. PLoS One 2023; 18:e0290071. [PMID: 37590224 PMCID: PMC10434918 DOI: 10.1371/journal.pone.0290071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023] Open
Abstract
Elevations of plasma creatinine are common after major surgery, but their pathophysiology is poorly understood. To identify possible contributing mechanisms, we pooled data from eight prospective studies performed in four different countries to study circumstances during which elevation of plasma creatinine occurs. We included 642 patients undergoing mixed major surgeries, mostly open gastrointestinal. Plasma and urinary creatinine and a composite index for renal fluid conservation (Fluid Retention Index, FRI) were measured just before surgery and on the first postoperative morning. Urine flow was measured during the surgery. The results show that patients with a postoperative increase in plasma creatinine by >25% had a high urinary creatinine concentration (11.0±5.9 vs. 8.3±5.6 mmol/L; P< 0001) and higher FRI value (3.2±1.0 vs. 2.9±1.1; P< 0.04) already before surgery was initiated. Progressive increase of plasma creatinine was associated with a gradually lower urine flow and larger blood loss during the surgery (Kruskal-Wallis test, P< 0.001). The patients with an elevation > 25% also showed higher creatinine and a higher FRI value on the first postoperative morning (P< 0.001). Elevations to > 50% of baseline were associated with slightly lower mean arterial pressure (73 ± 10 vs. 80 ± 12 mmHg; P< 0.005). We conclude that elevation of plasma creatinine in the perioperative period was associated with low urine flow and greater blood loss during surgery and with concentrated urine both before and after the surgery. Renal water conservation-related mechanisms seem to contribute to the development of increased plasma creatinine after surgery.
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Affiliation(s)
- Robert G. Hahn
- Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, Sweden
| | - Laurence Weinberg
- Department of Anesthesia, Austin Hospital; Melbourne, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
| | - Yuhong Li
- Department of Anesthesiology, Shulan International Hospital, Shuren University, Hangzhou, 3100004, Zhejiang Province, PR of China
| | - Hans Bahlmann
- Department of Anesthesiology and Intensive Care in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
- Department of Critical Care, The University of Melbourne; Melbourne, Australia
| | - Patrick Y. Wuethrich
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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11
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Francisco R, Jesus F, Nunes CL, Cioffi I, Alvim M, Mendonca GV, Lukaski H, Sardinha LB, Silva AM. Athletes with different habitual fluid intakes differ in hydration status but not in body water compartments. Scand J Med Sci Sports 2023; 33:1072-1078. [PMID: 36951582 DOI: 10.1111/sms.14355] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/09/2023] [Accepted: 03/20/2023] [Indexed: 03/24/2023]
Abstract
Physiological differences have been reported between individuals who have habitual low (LOW) and high (HIGH) water intake (WI). The aims of this study were to explore body water compartments, hydration status, and fat-free mass (FFM) hydration of elite athletes exposed to different habitual WI. A total of 68 athletes (20.6 ± 5.3 years, 23 females) participated in this observational cross-sectional study. Total WI was assessed by seven-day food diaries and through WI, athletes were categorized as HIGH (n = 28, WI≥40.0 mL/kg/d) and LOW (n = 40, WI≤35.0 mL/kg/d). Total body water (TBW) and extracellular water (ECW) were determined by dilution techniques and intracellular water (ICW) as TBW-ECW. Hydration status was assessed by urine-specific gravity (USG) using a refractometer. Fat (FM) and FFM were assessed by dual-energy X-ray absorptiometry (DXA). The FFM hydration was calculated by TBW/FFM. The USG was statistically different between groups for females (LOW: 1.024 ± 0.003; HIGH: 1.015 ± 0.006; p = 0.005) and males (LOW: 1.024 ± 0.002; HIGH: 1.018 ± 0.005; p < 0.001). No differences between groups were detected in body water compartments and FFM hydration in both sexes (p > 0.05). Multiple regression showed that WI remains a predictor of USG regardless of FFM, age, and sex (β = -0.0004, p < 0.01). We concluded that LOW athletes were classified as dehydrated through USG although their water compartments were not different from HIGH athletes. These results suggest that LOW athletes may expectedly maintain the body water compartments' homeostasis through endocrine mechanisms. Interventions should be taken to encourage athletes to have sufficient WI to maintain optimal hydration.
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Affiliation(s)
- Rúben Francisco
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Filipe Jesus
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Catarina L Nunes
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Iolanda Cioffi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Marta Alvim
- National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Goncalo V Mendonca
- Neuromuscular Research Lab, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Henry Lukaski
- Department of Kinesiology and Public Health Education, Hyslop Sports Center, University of North Dakota, Grand Forks, North Dakota, USA
| | - Luís B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Analiza M Silva
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
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12
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Seal AD, Colburn AT, Johnson EC, Péronnet F, Jansen LT, Adams JD, Bardis CN, Guelinckx I, Perrier ET, Kavouras SA. Total water intake guidelines are sufficient for optimal hydration in United States adults. Eur J Nutr 2023; 62:221-226. [PMID: 35943601 DOI: 10.1007/s00394-022-02972-2] [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: 02/13/2022] [Accepted: 07/19/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Recent studies suggest that 24-h urine osmolality (UOsm) for optimal water intake should be maintained < 500 mmol·kg-1. The purpose of this study was to determine the total water intake (TWI) requirement for healthy adults to maintain optimal hydration as indicated by 24-h urine osmolality < 500 mmol·kg-1. METHODS Twenty-four-hour UOsm was assessed in 49 men and 50 women residing in the United States (age: 41 ± 14 y, body mass index: 26.3 ± 5.2 kg·m-2). TWI was assessed from 7-day water turnover, using a dilution of deuterium oxide, corrected for metabolic water production. The diagnostic accuracy of TWI to identify UOsm < 500 mmol·kg-1 was evaluated using receiver operating characteristic (ROC) analysis in men and women separately. RESULTS Twenty-four-hour UOsm was 482 ± 229 and 346 ± 182 mmol·kg-1 and TWI was 3.57 ± 1.10 L·d-1 and 3.20 ± 1.27 L·d-1 in men and women, respectively. ROC analysis for TWI detecting 24-h UOsm < 500 mmol·kg-1 in men yielded an area under the curve (AUC) of 77.4% with sensitivity, specificity, and threshold values of 83.3%, 64.5%, and 3.39 L·d-1, respectively. The AUC was 82.4% in women with sensitivity, specificity, and threshold values of 85.7%, 72.1%, and 2.61 L·d-1. CONCLUSION Considering threshold values in men and women of 3.4 L·d-1 and 2.6 L·d-1, respectively, maintaining TWI in line with National Academy of Medicine guidelines of 3.7 L·d-1 in men and 2.7 L·d-1 in women should be sufficient for most individuals in the United States to maintain 24-h UOsm < 500 mmol·kg-1.
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Affiliation(s)
- Adam D Seal
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Abigail T Colburn
- Hydration Science Lab, Arizona State University, College of Health Solutions, Phoenix, AZ, USA
| | - Evan C Johnson
- Human Integrated Physiology Laboratory, University of Wyoming, Laramie, WY, USA
| | - François Péronnet
- École de Kinésiologie et des Sciences de l'Activité Physique, University of Montreal, Montreal, QC, Canada
| | - Lisa T Jansen
- Department of Dietetics and Nutrition, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J D Adams
- Department of Health and Human Performance, College of Charleston, Charleston, SC, USA
| | - Costas N Bardis
- Section of Sports Medicine and Biology of Physical Activity, School of Physical Education and Sport Science, University of Athens, Athens, Greece
| | | | | | - Stavros A Kavouras
- Hydration Science Lab, Arizona State University, College of Health Solutions, Phoenix, AZ, USA.
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13
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Hahn RG. Quantifying the daily intake of water from morning and spot urine samples; retrospective analysis of a clinical trial in volunteers. BMC Nutr 2023; 9:3. [PMID: 36593492 PMCID: PMC9809043 DOI: 10.1186/s40795-022-00660-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The hydration status can be indicated by biomarkers in the urine. However, the sensitivity and specificity of single measurements of biomarkers in morning urine and spot urine samples to quantify previous and current daily water ingestion is unclear. METHODS The water content of food and liquid consumed by 20 volunteers (mean age 42 years) was calculated daily for two weeks. The volunteers increased their consumption of water by approximately 30% during the second week. They measured their excreted urine volume and sampled the morning urine and 24-h collections of urine for analysis of osmolality and creatinine during the first four days of both weeks (N = 157). The same biomarkers of hydration were measured in spot samples taken at every voiding on the other days (N = 762). Receiver operating characteristic (ROC) curves were used to study the ability of pre-specified ranges of biomarkers to quantify the water intake. RESULTS The biomarkers in the morning urine obtained during normal fluid intake quantified the water consumption with an average area under the ROC curve (AUC) of 0.72 for osmolality and 0.66 for creatinine. Spot urine yielded an AUC of 0.74 for osmolality and 0.70 for creatinine. The AUCs obtained for days of increased fluid intake were approximately 10% lower. Large intakes (3-4 L daily) were identified with a sensitivity of 50-80% and low intakes (< 1.5-2 L) with a sensitivity of 20-50%, while false positives occurred in approximately 10%. CONCLUSION Biomarkers in morning urine and spot urine samples distinguished between large and small daily water intakes. Osmolality was slightly superior to creatinine. The indications were less useful during days of increased fluid intake.
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Affiliation(s)
- Robert G. Hahn
- grid.440117.70000 0000 9689 9786Research Unit, Södertälje Hospital, Södertälje, Sweden ,grid.4714.60000 0004 1937 0626Karolinska Institutet at Danderyds Hospital (KIDS), 152 86 Södertälje, Sweden
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14
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Rogerson G, Whelan M, Gibson R. A systematic review of measurement methods used to estimate fluid and beverage intake in free-living, working-age adults. J Hum Nutr Diet 2022. [PMID: 36514191 DOI: 10.1111/jhn.13127] [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: 08/30/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Beverage intake in employees is important to quantify due to the potential of dehydration to increase the risk of errors and reduced work performance. This systematic review aimed to (1) characterise existing fluid intake measurement tools used in the workplace setting or among free-living, healthy adults of working age and (2) report the current validation status of available assessment tools for use in a UK setting. METHODS Three electronic databases were searched for publications measuring beverage intake using a defined tool or method. Additional studies were identified by hand from trial registers, grey literature and reference lists. Eligibility was determined using predefined inclusion/exclusion criteria. Study quality was assessed using a modified Strengthening the Reporting of Observational Studies in Epidemiology framework. Narrative synthesis was performed. RESULTS The review identified 105 studies. The most frequently reported beverage assessment methods were total diet diaries/records (n = 22), fluid specific diaries/records (n = 18), food and fluid frequency questionnaires (n = 17), beverage-specific frequency questionnaires (n = 23) and diet recalls (n = 11). General dietary measurement tools (measuring beverages as part of total diet) were used in 60 studies, and 45 studies used a beverage-specific tool. This review identified 18 distinct dietary assessment tools, of which 6 were fluid/beverage specific. Twelve tools published relative validity for a beverage-related variable and seven tools for total daily fluid intake (from whole diet or from beverages only). CONCLUSIONS Several fluid intake assessment tools were identified; however, few have been fully evaluated for total beverage intake, and none in a UK working population.
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Affiliation(s)
- Georgia Rogerson
- Department of Nutritional Sciences, King's College London, London, UK
| | - Megan Whelan
- Department of Nutritional Sciences, King's College London, London, UK
| | - Rachel Gibson
- Department of Nutritional Sciences, King's College London, London, UK
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15
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Hahn RG, Yanase F, Zdolsek JH, Tosif SH, Bellomo R, Weinberg L. Serum Creatinine Levels and Nephrocheck® Values With and Without Correction for Urine Dilution-A Multicenter Observational Study. Front Med (Lausanne) 2022; 9:847129. [PMID: 35252280 PMCID: PMC8894808 DOI: 10.3389/fmed.2022.847129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 01/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background The Nephrocheck® test is a single-use cartridge designed to measure the concentrations of two novel cell-cycle arrest biomarkers of acute kidney injury, namely tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7). Correlations of serum creatine values and TIMP-2 and IGFBP7 with and without correction for urine dilution have not been previously undertaken in patients undergoing major abdominal surgery. We hypothesized that the Nephrocheck® values would be significantly different with and without correction for urine dilution in patients with elevated creatinine values post major abdominal surgery. Methods We performed a post hoc analysis of serum and urine specimens sampled preoperatively and postoperatively in 72 patients undergoing major abdominal surgery. Thirty samples were measured from patients with the greatest decrease and the greatest increase in postoperative serum creatinine values. Urine was analyzed with the Nephrocheck to predict the risk of acute kidney injury (AKIRisk™). We then examined the relationship between serum creatinine and the urinary excretion of TIMP-2 and IGFBP7 as measured by the Nephrocheck test. The AKIRisk between the groups with and without correction for urine dilution was assessed. Results The median perioperative change in serum creatinine in the two groups was −19% and +57%, respectively. The uncorrected median baseline AKIRisk decreased from 0.70 (25th−75th percentiles, 0.09–1.98) to 0.35 (0.19–0.57) (mg/L)2 in the first group and rose from 0.57 (0.22–1.53) to 0.85 (0.67–2.20) (mg/L)2 in the second group. However, when corrected for the squared urine dilution, the AKIRisk™ in patients with postoperative increases in serum creatinine was not indicative of kidney injury; the corrected AKIRisk was 8.0 (3.2–11.7) μg2/mmol2 before surgery vs.6.9 (5.3–11.0) μg2/mmol2 after the surgery (P = 0.69). Conclusion In the setting of major abdominal surgery, after correction of TIMP-2 and IGFBP7 for urine dilution, the Nephrocheck AKIRisk scores were significantly different from the uncorrected values. These finding imply that the AKIRisk index is a function of urine flow in addition to an increased release of the biomarkers.
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Affiliation(s)
- Robert G. Hahn
- Karolinska Institute at Danderyd's Hospital (KIDS), Stockholm, Sweden
- Department of Research, Sodertalje Hospital, Sodertalje, Sweden
| | - Fumitaka Yanase
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joachim H. Zdolsek
- Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
| | - Shervin H. Tosif
- Department of Anaesthesia, Austin Hospital, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Melbourne, VIC, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Laurence Weinberg
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16
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Löffel LM, Engel DA, Beilstein CM, Hahn RG, Furrer MA, Wuethrich PY. Dehydration before Major Urological Surgery and the Perioperative Pattern of Plasma Creatinine: A Prospective Cohort Series. J Clin Med 2021; 10:jcm10245817. [PMID: 34945113 PMCID: PMC8706637 DOI: 10.3390/jcm10245817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/17/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022] Open
Abstract
Preoperative dehydration is usually found in 30–50% of surgical patients, but the incidence is unknown in the urologic population. We determined the prevalence of preoperative dehydration in major elective urological surgery and studied its association with postoperative outcome, with special attention to plasma creatinine changes. We recruited 187 patients scheduled for major abdominal urological surgery to participate in a single-center study that used the fluid retention index (FRI), which is a composite index of four urinary biomarkers that correlate with renal water conservation, to assess the presence of dehydration. Secondary outcomes were postoperative nausea and vomiting (PONV), return of gastrointestinal function, in-hospital complications, quality of recovery, and plasma creatinine. The proportion of dehydrated patients at surgery was 20.4%. Dehydration did not correlate with quality of recovery, PONV, or other complications, but dehydrated patients showed later defecation (p = 0.02) and significant elevations of plasma creatinine after surgery. The elevations were also greater when plasma creatinine had increased rather than decreased during the 24 h prior to surgery (p < 0.001). Overall, the increase in plasma creatinine at 6 h after surgery correlated well with elevations on postoperative days one and two. In conclusion, we found preoperative dehydration in one-fifth of the patients. Dehydration was associated with delayed defecation and elevated postoperative plasma creatinine. The preoperative plasma creatinine pattern could independently forecast more pronounced increases during the early postoperative period.
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Affiliation(s)
- Lukas M. Löffel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland; (L.M.L.); (D.A.E.); (C.M.B.)
| | - Dominique A. Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland; (L.M.L.); (D.A.E.); (C.M.B.)
| | - Christian M. Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland; (L.M.L.); (D.A.E.); (C.M.B.)
| | - Robert G. Hahn
- Research Unit, Södertälje Hospital, Södertälje, Karolinska Institutet at Danderyds Hospital (KIDS), 18288 Stockholm, Sweden;
| | - Marc A. Furrer
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland;
| | - Patrick Y. Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland; (L.M.L.); (D.A.E.); (C.M.B.)
- Correspondence: ; Tel.: +41-31-632-0554
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17
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Jacques PF, Rogers G, Stookey JD, Perrier ET. Water Intake and Markers of Hydration Are Related to Cardiometabolic Risk Biomarkers in Community-Dwelling Older Adults: A Cross-Sectional Analysis. J Nutr 2021; 151:3205-3213. [PMID: 34383920 PMCID: PMC8485913 DOI: 10.1093/jn/nxab233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/14/2021] [Accepted: 06/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Emerging evidence links underhydration and habitual low water intake to higher cardiometabolic risk, but evidence is limited in community-dwelling older adults. OBJECTIVES The objective is to examine if higher water intake and better hydration are associated with better cardiometabolic health. METHODS This cross-sectional analysis using general linear models included 2238 participants from the Framingham Heart Study Second Generation and First Generation Omni cohorts with an estimated glomerular filtration rate >30 mL·min-1·1.73 m-2 and a valid FFQ for assessment of water intake. Of these participants, 2219 had fasting spot urinary creatinine data and 950 had 24-h urine creatinine data to assess hydration. Cardiometabolic risk factors included fasting glucose, triglycerides (TGs), total cholesterol (TC), HDL cholesterol, and calculated LDL cholesterol; glycated hemoglobin (HbA1c); C-reactive protein (CRP); and systolic (SBP) and diastolic (DBP) blood pressure. RESULTS The combined cohorts were on average aged 70 y; 55% were women. Mean (95% CI) daily total water intakes were 2098 (2048, 2150) mL for men and 2109 (2063, 2156) mL for women. Total daily water, beverage (including plain water), and plain water intakes demonstrated significant positive trends with HDL cholesterol (P < 0.01). TG concentrations were significantly lower among the highest plain water consumers (P < 0.05). The 24-h urine concentration, as measured by creatinine, was positively associated with LDL cholesterol and TG concentrations ( P < 0.01) and inversely associated with HDL cholesterol concentrations (P < 0.002). Neither water intake nor urine concentration was associated with glucose or HbA1c (P > 0.05). CONCLUSIONS Our findings of a consistent pattern between circulating lipid concentrations and different water sources and hydration markers support an association between hydration and lipid metabolism in older adults and add to the growing evidence that inadequate water intake and underhydration may lead to higher cardiometabolic risk.
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Affiliation(s)
- Paul F Jacques
- USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Gail Rogers
- USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Erica T Perrier
- Health, Hydration & Nutrition Science, Danone Research, Palaiseau, France
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18
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Engel D, Löffel LM, Wuethrich PY, Hahn RG. Preoperative Concentrated Urine Increases the Incidence of Plasma Creatinine Elevation After Major Surgery. Front Med (Lausanne) 2021; 8:699969. [PMID: 34350198 PMCID: PMC8327205 DOI: 10.3389/fmed.2021.699969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Postoperative elevation of plasma creatinine is a frequent complication to major surgery. A rise by 50% fulfills the criterion for Acute Kidney Injury. We studied the relationship between concentrated urine before surgery, which is usually a sign of chronically low intake of water, and the perioperative change in plasma creatinine. Methods: The creatinine concentration was measured in plasma and urine just before and at 6 h, 1 day, and 2 days after major abdominal surgery in a consecutive series of 181 patients. Receiver operating curve analysis was used to find the optimal cut-off to separate concentrated from diluted urine. Results: Urine creatinine of 11.3 mmol/L before the surgery started was exceeded in one third of the patients and associated with greater increase in plasma creatinine at 6 h (median 21 vs. 10%) and at 1 day postoperatively (21 vs. 7%; P < 0.0001). Elevation of plasma creatinine of >25% occurred in 41% and 19% in those with high and low urine creatinine, respectively (P < 0.001) and an increase by >50% in 16% and 10% (P = 0.27). Patients with high urine creatinine before surgery failed to further concentrate their urine during the perioperative period, which is normally associated with intensified renal fluid conservation. Conclusion: High urinary concentration of creatinine before surgery should be considered as a risk factor for postoperative elevation of plasma creatinine. The mechanism is probably that the renal threshold is then more easily reached.
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Affiliation(s)
- Dominique Engel
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas M Löffel
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Y Wuethrich
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert G Hahn
- Research Unit, Södertälje Hospital, Södertälje, Sweden.,Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, Sweden
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Associations between urinary hydration markers and metabolic dysfunction: a cross-sectional analysis of NHANES data, 2008-2010. Eur J Nutr 2021; 60:4229-4241. [PMID: 34003332 PMCID: PMC8572195 DOI: 10.1007/s00394-021-02575-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/27/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Growing evidence suggests hydration plays a role in metabolic dysfunction, however data in humans are scarce. This study examined the cross-sectional association between hydration and metabolic dysfunction in a representative sample of the US population. METHODS Data from 3961 adult NHANES (National Health and Nutrition Examination Survey) participants (49.8% female; age 46.3 ± 0.5 years) were grouped by quartile of urine specific gravity (USG, 2007-2008 cohort) or urine osmolality (UOsm, 2009-2010 cohort) as measures of hydration. Metabolic dysfunction was assessed by glycemic and insulinemic endpoints and by components of the metabolic syndrome. Multivariate-adjusted linear and logistic regression models were used. RESULTS Increasing quartiles of USG but not UOsm was associated with higher fasting plasma glucose (FPG), glycated hemoglobin (all P < 0.01), HOMA-IR and elevated insulin (all P < 0.05). Compared with the lowest quartile, those with the highest USG but not UOsm had greater risk of metabolic syndrome (Q4 vs. Q1, OR (99% CI): 1.6 (1.0, 2.7), P = 0.01) and diabetes (Q4 vs. Q1, OR: 1.8 (1.0, 3.4), P < 0.05). Additionally, those with USG > 1.013 or UOsm > 500 mOsm/kg, common cut-off values for optimal hydration based on retrospective analyses of existing data, had less favorable metabolic markers. In a subset of participants free from diabetes mellitus, impaired kidney function, hypertension and diuretic medication, USG remained positively associated with FPG (P < 0.01) and elevated FPG (P < 0.05). CONCLUSION These analyses provide population-based evidence that USG as a proxy for hydration is associated with glucose homeostasis in NHANES 2007-2008. The same association was not significant when UOsm was used as a proxy for hydration in the 2009-2010 wave. CLINICAL TRIAL REGISTRY Not applicable, as this was a reanalysis of existing NHANES data.
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Caldwell AR, Rosa-Caldwell ME, Keeter C, Johnson EC, Péronnet F, Ganio MS. Effects of a 14-Day Hydration Intervention on Individuals with Habitually Low Fluid Intake. ANNALS OF NUTRITION AND METABOLISM 2021; 76 Suppl 1:67-68. [PMID: 33780930 DOI: 10.1159/000515375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Debate continues over whether or not individuals with low total water intake (TWI) are in a chronic fluid deficit (i.e., low total body water) [<xref ref-type="bibr" rid="ref1">1</xref>]. When women with habitually low TWI (1.6 ± 0.5 L/day) increased their fluid intake (3.5 ± 0.1 L/day) for 4 days 24-h urine osmolality decreased, but there was no change in body weight, a proxy for total body water (TBW) [<xref ref-type="bibr" rid="ref2">2</xref>]. In a small (n = 5) study of adult men, there were no observable changes in TBW, as measured by bioelectrical impedance, after increasing TWI for 4 weeks [<xref ref-type="bibr" rid="ref3">3</xref>]. However, body weight increased and salivary osmolality decreased indicating that the study may have been underpowered to detect changes in TBW. Further, no studies to date have measured changes in blood volume (BV) when TWI is increased. OBJECTIVES Therefore, the purpose of this study was to identify individuals with habitually low fluid intake and determine if increasing TWI, for 14 days, resulted in changes in TBW or BV. METHODS In order to identify individuals with low TWI, 889 healthy adults were screened. Participants with a self-reported TWI less than 1.8 L/day (men) or 1.2 L/day (women), and a 24-h urine osmolality greater than 800 mOsm were included in the intervention phase of the study. For the intervention phase, 15 participants were assigned to the experimental group and 8 participants were assigned to the control group. The intervention period lasted for 14 days and consisted of 2 visits to our laboratory: one before the intervention (baseline) and 14 days into the intervention (14-day follow-up). At these visits, BV was measured using a CO-rebreathe procedure and deuterium oxide (D2O) was administered to measure TBW. Urine samples were collected immediately prior, and 3-8 h after the D2O dose to allow for equilibration. Prior to each visit, participants collected 24-h urine to measure 24-h hydration status. After the baseline visit, the experimental group increased their TWI to 3.7 L for males and 2.7 L for females in order to meet the current Institute of Medicine recommendations for TWI. RESULTS Twenty-four-hour urine osmolality decreased (-438.7 ± 362.1 mOsm; p < 0.001) and urine volume increased (1,526 ± 869 mL; p < 0.001) in the experimental group from baseline, while there were no differences in osmolality (-74.7 ± 572 mOsm; p = 0.45), or urine volume (-32 ± 1,376 mL; p = 0.89) in the control group. However, there were no changes in BV (Fig. <xref ref-type="fig" rid="f01">1</xref>a) or changes in TBW (Fig. <xref ref-type="fig" rid="f01">1</xref>b) in either group. CONCLUSIONS Increasing fluid intake in individuals with habitually low TWI increases 24-h urine volume and decreases urine osmolality but does not result in changes in TBW or BV. These findings are in agreement with previous work indicating that TWI interventions lasting 3 days [<xref ref-type="bibr" rid="ref2">2</xref>] to 4 weeks [<xref ref-type="bibr" rid="ref3">3</xref>] do not result in changes in TBW. Current evidence would suggest that the benefits of increasing TWI are not related changes in TBW.
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Affiliation(s)
- Aaron R Caldwell
- Exercise Science Research Center, University of Arkansas-Fayetteville, Fayetteville, Arkansas, USA
| | - Megan E Rosa-Caldwell
- Exercise Science Research Center, University of Arkansas-Fayetteville, Fayetteville, Arkansas, USA
| | - Carson Keeter
- Hydration Physiology Laboratory, University of Wyoming, Laramie, Wyoming, USA
| | - Evan C Johnson
- Hydration Physiology Laboratory, University of Wyoming, Laramie, Wyoming, USA
| | | | - Matthew S Ganio
- Exercise Science Research Center, University of Arkansas-Fayetteville, Fayetteville, Arkansas, USA
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21
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Perrier ET, Armstrong LE, Bottin JH, Clark WF, Dolci A, Guelinckx I, Iroz A, Kavouras SA, Lang F, Lieberman HR, Melander O, Morin C, Seksek I, Stookey JD, Tack I, Vanhaecke T, Vecchio M, Péronnet F. Hydration for health hypothesis: a narrative review of supporting evidence. Eur J Nutr 2020; 60:1167-1180. [PMID: 32632658 PMCID: PMC7987589 DOI: 10.1007/s00394-020-02296-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE An increasing body of evidence suggests that excreting a generous volume of diluted urine is associated with short- and long-term beneficial health effects, especially for kidney and metabolic function. However, water intake and hydration remain under-investigated and optimal hydration is poorly and inconsistently defined. This review tests the hypothesis that optimal chronic water intake positively impacts various aspects of health and proposes an evidence-based definition of optimal hydration. METHODS Search strategy included PubMed and Google Scholar using relevant keywords for each health outcome, complemented by manual search of article reference lists and the expertise of relevant practitioners for each area studied. RESULTS The available literature suggest the effects of increased water intake on health may be direct, due to increased urine flow or urine dilution, or indirect, mediated by a reduction in osmotically -stimulated vasopressin (AVP). Urine flow affects the formation of kidney stones and recurrence of urinary tract infection, while increased circulating AVP is implicated in metabolic disease, chronic kidney disease, and autosomal dominant polycystic kidney disease. CONCLUSION In order to ensure optimal hydration, it is proposed that optimal total water intake should approach 2.5 to 3.5 L day-1 to allow for the daily excretion of 2 to 3 L of dilute (< 500 mOsm kg-1) urine. Simple urinary markers of hydration such as urine color or void frequency may be used to monitor and adjust intake.
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Affiliation(s)
- Erica T Perrier
- Health, Hydration & Nutrition Science, Danone Research, Route Départementale 128, 91767, Palaiseau cedex, France.
| | - Lawrence E Armstrong
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA.,Hydration & Nutrition, LLC, Newport News, VA, USA
| | - Jeanne H Bottin
- Health, Hydration & Nutrition Science, Danone Research, Route Départementale 128, 91767, Palaiseau cedex, France
| | - William F Clark
- London Health Sciences Centre and Western University, London, ON, Canada
| | - Alberto Dolci
- Health, Hydration & Nutrition Science, Danone Research, Route Départementale 128, 91767, Palaiseau cedex, France
| | - Isabelle Guelinckx
- Health, Hydration & Nutrition Science, Danone Research, Route Départementale 128, 91767, Palaiseau cedex, France
| | - Alison Iroz
- Health, Hydration & Nutrition Science, Danone Research, Route Départementale 128, 91767, Palaiseau cedex, France
| | - Stavros A Kavouras
- College of Health Solutions and Hydration Science Lab, Arizona State University, Phoenix, AZ, USA
| | - Florian Lang
- Department of Physiology, Eberhard Karls University, Tübingen, Germany
| | | | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Clementine Morin
- Health, Hydration & Nutrition Science, Danone Research, Route Départementale 128, 91767, Palaiseau cedex, France
| | - Isabelle Seksek
- Health, Hydration & Nutrition Science, Danone Research, Route Départementale 128, 91767, Palaiseau cedex, France
| | - Jodi D Stookey
- Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - Ivan Tack
- Explorations Fonctionnelles Physiologiques, Hôpital Rangueil, Toulouse, France
| | - Tiphaine Vanhaecke
- Health, Hydration & Nutrition Science, Danone Research, Route Départementale 128, 91767, Palaiseau cedex, France
| | - Mariacristina Vecchio
- Health, Hydration & Nutrition Science, Danone Research, Route Départementale 128, 91767, Palaiseau cedex, France
| | - François Péronnet
- École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
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Effects of diet, habitual water intake and increased hydration on body fluid volumes and urinary analysis of renal fluid retention in healthy volunteers. Eur J Nutr 2020; 60:691-702. [PMID: 32430554 PMCID: PMC7900032 DOI: 10.1007/s00394-020-02275-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/06/2020] [Indexed: 12/13/2022]
Abstract
Purpose To increase our knowledge about the causes and physiological consequences of concentrated urine, the relevance of which in the general population is uncertain. Methods Twenty healthy volunteers (mean age 42 years) recorded all intake of food and water for 2 weeks. During the 2nd week, they increased their daily consumption of water by 716 mL (32%). The volunteers delivered a 24-h and a morning urine sample for analysis of osmolality and creatinine during the first 4 days of both weeks, and a sample each time they voided on the other days. The water content of food and liquid was calculated and the body fluid volumes were measured by bioimpedance. Haemodynamic stability was assessed with the passive leg-raising test. Results There was a curvilinear correlation between the daily intake of water and biomarkers measured in the 24-h collection of urine (coefficient of determination 0.37–0.70). Habitual low intake of water was associated with larger body fluid volumes. The increased fluid intake during the 2nd week was best reflected in the 24-h collection (−15 and −20% for the osmolality and creatinine, respectively, P < 0.002), while morning urine and body fluid volumes were unchanged. Increased fluid intake improved the haemodynamic stability in volunteers with a low intake of water (< median), but only in those who had minimally concentrated morning urine. Conclusions The 24-h collection reflected recent intake of fluid, whereas the morning urine seemed to mirror long-term corrections of the fluid balance. Concentrated urine was associated with larger body fluid volumes.
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23
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Armstrong LE, Muñoz CX, Armstrong EM. Distinguishing Low and High Water Consumers-A Paradigm of Disease Risk. Nutrients 2020; 12:E858. [PMID: 32210168 PMCID: PMC7146321 DOI: 10.3390/nu12030858] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 12/31/2022] Open
Abstract
A long-standing body of clinical observations associates low 24-h total water intake (TWI = water + beverages + food moisture) with acute renal disorders such as kidney stones and urinary tract infections. These findings prompted observational studies and experimental interventions comparing habitual low volume (LOW) and high volume (HIGH) drinkers. Investigators have learned that the TWI of LOW and HIGH differ by 1-2 L·d-1, their hematological values (e.g., plasma osmolality, plasma sodium) are similar and lie within the laboratory reference ranges of healthy adults and both groups appear to successfully maintain water-electrolyte homeostasis. However, LOW differs from HIGH in urinary biomarkers (e.g., reduced urine volume and increased osmolality or specific gravity), as well as higher plasma concentrations of arginine vasopressin (AVP) and cortisol. Further, evidence suggests that both a low daily TWI and/or elevated plasma AVP influence the development and progression of metabolic syndrome, diabetes, obesity, chronic kidney disease, hypertension and cardiovascular disease. Based on these studies, we propose a theory of increased disease risk in LOW that involves chronic release of fluid-electrolyte (i.e., AVP) and stress (i.e., cortisol) hormones. This narrative review describes small but important differences between LOW and HIGH, advises future investigations and provides practical dietary recommendations for LOW that are intended to decrease their risk of chronic diseases.
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Affiliation(s)
- Lawrence E. Armstrong
- Professor Emeritus, Human Performance Laboratory and Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Colleen X. Muñoz
- Assistant Professor, Department of Health Sciences, University of Hartford, West Hartford, CT 06117, USA;
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24
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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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25
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Fluctuation of Water Intake and of Hydration Indices during the Day in a Sample of Healthy Greek Adults. Nutrients 2019; 11:nu11040793. [PMID: 30959872 PMCID: PMC6521245 DOI: 10.3390/nu11040793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/21/2019] [Accepted: 04/02/2019] [Indexed: 01/14/2023] Open
Abstract
Mild dehydration may occur during specific periods of the day because of poor hydration habits and/or limited access to a variety of beverages or foods, for example, in work environments. Measurement of hydration indices in spot or in 24 h urine samples may mask mild dehydration in specific periods of the day. Healthy subjects (n = 164; 74 females; age 38 ± 12 years) living in Athens, Greece were enrolled in the study. Subjects recorded their solid food and drink intakes and recorded and collected all urinations for three consecutive days. Water intake was analyzed in 24 h and 6 h periods from wake-up time and scored for variety. Urine hydration indices (osmolality, volume, color, specific gravity) were analyzed in 24 h samples, in morning urine samples and in samples collected in 6 h periods from wake-up time. Fluctuations during the day were significant for the intake of drinking water, hot beverages, milk, fruit and vegetable juices, and alcoholic drinks and for urine osmolality, volume, color, and specific gravity. The urine volume of the first 6 h period after wake-up time (557 ± 231 mL/day) reflects by 76% the 24 h urine collection (1331 ± 144 mL/day). Water intake from all beverages, with the exception of alcoholic beverages, was greater in the first 6h period (morning period) and decreased throughout the day. Hydration indices changed accordingly. The 6 h timed urine sample collected reflects indices in samples collected over 24 h better than any spot urine sample.
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Kavouras SA. Hydration, dehydration, underhydration, optimal hydration: are we barking up the wrong tree? Eur J Nutr 2019; 58:471-473. [DOI: 10.1007/s00394-018-01889-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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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28
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Hebisz P, Hebisz R, Bakońska-Pacoń E, Zatoń M. Acute hematological response to a single dose of sprint interval training in competitive cyclists. Sci Sports 2017. [DOI: 10.1016/j.scispo.2017.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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Hahn RG, Grankvist N, Krizhanovskii C. Urinary Analysis of Fluid Retention in the General Population: A Cross-Sectional Study. PLoS One 2016; 11:e0164152. [PMID: 27764121 PMCID: PMC5072703 DOI: 10.1371/journal.pone.0164152] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/20/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Renal conservation (retention) of fluid might affect the outcome of hospital care and can be indicated by increased urinary concentrations of metabolic waste products. We obtained a reference material for further studies by exploring the prevalence of fluid retention in a healthy population. METHODS Spot urine sampling was performed in 300 healthy hospital workers. A previously validated algorithm summarized the urine-specific gravity, osmolality, creatinine, and color to a fluid retention index (FRI), where 4.0 is the cut-off for fluid retention consistent with dehydration. In 50 of the volunteers, we also studied the relationships between FRI, plasma osmolality, and water-retaining hormones. RESULTS The cut-off for fluid retention (FRI ≥ 4.0) was reached by 38% of the population. No correlation was found between the FRI and the time of the day of urine sample collection, and the FRI was only marginally correlated with the time period spent without fluid intake. Volunteers with fluid retention were younger, generally men, and more often had albuminuria (88% vs. 34%, P < 0.001). Plasma osmolality and plasma sodium were somewhat higher in those with a high FRI (mean 294.8 vs. 293.4 mosmol/kg and 140.3 vs. 139.9 mmol/l). Plasma vasopressin was consistently below the limit of detection, and the plasma cortisol, aldosterone, and renin concentrations were similar in subjects with a high or low FRI. The very highest FRI values (≥ 5.0, N = 61) were always accompanied by albuminuria. CONCLUSION Fluid retention consistent with moderate dehydration is common in healthy staff working in a Swedish hospital.
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Affiliation(s)
- Robert G. Hahn
- Research Unit, Södertälje Hospital, 152 86, Södertälje, Sweden
- * E-mail:
| | - Nina Grankvist
- Research Unit, Södertälje Hospital, 152 86, Södertälje, Sweden
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Cheuvront SN, Muñoz CX, Kenefick RW. The void in using urine concentration to assess population fluid intake adequacy or hydration status. Am J Clin Nutr 2016; 104:553-6. [PMID: 27465376 DOI: 10.3945/ajcn.115.129858] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 05/27/2016] [Indexed: 01/08/2023] Open
Abstract
Urine concentration can be used to assess fluid intake adequacy or to diagnose dehydration. However, too often urine concentration is used inappropriately to draw dubious conclusions that could have harmful health and economic consequences. Inappropriate uses of urine concentration relate primarily to convenience sampling (timing) and problems related to convenience sampling (misapplication of thresholds), but a conceptual problem also exists with using urine concentration in isolation. The purpose of this Perspective article is to briefly explain the problematic nature of current practices and to offer a possible solution to improve practice with minimal added complication. When urine is used exclusively to assess fluid intake adequacy and hydration status in adults, we propose that only when urine concentration is high (>850 mmol/kg) and urine excretion rate is low (<850 mL/24 h) should suspicion of inadequate drinking or impending dehydration be considered. Prospective tests of the 850 × 850 thresholds will provide supporting evidence and/or help refine the best thresholds for men and women, young and old.
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Affiliation(s)
| | | | - Robert W Kenefick
- US Army Research Institute of Environmental Medicine, Natick, MA; and
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Beverage Intake Assessment Questionnaire: Relative Validity and Repeatability in a Spanish Population with Metabolic Syndrome from the PREDIMED-PLUS Study. Nutrients 2016; 8:nu8080475. [PMID: 27483318 PMCID: PMC4997388 DOI: 10.3390/nu8080475] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 12/21/2022] Open
Abstract
We assess the repeatability and relative validity of a Spanish beverage intake questionnaire for assessing water intake from beverages. The present analysis was performed within the framework of the PREDIMED-PLUS trial. The study participants were adults (aged 55–75) with a BMI ≥27 and <40 kg/m2, and at least three components of Metabolic Syndrome (MetS). A trained dietitian completed the questionnaire. Participants provided 24-h urine samples, and the volume and urine osmolality were recorded. The repeatability of the baseline measurement at 6 and 1 year was examined by paired Student’s t-test comparisons. A total of 160 participants were included in the analysis. The Bland–Altman analysis showed relatively good agreement between total daily fluid intake assessed using the fluid-specific questionnaire, and urine osmolality and 24-h volume with parameter estimates of −0.65 and 0.22, respectively (R2 = 0.20; p < 0.001). In the repeatability test, no significant differences were found between neither type of beverage nor total daily fluid intake at 6 months and 1-year assessment, compared to baseline. The proposed fluid-specific assessment questionnaire designed to assess the consumption of water and other beverages in Spanish adult individuals was found to be relatively valid with good repeatability.
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Johnson EC, Muñoz CX, Jimenez L, Le Bellego L, Kupchak BR, Kraemer WJ, Casa DJ, Maresh CM, Armstrong LE. Hormonal and Thirst Modulated Maintenance of Fluid Balance in Young Women with Different Levels of Habitual Fluid Consumption. Nutrients 2016; 8:nu8050302. [PMID: 27213436 PMCID: PMC4882714 DOI: 10.3390/nu8050302] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/21/2016] [Accepted: 05/11/2016] [Indexed: 12/03/2022] Open
Abstract
Background: Surprisingly little is known about the physiological and perceptual differences of women who consume different volumes of water each day. The purposes of this investigation were to (a) analyze blood osmolality, arginine vasopressin (AVP), and aldosterone; (b) assess the responses of physiological, thirst, and hydration indices; and (c) compare the responses of individuals with high and low total water intake (TWI; HIGH and LOW, respectively) when consuming similar volumes of water each day and when their habitual total water intake was modified. Methods: In a single-blind controlled experiment, we measured the 24 h total water intake (TWI; water + beverages + food moisture) of 120 young women. Those who consumed the highest (HIGH, 3.2 ± 0.6 L·day−1, mean ± SD) and the lowest (LOW, 1.6 ± 0.5 L·day−1) mean habitual TWI were identified and compared. Outcome variables were measured during two ad libitum baseline days, a four-day intervention of either decreased TWI (HIGH) or increased TWI (LOW), and one ad libitum recovery day. Results: During the four-day intervention, HIGH and LOW experienced differences in thirst (p = 0.002); also, a statistically significant change of AVP occurred (main effect of TWI and day, p < 0.001), with no effect (TWI or day) on aldosterone and serum osmolality. Urine osmolality and volume distinguished HIGH from LOW (p = 0.002) when they consumed similar 24 h TWI.
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Affiliation(s)
- Evan C Johnson
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA.
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY 82071, USA.
| | - Colleen X Muñoz
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA.
- Department of Health Sciences and Nursing, University of Hartford, West Hartford, CT 06117, USA.
| | - Liliana Jimenez
- Hydration & Health Department, Danone Research, Palaiseau 91767, France.
| | - Laurent Le Bellego
- Hydration & Health Department, Danone Research, Palaiseau 91767, France.
| | - Brian R Kupchak
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA.
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - William J Kraemer
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA.
- Department of Human Sciences, the Ohio State University, Columbus, OH 43210, USA.
| | - Douglas J Casa
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA.
| | - Carl M Maresh
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA.
- Department of Human Sciences, the Ohio State University, Columbus, OH 43210, USA.
| | - Lawrence E Armstrong
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA.
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McKenzie AL, Muñoz CX, Ellis LA, Perrier ET, Guelinckx I, Klein A, Kavouras SA, Armstrong LE. Urine color as an indicator of urine concentration in pregnant and lactating women. Eur J Nutr 2015; 56:355-362. [PMID: 26572890 PMCID: PMC5290087 DOI: 10.1007/s00394-015-1085-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/12/2015] [Indexed: 11/30/2022]
Abstract
Aim
Urine concentration measured via osmolality (UOSM) and specific gravity (USG) reflects the adequacy of daily fluid intake, which has important relationships to health in pregnant (PREG) and lactating (LACT) women. Urine color (UCOL) may be a practical, surrogate marker for whole-body hydration status.
Purpose To determine whether UCOL was a valid measure of urine concentration in PREG and LACT, and pair-matched non-pregnant, non-lactating control women (CON). Methods Eighteen PREG/LACT (age 31 ± 1 years, pre-pregnancy BMI 24.3 ± 5.9 kg m−2) and eighteen CON (age 29 ± 4 years, BMI 24.1 ± 3.7 kg m−2) collected 24-h and single-urine samples on specified daily voids at five time points (15 ± 2, 26 ± 1, and 37 ± 1 weeks gestation, 3 ± 1 and 9 ± 1 weeks postpartum during lactation; CON visits were separated by similar time intervals) for measurement of 24-h UOSM, USG, and UCOL and single-sample UOSM and UCOL. Results Twenty-four-hour UCOL was significantly correlated with 24-h UOSM (r = 0.6085–0.8390, P < 0.0001) and 24-h USG (r = 0.6213–0.8985, P < 0.0001) in all groups. A 24-h UCOL ≥ 4 (AUC = 0.6848–0.9513, P < 0.05) and single-sample UCOL ≥ 4 (AUC = 0.9094–0.9216, P < 0.0001) indicated 24-h UOSM ≥ 500 mOsm kg−1 (representing inadequate fluid intake) in PREG, LACT, and CON. Conclusions Urine color was a valid marker of urine concentration in all groups. Thus, PREG, LACT, and CON can utilize UCOL to monitor their daily fluid balance. Women who present with a UCOL ≥ 4 likely have a UOSM ≥ 500 mOsm kg−1 and should increase fluid consumption to improve overall hydration status.
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Affiliation(s)
- Amy L McKenzie
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, 2095 Hillside Road, U1110, Storrs, CT, 06269-1110, USA.
| | - Colleen X Muñoz
- Department of Health Sciences and Nursing, University of Hartford, 200 Bloomfield Ave, West Hartford, CT, 06117, USA
| | - Lindsay A Ellis
- Centre for Heart Lung and Vascular Health, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | | | | | - Alexis Klein
- Danone Research, RD 128, 91767, Palaiseau, France
| | - 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
| | - Lawrence E Armstrong
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, 2095 Hillside Road, U1110, Storrs, CT, 06269-1110, USA
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35
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Hooper L, Abdelhamid A, Ali A, Bunn DK, Jennings A, John WG, Kerry S, Lindner G, Pfortmueller CA, Sjöstrand F, Walsh NP, Fairweather-Tait SJ, Potter JF, Hunter PR, Shepstone L. Diagnostic accuracy of calculated serum osmolarity to predict dehydration in older people: adding value to pathology laboratory reports. BMJ Open 2015; 5:e008846. [PMID: 26490100 PMCID: PMC4636668 DOI: 10.1136/bmjopen-2015-008846] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/26/2015] [Accepted: 09/18/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To assess which osmolarity equation best predicts directly measured serum/plasma osmolality and whether its use could add value to routine blood test results through screening for dehydration in older people. DESIGN Diagnostic accuracy study. PARTICIPANTS Older people (≥65 years) in 5 cohorts: Dietary Strategies for Healthy Ageing in Europe (NU-AGE, living in the community), Dehydration Recognition In our Elders (DRIE, living in residential care), Fortes (admitted to acute medical care), Sjöstrand (emergency room) or Pfortmueller cohorts (hospitalised with liver cirrhosis). REFERENCE STANDARD FOR HYDRATION STATUS Directly measured serum/plasma osmolality: current dehydration (serum osmolality>300 mOsm/kg), impending/current dehydration (≥295 mOsm/kg). INDEX TESTS 39 osmolarity equations calculated using serum indices from the same blood draw as directly measured osmolality. RESULTS Across 5 cohorts 595 older people were included, of whom 19% were dehydrated (directly measured osmolality>300 mOsm/kg). Of 39 osmolarity equations, 5 showed reasonable agreement with directly measured osmolality and 3 had good predictive accuracy in subgroups with diabetes and poor renal function. Two equations were characterised by narrower limits of agreement, low levels of differential bias and good diagnostic accuracy in receiver operating characteristic plots (areas under the curve>0.8). The best equation was osmolarity=1.86×(Na++K+)+1.15×glucose+urea+14 (all measured in mmol/L). It appeared useful in people aged ≥65 years with and without diabetes, poor renal function, dehydration, in men and women, with a range of ages, health, cognitive and functional status. CONCLUSIONS Some commonly used osmolarity equations work poorly, and should not be used. Given costs and prevalence of dehydration in older people we suggest use of the best formula by pathology laboratories using a cutpoint of 295 mOsm/L (sensitivity 85%, specificity 59%), to report dehydration risk opportunistically when serum glucose, urea and electrolytes are measured for other reasons in older adults. TRIAL REGISTRATION NUMBERS DRIE: Research Register for Social Care, 122273; NU-AGE: ClinicalTrials.gov NCT01754012.
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Affiliation(s)
- Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Adam Ali
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Diane K Bunn
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Amy Jennings
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - W Garry John
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Susan Kerry
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Gregor Lindner
- Department of General Internal Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Carmen A Pfortmueller
- Department of General Anesthesiology, Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria
| | - Fredrik Sjöstrand
- Department of Emergency Medicine, Södersjukhuset AB, Stockholm, Sweden
| | - Neil P Walsh
- College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | | | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
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36
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Armstrong LE, Johnson EC, McKenzie AL, Muñoz CX. An empirical method to determine inadequacy of dietary water. Nutrition 2015; 32:79-82. [PMID: 26440862 DOI: 10.1016/j.nut.2015.07.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/19/2015] [Accepted: 07/28/2015] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The physiological regulation of total body water and fluid concentrations is complex and dynamic. The human daily water requirement varies because of differences in body size, dietary solute load, exercise, and activities. Although chronically concentrated urine increases the risk of renal diseases, an empirical method to determine inadequate daily water consumption has not been described for any demographic group; instead, statistical analyses are applied to estimate nutritional guidelines (i.e., adequate intake). This investigation describes a novel empirical method to determine the 24-h total fluid intake (TFI; TFI = water + beverages + moisture in food) and 24-h urine volume, which correspond to inadequate 24-h water intake (defined as urine osmolality of 800 mOsm/kg; U800). METHODS Healthy young women (mean ± standard deviation; age, 20 ± 2 y, mass, 60.8 ± 11.7 kg; n = 28) were observed for 7 consecutive days. A 24-h urine sample was analyzed for volume and osmolality. Diet records were analyzed to determine 24-h TFI. RESULTS For these 28 healthy young women, the U800 corresponded to a TFI ≥2.4 L/d (≥39 mL/kg/d) and a urine volume ≥1.3 L/d. CONCLUSIONS The U800 method could be employed to empirically determine 24-h TFI and 24-h urine volumes that correspond to inadequate water intake in diverse demographic groups, residents of specific geographic regions, and individuals who consume specialized diets or experience large daily water turnover. Because laboratory expertise and instrumentation are required, this technique provides greatest value in research and clinical settings.
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Affiliation(s)
- Lawrence E Armstrong
- University of Connecticut, Department of Kinesiology, Human Performance Laboratory, Storrs, Connecticut, USA; University of Connecticut, Department of Nutritional Sciences, Storrs, Connecticut, USA.
| | - Evan C Johnson
- University of Connecticut, Department of Kinesiology, Human Performance Laboratory, Storrs, Connecticut, USA
| | - Amy L McKenzie
- University of Connecticut, Department of Kinesiology, Human Performance Laboratory, Storrs, Connecticut, USA
| | - Colleen X Muñoz
- University of Connecticut, Department of Kinesiology, Human Performance Laboratory, Storrs, Connecticut, USA
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